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Posts Tagged ‘healthcare’

This morning, as most of you already know, the Supreme Court ruled that the Privacy Protection and Affordable Care Act (commonly known as ACA) is constitutional and basically left the entire law intact. While it was no surprise that this was a close 5-4 decision, it was surprising that rather than rule that certain sections of the law were unconstitutional (e.g., the individual mandate), it was either an all-in or all-out dividing line (those in dissent would have thrown the entire law out the window). In fact, among our esteemed and we like to think highly knowledgeable readers, two-thirds voted in our prediction poll that ACA would be circumscribed by the Supreme Court while 17% felt the law would be upheld in its entirety.

Implications of Decision:
We are an analyst firm that is focused on the adoption and use of healthcare IT. Thus the implications of the Supreme Court decision which follow are focused on just that:

Healthcare systems will continue to aggressively move forward to form comprehensive care delivery systems (acquiring practices, long-term care facilities, etc.) to more effectively manage their patient populations across care settings. This will in turn require greater clinical connectivity and integration across these care settings. Expect to see very strong demand for health information exchanges.

Payers will continue to struggle with improving their operating margins. Some, such as United Health Group and Aetna, have ventured into the more lucrative and higher margin HIT market via acquisitions. Expect to see other payers make a move here as well jumping into the HIT market via acquisition(s).

Payers will also venture directly into care delivery via partnerships with large providers to stand-up ACO-like entities (e.g., Blue Cross of CA & Dignity Health) or acquire (e.g., Highmark and West Allegheny). We may also see some payers be quite innovative and begin providing more state-of-the-art, low cost concierge care services such as One Medical to serve the vast pool of some 30M+ new members nationwide.

To effectively and efficiently survive under future bundled care reimbursement models, hospital systems will finally have to get truly serious about patient engagement. No longer can they view this as just something for the marketing department to deal with (listen to yesterday’s podcast) but will need to actively engage with patients and aggressively encourage self-management of chronic diseases. This need will lead to a blossoming of innovation in new solutions, be they mobile, telehealth, whatever you want to call it to improve patient adherence outside of the clinical setting.

Got Analytics? Yes, analytics is going to be huge but today, most analytics solutions are not up to the task of serving all healthcare provider needs, or at least no single solution/vendor is. Providers will need to accept the fact that for the foreseeable future they’ll be purchasing best-of-breed solutions. But providers also need to do their homework as we predict that there will be a significant amount of consolidation, via acquisition, in this market over the next five years. And one last word of advice to providers, don’t count on your EHR vendor to deliver these solutions anytime soon.

Of course there is far more that we could delve into on the implications of this ruling to the HIT market but for now believe we have provided enough to get your collective  juices flowing. Is there anything we missed that you believe is screaming out loud in the HIT market due to this decision? If so, please let us know via a comment – we love comments!

In closing, hope all have a great July 4th week ahead and…

God Bless America

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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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Before entering the convoluted healthcare IT sector, I had worked in the manufacturing sector both as an IT analyst and in corporate strategy for Europe’s second largest enterprise software company. In those many years I learn quite a bit about not only how to effectively deploy large enterprise software systems (SAP, PeopleSoft, i2, PTC, SSA, Dassault Systemes, etc.) but how to create models that would guide clients in a methodical manner in IT adoption. A common model used was the five stage Maturity Model, which was originally developed at Carnegie Mellon University.

The beauty of the maturity model is its simplicity and focus on process change. This proved very effective in educating all stakeholders within a manufacturing company, from the C-suite on down, as to how they needed to think about their internal processes, the technology they were preparing to deploy and the final end-point that they should strive towards. But one should not look at maturity models as completely static for the technology does change overtime and subsequently what is possible.

