HealthVault Integration OptionsChallenges & Possibilities

Outline

• Brief description of what HealthVault is (and is not)

• Scenarios, scenarios, scenarios

• FAQ and common issues

• Q&A

Common misconceptions

• Microsoft technology/.NET only

• HealthVault is an application

• HealthVault is an institutional data store

HealthVault is…

• A consumer/patient data platform

• An ecosystem of connected applications and devices

• Technology/platform independent

– XML-based web service

– First party .NET SDK, external SDKs for other platforms

• A single database across all connected applications and devices

– Data organized by record, where each record 1:1 with an individual

– Central data space

• All apps/devices/users access the same user record

Scenario: Deliver Summary to PatientDrop Off Pick Up

• We have a package of data to deliver to the patient, but we don’t

expect to have an ongoing relationship with that patient.

– Let’s say CCD for now, but that’s not required

• We want the simplest integration model.

Institution

Patient Record

HealthVault

User

Record

HealthVault.co.uk

Delivering a summary to the patientDrop Off Pick Up

CCD

Q: What is the name

of your first pet?

A: Sir Barks a Lot

Holding

Area

Secret

CodeCCD

A: Sir Barks a LotThe institution collects

a question & answer

from the patient.The answer is used to

encrypt the informationThe question and

information are sent to

HealthVault

HealthVault generates a

secret code that is

returned to the user

The user logs into

HealthVault.co.uk,

enters their code, and

provides their answer

HealthVault uses the

answer to decrypt the

data and it is placed in

the user’s record.

CCD

Drop Off Pick Up (DOPU)

• Benefits:

– Simple, easy

– No need to store any additional data or ID mapping locally

• Limitations:

– Must repeat process for repeat transfers

– Can only send data to patient

Institution HealthVault

Jane Smith’s Record

HealthVault.co.uk

An ongoing relationship with the patientPatient Connect

A: Sir Barks a Lot

The institution collects

a question & answer

from the patient.

The question, answer,

and patient id are sent

to HealthVault

HealthVault generates a

secret code that is

returned to the user

HealthVault associates

the patient id with a

specific user record

Patient Record

ID: 153453ID: 153453

Lab Test Results

Q: What is the name

of your first pet?

A: Sir Barks a Lot

The user logs into

HealthVault.co.uk,

enters their code, and

provides their answer

App User ID:BCD…

App Record ID: A9…

When queried, HealthVault

sends the patient id and the

HealthVault user and record ids

to the institution.

The user and record ids can be

used to place information into

the user’s health record.

Secret

Code

The user selects the

record to associate.

Choose a record:

John Smith

Jane Smith

Suzy Smith

HealthVault

User Record

HealthVault.co.ukHospital

Patient Record

Lab Test Results

Website

User logs into

HealthVault

through website

Website obtains

HealthVault user and

record ids, and stores

them with patient

record

The hospital can use

this information to

send information to

the record

Or when the user

decides to send the

information.

CCD

An ongoing relationship with the patientLinking Application

App User ID:BCD…

App Record ID: A9…

Choose a record:

John Smith

Jane Smith

Suzy Smith

Selects the

record to use

Patient Connect or Linking?

• Patient Connect

+ No need to create any user interface

– More complex user process

– Requires Q/A pair, secret code, and offline steps

– Requires periodic polling of HV to retrieve newly authorized HV records

• Linking Application

+ Simpler process for user, no need to generate question/answer or enter

secret code.

+ One step process, no polling required

– Requires patient facing user interface

DOPU, Patient Connect, Linking App

• Success! We can:

– Connect to a patient using one of three methods

– Send packages of data

• What if we want to do something more complicated?

Diabetes Management

• You want to collect home blood glucose measurements from diabetic

patients

HealthVault

User Record

User PC

Clinical System

The user connects their blood glucometer,

and HealthVault connection center copies

the data to the user’s record

HealthVault Connector

HealthVault

Connection

Center

BG

Before a patient’s visit, the doctor requests

the current data from HealthVault

Get HealthVault Data Get HealthVault Data

BG BG BGBG BG

The doctor can now review the data86

Diabetes ManagementDevice Data

HealthVault

User Record

Clinical System

HealthVault records which

application created the data

HealthVault Connector

BG

BG

BG

Data may come from another source, one

that requires more review.

BG

BG

BG

So the data can be presented

appropriately

GlucoseTracker.com

BG

BG Device

BG Device

BG Device

GTBG

Diabetes ManagementHow trustworthy is the data?

HealthVault

User Record

User PC

Clinical System

The user uploads a reading…

HealthVault Connector HealthVault

Connection

Center

BG

BG

BGBG

BG

There is now duplicate data.The next day, the same thing

happens…Each data item has a id associated with it,

and the application can use the id to know

what items are new.

#1

#2

#1

#2

#1

86That night, the monitoring application

copies the data to the clinical system.

Diabetes ManagementRemote monitoring

Controlling data access

HealthVault

But others could use

the same id…

The application requests

data using the id it has

registered…

Institution A

ID: 20be3315

Somebody else

ID App Name

43a1dcb6 General

20be3315 Institution A

f513d74a Plains

Data

20be3315

20be3315Data

Application identity

HealthVault

A connection request is

signed with the private key

And registers the public key

with the HealthVault Platform

Institution A

ID: 20be3315

Somebody else

ID App Name Key

43a1dcb6 General

20be3315 Institution A

f513d74a Plains

Data

20be3315

20be3315

Certificate

Private Key

Public KeyPublic Key

The organization obtains a

digital certificate

Private Key

HealthVault

validates it with

the public keyOther applications don’t

have the private key, and

can’t access the data…

x

Application identity

HealthVault

User Record

HealthVault.co.uk

But the user doesn’t

want to give access

to condition or lab

tests results…

The application wants

access to the Blood

Glucose readings in

the user’s record…

Blood Glucose

Condition

Lab Test Results

HealthVault Application

Application Definition

• Name: Institution A

• ID: 20be3315

• Certificate public key

• Access

• Read access to

blood glucose data

Application

Institution A would

like to have read

access to your

blood glucose

data.

