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Posts Tagged ‘MEDSEEK’

Last week we attended the big healthcare IT confab HIMSS in that grand city of sin, Las Vegas. While many spoke of how HIMSS hit an all time record of over 37K attendees (an impressive number), HIMSS is still dwarfed by what is arguably the largest US-based healthcare trade show, RSNA, which had a 2011 attendance of just over 57K, (roughly 54% greater than HIMSS). Why such a radical difference you ask? As one colleague put it:

RSNA is where providers come to make money and HIMSS is where they go to lose money.

While that may be the case today, it is unlikely to be so in the future. The healthcare industry is undergoing a massive transformation that will likely take a decade to complete as we transition from a reimbursement model largely based on fee for service to one based on outcomes. Under this new model, providers will be taking on a greater portion of risk. In reward, these providers have an opportunity to receive a significantly higher net reimbursement. This transition is making for some interesting bedfellows as payers and providers join together to create new care delivery models such as Accountable Care Organizations (ACOs) and Patient Centered Medical Homes (PCMHs). These new models will be increasingly dependent on a robust HIT infrastructure to effectively measure quality, risk and performance, something that simply cannot be done effectively with the antiquated systems that are in place today in many healthcare organizations (HCOs).

Nearly every vendor we met with at HIMSS had a story to tell about how they had the solution the market was seeking for ACO enablement. This was not entirely unexpected for last year we thought that would be the year of ACO. Obviously, we were a little ahead of ourselves and the industry with that prediction but alas it has come to pass. Small problem though: HIT vendors have had plenty of time to prepare their solutions for ACO enablement but to our surprise, most solutions were still far from mature. Frankly, we are not too worried about this right now for Chilmark is forecasting significant evolution, innovation, and in short-time maturity in these solutions as customers (HCOs) further define what they truly need to succeed in this new world order of reimbursement for healthcare delivery in the US.

This raises what our research team found to be the most significant learning from HIMSS’12.

As most of you already know, ONC made quite a splash at HIMSS by announcing the release of Stage 2 meaningful use (MU) requirements (we’ll have a future post on the implications of these requirements later this week). But honestly, we did not see a wild wrangling of commentary and discussion in the halls of HIMSS’12 regarding these new requirements. Maybe this was because most attendees were simply addressing the needs of today and did not have time to thoroughly review these new requirements.┬áBut we believe something else may be at work here.

Our Thesis:
The MU requirements have become little more than a “spec-sheet” for vendors, consultants and IT shops and departments. These requirements have nothing to do with innovation and have little to do with the dramatic changes that will occur in this industry in the next decade. Quoting that oft-used phrase, “follow the money” one can quickly see that the billions in funding for incentivizing providers to adopt EHRs under the HITECH Act is relative chump change to the dramatic fortunes that may be won or lost under the new value-based payment models that are proliferating throughout the industry – payment models that commonly fall under the rubric of ACO or PCMH. In each of these models, EHRs are important to a degree, they are part of the basic infrastructure. But it is what one does with the data that matters (collect, communicate, collaborate, synthesize, analyze, measure and improve). Therefore, if you want to see innovation look beyond today and the tactical push to effectively adopt and meaningfully use EHRs and towards the future of how that data will be used to drive quality improvements, better outcomes and lowering risk exposure.

And speaking of risks…

What was clearly lacking at this year’s HIMSS was patient engagement. Yes, there was a seminar on the topic and sure, everyone speaks of patient-centric care but there was little evidence among exhibitors at this year’s HIMSS (with a few exceptions, e.g., Cerner, MEDSEEK, RelayHealth) that spoke to the need to engage patients as part of the care team. Get a clue folks, one will never get to that nirvana of a truly effective ACO or PCMH without active, effective engagement of the patient. Not having an engaged patient is your greatest risk.

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As part of the process of setting our broader research agenda at Chilmark Research, we do a significant amount of secondary research combined with more limited, but highly focused primary research. We use this research to identify the “white spaces” where there appears to be a demand for some thoughtful, in-depth research and reporting that only an analyst firm such as Chilmark can provide. During that process, however, we often uncover some interesting trends similar to the HIE Snippets of the previous post.

