Posts Tagged ‘AT&T’

mHealth12Be careful what you wish for sure did apply to this year’s mHealth Summit, which was held last week in Washington D.C. Of the some 4,000 in attendance, I was one of the 10% or was it even 1% of those present that have attended all four events in succession. It is with that perspective that I came away from this year’s mHealth Summit more disappointed than ever.

At previous mHealth Summits, I often bemoaned the lack of organization of the conference, the often bizarre exhibitors one would find (couple of years back one exhibitor, and I kid you not, was marketing herbal aphrodisiacs) and basic necessities one would find at virtually any event, breaks with coffee, maybe a snack here and there. This disorganized, but charming event was mHealth Alliance Summits of years past.

After an initial partnership last year with the NIH Foundation, the original organizers of the mHealth Summit, HIMSS formerly took over the mHealth event this year. The result, a much more well organized registration process, greater focus on the exhibition area and a definite improvement on basic event logistics.

Unfortunately, HIMSS was less successful in improving the content of the numerous sessions that were held. It seemed that anyone with an idea for a topic was given a stage to stand on, or at least a panel to participate on even if what they had to say had very little to do with the session topic.

The exhibit area, while improving, still lacked a core constituency, HIMSS’s bread n’ butter customer base, the traditional HIT companies that one finds at the national HIMSS conference. This struck me as quite surprising as we are now beginning to see EHR vendors finally release solutions that truly enable physicians to use their tablets for bi-directional interaction with a healthcare facility’s core health information system.

But there were two things I found most disturbing about this year’s event. The first was how HIMSS handled the keynote presentations. From this vantage point, it appeared that each and every one of keynote was simply sold to the highest bidder and since they were sold, the winning bidder felt that their keynote provided them the opportunity to sell the audience on their concept, their product, their platform for mHealth. It was horrid to watch and cheapened this event to a level it has never seen in its short history. Seriously HIMSS, today you have enough clout in the market to not stoop this low so why did you?

Another big omission in the main stage was the lack of clinicians discussing the potential use cases for mHealth, the challenges to adoption, the challenges to link into legacy systems and how they see mHealth evolving in the future to meet their care delivery needs. THere could have been some stunning visionary talks on the topic, but none were to be found at this year’s Summit.

The other disturbing issue relates more to the industry itself and those positioning themselves to be the leaders in the mHealth market. Companies such as Aetna, AT&T, Qualcomm, Verizon, et. al., all spoke about an open platform for mHealth applications. Of course each of them was talking about their own proprietary “open platform” that they are hoping will become the de facto standard in this industry sector. Problem is: none of them have the consumer traction, nor a compelling enough vision to gain a critical mass of developers for their specific platform. There are no “Apples” in this bunch.

The need for a common set of standards that will allow mHealth apps to cross-talk to one another is a serious need in this sector, Without such standards, mHealth will never truly blossom into its full potential and remain the sideshow that it is today. Now, if we could get these big players to all agree that mHealth is far more important than any single one of them, that competing via proprietary platforms is a dead-end, then maybe we will finally get somewhere.

Note: As mentioned previously, we are getting ready to switch to a completely new site. THerefore, while you can leave comments here now for discussion, it is unlikely that they’ll be transfered over to the new site.

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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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Covisint is one of those companies that shows up in a market, seemingly from nowhere, strikes a couple of partnerships many wonder, where did they come from?

In February 2008, Covisint had a co-announcement with AT&T on being selected by the State of Tennessee to be the infrastructure backbone for the state’s eHealth initiative (Vanderbilt professor Mark Frisse did a good write-up on this announcement). Covisint also announced in that same month a partnership with Microsoft’s HealthVault. Finally in late June, a joint announcement was made by AT&T, Covisint and HealthVault. It was this last announcement that prodded me to dig deeper into Covisint

First-off, having been an analyst for several years in the manufacturing space and for a time addressing supply chain/e-procurement, Covisint was no stranger to me.

  • Covisint was formed in 1999 to address supply chain/e-procurement for the big three auto companies.
  • Ran into all sorts of challenges as e-procurement was far from ready for prime-time.
  • Almost went bankrupt, was shopped around, Compuware picked them up in 2004.
  • Platform was delivering some value to auto industry, particularly for supply chain collaboration. Such collaboration required strict identity mgmt & secure messaging. Covisint also built out a portal solution allowing users to create personalized portals with Web Service calls to numerous apps across the automotive supply chain.

