Archive for the ‘RHIO’ Category

Last week, a discussion got started on Google + by Brian Ahier about whether or not ONC’s aggressive support of Direct is undercutting many a Regional Health Information Organization (RHIO). What got this whole conversation started was an article in the January issue of JAMIA titled: Shifts in the architecture of the Nationwide Health Information Network. While there is some excellent commentary regarding this article, you may not want to spend your time wading through some 60+ comments on Google + and Vince Kuratis has done a good job summarizing many of them in his own post yesterday.

Seeing as we are in the midst of pulling together a new HIE Rpt, we could not help but chime in to this discussion with the comment that follows:

Great discussion here, albeit at times there seems to be a mix of HIE the noun, HIE the verb, which sometimes even leaves me confused as to what someone is trying to say and I follow this market for a living!

Speaking of which, we/Chilmark Research is in the process of updating its HIE Market Trends Rpt which will be published in March. As part of our research, primary & secondary, countless interviews, etc., we’ve identified a third market, what one vendor referred to as the “micro-HIE”.

The First market, which has been discussed in detail here, is the public market (we group both RHIOs & SDE and their HIE initiatives into this pot). By and large these have been and will continue to be Exchanges (the noun) that will struggle to find relevance. Over time, we see these exchanges being tightly linked to other critical needs at the State level, chief among them, their Medicaid programs. Problem we see here though is that most states have woefully underinvested in IT for their Medicaid programs so will their HIE efforts suffer the same fate? We at Chilmark have never been big fans of these “public” HIEs for they are most often poorly managed, mired in political infighting and rarely have a clue on how to run a business (deliver value that is greater than risk) for their intended market/customers.

The second market is what we refer to as the enterprise market. Folks, this is where the action is and while last year’s report showed a significant number of vendors focusing on the “public” market, this year virtually all HIE vendors have turned their sights upon the enterprise market. It is here where we will see the greatest advances, the greatest innovations, as there is a clear and compelling case for organizations to use HIE (the verb) to facilitate care management processes across care settings in a future where reimbursement will be increasingly tied to outcomes.

The third market, the Micro-HIE, is one that unlike the previous two markets, does not have a central sponsor of the HIE. It is more ad hoc in nature, self-forming, self-organizing. This is a market where Direct will be prevalent and for those who want a tad more in the way of services, physicians may subscribe to the new Surescripts Clinical Interop solution or a similar offering, albeit coming from the claims side, NaviNet. Medicity is also making a play here with its still nascent Inexx platform. This market is still very much a work in process, but may be the ultimate solution to connect the last mile, if these solutions can deliver value.

And that, at the end of the day is really what it is all about, yes? Delivering value that exceeds risk to the end user whoever that end user happens to be is the fundamental precept of any successful program, initiative or business. That has been the operating principle for the U.S. pretty much since its founding, should it be any different for the HIE market.

So in answer to our original question in the title…

Yes, we do foresee lightweight, micro-HIEs that use Direct or something similar to provide physicians an easy mechanism to securely collaborate will threaten many a RHIO and even SDE-HIE. Here in the Commonwealth of MA, the HIE workgroup has from the beginning been looking at a “network-of-networks” model for delivering a statewide HIE. Those discussions are now increasingly focusing on using Direct as the key underlying technology to make that happen. Will it work? We shall see. But one thing is certain, the days of big and glorious public HIEs and the associated political fiefdoms to support them may be coming to an end as their value has rarely exceeded their risk..

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It is almost becoming the norm to say that it has been another tumultuous year in the healthcare IT market. Market consolidation, pushback on timelines, growing chorus from IT departments that enough is enough against the backdrop of the political circus in Washington and across the land as we prepare for the 2012 election year. If 2011, was a bit bumpy, believe we will see craters in the road to HIT enlightenment in 2012. But we’ll save that discussion for our future predictions for 2012 post, which we hope to get to next week. (Editor’s Note: Don’t hold your breath though, if the snow flakes are flying, we’ll be on the slopes next week.)

Today’s post takes a look back on 2011 by reviewing our predictions earlier in the year and assessing where we hit the mark, where we missed and if there is such a thing, where we came close. So without further adieu…

1. MU Initiatives Move to Tactical 
Hit This did come true as meaningful use, while still top of mind for the CIO, is not top of mind for others in the executive suite who are now looking at how to compete in the future as reimbursement models shift from fee-for-service to value-based contracts.

