Now here’s something you don’t see every day: the words “health” and “vault” in the same sentence.  Oh sure, we expect to see “health” and “exercise” or “health” and “diet” or even “health” and “medicine,” … but “health” and “vault”?

Well, let’s all get used to it because Microsoft has launched HealthVault, a free advertising-supported health portal.  (See article.)  Others like Revolution Health, WebMD and a number of insurance companies have been working on, or offering, similar portals that allow people to upload their medical records to a Web site and then choose to share that data with doctors, other health care providers or family members. 

Like all the others, Microsoft has offered assurances about patient control over all data submitted and the privacy of all personal information.  But health care information automation in the U.S. has struggled under concerns about the protection of private information and the inability to exchange health care data from one user or application to another.  Despite the efforts under the Health Information Portability and Accountability Act (HIPAA), and studies that show huge potential for cost savings in the health care system in excess of $500 billion over 15 years, the U.S. does not yet enjoy the same progress as some other countries have seen (e.g., Germany, Britain).

Value for Everyone?
If Microsoft (and Revolution Health, WebMD and various insurance companies) is successful over time in its claims of data protection and privacy for the individual, then the individual patient can obtain value from this service.  (None of the health care portal providers have offered up the transparency and evidence of design, deployment and operation to confirm and expand on the digital trust claims being made.)  But, this service, and the digital trust that accompanies it, does not offer value to the other important constituencies involved, so it is limited in its ability to pull health care information automation together for the big payoff.

For example, doctors, clinics and hospitals need other kinds of digital trust beyond mere patient records confidentiality to capture value in the service.  Imagine automatic (wireless) digital blood pressure cuffs, thermometers and even digital (wireless) stethoscopes easily, reliably and securely collecting, recording and transmitting patient data to a (secure) standard repository of clinical data (maybe even the HealthVault)!  Parts of this scenario have already been built and are being used in smaller ways.  For example, devices like the Health Buddy are used today in the Health Hero Network.  Or, imagine government accountability reports and pharmacy controls being included automatically!  These functions deliver value for other constituencies needed to succeed in overall value capture.  And, they need different kinds of digital trust to come along with them.

Been There Before!
The Digital Trust report series has chronicled this kind of circumstance before.  The whole scenario around electronic voting (see Volume 4 on “Compliance Management: the Business of Keeping the Business in Business” ) illustrates what happens when digital trust is absent for an important constituency.  In that case, election boards captured value from a claim of digital trust, but individual voters did not see the (different) digital trust necessary for their value payoff.  Only today, as digital trust features and evidences are being made mandatory through law and regulation, do we see the full value trail for electronic voting.

Maybe that’s what it will take for digital trust to emerge completely enough for all of the constituencies involved in health care information automation.  It would be a shame, however, if all we did was wait for law and regulation to force it to happen when the digital trust technology we need is already here.

The first tenet of the Hippocratic Oath is “First, do no harm.”  While I’m sure we’ll need a little bureaucratic boost to get standard formats and protocols, I’m also pretty sure that even Hippocrates himself would want us to press on with integrated technology, including digital trust technology, to deliver the tremendous value of better health care at less cost.