Presentation based on recent research on cloud computing in healthcare for consumer-facing applications.

1. What’s Really Going On?
or
PHRs, Platforms, & Consumer
Trends
By: John Moore, Managing Director
John@ChilmarkResearch.com
1/12/09 1
Copyright: Chilmark Research
For internal use only, not for distribution

2. Three Take-Aways
What is State of
PHR Market Today
Advent of Health
Clouds
Implications
Trajectory
Drivers
Challenges
What to Watch
1/12/09 2
Copyright: Chilmark Research
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3. While Consumers Increasingly Go
Online for Health Info…
Source: Pew Research 2006
74% of all adults are online
1/12/09 3
Copyright: Chilmark Research
For internal use only, not for distribution

4. Few Manage Their Health Records
That Way
Source: Forrester Research Q2’08 Survey
n= 5,242
Today, Meager 3.3% iManage PHI
1/12/09 4
Copyright: Chilmark Research
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5. iPHR Adoption is Widely Dispersed
Entity Type No. of PHR Features
Users Platform
Kaiser- Provider 2.5M MyChart EMR portal w/email &
transaction services
Permanente
Portability w/HealthVault
Veteran’s Admin Provider 650K RYO (VistA) EMR portal, Not portable
WebMD ISV 500K WebMD Client defined, claims-based
HRA & alerts Rarely portable
Aetna Payer ~250K ActiveHealth Focus on HRA, DM, aggressive
build-out Portability w/HealthVault
United Health Grp Payer ~200K HealthAtoZ Claims-based, part of new
OptumHealth Div.
Portability w/HealthVault
Cleveland Clinic Provider 100K MyChart Similar to KP
Portability w/Google
BIDMC Provider 40K RYO Aging portal w/email
Portability w/Google & HealthVault
All Others Mix 3M Countless Highly variable, most 5 simple
1/12/09 Copyright: Chilmark Research
templates Little portability
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6. iPHR Market has Moved to B2B Model
High Barriers to
Entry in Provider
Market
Entrenched EMR
Employer & Health
Plan Markets
Similar
Consumer Plays
Often Legacy
Not actively supported
B2C is Road to Ruin for PHR Vendors
1/12/09 6
Copyright: Chilmark Research
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7. Stand-Alone, Consumer PHI Apps:
Manage Health
nt
e
nt
Co
Attributes Rating Notes
Data Source NA Self-entry, Fax, Cumbersome, Current/Trusted?
Control High Owned & managed by consumer
Interoperability Medium Standards adoption increasing (CCR dominant)
Portability Medium Highly variable across vendors
Tools Modest Highly variable across vendors
Personalization Low Generic, simplistic solutions dominate
1/12/09 7
Copyright: Chilmark Research
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Adoption Low Self-entry key detriment, Highly motivated only

8. Employer & Health Plan Sponsored
Platforms: Manage Risks, Lower Costs
a
nt at
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Attributes Rating Notes
Data Source(s) NA Claims, PBM & HRA, Partial View
Control Low Sponsor controlled
Interoperability Medium Potential there, more talk than action
Portability Low Tethered to employer or insurer
Tools Good Significant activity, behavioral change
Personalization High Copyright: Chilmark Research claims
Leverage HRA & data
1/12/09 8
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Adoption Medium Trust, Incentives often required

9. Provider Sponsored Platforms:
Consumer Retention
nt
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Co lD
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Attributes Rating Notes
Data Source(s) NA EMR, Gold Standard, Myopic
Control Low Portal to host EMR
Interoperability Low Disparate systems, competitive pressures
Portability Low Tethered to EMR
Tools Medium Communication for engagement/retention
Personalization Low-Med.Copyright: Chilmark poor job, some exceptions
Most do Research
1/12/09 9
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Adoption Variable Perceived value?

10. Utility Service Model for PHI:
Creating an Ecosystem
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Attributes Potential Notes
Data Source(s) NA Virtually any pertinent data source
Control High Strong consumer control of data
Interoperability High Adoption of Open Systems and standards
Portability Medium Still under development
Tools Very Good Multiple tools/widgets, communications???
Personalization High Copyright: Chilmark Research the
Farther down road
1/12/09 10
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Adoption High Perceived value?

11. Utility Service Model for PHI:
A Health Cloud Ecosystem
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Attributes Potential Notes
Data Source(s) NA Virtually any pertinent data source
Control High Strong consumer control of data
Interoperability High Adoption of Open Systems and standards
Portability Medium Still under development
Tools Very Good Multiple tools/widgets, communications???
Personalization High Copyright: Chilmark Research the
Farther down road
1/12/09 11
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Adoption High Perceived value?