In doing research for the HIE Market Report I was surprised to not find a maturity model for HIEs (heck, it was hard to find much of anything with regards to maturity models in HIT). This puzzled me greatly for if any sector of the HIT space needs a maturity model, it certainly is the HIE sector. This pushed me to create the five stage HIE maturity model shown below. In viewing this model, keep in mind that the model is not meant to be an exhaustive list of all that is possible but simply describe what are the natural characteristics of an HIE as it matures over time.  As in the models I created for the manufacturing sector, this one is designed to assist those who are planning to deploy an HIE, or may be operating one now, on what they need to think about in mapping out their future strategy. For this particular model, I used three instead of the customary two columns with the third column (Characteristics) providing guidance as to the IT capabilities that would be required to meet the Objectives of that particular Stage.

What’s next?
Ideally, this maturity model sees wide adoption and use by both public and enterprise HIEs. Honestly, that is why I’m pulling it out of the HIE Market Report and putting it out here in the public domain for part of the mission here at Chilmark Research is to indeed facilitate the effective adoption and use of HIT by ALL stakeholders in the healthcare sector.

Secondly, this is being released to get the feedback of those in the field that are deploying HIEs, running HIEs, providing HIE solutions. Please provide your views, your perspectives on this model. Is it logical? Does it make sense? Is there anything missing?

I look forward to your critque.

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There have been a lot of discussions on the Net regarding the potential impact of the iPad in the healthcare sector.  At this point, there is very little agreement with some pointing to the ubiquitous nature of the iPhone in healthcare as a foreshadowing of the iPad’s future impact, while others point to the modest uptake of tablet computing platforms as a precursor for minimal impact.

Our 2 cents worth…

We believe the iPad will see the biggest impact in two areas: medical education and patient-clinician communication.

The iPad’s rich user interface, native support for eReading, strong graphics (color) capabilities, ability to use various medical calculators (there are a slew of them already in the AppStore) and numerous other medical apps (most of these are iPhone apps and will need to be updated to take full advantage of the iPad’s larger 9″ screen) provides an incredibly rich ecosystem/learning environment for medical students.  Nothing else comes close – a slam-dunk for Apple.

That rich, graphical user interface, it’s inherent e-reader capabilities and portability also lends itself as possibly the best patient education platform yet created to foster patient-clinician interaction.  At bedside, a clinician has the ability to review with a patient a given treatment, say a surgical procedure, prior to the operation showing rich anatomical details (e.g., a patient’s 64 slice color enhanced 3D CAT scan), potential risks, etc. Heck, one could even show a video clip of the procedure right there on the iPad.  Now that is cool and sure beats the common approach today, some long lecture that oft-times is difficult to follow.

Beyond those two compelling use cases, other uses in healthcare for the iPad include its use by nurses and hospitalists to provide bedside care, tap multiple apps (hopefully multi-tasking will come in OS v4.0 to be announced on April 8th), in an intuitive environment.  As to how the iPad may extend beyond these limited boundaries for support of say charge capture and CPOE remains to be seen but in the immortal words of many an Apple iPhone advertisement:

There is an app for that.

And based on some of our initial conversations with mHealth app developers, many are already working on just these types of applications for the iPad, which they hope to bring to market within next several months.

One thing is certain, from at least one data point we received this past weekend, there is strong, initial interest in the medical community as to what the iPad may facilitate.  Speaking to one of the technical folks at the local Apple store this past weekend we learned the following: Of the 1,000 iPads sold on Saturday (this store did sell-out), 700 were sold off the floor and 300 were reserved for business customers.  Of those “business customers” a significant share of those 300 iPads (north of 30%) were sold to local medical institutions.

One of those local healthcare institutions appears to be Beth Israel Deaconess Medical Center (BIDMC) where an ER doc has provided his own iPad review, based on actual use during a shift.  Particularly like his comment about using it for patient education.  Might the iPad truly bridge the information gap between patient and clinician?  One thing is for certain, it will make it much easier for patient and clinician to confer over a given diagnosis, results and creation of a treatment plan with supporting documentation/graphics.

