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Posts Tagged ‘Health 2.0’

Another year, another Health 2.0 under the belt. This being the fourth time attending it is interesting to see how this event and its participants have evolved. Like many things in life, some things at Health 2.0 have changed, some have not, most for the better, but there remain some troubling aspects to this event that cannot be ignored.

When thinking back on the demos of countless vendors of years’ past, this year’s Health 2.0 had two distinguishing characteristics:

Demos are cleaner, with better user interfaces (UI). The companies demoing at Health 2.0 are spending a lot more time and resources on creating inviting, clean and engaging interfaces that are a welcome change from the cluttered messes of demos past. As with Mark Twain’s famous quote: “I would have written you a shorter letter if I had the time.” reducing an application to its core elements takes time. Clearly, the majority of Health 2.0 vendors this year have spent the time and resources necessary to create a simple and engaging environment for the end user.

Business models are more sophisticated. At the first Health 2.0 event, just about every single vendor there stated that their business model was going to be based on some mix of Freemium and advertising revenue. Needless to say, just about every Health 2.0 start-up from that conference has either gone out of business, is among the walking dead (takes a lot to completely kill a company – trust me, I’ve been there) or has changed their model to survive. This year, the business models presented are more creative and for some, likely to see success in the market.

The contributing factor to these two changes is the amount of money now flowing into the health IT sector. Investors smell opportunity and are placing some pretty big bets as represented by the investments in Castlight (~$80M), ZocDoc ($50M) and CareCloud, who announced a $20M round at the event. That’s some serious cash and with all the investors that were present at this event, quite sure there are more investments in the wings.

Snap-shot impressions of demos:

  • Mobile remains hot but no one seems to have figured out a way to rise above the noise.
  • Big data is the new hot phrase but few understand its implications. Most demos simply demonstrated even more fractionation of data into distinct silos with no clear path towards aggregation.
  • Many see the key to success as becoming the facebook of healthcare with a Zynga Farmville thrown in for good measure. By the end of two days, just about ready to strangle the next demo that started with some reference to facebook and/or gamification.
  • Pricing transparency is a big area of focus for many but seriously doubt most will get past their first round of angel funding as this is already a competitive market. Speaking of which, almost as frustrating as short vacuous demos is the lack of clear arguments by those giving these demos as to why they’ll succeed.
  • Demos never get into details, thus rarely instructive.
  • Many platform plays, ala PaaS, but like big data, few truly understand what that means and how to get there.

While Health 2.0 can get overwhelming with the number of rapid fire, albeit  shallow demos from the multitudes of vendors who are all trying to make their mark in a market that has experienced a significant amount of churn, the event is invigorating for the passion that is shown. Sure, everyone is hoping to make a living on their next greatest innovation, but unlike virtually any other health IT related conference, those at Health 2.0 have passion. They are on a mission. They want to truly change healthcare. They want to make a difference. That passion is contagious. Unfortunately, that passion appears to be confined to the digerati.

Looking around at the Health 2.0 audience one sees a sea of almost exclusively upper, middle class professionals that are tapping away on their iPad, smartphone or laptop. When one sits back and thinks about the many demos seen, virtually all of them seem to be designed for this audience. Maybe the most disturbing part of the event was the on-stage interview with a mother of eight kids (she was white, middle age and clearly upper middle class) showing how her family is tapped into the quantified self movement with the various Apps they use to track their health and fitness. This is not representative of the broad swath of the American populace who are the ones that will drive our healthcare system off the proverbial cliff. It is that grandmother in Indiana who is caring for her diabetic, overweight husband, two grandchildren, a daughter suffering from an addiction and a son-in-law who is unemployed and has no health insurance that we need to talk to, have up on stage to tell us what they need to better manage their health and interaction with the healthcare system. And we need not go to that extreme, how about just having someone from a safety-net clinic talk about their needs? Sadly, no such representatives were to be found at Health 2.0.