2. C-Suite Strategy Focuses on New Payment Models 
Hit An admittedly “softball” prediction, this was a natural fall-out of prediction numero uno. And yes, the consultants are making out like bandits as we predicted they would helping senior execs figure out their future competitive strategy.

3. RCM & Charge Capture Systems Require Overhaul 
Miss By and large, most vendors in this sector have not done a whole lot yet as they await to see how the market develops. With most healthcare organizations struggling to get the basics done (e.g., meet MU requirements, ICD-9 -> ICD-10, apply analytics, etc.) we are not seeing big demand from customers and subsequently, not a big push by vendors.

4. Mergers & Acquisitions Continue Unabated
Hit Another “gimme” of sorts for we had this prediction in 2010 and it was a “hit” and need only look at this market with its some odd 300+ EHRs to choose from, everyone wanting to call themselves at HIE vendor (last we checked, HIMSS listed some 189 HIE vendors alone), countless other HIT solutions to see that this market is far from mature. But arguably the biggest news in 2011 was Microsoft’s capitulation that despite the billion dollar plus investment, it wasn’t cut out or the clinical market and dumping its HIT assets into a new joint venture with GE. What we are also seeing is some rationality return as valuations have moderated. This may have led to Thomson Reuters’ recent decision to not sell-off its healthcare division – no one was willing to pay the high price tag they had on this property.

5. Federally Funded State Initiatives Struggle
Toss-up There has been some progress and there are those that would vehemently argue that Beacon Communities, RECs and state HIEs are moving ahead briskly. But then again, we do get some disturbing reports that all is not progressing as once envisioned, one might even go so far as to say some of these programs are beyond just struggling, but clearly going off the tracks. We’ll reserve judgment until we see clear evidence of such pending disasters, which will likely be prevalent, but highly distributed.

6. Changing of the Guard at ONC
Hit Not long after we posted our 2011 predictions, Blumenthal announced his resignation from ONC. We could not have been more prophetic if we tried.

7. Physicians will continue to go Ga-Ga over the iPad and the fast-following touchscreen tablets much to the chagrin of CIOs.
Hit Enabling physicians access to health information systems via their hand-held mobile devices, including touch-screen tablets is still a struggle for most organizations. At first, IT departments turned to Citrix as stop-gap measure, but the UX was far from ideal. In our recent research we found many an IT department still struggling to address this issue. mobile enablement of physicians is a top priority.

8. Apps Proliferate: Consumer-facing First, Private Practice Second, Enterprises Dead Last
Hit In hindsight, another admittedly easy prediction to make. What may be a more interesting prediction is when will mHealth Apps really become a truly viable market? Does the profitable exit of iTriage/Healthagen, which was picked up by Aetna portend such? By our standards, no. Go back to our recent post from the mHealth Summit for more in-depth analysis.

9. The Poor Man’s (doctor’s) HIE Takes Hold
Miss We thought that the Direct Project would quickly take hold and see rapid adoption among smaller physician practices and those organizations looking to “connect the last mile” to small affiliated practices in their network. Not happening yet though the current administration is doing its best to push this technology by requiring all state designated entities that are standing up statewide HIEs to include Direct in the strategic operating plan.

10. Analytics & Business Intelligence Perceived as Nirvana 
Hit, kind of… 
In retrospect, not even sure this was really a prediction but simply more of a statement as to where healthcare organizations are headed with their HIT investments. We have a long ways to go, though there is certainly no lack of vendors that now are touting some form of analytics capabilities. Our advice, tread carefully as most solutions today are half-baked.

11) The Buzz at HIMSS’11? Everything ACO! 
While some vendors were discussing ACO enablement at the 2011 HIMSS, the vast majority were not with the key focus continuing to be meeting Meaningful Use requirements. As mentioned in previous prediction, we see MU as a tactical issue with the strategic issue being: How do we leverage IT infrastructure to support communities of care? Maybe at HIMSS’12 we’ll see more discussion of this issue, but we’re not holding our breath.

This may have been our best year yet with our predictions having only 3 clear misses out of 11 predictions made. Granted, some of those predictions were not exactly the most profound or shall we say big stretches, but we do take some satisfaction in really nailing a few.