Read into that what you may but one thing is for certain, there is significant interest in the healthcare sector to at least understand how the iPad may be used within the context of care delivery in a hospital.  It remains to be seen as to how end users will actually use these devices and what apps will be developed to serve this market (might Epocrates see stronger uptake for their EMR on the iPad vs. the iPhone?) that take advantage of the larger, 9″ screen, but based on what we have experienced with the iPhone, there are likely more than a few developers right now working on novel applications that clinicians will find valuable. Question is: Will they be valuable enough to augment the extra weight and volume of lugging the iPad versus a smartphone?

Only time will tell.

That being said, based on initial impressions of physicians, such as the one from BIDMC (see above) and our own limited experience in using the iPad this week, the iPad is pretty incredible and could usher in a whole new approach to healthcare IT (interfacing to and interacting with an EMR/EHR system) that may result in physicians adopting and using such technology, willingly.  Could we even go so far as to say that the iPad will be a bigger contributor to HIT adoption and use than the $40B in ARRA funding that the feds will spend over the next several years as part of the HITECH Act?

Again, only time will tell.

Appendix:

Some other perspectives on the iPad in healthcare:

Article in HealthLeaders with some interviews with med professionals buying an iPad at Apple store in SanDiego.

ComputerWorld article looking at various business sector (including healthcare) uses of iPad.

Post by iPhone iMedicalApps on some of the current challenges for those adopting an iPad for medical use (virtually all the problems listed will be resolved within next few months)

Another post, this time at iPhoneCTO looks at the iPad in the med space for workforce mgmt.

Well look at this!  Children’s Hospital here in Boston announced today (4/8/10) that it has received one of the recent HHS innovation grants to “…investigate, evaluate, and prototype approaches to achieving an “iPhone-like” health information technology platform model…”

Another ER doc writes a review of the iPad.

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informatics_TRDon’t vaccinate your child for whooping cough and put them at a 23x greater risk of contracting this nasty disease.  That is the finding of a research report released today by Kaiser-Permanente (KP).  Last week Chilmark Research had the opportunity to speak with the lead researcher, Dr. Jason Glanz of KP on this research project and lessons learned.  Our interests lied in better understanding how the research leveraged the KP EMR.  Here is what we learned.

First some quick background:

Whooping cough is actually on the rise having hit a low of ~1,000 reported cases in 1976 and in 2004, over 25,000 cases were reported.  The rise is believed to be caused from two factors: teenagers contracting the disease as vaccine loses effectiveness and secondly, lack of full set of vaccines to infants (requires three successive shots).  While whooping cough is not that dangerous for teenagers and adults, it can be life-threatening for infants and small children, however, is preventable.

Goal & Methodology:

One of the primary goals of the research was to determine if parents who refuse to give their children the full set of vaccinations put their children at greater risk.  While there is the assumption that this is the case, Dr. Glanz wanted to determine what is the level of that risk in quantifiable terms.  In doing so, the hope is that pediatricians will have better, evidence-based research at their disposal to assist in educating their customers (parents) the risk they put upon their child when refusing a vaccination.

Digging into the data of KP’s EMR in Colorado, the researchers extracted the records of children over an 11 year period (1996-2007) to look for cases of whooping cough and correlation to vaccine refusal.  Over 100K records were reviewed. Once the data was extracted and reviewed, SAS statistical tools were applied for analysis.

Why this is important:

As we march down the EHR adoption road with a $36B wind at our back, compliments of Uncle Sam, a critical issue is: What do we, as tax payers who are ultimately paying for this, get in return?

Part of the answer may lie in research such as this that leverages massive amounts of data in an EHR (or in the future a network of EHRs) to determine with a high degree of confidence such issues as behavioral risk, adverse drug events, effectiveness of various treatments to demographic subsets of the population, etc.  This could have a massive impact on future healthcare practices resulting in better, more effective and potentially personalized care.

For example, in this whooping cough example researchers found that the demographic most likely to refuse a vaccination is Caucasian, upper middle-class and well-educated.  Knowing that information in advance will assist educators in crafting educational content targeting that demographic.  If, on the contrary, it were primarily a Hispanic population, content could be generated in both Spanish and English.

