HealthVault evaluation report

Department of Computing and Information Systems The University of Melbourne

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Full Name: Graciela Fernanda León Moraga Student ID: 648979 Subject Code/Name: ISYS90069 – eHealth & Biomedical Informatics Systems Assignment Title: Technology Evaluation Report - Microsoft® HealthVault™ Class/Tutorial/Lab: (day) (time) Signed: …….Graciela León Moraga.......................................................... Date: 04/08/2014 ................. Note: For electronic submissions the signatures may be typed.

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The University of Melbourne

ISYS90069 - eHealth & Biomedical Informatics July 2014 - Dr. Kathleen Gray

Graciela León (ID 648979) Master of IT - Health

Technology Evaluation Report Microsoft® HealthVault™

Technology Evaluation Report Microsoft® HealthVault™ 2014

3 Graciela León (ID 648979)

Table of Contents

Abstract ......................................................................................................................................... 4

I. Introduction .......................................................................................................................... 5

1. BACKGROUND ...................................................................................................................... 5

2. THE HEALTH TECHNOLOGY NEED .......................................................................................... 5

3. THE PROPOSED TOOL TO EVALUATE: MICROSOFT® HEALTHVAULT™ ........................................ 6

II. Rationale for choosing HealthVault™ .................................................................................... 8

III. Methodology ......................................................................................................................... 9

IV. Evaluation Framework .......................................................................................................... 9

V. Technical design & Benefits ................................................................................................ 12

1. TECHNICAL DESIGN ............................................................................................................ 12

User-friendly API ......................................................................................................... 12

A flexible health system that supports data interoperability ..................................... 13

Privacy, security, and data provenance ...................................................................... 13

Cloud service and storage ........................................................................................... 14

2. BENEFITS ........................................................................................................................... 14

3. APPLICATION EXPERIENCES ................................................................................................. 14

VI. Evaluation through Experiences .......................................................................................... 16

VII. Conclusions - Recommendations ........................................................................................ 18

References ................................................................................................................................... 19



Abstract

One of the top health issues that nations are facing at present is how to provide competent

and suitable healthcare solutions to the growing population, at a cost that can be comfortably

financed. Introducing an approach to that, Electronic Records (ERs) have tended to provide

effective solutions to use health information, developing in consequence new mechanisms in

the Health Information Technology (HIT) setting.

In this context, the way in which healthcare has been treated over time has changed, and

meeting the needs from the providers and practitioners still represents a challenge. What is

clear so far is that patients participation in healthcare is taking an active role, specially in

prevention, by monitoring themselves and, thus, being aware of anomalies in their own lives.

Personal Health Record (PHR), Electronic Health Record (EHR) and Electronic Medical Record

(EMR) are playing a fundamental role in healthcare; however, the successful adoption of these

still remains outstanding. Despite the slow progress, the combination of EMR and Web-

enabled technology, or cloud computing as it is well known, has lead to develop quality

software to face issues in this area, as in the case of Microsoft® HealthVault™.

In this report, an intended evaluation of this tool will be presented. The focus of the evaluation

is oriented to examine key aspects provided from different evaluation frameworks:

Automation, Connectivity, Function, Integration, Data Availability, Cognitive function Support

and Context. A final review of the evaluation will be addressed together with a few conclusions

and recommendations.



I. Introduction

1. BACKGROUND

Healthcare informatics systems commonly pursue to add value in the HIT sector, through the

benefits they offer by diminishing costs and increasing information resources in their solutions

(Eisenstein et al. 2011). In this regard, electronic records are dealing with figures like:

• 1 of 10 patients use electronic medical records, or have doctor-interaction by email

• Patients manifests their wishes to have doctors accessing their medical records

immediately

• Most patients agreed that electronic records are valuable; however, they are less

sympathetic on sharing them

(Kaiser Family Foundation 2010)

Whereas PHRs are referred to the electronic records that patients might control, EHRs and

EMRs are those that clinicians, and other professionals in the field, might control. In this

context, Al-Ubaydli (2011) tends to explain why people reject the adoption of electronic

records:

• using paper is simple and fits within the traditional clinical system

• the traditional process is rapid; therefore, the number of patients that are waiting for

medical attention is low

2. THE HEALTH TECHNOLOGY NEED

Effective solutions in the healthcare field are needed undeniably. An approach that mixes the

best of ERs and Web-enabled technologies is presented by Chen et al. (2010) to establish an

overview in this sense:

The number of service providers versus the number of consumers, evidences the

complex scenario for EMR systems in Web-enabled healthcare services.

Understandable EMR platform with user interface, integrated, secure, interoperable

and at low cost of maintenance are difficult to find, but those are key.