It is this detachment that has Chilmark most concern with this passionate movement. Yes, virtually all Health 2.0 participants are passionate about helping all healthcare stakeholders but if we do not start talking to a broader cross-section of the populace, this movement may be much like the barricade scene in Les Miserables wherein the students leading the call for a revolution end up dead and with little to show for they had not engaged the populace-at-large. Some may argue that like this technology will indeed trickle down to the masses in much the same way that smartphones are now replacing feature phones in the mobile market. This “trickle-down theory may indeed come to pass but then again, we could just as easily end up with something very similar toPresident Reagan’s trickle-down theory for wealth distribution and we all know what the end result of that has been.

 

 

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Moving from an event focusing on HIE/REC initiatives by various States, the next two events, HealthCampSF and Health 2.0, took data liquidity to new heights.  Having the CTO of HHS, Todd Park, kick things off at HealthCamp by channeling Oprah and discussing/promoting the Clinical Health Data Initiative (CDHI) as well as the Blue Button sure got things started. But that was only the beginning. The organizers of Health 2.0 really out-did themselves this year, certainly making up for last year’s event, with a highlight being the Code-a-Thon challenge wherein teams of developers joined together to use freely available data (e.g., CDHI) to create new, novel and potentially useful apps.  While these developers only had a few days to put together an app, their efforts, while a little rough around the edges, were creative and demonstrated what might be possible once we bring some liquidity to health data.

But there are certainly examples where an abundance of data, or at least data sharing can run amuck and likewise there are examples, such as the Code-A-Thon and others at the Health 2.0 conference that exemplify what may be done with data if it is applied in a streamlined fashion.

An example of the former was the Accelerator Demo.  In this mock demonstration an elderly woman and her adult child navigated the ins and outs of the healthcare system through a multitude of consumer facing healthcare-centric apps. (FYI: Health 2.0 Accelerator, or H2A for short, was created to facilitate data sharing across the multitude of consumer-facing healthcare applications). Unfortunately, rather than showing how a consumer can readily and easily use such apps, leveraging data to facilitate their interaction with the healthcare system this demo completely bogged down becoming almost impossible to follow.  After watching this demo it was quite easy to see why most of these Health 2.0 apps have failed to catch hold. Each app is trying to performing some unique function.  Consumers don’t want that, won’t adopt that.  What they want, what they need is a solution that addresses several needs in one neat, tight package (app).  Today, it seems that only WebMD comes close to addressing this need. Unfortunately, it often seems that WebMD is more interested in only maximizing advertising dollars then delivering on this need through further development of their solution suite.  But maybe that is just a clear signal that this is still a very immature market with very low rates of adoption and thus not worthy of significant investment.

That’s not to say a number of companies aren’t trying to change this, see a wealth of opportunity and are investing for the future.  Unlike past Health 2.0 events where Microsoft has played a small role, this year the folks from Redmond were quite active in a number of panels, demos and the like. Adobe was also there having participated in and won the Blue Button Developer’s Challenge sponsored by the Markle Foundation and Robert Wood Johnson Foundation. Adobe’s winning entry allowed for the automatic creation of a PDF document upon downloading a Blue Button file (Blue Button files are currently flat, ASCII files).

Nearly perennial speakers at Health 2.0 conferences past have been AllScripts CEO, Glen Tullman and athenahealth’s CEO, Jonathan Bush speaking on their respective views of clinical HIT issues. This year neither took the stage, but Cerner did. Unlike their clinical HIT brethren, Cerner did not wax poetically on interoperability, meaningful use and the like but instead gave a presentation on their Personal Health Record (PHR) system, Cerner Health as well as a new game-like platform, Cerner Active that promotes and tracks physical activity. These systems are interlinked with each other and likewise with the host EHR – again letting the data flow across these systems in the promotion of health and wellness objectives.  While the interface/GUI of Cerner Health and Cerner Active still require additional work, the overall system architecture is well executed. Unlike what is arguably the best PHR from an EHR company (Epic’s MyChart) today, Cerner’s PHR is fully portable. Granted, this is a modest distinction as all EHR-based PHRs will be required to provide a level of portability in the future under Meaningful Use Rules, but it is good to see one of the largest EHR vendors take a proactive stance. So Epic, when will you open up?

