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Posts Tagged ‘eClinicalWorks’

Introductory Remarks: Chilmark Research is pleased to welcome a new addition to our staff, Cora Sharma.  Cora will be leading our research efforts in the mobile health app market (mHealth) and below is her first post on the subject.  Cora has a great background having received a BSc in Computer Science, worked in the software sector for several years and recently graduated from MIT’s Sloan School of Business. While at Sloan, Cora did an internship with McKesson where she found her calling, HIT and the desire to become an analyst.  She’s a great addition to Chilmark Research and I’m confident she’ll produce some excellent research. – Stay tuned.

The concept of mobility in healthcare is nothing new to providers, vendors, and to Chilmark Research alike.  The current media and investor buzz surrounding mHealth stems from the belief that: 1) mobile technology has finally matured to a point where age-old healthcare processes can finally be revamped; and 2) mobile technology has not only matured but has actually been adopted en-mass by physicians and shows no signs of abating.

Doctors Love Smartphones, but are GaGa over the iPad
Recent reports from SpyGlass Consulting and Manhattan Research show that the vast majority of physicians already use smartphones. Pamela Dolan at the AMA has a nice commentary on these latest numbers. Chilmark Research’s recent talks with industry folks shows that the iPad is also gaining significant traction with physicians.  At a recent conference in Denver where Chilmark Research attended and spoke, the CIO of Catholic Health Initiative (CHI) sees providing their doctors with mobile apps (in CHI’s case on the iPad) as critical to the success of complying with meaningful use requirements.

mHealth Apps in Acute Care
Given that physicians have now ‘gone mobile’, does this imply that they will no longer be satisfied with computers-on-wheels (COWs), demanding mobile access to every piece of data buried in Health Information Systems (HIS)?   If yes, providing doctors with mobile access to patient and hospital data could be just the perk needed to attract more affiliated physicians, satisfy existing ones and ultimately drive the adoption and use of HIT by clinicians.

Here is a brief look at the mHealth acute care vendor landscape:

  • Pure play inpatient mobile solutions companies like PatientKeeper and MedAptus have built their businesses on providing clinicians with mobile apps, each having started with charge capture and quality measures.  PatientKeeper expanded into CPOE with a limited roll-out that is scheduled to go GA in 2011. As the mHealth market continues to gain momentum, it will be interesting to follow the fate of these two companies.
  • The big boys of HIS (Cerner, Eclipsys/Allscripts, Epic, GE Healthcare, McKesson, MEDITECH, Siemens) all have mHealth stories, albeit weak ones that revolve mostly around mobile browser access to their core EHR.  Early this year Epic released the Haiku app to Apple’s AppStore, resulting in some fanfare from the tech community.   Also, the Citrix Receiver app makes it possible to run Windows-based apps like McKesson and Cerner securely on the iPhone/iPad and Android, though with obvious usability issues associated with being a non-native app.
  • Potential entrants/disruptors from outside the industry face a battle with the big boys, who seem to want to reduce mobility to an extra feature on their systems.  Diversinet is making a play in secure doctor-doctor and doctor-patient communications for the enterprise. The company has made extensive investments to the tune of some $80M spent over the last decade developing IP in encryption and identity management.

mHealth Apps in Ambulatory
There are a multitude of physician content and productivity apps in the AppStore, from anatomical diagrams to medical calculators to ICD-9 lookup and arguably the most successful category, medical content apps.

Mobile medical content companies such as Epocrates and Medscape have had a presence on physicians’ phones/PDAs for years.   We are closely following Epocrates’ expansion into the SaaS EHR market.  If mobile EHR access is a truly compelling value proposition for ambulatory physicians (we aren’t convinced it is), then Epocrates may be able to leverage the brand’s mobile association and large, existing installed base to stand out from the 400+ competing EHR vendors.

A number of ambulatory EHR vendors (AllScripts, eClinicalWorks, Greenway and NextGen) have recently introduced their own EHR mobile apps, most built for Apple’s mobile OS. Currently, it appears that little is on offer from EHR vendors for Google’s Android mobile OS, though that may change as Android becomes an increasingly compelling alternative to Apple.