And while we intend to provide our own 2012 predictions, no time like the present to begin the process. So we ask you dear reader, what is your 2-3 top predictions for 2012? Will Todd Park stay on at HHS? Will forced budget cuts decimate HITECH? Will the Supreme Court’s ruling on ACA have any impact on HIT spend by either payers or providers? Will mHealth Apps such as WellDoc’s for diabetic care finally receive a CBT code thereby accelerating adoption of such tools?  We look forward to your input.

And of course we wish everyone a Joyous holiday season and wish you and yours continued good health in the new year to come.

Home for Christmas by Thomas Kinkade

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In January, we released our HIE Market Report: Analysis & Trends which was extremely well-received. Sales have exceeded our rather optimistic projections – great for us. But what we are most proud of and honestly what keeps us going is that others are also gaining value from this report, especially those looking to purchase an HIE solution. As one large healthcare organization recently told us:

Your report has been invaluable in not only our vendor assessment process, but how our organization needs to think about our long-term HIE strategy.

We have also heard on numerous occasions the need to update the report as the market is changing so quickly and indeed it has. Several HIE vendors have been acquired, others have withdrawn from the market and there continues to be an influx of new entrants hoping to capitalize on what remains an immature market.

There are also a number of underlying trends that have disrupted the market to varying degrees. Thus, we have begun putting together our research plan for an update of the HIE report. As part of that process we have been contacting and interviewing those who purchased the first report to get their feedback on what they would like to see in the next edition. Several interviews have been conducted so far and we even had a briefing with one HIE vendor that we had given up for dead, but no, looks they are very much alive and may (emphasis on may) become a strong player in the future provided their new parent invests in them at the level required to build market share.

Following are a few snippets of what we have learned through these interviews so far:

Workflow, workflow, workflow: Embedding information exchange processes into the workflow of a clinician is becoming a very big issue. Now the question is: What are the top priority workflows that users wish to enable and what are the HIE vendors offering in this regard and how easy is it to configure workflows to meet specific needs?

Analytics & reporting: Everyone continues to talk about this issue, which has been a dominant issue for enterprise HIEs. What has changed though is that even public HIEs are now looking to enable analytics & reporting capabilities as one approach for creating a sustainable business model. HIE vendors are dedicating significant resources to address this need but there is very little understanding as to the actual maturity of these offerings.

Fragmentation in enterprise HIE market: In the last report we split the market into two large classifications, Public and Enterprise. Several we have interviewed suggested we ignore the public market and focus the next report solely on the enterprise market further breaking it down by the healthcare organization’s business strategy justification for deploying an HIE.

Dominant HIE business models: The HIE market continues to evolve rapidly and a key question posed to us is: How do we see this market evolving, where will it be in five years? Quite the loaded question but sure as hell fun to ponder. Currently, we see the market bifurcating into one group of companies that are providing solutions to facilitate care management and another group looking to provide solutions that facilitate operations management.

Clarify closed, EHR-driven HIE solutions versus standalone, open HIE solutions: Several EHR vendors are offering their own HIE solutions but these solutions do not readily connect to other EHRs thus mostly a closed system. Then we have the open HIEs, including some offered by EHR vendors that have the ability to connect to multitude of EHRs via interface engines. In the enterprise HIE market, there is considerable confusion among end users as to which path is optimal for their organization and this is a topic worthy of deeper discussion. (In our last report we simply ignored these closed systems as they were outside the scope of the report.)

Future impact of NHIN Direct: There has been a big push by those controlling the purse strings in Washington DC (election year coming up, need to show some successes with that $564M that went to States for HIEs) to drive adoption and use of NHIN Direct. Any vendor wishing to land a publicly funded project must now have the ability to enable NHIN Direct on their HIE platform. NHIN Direct, as we pointed out input last report, will commoditize basic messaging services of an HIE. Now the question is: How will NHIN Direct impact the broader healthcare sector and will it find its way into enterprise HIEs or remain an confined to public HIEs?

Plenty to chew on here and a lot of research will be required to tease out the answers to these questions. But that is exactly what analysts thrive upon and we are more than ready for the challenge, in fact we welcome it with open arms.

