Posts Tagged ‘Amalga’

Today, GE and Microsoft announced a joint venture (JV) that will lead to the formation of a new company (NewCo) targeting the clinical healthcare market sector. The NewCo will be located near Microsoft HQ in Redmond, WA, start with roughly 700 employees and combine the remaining Microsoft clinical products, Amalga UIS and the former Sentillion products Vergence and expreSSO with GE’s eHealth and Qualibria suite. NewCo’s new CEO will be GE’s Michael Simpson, who has been heading up the combined Qualibria-eHealth group since earlier this year after a re-org at GE. Along with this announcement, Microsoft’s Health Solutions Group (HSG) leader, Peter Neupert stated that he’ll be retiring.

Combine the above announcement with Microsoft’s long anticipated sale of Amalga HIS, which went to Orion Health in October, and you are left with Microsoft completely pulling out of the clinical market. Sure, they’ll claim to be still in healthcare by directly selling their horizontal products (e.g., SharePoint, MS Office, various server products, etc.) into this sector and having a stake in this JV, but it is also exceedingly clear that Microsoft will no longer have any direct involvement in this market, that will be left to GE. That being said, Microsoft did state that they’ll hang onto HealthVault, but even here, that is more likely a by-product of no one wanting to take on HealthVault rather than Microsoft’s strong desire to continue to try and build a viable, revenue generating entity out of it. Do not be too surprised if, in a year’s time, HealthVault falls to the wayside much like Google Health did this year.

During our briefing call with Microsoft and GE we learned the following:

Core to NewCo’s objectives is to leverage the joint assets of Microsoft and GE to build out an entirely new platform that will focus on four key areas to begin with:

  • Clinical surveillance to identify such things as infection outbreaks within an acute care facility before they run rampent.
  • Population health management to facilitate care management processes, which is a productization of work GE has been doing with Geisinger as part of the Keystone Beacon program.
  • Reduce hospital readmissions by leveraging analytics to identify patients at risk and initiate appropriate interventions.
  • Facilitate transitions in care, which like reducing hospital readmissions, is something that is on the mind of every senior healthcare executive we talk to.

These four target areas are nothing new or inspirational as just about every vendor we talk to has some program in place or under development to address these four areas as well. The product roadmap does not have much hitting the market until 2014.

Financial terms were not disclosed but our guess is that Microsoft contributed IP and the development team behind these products. In return, they will receive some sort of royalty stake in future sales. GE will lead the new organization, contribute its Qualibria/eHealth IP and GE sales and marketing will take the product(s) to market. Thus, most sales and marketing folks and other support staff in Microsoft’s former Health Solutions Group are being shown the door, which is unfortunate as we head into the holidays.

A couple of things come across as a bit ironic. First, Microsoft executives time and again stated that they knew what they were getting into when they entered this vertical and that it would take patience to build a viable presence. So much for patience. Second, Microsoft sold off the Amalga HIS product as many a potential HIT partner was wary of partnering with Microsoft as long as Microsoft had under ownership an EHR. Now what does Microsoft do, it joins in partnership with a struggling HIT vendor in the acute care market. Will any of the other major or even second tier HIT vendors partner up with the GE/MSFT NewCo – don’t bet on it.

The announcement also raises more than a few questions such as:

What becomes of Microsoft’s existing HIE contracts, particularly the one they pulled all the stops out to win, the Chicago HIE which is now under development?

What becomes of Microsoft’s recently announced relationship with Orion Health? Will Orion now be partnering with NewCo, which is essentially GE?  GE, with its own HIE solutions targeting enterprise accounts, is a direct competitor to Orion.

What becomes of HealthVault Community Connect, which combined Amalga with HealthVault and SharePoint? Is this now a dead product or will NewCo simply use the Centricity patient portal?

As you can probably tell by the tenor of this piece, we’re not a big fan of this announcement and are disappointed that Microsoft has decided to fold-up its tent and retreat. Unlike the legacy HIT vendors in this market, Microsoft could lay the claim to some neutrality and potentially build-out an Amalga-based ecosystem platform. But business is often not kind to those that have an altruistic bent and in this case Microsoft simply made a clear-cut business decision to unleash an asset that was not meeting internal metrics despite what some believe may have been an investment in excess of $1B in the last 5 years to build-out HSG.

