Posts Tagged ‘athenahealth’

Over a 1,000 exhibitors, some 30,000+ attendees and I come away from HIMSS, again, thinking is this all there is? Where is the innovation that the Obama administration i.e., Sec. Sebellius and Dr. Blumenthal both touted in their less than inspiring keynotes on Wednesday morn? Maybe I had my blinders on, maybe I was looking in the wrong places but honestly, outside of the expected, we now have an iPad App for that type of innovation where nearly every EHR vendor has an iPad App for the EHR, or will be realeasing such this year, I just didn’t see anything that really caught my attention. But then again, looking over my posts from previous HIMSS (this was my fourth), maybe my expectations need a serious reset and it would be wise of me to read this post next year before I get on the plane to Las Vegas and HIMSS’12.

Prior to HIMSS I participated in a webinar put on by mobihealthnews (BTW, Brian at mobi has a good article on some of those mobile apps being rolled out at HIMSS this year). My role in this webinar was to give an overview of what one might expect at HIMSS’11. Having weathered the last two HIMSS and the major hype in ’09 about Meaningful Use and ’10 when HIEs were all the rage, this year I predicted that the big hype would be around ACOs. Much to my surprise such was not the case.

The reason was quite simple and two fold.

First healthcare CIOs and their staff are going through numerous contortions to get their IT systems in order to meet Stage One Meaningful Use (MU) requirements. Looking ahead their focus is naturally myopic: What do I need to do to meet Stage Two and finally Stage Three MU requirements, requirements that have yet to be published? Then there is this little transition to ICD-10 that some pundits claim is the HIT sector’s own Y2K nightmare (not sure if that means the hype and fear is far greater than reality or what). Either way, CIOs are having a tough enough time just keeping up these demands and filling their ranks with knowledgable staff (one CIO told me he has 53 open positions he’s trying to fill) to even begin thinking about ACOs.

Secondly, there are the vendors who today are not completely sure of what exactly healthcare organizations (HCOs) will need to succeed under the new ACO model of care and bundled payments. In countless meetings I had over the course of my three days at HIMSS I did not meet one vendor that had a clear picture of what they intended to offer the market to help HCOs become successful ACOs. There was unanimous agreement among the vendors I met with that analytics/BI would play a pivotal role, but what those analytics would look like, what types of reports would be produced and for whom, were less than clear. So it looks like we may have to wait another year before the ACO banter begins in earnest at HIMSS.

Some Miscellaneous HIMSS Snippets:

Much to the chagrin of virtually every EHR vendor at HIMSS (still far too many and I just can’t even begin to figure out how they all stay in business) Chuck Friedman of ONC announced in his presentation on Sunday that they are looking into usability testing of EHRs as part of certification process. Spoke to someone from NIST who told me this is a very serious consideration and they are putting in place the necessary pieces to make it happen.

Defense contractor and beltway bandit of NHIN CONNECT fame, Harris Corp. acquired HIE/provider portal vendor Carefx (Carefx was profiled in our recent HIE Market Report) from Carlyle Grp for a relatively modest $155M. I say modest as this was some 2x sales and far less than the spectacular valuations that Axolotl and Medicity received. Could this be a reset of expectations for those other HIE vendors looking to be acquired? Reason for acquisition is likely two-fold: Carefx has a good presence in DoD and this may help Harris land some potentially very lucrative contracts as the DoD and VA look to bring their systems together. Secondly, for some bizarre, and likely highly political reason, Harris won the Florida State HIE contract and now has to go out and pull the pieces together to actually deliver a solution, which frankly they don’t have but Carefx will help them get there..

Kathleen Sebellius needs a new speech writer. David Blumenthal needs more coffee before he hits the stage.

The folks at HIStalk once again provided excellent, albeit slightly self-congratulatory coverage of HIMSS. They also threw one of the better parties that I attended. Thank you HIStalk team.

