The document discusses the evolution of personal health records (PHRs) and their transition toward online platforms amid growing consumerism in healthcare. It highlights key challenges in data management, privacy, and security, while emphasizing the need for consumer engagement and the incorporation of mobile technologies. The future of healthcare is seen as shifting to Personal Health Platforms (PHPs), which require actionable and personalized data to ensure higher adoption rates.

1. PHRs: Where We’ve Been, Where We’re Going By: John Moore, Managing Partner [email_address]

2. Three Take-Aways Healthcare in Transition & the Move Online Implications PHRs Today Adoption/Drivers Challenges Successes PHRs Tomorrow Platforms mHealth Death of PHRs

3. Macro Trends Reshaping Healthcare Growing Consumerism in Healthcare Employee Accountability & Cost Sharing Out of Pocket Expense Yr’00: $200B, Yr’07: $267B Disintermediation of Care Retail Clinics, eVisits, MedTourism, Virtual Labs Information Liberation Traditional: PubMed, Mayo, WebMD Crowd-sourced: Wiki(s), Blogs, Twitter, Communities Stimulus Bill & Healthcare Reform Unprecedented $$$ to Digitize Healthcare Comparative Effectiveness

4. While Consumers Increasingly Go Online for Health Info… Source: Pew Research 2006 74% of all adults are online Now One of the Top Activities on the Net

5. Few Manage Health Records on Net Source: Forrester Research Q2’08 Survey n= 5,242 Today, Meager 3.3% iManage PHI

6. Three Dominate PHR Models Direct to Consumer => Manage Records Consumer has Full Control Consumer self-populates, disconnect Small ISVs with Little Market Influence CapMed, Medikeeper, PassportMD Payer/Employer Sponsored => Lower MLRs Consumer has Limited Control Trust issues, portability Focus on HRAs, Health & Wellness, Disease Mgmt Incentives common to drive adoption Provider Sponsored => Customer Retention Consumer has Limited Control Little portability, modest tools, incomplete longitudinal record Present Labs, Meds, Discharge Facilitate transactional processes

7. PHR Adoption is Widely Dispersed Mix Provider Provider Payer Payer ISV Provider Provider Type Client defined, claims-based HRA & alerts Rarely portable WebMD 500K WebMD Countless RYO MyChart HealthAtoZ ActiveHealth RYO (VistA) MyChart PHR Platform Similar to KP Portability w/Google 100K Cleveland Clinic Highly variable, most simple templates Little portability 2.5M All Others Aging portal w/email Portability w/Google & HealthVault 40K BIDMC Claims-based, part of new OptumHealth Div. Portability w/HealthVault ~200K United Health Grp Focus on HRA, DM, aggressive build-out Portability w/HealthVault ~780K Aetna EMR portal, Not portable 650K Veteran’s Admin EMR portal w/email & transaction services Portability w/HealthVault 3.0M+ Kaiser-Permanente Features No. of Users Entity

8. PHRs: What Are They Good For? EMC Adoption: Over 50% of Employees Benefit: Lower MLRs = Lower Healthcare Costs NET: $50M in 4 years Kaiser-Permanente Adoption: Over 50% of Members with Internet Access Benefit: Cost Savings via Fewer Office Visits Indiana University Adoption: Over 40% of Entering Class Benefit: Lower Admin Costs, Student Engagement All Depends on Who You Ask!

9. Top 3 Challenges to Adoption Data Getting it, Cleansing it, Sharing it Trust Privacy & Security Providence Value Personal Actionable Relevant Consumer Engagement Begins Here

10. “Health Clouds” on the Horizon Data Sources Secure Repository Applications Multiple tools/widgets, communications??? Very Good Tools Perceived value? High Adoption Farther down the road High Personalization Still under development Medium Portability Adoption of Open Systems and standards High Interoperability Strong consumer control of data High Control Virtually any pertinent data source High Data Source(s) Notes Potential Attributes

11. Health is Mobile! Explosive Growth in Use Over 1B AppStore Downloads iPhone Rep. 0.7% of All Internet Traffic Over 30K Apps Nearly 1.5K are Health Focused Every Major Mobile OS Now has App Market And Still Only mHealth1.0

12. Evolution Accelerates PHR Adoption 2008 Gen 3: Data Aggregation (Health Clouds Form) Gen 4: Personal, Actionable & Mobile Gen 2: Online & Connected 2011 Gen 1: Isolated 2003 1992 Time User Value Proposition Adoption 2000 (Online) 20 1992 40 80 Users (Millions) Low High

13. Generation 4: “Convergence” Personal, Actionable, Connected Value: About Me, By Me, With Me, For Me

14. What to Watch Traction of Platform Plays Data Sources (agreements) E.g., Cleveland-Google, KP-MS New HIPAA Extensions Consumer Adoption Sub-group types Developer Adoption Popular apps/services Employer Successes Demonstrable ROI All Things mHealth Smartphones change equation Biometrics play key role

15. Looking Into the Future… Biometric Devices Become a Critical Data Source HIEs will Serve Citizens as Well Data Liquidity & Quality will Prove Challenging Meaningful Use Requirement May Backfire Biggest Challenge: Sourcing Quality Data

16. Final Thoughts… Time to Ditch PHR Term Consumers NOT Interested in Digital File Cabinet Personal Health Platforms (PHP) are Future Personal, Actionable Data Education Critical What’s in it for me? Without Consumer Engagement, HIT Adoption may be DOA Stimulus Funding is Not Enough to Move Needle

17. The First Wealth is Health -Ralph Waldo Emerson The Best Way to Predict the Future is to Create it - Peter Drucker