Onward Ho!
Dipping our research fingers into the mHealth market, Chilmark Research is launching a new initiative that will culminate in the report: Enterprise Adoption of mHealth apps: Trends, Issues and Challenges. Over the course of the next couple of months (target release date is in advance of NIH’s mHealth Summit in DC) we will interview executives from the major HIS vendors, best-of-breed vendors, tech entrants, and leading Hospitals/IDNs. Through both primary and secondary research we will answer such questions as:

  • What top mobile apps are currently being adopted in the enterprise?
  • What are the priority unmet needs among leading Hospitals/IDNs?
  • What challenges are currently hindering adoption of mHealth apps in the enterprise?

In the meantime we will be posting every other week specifically to give updates on our mHealth research.  Onward Ho!

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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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Today, leading ambulatory EHR vendor AllScripts announced that it will merge (it’s really acquire) with one of the larger acute care EHR vendors, Eclipsys creating one of the largest EHR vendors in the market with some 180,000 physicians using their solutions.  This acquisition is being driven not by ARRA and all the taxpayer dollars flowing into healthcare, but by healthcare reform and the trend towards bundled payments, patient centered medical home models and the move by hospital networks to become Accountable Care Organizations (ACOs). Large healthcare organizations will increasingly be looking to HIT vendors who can provide the full suite of solutions for both acute and ambulatory requirements. This merger is simply an acknowledgement of that need.  It will be interesting to see what impact this merger will have on other ambulatory EHRs, such as NextGen and eClinicalWorks.

Now there will be plenty of others writing about this merger and its implications to the market so rather than focus on the obvious issues regarding EHRs, rationalization of product portfolios, go to market, etc., Chilmark Research will look into one small and important piece:

What might this acquisition mean to these companies’ respective HIE partners, dbMotion and Medicity?

We’ve spoken to both HIE vendors and are on track to release our HIE Market Trends Report (includes in-depth profiles of the twenty leading HIE vendors in the market) by the end of June so we are uniquely positioned (at least we think so) to provide an educated assessment.

AllScripts+dbMotion:
In April 2009, AllScripts and dbMotion announced a go-to-market partnership wherein dbMotion would be AllScripts go to partner for all things HIE.  This partnership is both marketing and R&D with both companies working together to deliver what is called the AllScripts Community Record powered by dbMotion solution.  This partnership did not make a lot of sense to us as dbMotion is a fairly sophisticated solution that is more suitable for large IDNs and academic medical institutions like its US lighthouse customer, UPMC, which also happens to have a significant equity stake in dbMotion.  dbMotion is also not exactly an inexpensive solution.  So how does this fit in the ambulatory market that is the sweet spot for AllScripts?

Speaking to Peter McClennen, dbMotion’s North American President, Peter stated that he is both “excited and humbled” at the thought of this merger. Excited in the future prospects, humbled in its implications to the broader market. Peter went on to state that to date, the partnership has seen a number of market successes such as that at UMass Medical Center, and most recently the win at Thomas Jefferson University.  Today, AllScripts/dbMotion have about a half dozen customers that are leveraging the dbMotion suite to enable, as Peter put it, “actionable semantic interoperability” between an acute care facility and affiliated ambulatory practices.  What Peter means by actionable semantic interoperability is basically an ability to create an on-demand view of a patient record (drawing from all data sources in a dynamic fashion), which is quite similar to Microsoft’s Amalga platform.  This is an important factor which we’ll come back to later.

So getting back to the question: How does dbMotion fit in the ambulatory market that is the sweet spot for AllScripts?  Looking at those joint sales, large mothership institutions (UMass, Jefferson, etc.) are making the investments in dbMotion to more closely tie affiliated practices who are on AllScripts.  These large institutions have the need and the resources to make this happen.

Eclipsys+Medicity:
In June 2009, Eclipsys and Medicity likewise announced a a go-to-market partnership.  Unlike the AllScripts/dbMotion partnership, the Eclipsys/Medicity partnership is far deeper wherein Medicity is the underlying technology powering the Eclipsys’s branded HealthXchange.  This requires a deep level of technology integration between the two respective platforms.  It also requires a higher level of sales and marketing investment by Eclipsys as HealthXchange is on the price sheet that their sales force takes to market.  It’s no easy task to back-out of such a deep integration.

