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Microsoft’s HealthVault: What Was It and Why Did It Fail?

Microsoft HealthVault was a web-based system for recording, storing, and maintaining digitised health information. Healthcare professionals and individuals could both use the service. 

The health record system was launched in 2007; however, due to low user numbers, HealthVault was permanently shut down in 2019 — despite the popularity of health and wellness applications, and the fact that the system was created by one of the world’s biggest software companies. 

So what was HealthVault? How was it used? And why was it closed?

Here’s a brief history of Microsoft’s healthcare record system and some of the lessons that the industry has taken from its failure.  

What Was HealthVault?

HealthVault was set up to let users collect their own personal healthcare information. Microsoft launched the service with the support of Johnson & Johnson, the American Heart Association, and Allscripts. 

Users could access information via the HealthVault website; however, its data could be shared with up to 120 different partner apps, including Microsoft Health, along with those of various hospitals and other providers. 

Microsoft’s HealthVault was the first service of its kind to reach the market; however, the lack of actionable information and low user numbers meant that it also served as a lesson for competitors venturing into the field later. 

When Was HealthVault In Operation?

Microsoft launched HealthVault in the United States in October 2007. The service was extended to the United Kingdom in June 2010. 

Microsoft initially announced HealthVault’s closure on April 5th, 2019. The service was operational until November 20th, 2019. 

Who Could Use HealthVault?

HealthVault was designed for individuals and healthcare professionals. As well as being able to access their own health records, parents could also manage their child’s records.

The system initially required users to have a HealthVault account which could be linked to a Windows Live ID, OpenID, or Facebook account; however, the ability to connect to Facebook and OpenID accounts was removed in May 2016. 

Using HealthVault

Users could either use HealthVault records via the HealthVault website, or through a device or partner app that could connect to the platform. 

When signing up to HealthVault for the first time, new users had to determine what data they would manage. Options included: 

• Managing conditions
• Tracking prescriptions
• Managing lab test results
• Getting and staying fit
• Caring for family members
• Connecting with healthcare providers

Users could also create an emergency profile that included details about allergies, conditions, medications, and emergency contact information. 

Using the HealthVault Connection Centre, it was possible to gather stats such as heart rate and blood pressure from connected medical devices. In 2014, Microsoft launched its own fitness tracker called Microsoft Band. Development and sales of this device were halted in 2016, and support for the companion app was discontinued in 2019. 

HealthVault also allowed the storage of medical imaging records. Both consumers and providers could view, upload, and download DICOM-based images either through the website or by a licensed third-party imaging viewer connected to HealthVault.  

What Went Wrong With HealthVault?

As with many tech projects, the failure of HealthVault wasn’t down to one specific issue. A catalogue of problems possibly contributed to the low user uptake.

Parallels could be drawn to Google Health which was launched in 2008 before being closed after just three years due to a lack of users. When Google wound down its health app, HealthVault was recommended as an alternative service. 

As smartphones and wearable devices grew in popularity, HealthVault remained a largely browser-based experience without a mobile app. With no app, HealthVault missed the opportunity to gather telemetry data, information on health habits, and other user-generated input. 

Over the years, the idea of integration with devices like FitBits was explored on several occasions, but these projects were always abandoned. 

In an age when patient-acquired data from social sharing and smart wearable health technology was growing, HealthVault’s lack of attention to dynamic data was costly. The web-based app was predominantly focused on traditional health records. However, this type of data is only a fraction of the picture of an individual’s health. 

Medical data in this format has limited use. These records were helpful for making insurance claims and for organisations processing healthcare billing but largely missed opportunities to add meaningful value in driving change in users’ health and wellbeing. 

What Was HealthVault Insights?

Launched in 2017, HealthVault Insights was a seperate app that provided trend analysis to users and providers. This short-lived research project used machine learning to examine data gathered from Apple Health and Google Fit services.

Microsoft gave no formal explanation for the app’s closure in 2018; however, at the time, it was believed that the decision was based on a lukewarm reception, with the few reviews on Microsoft and Apple app stores achieving low average scores. 

Microsoft’s Post HealthVault Focus

HealthVault’s demise coincided with a general shift at Microsoft from consumer-facing technology toward enterprise-level software. The company is now focused on developing services aimed at healthcare providers, allowing clinicians to share information securely and streamline interoperability and patient navigation. 

At the helm of the changes is Gary Moore, Microsoft’s corporate vice president for health technologies and alliances. Using Microsoft Azure-based applications, Moore is charged with building healthcare partnerships. 

What Next for Health Data?

Where the likes of HealthVault and Google Health have failed, Apple is looking for success. Launched in 2018, Apple Health Records connects with iPhones and Apple Watches for a connected user experience, allowing continuous monitoring and collection of health data. 

But it doesn’t end there. Apple’s Health Records can also gather data from third-party devices like blood-sugar monitors. 

What Happened to HealthVault Data?

After the closure of HealthVault, Microsoft deleted any data left in user accounts, and all apps reliant on any HealthVault data stopped working. 

Before deletion, all HealthVault users could migrate their data to services such as Get Real Health and FollowMyHealth. Users were contacted before data deletion, giving them the opportunity to migrate.

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HealthVault: Can Microsoft’s Personal Health Records System Change the Face of Healthcare?

Microsoft's new system to track personal health information aims to make it easy for patients to manage their health care. the program must overcome privacy concerns and win buy-in from many different players..

Meet Lisa. Lisa is a mother of two children, whose mother, coping with diabetes and asthma, lives with her. Microsoft’s recently released free personal health record system, HealthVault, was created with someone like Lisa in mind. HealthVault can enable Lisa to upload her mother’s peak-flow and glucose readings to her computer and share them with doctors. She can track her children’s immunizations, allergies, illnesses and doctor’s visits; search for information on illnesses and save to the HealthVault “scrapbook” what she finds.

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As “custodian” of this health data, Lisa sets who sees what; for example, her daughter’s track coach can see only relevant fitness information, and her son’s doctor sees only his information. And she can choose add-ons from HealthVault partners. For example, Lisa could select the “in case of emergency” application and print out cards for her family to enable emergency room personnel to see crucial health information. (When she searches HealthVault for information, Lisa also will see advertisements which support the program’s business model.)

The Lisa’s of the world represent what Peter Neupert, Microsoft corporate vice president for Health Strategy and former CEO of Drugstore.com, would call a “family health manager.” And family health managers are crucial to the success of HealthVault.

HealthVault was designed for such family health managers who want simplified interactions with their healthcare providers. HealthVault, Microsoft’s first foray into the consumer health space (it has already been a software provider to hospitals and health care providers) has ambitious goals, said Neupert at the product launch: “The real promise is can we connect all of the providers, all of the hospitals, all of the pharmacies, all of the imaging labs, so that it’s easy like today banking is easy. It is possible to make it easy for people to take their data from the source data providers, and put it in a simple area where they can manage it.” The question is: Can HealthVault advance such a goal?

Health care information today is on the whole a fragmented maze that both consumers and healthcare providers must spend time and money navigating. But with privacy fears, doctors’ distrust of patient-initiated health information and difficulty getting user traction to overcome, Microsoft will face an uphill battle in using HealthVault as a key to connecting health care silos.

Spotlight on Healthcare IT

HealthVault’s debut comes at an important time for healthcare information technology. The day after HealthVault’s launch, contracts totaling $22.5 million to nine health information exchanges to begin trial implementations of the Nationwide Health Information Network (NHIN) were announced by Health and Human Services Secretary Mike Leavitt. The move is designed to advance the federal government’s goal of most Americans having access to secure electronic health records by 2014. Less than a week later, on October 10, the eHealth Initiative—a consortium of health care representatives that advocates better health care through IT—unveiled its eHealth Initiative Blueprint. The blueprint is the action plan and shared vision of over 200 healthcare representatives on policies and strategies for achieving its vision.

These moves by HHS and the eHealth Initiative point to the need for simplification and guidance in what is an incredibly complex landscape. They also highlight the currently fragmented market Microsoft has entered, and the difficulty the company faces in getting physician support. Such support is not required for a personal health records system to work if the only intention is to keep the record locked away on a home personal computer. But that support is crucial if the product is to realize its promise to consumers: making managing healthcare information easier.

The Battle for Healthcare Provider Buy-In

Judging by the adoption rates of electronic health records—the clinicals records used by healthcare providers—that won’t be easy. Just 24 percent of doctors use electronic health records (EHRs, also called electronic medical records), according to a study by the health care philanthropic group the Robert Wood Johnson Foundation . And although data is poor on the percentage of hospitals using electronic health records, the report estimates 5 percent of hospitals use computerized physical order entry systems, a form of electronic medical records.

Electronic medical records are to personal health records (PHR) what a doctor’s charts are to family health folders tucked away at home. In the latter, it is the patient who controls the information, and because of the idea of a PHR many healthcare providers distrust the concept as a clinical tool.

To truly be useful as a bridge across the silos of health care, a personal health record such as HealthVault would need to receive buy-in from doctors as well. But that will be difficult; healthcare professionals need electronic records that are useful to them, not only to patients, according to some healthcare IT practioners. A useful personal health record would need to be clinically accurate and available to different technology platforms that healthcare organizations use.

“In order for it to be a good electronic record, it has to have clinical relevancy, one record that goes across the continuum of care,” says Bert Reese, CIO of Sentara Healthcare.

