My Personal Health Record (PHR) in Microsoft’s Health Vault – Confessions of an “Early Adopter”!

This blogpost was first published on the 10th of October, 2007.

Milestone: This blogpost was referenced and the author quoted by the Washington Post in an article entitled, ‘New Ways to Manage Health Data’, March 2008.

Doctor and Patient with PHRs

It is a well known and incredibly shocking fact that inability to access vital, accurate and current health information especially in an emergency (usually an unforeseen event like a cardiac attack, stroke, seizure etc.) on time, leads to the loss of well over 80,000 lives in the United States alone! I actually experienced this pain while helping my 72 year old father with his triple bypass surgery in India, in May of this year. My father had a minor cardiac event while visiting us in the US a few years ago and was treated in a local Dallas hospital of repute and then discharged without any major intervention. He unfortunately forgot to secure copies of his health records before leaving this country. Having had a minor heart attack and being diagnosed with three clogged arteries that demanded a tripe bypass surgery, I needed to secure these records from his previous event for the cardiac surgeons in India.

Calling up the hospital in Dallas, sending them a written request from the doctor, having them dig up the relevant files and handing those off to my wife who then faxed them across to me in India, took all of 72 hours – and resulted in my father’s surgery being delayed by that length of time! Given his extremely precarious condition, this could have been potentially life threatening and could have been alleviated if I could have secured access to his health records on demand. Fortunately for us, my father’s surgery was very successful followed by a speedy recovery but the potentially devastating impact of not having right time access to his vital health information was an eye opening experience for me. I promised myself that this would never happen again as far as my health records and those of my family were concerned.

So given the release of Microsoft’s Health Vault Personal Health Record (PHR) Platform this year and my firm resolution to ensure right time access to our health records on demand, I enrolled myself and secured my personal Health Vault account.

In my previous blogpost (please see The Personal Health Record (PHR): Who will make this “Win-Win” for Patients to adopt?”), I have articulated the potential barriers to adoption and also painted a comprehensive forward looking vision on the evolution of the Personal Health Record (PHR) over time. This blog post articulates my personal experience with creating my Personal Health Record (PHR) using Microsoft’s Health Vault Platform, including the challenges, for other early adopters like myself.

Creating my Personal Health Record (PHR) with Microsoft’s Health Vault Platform – The Process, Experience and Challenges

Once you have signed up to the Microsoft Health Vault using your e-mail and have created your profile, the key is to create your data repository with your current and accurate health records, that you will need to painstakingly collect from your doctor’s offices. Physically making the rounds of these offices and picking up a freshly printed copy of each of my reports/records in my case, was the best option since most doctors to this day, do not e-mail responses or records, and the constraint that fax copies often tend to distort data and information.

* The first step I put myself thru was to scan each record, chart or report at home and then turn these into Microsoft Word documents and PDFs for upload into the Health Vault. This, in itself, is a huge barrier to adoption for most people that are not early adopters or tech savvy like me. Microsoft has endeavored to alleviate this pain by partnering with MaxEmail that will provide you with a virtual fax number for $ 8.95/year that will automatically upload faxed copies of your records from the doctor’s office onto your Health Vault PHR. I personally did not try this service and cannot comment on its efficacy, but this again, involves a change in behaviors and hence, is a barrier to adoption for most consumers. Having a portable scanner (like a number of the low priced card scanning devices available today) that potentially, can “plug-and-play” with the option of converting the scanned documents into a format like PDF and then uploading these directly onto the Health Vault, would be eminently desirable and lower the barrier to adoption for large segments of users. As well, this is currently a static data repository and needs to enable users like myself to stratify and store records by context and content type. For instance, being able to discern my annual physical exam data from my cardiac test data or my blood examination reports would be desirable vs. seeing a listing of documents with tags I have created. Over time, this needs to become more dynamic and hopefully evolve into what I have termed a Health Historian capable of data feeds from medical devices like implantable defibrillators and pacemakers. For now, the ability to access this life saving data from any place with internet access is very gratifying indeed.

* I then proceeded to http://www.healthvault.com/ to sign into my previously created account. I would have appreciated the “sign in” or “create an account” buttons on this very screen on the left hand navigation bar to preclude having to go thru two additional screens to get to my PHR.

* I was fairly impressed by the security/permissibility of the Microsoft Platform that lives up to the Health Vault brand, and in my case secured reciprocal sharing for my wife and myself.