Now you may be wondering; who was that HIE vendor given up for dead? None other than the Boston-based firm Wellogic, a company that made a number of strategic, go-to-market blunders but has now been acquired by Alere. Alere, a seemingly successful and very acquisitive company, certainly has the resources to bring Wellogic back from the dead and make them a serious competitor going forward provided, as we stated earlier, they invest for the long-term as this market, though still relatively immature, is seeing ever larger players enter with deep pockets and far greater resources at their disposal.

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Microsoft’s Health Solutions Group (HSG), which has straddled the fence with consumer-facing (HealthVault) and corporate-facing (Amalga), is increasingly moving to the corporate side of the fence. Not that surprising considering that the consumer market continues to struggle (Google Health is in virtual mothball state, consumer adoption of HealthVault is nothing to write home about) and that HSG has now moved out of R&D and is now under the business solutions group, Dynamics. At the end of the day, HSG head Peter Neupert has to show that he can deliver the goods and Amalga is the horse he’s betting on (Note: Sentillion is there as well, but think of Sentillion as the gate-keeper to accessing Amalga).

Yet Amalga has gone through its share of birthing pains with some in the industry beginning to question its value.

Amalga has suffered from two significant problems, both inter-related. The first is that Amalga is an extremely powerful set of data aggregation and analytical tools, but it is more of a toolset then a product and this leads to long implementation time-frames and subsequently an inability to extract value quickly (ROI for Amalga is measured in years). For example, in 2009 Golden Living signed on to adopt Amalga and HealthVault. At last week’s Connected Health Conference, (CHC) Golden Living presented some remarkable results of how they are transforming long-term care through the use of Amalga. But in their presentation, Golden Living also stated that they knew full well when signing on to Amalga that this was going to be a multi-year effort and their implementation team has been given 5 years to put Amalga in place. Five years to fully implement a software solution is a very long-time and similar to the installs of the largest EHR systems. Unfortunately, many early Amalga customers did not have the foresight of Golden Living. In recent conversations with Microsoft, Chilmark has been told that significant resources are now being dedicated to improving time to value for Amalga. We’ll have to wait and see as the CHC sessions we attended on Amalga and HealthVault Community Connect, did not make this readily apparent.

Secondly, the flexibility of Amalga led Microsoft to pursue a number of different strategies and markets. One apparently aborted strategy was for Amalga to become a Platform as a Service (PaaS) when it announced at the 2010 HIMSS its partnership with Eclipsys wherein specific Eclipsys modules would run on top of the Amalga platform. Well a platform is not a platform if it does not support an ecosystem of third party applications. To date, Microsoft has announced no additional partnerships similar to that of Eclipsys for Amalga so this strategy has stalled.

This was also looking to be the case for Microsoft’s HIE strategy. In the profile we did of Microsoft for the HIE Market Report we questioned whether or not Microsoft would stick with this market as they had not had a significant HIE win in nearly a year. In a conversation with a CIO of a large academic medical center at CHC, he also brought up the question of whether or not Microsoft was committed to supporting HIE functionality within Amalga, so clearly we were not alone in our opinion. Those fears were put to rest last week when Microsoft announced the Chicago HIE contract win, which is a monster representing some 70% of the healthcare facilities and a population of 9.5 million in the Chicago metro area. The Chicago HIE is a very visible win for Microsoft and a clear signal that they intend to be a major player in the HIE market.

It was also clear at CHC that Microsoft HSG is very focused on Amalga. The majority of sessions were dedicated to various aspects of leveraging Amalga (clinical decision support, care transitions support, comparative effectiveness, etc.). Virtually all users we spoke to at CHC were there to learn more about Amalga. And maybe the most telling sign was the list of exhibitors. Unlike CHCs of the past, there was not one EHR company, very few third party software vendors (~14%), and only a couple of exhibitors with clear connections to HealthVault.  Consulting and service firms, however, were there in force representing over 50% of exhibitors.

While the Chicago HIE win is a strong vote of confidence in Amalga sending a clear signal to the broader HIT market, Amalga is not out of the woods yet. Broader adoption of Amalga will be highly dependent on Microsoft’s ability to further “productize” Amalga to insure faster installs and accelerate time to value. In today’s market, where senior IT executives of healthcare organizations are literally swamped in various initiatives (e.g., 5010, ICD-10, EHR/meaningful use), the last thing most want to adopt is an Amalga toolset. Developing Amalga to address specific use cases will go a long way towards seeing broader adoption of this potentially powerful solution.