Paul Contino, VP of IT at Mount Sinai Medical Center in New York agrees. “[Microsoft doesn’t] have the data sources that are needed,” he says, noting that primary care physicians have some of the most valuable clinical information—and these time-strapped offices are the hardest to convince to participate in data-sharing systems like HealthVault.”

Microsoft officials say they are working on these problems. To increase HealthVault’s relevancy to doctors, clinical information (usually as a PDF) can be uploaded to the system. In addition, Microsoft is developing verification methods that ensure information has come untampered from a physician or a medical facility, says Sean Nolan, chief architect for Microsoft Health Solutions Group. Microsoft has also sought broad industry support. More than 40 applications and devices are expected to be available through HealthVault through partnerships with the American Diabetes Association, American Heart Association, Johnson & Johnson LifeScan, the Mayo Clinic, New York-Presbyterian Hospital among others. In addition, Microsoft says HealthVault is built with a platform that can be adapted to work with any health data standard and the company expects the ability to communicate with any widely used health information protocol.

Beyond the support required from healthcare providers, HealthVault needs users—like those family health managers Neupert spoke of. On the surface getting people to buy-in would seem a low-hanging fruit. In a 2006 survey of 1,003 Americans by the Markle Foundation, 65 percent of respondents said they are interested in accessing their own personal health electronically. And 90 percent said they considered it important to track online their symptoms or changes in health care.

But while Americans say they are interested in electronic personal health records, two other studies show that consumers aren’t actively participating in such systems. Only 11 percent of Americans currently use a personal health record to keep track of their medical and health history, according to a survey conducted by research consultancy Ipsos Mori for Aetna healthcare and the Financial Planning Association.

This despite the estimated 70 million who have access to basic PHRs through their health insurers, according to Aetna. The survey polled 2,100 adults 18 and older and found that 64 percent of respondents said they do not know or are unsure about what a personal health record is. A similar study conducted by IDC’s Health Industry Insights found that 83 percent of 1,095 consumers surveyed have never used personal health records in either electronic or paper form. The primary reason for not using a personal health record, according to the survey results, is lack of awareness. (IDC shares a parent company with CXO Media, CIO.com’s publisher.)

Contino, the IT executive from Mount Sinai Medical Center, says the Microsoft approach and others like it are asking a lot of consumers as they gather information. He feels consumers would pay for access to a personalized medical information portal, as opposed to Microsoft HealthVault’s ad-supported model (searches yield relevant ads). But, he says, the health provider has to make it easy for the consumer. “If I have to collate all the information, why would I pay?”

The P Word: Privacy

Even those who are aware of personal health records, have another issue with personal health records: privacy. The Markel survey found that 80 percent of Americans are very concerned about identify theft or fraud and 77 percent are concerned about the possibility of their information getting into the hands of marketers.

The public overestimates the security of personal information in the current system, says Dr. Ashish K. Jha, an assistant professor of health policy at the Harvard School of Public Health. Speaking earlier this year at an event to highlight the Robert Wood Foundation’s findings, Jha said : “You can walk into a hospital with a white coat, go to the medical records room and pull out somebody’s chart relatively easily. It’s very hard to do that with electronic records that are designed well.”

Micrsoft says it has put stringent security and privacy safeguards in place. As testatment Nolan points to the blessing HealthVault has received from Dr. Deborah Peel, founder of the consumer advocacy group Patient Privacy Rights .

“We knew that it was pretty important that [HealthVault] be something people could trust, so we set out clear strong privacy guidelines,” says Nolan. The company worked with the Coalition for Patient Privacy, which advocates putting patient privacy at the core of the healthcare IT system, to develop its product. For example, a central tenant to the coalition’s stance is that “patients own their health data and should control who has access to their personal health records.”

Nolan says the user’s control of all personal information in HealthVault accounts illustrates Microsoft’s commitment to privacy. The consumer has complete control over what information goes into HealthVault, and who sees what. (HealthVault can be opened selectively by the controller of the record, or the “custodian” who sets access and security of the record.) Microsoft says it will never use a consumer’s HealthVault information in a commercial way without getting his permission. In addition, the transmission of “sensitive personal information, such as a credit card number” is protected with secure socket layer (SSL) protocol. And although users will see ads based on their current search, searches will not carry from one visit to the next. In addition, HealthVault’s systems protect data by isolating its data traffic onto a virtually separate network and servers that are located in different locations and in locked cages.

Projecting the Impact of HealthVault

Janet Marchibroda, CEO of the eHealth Initiative is optimistic about what HealthVault’s significance might be. “What Microsoft’s announcement does is put pressure to provide consumer access to health information.” Once people knock on your door, and they find out you’re not electronic or have no interoperability there will be pressure to deliver those things.” As for consumers’ privacy concerns, she points out that what was unthinkable not too many years ago—online banking or purchasing, for example—has become commonplace. Likewise, HealthVault has one potential answer to consumer frustration over lost time and money in the Kafkaesque maze of the current healthcare system. “The key part is having consumer applications like this connect to the real places where I get care.”

Francois de Brantes, national coordinator for Bridges to Excellence, a health care quality reform organization, also thinks Microsoft’s HealthVault has the potential to have a profound effect. “One of the things that excites me about Microsoft’s HealthVault is that they’ve made inroads with provider organizations.” Adoption of HealthVault, he thinks, could serve to both push the electronic record discussion forward, as well as push legal issues around health information ownership.

All that hinges on what kind of buy-in HealthVault gets. If users do not trust in HealthVault’s privacy and security safeguards, Microsoft will be facing an uphill battle. “A trusted third-party [to using PHRs] is key. The consumer views of Microsoft are somewhat negative,” says Contino, adding that “a lot of other companies will have the same problem.” Contino guesses a trusted third-party will be a hospital or medical provider, as opposed to an insurer or software company.

Reese agrees that a trusted electronic health information system will come from hospitals and healthcare providers. However, he does think that software giant’s presence in the personal health records space may push forward the discussion of electronic health records more generally. “Microsoft in this space might get the conversation up on the national landscape,” he says. However, “it’s in no way a sustaining step.”

John Glaser, CIO at Partners Healthcare , says Microsoft’s entry into this space is “an interesting move. The personal health record is a complicated space and we are still learning about the importance of these applications, the provider willingness to integrate with them and consumer desire to have one.”

Ray Campbell, CEO of Massachusetts Health Data Consortium , comprised of key New England health care organizations and which provides comparative data and promotes electronic standards, echoes that cautiousness, “The Microsoft announcement is—like every other personal health record announcement—just an announcement. There are a lot of people with a lot of faith in personal health records, but nobody has been able to convince patients of the value of using an online system. My attitude is to wait and see what the adoption numbers look like.”

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• v.18(2); Mar-Apr 2011

The military health system's personal health record pilot with Microsoft HealthVault and Google Health

1 Clinical Informatics Department, Walter Reed Army Medical Center, Washington DC, USA

Rick Barnhill

2 Clinical Informatics Department, Madigan Army Medical Center, Tacoma, Washington, USA

Kimberly A Heermann-Do

3 Office of the Chief Medical Information Officer, Office of the Surgeon General, Falls Church, Virginia, USA

Keith L Salzman

Ronald w gimbel.

4 Biomedical Informatics Department, Uniformed Services University, Bethesda, Maryland, USA

To design, build, implement, and evaluate a personal health record (PHR), tethered to the Military Health System, that leverages Microsoft ® HealthVault and Google ® Health infrastructure based on user preference.

Materials and methods

A pilot project was conducted in 2008–2009 at Madigan Army Medical Center in Tacoma, Washington. Our PHR was architected to a flexible platform that incorporated standards-based models of Continuity of Document and Continuity of Care Record to map Department of Defense-sourced health data, via a secure Veterans Administration data broker, to Microsoft ® HealthVault and Google ® Health based on user preference. The project design and implementation were guided by provider and patient advisory panels with formal user evaluation.

The pilot project included 250 beneficiary users. Approximately 73.2% of users were <65 years of age, and 38.4% were female. Of the users, 169 (67.6%) selected Microsoft ® HealthVault, and 81 (32.4%) selected Google ® Health as their PHR of preference. Sample evaluation of users reflected 100% (n=60) satisfied with convenience of record access and 91.7% (n=55) satisfied with overall functionality of PHR.

Key lessons learned related to data-transfer decisions (push vs pull), purposeful delays in reporting sensitive information, understanding and mapping PHR use and clinical workflow, and decisions on information patients may choose to share with their provider.

Currently PHRs are being viewed as empowering tools for patient activation. Design and implementation issues (eg, technical, organizational, information security) are substantial and must be thoughtfully approached. Adopting standards into design can enhance the national goal of portability and interoperability.

Introduction

Like other large healthcare organizations, the Military Health System (MHS) recognizes the potential value of an interoperable personal health record (PHR) in improving efficiency, enhancing quality and safety of care, and increasing consumers' participation in the healthcare process. 1 2 The PHR also shows promise as a tool to accelerate recent policy and regulatory goals by providing a source of health information exchange. Despite the promise, there are substantial barriers (eg, lack of role definitions, immature interoperability standards) to PHR adoption. 3–6

There are multiple PHR models that have been described in the literature, but most are variations of the stand-alone and the tethered PHR models. 7–12 The stand-alone PHR can be completely freestanding and dependent on self-entered data from patients or as an interconnected third-party PHR that can receive both self-entered and electronic health record (EHR) sourced data. A tethered PHR can be either provider- or payer-tethered. Regardless of model design, implementation challenges are formidable given barriers and debate on key issues such as privacy and security, architecture options, functionalities, and supporting policies.

