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Posts Tagged ‘HIMSS’

mHealth12Be careful what you wish for sure did apply to this year’s mHealth Summit, which was held last week in Washington D.C. Of the some 4,000 in attendance, I was one of the 10% or was it even 1% of those present that have attended all four events in succession. It is with that perspective that I came away from this year’s mHealth Summit more disappointed than ever.

At previous mHealth Summits, I often bemoaned the lack of organization of the conference, the often bizarre exhibitors one would find (couple of years back one exhibitor, and I kid you not, was marketing herbal aphrodisiacs) and basic necessities one would find at virtually any event, breaks with coffee, maybe a snack here and there. This disorganized, but charming event was mHealth Alliance Summits of years past.

After an initial partnership last year with the NIH Foundation, the original organizers of the mHealth Summit, HIMSS formerly took over the mHealth event this year. The result, a much more well organized registration process, greater focus on the exhibition area and a definite improvement on basic event logistics.

Unfortunately, HIMSS was less successful in improving the content of the numerous sessions that were held. It seemed that anyone with an idea for a topic was given a stage to stand on, or at least a panel to participate on even if what they had to say had very little to do with the session topic.

The exhibit area, while improving, still lacked a core constituency, HIMSS’s bread n’ butter customer base, the traditional HIT companies that one finds at the national HIMSS conference. This struck me as quite surprising as we are now beginning to see EHR vendors finally release solutions that truly enable physicians to use their tablets for bi-directional interaction with a healthcare facility’s core health information system.

But there were two things I found most disturbing about this year’s event. The first was how HIMSS handled the keynote presentations. From this vantage point, it appeared that each and every one of keynote was simply sold to the highest bidder and since they were sold, the winning bidder felt that their keynote provided them the opportunity to sell the audience on their concept, their product, their platform for mHealth. It was horrid to watch and cheapened this event to a level it has never seen in its short history. Seriously HIMSS, today you have enough clout in the market to not stoop this low so why did you?

Another big omission in the main stage was the lack of clinicians discussing the potential use cases for mHealth, the challenges to adoption, the challenges to link into legacy systems and how they see mHealth evolving in the future to meet their care delivery needs. THere could have been some stunning visionary talks on the topic, but none were to be found at this year’s Summit.

The other disturbing issue relates more to the industry itself and those positioning themselves to be the leaders in the mHealth market. Companies such as Aetna, AT&T, Qualcomm, Verizon, et. al., all spoke about an open platform for mHealth applications. Of course each of them was talking about their own proprietary “open platform” that they are hoping will become the de facto standard in this industry sector. Problem is: none of them have the consumer traction, nor a compelling enough vision to gain a critical mass of developers for their specific platform. There are no “Apples” in this bunch.

The need for a common set of standards that will allow mHealth apps to cross-talk to one another is a serious need in this sector, Without such standards, mHealth will never truly blossom into its full potential and remain the sideshow that it is today. Now, if we could get these big players to all agree that mHealth is far more important than any single one of them, that competing via proprietary platforms is a dead-end, then maybe we will finally get somewhere.

Note: As mentioned previously, we are getting ready to switch to a completely new site. THerefore, while you can leave comments here now for discussion, it is unlikely that they’ll be transfered over to the new site.

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The big health IT industry confab HIMSS kicks off one week from today.  With some 28 briefings scheduled over 2.5 days, the Chilmark Research team will be extremely busy to say the least.  It is with that in mind that Chilmark has prepared the top 5 do’s and don’ts that all vendors need to keep in mind when briefing analysts to insure that these briefings are fruitful for both parties. (This post is as much for self-preservation as it is a public service.)

In the lead-up to HIMSS, Chilmark has been absolutely inundated with requests for meetings with vendors of all shapes and sizes.  How do we select who will meet with? Our selection criteria is pretty simple:

1) Is the HIT vendor providing a solution for which we are currently doing research (HIE market) or in the future (provider-based PHRs, mobile health apps, cloud computing in healthcare, clinical decision support, etc.).

2) Have we had fruitful, meaningful discussions with this vendor in the past?

This last point is particularly critical and played a major role in prompting this post (along with a meeting last week with an executive from PR firm Schwartz Communication, who also encouraged such a post).  There were numerous requests to meet with vendors we met with last year.  Those who gave horrific briefings last year were turned down. This post is dedicated to them in the hopes that they will change their analyst briefing strategy.

