Peter Neupert: Microsoft HealthVault Launch

Remarks by Dr. Marc Pierson, Regional Vice President, Clinical Information & Special Projects and Regional Vice President of Medical Affairs, PeaceHealth
Dr. Meera Kanhouwa, Physician Executive, Health Solutions Group, Microsoft Corporation
Peter Neupert, Corporate Vice President Health Solutions Group, Microsoft Corporation
Charles M. Kilo, Chief Executive Officer, GreenField Health System
Microsoft HealthVault Launch
Washington, D.C.
Oct. 4, 2007

DR. MARC PIERSON: I’m Dr. Marc Pierson, and I’ve been an internist and an ER physician for about 20 years, and for the last 14 years I’ve worked with Peace Health, a leading community-based clinical information initiative in Whatcom County, Wash., which is about 90 miles north of Seattle.

In the early days of the Internet, there are some things about today’s healthcare system that really just don’t make sense. Think about it, if today’s healthcare system managed the banking industry, you could only make deposits at one branch, because that’s where your records are. Your ATM card would only work with machines from your bank. Your balances would frequently be wrong because of the teller’s illegible handwriting, and withdrawals would take hours because the taxi has to go get your money from the main office.

Today, we’re going to talk about how we can change that. In this room are dozens of partners who have made a commitment to that change, a commit to create new applications, and to help people live longer, healthier lives. This slide, I hope, shows logos of 45 partners who are here today, organizations who believe that it’s time to bring healthcare into the new century, and my organization is one of those.

I’m up here today because I can tell you that although we do have information problems in medicine, they can be fixed, and we are doing that in Whatcom County. Five local institutions and a lot of patients have been involved in a multi-year process called Redesigning American Medicine with the Robert Wood Johnson Foundation, and the Institute for Healthcare Improvement. When we started this journey, we actually thought that our patients wanted access to our business medical records. They told us that actually they didn’t, they wanted access to their own health records, records where they can enter information, records where they can share it with people they didn’t necessarily think we would want them sharing it with, and they wanted to control who could see it. This was a big shift for us, one that I think is becoming a trend, a shift that health management from solely the physician’s office into the patient’s home.

In Whatcom County today, 1,200 residents are actively using something they named the Shared Care Plan. This is a community-wide, patient controlled personal health record that’s integrated into our county’s medical system. It’s available to the patient, and their physicians everywhere, and especially it’s appreciated in the emergency department by the families and the doctors. Among other things, it includes prescriptions, allergies, and advanced directives. The benefits have been remarkable. For example, diabetics who had this Shared Care Plan, and care managers markedly improved the diabetes measures for the blood pressure, lipid and blood sugar control when compared with actually less sick patients in the same practices. Also, the first 30 of these patients where we measured this, decreased the cost of emergency room visits, and hospitalizations by over US$3,000 per person per year.

The major reason that we were successful is that we focused on the family and the home. We learned that families are competent, and that they know how to look out for each other if they’re given the tools. Based on our experience, I firmly believe that any organizing principle in healthcare must have its core focus on the family and the home as the key. The scale for what we’ve been doing in Whatcom County on a national basis requires an extensible infrastructure, and a shared data platform on which everyone, patients, providers, payers, employers, the whole industry can share and exchange data. Microsoft has built that platform, and I am an enthusiastic supporter of their vision around families, partners, and privacy.

To wrap-up my comments, I want to reflect on the complexity of the healthcare system. To create a shared data platform will require the enthusiastic support of participants in the entire healthcare ecosystem. This situation reminds me of an African proverb, if you want to go fast, travel alone; if you want to go far, travel together. Today Microsoft is inviting all of us to help our patients and our enterprises, so we can go far together for a healthier America.

I’m going to pass things over to Dr. Meera Kanhouwa, who will be talking about the most important part of the healthcare ecosystem, family. Meera.

DR. MEERA KANHOUWA: Thank you, Marc.

Good morning. It’s a pleasure to be here. I want to tell you a little bit about myself. I was actually in the Army back in the first Desert Storm, where I got my training as a physician, and trained as an emergency physician, practiced clinically for 17 years, trained here in town at GW, ran the ER at P.G. County, which for those of you who live in DC know what a nice  (inaudible)  that place is. And so I moved out to Seattle, and I was a chief medical information officer there before joining Microsoft a couple of years ago. And it is really a pleasure to be here.

I joined Microsoft because the person recruiting me said, come on, we can change the world of healthcare, and I didn’t believe them. But today I believe them. We’ve made tremendous strides in the last few years, and I would like to tell you a little bit about what we’re doing with that today.

Marc, you are absolutely correct. Our research has shown that the family is the center of healthcare, and, in fact, our research has shown that there is a single individual, we call her the family health manager, who literally feels herself to be responsible not only for the health of her children, and her immediate family, but potentially for older parents as well, and this family health manager today is inundated with reams of information from multiple doctors, payers, CDMs, diagnostic centers, and she is struggling. And these folks have literally begged us to come up with a solution that will allow them to organize and simplify all of this information so that they can better manage the health of those that they love.

The family health manager views herself as the protector of her family, and she will do anything, she will try anything, she will change anything that she thinks might positively impact on the health and well-being of those around her. The family health manager is a mom, and she is the center of managing health for her family, and this group of women has the most compelling need today for innovation solutions that allow them to manage the real complexity and fragmentation and disjointedness of how we deliver healthcare as a nation. Our extensive research has shown that parents are also very likely to use online tools to manage the health of their children, and to access their healthcare data, particularly for things like immunization, did your kid get their shots, can she go to second grade on time. If you can’t find the paper, forget about it, right? So we want to help these women take care of their families.

Those family health managers taking care of elders, and chronically ill spouses or children are really emotionally burdened just by having to deal with that chronic disease, and on top of that they have a very difficult time managing all of the information that they have to keep straight, and keep available at a moment’s notice when somebody falls ill and has to go to the emergency department. And they’re having a tough time sorting out the healthcare needs. They also tend to be very tenacious when it comes to their family members, and they’ll fight tooth and nail to protect their family from what they consider to be the pitfalls of the healthcare delivery system today.

We did some extraordinary research over the past year. We call them experience maps, and we really wanted to understand what this family health manager goes through, and what’s important to her. And with experience maps, we kind of move into your house for a couple of months with cameras, so it’s not really comfortable at the beginning. But after a while the family gets used to us being there, and really starts to open up and share with us their frustrations, and their challenges, and their hopes, and even their dreams. And we asked some of our original test subjects to come back to the studio, so that they can share with you their stories today about their experiences with the healthcare system, and you’ll see some great home footage as well, so you can get a glimpse of what the average family health manager has to deal with as she navigates through the complexity of her healthcare system.

With that, I’ll ask that we roll the video, please.

(Video segment.)

PETER NEUPERT: Good morning. My name is Peter Neupert. I’m the corporate vice president for the Health Solutions Group, and we wanted to put the faces of these women to show the real needs. Excuse me, I’m a little bit sick. It’s hard to do a health event, and not get sick. To really understand what challenges we are here to try to help move the ball forward in fixing. We all know health is incredibly complex, and it has lots of information, and we make it harder than it needs to be. And by making it harder than it needs to be, bad things happen. What we’re trying to do, we don’t want to spend a lot of time talking about the problem, what we want to talk about today is what we can do to fix the problem. And today I think what you saw from those women in the video is, they want tools, they want tools to simplify their interactions with the health delivery system. They want an information system, an information system that puts them at the center, that makes it easy for them to manage their health, and their family, and their activities when they interact with the health system. And we can do that. It’s hard, but it’s not that hard. It’s possible, and it’s possible today, because they need the confidence that the right things will happen when they engage with the health system.

Today, we’re launching HealthVault. HealthVault is three things, it’s a search experience, a new, private search experience designed to help the user navigate the rich and complete information that exists out there on the Web to help them find the info and the services that are relevant to them. Next, it’s a private, and secure shared data repository and online service for the family manager to collect, store, gather and share their health information. Last, it’s the HealthVault Connection Center. It’s a client application which enables a new set of personal home health devices to make a whole new important class of information, user generated information, information collected in the home and their activities in a plug and play simple way for them to collect, manage and share that information.

