I've written about electronic health records here and elsewhere, so it's been fascinating to me watching the health industry lurch its way towards an EHR future. While I've endorsed WorldVista - an open-source EHR based on the VA's EHR system - I'm really platform agnostic, so long as a) there's a premise of openness, so that the records are portable for the patient and the data useful (albeit anonymized as neccesary) for researchers and b) the industry stop talking about it and start loading it. So the arrival of Microsoft HealthVault is, to my mind, a welcome kick in the pants for every hospital administrator and HMO CTO - the realization that this is not an optional future; if the health care industry just keeps sitting around, the market will create its own solutions and innovation will happen. The notion that Google, too, is out there with a looming Health product (whatever form it may take), is probably even greater catalyst for change.

I was curious, then, to read on the WSJ Health Blog today that the CEO of Aetna dismissed the Microsoft and Google efforts as "vaporware." The full quote from Aetna's Ronald Williams: "“We’re perplexed by the fact that their vaporware gets all this attention and we get very little.”

Aetna, you see, has its own product, called CareEngine and a press release describes it as "a patented clinical decision support technology". (Sounds like just the sort of thing Grandma's been asking for!) Evidently a patient can add their own information to it, and all care billed to Aetna gets fed into the record as well.

I myself am an Aetna customer twice over, and I had no idea they had a patient-centric records offering (turns out it's only available currently to 800,000 of 16 million customers). At first I thought it'd be great to get Aetna's product to try - and I will try to do so, both as a customer and as a journalist. But on second thought, I realize they have a hefty challenge ahead if they're going to convince me that Aetna's product is better than something Microsoft or Google or even WorldVista may come up with. Here's why:

1) I don't trust Aetna. I don't mean that I don't trust them with my health infomation. I have no doubt they'll bend over backwards to triply encrypt everything to ensure my privacy (and cripple all sorts of intriguing uses of my data in the process). No, I don't trust Aetna's product to act in my best interest. The one advantage the Journal specifies is that "all of your health care that gets billed to Aetna automatically loaded into the system." I guess that's useful - I won't have to load anything into the system manually. But the mention of billing makes me wary; really, I suspect Aetna's product is made for Aetna first, and for me second. That means convenience and cost-savings on their end - but what's it mean for me? They may be the "fourth or fifth largest software development company in the country” (a claim I seriously doubt), but are all of those engineers trying to find ways for the records system to work for me or to work for Aetna? The benefit of Google (maybe) and Microsoft (now) is that they're trying to please me, not Aetna's shareholders.

2) Their system is proprietary. Dollars to donuts that Aetna's records aren't portable if I leave Aetna - and even if they are, that the software it's built on is closed and locked down to outside developers or possible partners. Why's that matter? Because if it's an open system, 16 million customers may find ways to improve it; if it's really the fourth or fifth biggest software development project in the country, then I bet there's more than a few programmers who may have some nifty and novel improvements for it. But my bet is that such openness is impossible with Aetna's system, where I know WorldVista and I bet Google have some component of encouraging innovation in the platform.

Moreover, what happens to the data? How might Aetna use my data (anonymized, etc) and bundle it with other patients and use that for research - not just their own research for how they can save money, but real, ambitious scientific research of the sort Isaac Kohane et al dream of? Moreover, will Aetna allow their data to be combined with, say, Kaiser's, or WorldVista's to create a uber-database that could drive public health and medical research ever faster? I'm skeptical.

3) I love this last quote from Williams about Google and Microsoft: "Most of them in my experience have very little experience with the system.” Yes, and bless them for it. The "system", such as it is, is a total mess and hardly something you want to work within. This smacks of Politburo rhetoric; if you don't know the Machine, you'll never get anything accomplished. That sort of health industry centric perspective is just the thing that has kept EHRs on the shelf, and it's the stuff that we desperately need to move away from.

To Williams and Aetna, I say: please, prove me wrong. I would love to post that I had you guys totally mistaken. And to Microsoft today (and Google someday?), I say: What took you so long?

UPDATE: a very thorough drill-down into Microsoft's product at VentureBeat here and here.