HealthVault at CHC 2011

Vaibhav and I (Eric) attended the Microsoft Connected Health Conference this week in Chicago, and on Thursday morning presented an update on what has happened in the HealthVault area over the past year. We covered a lot of ground and therefore thought it would be useful to write a post about what we talked about, both to share the information with those who couldn’t attend and to provide more details about what we did show.

Before I get into the details we'd like to thank everybody on the HealthVault team who helped us create the demo and get everything working. They worked hard to help us out on a short timeline and we really appreciate it.

We started with a demo that pulled together some released and some soon-to-be-released features into a demonstration of how HealthVault can work in the context of a single patient. There are 4 parts of the demo:

Part 1: Alex has shortness of breath

Alex (a senior who lives alone) has shortness of breath and after consultation with his PCP is referred to a heart specialist. The specialist diagnoses him with chronic heart failure, prescribes a couple of medications, and recommends that Alex monitor his weight on a daily basis (sudden weight gain can indicate issues for people with his condition). A summary of the visit is bundled up into a CCD summary by the doctor’s clinical system, and an email is created and sent:

To: newuser@direct.healthvault.com.
Subject: AlexBogue@live.com, Here is your visit summary
Attached: AlexBogueCCD.xml
Text: Alex, here is the summary of your visit. Remember to monitor your weight and get plenty of exercise. Dr. Ben.

The “direct” part of the email address refers to the Direct Project (technical introduction here), a way of exchanging medical information securely using existing email protocols. Some members of the HSG team have been at the core of the team working on the project, and we have implemented an email gateway that can take data from Direct and store it in HealthVault. The message and the attached CCD are stored as encrypted data on HealthVault using the Drop-off/Pick Up (DOPU) feature.

Users also have the option of creating their own HealthVault Direct email address (something like AlexBogue@direct.healthvault.com), and any messages to that address are placed directly in the user’s record. The HealthVault direct gateway will look at attachments and see if it knows how to do useful things with them; for our demo we use this ability to take a CCD attachment and create a CCD data item in the user’s record.

You can find additional information about Direct and HealthVault in Sean’s blog posts:

• Start sharing information with patients --- today!
• More on adding Direct patient messaging to an EHR
• Even More Thunder for Direct

Part 2: Alex discovers HealthVault

Alex picks up his message, creates an account for himself, and goes exploring. He find that he has a CCD in his account (courtesy of the direct gateway), and he also finds that his medications and conditions were extracted from the CCD automatically. In the current release of HealthVault, the user must start this process (which we call reconciliation), but in the upcoming release, the user can request this process to happen automatically (which we cleverly call “auto-reconciliation”).

The point that Alex is at has been problematic for some of our users; they get into HealthVault with some data but don’t know how to proceed from there. The getting started wizard presents the user with a short questionnaire, and the answers to the questions are used to suggest devices and applications that may be interesting to the user. This is determined by looking in the application and device directory, which is a place where applications and devices can describe how patients can use them. The getting started wizard queries that database to determine what information to present to Alex, and since it's a demo, he is directed to a single application.

The recommendation is a Weight Tracking application. Surprisingly, it’s not this application, but it’s a whole-new application.

And, in what is apparently a very poorly-kept secret, it’s a Mobile application, running on a Windows 7 phone. Alex uses this simple application to track his weight. The link is to a mock-up for our demo application; in the real world it would direct him to the application in Zune (or whichever marketplace is appropriate for the application).

It has been possible to write mobile applications since we released our SODA application support, but the current version of HealthVault uses public/private key cryptography to establish application identity, and creating the certificate (an X590 certificate) and doing the appropriate signing is a big hurdle on mobile platforms. A few partners have done it, but it's fairly complex.

Our current C# SDK doesn't run on the windows phone version of .NET, and it's pretty hefty for mobile applications anyway.

So, we decided to do something to make mobile development easier. Our design goals were:

• Work with commonly available cryptographic constructs (ie avoid public/private key cryptography).
• Encapsulate creating requests and decoding responses (the hard part)
• Encapsulate the first-run application provisioning (another hard part)
• Support multiple platforms.
• Be very simple.

We aren't quite finished with the work for this, but we have plans to ship support a library and sample application for the Windows 7 phone, iOS (iPhone/iPad) devices, and Android devices in the next release. We will ship a library in source form, a getting started guide, and a sample application that demonstrates how to use the library.