The Armed Forces Health Longitudinal Technology Application (AHLTA) is the official outpatient EHR of the MHS connecting its medical centers, community hospitals, and clinics globally. As directed by both congressional and executive action, AHLTA, and all future health information systems, incorporates federal interoperability standards and implementation specifications. 13–15 In the FY 2008 National Defense Authorization Bill, the Veterans Affairs (VA) and the Department of Defense (DoD) were charged with the implementation of ‘electronic health record system or capabilities that allow for full interoperability of personal healthcare information for DoD and VA.’ 13 Part of this charge was incorporating a patient focus where beneficiaries will have access to their own medical information. 14 The Military Care (MiCARE) pilot represented an opportunity to advance this goal.

To evaluate the feasibility of delivering an interoperable PHR for its beneficiaries, the MHS decided to pilot recent PHR offerings by Microsoft and Google. 16 The MHS considered a number of government and commercial off-the-shelf products in deciding what would best meet the overall needs of the health system and its beneficiaries. Initial cost and schedule constraints prohibited the delivery of a full complement of PHR functionalities, so a phased approach was used, starting with patients' access to a personal health data repository. Both Microsoft HealthVault and Google Health PHRs met DoD information privacy and security requirements while providing the opportunity for military beneficiaries to access their health information via the internet.

Initiated in the spring of 2008, MiCARE was developed as a pilot project with the objective of expanding MHS beneficiary access to their EHR-based medical information via Google Health or Microsoft HealthVault (or both). MiCARE was created as a portal for users to manage their PHR account and access future PHR functionalities, and for access to other sources of health data. In this manuscript, we describe the design, implementation, and lessons learned from our initial MiCARE pilot.

System description

Pilot study design.

Our pilot was conducted at Madigan Army Medical Center, a 1.2 M square foot 400 bed tertiary care facility located in Tacoma, Washington. The facility is a designated Level II trauma center for the military and for Pierce County, Washington. 17 The county contains 750 000 residents, of which approximately 100 000 are eligible military beneficiaries enrolled to the facility for care. The facility is home to a variety of graduate medical and nursing education programs and employs approximately 4224 military and civilian staff. In a given year, the facility realizes >1.6 M clinic visits, >1.4 M prescriptions and >1.9 M laboratory procedures. 17 Madigan Army Medical Center was selected as a home for the MiCARE pilot in part due to the facility's size and its developed clinical informatics department.

The MiCARE pilot project was approved and funded in 2008. Primary development occurred between May and November 2008, with recruitment activity focused during the last 2 months of development. The pilot formally began in November 2008, and for 10 months the enrollment was capped at the first 250 users. Recruitment was open to active duty members, active duty family members, retirees, and family members of retirees. The pilot concluded in November 2009 when enrollment was opened to additional beneficiaries and remains so today. As of October 2010, there are >2000 enrollees with approximately 30–40 new users enrolled each month.

The MiCARE pilot was marketed to the target population using several strategies. Between August and November 2008, formal presentations were made to active patient advisory groups and beneficiary support meetings. Print advertisements were placed in the base newspaper and two local community newspapers. Posters were posted in the base department store, grocery store, and large electronic signs at the facility's main gates. Hospital staff members were encouraged to promote enrollment by personal referral. Finally, manned registration booths were established within the facility, and both a registration phone number and email address were created.

MiCARE operations: how it worked

As shown in figure 1 , enrollees accessed the secure MiCARE web server located at the American Lake Veterans Administration (VA) Hospital in Lakewood, Washington. This VA-based gateway served as the access point for transfer of patient data. When the participant selected the desired PHR repository via a data broker, Microsoft or Google exchanged a token with MiCARE which was stored in the MiCARE database. This token supported continued sharing of records with the beneficiary's PHR of choice. As the beneficiaries selected PHR data elements ( box 1 ), MiCARE would run a query over the MHS-VA Bi-Directional Health Information Exchange (BHIE) framework to search for similar data types at over 100 MHS sites and the MHS clinical data repository. Data returned from the query were placed into the PHR repository of choice for the beneficiary's access. The MiCARE users had rather comprehensive PHR data elements (eg, laboratory results, physician notes) available to them; many contemporary PHRs do not include all of these elements. 18

MiCARE architecture BHIE, Bi-Directional Health Information Exchange; DNS, domain name system; MiCare, Military Care; SQL, structured query language; VA, Veterans Affairs.

Military Care personal health record data elements

• Laboratory results *
• Medications
• Radiology reports
• Appointments
• Medical procedures
• Medical problems list
• Consultation reports
• Inpatient notes
• Outpatient encounter notes

* Laboratory results were added in October 2009.

MiCARE architecture and design

MiCARE was architected to perform as a flexible platform for transferring data between various DoD data sources and stand-alone PHRs ( figure 1 ). MiCARE incorporated standards-based models including the Continuity of Care Document (CCD) and Continuity of Care Record (CCR) to map DoD-sourced data to standardized formats most commonly supported by healthcare systems. 19 In our pilot, Google Health operated a subset of the CCR to model its PHR data, while Microsoft maintained a custom model that includes support for the CCR as CCD standards. The architecture allowed MiCARE to adopt new data sources and partner with additional PHR systems in the future. The architecture repository was maintained by Microsoft and Google.

Microsoft HealthVault and Google Health utilize Service Oriented Architecture in their system design, providing accessibility of their systems through web services. The web services are implemented using varying technologies, Microsoft uses their standard Simple Object Access Protocol, and Google uses the Atom Publishing Protocol. Both service interfaces are encapsulated in software development kits (SDKs) which provide us with a simplistic means of integrating with the PHR systems using our native development environment, Microsoft.NET. Unfortunately, these two SDKs expose very different application programming interfaces (APIs), and the interfaces accept data in widely dissimilar formats requiring MiCARE to translate between a common set of DoD data types and interfaces, and the varying data and interfaces exposed by the PHR APIs.

The approach used in MiCARE was to define commonly used data types and interfaces for communicating with the disparate PHRs. MiCARE was designed to accommodate the implementations for each PHR by mapping commonly defined schemas and interfaces to and from the PHR-specific services. By virtue of this standardized communication scheme, it is possible to integrate additional DoD data sources and third-party PHR systems more quickly and easily. For a detailed comparison of Google Health and Microsoft HealthVault attributes, see table 1 .

Comparison of Google Health and Microsoft HealthVault attributes during pilot

PHR, personal health record.

Health system organizational issues

Although some health organizations make available all data for the patient when available in the EHR, clinicians at our pilot site elected a 7-day wait period for clinical studies and excluded results related to sexually transmitted disease, pregnancy tests, and pathology reports. The delay provided the provider with an opportunity to contact the patient to interpret the results before viewing in the PHR and is adopted by other health systems with PHR capabilities. 20 21

For consumer control, a MiCARE enrollment module provided MHS beneficiaries the ability to self-register, initiate, or stop the transfer of their electronic health information. The module also enabled the patients to share their data. Exactly what data to share and whom to share them with was facilitated through the PHR of choice (ie, Microsoft HealthVault or Google Health). With Google Health, the sharing was at the ‘all or none’ level. With Microsoft HealthVault, data sharing granularity was at the ‘individual data element’ level. Sharing decisions would be selected by the beneficiary as permanent or temporary. Access to the beneficiary PHR account was retained regardless of election to change provider or departure from beneficiary eligibility (eg, left military).

Data credibility is critical for system adoption by providers. 9 22 Microsoft and Google both identify sources for data received. Both products display the source as an institution such as ‘Madigan Army Medical Center’ or person such as ‘John Doe.’ In the case of Google Health, the source name remains constant with the addition or deletion of data. With Microsoft HealthVault, data may be edited or redacted, but when performed the source name is modified to reflect the institution or individual initiating change. In our pilot, beneficiaries were prohibited from directly editing or deleting their official medical record; necessary changes were performed instead through an administrative office. While our pilot allowed patients to be in full control of compiling and releasing their available medical record, it also provided the integrity of the unaltered data from the official medical record, necessary for provider confidence in the system.

Keeping medical information secure is of utmost importance to sustain the provider's and patient's trust. In our pilot, we established responsibilities for the MHS, the PHR vendors, and the patient participants. Data were generated from a Health Insurance Portability and Accountability Act (HIPAA) covered entity with a copy stored in the patient selected PHR repository (ie, Google and Microsoft); the PHRs were neither HIPAA covered entities nor linked to the MHS via Business Associate Agreement. Due to the sensitive and personal nature of the data stored in the PHR, Google and Microsoft relinquished complete control of the data to the patient, which in effect elevated the protective level beyond HIPAA requirements. While HIPAA allows disclosure of patient information without patient consent under certain criteria (eg, billing, quality improvement), Google Health and Microsoft HealthVault privacy policies did not.

The MHS Privacy Office extensively reviewed Microsoft and Google's privacy policies requesting multiple revisions and provisions related to our pilot. Revisions and accommodations related to specific requirements for physical location of PHR servers on US soil, physical security for servers and access procedures, and liability issues in event of breach. Both Google and Microsoft had well-established established policies in the event of security breaches. Both Microsoft and Google agreed to cover cost associated with any realized breach (eg, patient notification, individual credit reports) with liability capped at $1000 per user.

The legal exposure of providers who intentionally or unintentionally did not review patient-authored PHR health information was evaluated and cleared by MHS legal prior to pilot implementation.