The Cerner demo that showed data flowing back and forth from the EHR to the PHR got me thinking that these two terms, EHR and PHR are no longer relevant.  Hold on to your hats folks as it is now time to introduce a new acronym, drum roll please…

The CHR for Collaborative Health Record

Language is a powerful tool. By using the terms EHR and PHR we subconsciously, and even consciously, create divisions within a care team. On one side we have the patient, family and loved ones using the PHR,  On the other side is the clinicians with their EHR.  These divisions are becoming increasingly artificial and have the very real potential of hindering care rather than promoting it. While legislative laws have been written using the terms PHR, EHR and the like, it is high-time, before we get to far down the road of HITECH and Meaningful Use, that we begin talking about a larger vision of the future, one where a CHR is the core of HIT initiatives and future planning.

Now this was my fourth Health 2.0 conference and the best one to date.  With over 1,000 participants (it was a packed house) all appearing to have an active interest in changing/improving the healthcare system and along the way, make a business out of it, the Health 2.0 is easily the most exciting and innovative event in the HIT market, albeit with a heavy tilt towards consumer-facing apps.  But like Ben Rooks, an equity analyst who does an occasional post for HIStalk, the event makes one schizophrenic. You get excited by all the energy in the air, the innovative concepts being presented, but become quickly dis-heartened when you pull back the covers to find just another innovative idea/product, but not a company. Most presenters do not have a well-structured and viable path to market outside of the all too common Freemium model, a model that only seems to work in massively scalable markets.

There are always exceptions and one presentation that caught my attention was that of Will Barkis from Bill-Doctor. This company certainly did not have the polish of Castlight Health, nor did it have the some $80M in VC funding that Castlight received.  What Bill-Doctor did have though was a solution to solve a very real consumer and healthcare system problem, bill negotiation and payment. The solution addresses this issue in a very simple and straight-forward manner that will serve both sides of the bargaining table – doctors/hospitals get paid more then what a collection agency will gather and consumers get a more reasonable, negotiated bill to pay.  Bill-Doctor’s revenue model is also has a very compelling and will turn a profit quickly. If I could, I’d bet on this horse to show. (Note: I contacted Will re the Bill-Doctor website. He informed me that it is not live yet but was gracious enough to provide the slide-deck demo which is provided at end of this post.)

But what I find most troubling in the multitude of presentations I saw and discussions I had during the breaks was the lack of hard evidence that these creative solutions actually make a difference. The hard work of tying these ideas, these products, these concepts to outcomes, to improvements in quality of care delivered, to demonstrable returns on investment just aren’t there. Granted, some of these companies and products are very new to the market, but others have been at this for several years now and still, where is the evidence that these solutions actually make a difference? I can’t recall a single presentation where such hard evidence was presented.  Until that occurs, the Health 2.0 event and those that participate will remain more of a side show, dare a I say the freak show, while the main event occurs under the big top at a three ring circus such as HIMSS.

Don’t get me wrong, the Health 2.0 event is exciting, the ideas truly innovative and the organizers of the event have done a very good job putting together an event that covers the broad spectrum of health. If you want to see what the future may look like, this is definitely an event to attend. My concern rests with the need for hard-core impact analysis rather than the fluff and anecdotal evidence that is presented.  Without such evidence, broader buy-in and subsequently market adoption will remain elusive for those presenting at Health 2.0

ADDENDUM:
Above mosaic picture was taken in the Mission area of San Francisco.  Was staying there in a small studio apartment I found through Airbnb – a great site if you are on a budget.


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h20Another Health 2.0 Conference has come to pass and with broken wrist limiting typing fluidity, going to keep this synopsis short and sweet.

Not sure who said first impressions are lasting impressions, but coming up on the facilities that were to house this year’s Health 2.0 conference, I had a moment of trepidation upon seeing the signage for Health 2.0 (yes, the picture to right is real) with a back-drop of a funky auto parts and repair store across the street.  Once in the cavernous hall (note to self – cavernous halls should not concurrently house exhibits and stage) all went smoothly until one opened up the laptop and alas, no Wi-fi (actually there ended up being sporadic service but it was so bad as to be almost worthless).  An event focusing on Internet tools for health and no Wi-fi – am I in some sort of perverse David Lynch movie?