In speaking with Medicity’s CEO, Kipp Lassetter earlier today, Kipp stated that Eclipsys informed him that they remain “fully committed to the partnership.” Kipp went on to state that in addition to several wins to date, the partnership has a “number of deals in the works.”  As with the AllScripts/dbMotion partnership, the objectives are the same, help large IDNs and hospital networks better link acute to ambulatory.  HealthXchange is based more on Medicity’s MediTrust and layered in their some of their Novo Grid technology.

AllScripts+Eclipsys, Who Loses?
In any acquisition/merger there is a natural rationalization process, rationalization of staff, products and of course partnerships.  The combined entity will now have two HIE partners and some rationalization may occur with one HIE vendor remaining at the alter, while the other walks away with the groom.

In their investor slidedeck, AllScripts, on slide 22, clearly shows HealthXchange in the Eclipsys solution portfolio stack.  Looks like AllScripts certainly acknowledges the importance of HealthXchange, though it is curious that they have the solution under the columns of financial and administrative transactions and not clinical. Evenmore curious is that there is no mention of dbMotion and the AllScripts Community Record solution on this slide.

So does this mean dbMotion is the one that will be left standing alone at the alter?

Well, if anyone was left standing alone, it would likely be dbMotion, however, we do not believe this will happen for a couple of reasons:

First, though the relationship is barely a year old, AllScripts and dbMotion have benefited from landing a number of key wins, so why stop now?

Secondly, dbMotion has one of the more technologically advanced HIE solutions in the market today. It’s not cheap, but it does provide some pretty impressive capabilities that are not easily matched.  And remember what we said earlier, dbMotion is more akin to Microsoft’s Amalga than it is to the traditional HIE solutions in the market today, including Medicity’s solution suite. Thus, there may actually be more opportunities to create synergies between these two companies and their offerings.  The wildcard in this scenario is Microsoft’s partnership with Eclipsys wherein Eclipsys is now offering modular apps on top of the Amalga platform.  Will this have any influence on the dbMotion partnership?  That’s anyone’s guess today.

In closing, we see polygamy occurring with both Medicity and dbMotion playing a role in the combined AllScripts/Eclipsys organization.  If done properly, everyone will benefit, especially customers.  If done wrong, a major cluster f*ck in the making.  These are capable companies with capable leadership, our bet is on a successful polygamist relationship.

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top-ten-goldOne of the nice things about all the writing done over the past year is that one can go back, apply some analytics and see exactly what topics/posts were popular over the past year.

So, drumroll please…

Following are the Top Ten Posts at Chilmark Research for 2008 with brief commentary:

10) Zagat Physician Rating Goes LiveThere are now a plethora of physician rating services with this being but one example.  Unfortunately, this service is restricted to Wellpoint members.  Based on what we’ve seen from most payers in their seeming inability to truly engage consumers/members, doubt this Zagats service is getting much traction.

9) Wal-Mart EMR Mandate Implications: Wal-Mart is a massive presence in any of the markets it enters.  Their decision to chose a single EMR solution for all of their retail clinics reverberated throughout the market.  Now that Wal-Mart is rolling out the Personal Health Platform Dossia among its employees, one can expect eClinicalWorks to be closely tied to Dossia as well.

8 ) Oracle+Cerner=Opportunity: Rumors come, rumors go and some seem to take on a life of their own, resurfacing on a firly regular basis.  The rumor that Oracle will acquire Cerner does have some logic to it, but with the current financial mess, this won’t happen anytime soon.

7) Defining a Functional Model for PHRs or How Many Cooks Does it Take: This post took a critical look at the three functional models: one by HL7, another from the Robert Wood Johnson Foundation’s Project Health Design and the third from the payer organization AHIP.  We’re not too keen on any of these models as it is the market that will define a functional model that delivers value, not academics which predominate the first two groups or one from the payers, which have selfish self-interests at heart.

6) Google Health Goes Live: Post went up the day that Google formally released Google Health to the market.  A belated launch, some eight months after Microsoft released a pre-mature HealthVault.  Google Health will slightly more mature than HealthVault coming out of the gates, as seemingly stalled. See post in the Number 5 spot.

