198420 Resource 182415 183236 183236 1204227979492 1204228710439 Controlled Dossia: Under-visioned

New service moves in the right direction, but is still a long way from lifespan planning

I was asked recently by an MBA student to give my impressions of <a title="Dossia" href="www.dossia.org">Dossia</a>.<img style="WIDTH: 197px; HEIGHT: 98px" height="98" hspace="0" src="http://www.firstpointpr.com/dossia.jpg/dossia-full.jpg" width="197" align="right" border="0" />      What is Dossia? In its own words: "The Dossia Founders Group is a consortium of large employers united in their goal of providing employees, their dependents, retirees and others in their communities with an independent, lifelong health record. Dossia founders are funding Dossia, an independent secure, non-profit infrastructure for gathering and securely storing information for lifelong health records. At the request of employees and other eligible individuals, Dossia gathers health data from multiple sources. Employee participation as a Dossia user is completely voluntary and individuals have complete control over who sees their information. Once gathered and securely stored in a decentralized database, the health information is continually updated and is available to individuals for life even if they change employers, insurers, or doctors. The Dossia Founders Group includes AT&T, Applied Materials, BP America, Inc., Cardinal Health, Intel Corporation, Pitney Bowes, sanofi-aventis and Wal-Mart. The Dossia project has been endorsed by the American Academy of Pediatrics, the American Academy of Family Physicians, the Centers for Disease Control and Prevention and the National Association of Manufacturers. The Dossia Founders Group will work with Children's Hospital Boston and other qualified and experienced vendors to develop and implement the Dossia Network infrastructure."   Here's my take:   1. Dossia recognizes "Lifelong Record" but never grasps the power of using the tool as a forward-looking planning instrument. They are still imagining this as a relative backward facing passive repository of information -- an organizer, if you will -- that could help eliminate waste and inefficiency and potentially decrease health care costs.   2. They recognize the potential mine field between employer and employee here, and go to some lengths to ensure firewall protection of sensitive employee health records. Specifically they say that the employer and the insurer will not (at least for now) have access to the information, and that data security will be paramount.   3. The founders state as their motivation the creation of  "a new kind of health care benefit for their employees, dependents and retirees." That reflects the mindset here -- that employers will provide the leadership to transform American health care. This is not unreasonable since they are at considerable financial risk in the United States because of employer based health insurance. But it's useful to keep in mind that we are the only developed nation on the planet with an <a href="http://www.healthpolitics.org/program_transcript.asp?p=empbasedhc_two">employer-based health care system</a>. My point - that it is reasonable to ask where best to base an initiative like this, since (as here) the funders do color the solution proposed.   4. The medical collaborators are heavy hitters -- Children's Hospital (in Boston), Harvard and MIT. These have been at the forefront of HIT (Health Information Technology) for several decades. Their own weakness is that they are huge academic hospital health systems with the biases that this entails -- toward hospital and provider based solutions versus consumer based. Big health technology vendors like Intel, GE, Phillips and Siemens have traditionally focused on these big players to sell them machines like CAT scanners and MRI's, and chips to run these machines. It's natural that they would therefore turn to these same institutional partners for information solutions.   5. The corporations involved are contributing not only financial resources, but also access to their employee bases to test out the application, as well as serve as a potential customer base for new products and applications that integrate with Dossia as they are developed. The employee bases (certainly decoded and protected) could also in the future be accessed for research and development.   6. Key features emphasized are that the application is "personally controllable, private and portable" -- again the notion of a "container for disparate medical information" that will stay with the consumer wherever he or she is. Again no concept of this as a planning tool, nor discussion of integration of other planning health data (nutrition, exercise, reproductive planning, educational objectives, financial planning, housing needs, etc.) Thus the product is "medicalized" and supports institutions primarily as the data sources versus individuals as data sources within <a href="http://www.spencerbooks.com/">a holistic, home-based framework</a>.   7. Dossia does have the <a title="AAFP" href="http://www.aafp.org/online/en/home/publications/news/news-now/professional-issues/20060522medicalhome.html%20">endorsement of the AAFP</a> <a href="http://and/">and</a> the <a title="AAP" href="http://www.aap.org/advocacy/archives/julymedhome.htm">AAP</a>, <a href="http://both/">both</a> of whom have endorsed the "Medical Home" concept.   8. Governance of the non-profit involves current <a href="http://www.dossia.org/founders/dossia_leadership/">employees of the sponsoring companies</a>. (Colin Evans,director of the Systems Software Lab at Intel serves as President of the non-profit, and Michael Critelli, Executive Chairman of Pitney Bowes is Chairman of the Board of Dossia).   9. Dossia is committed to an "open platform" design. In doing this they are leaning toward enhanced compatibility and usability of the product, and suggesting that this will be non-proprietary and used in the public interest.   10. Why Wal-Mart? Several reasons. First, <a href="http://www.usatoday.com/money/industries/insurance/2007-09-18-walmart-health_N.htm">it improves their reputation in health care</a> where they've been criticized in the past, and offers their employees a additional health benefit at low cost to them.  Second, the intent is to have this open platform spur development of a range of compatible products, and those have to be sold somewhere. Third, health care is a high transactional space, and involvement with patients creates floor traffic. Wal-Mart, in hosting <a href="http://walmartstores.com/GlobalWMStoresWeb/navigate.do?catg=707&contId=6440">other health related activities and products</a><a href="http://%20now/"> now</a> and the build-out of a better medicial record, has the opportunity to leverage these activities to increase sales.   Summary: Dossia got the name (Lifelong Record) right, but has yet to absorb fully the concept. The <a href="http://www.healthpolitics.org/program_transcript.asp?p=your_health_future">Lifespan Planning Record</a> (LPR) is unique because it is fundamentally an integrated planning tool, that could be customized and individualized by consumers and their families to support better decision making, enhanced adherence to agreed upon plans, and incremental adjustment of behaviors to improve health outcomes. The goal? Not simply allowing an individual to construct a better health care record, but to empower individuals to reach their full human potential. And the design and graphic interface of the LPR must be so engaging, such a pleasure to use, so "sticky"  (integrating photos, videos, diary entries, personal hallmarks, individual research and breakthrough insights), that it will engender high customer loyality (as an electronic product) and support consumer driven (as opposed to employer driven) viral marketing.One last item: Today's headline on page 1D of the <a title="Wall Street Journal" href="http://biz.yahoo.com/wallstreet/080228/sb120416090319398335_id.html?.v=2">Wall Street Journal</a> reads, 'Google to offer health records on the Web:Tech Giant Joins Effort To Prod Consumers To Keep Their Data in Portable Electronic Profiles.' 10 application/xml false lifespan planning record Mike Magee patient advocacy Mozilla/4.0 (compatible; MSIE 7.0; Windows NT 5.1; (R1 1.5); .NET CLR 2.0.50727; .NET CLR 3.0.04506.30; .NET CLR 3.0.04506.648) 127.0.0.1 127.0.0.1 plarson 68.60.235.104 false true false false true 179654 false false true false false false true 198430 Resource 179654 173239 183236 1204235263468 1204295826860 Controlled Undervisioned? Maybe, But It's Fixable

