Microsoft, Google Joust—and Concur—On Personal Health Records

They may be cutthroat competitors. But tried as their representatives did to explain the fundamental differences between two personal health record (PHR) platforms, Microsoft and Google also may yet have some detente—at least when it comes to the like-minded goal of managing vast quantities of personal health information to benefit end users.

Appearing at the Mastermind Session at Everything Channel's Healthcare Summit in San Diego this week, Grad Conn, Microsoft Senior Director of Global Consumer Health Strategy in the Health Solutions Group, and Alfred Spector, Google Vice President of Research and Special Initiatives, fielded more than an hour of questions from both Gartner analysts and audience members regarding Microsoft HealthVault and Google Health.

Google Health is a PHR in which users can voluntarily enter their health records and create one, centralized profile. Privacy concerns have dogged the concept since it was unveiled in May 2008, though Google has maintained that it will not sell advertisements in Google Health. For its effors, the Mountain View, Calif.-based search giant has initially partnered with Walgreens, CVS, Quest Diagnostics, Beth Israel Deaconess Medical Center and other entities. Its application programming interface is based on the Continuity of Card Record (CCR)—an XML-based standard for health records developed to allow physicians to create and transfer electronic health records with ease.

Microsoft HealthVault, which launched in October 2007, is also a PHR platform designed to store and access personal health and fitness information. It combines single HealthVault records—the storage piece—with access provided by Windows Live ID, with Live Search Health, a search engine that allows HealthVault users to search for health and fitness information. HealthVault accomodates both the CCR standard and the Continuity of Care Document (CCD) standard, which was approved in 2007 and whose proponents say essentially harmonizes HL7 Clinical Document Architecture (CDA) and the CCR.

Since their release, both Google Health and Microsoft HealthVault have been met with a number of usability questions, and Gartner kicked off the panel by asking about specific differences in the offerings.

"Neither one takes the data from your health record and uses that to tune up a search," suggested Gartner Vice President and distinguished analyst Wes Rishel. "Both have a very strong philosophy that this is the consumer's data. They have control over the data, to make it go away or make it never be there in terms of how they use the product. If there's a difference at all, it's under what circumstances?"

Spector first reiterated that Google's advertising platform would not come into play in Google Health.

"The argument not to do it is that we're very interested in consumer acceptance," he explained. "With respect to Google's general search, that's a different world. It's a different kind of thing within the health environment, and it's an interesting question whether we made the right decision, but that's why we made it: getting consumer acceptance. We have no intention of [involving advertising] at this juncture."

"One of the 75,000-foot reasons to do this is the epidemiological research value in the data," Spector continued. "It must somehow be valuable over the long term, where we knew drug 'x' affected person 'y' because of a certain set of of factors, and that [a person] could check for not just correlation but cause and effect. Down the road I think that'd be an incredible contribution to the world, but only when consumer acceptance is there. There is no reason to believe that your medical account would be the same as any other Google accounts."

Conn was more forthcoming about how Microsoft intends HealthVault to function.

"HealthVault is a software and services platform," he explained. "What we see ourselves doing is, we're plumbers—not Joe the Plumber, but plumbers that enable the construction of consumer engagement. We're really like PayPal—I mean, no one goes to PayPal to go shopping. PayPal enables transactions to occur but it's a subordinate brand; 97 percent of PayPal users have never actually been to PayPal.com. We see the primary brand [in HealthVault's case] as, for example, New York Presbyterian."

"It's not an example we think is better or worse than Google's, but Google's a bit more like Facebook: it's the entry point but also a platform that you can plug into," he added. "I think [people] see us as solving different kinds of problems."

The question of profitability came up next.

"If I may be a bit crass," asked Gartner Managing Vice President Bob Booz, "How do you make money on this, and what happens if you don't?"

Spector maintained that advertising interests wouldn't come into play with Google Health; rather, Google views it as an extension of the brand.

"Google gets a large share of the search market," Spector explained. "We organize the world's information and make it universally acceptable and useful. There is an enormous amount of health-care data that is underorganized and underused—[search] is ripe for use in improving medical care. Our customers expect us to do this. We do this with a view that people will do more Google searching and enhance our overall brand. People go to Google more than anything else online before they see a physician."

"We're in a different spot; we look at ourselves as providing infrastructure," Conn said. "[Google] is more consumer-oriented; we're about getting the industry to build applications. [Microsoft CEO] Steve Ballmer has said that health care is one of the top six bets for the company, and he doesn't make those [statements] unless there's a lot of money going into it. We've got so much traction among CDOs in the U.S. that it's unimaginable to me that it won't work. Emerging business models come out of being at the center of ecosystems. Another one is images. Both the systems could easily do it, and we haven't explored deeply right now."

The Gartner panel wasn't willing to let either industry giant off the hook.

"So let me see if I get this right: You're both saying health care is a big deal, it's very information-intensive, and someday we'll be profitable?" asked Rishel.

"Getting electronic data organized and allowing the consumer to get involved, everyone must kind of believe in that," Spector said. "This has been Medical Informatics 101 for a very long time. It's good at the high level but no one gets sufficient benefit at the micro level—what's going to make this all valuable is specific value propositions. That's what's going to drive it."

"Steve has said that it's almost unnatural that the world's largest software company wouldn't be participating in health," Conn maintained. "Health is already a big business for us—a very profitable, significant segment. When we do make money on Amalga, which is our enterprise product, and HealthVault...well, when we break even on HealthVault, I'm not going to share, but it's not a ridiculous number. The value it provides to join scattered parts of the ecosystem is huge."

Additional concerns were raised over both vendors' use of CCR and CCD standards.

"CCD is a very complicated standard," Spector said. "We're trying to talk with organizations to have the right profile for the right interoperability."

"We support both CCR and CCD," Conn explained. "But our stance is we're not here to set standards, we're here to support them. As new CCs emerge, we'll support those as well."

Finally, Gartner analysts quizzed both executives on what would happen if HealthVault users wanted to migrate to Google Health, or vice versa. Wouldn't having separate platforms negate the idea of interoperability?

Conn was the first to suggest Microsoft was "ready to send data to Google any time."

"We'd like Google to operate the opposite way, too, but we're cool if they don't," he said. "It's kind of silly for us to create separate repositories. A lot of our partners are working for both of us."

"We will do this," Spector added. "There are somewhat interesting technical synchronization issues, but there's no reason Microsoft and Google can't work together on this."

"So you are in fact going to make nice with each other?" asked Booz during the session.

"We have this vision," Spector admitted. "We all believe, I think there's incredible value for both companies and for people."

"Besides," he added. "Plenty of time to fight about other things down the road."