Awkward Turtle…

It's been a classic good/bad day. On the good side --- we announced our relationship with Aetna, which is awesome and a big win for consumers. The American Heart Association also launched their new Heart360 application today, which is a huge step up from their original blood pressure app. And it's actually a beautiful, sunny day here in Seattle - not so much a guarantee in mid-October.

On the stage in San Francisco, things didn't go quite so well. Peter was on the "consumer aggregators" panel at Health 2.0 this morning and while by all accounts the discussion was great, our demo was not. Kaiser VP Anna-Lisa Silvestre walked folks through the Kaiser experience of sending a CCD "snapshot" to HealthVault, and then Peter was to show the process of merging the information from that CCD into a record at Unfortunately, Murphy was at work and between a password typo on the first try and problems with convention wireless connectivity the second - we never made it. As Chilmark said ... OUCH!

I am a complete glossophobic. Fortunately, Peter is not and he was able to laugh it off and keep things moving on the panel. But it is just really frustrating to have that happen in an environment like Health 2.0, where we have the opportunity to talk to folks who really share our goals and largely "get" what we're trying to do. So ... I figured I'd use the blog to share what the demo was supposed to look like - and folks could at least see that and try it for themselves.

Go ahead and create a HealthVault account and sign in. When you do, you'll see a screen like this:

Part of the demo setup is that Suzie has a single medication in her profile, an antifungal with the brand name "Diflucan". To get that in there, click on the "Health Info" tab and then click "Medication" under "Add new items to this record." Just type in the name "Diflucan", ignore the other fields and hit "Save".

Kaiser will insert their CCDs directly into the appropriate HealthVault record - but you're not connected to Kaiser. So instead, click the "Health Info" tab again and then use the file upload form on the right side of the page to upload this sample CCD. This will land you on your list of CCD documents, where you should see the file you just uploaded. Click anywhere on the row for the document and it will expand into a view that you can view, print or download.

Having the CCD as a "package" can be very useful - it represents exactly what Kaiser believed to be true at a point in time. But you'll also want to use the component parts of the package individually - for example in your consolidated list of immunizations. You can do that by clicking on the "integrate" link.

On this page you'll see all the items we found in the CCD, and you can choose to add them to your record, ignore them, or update an existing item. Most of the information here is new, but the "Fluconazole" medication is actually the same as our "Diflucan" - except using the generic name that was dispensed and containing more information about dosage, etc. Click the "replace" radio button next to Fluconazole, and we'll ask you which item should be replaced. Go ahead and pick Diflucan, click "replace" and then "save to record" to save your work. Magic!

That's about it. Peter was going to show a bit more about how the various items looked in the record, but you get the idea. For a more complete walkthrough of the HealthVault experience - take a look at our Nickel Tour - it touches on a whole bunch of features we wouldn't have had time to cover today anyways.

Blips happen, but it's sure crappy when they do. The positive thing is - what we tried to demo really exists, and - wireless connectivity aside - it's working great. Give it a try yourself, and let us know what you think!

Comments (3)
  1. John@Chilmark says:

    Thanks for putting this up Sean.

    And yes, Peter handled the glitches as well as can be expected but it was awkward, to say the least.

  2. Sean,

    Your blog post today is very illuminating.  It strikes me that Kaiser’s use of the CCD integrated into HealthVault is very leading edge.  Congratulations to all.

    I have a couple of questions — forgive me for inaccuracies in terminology as I’m basically a business guy, not an IT type.

    The CCD sample you show and the ability to "integrate" data into the HealthVault database is very intriguing.

    Is this based on Kaiser’s use of HL7 v3?  Does that explain the presence of what looks like XML formatting?  My understanding is that very few organizations are using HL7 v3, so I infer that what Kaiser is doing here is far beyond mainstream?  

    My understanding of the CCD is that in the most commonly used version it literally only pulls existing documents, and thus is not using computable (or "integrateable") data.

    Once the data is integrated into your data base, can you then export it to other formats?  e.g.., CCR, fax, whatever?

    in effect, is HealthVault becoming a "translator" between CCD and CCR formats?  is the practical effect here to minimize (or eliminate?) risk of one of these standards eventually becoming the dominant standard in the marketplace?  (I don’t personally see these standards as competing, but many others have told me that they’re taking a wait and see attitude, therefore delaying adoption of either standard.)


  3. Sean Nolan says:

    Hi Vince, great to hear from you!

    Yes, the CCD format (as a flavor of CDA) is part of HL7 v3. As you point out, v3 in general has seen pretty slow uptake here in the US, although it is becoming quite common in other countries. In the US, the one piece of v3 that does have a lot of momentum is the CDA, because it provides the ability for institutions to gradually "ramp" from unstructured to structured documents and exchanges as their capabilities mature.

    The CCD is a perfect example of this — it can be structured at a number of different levels. Kaiser is targeting what is known as the "HITSP/C32" level of CCD, which specifiies additional structure within the document. Most folks we are working with are using or moving towards this level.

    With this additional structure, you can think of the CCD as a pretty close analog to the CCR — so we can pull out individual items and use them in computable ways.

    Finally — it is absolutely our goal to be able to transform between types used in the marketplace — and CCR and CCD are two great examples of this. For example, we have partners that are constructing CCR documents out of the items in a HealthVault record, many of which may have originated from CCDs sourced from Kaiser or other providers.

    It is certain that we will continue to live in a world of many standards for some time … so this seems to us like the only strategy to really provide a record that will remain useful for the long term.

    I hope that’s helpful! Look forward to continuing the discussion as things continue to evolve, both within HealthVault and the broader community as well.


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