Planned evaluation of MiCARE

There have been a number of attempts at evaluating the utility and usability of PHR functionalities. 7 8 18 21 23–25 While there seems to be some agreement across studies on PHR functionality, implementation choices appear somewhat dependent on the home institution's beneficiary and provider preferences. When designing our pilot, we opted for a two-pronged approach to evaluation. Specifically, we administered telephonic surveys of users in April 2009 and received ongoing feedback from advisory panels (providers and patients) on functionality and usability of MiCARE.

Status report and results

Aggregate pilot study data.

The pilot study user group included 250 MiCARE users enrolled between November 2008 and November 2009. Of the MiCARE users, 169 (67.6%) users selected Microsoft HealthVault, and 81 (32.4%) selected Google Health as their PHR of preference. Formal agreement with MHS leadership limited the amount of demographic information (ie, gender, age, and beneficiary category) that our MiCARE team was permitted to collect and report ( table 2 ). The MiCARE pilot user group included 96 (38.4%) females and 154 (61.6%) males. When compared to facility and MHS beneficiary demographics, our pilot included slightly fewer females than represented in the population. With respect to beneficiary category, 60 (24%) were active duty members, 79 (55.6%) were family of active duty members, and 111 (44.4%) were retirees and their family members. In comparison, the MiCARE pilot included a better representation of active duty family members and retirees than active duty members. This might be explained by the substantial deployment requirements currently being imposed on the active duty members. With respect to age of the MiCARE users, the mean age was 53.14 (SD 1.5) years. During the pilot, 73.2% of users were <65 years of age, which compares well to MHS beneficiary-wide data, which were 79% for the same age parameter. 26 27 To our knowledge, only one (0.4%) of the 250 MiCARE enrollees withdrew during the pilot period.

Military Care pilot group users: demographics

The MiCARE team began tracking usage statistics, using Google Analytics beginning in April 15, 2009. Table 3 provides overview statistics trended over time. The usage rate approximately doubled in the last two periods that is explained by the introduction of laboratory results into MiCARE. While originally planned from the onset of the pilot, the provider 7-day wait period in release of laboratory results (mentioned previously) resulted in a delay in adding the highly desired feature by MiCARE users. This policy-imposed mandate was time-consuming to implement, as over 3000 laboratory result types were modified to accommodate the delay.

Military Care usage statistics—trended

Data were calculated from Military Care portal using Google Analytics.

Telephone interviews of MiCARE users

The MiCARE team conducted telephone user interviews as planned in April 2009 by selecting a convenience sample from the 250 users stratified by user type (ie, active duty members (n=20), family members of active duty members (n=20), and retirees (n=20)). The team members called on MiCARE users and continued calling from a stratified list until they had achieved their 60 participant target. Survey results are recorded in table 4 . As expected, the majority of users conveyed satisfaction with MiCARE access to their PHR. The respondents were consistent in their desire for additional functionality (eg, secure messaging, appointment function) and offered additional unscripted feedback on system improvement (see table 4 ).

Results of telephonic survey of Military Care (MiCARE) users (n=60)

Provider and patient panel feedback

Our provider and patient panels met on a monthly basis during the first phase of work (May to November 2008) and bi-monthly during the actual pilot (November 2008 to November 2009). These panels proved useful to the MiCARE team, especially in understanding clinical workflow of participating providers and clinics. The panels also served as a platform for providing feedback on the usability of initial and add-on applications throughout the pilot ( table 5 ). The panels initially comprised 10 participants each, but the composition and number of participants changed over time as additional participants joined early efforts.

Salient feedback from Military Care provider and patient advisory panels

Technical issues

During our pilot, Google implemented seven of 17 XML-based CCR standards (ie, allergies, conditions, immunizations, medications, procedures, test results, demographics). While these sections were useful, researchers have noted that radiology reports and physicians' notes are among the most often requested information by patients for the PHR. 18

Adding data to Google Health involved specifying two pieces of information, a Notice and an attached CCR payload. The Notice could be compared to an email message. In our pilot, MiCARE sent an empty Notice with a subject (eg, new medication) and attached a related CCR (eg, medication information). When Google Health received the notice it parsed the medications from the CCR and stored the records discretely in the PHR. Any data elements not in the seven CCR categories that Google had implemented such as clinical notes, radiology reports, and appointments were transformed into HTML and stored as Notices. The latter created a challenge for patients or providers to quickly identify, search, or retrieve information stored in Notices.

During our pilot, Microsoft HealthVault accepted both the CCR and CCD. The CCD's primary use case was also the sharing of summary data by constraining the Clinical Document Architecture (CDA) with the data set from the CCR. 28 Like the CCR, the CDA can be used to collect data from multiple sources and multiple encounters. Unlike the CCR, the CCD has an information model based on the HL7 Reference Information Model and is extensible, while CCR is fixed. 29 During the pilot, we found that the amount of resources and time required to assemble non-document data types, such as laboratory results, into the CCD was not acceptable, and so the HealthVault API was used for all laboratory results, medications, and allergies. For documents, the MHS has standardized sharing of clinical documents using the CDA. Currently, clinical documents such as discharge summary are out of scope for the CCR. 19 Despite the richness of the CDA metadata in describing document type and origin, Microsoft HealthVault did not capitalize on the metadata in managing clinical documents. The end result was a user experience similar to Google Health where the beneficiary was required to scan and click through a potentially long list of documents to find the information of interest. During the pilot, we discovered a number of clinical documents stored within our system of record that failed to validate against Microsoft HealthVault CCD schema. We designed MiCARE to convert these documents to PDFs and store them in HealthVault's ‘Documents (File)’ type. This too placed limitations on the user's ability to search and retrieve effectively.

Both CCR and CCD attempted to serve the same purpose of capturing a periodic episode of care. Google and Microsoft adopted two different approaches to constructing a longitudinal record from summary records. With Google Health, each incoming CCR was automatically parsed into discrete data elements. In Microsoft HealthVault, the user was required to manually select which data element, from the CCR or CCD, to store in the record by using a ‘reconcile’ process in the HealthVault user interface known as the HealthVault Shell.

Lessons learned

In the development and implementation of the MiCARE pilot, we realized four lessons learned which may be useful to others considering PHR adoption.

Data-transfer decisions (eg, push vs pull) are important and may influence system performance. We found that most of our MiCARE beneficiaries elected to transfer all of their health data into the PHR. Initially, the transfer of data occurred automatically as the data became available in the source system. However, the impact of substantial data transfer had a negative effect on the speed of the system which was not acceptable for the users. We made a decision during the pilot to eliminate automatic data transfer in favor of data transfer at the patient's request.

Issues surrounding purposeful delays in reporting and the sensitive nature of some clinical data in PHRs should be thoughtfully considered and discussed with key stakeholders. Some healthcare organizations, for example, provide laboratory results in the PHR as soon as they are available. In MiCARE, our provider panel requested a 7-day delay in the release of clinical results to facilitate sufficient time for the provider to contact the patient and explain the results prior to publication. While this policy was in conflict with the beneficiary panel request for instant access to their health data, we perceived that by not adopting the wait period, we would negatively affect provider acceptance and adoption. Additionally, in the absence of state or federal regulation, our provider panel decided that lab results related to sexually transmitted diseases findings, pregnancy results, and positive cancer findings would require contact from the provider and not be released into MiCARE without the request of patient and provider concurrence.

It is important to understand and map how the PHR may affect the providers' clinical workflow. Providers in our pilot found accessing the PHR to be a little disruptive in their clinical workflow. Feedback received from our provider panel included a recommendation to better integrate data from the MHS central data repository with PHR data to give a more complete view of individual patient records and a dashboard view of their patient panels for use in the provider's clinical workflow.

Decisions on what a patient may choose to share with their provider in their PHR is worthy of consideration and debate. The ability of a patient to exclude PHR information from their provider may result in the participating provider making clinical judgments with incomplete information which could result in negative unintended consequences. For example, there could be serious cardiac complications if a patient who is on an antipsychotic agent decides to hold that information from their cardiologist prescribing treatment with an antiarrhythmic agent. This can create a tension between patient control of health information and patient safety, which in turn may have an unintended consequence of lower provider acceptance of the PHR as a useful tool.

Although the PHR is being viewed as an empowering tool for patients, adoption is limited in part due to implementation barriers. We have adopted a third-party interconnected PHR model that incorporates national CCD and CCR standards. By adopting these standards, MiCARE and similar PHRs can move closer toward realizing a national goal of a portability and interoperability. Additional work remains in the full implementation of standards by both Google and Microsoft in improving the usability for both patients and providers.

By leveraging Microsoft and Google storage and infrastructure, our MiCARE pilot offered beneficiaries readily available access to their health information and use of PHR functionalities in Google Health and Microsoft HealthVault, or from optional third-party applications (eg, data import from medical devices, health-risk assessment tools) provided by Microsoft and Google's partners. While our providers and patients agreed on the desirability of various PHR functionalities, they were conflicted with respect to certain implementation choices. A central challenge faced when moving beyond pilot to full-system implementation is the emerging tension between access to health information and organizationally adopted business practices.

Acknowledgments

The contributions of J McCaffree, S Shore, T Nelson, K Allison, and E Eichost have been extremely valuable in the development of the MiCARE portal. The authors are also grateful to L Fagan for his reviews and to the many Microsoft and Google developers and administrators who were extremely supportive of the project.

Funding: Project funding was received from the DoD (Health Affairs) and the TRICARE Management Activity, project # 02EA3TTAUJ .