On to the event itself…

Highlights:

The Health 2.0 Accelerator demonstration was pretty impressive.  In the demonstration, nine different applications were used in a fairly seamless fashion to facilitate a consumer’s interaction with the healthcare system. A simple, yet powerful demonstration of what is possible when independent software vendors (ISVs) agree on some basic open standards, in this case OAuth and CCR to securely move data around a network. This example, while still a little too cumbersome or most consumers, points us in the right direction and might make an ideal case for the Health Internet.

Ability to meet many innovators in one place.  Health 2.0 is really the only game in town today that draws a wide range of innovators to one location.  J.D. Kleinke wrote a very good post on the event where he thought maybe the event was becoming a little too corporate.  I really do not see much problem with that, in fact, would like to see more realism demonstrated by these innovators through their articulation of clear and compelling business models, but I digress.

Best Demo: A tie, HealthVault & Quicken Health are the hands-down winners for best demos (outside of the Accelerator mentioned above).  HealthVault demonstrated their new “widget store” that is available within one’s personal MSN Health & Wellness account.  Leveraging data that one has in their HealthVault account, the MSN health widgets make that data truly actionable.  Over time, one can envision a health “AppStore” in MSN Health quite similar to Apple’s AppStore for the iPhone where ISVs build a wide range of health apps for the consumer that can be readily accessed all in one place.

While I have always had reservations about Quicken Health (too limited, only addresses one problem, financial) was very impressed with the architecture of the application.  Beautiful user interface, very nice tools built right in (e.g. hover over a given lab and you get a brief abstract of the lab test and its purpose). Another nice feature was the ability to contest claims, electronically, right from within Quicken.  Having dealt with many a mis-labeled/assessed claim before, that feature alone (no more voicemail hell) practically sold me on getting this app when it is released later this year.  Upon further thought though, better check with my payer first to see if they even would allow me to contest a claim electronically.

Excellent briefings with several companies including an update with Google Health, a deep and thoughtful dive with Within3 (keep track of them, they may have something if they move fast enough), a good update from Allviant (product CarePass is in beta), a great conversation, as always, with the folks of Polka and a surprising interview (amazed at how far they have come, more in near future) with MedHelp (another one to watch).

Disappointments:

While the Health 2.0 Accelerator succeeded, the Clinical Groupware session failed.  First off, I am not sure those in the audience fully understood what the term “clinical groupware” means and why it is important to consider.  Second, there was almost no discussion on what type of underlying architecture is required to make apps run in a clinical groupware environment.  So what we were left with was some very broad statements that clinical groupware is good for you, good for the industry, etc. but nothing about how it would actually work. Then there were the vendors in this session that did little to further the discussion.  Instead of demonstrating data sharing and substitutability of their apps, key tenets for clinical groupware to work, we were shown apps working in isolation.

Payers certainly have a voice in the healthcare discussion but do they really have a voice in the Health 2.0 discussion.  Certainly the organizers of this event think so but I differ.  Ultimately, it is employers that are footing the bill and have the most to potentially gain in offering their employees such tools.  And if not employers, how about the benefits consultants who advise them?  Getting quite tired of sessions composed of payers talking about how they always want to do good for their members.  Let’s be real, they want to maintain and/or improve margins and few consumers trust them.

The apparent fawning over the latest Health 2.0 rock star(s).  At the Spring event it was Jay Parkinson and Hello Health.  This fall it appeared that we had two: Roy Schoenberg of American Well and Adam Bosworth of Keas.  I’ll give credit to American Well to at least having a product/service in the market, but do they really need to be placed on a pedestal as the poster child for telemedicine? Roy is extremely polished and presents well, but hey, they are far from being the only game in town and not sure why they had two separate stage apearances, one on each day.  As for Adam and Keas, Adam certainly has a great publicist (gets an article on Keas in the NY Times on the first day of Health 2.0, coincidence, I doubt it) and is well known in IT circles, but he has also been extremely slow in introducing his product – suppose to go GA sometime this month.  So here we have a company founder without a live product in the market again being invited up on stage on two separate occasions.  Why, I can’t figure it out as my initial assessment of Keas is that it is a fairly simple product with low barriers for competing products (e.g., if Google put their mind to it, they could do the same with their search features and Google Health pretty easily).