Once again, another company with grandiose plans to change healthcare has quietly walked away leaving this market to the incumbent HIT vendors. We also do not see strong prospects for the future build-out of a robust ecosystem of partners on the combined Amalga-Qualibria platform that NewCo proposes as there are too many competitive issues that just get in the way. We could be wrong on this one, but our guess is that NewCo is likely to struggle as much as Microsoft has in the past for relevance in this fractious HIT market.

Sean Nolan, chief architect for Microsoft HealthVault, provides his own view on this JV announcement. While his view differs from ours on the implications and future of this JV and HealthVault, one thing we do hope that Sean proves us wrong on, is the future success of HealthVault. We would love nothing more than to see it succeed but at this juncture, we remain pessimistic. 

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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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Today, Microsoft, via a blog post by its UK leader John Coulthard, announced the launch of HealthVault in the United Kingdom. Yesterday, Chilmark received a briefing from Microsoft’s Director of International Development, Mark Johnston who provided us the back-story on this launch and how this launch is different from Microsoft’s previous international forays in Canada and Germany.

HealthVault UK is initially a very limited subset of capabilities focusing more on the MSN Wellness Center (or is it Centre for UK).  Two reasons for this: First, as the National Health Service (NHS) is Microsoft’s largest enterprise customer worldwide (yes, larger than say the US federal government) and Microsoft certainly does not wish to directly compete against NHS’s own citizen-facing personal health platform, Healthspace. Secondly, Microsoft has been working closely with Nuffield Health, a private health & wellness organization in the UK who will be its first customer.  Nuffield, which has ~150 facilities across the UK, both fitness centers, clinics and private hospitals, advocates a whole health model and is looking to the HealthVault platform, its wellness features and ability to take in biometric data as core to its strategy of providing customers a value-added service.

Unlike Canada and Germany, where partners Telus and Siemens respectively will take HealthVault to market, in the UK Microsoft is going direct and will offer the HealthVault platform to prospects (healthcare facilities, fitness centers, long term care, etc.) on a common subscriber access license (SAL) model.  With an SAL, Microsoft provides the base HealthVault “utility service,” and based on the client’s needs will build the ecosystem of apps on top of HealthVault, from third party ISVs as well as ones from Microsoft (e.g. MSN wellness widgets). Subscription costs scale, decreasing with a corresponding increase in number of subscribers.  A client, such as Nuffield, then offers HealthVault to their customers.  WebMD use a similar model for selling their platform to payers such as WellPoint or employers such as EMC or IBM here in the US.

As with instances of HealthVault in Canada and Germany, the UK HealthVault service will be fully hosted within the country and be in compliance with all local laws for privacy and security.  Microsoft has teamed up with the UK Cloud IT services provider, Attenda to provide hosting services.

Since Microsoft is already going direct in its sales strategy for Amalga and Sentillion in the UK, longer term, one can envision them also deploying a strategy similar to that at New York Presbyterian combining Amalga, HealthVault and the bridging solution SharePoint, which they have now offer as HealthVault Community Connect.

Clearly, there are those in industry that see the need for deeper consumer/citizen engagement in managing their health and are willing to take a a risk. Microsoft, Telus and Siemens are all huge companies with massive resources at their disposal to use patient money to build out these personal health platforms (PHP). But what we have not seen is a corresponding response from the market (consumers) that they are ready and willing nor, as in the case of the Telus release and this one in the UK, have we seen a ground swell of third party ISVs clamoring to get on-board and develop novel applications to serve the citizens of these countries.

To some extent it is a “chicken n’egg” scenario wherein ISVs may be reluctant to build to the HealthVault platform until they see some tangible traffic, which at least here in the US has seen a rise upward, but still sits at a paltry 7%. Not exactly a vibrant market. Chilmark dinged the Telus health space roll-out for its lack of an ecosystem.  Likewise, we have to ding Microsoft for its own efforts in the UK where honestly, this launch is extremely modest in scope, having no third party apps, just those simple widgets that were developed for the MSN Health & Wellness site.  Not exactly pushing the envelop.

But to their credit, Microsoft is putting their money where their mouth is investing for the long-term. If that investment pays off (i.e., consumers get on-board), Microsoft will have a substantial lead in the global market that will be near impossible for others to replicate.