High investment need on skilled professionals, potentially lead to the block of Web-

enabled healthcare services.

3. THE PROPOSED TOOL TO EVALUATE: MICROSOFT® HEALTHVAULT™

Microsoft® HealthVault™ moves into the category of EMR systems and is considered as a back-

end platform for interacting with health data (see Figure 1), well-designed, and user-friendly. It

is a cloud-based solution developed to give the control to people, and constitutes a patient-

oriented healthcare solution that focuses mainly on the delivery from clinics and hospitals to

patients (Chen et al. 2010).

Figure 1. Microsoft HealthVault™ platform for personal health information, Microsoft 2013

Launched in October 2007 (Rouse 2010), this personal data platform has allowed users to

gather, record and share their health information with family members and healthcare

providers. Due to the use of application programming interfaces (APIs), other devices are

enabled to use HealthVault™ and add value to end users (Bhandari 2012).

According to the literature reviewed, HealthVault™ presents advantages over other similar

solutions:



• enables an environ where more than 300 applications and 80 devices can track diet,

fitness and nutrition, for example, allowing connections to hospital or pharmacy

systems as well (see Figure 2)

• service connections are possible by using the HealthVault™ wizard provided by the

application

• has been built in order to facilitate others to develop their own software on top

Figure 2. HealthVault™ ecosystem with devices and applications, Bhandari (2012)

Getting Started to log in the system, users can create an account through an

existing Windows Live ID, Facebook or standard OpenID account.

Adding Data this can be done in many ways, and it is possible to include as much

information as the user know; however, to automate the system and avoid mistakes,

additional effort is required.

Loading Files the system allows to load test results and other documents files. It

also provides graph functions to plot the loaded data.

Sharing Data it is possible to send invitations to others via email and, depending on

the access permitted, the information can be viewed, viewed and modified, or it can be

completely accessed as the custodian.

(Al-Ubaydli 2011; Bhandari 2012)



II. Rationale for choosing HealthVault™

Fact 1 The healthcare industry and the environment around it, touch not only our lives

but also the lives of our loved ones.

Fact 2 Patients know more about themselves than doctors do, but doctors are the

experts in regards to prognosis and treatment.

Fact 3 Costs involved in the HIT setting are high and would increase in the future.

Under the motivation of joining those facts, the evaluation of HealthVault™ is a deliberate

attempt to show and take advantage of this free PHR Web-enabled healthcare solution. As we

have seen nowadays, personal health tools are conducting important changes and

strengthening patients and customers empowerment; Patient Centricity vision should be the

essential idea of technological projects for modernize healthcare field.

From a health perspective, this cost-effective tool may contribute in several ways (Chen et al.

2010):

• Connectivity , it is possible to connect systems across the healthcare networks,

allowing practitioners to have upgraded information access

• Quality Service , decision making might be supported through quality in the

information and services

• Simplicity , drill in the solution allows a better understanding of the data entered into

the health profile

• Tracking and Evolution , seeing audit trails conducts to understand the data

evolution



III. Methodology

The methodology used to find the information related to this report followed the next steps:

First of all, the sources were searched through the Internet, based on recommended

websites according to its reliability, such as Google Scholar and the Library Catalogue

from the University of Melbourne.

In order to obtain the most accurate and reliable information sources, the searching

strategy consisted of divided the topic into three main areas: the evaluation

framework, the tool-based information, and the application through cases and blogs.

Finally, after having all the information collected, similar issues were grouped and

organized to write an academic report.

IV. Evaluation Framework

For the HealthVault™ platform assessment, criteria coming from three different frames were

chosen in order to consider valuable aspects. In the next section, the sources of the selected

evaluation frameworks are mentioned to provide a better understanding of the key points

applied to the tool.

Firstly, from the paper named “Defining a Framework for Health Information

Technology Evaluation” presented by Eisenstein et al. (2011), the formative and

summative approaches were analyzed. As Figure 3 illustrates, formative evaluation is

responsible for the new health information technologies while summative evaluates

health care processes.



Figure 3. Biomedical Informatics Value Chain Mechanisms, Eisenstein et al. 2011

In addition, the authors mention that health information technology domains (Stead-Lin

typology) are relevant to consider when an evaluation is conducted. This classification, based

on primary functions of the systems, is shown in Table 1:

Health Information Technology Domains

Domain Name Domain Description Example Applications

1 Automation Performs tasks with little modification Administration, lab results, invoicing

2 Connectivity Connects systems to each other Wide networks, wireless infrastructure

3 Decision Support Facilitates or improves decisions Rule-based alerts, statistical/heuristic support

4 Data-Mining Capabilities Recognizes relationships Provides inputs for evidence-based medicine

Table 1. Health Information Technology Domains, Eisenstein et al. (2011)

However, for this evaluation report, only Automation and Connectivity criteria will be

considered.