Had several people, mostly investor types contact me for my opinion of the athenahealth-Microsoft partnership that was announced. Do not see much in the way of opportunities for either party in near-term. It will take a lot of work for anything truly meaningful and profitable to come from this relationship. That being said, did think that the Microsoft-Dell announcement was quite significant and should be watched closely, especially if Microsoft can truly get Amalga down to a productized, easily deployable version for community hospitals that Dell intends to target.

HIMSS and most vendors are still giving lip-service to patient engagement. Rather than seeing a slow rise in discussing how to engage consumers via HIT, this issue is something that few vendors bother mentioning and when they do, it is still with the old message of how to market to consumers with these types of tools rather than engaging consumers/patients as part of the care team. Hell, not even part of the care team, but the damn center of the care team. Not sure when these vendors will get religion on this issue. Maybe they are just following the lead of their customers who have yet to fully realize that in the future, a future where payment will be bundled, that actively engaging consumers in managing their health will be critical. While I have not completely given up hope on this industry to address what is arguably the most challenging issue facing healthcare’s future, I do chide them for not having more vision and frankly guts to take a leadership role and help guide their customers forward.

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Today, GE announced the release of Centricity Advance, their solution for the ambulatory market. Centricity Advance is basically a build-out/rebranding of MedPlexus an SaaS EHR solution vendor that GE acquired in March 2010.  GE now joins others (see below) in the EHR market who are striving to provide a complete acute to ambulatory EHR portfolio.

AllScripts’ acquisition last week of Eclipsys.

NextGen, a traditional ambulatory EHR vendor whose parent, Quality Systems Inc. acquired Sphere Health Systems and Opus Healthcare Solutions to target rural acute care facilities.

While some may argue that the HITECH Act and meaningful use requirements are core drivers for these acquisitions (e.g. tap future incentives payments in new markets), the real reason is the need for large healthcare organizations to more closely align smaller affiliated practices to their operations in anticipation of healthcare/payment reform (bundled payments, patient-centered medical home, etc.). These large institutions are increasingly seeking out such fully integrated acute to ambulatory solutions and is one of the core reasons that EPIC (they started in ambulatory and grew organically into acute) has seen success in the market.  It remains to be seen if those pursuing an acquisition strategy will be as successful as EPIC for it often takes years for two systems to be combined in a truly integrated fashion.

Looking to the future, one has to wonder what will be the fate of those who remain in either just the acute or ambulatory sector.  Our quick assessment of a few of the ambulatory vendors…

athenahealth: athenaclinicals is new to the market and the company has an opportunity to tap its existing customer base. Short-term, they’ll stay independent but likely to be acquired in 3-5 years.

eClinicalWorks: Fiercely independent and will likely attempt to pursue a strategy similar to EPIC’s and grow organically and stay independent. Will make some niche app acquisitions where needed to accelerate time to market.

Greenway: Will be acquired in next 1-2 years.

Sage: Like Greenway, acquired in near future.

Practicefusion: Will stay independent, may be rolled-up into a larger offering from a bigger entity that comes from outside healthcare sector, e.g., minority investor Salesforce.com

Now this is only our educated guess (and we certainly welcome yours in the comment section below), but in our conversations with numerous stakeholders in the market, this guess is one we’d be willing to bet on.

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8:15am Interview with healthcare SaaS darling athenahealth. CEO Jonathan Bush is being interviewed by Chris Lawton of the Wall St. Journal. Jonathan speaks so fast (he definitely has ADHD) it’s nearly impossible for me to keep up. One comment from Jonathan: Many of the Health 2.0 companies say they are different than Google but put nothing that truly shows they are different. Tey have not done the hard work to really create something different.

Jonathan just inferred that they are looking to deliver solutions that better connect physicians to consumers. Made reference to using technologies like RSS feed to get your lab results from your physician. Wants to enable consumers to go online to do appointment scheduling and other transactional processes.

Athena Clinicals, their new EMR, less than 1000 doctors using it now. Aveage they receive is 89 pages of paper from physicians per day, directly faxed to them for processing. Like the payments processing, which startd their company, they are looking to revolutionize doctor practices, making their life simpler and helping them, the doctors, make money.