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Unlike the free access that one has here in the US to sign-up for and use Microsoft’s HealthVault for managing personal health information (PHI), Telus will “licensed” Telus health space to providers, agencies, provinces, etc. who will then offer it to their constituents. Telus health space is the Canadian instance of HealthVault, which Telus licensed from Microsoft last year to bring to the Canadian market.

In announcing the launch of Telus health space last week, Telus stated that it currently has 12 ecosystem partners.

TELUS Health Solutions partners and sponsors include Asthma Society of Canada, Canadian Diabetes Association, Canadian Mental Health Association, Dapasoft, HealthScreen, Heart & Stroke Foundation, Johnson & Johnson LifeScan, Juvenile Diabetes Research Foundation, MedicAlert, OMRON, Shepell.fgi and Sunnybrook Health Sciences.

Quick Assessment:

The go-to-market strategy of Telus health space makes sense.  A direct-to-consumer strategy for such services is fraught with challenges that even big consumer heavyweights such as Revolution Health and more recently, Google Health have struggled with and is unlikely to change anytime soon, thus it makes sense that Telus would go directly to providers, provinces and others to act as sponsors for the platform to serve their constituents.  In a call Chilmark Research had prior to the announcement we did learn that Telus has conducted “deep” discussions with several Canadian provinces for their licensing of the Telus health space.  As Telus will also be look to license Telus health space to providers, we wonder if Telus will also begin acting as a VAR for Microsoft’s Amalga platform and sell something similar to one of Microsoft’s most recent offerings, HealthVault Community Connect, which is getting a lot of interest among provider organizations here in the US.

The ecosystem is extremely thin. Out of the box, HealthVault is a secure data repository with APIs (application programming interfaces), an SDK (software development kit) and the Connection Center for biometric device readings. There is very little if anything out of the box that can readily and easily be used by a consumer.  Thus, the success of HealthVault (or in this case Telus health space) is the ecosystem of partners that can be recruited to the platform to provide a rich end user experience.  A quick scan of the partners for Telus health space does not look too promising (5 non-profits, large IDN in Toronto, only a couple of the numerous device manufacturers, and a smattering of software vendors) – not exactly a rich ecosystem that would compel one to readily sign-on.

Good go to market strategy, poor partner recruitment.  The future success of Microsoft’s first international HealthVault partner is far from guaranteed.

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Seattle Bound

Tomorrow, I’ll be heading to Seattle to attend Microsoft’s annual Connected Health event.  Last year’s event provided some useful insight’s into Microsoft’s international intentions which were most recently reflected in their partnership with Siemens to take HealthVault to Germany.  Last year’s event was also prophetic in Microsoft’s deepening intent to serve the provider market.  Based on the agenda I’ve seen for this year’s event, that intention has only increased.

So what do I hope to get out of this year’s event?

A deeper understanding of how providers are actually using the Health Solutions Group (HSG) of products that MSFT is now taking to market.  Particularly interested in learning more about the HealthVault Community Connect product which is basically a productization of its work with New York Presbyterian that resulted in myNYP.org.

A clearer picture of the HSG strategy to facilitate a physician/hospital in meeting forthcoming meaningful use requirements.  In particular, wish to learn how HSG will extend its partnership with Eclipsys and other ISVs with regards to modular apps on the Amalga platform, which looks to be morphing into a Platform as a Service model similar to HealthValut.

Progress on HSG’s international efforts.  Yes, they’ve landed Telus in Canada, Siemens in Germany and some EMR sales in Southeast Asia, but what is next?  Also, with regards to Telus and Siemens, what progress has been made to date, what have been some of the challenges.

Now if there is anything in particular that you, dear reader, woul like to know more about, please feel free to add something to the comments section below and I’ll see what I can do to get some answers.

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Just released this morning, Microsoft announced that it has landed Golden Living, a provider of long-term care (LTC) and like services for the elderly and disabled.  Similar to the New York Presbyterian and the Caritas Christi Health wins, Golden Living will be adopting Amalga UIS for internal aggregation of a customer’s health data to facilitate care and HealthVault as the customer control repository of personal health information (PHI).

In each of these cases, these organizations are using the Amalga/HealthVault combination as a competitive differentiator.  It remains to be seen if it will actually drive future business, but for today, it does put these organizations out front of their competitors in the adoption of new technologies and approaches in support of collaborative care that goes beyond the clinician to the community.