Competing interests: None.

Provenance and peer review: Not commissioned; externally peer reviewed.

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Microsoft is dropping its HealthVault patient records-management service, the company notified customers via email today, April 5.  The service will be shut down on November 20 and any data residing in the service will be deleted after that date.

HealthVault was one of the last pieces left of Microsoft's original foray into first-part health services products. Recently, Microsoft officials said they were ending support for the Microsoft Health Dashboard applications and services as of May 31 . Early last year, Microsoft dropped its HealthVault Insights application . HealthVault is a service for storing individuals' health and medical records and information so they can be shared with health professionals. Microsoft launched a beta of HealthVault in 2007 and went live with the service in 2009. Microsoft was still updating its HealthVault documentation on the docs.microsoft.com site as of December 2018.

Here's the text of the email Microsoft is sending to HealthVault customers:

"We are reaching out to you because you are a registered user of the HealthVault service. We are providing you this notice to ensure you are aware of an important development:

"The Microsoft HealthVault service will be shut down as of November 20, 2019. "Data you have in your HealthVault account will be deleted effective November 20, 2019. If you wish to keep the data in your account, you need to take action now to transfer that data from your HealthVault account. "Please take appropriate action to move your data or information you may have stored in your HealthVault account. To help customers that wish to transfer their data out of HealthVault, several options are available and described below. "If you are using an Application (mobile, web, etc.) that is dependent on the HealthVault service, such applications may also stop working once the HealthVault service is shut down. Please reach out to the Application provider for information on their plans. "We appreciate your use of the HealthVault Service. If you have questions regarding this communication please do not hesitate to reach out to HealthVault Customer Support."

Microsoft is not giving up on the healthcare market. In February this year , Microsoft Healthcare announced it was making generally available its Healthcare Bot Service; adding more healthcare-specific features to Teams; and adding new health-record integration capabilities to Azure and Teams. But like it has been doing on many fronts lately , it seems to be getting out of the consumer-facing part of the business.

Microsoft made its initial foray into healthcare over a decade ago, but ended up  retrenching and selling off most of the health assets it originally acquired . A couple of years ago, Microsoft announced it was creating  a new healthcare-focused research unit, Healthcare NExT .  Healthcare is one of Microsoft's highest priority verticals, as it's a growing and pervasive market.  

Microsoft is suggesting users who want to transfer or export their data to another personal health record provider contact Get Real Health (U.S. and international customers) and/or FollowMyHealth (U.S. customers only).

According to Get Real Health's April 5, 2019 press release , "by simply clicking on three buttons, HealthVault account holders will have data migrated to Get Real Health's Lydia platform." Lydia provides native Apple and Android apps; the ability to upload health data from any doctor or hospital; and "continuity of using HealthVault credentials for Lydia login." 

(Thanks to Chamila Udukumbura on Twitter for the heads up on the HealthVault news.)

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Evaluation of Microsoft HealthVault and Google Health personal health records

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Consumer healthcare is an approach to encourage patients to participate in the health system, possibly resulting in a larger data and information basis with better quality, potentially leading to healthier lifestyles, better diagnoses and treatments. Personal health records (PHR) are the important parts of consumer healthcare, used to organize healthcare information. Currently, the most well-known systems in this new market are Microsoft HealthVault and Google Health. In this article we list 25 features that we deem the end user sees as necessary for a successful PHR. We analyze the state of Microsoft HealthVault and Google Health in regard to these features. This article also examines and compares the design of the Application Programming Interfaces (APIs) of both systems since it will affect the number and variety of value-added applications that will be developed. The accuracy of an API design could be essential for the commercial success of these PHR systems.

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Sunyaev, A. Evaluation of Microsoft HealthVault and Google Health personal health records. Health Technol. 3 , 3–10 (2013). https://doi.org/10.1007/s12553-013-0049-4

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Microsoft HealthVault is officially shutting down in November

While the end of HealthVault is admission of failure for the company's initial forays into health, Microsoft has refocused its efforts in the industry toward the enterprise market.

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Microsoft’s ambition to create its own web-based personal health record system will come to an end on November 20, when the company is officially pulling the plug on its HealthVault service and deleting user data stored on the platform.

Users have the option to migrate their data to other personal health record services like  Get Real Health and FollowMyHealth . The company also recommended that customers using third-party apps that integrate with HealthVault should contact developers to insure continuation of service.

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In the ever-evolving landscape of state-based health insurance exchanges, the convergence of technology and customer service is reshaping how these exchanges operate. The increasing advent of automation and artificial intelligence (AI) is rapidly dismantling the traditional business model that relies on the siloing of technology and customer service centers.

HealthVault was initially started with the mission of allowing patients to collect their own data on their terms, which would then be harnessed to create applications and additional healthcare services.

While the service launched with prominent partners including the American Heart Association, Johnson & Johnson and Allscripts, HealthVault suffered from many of the same issues that felled its competitor Google Health.

Google Health, the search giant’s personal health information service was introduced in 2008 and ended three years later because of low user adoption. Ironically, one of the services suggested by Google when their own record system wound down was HealthVault.

Microsoft struggled with creating a sustainable business model around HealthVault and integrations with companies like Fitbit were abandoned over the years.

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Earlier this year, Microsoft scrapped its HealthVault Insights app , which applied machine learning to patient data to unlock personalized health insights. In March, the company said it was also going drop support for its Microsoft Band wearable and Microsoft Health dashboard, offering refunds to some users.

While the end of HealthVault is an admission of failure for the company’s initial forays into health, Microsoft has refocused its efforts in the industry toward the enterprise market.

Reflecting a larger shift at the company away from consumer-facing technologies, Microsoft has instead launched new provider and health plan-focused products meant to allow clinicians to communicate and share notes securely, assist in patient navigation and remove technical barriers to interoperability.

Recently, Microsoft announced Gary Moore as the company’s corporate vice president of health technologies and alliances, charged with forging partnerships with existing healthcare stakeholders.

The company is also a leading cloud provider in healthcare with its Azure platform competing head to head with rivals like Amazon Web Services and Google Cloud.

Taking the baton from products like Google Health and Microsoft HealthVault, Apple has made major inroads with its Apple Health Records system.

Since its launch in 2018, the company has signed up more than 140 provider and health system partners and recently struck a deal with the VA to provide personal health records for veterans.

In a preliminary study on the effectiveness of Apple Health Records on patients, UC San Diego researchers pointed to a few factors that could lead Apple’s personal health record effort to succeed, where other tech giants have failed.

Chief among these were the near-universal adoption of mobile technology (like the iPhone), advances in connected devices (like the Apple Watch) that can continuously monitor and collect health data and the introduction of new data standards allowing for better sharing and connection with health system records.

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• DOI: 10.1007/s12553-013-0049-4
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Evaluation of Microsoft HealthVault and Google Health personal health records

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• Computer Science, Medicine

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Consumer facing health care systems, the usability study for the personal health record systems, comprehensive personal health knowledge graph for effective management and utilization of personal health data, personal health record systems as boundary objects, electronic personal health record assessment methodology: a review, computer-aided big healthcare data (bhd) analytics, exploring the far side of mobile health: information security and privacy of mobile health apps on ios and android, ambient intelligent model for life reinforcement, balancing patient control and practical access policy for electronic health records via blockchain technology, ehealth cloud security challenges: a survey, 38 references, comparative evaluation of google health api vs. microsoft healthvault api, evaluation framework for personal health records: microsoft healthvault vs. google health.

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A First Comparison of Google Health and MS HealthVault

While details are thin, here’s a first pass at comparing and contrasting Google Health (GH) and Microsoft HealthVault (HV).  Overall, there are many  common features, some differences, and many common challenges between these two platforms. 

A High Level Comparison

Google Health and Microsoft HealthVault Personal Health Information (PHI) Platforms

There’s still not much information available about the specifics of GH, although they did release  sketchy information on the Official Google Blog .  I’ll comment on a few of the particulars.

Commonalities

Both are patient controlled — data is released only with patient permission. 

Both GH and HV make claims of data portability.  This is in contrast to the “tethered” model of many personal health records (PHRs) being offered today by employers, health plans, and care providers; in a tethered model, PHI is not portable — if you leave a health plan or employer, or if you get care outside the provider’s system — your data does not follow you.

Both have adopted broad technical standards to facilitate interoperabilty of PHI (e.g., the HL7 CDA Continuity of Care Document and the ASTM Continuity of Care Record). Thus, it should be possible to exchange your PHI between GH and HV, and among other parties that have adopted similar standards.  When? can I move all my PHI? will data exchange be easy or require 32 steps? — these questions can’t be answered yet.

Thus, the market for PHI should look much more like the market for fax machines than the market for high definition DVD players. Fax machines of different brands can exchange information — but they compete on features, price, ease of use, etc.  At this point I don’t foresee a standards battle-to-the-death such as the one that occurred between Sony Blu-ray and Toshiba HD DVD.

GH and HV also will compete on many other levels — applications, 3 rd party complementors, user friendliness, etc.

HOWEVER, While GH and HV will compete, at this stage of evolution they are should be far more collaborative than competitive.  Using Clay Christensen’s terminology, the primary competition is non-consumption — people will need to learn about why their PHI is important and how to use a PHR. 

The common goal for both GH and HV is to build the size of the network for PHI.  The total value of the network is dependent on reaching a tipping point and creating a network effect ; the value of the network grows exponentially based on the number of users, thus growing the overall size of the market is a win-win.