Had a call last week with their VP of Healthcare, Brett Furst, who told me the following:

  • Covisint began targeting this market 3 yrs ago. Research points to the healthcare portal they developed and released in 2005 with first customer being BCBS of MI.
  • Currently they offer 3 key services on an SaaS (Software as a Service) model; identity management, secure messaging and a portal framework. All 3 services were originally developed for auto industry supply chain requirements.
  • Growth to date has been ~170%/yr. In 2007, 30% of Covisint’s annual revenue (~$40M) came from the healthcare sector. In 2008, over 50% of Covisint’s revenue is projected to come from healthcare.
  • There are 18,000 physicians using the Covisint platform today. (I estimate 35-40% are based in MI).
  • Flat fee set-up with annual subscription cost (cost depends on how much you want to do and can vary from $3/month to nearly $100/month). There is a transaction fee layered on top of that, again cost of transaction dependent on complexity.
  • Focus on Payer/health plan market and to lesser extent mid-size physician practices. Current customers include 9 Medicaid plans and 180 health plans.
  • Positioning themselves as “The Comcast of Healthcare” being completely agnostic to both applications and platforms. They want to provide the backbone upon which other apps will ride, like an HBO or Showtime channel. Thus, they do not see HIT vendors as competitors but as “channels” riding on top of their backbone service. For the Personal Health System (PHS) platform plays (Dossia, Google and HealthVault) same story.
  • Value prop: provide secure digital backbone to allow physicians and extended care practices to interact (have some 200 APIs to various HIT apps). For health plans, its all about simplifying workflow and payment processing.

Within the context of a PHS, Covisint will play an important role for HealthVault on a several fronts.

  • First, Covisint’s secure messaging capabilities will allow physicians to readily move a customer’s clinical files to a HealthVault account. A physician could even initiate the creation of a HealthVault account for a customer (auto register). Likewise, secure messaging will allow a consumer to push files to a physician who is on the Covisint platform.
  • Conversely, Covisint’s numerous APIs to various HIT apps as well as support of multiple HIT standards will allow data from a consumer’s HealthVault record to auot-populate their physician’s EMR platform. Also, biometric data from the 40 some odd devices now compatible with HealthVault could also be automatically fed into the physician’s EMR for tracking health status, thus enabling remote telehealth practices.
  • If the physician does not want thi data going directly into their EMR, they could instead use the Covisint portal technology to create specific consumer portlets that may facilitate tracking of care, though this may be more pain than its worth.
  • The secure messaging service could morph into enabling HealthVault account owners to request eRx refills, schedule appointments and even e-Consults.
  • With 18,000 physicians currently using the Covisint service, HealthVault has the potential to readily tap into these physicians and receive clinical records to populate consumers’ HealthVault accounts.
  • There is also the possibility that combining Covisint capabilities with the HealthVault data repository and the AT&T VPN a physician could theoretically create an inexpensive EMR, though data access and control will be governed by the consumer and not the physician. That could get tricky!

Stepping back and putting on the tough cynic hat of an analyst, here is where I see some problems or at least incongruities:

  • For a small practice, using Covisint isn’t exactly cheap. Those monthly fees coupled with transaction fees will certainly add-up. Thus, it is unlikely that providers themselves will run out and adopt the platform without some major incentives, as in the case of Tennessee, or financial support from health plans.
  • I have a hard time reconciling Covisint’s claims to being application agnostic, particularly as it pertains to messaging. Most EMR companies have secure messaging services, (e.g., Epic has a peer-to-peer messaging platform, albeit only with other Epic systems), Medem and RelayHealth offer messaging as well and are agnostic to an underlying EMR. Will Covisint’s messaging service eliminate the need for one of these other services? Also, the Covisint portal technology competes with similar solutions already in the market.
  • For a company that is making a major push into the healthcare sector, their website has not kept pace. There are several pages dedicated to specific healthcare stakeholder groups (e.g., RHIOs, Hospitals, Payers, etc.) some case studies and PRs, but when one goes to dig into the actual services/applications that Covisint provides all messaging is written for the automotive supply chain sector. Makes me question what Covisint’s level of commitment is to healthcare if they can’t go down to a deeper level of articulation on what their platform provides the healthcare sector.
  • Beyond getting the messaging right, Covisint has few true partners in the healthcare sector. Sure, they have partnerships with Initiate Systems, AT&T and HealthVault, but beyond that no other partnerships are to be found.