Mike,   Thanks for a great explanation and commentary.While you might be right about Dossia being limiited in not being a visionary lifetime record, I don't see anything in the Dossia model that would limit it's future expansion to what you describe.  You gotta start somewhere -- v9 will be better than v1. 10 application/xml false Mozilla/4.0 (compatible; MSIE 7.0; Windows NT 6.0; SLCC1; .NET CLR 2.0.50727; Media Center PC 5.0; .NET CLR 3.0.04506) 127.0.0.1 127.0.0.1 24.119.23.246 false true false false true 198478 Resource 179654 183236 183236 1204299645584 1204299645584 Controlled Need to Avoid Technology Segregation

If we address issues early, new technology will bring us together

Vince-   You're absolutely right about this -- that v9 will be better than v1, and we must start somewhere. My only concern is that the pace of change is accelerating, and if our vision is underpowered we could easily end up with technology segregating the people from the people caring for the people, rather then connecting them in a meaningful way. As we can see from the Google announcement this week, there is a logic of launching lifetime planning records off of an open consumer platform, with the expectation that we caregivers will move to the people rather than the other way around. The advantages include compatibility, speed of implementation and elimination of many of the financial and organizational obstacles that have slowed us down in the past. Were we to create the expectation that, for individuals to be insured, consumers would have to first establish their LPR (as one of the responsibilities that come with universal coverage) we might tip this whole system quite rapidly.   Mike Magee 10 application/xml false Mozilla/4.0 (compatible; MSIE 7.0; Windows NT 5.1; (R1 1.5); .NET CLR 2.0.50727; .NET CLR 3.0.04506.30; .NET CLR 3.0.04506.648) 127.0.0.1 127.0.0.1 plarson 68.60.235.104 false true false false true 182415 blog blogsite/HealthCommentary/web