By no means a slam dunk:

While it is great to hypothesize on the potential that prudent, secure and safe use of health record data to perform such studies will create a new revolution in healthcare research, it is far easier said than done.  Today, most EMRs can not readily share data in support of such research efforts.  One can only hope that the future criteria for meaningful use (information sharing) will reflect the need to support this type of research.

But even within most hospitals and IDNs, including KP, there is insufficient attention paid to how to structure the EMR to support research projects such as this example.  In the whooping cough case example, Dr. Glanz stated that one of the most time consuming processes in the research was the examination of records by researchers to determine if a parent exercised the exemption clause to refuse the vaccination for their child.  An outcome of this research, is a new field in the pediatrician’s EMR that they will check if the exemption clause is exercised by a parent.  This will automate future analysis of data sets for this critical variable.

Extending this example further, what do hospital and IDN CIOs need to be thinking about today in their EMR implementations to insure that data for such research is more readily collected and analyzed at some future point in time?  While it may be impossible to predict all potential use cases of EMR data, CIOs would be wise to start in areas where they have develop, or will develop strong competencies of care (e.g., cardiology, urology, oncology, pediatrics, etc.). They would also be wise to actively solicit the involvement/representation of their internal research group in defining attributes for the EHR prior to install.

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We do not like to venture down the path of healthcare policy discussions for the simple reason that there are far too many people far brighter and knowledgeable than us on the subject who we defer to, and besides, where would our differentiation be in what is already an extremely crowded market of political & policy pundits?

Yes, that realm is not the place for us.

But John Halamka has taken a stab at it, albeit a very “high-level” one, as to the differences between the McCain and Obama healthcare IT (HIT) policy platforms. Based on Halamka’s review, pretty clear that McCain’s HIT policy is about as informed as his use of technology. Quoting a NYTimes interview from this past summer…

He said, ruefully, that he had not mastered how to use the Internet and relied on his wife and aides like Mark Salter, a senior adviser, and Brooke Buchanan, his press secretary, to get him online to read newspapers (though he prefers reading those the old-fashioned way) and political Web sites and blogs.

“They go on for me,” he said. “I am learning to get online myself, and I will have that down fairly soon, getting on myself.

Obama appears to be more “up-to-speed” on HIT but the details remain exasperatingly thin. Heard Senator John Kerry speak last week at the Connected for Health event where all in attendance were hoping for some insight on future healthcare legislation, particularly as it pertained to HIT. Big time disappointment as Senator Kerry was about as ill-informed on HIT as McCain appears to be.

Either way you lean, do not expect any drastic changes in the near-term for HIT adoption and use and more broadly, healthcare policy as this sector is littered with vested interests who all have their fingers in the pie. Removing those fingers will not be easy, in fact it will most likely require a surgical procedure, like cutting them off.

No, healthcare reform and HIT adoption are not the most pressing issues today, (“Its the economy stu*id”) but there are certainly plenty of other reasons to get out and vote.

Add-on note: ZDNet just published an article today more broadly assessing the candidates and their potential impact to IT secotr.

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Health 2.0 Wrap-up

Couple of long days and now listening to the wrap-up panel, Looking Ahead – The Business and Society of Health 2.0. One of the panel members, David Lansky, formally of Markle Foundation and now heading up the business healthcare group, Pacific Business Group on Health. Disturbing statement from Lansky was that he worked with Matthew to offer free attendance to the big business leaders in California, many of them from hi-tech, not a single one is in attendance. Lansky went on to say that there are extremely large vested interests in healthcare that are very good at protecting their financial stake and are not going to let go easily. Many will co-op Health 2.0 approaches to keep that control of the purse strings. Lansky encouraged all in attendance that healthcare is a policy issue and that Health 2.0 companies really need to work together and with their customers to force the policy changes needed. Very good and prescient comments.

Panel is for the most part cheerleaders for Health 2.0. Thankfully, Lansky is up there giving some balance – quite pragmatic. Oh, almost forgot, we do have Kolodner from HHS up there on the panel as well. He is encouraging the audience to get involved with AHIC successor. Oh Boy, you are better off siting in your Congressman’s office.