* Going to the health details tab enables you to create a rudimentary profile comprising name, address, gender, birthday, ethnicity etc. as well as the ability to upload a low resolution photo of yourself. Having access to more capabilities like inclusion of family history, a choice of key therapeutic areas that are relevant e.g. cardiac vs. neurological etc. would have been desirable.

* Uploading your health records in word, excel, PowerPoint or PDF (in my case I had converted all of my documents into PDF) was fairly intuitive, as is the ability to view the audit trail for each of these documents on demand on the “history” tab. Clicking on each document throws up a dialog box that enables you to download, print or delete, with the added ability to click on three tabs to view the properties, history and the people you are sharing the document with.

*  Once you have uploaded all of your health records, you have the option of securing additional free as well as fee based applications and services from a number of vendors that Microsoft has partnered with including the American Heart Association, Cap Med, Healthy Circles and others. I signed up for the ones offered by the American Health Association and Healthy Circles to be able to enter data on my weight, blood pressure and exercise regimen to be able to see charts and how well my vital signs compare with my peers. The challenge I experienced was that I had to sign in each time I needed to access apps. from a different vendor to be able to enter data or see a chart showing trends, which is painful and again, a barrier to adoption. This is an obvious area of improvement.

*  In an ideal world, Health Vault should provide me with an excel like tool where I can manually enter data or upload data directly from my blood pressure monitor or glucose monitor using the Health Vault Connection Center utility and drivers from leading blood pressure, heart rate and glucose monitoring devices offered by Omron, Polar and Johnson and Johnson’s Life Scan division – you will need to download the utility and the drivers to your computer. Having the choice of which vital signs are relevant for me (weight, blood pressure, glucose levels, cholesterol types etc.) and entering this data to be able to see a chart showing trends in my vital signs over time, would be intuitive and extremely valuable from my perspective. As an example, I entered weight, blood pressure, sugar and cholesterol for a fictitious patient I have called John Doe into Excel and then created multiple graphs to simulate a Personal Health Dashboard (PHD) showing trends over time. A close look at this data immediately reveals the effectiveness of this patient’s health regimen including diet, exercise, medication, weight loss and their impact on the vital signs over time. Having something similar online greeting me everything I go to my Health Vault PHR would serve as a fairly simple yet high impact Health Dashboard (that I have referred to in my forward looking vision on the evolution of the EHR in my previous blog post “The Demand-Side Electronic Health Record (EHR): Who will make this “Win-Win” for Patients to adopt?). Over time, mapping this to benchmark data from sources like the American Heart Association for instance (with permission based access), could potentially alert the patient if one or more of their vital signs violates a benchmark threshold and prompt him/her to see the appropriate doctor for treatment. These data entry and online analytics capabilities are very well developed today and Microsoft would be well advised to offer these within the Health Vault Platform, perhaps for a fee that “enlightened prosumers” like myself would be happy to pay, for the incremental value these would deliver. These would be the first steps towards delivering a Healthcare Expert System that I have envisioned in my previous blog post.

* One of the most impressive capabilities of the Health Vault is the integrated Health Search capability. Searching for a term like “coronary artery disease” returns a well stratified stack of information for education and learning, research, useful tools and references neatly delivered within a navigation bar, web links as well as ads for suggested books from vendors like Amazon and other ad sponsors. This also offers the capability of including useful links and resources into a “scrapbook” that can be added to your Health Vault PHR for future reference.

My first experience with creating my Personal Health Record (PHR) using Microsoft’s Health Vault Platform was a fairly positive experience. It is user-friendly, reasonably easy to use, intuitive most of the time and perhaps most of all, backed by the Microsoft brand’s promise of security, quality and reliability. As well, having integrated search capabilities to lower search costs, as well as the capability to upload data from blood pressure or glucose monitoring devices via the Health Vault Connection Center, are significant additional benefits. Having a portable version of the PHR especially for travel to other parts of the world where the Internet is anything but ubiquitous would be eminently desirable. Being the early adopter that I am, I have actually created my portable PHR (that I can carry in my wallet without damaging it) with an exact replication of the data I have uploaded into the Microsoft Health Vault, using the really tiny yet robust USB memory device that Sony appropriately brands as the Micro Vault. The Health Vault and the Micro Vault both as PHRs – now is that a coincidence or what?!

So for now, the “enlightened prosumer” in me stands safe and secure in the knowledge that all of my vital and current health information can be easily accessed in the event of an emergency, or on demand, online via my Microsoft Health Vault PHR or thru my portable/mobile PHR on the Sony Micro Vault in my wallet. This is very reassuring and a comforting feeling indeed with the hope that I will not need to use this information under distress, in the foreseeable future!:-)

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