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Special Note:
When this post first went up an image of a tornado was used as a metaphor for the very turbulent times that the healthcare sector is currently experiencing. Little did we know that this week would see the most devastating tornados the Southern US has seen in three decades with hundreds of lives lost. Our prayers go out to those who have suffered loss this week as a result of these storms.

Yesterday was the annual Harvard School of Public Health Event, Public Health and Technology (PHAT2011) and today in Chicago getting ready for the Microsoft Connected Health Conference (CHC). First some highlights from PHAT, followed by expectations for CHC. Will follow up with more detailed review of CHC if warranted at end of week.

The PHAT event holds a special place in my heart as this was the third one and I was on the planning committee of the original. The event is put together by the grad students at the Harvard School of Public Health and I am always amazed at how fine a job they do under the close tutelage of Professor Ashish Jha and others. Following are a few of the key take aways from this event:

Health Information Exchange is the big elephant in the room. In his remarks, Dr. Jha stated that his research has found that only 3-5% of doctors/hospitals have exchange any EHR data and that the broader desire to improve quality while lowering costs is a non-starter if EHR data can not be readily exchanged. Significant policy and competitive issues need to be ironed out before we’ll see progress. When I asked Dr. Blumenthal (or is it Professor now) what it felt was the biggest challenge for his replacement at ONC, Dr. Mostashari, Blumenthal stated without hesitation HIE. Chilmark couldn’t agree more and is one of the reasons we made HIE one of our primary research areas for the next couple of years.

Too many EHRs, too few adopters (and does anyone validate/certify viability?). There are now over 500 EHRs and EHR modules certified from some 300 plus vendors. Of those 300 plus vendors, nearly two thirds have less than 50 employees. Simply mind boggling and rather than the certification process separating the truly viable and worthy EHR vendors from the get rich quick poseurs, we have an absolutely nightmare of choices. Where is Consumer Reports when you need them? And don’t go looking to RECs for assistance as their focus and knowledge is limited. Please someone with deep pockets come into this market and deploy a roll-up strategy similar to what Infor has done in the ERP market. (BTW, Infor just acquired Lawson who was struggling to remain independent – not sure what that might mean to the future of Lawson’s healthcare business, including forays into HIE. Word to wise: if considering Lawson, ask hard questions.)

Big battle brewing between enterprise and public funded HIEs. One State HIE rep characterized enterprise HIEs as almost a pox on the industry and nothing but more silos of information. She has a point, but a limited one. It is time for the statewide and even regional HIEs to see what they are really meant to do, address public health issues and not over-reach. Both enterprise and public HIEs have a reason for being. Enterprise HIEs have little issue with sustainability as there are clear business reasons to create and support an HIE, reasons that only become stronger with ACO rules. For public HIEs, sustainability is reoccurring problem whose only solution may be a recognition that this is a public service for the public good and needs to be government funded. Not a very palpable proposition in today’s political climate.

Lots of smoke on topic of ACOs but still can’t find the flame. Last session at PHAT looked at innovative care models which of course can not be spoken about in the same sentence today without mentioning Accountable Care Organizations. Despite a lot of talk about the need to improve quality, make patients take on more personal responsibility, etc., there was still very little clarity on how all this knits together to create a viable and profitable ACO. There are some promising studies (healthcare seems to have plenty research studies to throw about) but how it all comes together, what are the technical underpinnings and most importantly, how does all this fit into existing workflows and where needed how are workflows re-architected to support new care models – one could go on and on and quite sure many will for the foreseeable future.

Tomorrow I’ll be moderating a panel here at the CHC event – a bit of a “What if” panel that looks at what might be possible in a major metropolitan area if health data could be integrated and shared. Looks to be a good panel and will be particularly interested to hear more about the Chicago HIE, which just announced its award to MSFT (and partners) yesterday. One of those partners is yet another HIE, HealthUnity which we know little about except that it is based in Seattle and started by MSFT alumni in 2004. During our research for the HIE Market Report, not a single HIE vendor mentioned HealthUnity as a competitor so they must be operating in stealth mode – something that is likely to change after this big win. Getting harder and harder to track all of these HIEs that seem to keep popping up like mushrooms in the forests of the Pacific Northwest. At this rate, by the end of 2012 we’ll have as many HIE wannabes as we have EHR vendors today.