Final Wrap:

Looking at all the solutions I’ve seen here what strikes me most is the need for a roll-up. There is simply no way that a consumer is going to go to one site to manage their records, another to look at potential adverse reactions from meds, another to look at symptoms, a social community to talk about their health and the list goes on.

The WebMD/Healtheon merger leaves WebMD with a sizable war chest of some $340M to go out into the market and act as aggregator/acquirer to create a richer environment for their customers. Spoke to a couple of others who also have access to some very deep pockets who told me they will be out bottom fishing in 6-9 months.

Another strategy is a federated, best-of-breed roll-up where companies with complimentary solutions come together to deliver compelling solutions to institutional clients.

This market and the players within need scale. Virtually all of them are small operations with less than 25 employees. Most that I spoke to are still very much in start-up mode, fleshing out the product and only now begining to think about how they will take the product to market and scale. Channel strategies are immature, messaging non-existent. A lot of promise shown with regards to technology, despite all the overlap, but we are far from seeing this market truly succeed as technology is only a small piece of what it takes to make a business successful.

The event itself is a hell of a lot more interesting and more fun than HIMSS. Hat’s off to the organizers, they have done an excellent job bringing together some excellent people who are pushing the envelop and hopefully with input and engagement from the consumers and physicians they are targeting, these companies will push healthcare in the right direction.

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Fly out today to the Health 2.0 conference which begins tomorrow.

With some 1,000+ attendees, this event will certainly be buzzing, but what we are most interested to learn is what is really working, both pre and post financial bust.  One look at the agenda and you can clearly see that there is a tremendous amount of overlap in the solutions currently in the market, or coming to market.  Obviously, not all will survive.

So questions we hope to answer include:

  • Is there anyone truly doing something different that really hits one out of the proverbial park?  Yes, everyone claims to be different, have some unique advantage, but by and large we found most solutions are simply “me too’s” with a healthcare spin.
  • Who is actually seeing traction?  Plenty of interesting solutions, but are consumers actually using them/getting some value that is creating a viral effect in the market leading to accelerated growth?  In essence, what is their go-to-market strategy?  This is where so many stumble.
  • What is the revenue model and is it/will it be sufficient to foster long-term growth?  Ok, so you have nice growth in users, now how do you plan to make a profit?  Is it just another ad-supported model where you will barrage your visitors with mindless clutter or do you plan something more strategic via a given class of supporting partners?

And finally…

  • How has the recent turmoil in the market affected your strategy?  What are you doing right now to insure you will be there tomorrow seeing as your ability to access the credit market will likely be compromised?  At the recent Northeast Health 2.0 evening event, many of the companies we spoke to readily volunteered that they were either making a profit and/or trimming expenses to live within means. Expect much the same in SF, but will look to dig deeper than just these common responses.

In addition to seeking answers to the above, we will of course be on the look-out for surprises and the usual host of announcements from the vendors (already received a couple of announcements that we have to sit-on till formal release date/time) so stay tuned.

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Dan Nigrin, the CIO from Children’s Hospital Boston set the tone at this morning’s meeting stating what keeps him up at night is struggling with the insatiable demand for HIT among care providers (espeically newer and younger staff members) at Children’s while concurrently dealing with an industry that is so bound by tradition. On one hand he must prioritize spending across any number of categories that he characterized as infinitely long (healthcare still spends a woefully low 1-3% of revenue on IT, as a comparison, manufacturing is spending between 4-6% and financial institutions spend even more). Yet on the other-hand, he needs to find new ways to more effectively leverage this spend to insure effective adoption occurs. Not an easy task in this tied to tradition industry.