Secondly, from the paper named “Criteria for the Evaluation of a Cloud-Base Hospital

Information System Outsourcing Provider” proposed by Chen and Low (2011), five

issues were identified as part of the evaluation frame: system function, service quality,

integration, professionalism and economics. However, only two of them were included

in this assessment report: System Function and Integration. This framework was

elected due to the cloud-based orientation.

• System Function, in terms of cloud computing technology usage as a way of

expansion of the medical records services.



• Integration, of the clinical care and administrative management to increase

hospital efficiency.

Finally, from the paper named “Computational Technology for Effective Health Care:

Immediate Steps and Strategic Directions” suggested by Stead and Lin (2009), nine

principles are defined in order to evaluate the succeed of computational technologies.

The key principles chosen under this framework are:

• Principle 3: Record Available Data So That They Can Be Used for Care, Process

Improvement, and Research. This principle focuses on data aggregation and

its availability related to medical conditions, health status, demographic

information, and so on. This criteria points to data-driven improvements in

healthcare.

• Principle 5: Support the Cognitive Functions of All Caregivers, Including

Health Professionals, Patients, and Their Families. Through this principle it is

possible to assess data analysis, data workflow organization and data decision-

centric display, among others.

• Principle 9: Seek and Develop Technologies That Clarify the Context of Data.

This criteria is oriented to evaluate the presentation of the information based

on important biomedical patient knowledge.

To sum up, the table below exposes the criteria evaluation for the HealthVault™ technology.

KEY ASPECTS FOR EVALUATION

Defining a Framework for Health Information Technology Evaluation

Eisenstein et al. (2011)

Automation Connectivity

Criteria for the Evaluation of a Cloud-Base Hospital Information System Outsourcing Provider

Chen and Low (2011)

Function Integration

Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions

Stead and Lin (2009)

Data Availability Cognitive function Support Context

Table 2. Criteria for evaluating the HealthVault™ technology



V. Technical design & Benefits

1. TECHNICAL DESIGN

User-friendly API

• The design of the Application Programming Interfaces (APIs) of any system affects the

number and variety of value-added applications that will be developed, and the

accuracy of the API design could be essential for the commercial success of PHR

systems.

• A good API should allow quick enhancements of the functionality of PHR systems, and

HealthVault™ is conscious that patients and clinicians have different demands;

patients are concerned about data security, whereas clinicians seek for easy data

access.

• As it can be observed in Figure 4, the HealthVault™ interface is user-friendly mainly for

the information presentation. Data that need to be immediately in the profile of the

user is shown in the main view (age, weight, high, allergies, blood pressure, among

others). This view is configurable, but it can take time.

(Sunyaev 2013)

Figure 4. HealthVault™ Overviews 2014



A flexible health system that supports data interoperability

• Users can store once not only their personal data but also their families as well, and

use it whenever they need it.

• Users can bring their personal data from healthcare providers, other services and

devices permitted through the HealthVault™ ecosystem, as it is shown in Figure 5.

(Microsoft 2013)

Privacy, security, and data provenance

• Microsoft controls a particular privacy policy that comes along with HealthVault™, in

which certain levels of security are established. Nonetheless, it is not regulated by the

Health Insurance Portability and Accountability Act (HIPAA) (Rouse 2010).

• Microsoft has explicitly expressed their commitment to protect the data collected by

the HealthVault™ platform through the website.

• The storage and processing of the information take place in the United States and

others affiliation countries; however, under the users consent, this information flow

might change across countries. The technology implemented to ensure data security

Figure 5. Apps & Devices, Bhandari 2012

http://searchdatamanagement.techtarget.com/definition/HIPAA



is based on limited access servers and actions, such as unauthorized access, use, or

disclosure.

(Microsoft HealthVault™ Developer Site Privacy Statement 2013)

Cloud service and storage

• The infrastructure of HealthVault™ is based on innovation, and provides access for

external applications to use health information. In addition, it offers a single place with

enough storage capacity.

• Transferring healthcare information and services through HelathVault™ is possible

through digital formats and its interconnected solution: data can be read and used by

other applications, can be exported once, and keep transversely synchronized among

the systems.

(Microsoft 2013)

2. BENEFITS

In addition to the characteristics noted above, such as the cloud-based technology,

connectivity, flexibility, and security, another benefits that HealthVault™ offer to users, unlike

other PHR solutions, are tangible (Rouse 2010):

• My CVS/pharmacy Prescriptions, allows users to associate their prescriptions to the

system account.