Following is the presentation I will use tomorrow to kick-off the panel session. Enjoy.

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HIMSS or Bust

Two extremely short weeks from today will be the official start of that annual healthcare IT (HIT) confab called HIMSS. Tens of thousands will gather to hear the latest and greatest on how HIT will deliver unfathomable rewards to all who adopt. Of course there will also be those discussions that if you aren’t on the EHR, HIE, CDS, RCM or any other HIT acronym bandwagon then surely you will fail to meet the high goals and aspirations of the policy wonks in DC and State-houses across the country. Your days are surely numbered.

Don’t get us wrong. Chilmark Research is actually a strong proponent of HIT, if it is judiciously deployed, clinicians have a voice and training is truly training (A friend who is a nurse told me the horror story of sitting in two full days of training where the trainer from a very well-known ambulatory vendor refused to allow those in the class to actually use the EHR – they had to sit and watch endless demos). Problem is, as the training example points out, this is rarely done and the aggressive timelines of ARRA for EHR incentive payments sure doesn’t help.

But we digress. If nothing else, HIMSS affords one the opportunity to get a pulse on the industry if one just ignores most of the loud pronouncements plastered all over the front of the various booths and in those all too common theaters. Having been to countless events such as this in numerous market sectors, the pulse is found behind the scenes, behind the posters, in the hallways in casual conversations, in the questions that you overhear being asked, in private conversations with key people in the industry.

In my own case, I look to HIMSS as partly educational, partly business development. Over the last few weeks I have received countless invitations to meet with various companies of all shapes and sizes. I just wish those sending these invitations would actually take the time to get to know Chilmark Research first as the vast majority are of very little interest – I mean really, do I want to sit-down and learn about the latest COW?

I do a lot of planning upfront and select who I want to meet with and rarely entertain unsolicited invitations. At this point, my three days of HIMSS are completely packed and if I were wise I’d spend the next two weeks taking it easy and resting up for what will be a three day marathon that begins with breakfast meetings and ends sometime late after the last reception. The most exhausting part of it all, simply that as an analyst you are always “On”. In almost any conversation you are asked for an opinion, a forecast, a prediction and if they don’t like it, you then need to defend it with logic. I love the challenge, I love the intellectual stimulus but by the time I board that flight home I’m totally spent.

To help you prepare for HIMSS, here are a few suggestions:

Attend the mobihealthnews webinar this Thursday, February 10th at 2pm ET. I’ll be presenting alongside mobihealthnews editor Brian Dolan and Diversinet executive Mark Trigsted. We’ll be talking about mHealth Trends in 2011 and what to expect at HIMSS on the mHealth front. Registration is free and last I heard, they have nearly 800 registrants.

Register for the FierceHealthIT HIMSS Executive Breakfast which will be held Tuesday morning. I will be part of a great panel that includes Lynn Vogel from MD Anderson, Joe Kvedar of Partner’s Center for Connected Health and Capt. Robert Marshall, CMIO of the Navy.  Our topic: mHealth’s Evolving Role in Achieving Meaningful Use, should make for a lively conversation.

Keep your meetings with vendors short. There is so much going on for your typical vendor that it will be difficult for them to truly remember details of an in-depth discussion.  So much is happening at a big event like this that the best one can hope for is a meet n’greet type of meeting where one meets with some key executives of the vendor, gains a quick read on their direction, what the vendor sees as important. With this information, you can determine whether or not a more in-depth follow-up meeting is warranted.

Be sure to leave yourself a good 15-30 minutes of space between meetings. This time will prove invaluable for a number of reasons including:

  • Gives you a breather to go over your notes and add any details you may not have written down during the meeting itself.
  • Provides some cushion should a meeting be going very well allowing you to carry a conversation to a successful conclusion.
  • Allows you time to get to your next meeting without being late. (Last year was a nightmare for me with the exhibit hall split in two – took forever for me to get from one side to the next. Thankfully I had some cushion time built into schedule.)

