Sunday, March 30, 2008

"Time waits for no one, and he won't wait for me"

The market won't stand still. While a bunch of us are futzing around with patient portals, PHRs, patient kiosks, and other tools to add convenience to health care delivery, along comes ZocDoc ( which allows online scheduling of physician and dentist appointments for participating providers. Physicians pay for the service and it's free to patients.

Online scheduling has been around on the web for awhile. Booking tickets, for example, for everything from movies to airplanes. And allows free restaurant reservation booking in a number of cities. Like opentable, Zocdoc also allows patients to review their physicians on the site.

Physician offices are trickier than other businesses, however, because health care operates so much like a cottage industry. The workflow issues are always full of gotchas. Unless Zocdoc is interfaced with the physician's scheduling system, it seems like the only way to make it work will be to use it as the primary scheduling system in a practice, which could be problematic since there's no billing function. I'm also not sure how they've tackled the security issues, particularly with respect to the HIPAA security rule. With no in-person authentication, there seems to be something here that won't pass the basic HIPAA sniff test.

I think this is a cool idea though, and any innnovation pushes us all forward, even if the innovating company itself doesn't survive. My guess is that this type of service is highly unlikely to survive on its own, as a stand-alone. I could see EHRs or health information exchanges (HIEs) interfacing to the service or licensing the technology to build into their own suite of services. Zocdoc's best hope, and I'm sure what they're banking on, is to be acquired by Microsoft or Google who are looking to add to the service bundle offered in their PHRs.

Sunday, March 02, 2008

Battle Royale in PHRs

A lot of buzz lately around Google's and Microsoft's PHRs. John Halamka's blog (and Paul Levy's cross-linked entry) talk about Google's PHR -- these two guys get so many hits on their blogs that whatever they talk about is buzz, by definition.

Meanwhile, at HIMSS Microsoft announced the creation of a fund (the Be Well Fund) to spur ideas for integrating information into their HealthVault PHR. They plan on funding about 20 initiatives ("new and innovative scenarios") at about $150K apiece. A pretty clever way of getting the juices flowing on this issue if you ask me, especially since the biggest obstacle to getting real market traction is cracking the nut on connecting gazillions of disparate hospital and physician office legacy systems. HealthVault also had a full-page ad for the fund on the back page of Saturday's Wall Street Journal (you can only see the ad in the print edition).

Meanwhile, not much has been heard from RevolutionHealth, Steve Case's much ballyhooed entry into health care. I've got to think that they don't stand a chance now that Microsoft and Google are on the scene. From what I've seen of RevolutionHealth, it's more patient education than a PHR, and that segment is pretty crowded already.

It's been about 6 months since Aetna's Ron Williams called Microsoft's and Google's entrees "vaporware", and despite more concrete offerings now, there's still a fair amount of grousing that Google, in particular, should "just launch it already!"

I'm actually sympathetic with their instinct to move slowly. The health care sector is tougher than any market either Microsoft or Google has faced to date -- highly complicated subject area, fragmented supply- and demand-side, unsophisticated users (on both the supply- and demand-side), and potential for high liability exposure (privacy, misrepresentation of medical information, etc) with not much tolerance for error.

Neither Google nor Microsoft lacks for hubris, though, and in the end, that could be their undoing. At every conference I've seen them at they've both presented themselves as the white knights who are going to "change the paradigm" and "use disruptive technology" to unleash "demand-side pull-through" -- so much jingoism that it would make any 1st year business school student blush. Yet, their value proposition to patients is very tenuous, at best, because so little clinical data is electronically accessible at present. Couple that with the lofty, self-generated expectations they've created, and you've got the potential for one or both suffering a large public failure.

I hope not. I want health IT to mature to a point where they and other leading edge consumer-oriented companies like Apple and Sony and Panasonic can enter the space with customer-facing applications that just work -- no fuss, no muss. I just worry that they may be ahead of their time and if they fail now, it might be years before they're willing to come back.....