Allow Cancel

The application is

defined with only the

access that it needs.

And all other data is

hidden from the

application.

The user is asked to

approve that access…

Because the data is under user

control, the user can at any time

revoke an application’s access.

Remove access of

Institution A to

your record?

Yes No

Application data access

Quick Review

• “Delivering a summary”: CCD or CCR arrives in HealthVault

• “Diabetes management”: individual blood glucose measurements are

collected

• Questions:

– What happens to the summary document once it arrives in HealthVault?

– What if my institution wants to retrieve a summary of a user’s

HealthVault data as a CCD or CCR?

– What is the relationship between the summary document formats and

the individual items?

HealthVault

User Record

Institution 2

CCR

Institution 1

CCD

HealthVault.co.uk

Reconciliation & Data Sharing

CCD contents

□ Medication 1

□ Medication 2

□ Medication 3

□ Condition 1

□ Condition 2

CCD contents

■ Medication 1

■ Medication 2

□ Medication 3

■ Condition 1

□ Condition 2

Medicatio

n

Medicatio

n

Condition

An institution digitally signs a

CCD summary in the user’s

record, and notifies the user.The user goes to HealthVault.co.uk

and chooses to reconcile the CCD.

They choose the items

they want to reconcile.

ImmunizationAllergy

A doctor at another hospital wants

to review a patient’s HealthVault

data

Medicatio

n

ImmunizationAllergy

Joe Hospital

Pulling It All Together

• HealthVault is…

– A consumer/patient data platform

– A single database across all connected applications and devices

– An ecosystem of connected applications and devices

HealthVault Ecosystem

Our original institution:

Drop-off Pick-up

HealthVault

User Record

HealthVault.co.uk

Institution A

Patient Record

CCD

Institution B

Patient Record

ID: 153453ID: 153453

Lab Test Results

Patient Connect

HealthVault

User Record

HealthVault.co.uk

HealthVault Ecosystem

Institution A

Patient Record

CCD

Lab Test Results

Linking ApplicationHospital C

Patient Record

WebsiteInstitution B

Patient Record

ID: 153453ID: 153453

Imaging Study

HealthVault

User Record

HealthVault.co.uk

HealthVault Ecosystem

Institution A

Patient Record

Remote Monitoring

Hospital C

Patient Record

Imaging Study

Website

User PC

HealthVault

Connection

Center

GlucoseTracker.com

Institution B

Patient Record

ID: 153453ID: 153453

CCD

Lab Test Results

BG

BGBG

BG

86

HealthVault

User Record

HealthVault.co.uk

HealthVault Ecosystem

Institution A

Patient Record

Data Sharing

Hospital C

Patient Record

Website

User PC

HealthVault

Connection

Center

Imaging Study

GlucoseTracker.com

Institution B

Patient Record

ID: 153453ID: 153453

CCD

Lab Test Results

BGBG

CCR

BG BG

86

HealthVault

User Record

HealthVault.co.uk

HealthVault Ecosystem

Institution A

Patient Record

Consumer Applications

Hospital C

Patient Record

Website

User PC

HealthVault

Connection

Center

PHRHistory

Allergy

Institution B

Patient Record

ID: 153453ID: 153453

CCR

GlucoseTracker.com

BG BG

Imaging Study

CCD

Lab Test Results

BGBG

86

BGBG

HealthVault

User Record

HealthVault.co.uk

HealthVault Ecosystem

Institution A

Patient Record

Hospital C

Patient Record

Website

User PC

HealthVault

Connection

Center

Hospital D

Institution B

Patient Record

ID: 153453ID: 153453

CCR

PHR

GlucoseTracker.com

Imaging Study

CCD

Community Connect App

Example: Pre-registration

Lab Test Results

BGBG

History Allergy

BG BG

86

Allergy

Demographic Info

HealthVault

User Record

HealthVault.co.uk

HealthVault Ecosystem

Institution A

Patient Record

Hospital C

Patient Record

Website

User PC

HealthVault

Connection

Center

Hospital D

Institution B

Patient Record

ID: 153453ID: 153453

CCR

PHR

GlucoseTracker.com

Imaging Study

CCD

Lab Test Results

BGBG

BG BG

History Allergy

86

Data Sharing: Variable Fidelity

and VocabulariesMed

Med

Med

RxNorm

NDC

Multiple applications reading

and/or writing the same data typeDifferent coded vocabularies

in use… or none at allApplications must determine how to

handle known, unknown, or missing

vocabulary information

Allergy

Demographic Info

HealthVault Ecosystem

Institution A

Patient Record

Hospital C

Patient Record

Website

User PC

HealthVault

Connection

Center

HealthVault

User Record

HealthVault.co.uk Hospital D

Institution B

Patient Record

ID: 153453ID: 153453PHR

GlucoseTracker.com

Or… if you prefer an even more

colorful anthropomorphized

cartoon view (and/or work in

marketing)

86

Questions?

HealthVault is…

• A consumer/patient data platform

• An ecosystem of connected applications and devices

• Technology/platform independent

• XML-based web service

• First party .NET SDK, external SDKs for other platforms

• A single database across all connected applications and devices

• Data organized by record, where each record 1:1 with an individual

• Shared data space

• All apps/devices/users use the same records

• Users/patients own their copy of the data, must opt-in to authorize

connections