Both are platforms.  Platform models and platform strategy are almost unheard of in health care, but there’s extensive experience from other industries.  See e.g., The Elements of Platform Leadership , MITSloan Management Review, Spring 2002 or Platform Networks—Core Concepts , MIT Center for Digital Business, June 2007 (warning: not easy reads, but very helpful to understand platforms).

Both GH’s and HV’s long-term revenue model is unclear.  Neither Google nor MS have been very specific about their long-term plans for monetizing their offerings.  I think this is smart as it’s very early and we don’t know what will and won’t work; they have many options.  Both seem to recognize that there is tremendous value to be created in this type of collaborative network, yet both seem unclear about the best ways to do so.

Finally, both GH and HV appear to be extremely sensitive to privacy/security issues. Both claim that they will not use PHI to create targeted ads, but there are many disbelievers  Here’s a cynical but representative comment from the TechCrunch blog:

“Your search for cra sincaunre yielded 0 results. Since we can see from your medical records that you have dyslexia, perhaps you meant _car insurance_?”

Some Differences

Out of the box, GH is a PHI platform and a PHR. HV is a PHI platform, not a PHR.  (had enough initials?)

GH seems much more B2C focused.  HV seems more focused on developing B2B partnerships with their 3 rd party complementors taking on the responsibility of developing applications and signing up users.

Thus, HV seems more dependent on its complementors for ultimate success.  If the partners build good applications and attract a lot of patients, HV can flourish. If the partners sit on their hands, HV might have to rethink whether it wants to build and market more applications on its own. While GH also will allow 3 rd party complementors to build applications, GH seems more inclined also to build apps on its own.  Details here are particularly thin, so watch this over time.

GH seems more intent to develop mechanisms to automate gathering and updating of PHI from other parties in the health care system — hospitals, doctors, health plans, labs, etc.  While there is nothing to preclude HV from doing similarly in the future, I believe MS will have have more channel conflict issues because MS already does substantial business with health care organizations.  GH will probably be less concerned about using more strong-armed tactics to obtain data on patients’ behalf.  Again, the HV model seems to pass this responsibility on to complementors for now. 

Some Common Challenges

Gaining consumer trust — avoiding a fatal mistake of a PR disaster through a security breach or violation of confidentiality (real or perceived)

Using carrots and/or sticks in working with complementors?

Using carrots and/or sticks in trying to extract data from health care incumbents?

Growing the overall size of the network. 

Adding useful applications, whether from GH or HV themselves, or with 3 rd party complementors. 

Bottom line: more similarities than differences.  It’s early. The platforms are flexible and will evolve…stay tuned.

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13 Comments

Hi Vince, Pretty decent job here sizing up these two major healthcare initiatives. An important point to bring to the forefront is the over-riding trend to bring consumerism to the healthcare sector, which both MS and Google are intending to do. In my conversations with both firms, they have been equally adamant in stating that this is going to take a lot of effort and time and are in it for the long-haul. Will just have to wait and see how all this plays out.

Which leads to the next question: OK, so we have Google and MS with their platforms, so what is Dossia’s role in all of this and for that matter, with all the partnerships being announced, where are the HIEs and RHIOs in these announcements?

Maybe I can address that one over on my site. Will put up a brief post mentioning this one today.

John, YES, this is about bringing consumerism to health care, and YES, Dossia/HIEs/RHIOs and others will play a part in this new network and ecosystem (more on this soon on from my end as well). No one has this all figured out yet, and the blogosphere can help speed up the collective learning process. Let’s keep at it.

So is this concept “live”? I saw a company, My Medical Records, at HIMSS. For 9.95 a month they will track my medical records, my familys records, my car registration, pictures of items in my home, and the last time Fido had a case of Ringworm. Is this what Google and MS are up to? I would love to use it so I could transport my own medical condition across state lines by giving a Doc a website and access code to see all of the info that they charge me 5-15 dollars to get a copy of… What can I use now?

So here’s a product that mixes the best of all worlds. The EMRy Stick is a portable PHR flashdrive that patients carry with them therefore alleviating the HIPAA issue. It is the only product that I could find which has the capability of tying in all EMR systems so the medical records can be updated automatically. Currently it is configured for MYSIS, and is working on Centricity. As they configure more and more systems, patients will then be able to go to their Doctors and have accurate information uploaded automatically saving the Doctors and Patients time which ultimately means money.

Google and MS health vault seems to be very similar in terms of several issues. I think this is again a war about ads. Ads means money which is very important. In my opinion money should stand in the second row, trust of information should stand in the first row.

This is a great post and I’ve passed the link on to a number of my customers and colleagues who have been asking me about both the Google and Microsoft offerings in this space, what the major differences are and where they are headed.

great side by side comparison. it will be interesting to see how this plays out. It’s kind of exciting in a way.

The crucial thing is “Both are patient controlled — data is released only with patient permission. ” Now that thats out of the way we can look at other concerns. Privacy concerns will always be there but this is a fine start.

I think I’d still be concerned about privacy issues using either system

I think the issue is also privacy and what company has more potential to develop new products and services in the long run. Obviously, you already show us that it seems that once again, Google is the clear winner.

Marketing is what I do, but like the poster above I also agree that marketing should not come before patient privacy issues.

Being able to have portable patient care records is a major plus. In other places that I lived like Canada and england, socialized medicine has centralized some information but not a whole lot.

From one doctor to the next, they are frequently still insisting that you back under the darn x-ray machine to take a picture of something you know has been done thrice in the past few days/weeks/months ( take your pick )

Insurance companies can use a lot of this type of information to raise one’s premiums. Privacy issues were mentioned above, but what happens when they get involved?

I agree with that HV and GH should be doing this as a collaborative effort instead of a competitive one, this way they could share helpful information with one another , and this can be beneficial for both of them, they could better service their members/clients and in turn their satisfaction ratings would go up and they can propagate even further.

From what I see they seem to have more similarities that differences so they could interact easily , true that they may end up giving up some vital info to the other side but I think the benefits they will gain through cooperation outweighs that deficit,

OK, so when is the limit regarding medical privacy and the use of software? I simply can’t tell because at the end of the day, behind all these companies the money factor and the politics is a big issue, we should be alert to this type of issues and keep our eyes open for the future development of this “online” medical applications/services.

A First Comparison of Google Health and MS HealthVault | e-CareManagement http://bit.ly/3wBlIs

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How to view a health record in HealthVault

We care about your health and want you to know that Microsoft does not give any advice or recommendation on medical issues, medical procedures, dietary supplements, or other healthcare-related issues. Please contact your medical provider for any healthcare questions.

This article describes how to view a health record in Microsoft HealthVault.

More Information

You can store both personal and health information in a HealthVault health record. Personal information is stored on the Health information  tab as one of the following two types:

Basic Demographic Information. This includes gender, birth year, and postal code.

Personal Demographic Information. This includes name, birth date, and blood type.

Health information is also stored by item type on the Health information tab. To view the information in a health record, follow these steps. 

For more information about how to view a health record in HealthVault, go to the following Microsoft website: 

View a HealthVault Record

How to view information details

Any HealthVault customer who has sharing access for a health record can view the details of an information item unless the custodian marked the item as  Personal . To view the details for an item, follow these steps:

Print the item.

Edit the item.

Mark the information as personal.

View the history for the item.

From the top of the window, you can also take the following actions:

Delete the item.

Export the item.

See sharing.

Change the date range.

For example, you can save the data to a computer or disk as a .csv (comma-separated values) file. Then, you can open the file in a database, spreadsheet, or text-editing program that accepts the .csv format. The access and permissions for each user type are as follows:

A user who has View and modify  or  Custodian access can edit and delete the item.

A user who has Custodian  access can view the history and sharing status of each item and can mark the item as  Personal  to prevent noncustodian users from seeing the item when the record is shared. To confirm the source of an item, a customer can view the signature for the item if the creator digitally signed it.

Important When you delete an information item, you remove it from active status in the health record. All programs and noncustodian users cannot view the item. However, anyone who has  Custodian access can still view the deleted item on the History of Changes tab in the record.

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Competition Law Enforcement: Key Case Studies

Competition law enforcement has been instrumental in promoting fair market practices, with landmark cases serving as pivotal precedents for shaping the legal and regulatory landscape. Notable examples include Microsoft's antitrust saga, in which the company was accused of abusing its monopoly power by bundling its Internet Explorer web browser with its Windows operating system. The Google Shopping case is another prominent example, where the European Commission fined Google €2.42 billion for breaching EU antitrust rules by favoring its own shopping service over rivals. These cases, along with cartel conduct, abuse of dominance, and merger reviews in various regions, have contributed substantially to the development of competition law enforcement. Further examination of these cases and others reveals the complexities and nuances of competition law enforcement in action.

Table of Contents

Microsoft's Antitrust Saga

As the digital landscape was rapidly evolving in the 1990s, Microsoft's dominance in the software industry began to raise eyebrows among regulators and competitors alike. The company's market share and aggressive business practices sparked concerns about potential abuse of its monopoly leverage. Regulatory oversight bodies, such as the United States Department of Justice (DOJ), initiated investigations into Microsoft's conduct, focusing on its bundling of software products and alleged exclusionary behavior.