And what might some of those spending priorities be? John Halamka, the other CIO on the panel gave quite a laundry list that includes:

  • Getting non-affiliated doctors on-board in using an EMR throughout the New England region. He did a recent post on that one.
  • Addressing the demand for data storage. Demand now far exceeds his budget despite Moore’s law and he sees no slow down for the foreseeable future.
  • Insuring secure communication throughout the network.
  • Tackling security. They push back an attack on their system every 7 sec. (BTW, that works out to be some 12,300 attacks per day, or 4.3M/yr). While Halamka is using various commercial Spam filters, unfortunately these solutions today are too restrictive. Why? As it turns out, physicians use a lot of anatomical terms that Spam filters readily tag. He has 4 FTE on staff doing nothing but IT security.
  • Providing the best decision support tools at the point of care. The knowledge is coming in so fast and furious, he does not see any single entity being abl to address it. Recommends a “knowledge cloud” model.
  • Compliance – never ending list to contend with that seems to only grow over time.
  • Creating dynamic websites (internal & external facing) using new tools (ala Web2.0). This summer they will release new portals that incorporate social networking, dynamic content, etc. to create a richer, more cogent user experience.
  • Disaster recovery – 4x redundancy is the norm for his operations.

At one point during the first session, conversation veered off into the old, what about RHIOs. Conversation concluded when one of the panel members simply stated that even a successful RHIO, of which there are few, will struggle to stay afloat as there is not enough “low hanging fruit” for them to address that will sustain them long-term. That statement ended the conversation on RHIOs.

During the Q&A for the first session I shot up my hand and asked what about Pay for Performance (P4P), quality and pricing transparency (was quite surprised that this was not keeping them up at night, plenty of other CIOs are reporting otherwise). Both stated that yes this is a big issue and continues to drive many of their priorities. Halamka made mention that one P4P initiative represented some $22M to BI, so quite obviously, it became the number one priority for his group. I bet he’ll be seeing many more P4P initiatives in the future as this issue is not going away, only growing.  Maybe next year he’ll report that it is keeping him up at night.

The second session of the event focused on consumer healthcare IT. Again, most of the discussion was dominated by the two CIOs on the panel.

Both Halamka and Nigrin are in full support of the PHR concept and complete consumer control of their own record. Each are taking steps at their respective institutions to make that happen.

At Children’s they are still in the process of rolling out the PHR across the various practices, having only started the roll-out recently. They are using their home-grown solution, Indivo, which is the same solution underlying Dossia. In speaking with Nigrin after the event he stated that they are predicting relatively high adoption rates as in Nigrin’s words “there is no one more motivated than a parent caring for their child with an illness”.

Over at Beth Israel (BI), they have provided consumers with the tethered PHR portal PatientSite for several years. Halamka stated they get 40,000 visitors/month to the site. At BI they make it mandatory that all MS patients use PatientSite to facilitate care. Among primary care physicians (PCP), roughly 30% of PCPs are using a PHR with their patients. Another interesting point he made was that they have not actively pushed the PHR concept on many of the specialists at BI as they often only address episodic care events. Thus, chronic care specialists and PCPs are the focus for internal PHR adoption and use.

As part of their commitment to patient control of medical records, Halamka stated that they will interface to any leading Personal Health System. They have enabled Google (though reports are it is extremely limited version of one’s record), are working through the final steps to enable HealthVault and they are currently working with Dossia as well. While they may have gone live first with Google, there does not appear to be any overt favoritism.

Nearly universal belief among all panel members (to which I concur) that we are very early in the adoption and use of PHRs and it is difficult to say today how all this will play out. Patrick Boyle from IBM and David Hendren from Catalyst Health Ventures both stated that the current healthcare system is seriously broken, costs are unsustainable and drastic changes are needed. Part of the solution will be for the consumer to take a more direct and active role in managing their health. Boyle went on to relate how IBM has been using its internally hosted PHR (happens to be WebMD based) to drive down their healthcare costs, which are currently about half of the industry average with big savings coming from their ability to negotiate better rates with insurers. With the practices and incentives they have implemented at IBM via the PHR, they are able to go to insurers and provide clear evidence that IBM employees represent a lower health risk than say some company that does not provide such tools to their employees. IBM’s success has not gone unnoticed and is just one factor in the large ramp-up in PHR activity among employers, an issue covered in depth in our recent PHR Report.

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