Covisint does have a robust platform that has proven itself in the automotive sector and could potentially provide an extremely valuable service to the healthcare sector. Many talk of privacy and security in healthcare, which is critical, but if you want to see privacy and security in action, take a look at what Covisint had to do in the automotive sector to insure that competing interests did not peer into one another’s supply chains. Now that is privacy! Covisint put a lot of time and effort into solving that problem for the automotive sector and their move into healthcare should be a welcomed one. In addition, operating on an SaaS model is also a good fit for the healthcare sector as few healthcare practices do HIT very well, so why not hand over such infrastructure tasks to Covisint.

Covisint is not without challenges, however, chief among them is getting their pricing model right for broader adoption and demonstrating that they are serious about healthcare by cleaning up their messaging and expanding their partnerships.

And don’t be too surprised to see Covisint announce a similar partnership with Dossia.  After all, AT&T is one of the founding consortium members of Dossia.

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This just in, Microsoft’s HealthVault announced a partnership with AT&T and Covisint to enable healthcare data exchange across a highly distributed network.  While I have not had a chance to really dig into this announcement, it does appear, at least on the surface, to be quite an interesting partnership.

One of the most interesting aspects to this announcement is Covisint.  For those who may not remember the  dot-com hey-days of the late nineties, Covisint  was originally formed by the Big Three automakers with the purpose of creating a common architecture for e-Procurement and other supply chain enhancing functions.  Covisint never really did take-off, despite massive spending by the Big Three and Tier One suppliers.  Big problem came up when the automakers discovered that many of their pricing, contracts, and materials information were actually very proprietary and thus not suited for Covisint.  That left Covisint with commodity type products to attend to and there were simply not enough at sufficient margins to sustain the model.

Maybe their venture into healthcare will be more promising.  Covisint certainly has the secure data exchange angle well-covered.  Look to the AT&T/Covisint deal in Tennessee to understand more of where this may be going.

Will look into it further and possibly do a more in-depth report if warranted.  For

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Today’s Wall Street Journal (WSJ) has a fairly long article, by their standards, (section D, pg 1) on the use of cellphone text messaging to deliver health related information. Unfortunately, the article tries to cover too much ground going from texting for sex education info for teens in California to reminders for an appointment at your local spa to dieting and medication management.

Being hit with such a slew of possibilities left me wondering, “OK, now what?” Sure this looks interesting, but is there anyone doing it in a systematic fashion that can point to clinically and statistically relevant results? Based on the article it appears that no such study exists today but I am sure there is someone out there putting a proposal together for AHRQ funding to look at this issue.

But maybe we really don’t need such a study as it seems so intuitively obvious, particularly for the Generation Y-types out there, who text incessantly. For that generation, and maybe my own, who are slowly adopting text as a form of communication, this may be an ideal solution as it is fairly secure, can be automated, messages are short, and the message is delivered wherever you are, as long as you have your cellphone.

Now imagine this…

You have an online personal health record (PHR), but this PHR goes a step further than what we have today as this PHR offers a service, say for some nominal fee, whereby you can request a text message sent to your cellphone alerting you on any number of health related topics. Text messages could range from alerting you of an upcoming appointment (no more calls from the doctor’s office), to a text telling you that the latest lab results are now available, to alerts for taking various medications at defined intervals, or maybe even information about a loved one for which you are the primary caregiver. In that last example, you certainly wouldn’t want a text message saying your mother just fell and broke her hip, but there is plenty of other information that you may wish to receive. All of these text notices are user defined, thus inherently relevant and could go a long way in making PHRs more relevant and sticky for the consumer.

I have yet to come across a PHR vendor offering such a service, but this makes such good sense, that there maybe something out there among the plethora of PHR solutions, I just don’t know about it yet. Appears, at least from the article, that the WSJ didn’t find any either as none of the examples provided were from a PHR vendor. One thing I do know, however, is that Verizon Wireless, Sprint and AT&T were all at the recent Connected for Health symposium and it is only a matter of time before they start positioning their services for txtmed.

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