5) HealthVault Surges, Google Health Flounders: After all the anticipation for Google Health and the pending battle royale for mind-share between Microsoft and Google for the hearts and minds of health concious consumers, the battle is turning out to be boring. Google is following its common laissez faire approach to developing its service (very thin on resources being deployed) while Microsoft is investing significantly, and it shows.

4) Mobile Health on the iPhone: Since the launch of the 3G iPhone earlier this year we have seen an incredible number of health & wellness apps showing up on the AppStore, which number well over 400 today.  Recently, Apple redesigned the site to make it easier to see which apps are most popular.  Loads of opportunity remains for those that are creative as most apps are pretty simplistic.

3) eClinicalWorks Tight-lipped on the Wal-Mart Deal: This post followed on the heels of Number 9 above.  eClinicalWorks is one of the EMR darlings for smaller practices which remains a relatively untapped market.

2) Walgreen’s Ups Ante in Retail Health: In March, Walgreen’s made the dual move of acquiring both I-trax and Whole Health Management, two providers of corporate campus health clinics.  What seemed like a good move then, may now be one that they are regretting as employers continue to downsize and trim costs.  If Walgreens would have waited (and they could get the $$$ in this tight credit market) they would have been able to pick up these companies for a song today. Alas, hindsight is always 20-20.

and the Top Post in 2008 was…

1) Google’s Schmidt Outlines Health Platform: We all knew Google was going to release some form of PHR in 2008.  We even saw some early screenshots back in August of 2007 when a few presentation slides slipped into the public domain.  But after those slides, we heard nothing, saw nothing, but knew it was coming.  Thus, when Google’s CEO, Eric Schmidt took the stage as a keynote speaker at HIMSS, we waited in anticipation and Schmidt did not disappoint.

And that dear readers is what YOU, found most interesting at Chilmark Research, that is if we not include the post where we announced te release of our iPHR Market Report Executive Summary.  We were absolutely thrilled with how popular that post was (it far exceeded the number 1 post on Google above) and even more thrilled at all the people who have downloaded this Ex. Summary (nearly 400 downloads for all corners of the globe, at least all continents, withthe exception of Antactica, we’re still waiting for that one to come in.

Thank you all for visiting, reading and commenting. We value your input and hope in return, we have provided some valuable analysis on the 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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I’m here today at my alma mater, MIT to attend Technology Review’s annual conference, EmTech (short for emerging technologies). And why am I attending an event that appears to have little relevance to healthcare? Well, there is one session this afternoon addressing EMRs and another tomorrow on personalized medicine, but those are periphery to my real reason to attend.

Simply, I am a firm believer that in any industry sector, the Black Swans will almost always come from outside the industry. In healthcare, this will be particularly true as this industry is calcified with countless special interests unwilling to give ground to improve the overall system. Healthcare will see some pretty serious tectonic shifts over the coming years and innovations (black swans) will be a key contributor to those shifts.

I’ll be reporting sporadically from the event throughout the day. Warning – usually I take notes at an event, digest them and publish a summary a couple of days later. Today, I’ll report live the distillation process that usully occurs will not be present today.

10:15am First keynote was giving by V. Khosla, founder of Khosla Ventures. Very interesting and engaging talk on the principles that Khosla uses to assess innovations to invest in. Though the company focuses on “Green Technology”, here are some takeaways for healthcare innovators and investors. (Khosla’a presentation was so much better than Clayton Christensen’s that I heard last April at the WHCC. If you ever get a chance to hear Khosla speak, do it!)

Rules of Investing
Attack manageable, but material problems
Technology that achieves unsubsidized competitiveness
Technology that scales, scales at a competitive cost structure
Manageable start-up cost & short innovation cycles

Forecasts are almost always horribly wrong. Don’t trust them.

Always look at the total relevancy of an innovation. Understanding potential impact of technology requires one to look at what is relevant scale, without this, you do not/will not be able to capture the full opportunity if full relevancy is not considered.

When considering innovation scenarios, consider true total costs. Gave a very good example of photovoltaics and the current policies/push for low cost/low efficiency. The big costs in solar farms are, according o their calculations, infrastructure and construction costs – both of which scales dramatically in costs when pursuing low cost photovoltaics. Makes me wonder what in the healthcare sector has strong support today but total costs of adoption will negate its true long-term value.