Remember, it’s about the mom, the family health manager, and creating an information system that works for them. It starts with this shared data repository, the opportunity to collect data, because we need to make information reusable. We need to make it accessible. Why, because that’s how we can make it relevant to them. They need to know that they can get the right decisions made. And we’re all frustrated. We’re frustrated by the simple, stupid things, like having to fill out the clipboard all the time, or why do I have to go get my x-ray, when it’s right across from the doctor’s office. Why can’t the doctor figure out how to get it to the other doctor.

So today users, patients, moms, feel obligated to go make sure the right thing happens, because otherwise we inconvenience them, otherwise they have to make a new appointment, otherwise they have to do this. So that’s why we think a shared data repository, an online service that makes life easier is the first foundation.

So how do we get started? Well, people can type stuff in, they can fax stuff in, they can start with a search tool, which enables them to learn more about what they should do. But, the real promise is can we connect all of the providers, all of the hospitals, all of the pharmacies, all of the imaging labs, so that it’s easy like today banking is easy. Ten years ago, in 1995-1996, when the Internet was starting it wasn’t easy to get your banking information. Today it is. Similarly, today we’re that much further ahead, and we can connect all of these providers. It is possible to make it easy for people to take their data from the source data providers, and put it in a simple area where they can manage it.

It gets even more exciting when we can connect them to plan information, or new applications that know what to do with this data to make it more valuable to them. And you’ll see some of those today. And we can imagine a whole new set of tools that help them better understand, and better navigate what’s important. We can’t do it by ourselves. We can put a stake in the ground to get things started, but we need the creativity and knowledge of all the stakeholders, all the stakeholders that are in this room and many who aren’t, physicians, plans, people that are working with employers in wellness groups, fitness groups, to innovate on how to motivate, engage, inform, and encourage consumers, and providers, to deliver better care.

Microsoft has a long history of building exciting new platforms, and exciting end users, starting with the end user, about what the promise of personal computing is. When we excite end users, when we create the new tools for them that make their lives simpler, we have a tendency to transform industries. And we think by building an information system that is consumer-centric in health, like HealthVault, we can start  we can start, this is just a beginning, we can start to transform the health system. And I think consumers are the right agent of change to help make things different in health.

We had a few very important design principles when we built HealthVault. We know that consumers are very concerned about the privacy of their private health data. Yet, at the same time we know from long experience that sharing the data leads to better outcomes, that it doesn’t do any good just to collect the information and stick it in a lockbox, we need to make it reusable, so that people can gain understanding, and can gain the right information at the right time. And that collecting this kind of data could be, as Mark describes, an incredible way to help drive cost out of the health services.

So we started from the very beginning to design, build, and deliver new a system that puts the consumer in complete control of this data, at the finest granular element, but that allows for the sharing of that very data, under the control of the consumer, with any application that’s connected to the HealthVault. So we’ve accomplished something that has never existed before, the opportunity to have private, secure data, and still make it shareable, and reusable, and we will show how we do that next.

The data can’t be private unless it is secure. And, again, from the beginning, we designed security into the system. It’s why it’s an online service. It’s much easier to protect an online service than it is a really distributed system. We have locked servers in a physically secure location, physically separate from all the other servers in the room, and there’s only one point, one place that we have to be incredibly focused on making secure, and we’ve accomplished that.

The second important design principle was to make sure that the data could move around, and to do that we used industry standards wherever we could. Industry standards like the CTR, continuity of care record, or the CTD, the continuity of care document, or NCPDP standards for medications, or LOINC for lab data, and so on. We will use standards wherever they exist, and we’ve built an architecture that is extensible, because we don’t know what all data types are important for the future.

So we’ll continue to use and extend our system as new standards come together. And we’re committed to making it easy for a user to import their data, and export their data. We’re not trying to lock anybody in. We’re trying to be a catalyst for data liquidity in the broader health ecosystem, and we encourage folks to begin to start to think about that, and to start to make that happen.

And lastly, we decided that making HealthVault free to users, free to physicians, free to software developers, free to plans, was the best way to encourage adoption. We’re enabling new business models for our partners, they can provide free services, they can do subscription services. We’re not trying to inhibit any of that, but in order to encourage data liquidity, in order to get this started, we decided we would make this free.

The way we make money is by encouraging online activity, and through our search application. We know that search is a big business, it’s an important tool, it’s where consumers are today. And by growing the overall search market, and delivering more value to consumers, and delivering a better end-to-end search experience, that’s where we can make our money to support this effort.

Search is where consumers are today. Over 8 million consumers a day do some form of health related search. HealthVault search is better, it’s more private, it’s encrypted, we don’t store the logs beyond 90 days. It’s just a better experience. We’ve created a navigational aid to make it easier for users to learn at the very beginning, before diving into the deep, rich content, what it is they’re really looking for, what it is that’s going to help them.

We’re innovating in the ad area. We’ve done some really  many partners here have unique ad types that will help users. And in this context, ads are a very important part of the user experience, and the user content, because why? They don’t want to just learn, They want to fix their problem, they want to buy a service, or they want to buy a product that makes their health condition better. And in this way we will also enable user to find HealthVault compatible devices, HealthVault compatible applications, services that will make it easier for them to navigate and learn.

Search is a great tool to discover, but many want to be actively engaged in their everyday health, in monitoring and learning about what it is that can make them feel better. And personal health devices, from fitness devices like Polar, I’ve got my Polar watch on, because I use it when I work out. Like glucometers, peak flow meters, all the personal health devices can really help, but data today mostly gets lost. I’ll bet almost everybody in this room has a Blackberry or a Smart Phone. Eight years ago you couldn’t imagine how different your life is today by being able to connect, mobile, wherever you are, any time. And I think the same thing is going to be true for personal health devices.

We can’t imagine today what the world will look like eight years from today when all these devices are connected, seamlessly, simply, in ways that will help consumers better understand how to take advantage of what it means for them, and for their families, and what it might mean for a physician, and how they can understand what’s really going on when the person is not in their office.

You have 18 devices available today, all of which are easily Plug and Play-able with Windows. And we expect those manufacturers, now that there’s a simple way to make the data more valuable in HealthVault, to do a lot more new and exciting devices for the future.

I want to just get you to think beyond tomorrow, about what a connected world, and a consumer-centric information system might do for our health system. People in real life are more complex than just having a condition, like diabetes, or hypertension. The long-term promise of HealthVault, connected with devices, and connected to providers, is that having more data, and the software tools that allow us to gain insight from the data, like diet info, blood pressure combined with blood sugar, it will enable us, dad and dad’s provider, to better understand the many real life interactions and situations, and to improve every day choices that they’re making in treating dad from this example.

This connected system will also enable physicians to influence dad when dad is not in the office sitting next to them. We need new business models to make that a reality, we understand that, but by putting a stake in the ground perhaps we can encourage folks to see the opportunity to enable those new business models, and to accelerate.

Similarly, if you think about the challenge of these moms, the challenge of trying to manage a son or daughter with asthma, and the opportunity of being able to be connected when that son or daughter, when Jesse is playing at school. Six or seven hours a day they’re not around. They’re very active. They’re doing something. If we can create connectivity, as my Blackberry or Smart Phone is connected today, with smart information, mom can have the confidence that the right things will happen to Jesse, that he can have a full and active life, while still being able to be alert to change in the environment that could have real, serious impact on the outcomes for Jesse. And that’s the promise that we hope to deliver with the help of all the folks in this room, and all the folks not yet here, with HealthVault.

So now let me introduce Dan Jones, President of American Heart Association. In April 2007 he co-wrote an editorial for the association’s medical journal on hypertension, in which he encouraged an increased international effort to improve the detection, and control of high blood pressure. Dan. (Applause.)

DANIEL JONES: Good morning, and thank you, Peter. Thank you for the opportunity to be here today. The American Heart Association, through its programs of research and education, is working toward fulfilling our mission of building healthier lives, free of cardiovascular diseases, and stroke. And I’m excited today about what we think is an important opportunity for us to better fulfill that mission.