What is particularly interesting with this announcement is that the actual users of HealthVault at Golden Living are unlikely to be the residents of Golden Living facilities but their children, nephews and nieces.  This may provide Microsoft one more avenue to educate the market, getting consumers comfortable with the concept of online storage and sharing of PHI (privacy and security) and understanding the utility that such services as HealthVault’s brings to market.

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If you have read previous posts this week, you know that I was attending MIT’s EmTech conference. Event is a focused on technology and innovation of all stripes bringing together some pretty big names to discuss where we are today and where we are headed. For the first day, I had one continuous and long post, which in retrospect, I am not fond of – just too much to wade through to get to what may be important to you, dear reader.

The second day, I put up two separate posts, one on Craig Mundie’s keynote and the other on the Personal Genomics session. This approach came across clearer, and more focused.

So with that in mind, I am reposting the EMR session notes from day one. This will not be a verbatim repost as reflection on what I learned as well as comments by HealthVault’s Chief Architect, Sean Nolan, to the first post necessitated some revisions.

Recap of EMR Session:

Panel includes John Halamka (Beth Israel’s CIO), Karen Bell (HHS), Craig Feied, (Chief Strategy Officer, Microsoft Health Solutions, he developed Azzyxi at MedStar) and Girish Kumar Navani, (Founder & President, eClinicalWorks). Decent size audience, easily a third of the total attendees at EmTech (there are currently 3 concurrent sessions).

Karen started off basically setting the stage giving a broad overview of the challenges in healthcare and subsequently HIT, for the audience with the HIT Hierarchy of Needs slide (pyramid, privacy at the base up to public good at the pinnacle). For us in the HIT space, nothing new here, but for those in the audience, most of whom who do not work in healthcare, Karen’s presentation provided a good backdrop for follow-on discussions.

Halamka followed with the common statement regarding lack of EMR adoption. Halamka claims that EMR systems today are still too expensive. With an average cost of $40-60K per practice and the common drop in productivity of 25% for first 6 months after deployment, few physicians will shoulder this cost.

Despite this apparently prohibitive cost, Beth Israel is requiring all affiliated physicians to adopt and use an EMR. Beth Israel will subsidize adoption of EMR by offering a hosted eClinicalWorks solution for these affiliated practices at a big discount to encourage adoption. The plan is that through adoption of EMR, BI and affiliated practices will be able to better track and report quality and performance metrics that will result in higher payments, via P4P payouts, from CMS and other payers. This will augment the cost of hosting the EMR.

Halamka also talked of consumer’s abilty to move PHR data from BI’s PatientSite to either Google Health or HealthVault. Today, the only thing you can move into either repository from BI’s PatientSite is data pertaining to medications and allergies. Not much value there for the consumer, though this is the low hanging fruit of what physicians would want to see in a PHR, particularly in an emergency situation.

Kumar was next. eClinicalWorks is now in over 20k physician offices. Kumar talked in broad terms, not terribly specific. Does believe that “patient-centered healthcare” is the next major change in healthcare that will be a forcing function for EMR adoption. Not to surprising to hear from an EMR vendor.

The highlight of Kumar’s remarks was him stating that he does not like the term of EMR. For him, EMR is a static term that does not fully capture th purpose of an EMR, helping physicians deliver better, more informed care to their customers. Hmm, like this statement – he is absolutely right, EMR is a dead term, we need something new.

They just did a quick survey of audience, Managing Personal Health Information: 14% would trust lab or pharmacy, 32% would trust a company such as Google or Microsoft and 54% would trust only themselves or a doctor. Pretty liberal crowd here in that nearly 50% would trust a third party, beyond their doctor with the personal health information.

Craig talked about the development of Azzyxi and how what all he wanted to do was try to provide the most information possible at the point of care, in this case the ER. Believe that errors/failures in medicine are not about Execution, but in Planning. Unfortunately, he claims all the effort now is on Execution (meds, wrong patient, wrong procedure, etc.), rather than upfront Planning. Talked of the “Spectrum of Wellness” as core to MS’s health sector strategy – a rethinking of what healthcare is and how it is delivered, not only when you are sick, but when you are well. Good speaker, a bit heavy on the sales pitch though he does seem genuinely sincere.