11:00 Second morning keynote by Ning founder & CEO Gina Bianchini. Ning is a Web 2.0 type of social networking platform and not a “Walled Garden” which Gina called other social network sites such as Facebook, mySpace & YouTube. Gina demonstrated, through static screenshots, ala PowerPoint, a wide array of current Ning social community sites.

Honestly, not all that impressed with what I saw or her presentation. Static presentation that focused on only the big success stories and not the challenges/market needs that they are really trying to solve – the interesting problems today that Ning may facilitate in getting answers to.

Became quickly bored with her talk and went to the Ning site. Did a search on healthcare to see what kind of communities have been created. Search turned up loads of communities addressing a whole wide range of issues from job postings, to HIT, to consumer drected health and healthcare marketing. There are now over 400 different healthcare communities on Ning. Sounds like a lot doesn’t it.

Dig a little deeper and what I find is that most of these communities are very sparsely populated (e.g., almost all the ones I visited had less than 10 members) and not exactly dynamic (most “discussions” in these communities I visited were several months old). Looks like another emperor has no clothes story to me.

Hot Technology Tip: Most recent highpoint: great little demo by one of the TR35, an incredibly slick application for managing your Outlook email called Xobni (inbox spelled backwards). Technology was developed by an MIT grad while he was in the undergraduate program. Though I run on the Mac (Xobni is lost on me), person sitting next to me whispered he uses Xobni and absolutely loves it.

Panel on Mobile Technology of the Future:

Motorola rep just stated that Google’s Android does not have much of a future. Requires too much computing resources for the low cost mobile phones that make up the majority of the market.

Google responded that yes, Android is targeted at more full-featured phones but due to Moore’s Law, within 18 months, mid and even some low tier phones will be able to run Android. Claims that they have already run Android on phones at the $100 price point.

Adobe rep (Kevin Lynch, CTO) stated that most apps are still developed with the PC in mind, that developers have yet to fully re-think how apps might be used, displayed and leverage within the context of mobile platforms. Went on to say that there are far too many OSs for mobile platforms which makes it difficult for developers to create apps, becomes too expensive. Holy grail – develop once, use on any platform.

Ques: When will be see SDKs for mobile platforms based on Web technology? Web app development environments for mobile apps is still not there yet. Must use native apps today. Google stated that they are quickly moving in that direction and fuly believe in Web app development environments. Adobe also stated that their development of “Air” is targeted at creating a Web-based development environment for mobile apps, but it is still at least a year to two out.

Ques: How big and how fast will this market grow:

  • Google response: Android has had 100M downloads so far. It is moving very fast and changing very quickly.
  • Motorola: Yes, calling is still the primary function and will remain so until some really interesting apps arrive on the market and shift consumer perspectives
  • Adobe: We need break-throughs in battery technology for today, Moore’s Law does not apply to mobile until this problem is solved.

12:30 Lunch talk by Amazon CTO: Spoke of Amazon’s hosting services (Elastic Compute Cloud), how they came into being, how they leverage Amazon’s existing infrastructure, etc. More of a techie sales pitch. Gave some examples of those using the Amazon services. Focused on multi-media companies that are targeting consumers. Not exactly barn burner/difficult, services to provide. Definitely not “mission critical” examples. Will have to talk with him at one of the breaks to see if Amazon hosted services are being used in more challenging applications that may give some perspective as to how it might be used in healthcare.

Big selling point for something like Amazon services is that it is nearly infinitely scalable and can be tapped, as needed at a fairly reasonable cost. Such a service could be of value to PHR vendors (note, most are already using hosted services/data farms for their PHR). More broadly, HIEs and RHIOs als appear to be ideal applications for Amazon’s services. Though Amazon is not a “covered entity” I’d place my bet on them on keeping my health records secure and private than any hospital or IDN in the country today.

Do know one HIT company using Amazon today, MedCommons, who turned to Amazon due to Amazon’s proven ability to handle very rich data, for MedCommons, that means medical imaging. Spoken with one of the founders of MedCommons who has been quite impressed/happy with Amazon’s services.

