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Posts Tagged ‘healthcare IT’

Ok, before I even begin, let me put it right out there: I’ve been using Apple products since I first got my hands on one of those cute little Mac SEs in the late 80’s having given up my spanking, brand new Compaq 386 with 64kb of RAM and a dual 3.5 & 5.25 floppy drives to a post doc at MIT who traded me the Compaq, which he needed to finish his thesis, for his Mac. I never looked back. I will attempt to keep that bias in check in this post.

Tomorrow, Apple will formally release the iPad 2, a device that has seen extremely strong adoption in the healthcare sector and even one of the HIT industry’s leading spoke persons, John Halamka of Boston’s Beth Israel Deaconess Hospital (he’s also Harvard Med School’s CIO) spoke to the applicability of the iPad in the healthcare enterprise in the formal iPad 2 announcement last week.

The iPad 2 release is happening while most other touch tablet vendors including HP, RIM, Cisco and those building Android-based devices struggle to get their Gen 1 versions into the market. Of these other vendors, only Android-based devices are available today, including among others the Samsung Galaxy and the Motorola Xoom.

But it is not so much the new features in the iPad 2 (e.g., lighter weight, faster processor, two cameras, etc.) that will continue to make the iPad the go to device for physicians and healthcare enterprises, it is the process by which Apple vets and approves Apps that are available in the App Store. Apple imposes what at times for many App developers is an arduous and at times capricious approach to approving Apps. This approval process is in stark contrast of the one for Android, which is based on an open, free market model letting the market decide as to which Apps will succeed and which will not.

Virtually any patriotic, flag-waving American will say Hoorah, the free market rules. Of course a lot of App developers are saying the same thing and have riled against the Apple process since the first iPhone release back in 2007. But the free market, even here in America is truly not free. We have put laws and regulations in place, be they environmental, public health, etc. to protect the broader public good. Apple has done much the same for its App Store insuring that those Apps which are approved are unlikely to cause harm, which on a mobile device is usually the release of personal information such as passwords, credit card information, etc.

Unfortunately, the same can not be said for the Android OS and its marketplace of Apps. There have been numerous reported cases of malware Apps in the Android Market that most often are not removed until after thousands of users have had their personal information compromised. The latest occurred a little over a week ago when Google removed 21 malware Apps from the marketplace and then proceeded to remove about 30 more.

In the healthcare enterprise market, where very sensitive patient information is gathered and shared for improving the quality and efficiency of care delivered, touch tablets are seen as an ideal form factor for the ever on the move clinician who is looking to access the latest patient information at the point-of-care. Therefore, as clinicians increasingly demand access to such information via their touch tablet device, healthcare IT executives will increasingly seek to insure that the devices used are truly secure. Google’s continuing struggles to keep its Android Market free of malware will prevent devices using this OS from seeing greater adoption in the healthcare enterprise. This will allow Apple to continue to put distance between itself and other touch tablet competitors in this increasingly lucrative market.

Addendum:
Jared Sinclair, an ICU nurse in Nashville TN, has a similar view on the topic,

 

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HIMSS or Bust

Two extremely short weeks from today will be the official start of that annual healthcare IT (HIT) confab called HIMSS. Tens of thousands will gather to hear the latest and greatest on how HIT will deliver unfathomable rewards to all who adopt. Of course there will also be those discussions that if you aren’t on the EHR, HIE, CDS, RCM or any other HIT acronym bandwagon then surely you will fail to meet the high goals and aspirations of the policy wonks in DC and State-houses across the country. Your days are surely numbered.

Don’t get us wrong. Chilmark Research is actually a strong proponent of HIT, if it is judiciously deployed, clinicians have a voice and training is truly training (A friend who is a nurse told me the horror story of sitting in two full days of training where the trainer from a very well-known ambulatory vendor refused to allow those in the class to actually use the EHR – they had to sit and watch endless demos). Problem is, as the training example points out, this is rarely done and the aggressive timelines of ARRA for EHR incentive payments sure doesn’t help.

But we digress. If nothing else, HIMSS affords one the opportunity to get a pulse on the industry if one just ignores most of the loud pronouncements plastered all over the front of the various booths and in those all too common theaters. Having been to countless events such as this in numerous market sectors, the pulse is found behind the scenes, behind the posters, in the hallways in casual conversations, in the questions that you overhear being asked, in private conversations with key people in the industry.

In my own case, I look to HIMSS as partly educational, partly business development. Over the last few weeks I have received countless invitations to meet with various companies of all shapes and sizes. I just wish those sending these invitations would actually take the time to get to know Chilmark Research first as the vast majority are of very little interest – I mean really, do I want to sit-down and learn about the latest COW?