One of our important goals in trying to fulfill that mission is trying to improve the number of people with controlled blood pressure in our country. Right now about a third of Americans have high blood pressure. It’s the most common risk factor for heart disease, and for stroke. Only about a third of those Americans who have high blood pressure have it controlled today, and those are the best numbers that we’ve had.

We’ve been working on this, through the American Heart Association, through our healthcare system for more than 50 years now. And our success rate is only getting us to about one-third. Well, there’s a great opportunity for improving people’s lives through better blood pressure control, and just add onto that all the other risk factors for cardiovascular disease, because we could do better in controlling all of those.

So we have been looking for opportunities in the American Heart Association for ways to do that. If we look at the way we do business, at the way we connect with the world, the healthcare system, we’ve seen that we can do better, and we must do better. One of the things that we decided in the last days is that we need to be more directly connected to consumers.

So we’ve been looking for ways to improve the way we connect with consumers. And as we were looking for how we could do that, improving our own Web site, improving the other ways that we communicate with people, along comes Microsoft’s HealthVault. And it looks to us as a wonderful tool that will allow us to move forward with helping people to manage their health better, and we believe, we believe, can be an important tool in helping us meet our goals.

So we’re moving forward. We’ve spent a lot of hours in the last few weeks trying to build what we think is going to be something very important, a blood pressure management center. We believe this will help patients to manage their blood pressure better, and when it’s adopted by lots of people, and it’s robust in its fullest form, we believe it will be a tool that will help patients and their families to manage their health better, their blood pressure here, and will allow providers to have better and easier access to that information, as well.

So we’re moving forward to try to use this tool to help patients better manage their blood pressure. Today a patient can, either by using a monitor with an electronic input, or by typing it in if they wish to do that, can keep their blood pressure data and look at it longitudinally. They can look at their weight over time. They can look at their physical activity, health events, and so forth.

As you’ll see in our demonstration in a few moments, integrated with other systems it can be a powerful tool for patients, in comprehensively managing their health, with blood pressure being an important part of that. And importantly, adding information like pharmaceutical data, and so forth, it can become a very powerful tool for healthcare providers to be able to manage them better.

So let’s see how this might work with a particular patient. Our patient is a grandma. She’s been in the hospital, in a very highly monitored environment, she has a heart condition, has high blood pressure. Our patient likes to travel. She has children and grandchildren scattered around the world, and so after she’s cleared for travel she takes off on her journey to move around the world to see her family. Her health goes with her. Of course, she’d like to manage her health along the way. I think we all recognize that today it’s not as easy for her to manage her health around the world as it is for her to manage her banking business around the world.

So as she goes to visit various members of her family, she goes to visit her children, her health data can go with her through the HealthVault, and if she wants to share that data with her children she can share that data with her children. Her sister back home, who is worried about how her blood pressure is doing while she’s on the road, can have that view of her health, as well, if she wants to do that.

Then her healthcare professionals back at home, by using access that she would give them to her information in her HealthVault, would be able to monitor and track how she’s doing. Then if she had a problem and needed to see a physician in another state, in another part of the world, there’s her own health record right there with her, that she can share, with her permission, with providers.

What you’re seeing today, what you’ll see in the demonstration in a few moments, is just the beginning of the power that we believe this tool can have, beginning with this blood pressure management tool, in its form today, we believe will be a powerful help in helping people to manage their blood pressure, and their other health problems. But, we believe, we have the vision, that this can be an important tool for empowering consumers, empowering patients to manage their own health, and to help other people involved in their healthcare to manage it, as well. So we’re pleased to be a part of the launch today. We have great hope that this is going to help us to meet our mission of building healthier lives.

Peter, thank you for the opportunity to be with you today. (Applause.)

PETER NEUPERT: Thank you, Dan.

So now that we’ve spent some time describing the platform, and showing some of the future-facing scenarios, I’d like to show you what’s actually working today. This isn’t just all vision, this is stuff that’s actually working today. So I’d like to invite Chuck Kilo, Dr. Chuck Kilo, CEO of Greenfield Health, and executive director of the trust for Healthcare Excellence, to come up to the stage.

Dr. Kilo will be walking us through a real demonstration, live and online today, using a variety of HealthVault launch partners. Dr. Kilo will be assisted by two members of my team, Bert van Hoof, and Oren Rosenbloom.

Chuck. (Applause.)

CHARLES M. KILO: Thank you, Peter.

Good morning, again, everybody. My name is Chuck Kilo, and I lead Greenfield Health, its a medical group in Portland, Oregon, that has a long history of working with others who are focused on transforming healthcare. We have been highly connected to our patients for quite a long time, using products like Kryptiq Corporation. And today we’re here to launch Microsoft’s HealthVault, as you heard. And today I think what is happening is we’re seeing, as quoted by Kryptiq CEO Luis Machuca the broad democratization of connectivity in healthcare, which is there really to help our patients become more proficient managers of their own healthcare.

What’s different about this launch today of HealthVault is that it represents a real, and live product, that you can use today, you will use today, hopefully, using your Polaris watches, which you’ll get later. We want to walk through a very brief demo with you to demonstrate some of the connectivity that is available today. I’d like to introduce to you Mr. John Smith, who is a 58-year-old gentleman, who began experiencing a vague chest pain several weeks ago, and on one particularly bad episode he presented to a Med Star hospital, and upon checking into that hospital’s emergency room, he pulls out his wallet card, gives it to the emergency room personnel, and they’re able to access this his ICE PHR, his in case of emergency PHR by Cap Med.

BERT VAN HOOF: So this is what they see in the emergency room, this is Cap Med ICE PHR. There are two logins here, one for emergency personnel, so they’re immediately drawn to the left hand side here. And when they enter the specific data from his wallet card they get into the ICE PHR and see all the specific information about John Smith. Now, this information is something that John Smith has been collecting through his HealthVault account over time. So there’s two views to this application, one is his personal view, where he has all his private data, and this is the data he decided to share in case of an emergency.

You’ll see that he has his demographic information, medical information about his conditions, allergies, immunizations he has gotten, some advanced directives, insurance information, contact information, et cetera.

CHARLES M. KILO: The healthcare quality really is highly correlated with the ability to different sites of care to access patient’s accurate medication lists, problem lists, and allergies. In this case they can do so, due to this connectivity. In the emergency room the personnel diagnosed Mr. Smith as being on the verge of having a heart attack. He’s taken to the cardiac catheterization lab, where he undergoes an angiogram, and subsequently an angioplasty and the placement of a cardiac stent. Very shortly after this Mr. Smith is ready for discharge. Fortunately his heart suffered no damage, and he is discharged in good condition.

BERT VAN HOOF: So John gets an e-mail from the Med Star hospital after his discharge, and he’s invited to enroll in a program, and pick up his health information, and that’s this e-mail. It eventually ends up here, by clicking a link in the e-mail at Med Star Heath’s patient portal, he signs in, picks up his information. So you’ll see that every time we go through an application we sign in specifically, and this is part of the privacy aspect, in each application you have to go through this login. We think that’s a good thing. So now here you see the discharge instructions that he received through the Med Star Health patient portal.

CHARLES M. KILO: There are a couple of critical aspects that important for Mr. Smith here, the sharing of medication lists, diagnosis for the coordination of care, subsequent management of his medical conditions, in this case his hypertension, high blood pressure, his hypercholesterolemia, high cholesterol, diet, nutrition, and his exercise. Well, in follow up with his primary care physician John is able to take the information that was sent to him by the hospital, and he’s able to take that information, and bring it into his own personal health records, and the portal that his clinic uses, the Contoso Clinic, and his private physician Doctor Adams. He does this by logging onto the clinic’s portal that is designed by Kryptiq Corporation.

BERT VAN HOOF: So you see the Contoso Clinic patient portal here, and John just logged in. And now to be clear, Contoso Clinic is a fictitious organization, but the Connect IQ, Patient Portal, are very real. As Peter said, all of these are live today, so you can go check them out afterwards through So John logs in here, and one of the options he has in his patient services is to send a document to his doctor. Again, we’re doing the login.

