Hope springs eternal for the potential of increasingly sophisticated information technology to drive improvements in employee health and wellness. And why shouldn't it? Computing power is continuously getting cheaper and smarter, while conventionally delivered health care continues to grow in cost.

Employers should take heart at the scope and pace of innovation at the intersection of medicine and technology, with the realistic hope that such applications will one day prove as popular as the latest Wii game or iPhone app.

However, employers also are cautioned not to prematurely abandon low-tech modalities of spurring employees to take charge of improving their health.

"Carve-out vendors are trying to leverage technology as best they can to lower risk factors, manage daily self-care better and make wiser health care decisions," says Michael Wood, a senior health and productivity consultant for Watson Wyatt. "They're trying to use next-generation technologies - whether it's text messaging to cell phones and PDAs to online coaching."

Tail wagging the dog?

The danger is avoiding the tail wagging the dog. "It's like, 'Wow, I've got this computer, or this PDA or smart phone that does all these cool things. How can I make it work for health care?'" Wood adds.

A new entrant to the high-tech health promotion landscape, San Francisco-based Keas.com, comes with a strong Silicon Valley pedigree: Founder and CEO Adam Bosworth has spent 25 years in top software engineering positions with Microsoft and Google, among other companies, focusing on database products. At Google, he headed the development of Google Health, a personal health information centralization service.

In a nutshell, Keas says its interactive online infrastructure is designed to give individuals access to ongoing advice and interpretation about their unique health data, and help them take action to achieve their health and wellness goals. But Keas itself is not the source of the medical expertise.

Rather, Bosworth explains, "we built a tool where best medical minds can go and build 'care plans', without needing to build a Web site, buy a bunch of servers, hire a bunch of programmers or any of the normal IT." The result, he says: "The cost of the effort is massively lower."

The ultimate benefit, he suggests, isn't merely lower cost. "There is talent everywhere in the world, and people who are dying to help consumers get personalized advice on what to do, but have no idea how to deliver that."

In addition, Bosworth believes other Web-based personal health management systems often fall short because they overwhelm people with complex data, including their own lab results. The Keas interface will "show you which data you should actually be paying attention to," Bosworth says. "And that can be derived data. It doesn't have to be something primitive like your weight. It can be what's your risk of a heart attack ... given the data you are giving."

Individuals' risks are expressed "using a traffic light analogy, red, yellow and green," Bosworth says. "If it can't basically be on one page and be very simple, you're probably going to lose them."

Personalized dashboards

The individual's personalized dashboard yields a "highly personalized set of interpretation of data, showing them the information they need when they need it," Bosworth says, adding that the only way people otherwise receive such information is directly from physicians, a model of care "that doesn't scale very well."

He insists that the "care plan" creators are not practicing medicine per se. But, he adds, "we are looking at letting physicians look over your shoulder and, for a fee, 'jaw-bone' you" to pursue the necessary steps to address the health issue at hand.

"At that point, those care plans are doctor-patient plans. Then you'd have the impact of the moral suasion of a physician. The issue," not yet resolved, "is cost."

Employers can enroll at-risk employees in care plans. Bosworth is mindful of the eternal challenge of motivating participation. "For some, just the moral suasion of the group is sufficient. For other people, if the doctor starts to chime in and say, 'I noticed that you have actually not been up and walking the last three weeks,' that's enough to trigger them. And for other people, nothing is enough."

Still, lowering the barriers to exploiting such technology is the goal of all the technology-based health management promotion groups. Another is Dossia, a Cambridge, Mass.- based nonprofit consortium of large employers that, the organization says, "have united under a common vision: to help their employees make smarter and more informed decisions about their health care."

Dossia's basic concept is giving employees permanent, convenient access to their personal health data, independent of their relationship with a particular health plan or provider. Steve Munini, Dossia's chief operating office, calls it a "personal health record for life."

At the employee's option, basic health data is entered into the system. Employees cannot change it, but they can make their own notes on the data, as well as enter supplementary data, such as their use of over-the-counter medications.

Dossia will soon be introducing a new user interface that will provide more graphic depictions of trends with lab results and other personal health indicators, such as weight, pedometer steps, and so on, Munini says. In addition, Dossia is "integrating various tools to allow for wireless transmission of data to PCs," he says.

Family plan

Feedback from the original version of the system unveiled a year ago led to a decision to expand its availability to employees' dependents. "Families want to develop records for their own family," Munini says. But opening it up that way required certain restrictions on access to certain legally protected information about adolescent children, particularly females, "with respect to pregnancy and STDs," Munini says.