I do a lot of planning upfront and select who I want to meet with and rarely entertain unsolicited invitations. At this point, my three days of HIMSS are completely packed and if I were wise I’d spend the next two weeks taking it easy and resting up for what will be a three day marathon that begins with breakfast meetings and ends sometime late after the last reception. The most exhausting part of it all, simply that as an analyst you are always “On”. In almost any conversation you are asked for an opinion, a forecast, a prediction and if they don’t like it, you then need to defend it with logic. I love the challenge, I love the intellectual stimulus but by the time I board that flight home I’m totally spent.

To help you prepare for HIMSS, here are a few suggestions:

Attend the mobihealthnews webinar this Thursday, February 10th at 2pm ET. I’ll be presenting alongside mobihealthnews editor Brian Dolan and Diversinet executive Mark Trigsted. We’ll be talking about mHealth Trends in 2011 and what to expect at HIMSS on the mHealth front. Registration is free and last I heard, they have nearly 800 registrants.

Register for the FierceHealthIT HIMSS Executive Breakfast which will be held Tuesday morning. I will be part of a great panel that includes Lynn Vogel from MD Anderson, Joe Kvedar of Partner’s Center for Connected Health and Capt. Robert Marshall, CMIO of the Navy.  Our topic: mHealth’s Evolving Role in Achieving Meaningful Use, should make for a lively conversation.

Keep your meetings with vendors short. There is so much going on for your typical vendor that it will be difficult for them to truly remember details of an in-depth discussion.  So much is happening at a big event like this that the best one can hope for is a meet n’greet type of meeting where one meets with some key executives of the vendor, gains a quick read on their direction, what the vendor sees as important. With this information, you can determine whether or not a more in-depth follow-up meeting is warranted.

Be sure to leave yourself a good 15-30 minutes of space between meetings. This time will prove invaluable for a number of reasons including:

  • Gives you a breather to go over your notes and add any details you may not have written down during the meeting itself.
  • Provides some cushion should a meeting be going very well allowing you to carry a conversation to a successful conclusion.
  • Allows you time to get to your next meeting without being late. (Last year was a nightmare for me with the exhibit hall split in two – took forever for me to get from one side to the next. Thankfully I had some cushion time built into schedule.)

In closing, while I find HIMSS to be depressing at times and the hype of vendors far out-strips their ability to execute, this is a valuable conference to attend as it does bring all the key industry players in HIT under one roof. Despite all the wonderful communication tools we now have at our disposal from Facebook to Twitter to webcasts, emails and good old fashion phone calls, we are still social creatures and we do need face-time with one another to strengthen relationships, form new ones and assess ones we are unsure of. This can only be done in-person and HIMSS provides that opportunity.

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Yesterday, had the privilege to attend and present to a packed audience in New York City for CRG’s conference: IT & the Future of Managed Care: The Next Wave. Unlike most conferences I attend that are predominately focused on either the provider consumer sector of the healthcare market (tomorrow its the local New England HIMSS Chapter’s Annual Event), this event was for payers.  In light of the recent passage of the Healthcare Reform Act, ARRA and the move to digitize providers, they had a lot on their minds, particularly with regards to their future role in the digitization of medical records.

Following is my presentation. Brief as it is (was part of a panel and had about 7 minutes to fly through it), it does have a few nuggets worthy of a looksie.

Key Event Take-Aways:

Payers are struggling to develop new cost control models.  The Patient Centered Medical Home (PCMH) is attracting a lot of attention, lots of pilot studies currently underway or will be launched this year.  Remains to be seen as to true efficacy of this care model.

Telehealth is definitely ramping up, or at least some of the more innovative payers are looking to use telehealth in rural settings. (Of course, we have heard this so many times before and it remains to be seen if this time it is for real, but Cisco among others is making a big push, and with payers behind it, it may actually take hold).

Payers want to introduce best practices (comparative effectiveness) into the clinician’s workflow to insure that clinicians are complying to well-regarded and uniform standards of care.  Again, objective is to lower costs of care and improve outcomes.  Challenge, however is that clinicians are trained to deal with variability, they thrive on it.  Best practices, standards of care, etc., run counter to clinician training/culture.

Providing cost transparency/comparisons to consumers to allow them to consider costs as a variable in their healthcare decision making is difficult in many regions of the country as providers do not wish to be compared on costs and are reluctant to share such information.

Payers, as they have been for a number of years, are promoting collaborative care but are still running into significant challenges in making this happen.  The usual obstacles stand in their way, primary among them is data ownership and trust.  Payers are hopeful that HIE initiatives via ARRA and in the future CMS penalties will finally break this log-jam.