CHARLES M. KILO: Private and secure.

BERT VAN HOOF: And now he can pick his doctor, Terry Adams, and he sees a document in his HealthVault account, which is the discharge information, and so he types in a few comments, Dr. Adams, here’s my data. There we go, and he copies it from his HealthVault account to his physician.

CHARLES M. KILO: Amazing, with a few clicks he can do things he could never have done before. So patient, consumer self-management and engagement is really a very powerful tool for quality of care, highly correlated with healthcare outcomes. It’s important for Mr. Smith to be able to monitor and manage his own high blood pressure. The work that he does at home is more important than the work that we do in these very brief office visits that we have for him. So what we’d like to do is provide Mr. Smith with lots of capabilities to allow him to coordinate his care with me, but also to become an expert in his own health management.

BERT VAN HOOF: So when John comes back from his physician visit, he goes back into his patient portal and now he sees that hypertension has been added as a condition. Now, when he clicks on this, it opens HealthVault search, and it comes up right there with hypertension, and now only does he find great content to further educate him on the specific newly added condition, he also sees a number of interesting action modules on the right hand side. He sees that there is blood pressure monitors available from Amazon, and he finds a couple of interesting blood pressure tools that he can use, and as you just heard the American Heart Association Blood Pressure Management Center is one of them.

CHARLES M. KILO: Great. So John purchases a blood pressure monitor device. He’s been monitoring his blood pressure for the past couple of weeks in the blood pressure management center, and he’s going to sign in, and again, private and secure, I’m choosing to share my data.

BERT VAN HOOF: And he’s been monitoring his blood pressure for these past couple of weeks, with his brand new microized blood pressure monitor. As you can see, we have a graph here, a very simple to read and understand graph, where his blood pressure started a bit high in the red and yellows, and over the past couple of weeks of medication we’ve brought it down to more manageable levels. John is preparing to visit his physician again. He’s been giving a week’s worth of reading, on his device. He’s not a very computer literate individual, but he does know how to plug things in. So that’s what I’m going to do, plug in my blood pressure monitor.

CHARLES M. KILO: And that works with all the other devices you see here up front. There are 18 devices today that connect to HealthVault, including glucose monitors, the sports watches that you see, blood pressure monitors, a whole range of devices.

BERT VAN HOOF: So here we have the HealthVault connection center, it pops up. Notice, I didn’t do anything. It uploaded by data all into my HealthVault account. Now let’s go look at that. In the blood pressure management center if I refresh the site data it’s going to pull my new reading from my HealthVault account. As you can see, we added a new tail end to that blood pressure graph.

Now, let’s take a look at a bit more detail here. September 25th he had a reading of 122 over 76, not bad, getting better. Let’s remember that number for a few seconds. Now, John is getting ready to go back to his physician. So he logs back onto the Contoso Clinic Patient Portal, and he’s going to select, send my blood pressure readings to my doctor. Let’s go do that. And as you can see, he’s presented with his list of readings. The first one is September 25th 122 over 76, the same data from the same location, and I’m going to say, copy this to my doctor.

CHARLES M. KILO: It’s that simple. You will see two screens now up here, different screens. One will be the electronic health record that Dr. Adams will be using in the medical clinic, and that information will come in, this data is all being sent live, and that data will come in. Dr. Adams would come onto the electronic health record, and sign that off, if you can see that. And what that will allow Dr. Adams to do, once he signs that off, is to go in and graph the patient’s blood pressure, and see exactly what the patient was seeing at home. And that data comes in, it comes in live, and is able to be saved.

Now, this occurs in a rich, robust IP environment, using an electronic health record, but many of the capabilities you’re seeing today are available to physicians free, by products such as ERX Now, a handheld prescribing system made by All Scripts. So you need not be in a fully electronic environment on the physician’s side in order to make use of these tools.

So now that we’ve managed his blood pressure, we have some additional work to do with Mr. Smith. We know that most people are really not very aware of their diet, and their nutrition, and they need help with that, they need help understanding the amount of calories, and the quality of nutrition of the nutrition they’re taking in. And, in fact, HealthVault is there to help people with this challenge, as well.

BERT VAN HOOF: So he signs up for Pure Wellness, which is an application that helps him to track his food intake, and the calories he burns on a day-to-day basis. You see a couple of things logged in here today. He can also look at his health logs, you see blood glucose monitoring, blood pressure logs, and there is the same data that you saw in all those applications, but this happens to be an application also registered for this data, and this is a clear showcase on how that data can travel from app to app, if you allow it to. It’s your private data, but you can share it at any point. So now this application can also take advantage of data you’ve been collecting in other places.

DR. CHARLES M. KILO: One of the challenges that we have, now that we’ve helped Mr. Smith with his medications, and helping him manage his diagnosis with this hypertension management, and now with his diet and nutritional needs, is lastly his exercise. We know that his exercise is highly correlated with his overall health, and we know that many people have a hard time sort of understanding how they should exercise, monitoring their exercises, and the quality of their exercise. And HealthVault and various products are available for that as well.

OREN ROSENBLOOM: Right. So HealthVault Search, as you can see we have a green bar at the top, a green bar means it is from a trusted source. The lock in the corner means it’s secure, private and secure search. We search for hypertension, we are going to refine our search in a unique way that we could never do so before, I click on exercise. As you can see, I can read up on some exercise and hypertension. I also have a new set of applications I can use, such as Fitness Peaks, which we’ll see in a moment. And I can also purchase a couple of devices. Here I have the Polar S55, which each of you should have received in your gift bag this morning.

Now what we’re going to go do is, we’re going to go back to Fitness Peaks.

BERT VAN HOOF: That’s an application where you connect with your trainer, and using devices, and getting assistance from the trainer or coach.

OREN ROSENBLOOM: Right. So, as you can see here, I have a personal trainer online, he’s giving me instructions on how to train for the next week. I’m going to go check out  I’m going to make sure I can sync this to my HealthVault account, copied in, piece of cake. Now we can go back to the blood pressure management center. And I’m going to look at my data really quick just to make sure that it’s there. At the bottom you can see I have these data points. I’m supposed to walk, my first thing. So now let’s go look at my exercises again.

BERT VAN HOOF: This is also an example on how you use the data to work with your coach, but it also showed up in the American Heart Association application.

OREN ROSENBLOOM: Okay, so here I have a graph. You can see it’s empty. I have a heart rate monitor (inaudible) the S55, the same one you have, again, this one I’m not going to plug it in, it’s actually wireless. John is not too computer literate, as I said, HealthVault Connection Center discovers the device, locating its recorded fitness sessions on the device. It’s importing them, uploading them, again, no hands, I haven’t done anything yet. Let’s refresh my site data there. There you go, my exercise. Let’s go look at the data again, here are some of the readings. So I worked out for 19-1/2 minutes, my heart rate is a little low, we should probably pump up his intensity there.

DR. CHARLES M. KILO: We are now several weeks after John’s unfortunate interaction with the healthcare system, and his near heart attack. He is now empowered with good information, secure connectivity to his healthcare provider, great information and search capabilities via HealthVault. HealthVault is helping people manage their health better. Mr. Smith really feels like he’s gained a new life, that ER visit is a very, very distant memory, and we’re delighted by his ability now to begin to manage, in coordination with his care providers, his own health in a much more detailed way. Thank you very much. (Applause.)

PETER NEUPERT: I hope we made our point. We had a simple point we wanted to make, and that is, it really works, there’s lots of applications, there’s lots of excitement. There is a new way to start thinking about how to think about the future in our health delivery system.

With that, they’re going to put some chairs here behind me. I would like to introduce a panel, a distinguished panel, all of who you see up here, and we’ll spend 20-25 minutes talking about how they view the transformation, what they might do to make a new and improved health delivery system and experience for consumers.