Chilmark continues to follow the patient engagement realm, from mHealth Apps to PHRs, patient portals and personal health platforms such as Dossia and HealthVault. Recently, we have been receiving a significant number of inquiries from healthcare organizations that are developing IT strategies to meet Stage 2 meaningful use criteria to provide patients online access to their personal health information (PHI). We are also beginning to hear very early rumblings by a few forward thinking organizations on the use of new technology platforms, particularly mobile, to more deeply engage patients in managing their health in conjunction with impending value-based contracts. There have also been several announcements lately of roll-outs of Epic’s mobile patient engagement platform My Health. Lastly, earlier this week we had the pleasure to attend GE Healthcare’s Centricity Business National User’s Conference where we sat in on several patient engagement presentations. Following are some of the trends we are seeing that will be foundational to our future research on the topic:

HIE Vendors not up to task: A number of large healthcare organizations that have grown organically and through acquisition have a multitude of legacy IT systems from numerous vendors (not everyone is going Epic) in place. These organizations are now looking to link these systems together with an HIE solution and while they are at it, want to be able to provide patient access to their PHI. Problem is, most leading HIE vendors that have proven solutions for interfacing to multiple systems typically have poor patient-centric solutions. There are exceptions to every rule and companies such as RelayHealth and Kryptiq offer quite capable patient portals combined with secure messaging. But for those HIE solutions that lack such capabilities, healthcare organizations are having to look elsewhere to fulfill this need which is bringing business to MEDSEEK and Intuit Health.

Patient Portals interface first to transactions: Several of the presentations at the Centricity event were given by organizations with distinct clinical and administrative systems. Maybe it was just the venue, it was a Centricity Business Users’ Conference after all, but in each presentation on patient engagement the patient portal was driven from the admin-side. Sure, the portal could provide labs and some basic clinical data but it was really designed to help with the pre-registration process, appointment scheduling, secure messaging and Rx refill requests. Each organization we spoke to have plans to bring clinicals (some had Epic for clinicals, others Cerner) into the portal in the future to facilitate care processes for the truly sick, but that is a second order priority. This raises the question: Will front-end admin solutions, like Centricity’s Business Suite, become the core patient portal at the expense of those developed and offered by those from the clinical side of the fence?

Still in very, very early stages of mHealth App adoption: As mentioned previously, a number of organizations (Group Health Collaborative, Kaiser-Permanente, Stanford, UPenn Medical Center, etc.) have announced the release of an mHealth App for patient engagement, virtually all of them, My Chart instances. These releases are basically a mirroring of what is being done with patient portals mentioned above – enable transactional processes. We have yet to see anything, at any organization that has gone beyond pilot stage (e.g.WellDoc in Baltimore) in the deployment of a mHealth App to address a large at-risk population. This is puzzling for as we move to value-based contracts and accountable care, healthcare organizations will need to seriously rethink how they deliver health to chronic disease patients not just in the exam room, but at the patient’s home, in their car at work, wherever they may be to ensure compliance. mHealth can play a very effective role here but organizations’ reluctance to adopt is a chicken and egg scenario. There is not enough evidence to prove efficacy of mHealth Apps but if they don’t adopt, the evidence will not present itself. This will eventually break-thru, the question now is simply, when? And based on what we have seen in healthcare IT adoption to date, it could be a much longer wait than many VC firms and entrepreneurs currently have in their financial models.

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The long awaited, dare I say anticipated HIE Market Report is now complete and ready for purchase. This report, arguably the most comprehensive report yet published on this rapidly evolving market (116pgs, 21 vendors profiled, 0ver 25 tables and figures) will provide the reader with a detailed portrait of today’s HIE Market, its leading vendors, and the capabilities that they bring to market. Here’s the HIE Report’s Table of Contents (warning PDF).