8:30am Interview with Sermo CEO Daniel Palestrant. Sermo made a big announcement this morning partnering with investor publisher, Bloomberg, to connect healthcare investors with physicians. Sermo is now working with 10 of the 12 top pharmaceutical companies. (At last year’s Health 2.0 event, Sermo announced Pfizer as first pharma partner.) Clearly, pharma is lookng for new channels to reach physicians. Today, Sermo in reaching only a small percentage of physicians though, so how much patience will pharma companies have as Sermo looks to expand its reach remains to be seen? OK, Daniel just answered that question stating they are getting 7K new physicians/month signing up. Surpirsingly, it is older physicians where they are seeing the most growth. Daniel claims these physicians are leveraging Sermo as they are too busy to use traditional learning channels.

Future at Sermo: Now preparing to expand service overseas. By mid-2009 will have an offering that brings in the consumer. Still, I wonder how Sermo will actually start making money, something that Daniel did not touch upon. Even with forecasted growth of some 7K new physicians/month, it is going to take them a very long time to have a truly influential presence in healthcare. Even the Bloomberg announcement today, while interesting, it is unclear how it would actually work and how investors would benefit by it. Physicians are busy people and investors maybe more so. Will have to get a demo on this new Sermo-Bloomberg service as at first glance, this looks like a non-starter.

9:00am Panel Session on Health 2.0 Around the World: Starting off with Sage Software exec, James Matthews emphasizing the term mHealth. India, 300M paid cell phone subscribers which will grow quickly to 720M. Becoming ubiquitious in India, everyone SMS’s each other. This is where health is moving – this is how the world will connect.

First up from panel is VOXIVA, which is focused on mHealth (right at top of their homepage). They target the physician market to ease physician-consumer communication. Working in Uganda with a nationwide mHealth service to assist tracking population health and wellness. Gave demo of using SMS on a service offered in Mexico, CancerNet. VOXIVA’s model is leveraging what is already out there by offering a platform for others to quickly build out mobile health apps. (Will need to look into this more as it is difficult to understand where thy make their $$$)

Next up, isis, a nonprofit developing apps focused on sexual health education. SMS text messaging for prevention and referral. Lots of work focused on youth, thus the emphasis on mHealth. Also working in South Africa. Beginning to expand beyond sexual health issues to address depression in teenage youth. Some really good stuff they are doing – quite impressive and their product/service development model is excellent. One of my favs so far at Health 2.0

Now we have Alensa, a European company focused on mail-order health products. Making a profit. Work closely with the physician community, started with 12 docs to provide advice on their site. Company is Romanian. Recently launched a health blog aggregator for clinicians to put their blog and even moneitize their posts (has widget for charging reader a fee to see full post, can be done via mobile, numerous currencies supported). Odd, just don’t see anyone actually paying for your typical Blog post.

Now we have German company PHR provider ICW. (Note, they were profiled in our iPHR Market Report – some nice technology, particularly for linking in biometric devices). Demonstrated a technology they developed that links blister packaging of medications to unique medication regime of a given patient profile. Closed loop process from the inital entering of medication regime, to blister packaging, to barcode bedside delivery and link-back to the patient profile updating profile that medications have been taken at prescribe time./interval. Guess, ICW, like most PHR providers, must look to other markets to foster growth. But let me put that in context: From early on, ICW has always had some development focused on the clinician. And with some 600+ employees, it is also clear that much of their business today comes from outside of consumer-focused apps.

Now have a spokesperson from the UK’s NHS who is giving an overview of their PHR, MyHealthSpace. Not unlike what KP has done with MyHealthManager – track health, see labs, support eVisits, make appointments, etc. Nothing new here if you have been tracking KP’s roll-out.

Panel discussion/comments: Need to design apps/services that are able to run on any number of modalities. Too many are focused on just one or another, basically painting themselves into a corner. IDEO chief, Doug Solomon finds health and technology like oil and water right now, each in their own separate worlds in creating products/services. He is seeing an amazing amount of creativity occurring overseas, particularly among poor people using mobile technology in rural areas. Encourages developers to get out in the field and see what is being done – “you’ll be amazed”.