I’m going to introduce them alphabetically, Dr. Brooks Edwards. Brooks is from the Mayo Clinic, he’s a consultant for the cardiovascular disease in the Department of Internal Medicine, and he was the first chair of the computer-aided instruction committee for the Mayo Medical School, and founding editor for the award-winning Richard Kahn, chief scientific and medical officer of the American Diabetes Association, he has published more than 50 original research reports, as well as numerous book chapters, and has received many awards and honors and lectureships, and is a member of a variety of professional organizations. Dr. Robert Kelly, senior vice president and chief operating officer, chief medical officer, the New York Presbyterian Hospital, Columbia University Medical Center. Michael Rechtiene, president Animus Corporation, and vice president at Life Scan. Dr. Lonny Reisman, chief executive officer of Active Health, he is the architect behind the development of Active Healthcare Engine System Intelligence. Glen Tullman, CEO of Allscripts, he serves on the International Board for the Juvenile Diabetes Research Foundation, and on the board of trustees of the Certification Commission for Healthcare Information Technology, and in 2006 he was named CEO of the year by the Illinois Information Technology Association. And Dr. Deborah Peel, founder of the Patient Privacy Rights Foundation. Dr. Peel was named one of the 100 most powerful people in healthcare by Modern Healthcare Magazine.

Thanks everybody for coming up here. It’s going to be a little tight. After we have a discussion, which we hope we make a little bit lively, we will take questions from the audience.

Deborah, why don’t we start with you, I’ll sit down in a minute. What do you think sort of the key things are in terms of making happen a consumer-centric health information system?

DR. DEBORAH PEEL: Well, for those of you that don’t know, the mission of Patient Privacy Rights is to guarantee that every American controls all access to their health information. So let me just start by saying that 50 years ago today, the Russians launched Sputnik, and it was a wakeup call to Americans, and to American industry. That successful launch, we hope, will be echoed today by the successful launch of this product, which is really HealthVault is the absolute first major corporation Microsoft HealthVault is the first example of a product, a technology product and system, that’s actually guarantees that patients will control their information. HealthVault and Microsoft  and congratulations to all of you partners, you all have agreed that information in this system will be controlled only by patients. Microsoft is going to meet the 2007 privacy principles developed by the Bipartisan Coalition for Patient Privacy, and even more than that, not only are they making this pledge, but they’re going to have external audits to see that they’re really doing what they say they’re going to do. So the reason that Patient Privacy Rights is here is we think what you’re doing really is revolutionary, it’s a critical first step for the healthcare industry, because patients, consumers, and Americans are never going to take part in health IT unless they’re back in control of their health information. So we congratulate you.

PETER NEUPERT: Thanks, Deborah.

Deborah has helped us a lot really think through, how do we make real this consumer-centric, private, and secure system.

Brooks, how do you think Mayo might use this in your delivery?

DR. BROOKS EDWARDS: Let me give you an example. I spend a lot of my time in a transplant program, a busy program, a lot of patients, complex medical issues, but common issues, diabetes, hypertension, hyperlipidemia, coronary artery disease. And I was in the clinic this week, and I’ll give you a real life example, but this is not an unusual example. A patient comes in new to our system, and I was taking a history, and said, tell me about some medications you’re on, do you have a list of the medications you’re on? And they said, I don’t have a list, but I can show you. Okay, and with that they take out a bottle, and they dump the medications on the desk. And then they say, this is a heart pill, I take that once a day. This is for my blood pressure  this is my husband’s blood pressure pill. And this is for cholesterol. And it’s funny, but it’s not funny because that’s really the reality of the system we live in, and the opportunity for patients to be placed back at the center of the healthcare equation, to be in control of data, to be knowledgeable, and to have the data that’s current, that’s relevant, that’s up to date, all in one place I think is going to be a major step forward for the way I practice, and the way care will be delivered for all of us.

PETER NEUPERT: Thanks, Brooks.

Dr. Kelly.

DR. ROBERT KELLY: It’s fascinating that probably the most important information that one has, which is their health information is the most confusing to most people. We have no way of systematizing how we store it. We have terminology that people cannot understand. We make it about as challenging as possible. And then we expect people to come and relate that information to us. This is an opportunity to put it in one place, and have it accessible to all, not only the patients, but the providers.

More importantly, though, I think that the fact that we experience just a small part of the patient’s life when they’re in the office, or in the hospital, and a system such as this will allow us to really look at what’s going on. No longer will we be reliant on them sort of remembering, they felt good, they didn’t feel good, what their blood pressure was, this is a way for us to have a system that we can look at this and really incorporate every day life into their health. I think that’s a huge step forward.

PETER NEUPERT: One of the issues I heard, before I get to the rest, I’m just going to jump in, one of the issues I’ve heard from many people as we started to build this system was that physicians won’t share information. They want to keep it to themselves, they don’t want to give it to their patients.

DR. BROOKS EDWARDS: I think there’s probably a vast spectrum of physicians out there, but really the goal, our motto at the Mayo Clinic is, the needs of the patient come first. I think most physicians have that same adage in one way, shape or form. And when you think about that, the needs of the patient come first, it really is to empower the patient, to now put the patient in the center of the equation, and say, you’re in charge, but as you become in charge you also have the burden, or the responsibility of keeping track of all this stuff, and this is one way to do this, one tool to empower the people we’ve now put in charge.

DR. DEBORAH PEEL: This way it really is the right of the consumer to have a copy of their records. It’s a legal right, it’s an ethnical right. Doctors may balk, but that’s what life is going to be. They’re going to have to follow the rules.

DR. ROBERT KELLY: I think that physicians have been resistant in the past because, quite frankly, they didn’t trust some of the sources of the information. Something like this, I think, will make it more transparent, and make physicians more comfortable with the information. As care has become more and more complex, clearly you need interdisciplinary teams working together, and I think that the practice of medicine is really transforming. This can be a big step in helping that transformation.

PETER NEUPERT: Lonny, you’ve spent a lot of time trying to figure out how to make information more valuable. What do you think about what we’re doing?

DR. LONNY REISMAN: Well, as I react to what I’ve known about your work, and listening this morning, I’m struck by the fact that this development 10 years ago might have obviated the need for the creation of Active Health. So, thanks for waiting, thanks for being slow. I do appreciate that. I’m glad I didn’t speak to you at the time, frankly. I think, just a word about Active Health, we aggregate clinical data from manuscript sources, administrative sources, like pharmacy benefit managers, like big reference laboratories, and payers, and our goal at the outset was to create an aggregate clinical record, which we then could expose to various standards depicting safety, and clinical excellence. Frankly, we started with what was available, the stuff that I just mentioned. As we have evolved, we have tried very, very desperately to enhance the access to different types of data, with the goal ultimately being, for example, genomics data, really understanding as much as one could possibly understand about the member.

So with the advent of HealthVault, I think there’s information that the consumer can provide, there is information that we’ll get about patients, consumers, through hospital systems, through some of the applications that you’ve alluded to before. I think having information around biometric issues will be very important. And with regard to our ultimate goal, which would be to convert that comprehensive information into actionable, explicit steps for the member to take, including, by the way, search, you might be looking for sugar issues around your diabetes, but the salient issues for you really relate to blood pressure and kidney function, for example. So the ability to have this comprehensive a substrate to analyze, and then define opportunities for caregivers or patients, we think represents an opportunity for us, frankly, to make a confident leap with regard to the benefit we’ve been providing.

PETER NEUPERT: Glen, you’ve been a leader in trying to help get physicians to use electronic tools, and have gone so far to start (NESPSI?), which is a free service for physicians. How do you think we can connect those two things to make better outcomes happen?

GLEN TULLMAN: Peter, I think this really is an issue of connectivity, and we spent years, as you mentioned, trying to get physicians automated using electronic health records, and the like, and along the way we realized that getting physicians automated was really only half of the equation, they had to be able to talk with and connect in a sincere way to their patients. And so we were working one side of the equation fully realizing that the other side, that connectivity, had to take place. And I think that’s what you’re providing today that’s so critical.