In closing, while I find HIMSS to be depressing at times and the hype of vendors far out-strips their ability to execute, this is a valuable conference to attend as it does bring all the key industry players in HIT under one roof. Despite all the wonderful communication tools we now have at our disposal from Facebook to Twitter to webcasts, emails and good old fashion phone calls, we are still social creatures and we do need face-time with one another to strengthen relationships, form new ones and assess ones we are unsure of. This can only be done in-person and HIMSS provides that opportunity.

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The telecom industry makes its money delivering bits and bytes. Therefore, it is not too surprising that the two major players here in the US, AT&T and Verizon are placing some bets in the healthcare sector.  Primary among those bets are enabling telehealth (both have been perennial sponsors of the Partners Connected for Health Symposium), providing communication services to large IDNs and more recently making a play in the still emerging Health Information Exchange (HIE) market.

AT&T has Healthcare Community Online (HCO) as their primary HIE solution, which they often take to market with partner Covisint.  The lighthouse customer for these two was the now belly-up SharedHealth in the state of Tennessee. Despite AT&T’s claims to have a viable and competitive HIE solution, we have never heard anyone mention them, either within the context of an RFP, a competitive bake-off, mentioned as a competitor by other HIE vendors, etc.  Nothing. Nada.  It’s as if they don’t exist, and frankly, maybe they don’t in the HIE market. (Chilmark did not discount Covisint and there will be a detailed profile of this HIE vendor in our forthcoming report.)

Is Verizon doing anything more substantial in the HIE market?

Late last week, Verizon announced its own HIE product suite.  Let’s be polite, the press release didn’t have us in a panic wanting to call Verizon and immediately get a briefing.  Heck, writing this post several days after the release went out may give you another hint as to our level of interest and excitement.

What’s the problem?

1) Putting “Cloud” in the title of the press release.  Boring, and honestly not at all new as virtually all the leading HIE vendors having been providing cloud-based HIE solutions for years.

2) More importantly, Verizon’s chosen partners, MEDfx, MedVirginia and Oracle.  First MEDfx is but one of the countless and like its brethren, nameless, little HIT vendors out there in the market trying to survive, offering a wide range of solutions from EMR to PM, to HIE etc.  A mish-mash of products with little market traction.. Our bet is that 5 years from now, they’ll be gone.  One would have thought that with its size, brand and clout, Verizon would have been able to do better than this for an app partner. Second, picking a client as a partner? There may be some small value to that but to make that a key part of your announcement message, not so good and a clear sign of weakness.  Besides, it looks like what is really going on here is that MedVirginia is simply replacing its existing HIE vendor, Wellogic, an HIE vendor who, if field reports are correct, is on its last legs.  OK, we’ll give Verizon credit for partnering with Oracle for Oracle’s Master Patient Index solution, if it is indeed the one that Oracle built and not the poorer substitute built by one of Oracle’s most recent acquisition, Sun Microsystems.

It just puzzle’s us that these two very large companies, with clear established brands in the market are making such tepid plays in the HIE market.  They certainly have the resources to do something far bigger, say acquire one of the leading HIE vendors that has an established presence, good customer list and build from there.  In some of our more recent discussions with those assessing and looking to purchase an HIE solution, the issue of vendor viability is always a topic of discussion.  A large company like one of these telecoms could clearly remove that issue from discussion.

Maybe it is just a case of it’s not in their DNA.  Telecoms sell simple services that can be leverage across multiple markets.  Delving into the healthcare sector with an HIE play requires more than just a communication network, it requires secure messaging, deep domain knowledge of healthcare workflow and best practices and it requires a level of software expertise that is foreign to these companies.  No, it is Chilmark’s belief that announcements such as this simply cloud-up what is already a pretty murky market.

Our bottom-line advice to those assessing HIE solutions in this murky market:

1) Look to a vendor that has a proven track record, with good references from those you respect.

2) Seek a vendor (and not just their service partners) who has domain expertise and truly understands what is trying to be accomplished within the context of an HIE.  Look closely at their workflow templates as these will give you some idea as to how well they understand the business.

3) Delve deeply to understand a vendor’s true compettive differentiators.

4) Look closely at their list of partners, both software and service, and talk to the vendors customers about how well these partners’ solutions are integrated into the entire solution suite.

And dear readers, if you have a few suggestions of your own, please add them to the list in the comment section below.

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