The DOJ filed an antitrust lawsuit against Microsoft in 1998, accusing the company of violating Section 2 of the Sherman Act. The case centered on Microsoft's practice of bundling its Internet Explorer web browser with its Windows operating system, thereby stifling competition from rival browser providers. The court ultimately ruled that Microsoft had engaged in anticompetitive behavior, ordering the company to split into two separate entities. While the breakup was later overturned on appeal, the case marked a significant milestone in the enforcement of competition law, highlighting the need for robust regulatory oversight to prevent the misuse of monopoly leverage.

The Google Shopping Case

The Google Shopping Case is a landmark competition law enforcement action that highlights the European Commission's scrutiny of digital platforms. In 2017, the Commission levied a record-breaking fine of €2.42 billion against Google for breaching EU antitrust rules, specifically for illegally promoting its own shopping service over those of competitors. This case centers on allegations of self-preferencing practices that distorted the online shopping market, ultimately hindering consumer choice and innovation.

Antitrust Allegations Raised

Regulatory scrutiny has been a recurring theme in Google's operational landscape, and the Google Shopping case is a seminal example of this phenomenon. The European Commission's antitrust allegations against Google underscore the importance of regulatory oversight in ensuring a level playing field in the digital marketplace. The Commission's investigation, launched in 2010, centered on allegations that Google had abused its dominant position in the search engine market by favoring its own comparison shopping service, Google Shopping, over rival services.

Industry scrutiny has been intense, with competitors and consumer groups arguing that Google's practices stifled innovation and hindered competition. The Commission's probe revealed that Google had systematically demoted rival comparison shopping services in its search results, while promoting its own service. This alleged conduct, the Commission argued, had a significant impact on the market, reducing traffic to rival services and depriving them of the opportunity to compete on equal terms. The Google Shopping case highlights the need for effective regulatory oversight to prevent dominant firms from abusing their market power and undermining competition.

Illegal Self-Promotion Practices

Google's self-promotion practices in the Google Shopping case have been a focal point of the European Commission's antitrust allegations. The Commission accused Google of favoring its own comparison shopping service, Google Shopping, over those of its competitors. This self-preferencing led to the demotion of rival services in search results, ultimately stifling competition. In addition, Google's practices were found to be misleading, as they included fake reviews and ratings that artificially boosted its own shopping service. Additionally, Google's advertising practices were deemed misleading, as they failed to clearly distinguish between organic search results and paid advertisements. These practices not only harmed competitors but also misled consumers, who were unable to make informed purchasing decisions. The Commission's investigation revealed that Google's self-promotion tactics had a significant impact on the market, leading to a substantial reduction in traffic to rival services. This case highlights the importance of ensuring that dominant companies do not abuse their market position through illegal self-promotion practices.

Record-Breaking Fine Imposed

In a landmark decision, the European Commission imposed a record-breaking fine of €2.42 billion on Google for breaching EU antitrust rules, marking one of the largest penalties ever levied on a single company. This decision followed a lengthy investigation into Google's alleged abuse of dominance in the online shopping market, where it was found to have unfairly promoted its own comparison shopping service, Google Shopping, over rival services.

The fine calculation was based on the gravity and duration of the infringement, as well as Google's revenue from its comparison shopping service. The European Commission considered the fine necessary to deter future anti-competitive behavior and restore fair competition in the online shopping market. This decision demonstrates the European Commission's commitment to regulatory scrutiny, ensuring that dominant companies do not abuse their market position to stifle competition. The Google Shopping case serves as a precedent for future antitrust enforcement, emphasizing the importance of fair competition in the digital economy.

Cartel Conduct in Europe

In the European competition law enforcement landscape, cartel conduct remains a significant concern, with the European Commission imposing substantial fines on companies found to have engaged in anti-competitive behavior. Notable price fixing cases have led to hefty penalties, highlighting the importance of effective leniency programs in detecting and deterring such conduct. The European Commission's approach to cartel enforcement has been shaped by its experience with high-profile cases, informing its strategies for identifying and punishing cartel activities.

European Cartel Fines

How effectively have European antitrust authorities been fining cartel participants, and what trends can be discerned from the sanctions imposed? The European Commission has been instrumental in cracking down on cartel conduct, imposing significant fines on companies found to be engaging in anti-competitive behavior. In recent years, the Commission has levied record-breaking fines, with some exceeding €1 billion.

In terms of fine calculation methods, the Commission typically considers factors such as the gravity and duration of the infringement, as well as the company's turnover. Additionally, the Commission may also take into account any mitigating or aggravating circumstances, such as cooperation with the investigation or obstruction of justice. Cartel investigations have revealed that companies often engage in sophisticated schemes to conceal their anti-competitive activities, underscoring the need for robust enforcement measures.

The Commission's approach to fining cartel participants has been shaped by its desire to deter similar conduct in the future. By imposing significant financial penalties, the Commission aims to create a strong incentive for companies to comply with competition law. In this respect, the trend towards increasingly severe fines is likely to continue, serving as a powerful deterrent to would-be cartel participants.

Price Fixing Cases

The European Commission's vigorous enforcement of competition law has led to the uncovering of numerous price fixing cases, underscoring the prevalence of cartel conduct in various industries across Europe. These cases involve anti-competitive agreements among competitors to fix prices, rig bids, or allocate markets, ultimately harming consumers and distorting competition.

These cases demonstrate the Commission's commitment to detecting and prosecuting cartel conduct, including bid rigging and market allocation schemes. By cracking down on such anti-competitive practices, the Commission aims to promote fair competition and protect consumers' interests. The Commission's enforcement actions serve as a deterrent to companies considering engaging in cartel conduct, promoting a level playing field across European markets.

Leniency Programs

A cornerstone of the European Commission's efforts to combat cartel conduct is its leniency program, which offers incentives to companies that self-report and cooperate with investigations. This program has been instrumental in detecting and prosecuting cartel cases, as it encourages companies to come forward and disclose their involvement in anti-competitive activities.

The leniency program provides significant benefits to companies that cooperate, including full immunity from fines for the first company to report a cartel and reduced fines for subsequent cooperators. The program's amnesty effectiveness is evident in the high number of cartel cases uncovered through self-reporting. In fact, the majority of cartel cases pursued by the European Commission have been initiated through leniency applications.

The leniency benefits are conditional upon the company's continuous cooperation throughout the investigation. Companies must provide detailed information about the cartel, including its scope, duration, and participants, as well as any evidence in their possession. The program's success can be attributed to its ability to create a strong incentive for companies to self-report and cooperate, thereby facilitating the detection and prosecution of cartel conduct.

Abuse of Dominance in Asia

Across Asia, competition authorities have been grappling with the complex issue of abuse of dominance, wherein a single entity or a group of entities exploit their market power to stifle competition and harm consumers. This phenomenon is particularly prevalent in markets with high concentration levels, where a single firm or a few firms wield significant market power.

In recent years, regulatory frameworks in Asia have evolved to address this issue. For instance, the Competition Commission of Singapore (CCS) has been actively enforcing Section 47 of the Competition Act, which prohibits abuse of dominance. Similarly, the Japanese Fair Trade Commission (JFTC) has been cracking down on abuse of superior bargaining position, which is a variant of abuse of dominance. In China, the State Administration for Market Regulation (SAMR) has been enforcing the Anti-Monopoly Law, which prohibits abuse of dominance. These regulatory frameworks have been instrumental in curbing abuses of market power and promoting competition in Asian markets.

Anti-Competitive Mergers Blocked

Scores of proposed mergers and acquisitions in Asia have been thwarted by competition authorities in recent years, citing concerns that these deals would substantially lessen competition in the relevant markets. These deal vetoes demonstrate the importance of merger reviews in maintaining a competitive landscape.

In several instances, the mergers were blocked due to concerns about the creation of dominant players, which would have led to reduced competition and innovation. For example, in the telecommunications sector, a proposed merger between two major players was vetoed due to fears that it would result in a dominant entity controlling a significant market share. Similarly, in the e-commerce space, a deal was rejected as it would have led to the creation of a dominant player with significant market power.

These decisions highlight the role of competition authorities in ensuring that mergers and acquisitions do not harm competition. By conducting thorough merger reviews, these authorities can identify potential competitive concerns and take steps to address them, ultimately promoting a competitive and innovative business environment.

Landmark Cases in Emerging Markets

In the domain of competition law enforcement, emerging markets have witnessed several landmark cases that have shaped the regulatory landscape and sent a strong message to businesses operating in these jurisdictions. These cases have addressed complex issues, such as market dynamics and regulatory hurdles, and have had a significant impact on the business environment.

One notable example is the case of Brazil's Administrative Council for Economic Defense (CADE) vs. Petrobras, which addressed allegations of anticompetitive practices in the fuel market. The case led to significant changes in the market dynamics of the Brazilian fuel sector, with CADE imposing substantial fines and requiring Petrobras to divest assets.

Another example is the case of India's Competition Commission of India (CCI) vs. Google, which involved allegations of abuse of dominance in the search engine market. The CCI's decision sent a strong message to digital platforms operating in India, emphasizing the significance of compliance with competition regulations.

These landmark cases demonstrate the commitment of emerging market regulators to enforcing competition laws and promoting fair market practices. They also serve as crucial precedents, shaping the regulatory landscape and influencing market dynamics in these jurisdictions.

Frequently Asked Questions

What are the consequences of non-compliance with competition law.

Non-compliance with competition law can result in severe consequences, including substantial fines imposed by regulatory authorities, as well as reputation damage that can lead to long-term financial losses and erosion of stakeholder trust.

How Do Authorities Detect Cartel Conduct in Various Industries?