12. Personal Health Platforms (PHP):
Model & Attributes
Business Model (+) (-)
PHP
Dossia Lg. Employer Sponsors Instantaneous user base of Poor partner strategy =
over 8M+ employees ecosystem non-existent
Initial joiners fee (founding
mbrs, $1.5M ea.) Built on open, Indivo Health Lack of traction, slow uptake
platform by employers
Annual fee based on
number of subscribing Future biometrics, via Continua Portability of records?
employees Free to employees
Google Attract more visitors to Clean, easy to use interface Limited to structured data
Google properties Good consumer controlled Limited to CCR standard
Health Ubiquitous in all aspects of process for data collection Small internal development
consumer’s life Reasonable ecosystem grp (commitment) to build out
Have not ruled out ads in platform
Future biometrics, via Continua
future TBD - ability to attract
Free to consumer
consumers
Microsoft Similar to Google’s Largest & most complete Cumbersome, messy
ecosystem (>14,000 SDK interface
Become base for MSN
HealthVault downloads)
Health Mish-mash of partner apps
Largest investment of
Extend desktop OS to Ulterior motives? (no
resources
health e.g., Connection support for Apple OS)
Center Unique biometric capabilities TBD - ability to attract
Advertising revenue via Free to consumer consumers
health search
1/12/09 12
Copyright: Chilmark Research
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13. Dossia’s Ecosystem: Where is It?
Date Sources 3rd Party Apps/Services
Only WebMD “Live” Today
1/12/09 13
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14. Google’s Ecosystem: Stalled
Date Sources 3rd Party Apps/Services
Slow Progress Recruiting Data Sources
1/12/09 14
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15. HealthVault’s Ecosystem: Expanding
Date Sources 3rd Party Apps/
Services
Excellent Partner Recruitment
1/12/09 15
Copyright: Chilmark Research
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16. Engaging the Consumer:
Google Health vs MS-HealthVault
Consumer Consumer
ISV1 ISV3 ISV5
ISV2 ISV4
ISV1 ISV3 ISV5
ISV2 ISV4
Models will Significantly Affect Adoption
1/12/09 16
Copyright: Chilmark Research
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17. Listening-In:
Early Reports on PHPs
Few Click-thrus from HealthVault
But good enterprise visibility
Connection Center gaining traction
Over 20K users of AHA widget for BP monitoring
Highly structured, significant resources, political
Grumblings: “Where’s the marketing?”
Significant Traffic from Google
~4k/day seen by partner ISV
Loosely structured, few resources
Are they serious about healthcare?
Dossia Remains an Enigma
Slow roll-out, only one ISV live, APIs to build ecosystem?
No new members/employers
Where’s the value?
1/12/09 17
Copyright: Chilmark Research
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18. Looking to the Future for PHPs…
HealthVault No Longer Standalone
Property
Embedded in MSNHealth
Maintains strong clinical underpinnings
Google Focuses on Wellness
Healthy consumer centric
Turns to ad-rev model for support
Ads outside private domain
Dossia Slowly Fades
New members slow to appear
Governance challenges
Not an influencer in the market
Fourth Entity Appears
Many circling today
1/12/09 18
Copyright: Chilmark Research
For internal use only, not for distribution

19. Is the iPhone a Platform?
Leading Mobile
Web Platform
46% NA mkt
share
32% WW mkt
share
Tremendous
Momentum
Over 10K Apps
Over 450 in
Health &
Wellness
Technically, Not
a Cloud
Platform but…
Becoming de
facto platform
1/12/09 19
Copyright: Chilmark Research
For internal use only, not for distribution

20. Evolution Accelerates PHR Adoption
Adoption
High
User Value Proposition
Gen 4: Personal,
Users
Actionable, &
(Millions)
Connected
80
Gen 3: Data Aggregation
(Health Clouds Form)
Gen 2: Online 40
20
Gen 1: Isolated
Low
Time
2000 2003
1992 2008 2011
(Online)
1/12/09 20
Copyright: Chilmark Research
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21. Generation 4: “Convergence”
Personal, Actionable, Connected
Value: About Me, By Me, With Me, For Me,
Because of Me
1/12/09 21
Copyright: Chilmark Research
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22. Moving Ahead:
Adoption Challenges Remain
Data Liquidity
EMR adoption
Standards Adoption
Policies & Incentives
Portability, Privacy, Liability
Trust
Health Plan, Employer, 3rd Party
Consumer Apathy/Indifference
Education
Incentives
Solution Capabilities
Immature, Disparate
1/12/09 22
Copyright: Chilmark Research
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23. Drivers to Overcome Challenges
Accelerating, Employer-led Initiatives
Employee’s Financial Skin
Accelerating IT Adoption Among Providers
Incentives, e.g., eVisits, eRx
Consumerism Entering Healthcare
Visibility, Education
New Consumer-centric Technologies & Tools
Delivering Radically New Capabilities
Disintermediation of Care
Retail Clinics, Med Tourism, etc.
Providers Becoming Consumer-Savvy
1/12/09 23
Copyright: Chilmark Research
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24. What to Watch
Traction of Platform Plays
Data Sources (agreements)
E.g., Cleveland-Google, KP-MS
Consumer Adoption
Which sub-groups adopt
Developer Adoption
What are popular apps/services
Market Consolidation
Rationalization & Acquisitions
New players entering
Employer Successes
Demonstrable ROI
All Things mHealth
Smartphones App Ecosystems
Biometrics + Smartphone
1/12/09 24
Copyright: Chilmark Research
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25. Final Thoughts…
Privacy is a Ruse
Value is the Metric
Most PHRs are Garbage
Time to Kill PHR Term
Dated, confusing, and not reflective of consumer needs
Govt. Sponsored RHIOs & NHIN are Folly
Self-forming Clouds rain on parade
HIT Stimulus may be Wet Cement
Difficult to chip-out later
1/12/09 25
Copyright: Chilmark Research
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26. www.ChilmarkResearch.com
5 JFK St., Suite 404
Cambridge, MA 02138
1/12/09 26
Copyright: Chilmark Research
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