One of the more interesting aspects of the Google and Microsoft entries is the introduction of the intangible into the economic equation for hospitals. That is, while they will not be shouldering the cost of creating or storing these applications and databases, they will have to find some way to integrate them with their existing or proposed EHR/PHR plan. And, because direct marketing via these platforms is being strongly discouraged to protect patient privacy, it can be hard to discern a quantifiable ROI. But Halamka (who served on the Google Health advisory panel prior to the pilot's launch), Cleveland Clinic CIO C. Martin Harris, M.D., Stofko, and Weider all say there is enough upside to the Google and Microsoft platforms to bore ahead.

“The patients who use PHRs love them, and have basically said it is the one thing that has kept them a devoted patient of Beth Israel Deaconess,” Halamka says. “So, if I can attract and retain patients based on PHR integration, it's pretty important.”

In fact, he says a recent Beth Israel random phone survey of 2,000 adults in eastern Massachusetts revealed 19 percent of respondents would change to an e-enabled doctor if they had the choice. “That's a major forcing mechanism,” says Halamka.

Harris offers a more bottom-line example of how these PHRs are a boon to hospitals. He estimates that 2,000 of the 8,000 patients a day the hospital treats have no electronic record with the Clinic in any form. Should the technologies become as popular as their advocates hope, Harris says even those patients whose physicians do not use EMRs could still have critical data stored on a Google or Microsoft-type PHR and available to hospital staff on their first encounter.

“Even a physician who's still using a pen and paper in their office sends their patient to a retail pharmacy or commercial lab or hospital where that information is available in electronic form,” Harris says. “So I can know their basics; their allergies, their medication list, and diagnostic testing, which is an enormous step forward for us when we're seeing one of those 2,000 patients.”

The possibilities of patient-controlled PHRs have also reached hospital directors. Weider, who also thinks the Dossia effort led by some large employers (including Wal-Mart) could be a major player in PHRs, says the Ministry board recently asked him if patients' records could be easily portable, even if they switched physicians with the new technologies.

“I said that, for the first time in my life, I have optimism about that,” Weider says. “We've been stuck with a lack of standards and no one organization big enough to drive it, but now I see these three and, in the next few years, there's going to be a major sea change.”

Uncertainties and imperatives

Even the most optimistic backer of the Google and Microsoft model concedes that sea change will be slow, however. Near-term, both concepts have to work through the pilot stage. Harris, for instance, says the Google Health UI had to be tweaked early on in the pilot to make it more user-friendly; and Dunbrack says the HealthVault setup is also quite complex.

In fact, in order for a prospective user to see how it works, they are first asked to set up an account — which might be off-putting for consumers wary of Microsoft's no-holds-barred competitive philosophy. In fact, even a technology veteran like Stofko still has some “show me” attitude toward Microsoft, which has seen another central Web-wide repository idea (its Passport identity architecture) fall flat.

“Over the years, we've seen Microsoft in and out of healthcare,” he says. “I think before, the perception was they created a healthcare division — at least this was my perception — because a hospital is typically in the top five employers in any city, and that's a huge number of individual desktop licenses. I think they're past that, and with the people they've brought in from the healthcare industry, they've put some meat and teeth behind it. Now, they have to prove the longevity of their commitment, so I'm not past that hurdle, but I am past the, ‘We're just in it for software seats’ skepticism.”

There are perhaps two factors that might determine the ultimate success of the two platforms. The first is patient acceptance. Dunbrack, for instance, says that in the last survey Health Industry Insights did on PHRs, more than half the respondents had no idea what the concept was. Some patients might also hesitate to post data online, as early critics of the technologies warn neither Google nor Microsoft is subject to HIPAA regulations. Both Halamka and Dunbrack, however, say both companies are well aware of the commercial ramifications of a data breach or even a whiff of unbidden commercialization in either platform, and are sanguine, because safeguards are in place.