Along the way, we also realized that every physician isn’t going to have an electronic health record, at least not right away, so the founding of the National Electronic Society Patient Safety Initiative was a way to offer every physician in the United States access to free electronic prescribing. What that means today is that every physician in the United States also will have access to HealthVault through that same set of services, and it’s really about giving, and I think the example has been used a number of times, this is really about having the ATM of healthcare, and that is giving patients access to their information whenever, wherever they want it, anywhere in the world. And that’s what we’re really talking about.

It is also, though, a benefit for our physicians, because, as was mentioned earlier, physicians don’t practice in kind of single treatment modalities anymore. There’s multiple physicians working a particular case. I see this as a benefit not just to the patients who can now aggregate multiple physicians’ work into one place that only they may see, and then they can release that, but it’s also valuable for physicians because now, with the patient’s permission, they can see two, or three, or four different physicians working on the particular case.

One last point I’ll make, and it’s a personal one. In managing my own mother’s care from a different state, I know that sitting and trying to track what four different physicians working with her were doing on a daily basis was near impossible, and I have a full-time assistant. And I was thinking to myself, what would a normal person do? This is really the answer that was reflected in the video, because this is about coordinating care, and better care. So I applaud your efforts.

PETER NEUPERT: We have to work together to make sure that Brooks doesn’t get any more pill bottles.

Richard, American Diabetes Association has been long trying to get people to take better self-management of their disease, and better understanding. How do you think they can help?

RICHARD KAHN: Well, I think that, sort of to paraphrase all the previous panelists, and I’m sure those to come, that diabetes is a fantastic model for the problem. I mean, here you have a person that is going to have a disease for decades. They’re going to see multiple physicians. They’re going to get innumerable tests and procedures. They’re going to have an average of five to seven different drugs. And now they go to this  and they’re going to see, at least, at the very least, two, three, four, five different doctors. And so now you have this person coming to the doctor’s office for an appointment to do whatever, and the doctor has like 20-30 minutes to do something, and take the medicals. You’re never going to be able to take a complete medical history, and the patient is never going to be able to relate everything.

So here we have a system where everybody has had these different medical records, all this information, and it’s not integrated, it’s not displayed in any kind of efficient form. Now we’re seeing an opportunity to get all this stuff actually integrated, concisely displayed, concisely formatted, easily accessible, the patient is in charge, he or she can move it around whenever he wants. This is truly the wave of the future, and you cannot manage a chronic condition, with multiple core morbidities, drugs, et cetera, without these kinds of tools.

And, for example, just today, just today the American Diabetes Association is launching something called My Diabetes Connector, in which people can take any kind of glucose meter they want, they can download that information to our secure Web site, and then they can move that information to whomever they want, a relative, or the HealthVault. They can do anything they want with that information, and they can add in other information to keep it in one concise, great place. So everybody is kind of developing these tools. This is a phenomenal step. It’s not a quick trip, it’s a long journey. There are lots of issues. I think it’s terrific that we’re doing all this.

PETER NEUPERT: Still no silver bullet.


MICHAEL RECHTIENE: Peter, I wanted to first congratulate Microsoft and your team on empowering the family health manager through the launch of HealthVault, as well as thank you for involving partners early on as we started doing here. I think that from a Johnson and Johnson, and a Life Scan, and an Animus standpoint, we look at a family health manager, the mom, in many cases, and that mom may have one or two scenarios of diabetes. I appreciated, Richard, your comment that diabetes is a broad disease. On one hand, that mother or wife may be dealing with a husband who has Type 2 diabetes, is seeing a primary care physician. He also has cardiovascular complications, also struggling with exercise, and the information being brought together can come from looking at how medication changes have an affect on blood glucose data, have an affect on bringing exercise data together, and then bringing it together with cardiovascular data in one place that the patient or the spouse can work with the health care provider to optimize the regimen is one great thing that we see as an example.

On the other hand, you know, on the other side of diabetes, you’ve got the mom who has a 12-year-old daughter who was diagnosed last year with Type 1 diabetes, and is on an Animus insulin pump, and they’re working with their doctor to get the right dosing of insulin throughout the day. Sending the daughter to school for the first time with an insulin pump, first sleepover, and the ability to be able to have that data available coming out of the one touch blood glucose monitors, and be available for the doctor and the physician to help in a partnership, a collaboration, we feel that there’s a real power in knowing. And a power in knowing of bringing the patient, the parent, the caregiver, along with the physician together to be able to optimally figure out the dosing, and the treatment regimen in diabetes when, today, nearly  I was struck by the blood pressure numbers. Today in diabetes, less than 40 percent of people with diabetes are in clinical control, and we see HealthVault as a place where, through the sharing of data, we could actually help physicians and patients, and mothers and fathers, make better decisions.

PETER NEUPERT: So we all see that there’s challenges. This vision, this need for connectivity between patient and physician has been obvious. This need for being able to do a better job with chronic conditions has been well-known for a long time, the challenge for us as an industry, if we will, if I put us in the health industry for a moment, is how do we make change happen. What do you think a tipping point might be to help motivate people to change behavior, or physicians to change behavior, or plans to change behavior in terms of trying to make connectivity real as opposed to just talking about it? Lonny, you’ve worked hard to try to get everybody connected behind the scenes, if you will, what do you think it will take to make the tipping point?

DR. LONNY REISMAN: I think the issues of engagement, and it relates to incentives going forward, and I’ll start with the providers, the doctors, it’s wonderful to have this information. We’ve been clamoring for it. But as physicians, are we really going to look at it, and are we really going to exploit it? In fact, will we be intimidated by it? What I don’t know I can’t be held responsible for. And now you’re sort of turning it up, am I going to miss something  (inaudible)  I think it does raise issues. I actually think those will, in fact, successfully avoid, and I have argued vigorously that it’s better to sort of address the issues the day before rather than the day after, but I think as we work with physicians, as we talk about high performance networks, an emerging theme in the managed care industry, we have to make sure that, in fact, physicians are rewarded for these sorts of activities.

With regard to the consumer, assuming making it free is important. I think involving other partners so that they are as comprehensive as possible is important. But other types of incentives, like paying people, giving them vouchers for fitness, and other types of lifestyle issues are important. We’ve also seen good success in addressing frame design issues around desirable behaviors, and desirable diagnostic and therapeutic interventions. So if, in fact, a diabetic needs to access multiple specialists, and engage in multiple activities directed by the HealthVault, for example, why would you have a cost there in the way of them accessing those services. So as we think about plan design and cost shifting, you have to be cognizant of the potential impact with regard to access.

I think it’s, certainly, the multidisciplinary problem but, again, as a foundation, I think with what you’ve done it gives us an opportunity to start answering these questions, and involving the appropriate parties.

PETER NEUPERT: Robert, in your institution what do you think it will take to really get the ball rolling?

DR. ROBERT KELLY: Well, I think that this is something that’s been building for a long time. As patient care has become more complex, and patients have been more active in managing their healthcare, I think there is a need that’s been growing. I think that the HealthVault actually could be a tipping point in and of itself. I think patients will start clamoring for something like this, and demanding that their physicians are participating in it I do think as a physician it could be a challenge. As you said, some of the, I don’t know what I don’t know, and that’s okay. But I think we can start thinking about patients differently. Knowing what’s happening to them throughout the weeks in-between visits, and as you mentioned earlier, Peter, I don’t think we’ve even begun to think about the long-term effects of this. So, for instance, having data start accumulating now, 5, 10, 15, 25 years from now, and how that will start looking differently as we start incorporating genomics into personalized medicine, I think that this just a wealth of information that we’re going to need, and having a system that is transparent like this, we don’t even know the questions we want to be able to answer yet, but we’ll be able to have the data and be able to manipulate it. I think we’re starting to go down that hill right now.

GLENN TULLMAN: If I can add one, I think, important point, when you look at the tipping point, if you read the book The Tipping Point, one of the things it talks about is, it’s never just one thing. But I think Microsoft getting behind this initiative sends a message to consumers, and to business partners alike saying, Microsoft is involved here and getting behind this, that you’ve brought this conglomeration of partners together, that this is really going to start happening. I think that’s supported by this incredible trend of patients starting to take charge, saying this is important, healthcare is important, and I would like to say that patients aren’t going to be patient anymore, they’re saying they want this information, they see their kids get what they want on the Internet quickly, and they’re saying, why can’t I e-mail my doctor, why can’t I use Microsoft to schedule an appointment with my patient, all these places I’m sure you’re thinking about going, and the people want you to go there. So I think it’s going to be patient-driven, and I think it’s going to be much faster than any of us imagine.

