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Posts Tagged ‘Eclipsys’

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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Been a lot of talk over the last year or so regarding the move to smaller, more modular, substitutable apps (think iPhone) to address healthcare IT sector needs, particularly for providers. This discussion has progressed to the point where HHS, in looking to certify EHRs, is also looking at how these small modular EHR apps might also be certified in the broader context of meaningful use.  Now how the hell HHS and in particular CMS will be able to determine whether or not a provider is using a host of modular HIT apps to meet meaningful use requirements remains a mystery and probably better left for some future post.

Chilmark has been seeing a progressive movement by a number of HIT providers, especially among HIE vendors (Axolotl, Covisint and Medicity) to open up their HIE platform (publish APIs) to potentially support a multitude of modular apps to meet various provider needs.  Basically, these vendors are moving to a Platform as a Service (PaaS) model, each taking a slightly different spin on a PaaS that will likely require Chilmark to produce a separate report to explore further.  What is important though for this industry is that this is a fairly nascent trend that will likely accelerate in the future.

And today, we can add one more vendor to the PaaS mix, Microsoft, who announced a partnership with EHR vendor, Eclipsys who has built several modular apps (Data Connectivity, Quick Order Entry and Visual Workflow) on top of Microsoft’s Amalga UIS.  Eclipsys will be demonstrating these apps next week at HIMSS.

What’s in it for all Stakeholders:

Microsoft is taking Amalga UIS from simply being a data aggregator/reporting engine to becoming a platform similar to HealthVault thereby making the data that it aggregates actionable by the apps that ride on top of it.  This creates a higher value proposition for Amalga UIS in future deals with large hospitals and IDNs.

Eclipsys & other HIT vendors now have an opportunity to enter accounts that may have been dominated by large, monolithic solutions from such companies as Cerner and Epic.  It may also provide smaller HIT vendors an ability to rise above the noise and gain some traction in the market.

Hospital CIOs & end users will no longer be strictly tied to only those apps provided by their core HIT vendor(s), but may now be able to “flex-in” certain “best-of-breed” apps as needed to meet specific internal needs/requirements.  In our briefing call with Microsoft yesterday, Microsoft stated that the Amalga UIS APIs will also be made available to customers allowing them to build their own apps, further increasing the utlity of Amalga UIS.

Sounds great, doesn’t it?

On the surface yes, but there are certainly risks, primary among them…

How will the hospital CIO and IT staff manage a multitude of these modular apps over time?  Yes, small modular apps give one flexibility and the opportunity to use best-of-breed apps but managing such can be become incredibly resource intensive and ultimately negate any net benefit.  There is also the issue of having “one throat to choke.”  When you have one or even just a selet few vendors, if anything goes wrong, it is easy to just put the pressure of them to fix it.  Not so easy when you may be using 20 or more modular apps from 15 or more vendors.

Next week at HIMSS, one of our research goals is to better understand the PaaS trend in healthcare from both the perspective of end users and vendors.  We’ll keep you posted.

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Received an email this weekend from the organizers of the big healthcare IT conference, HIMSS, which will be held next week in Orlando. This is the BIG EVENT, where virtually all present and future players in the HIT market come to pontificate on HIT’s future (e.g., both Google’s and Revolution Health’s CEOs will be giving keynote presentations).

Now getting back to that email, which provided me a link to a “HIMSS Yellow Pages” online directory of exhibitors. Naturally clicked through to take a look at the directory and found a listing for PHR providers. Great, this will make my planning easier I thought and went to take a look at who will be exhibiting. Imagine my disappointment in finding just three companies listed (CareData, ICW and Greenway) none of which are significant players. Actually did a quick check on them, here’s what I found:

  • CareData is a small EMR supplier with a PHR called GlobalPatientRecord. Went to the PHR section and virtually all of the links associated with the tabs across the top (e.g., Company, Features, Testimonials, FAQ, etc.) are broken. Pretty clear that PHR is not a focal point for this company.
  • ICW is a PHR pure play with their solution Life Sensor. Life Sensor has seen some success in Germany, but after several years of trying to break into the North American market, they still have nothing to show for it. Give them an A for persistence but an F for execution.
  • Greenway Medical is another small EMR company who is pitching a PHR solution. This solution. however, is nothing more than a tethered portal to the Greenway EMR and not a true PHR.

Note, that Microsoft’s HealthVault was also listed, but as I have explained before, HealthVault is a Personal Health System, (PHS) and NOT a PHR.

So What’s Going On Here?

In my research on the PHR market, I have heard more than a few grumblings from PHR vendors that HIMSS is just giving lip-service to this sector, which seems quite evident based on what one sees here for this conference as well as what one may find on the HIMSS website (very little and dated) on PHRs. These PHR vendors have also reported that the HIMSS PHR task force has really gone nowhere, receiving little substantive support from HIMSS.

All of this is not that surprising seeing that HIMSS receives the vast majority of funding from those much larger hospital information system (HIS) providers such as Cerner, Eclipsys, Epic, GE Healthcare and Siemens to name a few. These HIS vendors have been anything but cooperative with PHR companies who are looking to develop APIs to these systems to facilitate interoperability and automate the updating of a consumer’s PHR. The HIS vendors have their own plans and would much rather have their customers (hospitals and larger physician practices) buy the patient portal solutions they are offering.  Could this lead to a jaundiced eye cast upon PHR vendors by HIMSS?

This leaves the independent PHR vendors out in the cold at an event such as HIMSS. But, this may change in time should the PHR market really begin to gain some traction. Question is though, where does one go to see that traction occurring? What even(s) will have a critical mass of PHR vendors where one can really begin to size up this market and its future? Unfortunately, no such event exists today that I am aware of.

In time, maybe (and that’s a big maybe), HIMSS will be the event. Then again, a number of PHR vendors will be at the big payers event, AHIP in June.

What is becoming clear is that today, the PHR market is splitting into three distinct markets, providers, payers and employers.  Therefore, if one is looking for such solutions, you’ll be looking at tethered EMR/PHR solutions from HIS vendors at HIMSS, payer-centric solutions that focus on disease management at AHIP and health & wellness with incentive management capabilities for those employer-centric PHR solutions.  Right now, most PHR vendors are using word-of-mouth for this last target opportunity.

Final Notes & FYI: 

What I can’t quite figure out is why, if HIMSS is giving so little visibility to PHRs, that the likes of CEO’s from Google, Microsoft and Revolution Health feel compelled to present at this event.  One can write-off Microsoft for they are targeting healthcare providers as well with Amalga, but the others?

Looking at the broader HIMSS agenda, one does finds a single session dedicated to PHRs titled PHR: An Industry Update from Various Perspectives to be held on Tuesday, Feb, 26th @ 1pm, room 203A for those interested.  I’ll be there, so please introduce yourself if you see me in the crowd.

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