On 23 June 2008, Covisint, Microsoft and AT&T issued a press release about synergy among their health information exchange (HIE) products. Covisint software will connect Microsoft HealthVault and the AT&T Healthcare Community Online (HCO), a virtual-private-network-based portal. 
This announcement restates previously announced bilateral relationships between Covisint and each of the other vendors. Its true significance lies in the synergy the trilateral relationship brings to HealthVault and HCO. For AT&T, it ensures that state governments and other HIEs that want a HealthVault connection will obtain it through the HCO package. AT&T must also find a way to provide access to the primary HealthVault competitor, Google Health. For Microsoft, the relationship solves a problem that poses a daunting barrier to achieving critical mass. Microsoft and Google are vigorously competing in partnering with care delivery organizations (CDOs). Each has succeeded in lining up big-name CDOs. But the most care in the U.S. is delivered by clinicians in small practices. These clinicians generally do not have their own electronic medical records (EMRs). Those that do have EMRs use products that have idiosyncratic interfaces for accepting and transmitting clinical information. Covisint, the underlying engine for HCO, addresses both these issues. It provides a very inexpensive portal with some EMR features which has had some success in bringing online those practices that don’t want full EMRs. Its software also greatly reduces the per-practice cost in connecting to those organizations that do have EMRs. Microsoft faces another challenge with small practices. It must establish a connection that is technologically secure and has been responsibly vetted to ensure that the entities involved are licensed clinicians. Achieving these aspects of security is not conceptually challenging; rather, the challenge lies in making it economical to do so for 250,000 or more small practices. The scale of AT&T offers Microsoft a “retail channel” to small CDOs to complement the “wholesale” arrangements it makes directly with big-name CDOs. This announcement offers a promising approach to addressing one big uncertainly involving HealthVault: the ability to enroll small practices economically. While uncertainties about consumer and physician acceptance remain, this deal adds to the momentum of HealthVault. Google Health has the same problem; we expect Google to announce a similar arrangement.
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