DR. DEBORAH PEEL: Speaking about patient-driven, and consumer organizations, I just have to jump in. There is no way consumers are going to do this unless we have a system where they control the information. And one of the things that I think that this discussion has shown is that there is plenty of electronic information out there, and the two people that need it, the patient and the doctor, haven’t had it. That can be possible with HealthVault, but doctors, but particularly consumers, doctors are very concerned about privacy, too. It’s not just patients. They don’t want to be part of a system that violates ethics. They don’t want the information to go places that they know that their patients would never want it to go, but the key issue for consumers, and millions of consumers are represented in our coalition, from the far left including the American Conservative Union, to the far right, the ACLU, Americans want privacy, particularly because they know the dangers in the electronic environment. I just have to say, for consumers, for us, the tipping point is restoring control, our control over the most sensitive information that exists about us on earth.

DR. BROOKS EDWARDS: The point I would  we’re all  many of us are physicians, and used to patients. But I think part of the tipping point, and part of the beauty of these sorts of systems is that they really work well for people who aren’t patients, who are healthy, and how do you use these to stay healthy, to not become a patient, to not get diabetes, to not get hypertension, and it may be that the patients may be the slower adopters, but really the healthy people who are concerned about, am I getting enough exercise, how do I track my calories, what’s my ideal body weight, are going to start a wave, and then some of those will, unfortunately, become patients. But we’ve got to remember there’s a lot of non-patient consumer that a tool like this I think has a lot of application for.

PETER NEUPERT: We’ve made very clear that we want to cover the whole gamut, because really the goal is to keep people from being sick. We get that, and we put those data types into the model. I do want to make it clear, I don’t know what the tipping point is going to be. But what we tried to do is create a system that enables lots of places, and lots of access points that we can all start a little bit at a time. Because if we try to connect all the world all at once, it won’t happen. But if everybody can make a decision today that I’m going to get connected, then NYP can get connected, and Mayo, and others, consumers can start to get connected and demand that kind of thing, that maybe some momentum will happen. I actually think that’s the most likely way is that people will make decisions, hopefully because we’ve put a stake in the ground, hopefully because the need is so obvious, and hopefully because the price is right in the context of, hey, I can actually start to do something different today, and make sure that I do it in a way that is patient friendly, or consumer friendly, and appropriate.

RICHARD KAHN: I think if we all go back to the first time we bought a book on Amazon, besides those who were early adopters, I think we did so because a friend said, it’s fast, it’s efficient, it’s cool, it’s easy, and we said, I’ll try it. And then you communicate that to the next person, and then we get that critical mass, and then it just takes off. I think you wait for all these applications are there, the use of applications on a lot of Web sites, and a lot of these cool tools are available, people are more and more saying, if you go there, you can try this, you can get this, and you can get that. The technology is there, I think the critical mass of both the physician, the healthcare industry, and the consumer that says, I feel comfortable with this stuff, and I’m going to tell my friends about it, and then the movement starts.

PETER NEUPERT: Well, I think we’ve demonstrated that we’re all excited, that we see a common vision and a common need, and that we’re ready to get started.

With that, I think what I would like to do, if I can get the runners in the room, I can’t see with the light, is I would like to open it up to questions from the audience. I know there are some members of the press, if there are other people that have questions that they want to ask, it’s not very often that you get this kind of panel put together, so if you want to ask anything.

Question over there. Please identify, as you’re going to ask a question, can we get a mike? So just rules of the road, please introduce yourself into the microphone.

QUESTION: The stuff you’re doing is wonderful. One question, though, would be how do you think patients would be able to take this to action? Information, knowledge is great, but you know it’s not sufficient to actually change behavior. How would the HealthVault be able to get these 

(Operator Direction.)

PETER NEUPERT: I am just this sort of technology optimist. I understand how hard it is to change consumer behavior, and I know how hard it is for me to get up in the morning and workout. But I believe that communications, cool devices, graphs, competitions, one of the applications we’ve worked on internal to our organization, just to be fun, is a competition where everybody exercise workout, we can travel along and compete against each other are ways to motivate. So I believe that technology, communications, mobility, and the creativeness of partners creating applications can create an environment where people will, perhaps, at the margins, change their behavior a little bit.

RICHARD KAHN: I would just add one other thing on this, which I think is going to come. So here you have this source of the information, the information is all there, and I think the great question is how do you change behavior. I think the next generation, and we’re not talking about years, in fact, it’s here now, I’ll give you an example, is to say, okay, you do this, this is likely to happen now. If you change your blood pressure, you take your pill on a regular basis, for example  how often are you taking your pill? Three times a week. If you went to four times, what’s going to happen? For example, on the ADA Web site, we have this risk assessment tool and it says, put in all your information, here’s your risk.

Okay. So now what do I do, and you can put in and say, okay, if I change my blood pressure, I change my lipids, I can see how my risk is going to go down. That is easy to do. I think that’s clearly something that Microsoft and everybody else can do with applications. Here’s your risk profile, here’s where you are now, if you change this, this is what’s going to happen, this is what’s likely going to happen to you. We have that tool, others have that tool. I thin it’s going to be fantastic.

DR. BROOKS EDWARDS: The one thing I’d say is, I think the numbers, statistics are good, but other incentives are important. If you’re going to start thinking about programs where you’re going to offer incentives for managing your  keeping your glycohemoglobin low, or incentives for exercising, you have to have a way of documenting and tracking that. So this is a tool that really would work with an incentives-based program, that whether it’s an employer, or a third-party payer, that has not seen the benefit to putting incentives back into the programs for you as an individual.

DR. ROBERT KELLY: I think the other thing in terms of changing patient behavior, a lot of patients deal with their illness by denial. They try not to acknowledge it. And by getting something like this, where the data are right in front of them, and blood sugar, if it goes into a database where they can look at it, as opposed to remembering yesterday’s data, and sort of thinking, well, maybe it wasn’t so bad, I think having it right there in front of you will take away that crutch. I think that will start transforming behavior. You can see that sort of in a variety of systems. As soon as you put it in front of people it takes away one of the crutches that they’ve been using.

MICHAEL RECHTIENE: Neil, thanks. Great question.

Peter, you’re a technology optimist. I’m actually an optimist, I love technology, but I’m an optimist on the family. And an optimist that where the mother, or the wife starts to see that by utilizing enabling technology to have their child  feel that their child is going to be normal again, or the mother, the spouse starts to feel like they’re  what happens through the HealthVault that their husband is going to be  that they’ll live a long, happy married life together.

So we talked about tipping point earlier. I think that the data, the information, the cool tools, all that stuff is neat, but it’s until that emotional bond happens, where that family health manager, that mother, that spouse, actually sees that this has enabled a longer married life, a happy life, a child that’s going to grow up normal, I think that’s contributory to both the tipping point, as well as, Neil, to your point, how people actually start to say that this is something worthwhile, more than a cool gadget.

PETER NEUPERT: That’s great. All good answers.

Is there another question?

QUESTION: (Off mike.)

PETER NEUPERT: Can you restate your name, that mike wasn’t up yet.

QUESTION: We may be an anomaly in the room, because we’re land developers, and we’re actually building communities, and we partnered with Microsoft on the HealthVault to actually build this as a component into the home. So we have entitlement to build on 90,000 new homes in the future. So one of the things that I’m interested in, I haven’t heard the word insurance, or health insurance come up yet. The tipping point for us would be to say that when we build these homes we’re going to be able to give people access to health insurance, to actually couple the development of homes, and revolutionize both healthcare and home building at the same time.