11:00am Panel/talk show format – Tools for Consumers: Matthew Holt, one of the founders of this conference has just danced up on stage as Matilda, long red hair wig and all. “Matilda” has a new iPhone and A.D.A.M. has just taken the stage to introduce/demo their iPhone Health Navigator app. Note: talked to A.D.A.M. head of engineering yesterday who told me this app would not be available until Q1’09. Still working through some of features (some pretty slick ones he demo’d for me, including streaming educational health videos delivered over the iPhone. They are still working through the pricing model and what will be offered for free and what will be add-on features for a fee.

David Clymer of myMedLab just gave a demo with Matilida demo’ing the ability to purchase a lab test online. DTC (direct to consumer) model. Operate in 47 states today with 200 collection sites. Had talked to David several months back. As I recall, they have a close partnership with the second largest national lab service, LabCorp. David gave me a free test to try out the service. Unfortunately, the closest lab to draw my blood was some 40 miles away – to much of a hassle to bother. Wonder if they are having the same problems with other consumers.

Next up, Linda Avery from 23andMe and Mari Baker from Navigenics to talk about DTC genomics testing. Linda is seeing the genetics testing market moving very quickly. Early learnings at Navigenics is provindg a completely new level of information and inspiration. Over 6,000 physicians have taken the CME course that they are offering online. Now looking to partner with one of the big societies to extend the reach of the CME course. Matilda took genetics tests from both. Linda demos the private customer site showing various risks, based on their combing of the research, and provide links to specific reports that the consumer can review and learn more about their risk(s)and ways to augment the risks. Now we are looking at the Navigenics test results, again showing various risk profiles. Mari started demo, unlike Linda, clearly stating that she is not a genetic adviser/counselor and encourages Matilda to use one when evaluating one’s genetic profile and risks. Good move Mari – this is absolutely critical for all in this audience to understand.

This should be good, we now have former Googler, and founder of Keas – Adam Bosworth. When signing up fo rthe service, looks like one will complete a baseline HRA to set your baseline on health. This is a health & wellness app/service. Also structured to import your lab data, or order, via DTC a lab test. Some nice grapics to display various charts and goals. Five tabs across top: My To-dos, Overall Progress, My Labs,My Meal Plan and My Exercise Plan. Under My Meal Plan, three choices, create your own, Keas recommends or other member recommendations. More pictures/graphics. Very graphics heavy site – you’re going to need broadband. Also has streaming video (Youtube videos) embedded.

Opps, looks Adam is having a “Neupert moment” a burp in he demo.

Demo is back and live, albeit with some “operational problems.” As one, over time, mproves their health profile within Keas – Keas provides positve feedback messaging. So, Adam, who is your customer? The end user or employers/payers looking for health & wellness apps they can sponsor for ther constiuents? Likely the latter, but will have to follow-up.

So there you have it, Keas is a health & wellness ap that will draw in data from labs and self-entered to help guide one in taking better care of their health. One big missing piece though is medications. Real mystery as to why that was left out. There must be some justification, but I can’t figure it out – especially since they are advising the user on meal plan. That meal plan may be in direct conflict with a consumer’s medication regime.

Roy, CEO of AmericanWell has now taken the stage with Matilda to demo their online doctor eVisit. Live video feed via webcam for consultation between doctor and consumer. eVisit is timed for 10 minutes, which can be extended by physician if they deem it appropriate. Plenty has been written on this company before – they have conducted an extremely heavy marketing push. Despite all that marketing, they have only landed one significant client, BCBS of HI. They are going to need a lot more than that to stay in the game.

Now Matilda just got a phone call with an automated system leading Matilda through her Rx reill including asking her if she wanted to save some cash by going with a generic. Matilda made the switch and the automated system confirmed request and sent the script to the pharmacist and a note to her physician.