Q&A Session: What’s the value to a primary care physician in adopting EMR. Halamka claims that P4P and quality reporting is becoming an ever bigger issue for physicians and that these systems can actually help doctors ultimately earn more and earn it easier (HIT can greatly facilitate all sorts of transactional processes). Kumar followed up stating that it will help physicians better understand what they are doing as well as help doctors prepare more effectively for patient visits. Supported Halamka’s view that quality and P4P will also push adoption going forward. These programs start to really put some cost justification behind EMR adoption. Craig thought that it is up to software vendors to create sufficient value in their solutions that will lead to adoption.

Status oF PHRs: Halamka – we have 40K users of PatientSite and believe in patient control, thus opening up to Google Health and HealthVault. Karen, still informative stages but right now pretty wide open as the apps are simple today and maybe not what consumer will use tomorrow.

Addendum to EMR Session – picked-up through conversations after formal session:

  • According to recent HHS calculations, there is over $700M in incentives, via payers, through various P4P and quality improvement programs that can be used to subsidize EMR adoption by practicing physicians. Clearly, there is money to be had, though I am not sure that most physicians know how to capitalize on it. Unfortunately, few, if any EMR vendors today are helping physicians understand that there is an opportunity to augment the cost of EMR adoption. Truly, a missed opportunity.
  • Today, Beth Israel is allowing their customer to export their PatientSite PHR data to either Google Health or HealthVault. Problem is, a BI customer can only export medications (includes immunizations) and allergies. I asked Halamka why they are not exporting the full record and he told me that neither Google nor Microsoft’s offerings can handle anymore than that and used the example of imaging data, stating that the data models for both Google and HealthVault just aren’t there yet. There may have been some misunderstanding as Sean Nolan quickly commented on the previous post that HealthVault was capable of accepting numerous data types, (e.g., labs, clinical notes, etc.) with the exception of images. Sean went on to check with Halamka who states that he was just referring to images when I initially spoke to him. But that just brings me back to my original question to Halamka: Why are you not allowing customers to export as much of their record as a service like HealthVault can accept? Will need to follow-up on this one.
  • eClinicalWorks is seeing no issue with reluctance in market to adopt EMR solutions. Kumar told me they have plenty of business and are still on a very rapid growth path. Early problems precipitated by a couple of huge orders (e.g., NYC) are behind them now and they are meeting target implementation and delivery dates. Also, despite all the rumors of eClinicalWorks relying heavily on offshore developers, over 80% of all employees are based right here in the US. Kumar does use resources in India, but on a flex model to address pressing, unexpected customer needs, which are not an every day occurrence.

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Amalga = Amalgamation

Earlier this week, Microsoft announced the release of its new product suite for the healthcare sector, Amalga. Almaga includes the Azyxxi solution, which they acquired from Medstory, and the Global 2000, hospital information management (HIS) solution being used at the medical tourism destination, Bumrungrad International Hospital.

A relatively minor announcement in the grand scheme of things, but a couple of points in the announcement are worth noting.

Once again, Microsoft made it clear that the Global 2000 HIS solution, (now called Amalga HIS) will not be sold in the US. Obviously, Microsoft doesn’t want to alienate existing HIT partners in the US, though not sure why Microsoft would be all that concerned as it is unlikely that other HIT vendors will run from Microsoft and into the arms of Red Hat/Linux or some other system.

I say this from experience.

Many moons ago, I made a prediction that ERP vendors would abandon their relationship with Microsoft when they acquired Great Plains and then Navision. I was not alone in this prediction. Sure, Microsoft’s ERP partners were all nervous and distanced themselves from Microsoft for a period of time. But within a relatively short period of time, these companies were back talking with MS and putting the MS certified sticker on their website. Why? Quite simple, their customers told them to. No customer was going to change their MS-based infrastructure just because Microsoft got into the market. So, expect Microsoft to initially target overseas markets for Amalga HIS, but in time, they will be selling it in the US if it makes business sense (i.e., their Amalga-Azyxxi customers ask for it).

As for Microsoft making a new category of software, ala Unified Intelligence System (which is the former Azyxxi) – well maybe it is new to the HIT space, but this is very old in other sectors, such as manufacturing where there have been such systems for years. Amalga (Azyxxi) will go GA sometime in the first half of 2008.

And where did they ever find that name Amalga – sounds like something out of a Bugs Bunny cartoon – short for amalgamation, but maybe that gives us some idea of their overall HIT strategy.

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