Authorities detect cartel conduct through a combination of cartel markers, such as unusual pricing patterns, and industry profiling, which involves analyzing market structures and firm behaviors to identify potential collusive activities.

Can Individuals Be Held Liable for Antitrust Violations?

In antitrust law, individuals can be held liable for violations, emphasizing personal accountability. Criminal prosecutions are employed to deter and punish culpable individuals, as seen in cases where executives are fined or imprisoned for cartel participation or other anticompetitive conduct.

What Role Do Economics Play in Competition Law Enforcement?

In competition law enforcement, economics plays a crucial role through economic analysis, which informs merger reviews and antitrust investigations, providing a framework to assess market dynamics, competitive effects, and potential harm to consumers.

Are Competition Authorities Effective in Promoting Consumer Welfare?

Competition authorities' effectiveness in promoting consumer welfare is contingent upon their ability to mitigate market power abuse and resist regulatory capture, ensuring that enforcement decisions prioritize consumer interests over corporate influence.

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Case study: Kingfisher Group takes DIY approach to AI roll-out across e-commerce sites

International home improvement retailer kingfisher group opens up about the evolution of its ai strategy, and the rewards it is reaping.

• Caroline Donnelly, Senior Editor, UK

Several months into the start of the global Covid-19 coronavirus pandemic, international home improvement retail group Kingfisher debuted a revamped company strategy focused on repositioning the organisation as a digital and service-oriented entity.

Kingfisher, which owns the B&Q, Screwfix and DIY.com brands in the UK, had seen several of its brands suffer sales declines as a result of what it termed in its 2020 financial results  as “the company’s operating model becoming overly complex”.

“While some of our banners [brands] have delivered growth over the past four years … our performance has been disappointing. Group sales and retail profit need to improve,” its financial report, published in June 2020, stated.

In the wake of this realisation, the Powered by Kingfisher strategy was created, with an emphasis on ensuring each of the company’s brands was meeting the diverse and distinct needs of their respective customer bases, while also drawing on the businesses “core strengths and commercial assets”.    

“To serve customers effectively today, we also need to be digital and service-orientated, while leveraging our strong store assets,” the report added.

A month after going public with its plans for a strategic shift in how the company operates, Kingfisher announced the creation of a new role within its customer team with the appointment of Tom Betts as group data director.

Fast forward several years, and these two events have led to Kingfisher having its own in-house data and artificial intelligence (AI) team whose efforts have seen it centrally develop and roll out various digital tools that have boosted sales across its brands.

On this point, the company’s 2024 financial report stated: “Our [brands] are leveraging data and artificial intelligence to build customer-centric tools and solutions, support better commercial decision-making and higher productivity, thereby unlocking significant new sources of revenue, profit and cash.”

Speaking to Computer Weekly, Mohsen Ghasempour, group AI director at Kingfisher, said the appointment of Betts led to the creation of a team that has steadily grown in size and whose work has led to a notable uptick in sale across the group.

“We started with almost zero people on AI, and today we have around 28 – a mixture of machine learning engineers, data scientists, and engineers – so we [have the internal capabilities] to develop our own AI solutions,” he said,

“If you look at our portfolio of AI offerings today, we have 30-plus different initiatives on the go … and it might surprise people to know how much AI technology is impacting the way the DIY industry is operating.”

The company is using AI in its supply chain management and logistics function to deliver a demand forecasting model that can predict how demand for certain products will change over a 12-month period, as well as to pick up on patterns within the reviews customers leave about its products.

“We have services that sit on top of our customer reviews to extract actionable insights. Our AI algorithm can detect that 200 reviews are about product quality, and what specifically they are complaining about,” said Ghasempour.  

The company is also working on some “very cool technology” that will help the group’s in-store customers find the products they are looking for more efficiently, he added. “There is a lot happening with AI here at the moment.”

AI at the beginning

However, when Ghasempour first joined the company three years ago, Kingfisher knew it wanted to use AI to help achieve its strategic goals, but was still figuring out what role the technology would play in its business.

“When we started, there was no plan in terms of ‘This is how we’re going to use AI’,” he said. “So, the question became ‘How are we going to use it?’”

The answer to that came through trying to address what Ghasempour describes as one of the businesses’ biggest problems: a customer wanting to buy a product online that is no longer in stock.

“It wasn’t an AI problem, it was a product availability issue [that needed solving] that was affecting customer experience,” he said. “At that time, the challenge was ‘How are we going to solve it?’, but we did not necessarily think the answer was in using AI.”

While addressing this challenge, the idea of creating an “alternative product” recommendation algorithm emerged, which Ghasempour said gave way to an exploration of what role AI could play in the process.

“We started investigating how we can use AI when customers are at the point of buying a product that is not available, and how you can recommend a product which is very similar to the product that they’re looking for as an alternative,” he said. “That was the first recommendation service we developed, it went live in early 2023 on [B&Q’s online site] diy.com.”

This service has now been rolled out, in one form or another, across all of Kingfisher’s brands, and since B&Q became the early adopter of the technology, the brand has seen more than 10% of its e-commerce sales originate from product recommendations, according to the company’s own stats.

“From the basic algorithm to solve one problem, today we have 10 different recommendation algorithms that try to help the customer journey in different ways by offering [serving customers information about] frequently bought together products and personalised recommendations,” said Ghasempour.

And the early success achieved from its first forays into building AI-powered recommendation engines allowed the company to take the concept of Powered by Kingfisher even further by providing it with the proof points needed to ditch some of its legacy tech providers, he added.

“We had some legacy recommendation providers on [our]  e-commerce platform, and we started running tests A-B tests against those providers to demonstrate that we can achieve better performance, which justified building [out] this in-house [data and AI] capability even more,” he said.

“We completely replaced all the third-party providers we used for recommendation engines, so all of that, across all of our e-commerce platforms, is now powered by internal capabilities.”

These capabilities have also been created using Google Cloud’s portfolio of AI tools , with Ghasempour revealing that Kingfisher has partnerships in place with Microsoft and Amazon Web Services (AWS) too.

“Anybody wanting to build any kind of AI capability needs some infrastructure and at Kingfisher we have a partnership with all three cloud providers, but when it comes to AI and data science capability, Google has a bit more of a mature platform, from our point of view,” he said. “It was more intuitive and easier to use, so we started building that capability in Google’s infrastructure.”

Attuned to AI with Athena

Google Cloud’s fully managed development platform, Vertex AI, is playing a foundational role in the delivery of Kingfisher’s AI and data strategy, as it forms the basis of the company’s AI orchestration framework Athena.

Before the introduction of Athena, Kingfisher was effectively setting about addressing individual customer pain points, such as lack of product availability, by creating the AI microservices needed to address these problems from scratch each time.

In Kingfisher’s own words , this way of working resulted in lengthy development times for each microservice, which in turn slowed down the release time for them and caused scalability issues.

What Athena does is allow the Kingfisher team to automatically select the correct, ready-made Microsoft needed to answer a specific user issue or query, which it claims has cut the development time for new AI services from months to weeks.

“This is a fairly new technology for us, and is probably about a year old,” said Ghasempour. “And the idea behind Athena was, ‘How can we actually build a framework that means we can start to utilise the services in a in a safe and secure way, but also move fast because whoever is using this technology fastest is going to get the competitive advantage?’”

Athena acts as a “wrapper” around existing large language models, such as Google Gemini and Chat GPT, that allows Kingfisher to tap into the respective capabilities of these competing tools at once.   

“Athena can wrap around all of those large language models, and provide a stronger and more powerful service because it can utilise all of those language models at the same time, plus build the security model around them. So, we can we can track all the conversation and we can make sure there is nothing inappropriate happening,” said Ghasempour.

This means Kingfisher can essentially take a “build once, apply everywhere” approach to rolling out AI services across its retail brands.

“You can just do the development once but you can scale it up to more banners [brands] while you’re still secure in the safe environment,” said Ghasempour.

Presently, Kingfisher is using Athena to create services that will make it even easier for the company’s customers to find products using AI-based conversational, image and text searches.

For instance, if a customer does not know the name of the piece of equipment they need to replace on a household item or what the name of a certain tool is, Athena makes it possible for the customer to search the product catalogue for what they need using an image and get a result in seconds.

“All they have to do is upload a photo of the part and we’ll show them exactly what they need,” said Ghasempour.

It is also experimenting with using Athena to moderate the content of the listings published on the marketplace section of diy.com, which allows third-party sellers to sell their home improvement wares online through its website.

“Athena assesses the description of the product to check for any racism or sexism, for example, and offers visual moderation of all the product images,” said Ghasempour.  

Furthermore, the technology is being put to use internally at Kingfisher, to assist its 82,000-strong workforce with finding information about the group’s employment policies and guidelines that are contained within hundreds of internal staff documents.

“In any organisation you have a lot of documentation, from the legal team or HR, that tell staff what the rules of working there are, but people don’t go read the documents. So, at the moment, we’re putting [Athena] on top of those documents, so staff can ask an [internal chatbot] about the maternity leave policy, for example, and get the information they need,” said Ghasempour.

“Over the next couple of months, we’ve got a few more services going live internally to empower our colleagues using this technology to do their day-to-day jobs more efficiently.”

Read more about cloud AI use in retail

• Retail-related studies into AI’s influence suggest its capabilities are welcome by the sector and shoppers alike – but tech leaders advise treading cautiously.
• The French retailer has some catching up to do on its data strategy and digital transformation – and its new data chief has an ambitious roadmap to deliver on data science, business intelligence and artificial intelligence.

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