I’m wondering, through the collection of this data, our ultimate goal is to pass it through the doctors, and eventually to the insurance companies. And that’s the tipping point for us, and I’d like to ask you this question, do you think that the health companies will, or insurers will start to acknowledge this, this kind of formatting of data, and try to lower premiums for families that are in the preventive mode, like you said, sir. Just trying to stay healthy, that healthy people shouldn’t have to pay unhealthy premiums.

PETER NEUPERT: You have a challenging business model. I appreciate that question. I think I’ll Lonny mentioned it in his concept of benefit plan design. I want to just make one thing really clear, and I know Deborah is going to jump in, but I’m going to get there first. The point is the consumer is going to be in charge of the data, and they’re going to decide where it goes. I do believe in a market-driven approach that says, some plans might encourage and motivate in their plan design to get and share the data with the consumers, and they’ll choose to do that. But, it’s going to  just to be clear, it’s going to be under their choice whether they share this information, anyway, with anybody up the chain, whether it’s their provider or their plan.

DEBORAH PEEL: Okay. All right. Here’s the deal, the consumers really should have control over who sees this information. One of the reasons that HealthVault, I think, really is safe for families, and family managers, and I’m one, too, and I’m a mom, and I’m managing family health, is I want to put that data, accumulate all of that detail in a place that’s safe. This has Fort Knox, state of the art security, and it has top notch, the toughest privacy standards in this country backing up who sees the data.

So the data will never be data mined. But, in competition with HealthVault, and everybody knows it, insurers are kindly offering families free PHRs to accumulate their health records. That is a non-start for consumers. The last people they want to give more data to are insurers, because typically the data is used against them. So there really is tension around this. We obviously need healthcare system reform. I don’t have the answers there. But, right now the major use of health information is not to help sick people get well, it’s to help you stay healthy, but to discriminate against you and harm you in various ways. So that’s a very tough issue.

PETER NEUPERT: Can I just maybe let Lonny, because he’s inside the health industry, the health plan industry 

LONNY REISMAN: We’ve been doing much of this, as I mentioned at the outset, accessing clinical data that are available. We’re currently doing it for 16 million people, and  

DEBORAH PEEL: Without their consent?


DEBORAH PEEL: All right.

LONNY REISMAN: So the fact is, the data are there. People do have an opportunity to opt out, and for program like disease management and care management they explicitly opt in. That’s one point. The second point, which I completely agree with you is, in terms of distribution of the data, we can’t do that without the member’s consent, we’ll never do that. So they have the ability to, in fact, access clinical data that, in fact, has been generated during the course of encounters with doctors and hospitals. With this mechanism we have the ability to complement it. And in our own experience, with a personal health record, we have at this point hundreds of thousands of people who are actually adding data, because we have, in fact, assured them that it is going to be secure, it’s not going to be shared, it is not going to be used for purposes around underwriting and not ensuring them, and explicit about that, and that’s absolutely clear.

Again, it relates to the output of the system. The structured data is essential, but the real opportunity here is represented in the distillation of the data, and defining opportunities at the individual member. And that’s part of the engagement, too, it’s customized, about how your data will link to the literature around safety and efficacy of various diagnostic and therapeutic modalities. When we share information with a member, we share that information with the physician, we are creating collaboration that perhaps we’ve been able to demonstrate has resulted in better clinical outcomes, and actually reduction in cost. So it’s got to be done carefully, it’s got to be done with great respect to privacy. But, the data that are available in the managed care world can be used to complement, I think, the HealthVault is trying to do.

DEBORAH PEEL: Absolutely, managed care data can be used to complement this, but so far the data that’s collected by insurers in managed care companies, I will have to say, a lot of it is illegal and unethical, because when you sign up with your plan you consent to giving your health plan access to data in the future that hasn’t even been created yet. You can’t meaningfully give consent to the disclosure of information that doesn’t exist. So we think that absolutely health plans and managed care can contribute a lot of data, but we want to be absolutely sure that they’re not using the data without truly informed consent.

PETER NEUPERT: I appreciate that, and I think we’ve covered it well. Let me just push one more little bit on Lonny, and that is I think the essence of the question is, do you think plans will figure out ways to motivate, in a sense, good behavior, not just try to figure out how to do other things?

LONNY REISMAN: I’d just give you a good example, where it actually happens. So here you have someone who has insurance, they have diabetes, and the insurance agency says, or the insurer says, I’ll lower your premiums if you can show me that your blood glucose readings are getting down to normal, your A1C is getting down to normal, your blood pressure is getting down to normal, and it’s been maintained over a long period of time. If you’ll show me that I’ll lower your premiums. Well, how am I going to show them that?

Let’s imagine that they used our My Diabetes Connector, all their figures are downloaded, their readings are  their A1C is downloaded. That sends it off to the HealthVault, they’ve done that over a long period of time. They put it in My Diabetes Connector, it goes to the HealthVault. In addition to that in the HealthVault is their blood pressure readings over a long period of time, long period of time, not just one or two. They don’t have to contact their doctor’s office, they can get all that information, and they say, okay, I’m going to send you the insurer that information, those two pieces of information over a long period of time. It’s collected legitimately. It’s from the machine. I’m not fudging a thing. The insurer sees it and say, you’ve demonstrated in a quick, efficient, effective way that you’ve actually succeeded, we’re going to lower your premiums.

PETER NEUPERT: How do you know I didn’t download my wife’s blood pressure?

LONNY REISMAN: Because I know your wife. If a doctor did it, if the doctor downloaded that information, if the doctors put it into the different programs or the HealthVault, if the doctors had electronic medical records, and that information went into the HealthVault, then you know with some sense of security, you know where it’s coming from. But, you’re right. This is a whole concept of who’s putting this information in, is it accurate, do they have the wherewithal to connect to it. These are things that we’re going to have to fix as we go down this road.

PETER NEUPERT: That’s right. I think that’s where I’m going to leave that question, because it’s exactly right. We haven’t fixed all the problems. We’re going to put a stake in the ground  we put a stake in the ground about ways we can fix these future problems, and I to think getting the connections is the first place to get started, and that we are on that path today. I thank you.

I’m told I have time for one more question, and I see somebody has the mike. So you get the last question.

QUESTION: I’d like to just kind of take the insurance just on a different tack, because today we’ve heard a lot about HealthVault and the management of the clinical information of healthcare, but increasingly due to benefit design, or just complexity of care, the family health manager is trying to manage the administrative side, and the financial side of healthcare. Can you comment on your vision for that?

PETER NEUPERT: Sure, and I’ll just take that one real quickly. We’ve deployed in today’s version of HealthVault about 35 or 40 different data elements. The addition of the financial data elements, and the opportunity to create applications around those financial data elements is relatively straightforward. We focused first, because of my passion, on the clinical data elements, because I think that’s where the most value, new value can be created. I completely understand and agree that there is administrative complexity to the financial sets of issues, and we will get there. It just wasn’t the place that I thought I could get the most impact and really get consumers engaged, to get this ball rolling. But, absolutely, we will get there. We know it needs to be one place, not 100 places to go.

So with that, I think the appropriate thing for us is to close this beginning point. This has been the beginning step of what we know is going to be a long journey. The great thing about being back at Microsoft is, we stick for a long time on the hard problems. We have the stamina to make sure that over time we can make the industry move forward, and we’re committed  we’re committed. We got started, I appreciate all of the support of all the partners that have been here today, and all of the people in the room that came to see what we were trying to do in terms of getting the ball rolling.

I think it’s going to be an exciting journey. I think it’s going to be exciting to see really what was that tipping pint, when we look back seven years form today, or eight years from today. I know I’m going to be keeping a journal probably in HealthVault, so I can get to it anywhere. And I think we’ll do this again. We’ll do this again as we go forward, to track our progress, and to make sure that we are getting everybody connected, and we are getting the people to change their outcomes, and the providers to change the way they do things, and the plans to change the way they do things, as we move forward.

So with that, I’d love to have that video go, and we’ll close. Thank you all for all of your attention.

(Video segment.)

Thank you all. Thanks for coming. Appreciate it.

Thank you, Lonny.

Glen, thanks for coming.

Thanks all. We’re done.