Employers vary in their methods of encouraging employees to exploit Dossia. Wal-Mart, one of Dossia's founding members, makes it available without charge via WebMD, a pioneer in Web-based consumer health promotion.

"Other employers might make [access to the Dossia-powered system] a requirement for getting into a better health plan, and others might provide financial incentives" for employees to take a personal health risk appraisal and have those results fed into the Dossia system, Munini says.

Dossia is also headed down the same path as Keas on medical counseling. "About 20 different organizations are integrating into our [application programming interface] to provide personal health applications for diabetes, weight management," and other issues, Munini says.

Giving "empowered" employees access to extra health expertise is not new, of course. Nashville-based Healthways, founded in 1981 as a disease management company, has been doing it for decades. Because the company's origins pre-date the Internet revolution, Healthways is not constitutionally enamored of Web-based employee health empowerment tools.

"We are trying to introduce as many employee engagement modalities as possible in an effort to get as many people as possible," says Scott Blanchette, the company's chief information officer. "Some people like to chat on the phone. Some people like to chat on the Web. Some people prefer e-mail. Some prefer IVR. Quite a few people still like paper," he adds.

Waiting for the science

"The science around all the modalities isn't complete."

Healthways recently completed a process of overhauling the integration of a host of independently produced health applications "and integrated it into one comprehensive, member-facing solution," Blanchette says. One of the goals of the effort was to produce a platform that "a member may use throughout their lifetime."

Healthways tries to analyze an employer's health population "before implementing a product," Blachette says. "We may spend six months pouring through an employer's claims data."

Like Watson Wyatt's Wood, Blanchette isn't swooning over the potential for smart phone-based applications, such as fitness and diet trackers, to impact employee health. "Those apps are very commonplace today ... but the efficacy of those solutions is yet to be determined." He says Healthways is "trying to see if the math teases out in a way that makes it worth our investing in that capability."

The math has "teased out," he says, for some social networks, such as Healthways' QuitNet Web-based smoking-cessation system.

"The older the solution," he adds, "the more science we have to substantiate or un-substantiate whether they are actually changing behavior. He cites "telephonic coaching," which has a 20-year track record.

Telephone-based coaching is at the heart of a combination of low- and high-tech approaches being used for the 2,000 employees of Piggly Wiggly Carolinas, a Charleston, S.C.-based store owner of 75 of those supermarkets.

The company is trying to kill two birds with one stone, having employees input basic personal health data into a system at the same time they make their benefit elections during open enrollment, according to Denise Dresel, the company's director of benefits and wellness. The "personal health assessment" application is incorporated into the "eEnrollment" solution of Benefit Focus, also based in Charleston.

Sitting with employees

Because few Piggly Wiggly employees have access to computers while at work, the company dispatches "enrollers with laptop computers who go out to our stores and sit down with the employees."

The initial PHA data is lifestyle-related, and employees can enter it on the spot. Additional data from a free physical rounds out the data. Employees are paid $25 for completing each round of the PHA data input. (Another Benefit Focus user, the Bon Secours Health System, last year paid employees $200 if they cranked in the clinical data; 80% of employees did so.)

Dresel only has access to aggregate data, but the individual private health data is reviewed by Piggly Wiggly's staff nurse practitioner, who "is going to be doing a lot of coaching over the telephone," Dresel says. The nurse will also be meeting directly with employees with serious health issues.

In a perfect world, trained medical professionals would meet with employees one-on-one regularly. Cost, of course, gets in the way. "The macroeconomic question is defining the optimal point where your investment is maximized," says Blanchette.

He also concedes there are limits to what can be accomplished both at the technology-based "no-touch" end of the health promotion spectrum and the other. "The assumption that all conditions and behaviors are modifiable has not always proven to be the case," he says, citing high-risk pregnancies.

Wood also cautions employers not to think of health care in the same vein as other consumer products, "where 'push technology' works much better. With Amazon.com, they know what you like to buy and send you messages like, 'Other people who bought X like you also bought Y.' That doesn't work in health care."

He's not a complete skeptic of technology-based health promotion solutions, however. "We just say, take it one step at a time. Do a pilot. Analyze it. Try it in combination with something else. See what works."

Finally, Wood stresses the importance of making the effort a corporate priority. "The leaders have to be behind it," and back their support with financial incentives. No matter how sophisticated the technology, without a "culture of health" permeating the organization, all bets are off.