Significant interest in what Google Health and HealthVault are doing and where are they headed.  Few that I talked to are ready to commit (allow their members to export their claims data) to either platform, but they are having some pretty serious discussions internally as to what they should do. Surprisingly, (then again maybe not) no one at his event ever mentioned Dossia.

This was a well-run event with some excellent presentations.  Certainly plenty of hand-wringing in the audience as this sector grapples with both healthcare reform and the digitization of the provider sector.  What role payers will play in the future is fairly well-spelled out in the Healthcare Reform Act. Lesser known is what role payers will play within the context of healthcare IT.  Payers believe that they can play an important role in facilitating care (via telehealth, care coordination or clinical decision support tools) but as I told the audience in one of my closing comments:

Clinicians do respect the role that payers can play to a point, but there is still a level of distrust and do not expect a clinician to allow you to enter the exam room.  Keeping that in mind and respecting it will instill a level of good will that can lead to more fruitful interactions/collaborations in the future.

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Since the beginning of 2010 there has been a series of acquisitions in healthcare IT (HIT) market, which recently culminated in one of the largest, IBM’s acquisition of Initiate.  Triggering this activity is the massive amount of federal spending on HIT, (stimulus funding via ARRA which depending on how you count it, adds up to some $40B) that will be spent over the next several years to finally get the healthcare sector up to some semblance of the 21st century in its use of IT.  But one of the key issues with ARRA is that this money needs to be spent within a given time frame, thus requiring software vendors to quickly build out their solution portfolio, partner with others or simply acquire another firm.

And it is not just traditional HIT vendors doing the acquiring (AdvancedMD, Emdeon, Healthcare Mgmt Systems, MediConnect, etc.).  As the table below shows, many of these acquisitions are being driven by those who wish to get into this market (Thoma Bravo, Wound Mgmt Technologies, etc.) and capitalize upon future investments that will be made by those in the healthcare sector.

We are only at the beginning of the sea change in the HIT market and one can expect far more acquisitions over the next 12-18 months as stronger players expand their portfolios and new companies enter the HIT market.  If you are currently assessing an HIT solution for your organization, be sure to assess a vendor’s product road map and how they will meet your future needs (government mandates – e.g., meaningful use, interoperability, etc.) for if their answers are not absolutely clear, compelling and logical, you’ll better off looking elsewhere.

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Doing some quick analysis of the healthcare IT market and have uncovered some 17 HIT software acquisitions since beginning of year.

Is this but a lead up to the big industry confab, HIMSS that begins in a few short weeks?

Certainly, the market is in desperate need of consolidation. Recent actions are likely but a small example of a trend that will accelerate over the next 12-18 months.

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The pundits are out beginning to comment on what the Obama administration will mean to the healthcare IT market.  One of the leading HIT spokespersons, John Halamka made his predictions earlier this week.  Today, I came across a fairly lengthy article in CNN Money.  At first thought of critiquing both, found the CNN article to be poorly researched (despite all the quotes and numbers) and Halamka’s slanted (all about hospitals, physicians and standards, little about consumers, record access and control) and a bit too rosy on programs, committees and progress to date.

So, putting on our pundit and forecasting hat, here is what we see coming from Obama’s new administration:

The oft-quoted $10B a year investment in HIT will not materialize, in the near-term.  There is a small problem down on Wall Street that has extended across the country, heck the world, that will consume most available resources.  During the second half of his term, Obama may begin opening up the spigots and direct some significant funding towards healthcare IT but that will only occur if more pressing financial issues are brought under control.

Tighten budgets will put strain on all healthcare stakeholders.  This will lead to no one willing to give up their stake for the better good. Such committees as AHIC will be impotent in their ability to move anything significant forward.

Federal funding of RHIOs will continue, but at a lower level.  Limited resources and a lack of RHIOs that have actually succeeded (become self-sustaining) will force the Feds to reassess such funding, despite Kolodner’s loud protestations.

While being a strong supporter of Obama (worked local voting booth for the primary election), not convinced that throwing money at the HIT adoption problem is sound policy.  Such approaches tend to be top-heavy, too perscriptive, and despite the best of intentions, mis-aligned with true market needs.

Where the government can play a much more important and significant role is in the restructuring of programs it already funds (CMS), crafting incentive policies that create market forces to drive HIT adoption.  For example, the CMS program to push eRx, first with a carrot, later with a stick, makes a whole lot of sense.

Now, if we could only get legislation changed to allow CMS to support telehealth (new technology with clear benefits) or funding in support of PHR demonstrations, then we would be getting somewhere.

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Today’s eWeek has an interesting interview with two hospital CIOs,

And if you are interested in the CBO Report that is referenced in the interview, the CBO Director’s Blog has a good post on the content of that report.

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