DestinationRx now giving a demo on Matilda’s medication regime and adverse drug interactions. Also advises on savings opportunities for Matilda for switching from one medication to another. Example used was Lipitor, a 90-day supply costing $80 and suggesting three comparable generics costing $6.00 for that 90 day supply. Great demo, nice pricing visibility for the consumer. This looks like a winner.

Destination Rx also allows one to manage the meds of a loved one, say a child managing their elderly parents Medicare Part D medication choices. Provides ability to compare plans from the various insurers, match it up to the medications one is taking to show which is the most cost effective plan. In this example, the plan with the lowest monthly premium was not the one with the lowest total cost – in this example, a $2k/yr difference.

Geez there are a lot of med checkers. Just had a demo of PharmaSURVEYOR. Unimpressed. Too complex and too messy a site that I personally would avoid. Had a strip of Google ads down the side of the page. Simply amazed at how many of these Health 2.0 apps are somewhat dependent on that Google ad bar.

Marlene, founder of doublecheckMD has taken the stage to demonstrate their new offering that provides a personalized treatment regime based on a condition one might have, in this case high blood pressure. (Note: Marlene, who is one of the nicest people I’ve met here, told me yesterday that this new offering was developed in close cooperation with Aetna). One of the nice features of their site is the use of a natural processing engine that allows the user to enter common everyday terms – very user friendly. Find their site text heavy and could be cleaner/easier on the eye.

QuickenHealth now demo’ing their Health Expense tracker. Shows bills one may need to pay as well as exactly what you are being charged for in simple understandable English, unlike a standard EOB. Do online bill pay. As others have stated, not much more than a health specific Quicken app. Claims and benefits, if they have a partnership with Intuit enable upload of claims/EOBs directly into expense tracker. Pretty simple, straightforward app – nothing new or exciting.

2:00pm Panel Discussion on Privacy: Yes privacy is important, of curse they are talking about HIPAA for non-covered entities, for and against – the usual, nearly intractable issues we have heard for years now so not much to report here.

As with any event, usually the best discussions and oft-times most interesting things seen are outside the formal presentations & demos. During lunch was introduced to the CEO and founder of MEDgle. He and his team have developed yet another health search engine, but this one actually has an intriguing twist. Rather than do broad web searches for the consumer, their system does a structured search on content that they have gathered. But the real twist and added value here is that when one does a search you are presented with a several demographic type filters that narrow the search to your specific profile (e.g., male, 30-50yrs old, sedentary). They launched their first product/service a little over a year ago, MEDgle.com which is focused on medical conditions/symptom search. Two days ago they launched a new service, Healthiermee.com. Just did a drive-by of Healthiermee: first impressions, easy sign-in, nice graphical interface for setting up initial profile, some quick feedback on health and risk(s). They’ve done a nice job. Along with what I saw from RightHealth/Kosmix yesterday, this looks like a search engine with some legs. Now comes the hard part, taking it to market. This is one to watch.

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In case you didn’t see it, Bloomberg had an article last week that assessed the possibility of the ever acquisitive Oracle (some 40 acquisitions in last 4+ years) making a move on healthcare by acquiring Cerner.

While I normally focus on consumer-facing apps, can’t help but comment on this story as I know Oracle quite well (and many of the companies it acquired) from my days as an IT analyst leading the Enterprise Group for the manufacturing centric analyst firm, ARC Advisory Group.

So is this possible/probable?

Well, yes and no for the following reasons:


  • Oracle is very savvy at making acquisitions work, no one does it better in the enterprise software market than Oracle.
  • Oracle, unlike major competitor SAP likes making acquisitions, its core to their growth strategy.
  • They need new markets to achieve target growth projections as their existing markets, while still having opportunities, are mostly at the mid-tier and lower levels and will not be enough.
  • Healthcare sector is increasing spending on IT, faster than most other large market sectors.  It is also a very large market.
  • They have existing presence in healthcare as most large healthcare enterprises are already running on top of Oracle databases.