• Blood Pressure Monitor devices can be connected directly to the users’ personal

computer to transfer the data collected.

The ability to add value to partners by taking advantage of the system itself, services and

devices, such as heart rate monitors and pedometers, has put HealthVault™ ahead other

platforms.

3. APPLICATION EXPERIENCES

The intended use of HealthVault™ in the HIT field has been tested by many users, and

commented in some cases through blogs:



• Kernisan (2013) manifests that HealthVault™ platform is: “nice and easy to sign up”;

however, she criticises the complex box to enter multiple medications for elderly

users.

Additionally, serious partner applications have taken advantage of this tool, as in the case of

The Mayo Clinic:

• A particular case in point is the Health Manager application (Bhandari 2012), in which

the weight tracking is being used to measure specific goals (see Figure 6).

Figure 6. The Mayo Clinic Health Manager application for tracking weigh, Bhandari 2012

In term of collaborative work with partners of the industry, HealthVault™ is present in a variety

of ways (Microsoft 2011):

• Columbus Research Foundation, that cooperates in the fight against childhood obesity,

received an award from Microsoft HealthVault™, “Be Well” fund, to develop an online

program to promote a healthy pathway in adolescents with the aim of prevent

diabetes. The initiative was combined through counselling advice and web connectivity

with HealthVault™. From the 1770 suitable students as participants, 55% participated

actively in the program together with their families.



• Kaiser Permanente, the American Heart Association, conducted a study to evidence

the strength of Microsoft HealthVault™ in chronic care management together with the

American Heart Association’s Heart360 Cardiovascular Wellness Center. Pharmacists

were able to use the upload information in Kaiser, coming from the Heart360 website

and the HealthVault™ records, from blood pressure readings; half of the participants

monitoring themselves were more likely to have pressure controlled.

VI. Evaluation through Experiences

According to the literature reviewed, results from conducted studies have been published in

users blogs principally, denoting satisfaction in terms of trust, security and the overall usability

(News Report 2009; User Centric’s blog 2009). Expressions of satisfaction have been observed

in some people:

• “HealthVault™ was very easy to access and user-friendly”, Heather Jay (parent of a

participating student).

• “…This gave the students an opportunity to go home, log in their activities, and share

the information with their families”, Lura Reed (Principal of the Arnold Magnet

School).

On the contrary, the criticism of the HealthVault™ user experience has lead to reduce

participants’ enthusiasm in the PHR technology adoption (Microsoft 2011):

• “Although a growing number of our health care providers are using electronic medical

records and sharing data, we have a very small number of patients that have ready

https://www.gfk.com/news-and-events/press-room/press-releases/Pages/GfK-expanding-user-experience-research.aspx



access to their personal health information in an electronic format…”, Jesús Hernández

(Executive Director of the Community Choice Health Network).

In terms of cloud computing functionality, the HealthVault™ platform seems to have facilitated

clinicians the access to patient’s records, improving external user services. In theory, putting

data in the cloud enhances doctors to provide quality healthcare due to the ubiquitous access.

However, evidence from their perspective has been hard to find, even though reliability

appears as the primary concern in informal discussion forums.

Related to data availability, HealthVault™ seems to be in compliance with some basic

requirements (Microsoft 2011):

• “Provider-to-provider exchange is inefficient when there are multiple sources. It will

be much better to have the essential data collated in one place”, William Gotthold

(Informatics Doctor at Wenatchee Valley Medical Center).

• “Consumers lack a crucial tool for taking an active role in their care. If patients want

their health information, they need to go to every place where they’ve had medical

treatment and get it on their own”, Jesús Hernández (Executive Director of the

Community Choice Health Network).

In the same context, the design of the platform has played an important role (Microsoft 2011):

• “HealthVault™ provides a single interface to diverse sources of data so patients have a

unified view of their data… It also acts as the consumer’s information repository, which

they use to store, manage, and share data, expanding consumer control over their

own health information”, Manish Sharma (Business Manager of Consumer Health at

CitiusTech)



VII. Conclusions - Recommendations

Implementing a successful PHR vision in the HIT field depends on the effort and

commitment of each actor: patients, clinicians and the overall healthcare

environment. Therefore, influencing professionals in this area to show engagement is

the first step in order to establish a widely EMR use.

The interface developed for this tools should be understandable by non-experts, and

should explain technical concepts in a basic and common language. The reliability of

the system might depend on the simplicity of the solution.