Top 5 Don’ts

1) Don’t give us a canned pitch. Not only is a canned pitch a waste of our precious time (and yours as well), canned pitches insult us, they insult our intelligence. Please save those for others less knowledgeable of the market.  Along with canned pitches, do not talk through Press Releases, ugh, we can read these on our flight home.

2) Don’t bother with PowerPoint. We only have at best 30min together, let’s not waste that time going through a series of PowerPoint slides – boring.  The other danger here is that analysts are bred to be cynics. When we see PowerPoint, first thing that comes into our heads – Vaporware! That is the last thing you want us thinking – Trust Me.

3) Don’t be obtrusive when we are talking to one of your customers. Let us have an unencumbered conversation with your customer which affords us the opportunity to drill down on the most critical issues/challenges as well as the significance of your solution in their organization.  Really quite annoying when a vendor is frequently interjecting themselves into a conversation. Please fade into background, you can clarify critical points later.

4) Don’t bad mouth your competition. Complete turn-off and also raises a red flag for that ever so cynical analyst leading him/her to think: Hmm, competition must be eating this company alive and they are struggling to remain relevant in the market.

5) Don’t forget to follow-up. Granted, not every briefing will be engaging, but that should not prevent you from following up after the show with analysts.  In that follow-up email, do reference specific conversation points and answering any questions that may have not been fully addressed during the show briefing.  Quite amazing how much this will assist you in your relationship(s) with analysts but also how infrequently it is done.  There were several briefing requests turned down this year due to lack of follow-up on their part after last year’s HIMSS.  Sloppy.

Top 5 Do’s

1) Do tell us about what you are seeing in the market. Sure, we”ll want to hear ever so briefly about your announcements at HIMSS, but more importantly, we want to hear about what YOU are seeing in the market and how your company is responding to market needs and challenges.  This puts your strategy in context for us. No you don’t have to be explicit, on your strategy that is, we can figure that out just fine on our own.  The more open and honest you are here will go a very long way to endearing your self in the analyst’s eyes.

2) Do have a couple of people involved in briefing from different disciplines (e.g., marketing, executive management, R&D). Too often, analyst briefings at events like HIMSS are seen as something similar to briefing the press with a press person and marketing executive present going through the motions.  Boring. Analysts want to understand your company at a far deeper level so leave the press bunny behind and bring in another senior exec from product development, management, etc.

3) Do keep conversation focused to one or two topics that are relevant to analyst and their research agenda. Remember, we only have about 20-25 minutes to work with once formal intros are done and we both want to get as much out of these briefing as humanly possible.  Focus discussion on one to two key points you want to get across as that is about all the time you’ll have.  Any more topics then that just get lost in the white noise of other activities.

4) Do introduce us to a customer or two. Analysts love talking to customers, ideally, not the ones that have been heavily coached by your marketing and sales team.  Do introduce us to a customer or two of yours that may also be attending HIMSS that we can talk to.  This need not take up our precious 30 minutes together, as an analyst can follow-up with customer.  And do take heed to Number 3 in the “Don’ts” above after making such an introduction.

5) Do ask us questions. Ideally, a briefing with an analyst is a conversation where both parties are asking questions of one another.  A good analyst (yes, there are many poor ones) has a unique perspective on the market that is actually a composite view of those conversations with numerous market players.  As I use to tell new analysts shortly after hiring: Think of yourself in the crow’s nest of a ship in the War of 1812.  You are not down on the deck in the heat of the action, you are removed from the intense excitement viewing the entire sea battle from your perch.  It is from that perch that you direct those below where to fire their cannons.  Use this time with the analyst to gain their perspective on the market and where you may need to point your cannons in the future.

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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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Today, the HIT Policy Committee met once again, this time to hammer out what the term “certified EHR” means within the context of future ARRA reimbursements to physicians and hospitals.  Chilmark sat in on the discussions, here is our assessment of what transpired. (See yesterday’s post, below, as to why the Certification issue is critical.)