  • Healthcare is a difficult, fragmented market with few large entities (target customers) among providers.  There are no GMs or Fords or Dow Chemicals to conquer, therefore cost of sales will likely be high.
  • Healthcare is full of regulatory requirements and lots of customization of software.  Oracle is not a fan of customized solutions and for years has aggressively promoted an out of box solution approach.
  • This sector has not seen much consolidation – there are far too many EMR solutions today.  Maybe a big play by Oracle will help to rationalize the market, but right now it appears too early for them, unless of course they acquire a couple of leading players serving different tiers of the market e.g., buy both Cerner and athenahealth.
  • This market has yet to demonstrate that it is truly a global market, which limits growth to North America for the time being.  Granted, that is still a big market, but its not like manufacturing where distributed product development and manufacturing has occurred for years and systems, process and software has been developed to support such activities.


Oracle will make a play in the healthcare market as it is one of the few markets remaining that does not have a large, true enterprise software vendor of the likes of Oracle or SAP (Note: SAP has seen some success in the native German healthcare sector but little here).  A company like Cerner is an obvious choice, but to be successful, they’ll need to make more than one acquisition to develop a significant presence.  Oracle may also come at it from the health plan side, though Trizetto, the dominant player here was recently acquired and unlikely to be available, unless of course Oracle pays a princely sum.

Oracle will make a play, but it won’t just be Cerner, or similar large EMR vendor, it will be several.

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I got religion.

At least religion that part of the savior to today’s, and more importantly, tomorrow’s healthcare crisis lies on the Internet.

With the abysmal adoption of IT to date within the healthcare sector, I am a strong believer that this industry will simply leap-frog the traditional, three-tiered IT architectural model and move directly to an SaaS-type model (ala athenahealth or Salesforce.com) coupled with cloud computing.  Granted, this will not occur over night and most large hospitals and IDNs will be loathed to give up on their server farms and internally developed apps, but there is a very large percentage of care (some estimate it at 80%) which takes place outside these large healthcare facilities, and it is here where adoption of healthcare IT (HIT) is lowest and where we will see the Interent play the biggest role.

We are still very early in the game here and there are numerous issues to contend with from privacy and security to uptime, to control – not insurmountable, but issues that must be addressed nonetheless.  So to get up to speed on how some of these issues may be tackled, I’m of to Harvard University for the next couple of days to get some schooling on the topic.  The Berkman Center for Internet & Society is having a 10th anniversary conference and have put together a very interesting agenda.  Will report back any insights I garner.

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athenahealth Makes a Splash

On Sept 20th, athenahealth (ATHN) went public on the NASDAQ becoming the most successful IPO to date in 2007. Coming out at $18/share, the share price soared to over $38/share, a 115% gain. Since then, the price has settled down (probably some profit taking by early purchasers) and is now trading at ~$33/share. Still a hefty increase over that entry IPO price.

While some claim that founder and CEO Jonathan Bush, being a cousin of Pres. Bush has a lot to do with the success of the IPO, I find this a rather simplistic view.

So why is the market excited about athenahealth? Here is my quick take:

  • Delivering a service that the market truly needs. Most physician practices are struggling to keep up with the myriad of rules to effectively and efficiently collect from payer. athenahealth provides a Web-based service that addresses this need.
  • Model is in some respects similar to Salesforce.com, a darling on the street, thus athenahealth gets some added value there.
  • Breaking from the tradition of most vendors in this market – it is a disruptor and better yet, a disruptor that users are readily adopting. With renewal rates close to 100% it’s hard to argue that this model will not work.
  • As a subscription service, it has an excellent and dependable annuity revenue model that provides assurances for the future.
  • Pricing model is also attractive to physicians as it is typically based on a small percentage cut of the revenue that their service is able to capture from payers on behalf of physicians.
  • Very healthy high double digit growth rate that appears to be accelerating.

While it remains to be seen just how scalable their model is, there is a lot to like about this company. My hope is that such success will spawn others to likewise go counter to traditional wisdom in this market as it may be the only way that we’ll see real change and subsequently better health, better outcomes and greater adoption of HIT in the broader market.

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