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HealthVault's timing seemed perfect. In 2007, personal health records were a buzzy technology and payers, hospitals and other health care players launched PHRs they hoped would usher in a new era of consumer-facing, consumer controlled health records.

Redwood, Wash.-based Microsoft Corp. got into the game in a big way by unveiling HealthVault, a medical records manager/repository designed to collect and store data from multiple caregivers and let patients control access to their health information.

Fast forward to today. PHRs are definitely making inroads, but not necessarily in the way Microsoft (or competitor Google Inc., which in 2008 launched its own consumer-oriented PHR service) had hoped. A Forrester Research survey of more than 5,200 consumers conducted in late 2009 found that almost a third of respondents had some form of PHR-but the vast majority are getting them from their health insurer.

That's a bit of a strange market twist. The lack of trust in insurers, one may recall, was a primary reason companies like Microsoft and Google saw opportunities in the emerging PHR market, since many industry experts felt that patients would have a hard time accepting the idea that their health insurance companies wouldn't find some nefarious use for their health data.

But payers are holding their own, and HealthVault has shifted gears somewhat. Originally marketed as a direct-to-consumer service, HealthVault is now making inroads into partnerships with hospitals and emerging health information exchanges/health records banks. The company also has aggressively sought partnerships with medical device manufacturers to establish connectivity to a slew of medical devices for home health monitoring, as well as pushing into hospital infrastructures with HealthVault and its Amalga data integration and aggregation software.

David Cerino, general manager for Microsoft's Health Solutions Group, says that there are 135 health care applications written for HealthVault, running the gamut from a consumer app that helps triathletes monitor their training and diet to software for managing chronic diseases. The company also has created interfaces with more than 70 medical devices, he adds. Cerino, citing company policy, declined to provide HealthVault usage numbers, but said the service is growing steadily month over month.

Testing the Waters

Providers that have been testing the waters with HealthVault say there's a lot to like, but note that a reality check is in order. The concept of linking multiple data streams collectively into one HealthVault record is great in theory, and users say Microsoft has done a lot of the heavy lifting by creating a platform to do so. But the use of industry-standard messaging and data formats is not widespread, so converging disparate data streams from multiple EHRs, monitoring devices and clinical information systems into one personal record is still a ways off in practice.

But that says more about the provider community and the current state of their I.T. capabilities than it does about HealthVault.

Rochester, Minn.-based Mayo Clinic is a case in point. In April 2009 the health system launched the Mayo Clinic Health Manager service. The service uses HealthVault as the storage facility for personal health information, and is designed to run Mayo Clinic's clinical rules engine atop that data to develop health guidelines based on clinical information in the record. For example, a diabetic patient's glucose readings and other information is analyzed by the Mayo Clinic rules, and a customized treatment plan, including alerts and automated outreach to clinicians, is generated based on that data.

But Mayo Clinic has not promoted Health Manager to its patient population, and the online service is still "in the birthing stage," says Sidna Tulledge-Scheitel, M.D., medical director of Mayo Clinic's global products and services group and associate dean of e-health.

"We are waiting until we can get Mayo clinical data flowing directly into HealthVault from our information systems-establishing that connection took to us longer than we anticipated," Tulledge-Scheitel says.

Mayo struggled to come up with a format for data feeds to HealthVault records, and ultimately decided to format the information using the Continuity of Care Record standard developed by ASTM International and its group of partners. Sending CCR data to HealthVault records ensures that the information can be "consumed" by the Mayo Clinic's clinical algorithms. But the problem is that data from other providers and stakeholders such as e-prescription networks, payers and medical devices is not standardized and may not be readable by the Mayo application.

"HealthVault can accept any type of data, but the industry doesn't use a standard nomenclature, which is a real barrier for us because that's the clinical service we developed Health Manager to provide," Tulledge-Scheitel says. "If we waited for a perfect solution, we would be waiting forever. But we are constantly reaching out to entities that are pouring data into HealthVault patient records to try to come up with strategies to standardize information."

Seeing Progress

While Mayo's Health Manager initiative is moving slower than anticipated, Tulledge-Scheitel says HealthVault is making the right moves. "Microsoft really is a master at interoperability, and the fact that they have focused on interoperability with medical devices is very smart. We are approached by medical device manufacturers all the time, but we don't have the resources to establish connections one device at a time. It's really powerful that HealthVault is agnostic in terms of devices."

In addition, it's encouraging that Microsoft is focusing HealthVault on the nitty-gritty side of health care-linking with EHRs and other hospital information systems and working with providers to create patient population services.

When HealthVault was launched in 2007, some of the first concerns voiced by industry stakeholders and consumer groups were over data security and privacy. Not everyone was convinced that Microsoft, which frequently has to deal with reports of security flaws in its consumer products, could be trusted to safeguard extremely sensitive health information.

But I.T. leaders who have kicked the tires say that HealthVault provides extremely good security. "We are very discerning with whom we partner with," remarks Tulledge-Scheitel, "and our team didn't unearth any security issues with HealthVault."