The Certification workgroup presented their refined recommendations today (these were first announced at the July 16th meeting), which were subsequently approved by the broader HIT Policy Committee.  Marc Probst of InterMountain Healthcare and co-chair of the workgroup led discussions which began with a high level list of five recommendations, (see slide below).  For simplicity, we will focus on these five recommendations in our discussions as they encapsulate the entire meeting and what was ultimately approved.

cert1

In Recommendation 1 the workgroup emphasized that certification criteria must be kept at a high level, (e.g., not specify how an alert would be presented, simply that one would be presented) criteria must directly link back to supporting the meaningful use criteria that were approved on July 16th. Th workgroup also emphasized that the creation of certification criteria must be the responsibility of HHS/ONC and not a third party such as CCHIT. (Note: CMS is now converting MU criteria into actual rules – and based on some comments today, it is not an easy task.  Creating certification criteria will be easier, but still a lot to add on to the plate of HHS who already has its hands full.)

But where the workgroup wants a lot of specificity is with interoperability suggesting that HHS/CMS develop certification criteria that is quite specific to insure interoperability between systems. With such tight time-frames and deadlines in place, this issue of interoperability could become one of the most challenging aspects of the whole HITECH Act, for underlying all three workgroups (Meaningful Use, Certification and HIEs) is interoperability.  But what is interoperability anyway?  Is it computable data? Is it transmittal and sharing of PDFs? Is it order sets, med lists, labs?

Looking back, the Meaningful Use matrix does provide some guidance as to what data is to be shared for care coordination, but that still does not eliminate the challenge of creating specific criteria for interoperability that can be readily certified and put into the market.  Also, it is important to note that certification for vendors may have to occur every two years (2011, 2013, 2015) in lock-step with the ever increasing requirements for meaningful use which itself calls for ever more complex data sets to be shared.

Recommendation 2 was pretty much a no brainer as ARRA legislation specifically calls for certain enhancements to security and privacy of medical records (audit trails, consent, etc.).   Here again the workgroup emphasized the need for HHS to get aggressive on establishing clear certification guidance on interoperability as it pertains to addressing security and privacy.

It was in Recommendation 3 that the workgroup suggested that HHS allow multiple certification organizations (not just CCHIT), to conduct certifications of EHR systems stating that this will help create a competitive market for such services and increase transparency into the certification process.  The workgroup also recommended that NIST establish and execute an accreditation process for certifying organizations.

While CCHIT has certainly been marginalized, they will still play an important role in the interim.  Right now there are no other certifying organizations, the market is being quite cautious in making any large EMR purchases awaiting to see what comes out of DC and this whole certification/accreditation development and meaningful use rule-making is going to take time.  What was proposed today is that CCHIT take the lead until at least October (it will more likely end up being well into Q1’10) for mapping meaningful use criteria, as defined in the matrix, to high level certification criteria and provide an interim certification for EHR systems.  Remember, this role of CCHIT is on an interim basis and NOT permanent, though others may want you to think differently (Note, Government Health IT is owned by HIMSS a strong advocate of CCHIT.)

The workgroup also wanted to acknowledge the investments that HIT vendors have already made to get CCHIT certified.  Thus, for those vendors with 2008 CCHIT certification, they need not go through a whole re-certification once guidelines are released, but simply be certified for any gaps that may exist between these two certification processes, with the latter focused on meaningful use.

For Recommendation 4 it appears that like CCHIT, the workgroup received a lot of feedback from Open Source advocates, those that developed their own solutions and smaller software companies that have developed EHR enabling modules.  Therefore, the workgroup followed CCHIT’s lead wih a similar strategy recommending that all systems be tested equally with same high level criteria, regardless of the source of the software. They also encouraged a “flexible certification process” that will account for non-traditional software sources (eg, the RYO camp) and that there be a process to certify distinct, meaningful use enabling modules (eg, eRx).  Chilmark thought CCHIT did a good job here and it is equally good to see the workgroup recommend the same.

Recommendation 5 ties back into what we discussed earlier with regards to the future role of CCHIT – there needs to be a transition phase to account for the time-lag between the need to begin certifying EHRs for market and the lengthy rule-making process for meaningful use.  The workgroup recommends adopting what certification criteria that exists today (obviously from CCHIT) that supports meaningful use and where there are no existing criteria, work to converge criteria to meaningful use rules through close internal collaborations within HHS.