The venue was just a disaster, enuf said.

Where are the established HIT companies, where are the intersections between these traditional ISVs that ultimately hold the data and these Health 2.0 ISVs looking to get their hands on it to power their services.  Bridges need to be built as today, Health 2.0 sits like an island, isolated in a very broad sea.

Wrap-up:

Health 2.0 is a great networking event.  Just about everyone in this particularly market is there and its always good to connect with people face-to-face as phone calls, emails, etc. only go so far.  Content of sessions though is a very mixed bag and appears highly slanted to those vendors who pay to play (sponsors, exhibitors, etc.) and not as expansive as it could be.  Hopefully, like many things in life, the organizers of this Fall’s Health 2.0 will learn from the many mistakes made and the next one will bring more value to attendees.

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Here at the Health 2.0 conference and have heard far too many demos (really just pitches) from a multitude of Health 2.0 companies that are really nothing more than some form of glorified search engine.  It is clear that very few, if any, of these companies will be around in five years as there is simply not enough differentiation between what they are offering the market, and what the established brands (WebMD, EveryDay Health, Google, etc.) already offer.

Probably the most frustrating aspect of the Health 2.0 event, of which more will be discussed later is a lack of transparency on the part of these Health 2.0 vendors to tell the audience how they are growing, where they are seeing traction and why we should even care.  Please folks, you want someone to remember you?  Give them numbers that substantiate your reason for existance.

Did a quick comparison of two of the demo Health 2.0 companies with the 800lb gorilla of health content on the Web, WebMD.  Not a pretty picture.  One Health 2.0 company has seen a slide in the past year of over 40% and the other, while seeing good growth, is but a gnat on the big gorilla’s arse.

content-biz

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Another Health 2.0 flame-out has occurred, this time Wellsphere was picked up yesterday by HealthCentral. Not sure why HealthCentral would even remotely be interested in Wellsphere as Wellsphere is one of those companies I just could not get excited about.

Why?

Wellsphere use to SPAM me about once a month requesting that I join their community by providing a direct RSS feed of Chilmark Research postings claiming that in doing so, Chilmark Research’s visibility will grow and who knows, maybe our influence leading to fame and fortune.  Each time I received one of these emails, I would head over to the Wellsphere site and take a quick look.  Each time, I left unimpressed.

Wellsphere was not going to help Chilmark and if anything, probably hurt us as our reason for being is not general, consumer information, but technical information better suited for stakeholders/businesses currently in the healthcare sector or those looking for opportunties and entry points therein.

refereeWith the demise, or let’s call it folding in of Wellsphere into HealthCentral for an undisclosed sum, all those bloggers that got suckered into Wellsphere are now crying foul for not getting a piece of the action and there has been a lot of moaning, groaning and bitching in the health Blogosphere.

Please folks, get it through your head: Wellsphere was a business and as a business would take what actions it deemed necessary that were in the best interests of their founders and funders, not you.  You, dear Blogger readily turned over your copyrights to Wellsphere.  Is that their problem, or yours?  Take this as a lesson to pay just a bit more attention to who you partner with and what interests you share that you may both profit upon. If those interests are not readily apparent, move on.

In other news…

The leading tracker of Internet traffic, comScore, just released its scores of top growing Internet properties and Everyday Health comes in at Number 5!  Nice uptick for them that will certainly get the attention of advertisers.  Expect Everyday Health to continue to do well as advertisers pull their funding from those sites getting less traffic, moving to quality properties. Expect more Health 2.0 flame-outs as most are still too reliant on advertising to make their business models work.