Part 3: Jill worries about Alex

Alex has a daughter Jill who is worried about his condition. She creates a HealthVault account, Alex shares his record with her, and she signs up for a care coordination application that she found through the getting started wizard. She enters some contact information into the application.

When Alex enters a series of weights that show a unexpected weight gain, the application sends Jill an SMS alert.

This notification is build with HealthVault eventing; the application has an event subscription on the weight data type, and is notified when any create, update, or delete operation is performed on a weight entry in a record the application has been authorized to access. The application then looks at the items in Alex's record and evaluates them based on a set of rules. If the "sudden weight gain" rule is activated, an alert message is sent.

This application is an example of the kind of application partners could build using eventing.

Part 4: Alex has a sudden weight gain

Jill takes Alex to the Doctor, and she is able to browse to the Mobile version of HealthVault on her phone (an iPhone in the demo) and show the information about Alex (his condition, medications, plus his recent weight measurements).

HealthVault mobile is our first step towards a richer mobile experience. In the upcoming release we will be providing mobile-tuned account creation and authorization screen, and a simplified screen to view the contents of a user's record.

That concludes the main demo, which showcases how the new HealthVault technologies enable Patient engagement and care coordination.

HealthVault Imaging

A couple of weeks ago the HealthVault Connection Center team released a new version which provides increased support for storing, retrieving, and viewing medical images.

More information can be found here.

8 improvements in 8 minutes

We had a number of other improvements form the last year that we wanted to cover, but not a lot of time so we created this section. The items that we presented were:

Application and Device Directory

The application and device directory allows users to search by activity or condition to find tools that will help them. This is another way to access the same information that was used by the getting started wizard in the demo.

Signup Experience Improvements

We've improved the user signup flow. We have removed the live-id branded signing page, we reduced the number of sign in pages from 5-6 to 3, and we simplified the pages.

Spanish in US HealthVault

Bienvenida a HealthVault Español. If I'm remembering my high-school Spanish correctly, we've rolled out a version of HealthVault translated into Spanish. Applications may provide translated strings for their metadata.

Second-Factor Authentication

Some users would prefer a more secure authentication system than a simple username and password, so we've added a second-factor authentication system. Users can register their phone number (typically a mobile phone) and a PIN, and whenever an attempt is made to log into their HealthVault account, a call will be made to their number. When they enter the pin, access will be granted.

Support for SNOMED-CT

Partners have requested access to the SNOMED-CT vocabulary. Developers can now specify that they have a valid license through Application Configuration Center, and then the application can access it programmatically.

Improved vocabulary search

We have provided a powerful vocabulary search mechanism that can rapidly return matches from large vocabularies. You can see it in use when entering a medication name in the HealthVault shell. In addition to searching through terms, this mechanism also provides metadata from the vocabulary; for example a medication search can return dosage and route information for the search term.

This capability is available for use from partner applications.

CCR/CCD import and export improvements

We have significantly improved our support of CCD and CCR summary documents. CCD and CCR now have rough parity in support, we have added support for a lot of different variants of these documents, and we support many more data types for import and export. Here's a list of all the types supported:

• Advance Directive
• Allergy
• Appointment
• Blood Glucose
• Blood Pressure
• Blood Oxygen
• Cholesterol Profile
• Condition
• Encounter
• Family History
• Height
• Immunization
• Lab Test Results
• Medication
• Payer
• Peak Flow
• Procedure
• Vital Signs
• Weight

HealthVault Application Data Checkup

The HealthVault data approach allows a lot of latitude in data entry. In the Medication data type, for example, all that is required is the medication name, but if applications can provide coding information or additional information, it is easier for other applications to consume the data.

The Application Data Checkup runs against a HealthVault record that has data that was created by an application, and will give guidance that the application can use to produce data this is more easily consumed.

We expect to ship this utility during the summer of 2011.

Availability of these features

Currently Available

• Direct email to HealthVault
• HealthVault Event Notification Service
• Spanish in US HealthVault
• Vocabulary search & auto-population
• Getting started wizard
• Second factor authentication
• Imaging support in HVCC

Available Summer 2011

• Auto reconcile of CCR and CCD
• Mobile device support
• Mobile shell
• Signup experience improvements
• Application Data Checkup
• Application and device directory with updated HealthVault branding