This is where it is going to get a little tricky as both the meaningful use matirx is a bit vague and well certification criteria, that is even more vague.  How do we bring convergence for all this in a timely fashion so that physicians and hospitals can begin installing certified EHRs that provide them the capability to demonstrate meaningful use in order to get their 2011 reimbursement?   We’re not sure how to get there from here, but one thing is for sure, it will be a rocky road ahead.

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Yesterday, at an mHealth event in Washington DC, Michael Fitzmaurice of AHRQ stated:

We’ll tell the world what meaningful use is on 6/16.

Referring to the next meeting of the ONC Policy Committee.If this indeed comes true, Chilmark will feel pretty good about this as it is something we predicted back on April 30th.

Many a vendor will also breath a sigh of relief as the delay in a meaningful use definition, which is required as part of the ARRA stimulus funding for EHRs, has stalled the market.  But that raises another question: Will the market continue to keep checkbooks in their drawers awaiting the definition of “certified EHRs?”

Hopefully, when it comes to certified EHRs, ONC will take a more measured and rational approach as advocated by the likes of the Markle Foundation, Adam Bosworth (former head of Google Health and one of the original developers of XML standard), Chilmark Research and many others rather than the approach that one legislator down in the Garden State of New Jersey has proposed in recent legislation that states, and I kid you not:

A prohibition on the sale or distribution in this State of HIT products that have not been certified by CCHIT…

Needless to say, it appears (thanks Mr. HIStalk) that this legislator has fans in Chicago (HIMSS), who, as we all know, is a big time supporter of all things CCHIT.

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rocksockMark Leavitt, the leader of CCHIT has apparently had enough and has gone on the offense with a recent post defending the organization he represents and attacking naysayers, particularly Dr. David Kibbe who was recently quoted in a Washington Post article.

Is Leavitt’s post a desperate act from an organization who seems to be coming under increasing scrutiny for its close relationship to the HIT vendor advocacy organization, HIMSS? At first blush, the vitriol of his response comes off that way which is unfortunate and really misses the point.

Yes, there may be some questionable conflicts of interest between CCHIT and HIMSS, a relationship that remains extremely close. As an example, earlier this week Chilmark received a copy of an email that was sent by a HIMSS subcommittee to Mark Leavitt with an attached draft White Paper on “Defining & Testing EHR Usability” an area that CCHIT has made noises about certifying in the future.  Looks to us as if HIMSS is directly advising and guiding CCHIT. Is that really appropriate?

We’ll leave that for others to answer.

What Chilmark’s chief concern has been all along, and one that Dr. Kibbe shares as well as those who participated in the recent Markle Framework workshop and are signatories to the published report: Getting Health IT Right is that the potential for sole reliance on CCHIT for “certifying EHRs” under the ARRA is an extremely risky proposition, though this is exactly what HIMSS and CCHIT have been promoting all along. Reporter Dana Blackenhorn of ZDNet also has chimed in on the issue from the perspective of one who has seen more than a few similar efforts over the years covering IT.

Sole reliance on one organization such as CCHIT to certify EHRs will result in stagnation of innovation as they simply will not be able to keep up. Let’s also not forget that CCHIT certification is a fairly cumbersome and expensive process that has had little actual impact on EMR/EHR adoption, so why bother?  Maybe we need to look at self-certification models that support meaningful use of EHRs, thereby minimizing the burden on innovators and maximizing the options for providers.

Getting back to the beginning,

Leavitt may have been attempting to “set the record straight” but ultimately, his post does little to address primary concerns among many: CCHIT’s continued close relationship to a vendor advocacy organization HIMSS, nor how CCHIT will not stand in the way of innovation but promote such, nor how CCHIT can accelerate adoption and meaningful use of EHRs among clinicians.  Skipping over these critical questions and concerns does little to articulate the role that CCHIT may play in the future regarding the meaningful use of certified EHRs.

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How to Win Billions for Your Members

Washington Post on Saturday had an interesting article that profiles how HIMSS, through strong lobbying efforts, was able to land the huge ARRA windfall for its member HIT vendors.  Great lessons here for those looking to tap the federal spigot, though doubt many will have such luck in timing as HIMSS had in this instance.

Now the question is: Will HIT vendors be the only beneficiaries of this federal windfall or will both clinicians and consumers also see value at the end of the day?  At this point, it is anybody’s guess.

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