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web20mapInteresting analysis of hospitals across the country that are using Internet-based, social networking tools, often referred to as Web2.0 (e.g., facebook, YouTube, Twitter) to connect with consumers.

Based on this analysis, we are clearly at the very early stages of adoption as only 2.5% of hospitals nationwide are currently using Web2.0 to connect.

If one looks at the monetization figure below, clearly for hospitals, efforts are targeted at the strategic value of:

  • Building Attention Trust (openness)
  • Increasing Competitiveness (market visibility, consumer retention, affiliated physician retention) and,
  • Customer Self-service (disease management, transactions, inquiries)

monetizingweb2

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crystal-ballMaintaining a tradition among IT analyst firms, following is Chilmark Research’s forecast of Top Trends for 2009.  While there is a significant amount of “crystal ball gazing” in any forecast, 2009 is particularly challenging due to an economy that has yet to stabilize and a new administration and re-invigorated Congress that seeks to “reform healthcare.” Against this backdrop, our predictions reflect and extend what we have seen in 2008, our continuing research, and conversations with numerous stakeholders in the healthcare sector.  As always, we welcome your feedback, via comments on what you foresee in 2009 as well.

Without further adieu our Top Ten are:

Healthcare Not Immune to Economic Woes: Declines in investment returns and philanthropic giving coupled rising bad debt, fewer consumer/patient visits (delay care) and increase in charity care will wreck havoc on an industry sector that is accustomed to being immune to economic downturns. As it pertains to healthcare IT (HIT) spending in 2009 will be way down as healthcare providers look to control costs.  Providers will go into maintenance mode simply maintaining the systems they now have in place. IT projects at least 50% of the way towards completion will see continued funding, if they can see light at the end of the tunnel and ROI will be quickly realized.  All other projects will be curtailed, delayed or killed.  Some bright spots in all this doom and gloom; apps that focus on eligibility checking, revenue cycle management and more progressive cloud-based offerings (e.g., HIE with hosted EMR) will see reasonable growth in the 8-12% range.

Health 2.0 Companies Shrivel on the Vine: As consumers take on more responsibility for healthcare costs and seek low cost alternatives, use of the Internet as a virtual doctor/adviser will increase.  Despite this increase, most Health 2.0 companies fortunes will evaporate for three simple reasons:

  1. Not enough competitive differentiation. There are far too many “me too” apps in market today.
  2. Access to additional funding and exit strategies have evaporated. Reliance on advertising revenue will only sustain “Big” Brands as Internet advertising contracts.
  3. Poor go-to-market strategies including; lack of partners, ill-defined value proposition and poor positioning.

Those Health 2.0 companies that address all three concurrently and successfully are the ones to watch – ignore the rest.

Retail Health Clinics Gain Traction, Corporate Clinics Stall: Budget-constrained consumers seeking lower cost alternatives, and payers encouraging such practices, will increasingly turn to retail clinics for much of their healthcare needs in 2009. This will lead to continued growth in use and build-out of retail clinics across the country.  Despite their potential savings, corporate clinics are a long-term investment. Corporate clinic providers such as the two Walgreens acquired in 2008, (i-Trax and Whole Health) will see growth stall as employers layoff employees and pursue shorter-term cost cutting strategies.

Virtual Visits – A Mixed Bag: Related to Health 2.0 is the proliferation of Internet-based third party healthcare service offerings, (e.g. American Well) which bring together technology, streaming video and an ability to access a doctor over the Web 24/7.  Problem is, healthcare is based on trust and as inherently social creatures, humans base trust on direct, in-person interactions.  Thus, third party virtual visits will struggle.  This will not be the case for eVisits with a consumer’s existing physician/care team where a relationship already exists.  eVisit reimbursements are now becoming commonplace and consumers will increasingly use such services due to convenience and lower costs.