1:30, Session on Cloud Computing: Nice panel representation that includes senior exec from Salesforce.com, Google exec, the Amazon CTO and one of the founders of VMWare (MIT has always done an excellent job of attracting some very talented, high-level speakers).

Overall theme – Internet as the platform, the operating system with applications sitting on top, this is what cloud computing is all about. Thus, not too surprising that there is a land-rush on right now by just about everyone in the computing industry (and even those you would not associate with hi-tech e.g., Amazon).

Comment by Salesforce.com – Right now the current regulatory structure and policies, on an international level are far-beyond where the technology is today. This could create some serious issues, potentially, in the future. Not unlike the current challenges and issues that have been raised regarding industry storage of medical records by non-covered entities.

Pricing for cloud computing services and apps are moving from user-based pricing to usage (pay as you go) pricing. In healthcare sector we’ll see a mixed model with a low subscription price supplemented with usage/transactional fees.

For software developers, start thinking about just the application and not worrying about the OS and underlying technologies so much. For example, it is now pretty easy to put together a service that combines Amazon data services, with Salesforce and Google to create an interesting offering for the market. Not much different than what Google and Microsoft are proposing with their healthcare plays. Will be interesting to see what someone like RelayHealth develops as they have a fairly high level strategic relationship with HealthVault.

3:15, Session on EHRs (note, I’ll use EMR acronym): 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, (President, eClinicalWorks). Karen started off basically setting the stage giving a broad landscape 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).

Decent size audience, easily a third of the total attendees at EmTech (there are currently 3 concurrent sessions).

Halamka followed with the common statement regarding lack of EMR adoption. Claims EMR is still too expensive at $40-60K per practice with a corresponding drop in productivity for first 6 months of 25%. Beth Israel s requiring all affiliated physicians to adopt and use an EMR. They are offering a hosted eClinicalWorks for these affiliated practices at a big discount to encourage adoption. Hopes that better P4P metrics will result in higher payments from CMS and other payers to 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 is medications and allergies. Not much value there!

Kumar was next. eClinicalWorks is now in over 20k physician offices. Talk in broad terms, not terribly specific. Does believe that “patient-center 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. He does not like the term of EMR, sees it more as a technology that helps patients get better care and allows a doctor to deliver better, more informed care. 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.

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.

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 (HT can greatly facilitate all sorts of transactional processes). Kumar also 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, not sure though that most physicians know how to capitalize on it. EMR vendors need to start educating the market on these opportunties and not leave it up to the physicians to learn about them.
  • Today, Beth Israel is allowing their customer to export their PatientSite PHR data to either Google Health or HealthVault. Problem is, they are only exporting medications (includes immunizations) and allergies. Ask 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 – the data model is just not there yet. So, all you consumers waiting with baited breadth for a full feature service from either of these companies will be waiting a little longer.
  • eClinicalWorks is seeing no issue with reluctance in adoption of 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. Also, despite all the rumors, and the fact that Kumar is originally from India, 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 – not an every day occurrence.

As I mentioned earlier, this is the first time that I have just reported directly from the event. Let me know, via comments, if you found this useful or prefer my former approach of distillation then reporting within a couple of days of actual event.

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Most recent post on the Wal-Mart/eClinicalWorks go to market announcement.

Just gave a call to eClinicalWorks regarding the announcement last week in the WSJ that they will be the standard EMR for all of Wal-Mart’s retail clinics. Was looking to get more background on the deal and what it might mean to eClinicalWorks going forward as follow-on to my post last week. They gave me a rather curt response stating that any such inquiries must be taken up with Wal-Mart. Appears that the leak by the WSJ was a surprise for them.

eClinicalWorks was, however, kind enough to point me in the direction of another article published in the NY Tmes last week which you will find here. Although the article does not mention eClinicalWorks, it does provide further background on their plans and relationship with Revolution Health, who will run many of the clinics through their division, RediClinics. With Revolution Health’s involvement, makes me wonder if they to will make a play to have these patients sign-up for the Revolution Health PHR (which by the way is one of the worst I’ve demo’d). One of the more interesting bits of information in this article is Wal-Mart’s finding that some 55% of visitors to these clinics do not have medical insurance.

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