The report is the culmination of interviews with countless HIE stakeholders, from State and regional officials, to healthcare CIOs, consultants and of course the HIE vendors as well. Combining these interviews with our own methodology for secondary research, the report comes presents a number of findings including:

  • A definitive classification schema of current HIE vendors that will clarify what appears at first glance as a very convoluted market.
  • The transition that is occurring as vendors move from SaaS to PaaS models and its future impact on the market.
  • The clear differences and similarity of needs of Enterprise and Public HIEs.
  • An HIE Maturity Model that will help adopters of this technology better understand the transitions that will be needed as their platform matures over time.
  • Comprehensive profiles on 21 leading HIE vendors including rankings on a number of HIE attributes as well as market presence.

If you are involved in any aspect of the HIE market, you would do your company a favor by purchasing this report. Really, it is that good.

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In Monday’s post, Chilmark reflected upon a piece that Peter Hudson, co-founder of Healthagen, the developers of mHealth app iTriage wrote for mobihealthnews. In that article, Peter talked about the utility of an mHealth-based PHR (iTriage recently launched such capabilities), but in our post, we countered that today, it is still far too difficult for a consumer to pull together their personal health information (PHI) to create a truly longitudinal record. This will likely stunt the efforts of companies such as Healthagen who are trying to offer consumers a PHR – the hassle factor is still far too great to overcome.

Now we will look at the red hot space of Health Information Exchanges (HIEs).

As local, regional or even statewide aggregators and distributors of health data to facilitate care coordination, HIEs have the potential to play a pivotal role in helping a consumer create and manage their PHI. Now that does not mean that the HIE has to offer the consumer a PHR per se, but what an HIE may be able to do is offer the consumer an ability to have a portal view into their PHI that resides within the context of a given HIE. Better yet, why not have as a condition of receiving some of that federal largesse of $564M for state HIE programs that these HIEs support “Blue Button” functionality allowing a consumer to readily download or export their PHI to wherever the consumer desires.

Ah, but we digress.

The purpose of this post is to extract a couple of data points from our forthcoming HIE report as they pertain to consumer engagement. Unfortunately, it is not a pretty picture.

As part of our market survey of twenty HIE vendors, we asked them a number of questions with regards to what consumer-centric capabilities did their HIE solution support. Fully eighty percent of those interviewed had either modest (15%) or weak (65%) consumer offerings.

The following table provides a brief snapshot of those HIE vendors that have what Chilmark considers strong consumer engagement tools. Two of those vendors, Kryptiq and MEDSEEK are somewhat difficult to classify as an HIE in the traditional sense, thus you will not find them running under the covers at your local RHIO. Microsoft is still new to the HIE market with one HIE live in Milwaukee and another in D.C.. While Microsoft’s platform offers these HIEs the potential for bi-directional communication with HealthVault, that capability, to the best of our knowledge has not been tested at either of these HIEs. Also, it is important to note that the Microsoft HIE solution offers little with regards to support for transactional processes (appointment scheduling, Rx refill, eVisit, etc.). RelayHealth is the remaining HIE vendor that actually has some of the more robust consumer tools in the market (they received fairly high ratings in our previous iPHR Market Report), so this is not too much of a surprise.

Now it is not necessarily the fault of laggard HIE vendors that today, their solutions offer weak consumer tools. Frankly, the market has not asked for them. Even as recently as last year when the various HIT policy committees were meeting in Washington to set policies for the HITECH Act and the funding to come, the committee on HIEs, in one of their seminal meetings, completely ignored the consumer role in an HIE. Shameful.

But this will change in due time. MEDecision and Carefx are building out their consumer-facing capabilities and we are sure others will add consumer functionality in time, most likely via partnerships or an occassional acquisition as market is moving too fast for an internal build-out. in the meantime, those vendors that have this capability bring to market competitive differentiation.

While this is all well and good, another development is also taking place, NHIN Direct – something that Microsoft’s chief architect, Sean Nolan mentioned in his comment to our Monday post. What role might a secure, lightweight communication system play within the broader context of HIEs, aggregated PHI, consumer access and potentially control of their PHI? A lot of questions to ponder that we will be looking into further over the next few days

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