Dossia Ramps-up: Over two years in the making and a couple of stumbles along the way, Dossia was finally launched in late 2008 with roll-out to consortium member Wal-Mart employees (actually, WebMD roll-out with WebMD sitting on top of Dossia stack).  Earlier this month Dossia announced its second PHR partner, Medikeeper.  While Dossia’s ecosystem of partner apps is dwarfed by Google Health (GHealth) and Microsoft’s HealthVault, Dossia brings something to the table that the other two platform providers do not, some 8M+ potential users (employees). Expect at least three more of the consortium’s eight members to begin rolling out the solution, via PHR vendor, to their employees.  We are placing our bets on Pitney-Bowes, AT&T and Intel to go live in 2009.

Chicken & Egg Scenario Plays-out for GHealth and HealthVault: As Google Health and Microsoft look to add more partners, in particular data providers such as pharmacies (GHealth) or payers (HealthVault) the big question remains: Will consumers begin actively storing their health data on these sites and subsequently engage any of the numerous apps that sit on top of these repositories?  Right now it is a very mixed message.  Today, traffic and subsequently use of either platform remains lackluster.  Early reports are that GHealth is generating some decent consumer traffic (click-thrus) for partners.  HealthVault, however, is generating very little traffic for its partners, but has created better visibility for these partners among larger corporate entities (e.g., payers, employers, providers, etc.).

Over the course of 2009 expect Google to become slightly more aggressive, first with biometrics, second with support for other standards and third attracting new partners, especially data owners.  This last point is contingent on additional standards support. HealthVault will couple its aggressive actions to bring more data providers (payers & providers) and software partners into the ecosystem with direct to consumer marketing. HealthVault’s biggest challenge will remain – creating an engaging and easy to use interface for the consumer.

New HIE Models Leveraging Cloud Computing and SaaS Gain Traction: Chilmark Research recently completed a project for a client that gave us an opportunity to gain an in-depth understanding of the HIE/RHIO market.  What is clear is that the vast majority of  quasi-public RHIOs still have not figured out a funding model that is sustainable (e.g.,  CalRHIO is one hairy initiative that will be declared DOA in 2009).  Health Information Exchanges (HIEs), that are increasingly receiving funding from payers or are set-up within a given IDN will continue to see reasonable, low-double digit growth.  Those HIEs that prosper will be based on a cloud computing model and offer small physician practices, at little or no cost (sponsored by payer), via SaaS, such services as lightweight EMRs and eRx capabilities. We learned of several such projects, yet to be announced, that will roll-out in 2009.

Continua Compliant Devices Hit Market with Little Impact to Anemic Telehealth Growth: The industry consortium, Continua, recently announced that Continua compliant biometric devices will enter the market in 2009.  Problem though is that Continua compliant devices only alleviate vendor lock-in for one can now mix and match Continua compliant devices from various vendors.  Continua does not address the much broader and seemingly intractable problem of how to incorporate telehealth into the existing workflow of care providers and even more importantly, reimbursement models for telehealth remains immature.  Until these issues are addressed, 2009 will not see a major boost in the sales of biometric devices.

Dreams of Big Fed Spending on HIT Do Not Materialize: Despite campaign promises and HIMSS Blueprints, healthcare reform and funding for HIT will not materialize in any meaningful amount in 2009.  Half of the problem will come from continued economic woes in other sectors seeking rescue from federal coffers that will start drying up.  The other half of the problem will result from healthcare reform, in all its many guises, that languishes as Congress over-reaches with its multitudinous approaches and little reconciliation in ’09.  We expect 2010 to hold more promise.

mHealth Continues Expansion, Most Apps Lame: We see tremendous promise for mHealth and honestly believe it will be here that consumers truly engage in health and wellness at a very personal level.  Despite the enormous potential, and a growing number of mHealth apps available for the consumer, we find that the vast majority of these apps are incredibly simplistic and do not fully leverage new smartphone capabilities.  Over the course of 2009 we will see far more apps, particularly those originally developed for the iPhone, being re-purposed for Google’s Android OS, the BlackBerry OS and in Europe, for Nokia’s Symbian OS.  Some truly novel, excellent apps are expected, but these will by far be in the minority.

That’s “IT” everyone and to a certain extent this list defines our research agenda for 2009.  Stay tuned, it promises to be an extremely interesting year ahead.

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