Microsoft HealthVault™ has proven to be a prominent solution for personally

controlled health records due to its open API, flexibility and connectivity with

providers. Giving an opportunity for people to monitor and research their own data,

this tool has positioned as one of the preferred one for users and other companies.

It is recommended to continue gathering research information about best practices to

validate further developments, and obtaining feedback from the users to increase the

PHR adoption.

Features such as tracking immunization records, sharing securely the health

information with clinicians, managing insurance information and getting reminders

about checkups, are some of the enhancements that HealthVault™ might implement

in the near future.



References

Al-Ubaydli, M. 2011. “Personal Health Records: A guide for clinicians”, 1st edition, Blackwell

Publishing Ltd.

Bhandari, V. 2012. “Enabling Programmable Self with HealthVault™: An Accessible Personal

Health Record”, O’Reilly Media Inc.,

http://books.google.com.au/books?hl=en&lr=&id=pfAFFttTX-

IC&oi=fnd&pg=PR3&dq=HealthVault™&ots=BGo7xpPBM2&sig=0yjurt8NKtG5VU0KjqdUJ

fH0Mdk#v=onepage&q=HealthVault™&f=false, retrieved 16 July 2014

Chen, M., Lai, X., Liao, L., Rodrigues, J., and Vuong, S. 2010. “A novel Web-enabled Healthcare

Solution on HealthVault™ System”, Springer

Chen, Y., and Low, C. 2011, “Criteria for the Evaluation of a Cloud-Base Hospital Information

System Outsourcing Provider”, Springer Science Business Media

Eisenstein, E., Juzwishin, D., Kushniruk, A., and Nahma, M. 2011. “Defining a Framework for

Health Information Technology Evaluation”, International Perspectives in Health

Informatics

HealthVault Overviews 2014. “Manage your health information with HealthVault - Gabriela's

story”, http://www.youtube.com/watch?v=-

P7fHzqWECs&list=PLwbubM9faR3mAezKvf6MLDuMSXrTgLRsH, retrieved 20 July 2014

Kaiser Family Foundation 2010. “Survey: Most Respondents Don't Really Get Health IT”, Kaiser

Health News, http://www.kaiserhealthnews.org/Daily-Reports/2010/June/18/Health-IT-

survey.aspx, retrieved 19 July 2014

Kernisan, L. 2013. “Designing for Caregivers”, The Health Care Blog,

http://thehealthcareblog.com/blog/2013/05/25/designing-for-caregivers/#more-61936,

retrieved 19 July 2014

Mayo Clinic Health Manager 2013, http://www.mayoclinic.org/healthmanager/art-20050589,

retrieved 19 July 2014

Microsoft 2011. “Microsoft HealthVault™ Ecosystem Overview”,

www.whatsnextinhealth.com/HealthVault™, retrieved 27 July 2014

Microsoft 2013. “HealthVault™: a platform for connected health information and innovation”,

HealthVault™ Developer Center, http://msdn.microsoft.com/en-

au/HealthVault™/jj128027.aspx, retrieved 19 July 2014

Microsoft HealthVault™ Developer Site Privacy Statement 2013,

https://account.HealthVault™-ppe.com/help.aspx?topicid=PrivacyPolicy, retrieved 19

July 2014



News Report 2009. “Google Health vs. Microsoft HealthVault™ Compared”, Government

Technology, Health and Human Services, http://www.govtech.com/health/Google-

Health-vs-Microsoft-HealthVault™-Compared.html, retrieved 19 July 2014

Rouse, M. 2010. “Definition Microsoft HealthVault™”, Search Health IT, TechTarget,

http://searchhealthit.techtarget.com/definition/Microsoft-HealthVault™, retrieved 19

July 2014

Stead, W., and Lin, H. 2009. “Computational Technology for Effective Health Care: Immediate

Steps and Strategic Directions”, Committee on Engaging the Computer Science

Research, Community in Health Care Informatics, The National Academies Press, chapter

4: “Principles for Success”, pp. 30-35,

http://www.nap.edu/openbook.php?record_id=12572&page=31, retrieved 15 July 2014

Sunyaev, A. 2013. “Evaluation of Microsoft Health Vault and Google Health personal health

records”, IUPESM and Springer-Verlag Berlin Heidelberg

User Centric’s blog 2009. “ Google Health vs. Microsoft HealthVault™: Consumers Compare

Online Personal Health Record (PHR) Applications”, User Experience Team in Health,

http://blog.gfk.com/2009/02/google-health-vs-microsoft-HealthVault™-consumers-

compare-online-personal-health-record-phr-applications/, retrieved 26 July 2014

HealthVault evaluation report

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