Posts Tagged ‘PaaS’

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

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

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

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

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

Snap-shot impressions of demos:

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

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

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

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



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Last week, Ingenix announced that it would be acquiring Axolotl.  Probably no one was happier than the folks at Gilat Satellite Networks who had invested $4.5M in Axolotl over ten years ago, had written off that investment during the dot-com bust in 2001 and now is looking at getting some $24M in cash plus another $3M by year’s end.  Gilat receiving $27M from the sale of Axolotl (we estimate Axolotl’s sales in FY09 to be about $15-18M) signals only one thing: Ingenix paid a kingly ransom to acquire Axolotl, in excess of 8x 2009 sales.

This begs the question: Why did Ingenix pay so much for such a small HIT vendor?

Having interviewed a couple of Axolotl competitors about this deal and completing a briefing call this morning with Ingenix executives Bill Miller, EVP for Provider Solutions and Art Glasgow, CTO along with our broader analysis of the market, vis a vie the forthcoming HIE Market Report (yes, its coming, really it is), following are some thoughts and perspectives.

Ingenix is a company that grows by acquisition having acquired some 50+ companies since 1996. Since the beginning of 2010, the company has made 5 acquisitions already and based on the call with Ingenix today, there will be more. Miller stated on the call that Ingenix has primarily served the payer market but sees a convergence of administrative and clinical processes, thus has been making targeted acquisitions in the provider HIT market (e.g., CareTracker, a PM/EMR solution, Picis, an EMR for ED, QualityMetric for outcomes measurement) and now Axolotl. Miller inferred in the call that part of its provider acquisition strategy is to acquire companies with strong brand recognition in the provider market. Clearly, Axolotl has that in the HIE market, particularly among publicly-led HIEs, or RHIOs.

As one competitor put it: “Ingenix bought into the market.” And as another one stated, (Axolotl’s top competitor): “We are very happy.” Ingenix paid heavily for brand and for an established presence in the market (Axolotl has roughly 250 hospitals using their Elysium HIE platform and currently support four state-wide HIEs). As an independent company similar to Axolotl, the second vendor must be seeing the potential for a very large pay-out should they be acquired, thus not too surprising that they would be happy with this deal. But that second vendor may also be developing a slightly nervous twitch as very large players with deep pockets such as Carlyle Group (they own Carefx), GE, IBM, McKesson (owners of RelayHealth), Microsoft, Thomson-Reuters (partner with Care Evolution) and now Ingenix enter the HIE market. Let’s not count out the EHR vendors such as Cerner, Epic, and others who are also developing their own HIE solutions. The writing is on the wall: In five years time there will no longer be small, independent HIE vendors.  Those independent HIE vendors that survive will be a division of a far larger company.

During our call with Ingenix, Glasgow stated that Ingenix’s core competency is analytics and this is the focus of internal R&D expenditures. For all other HIT application areas, Ingenix would rather make an acquisition than organically build. Coupling Ingenix’s analytical capabilities with Axolotl’s Elysium platform creates some intriguing possibilities both from the perspective of Ingenix selling more of its portfolio in a larger more comprehensive HIE platform sale, but also creating the possibility for the HIE organization to create a sustainable model for future viability as articulated in an Ingenix White Paper (caution PDF). With forthcoming changes in healthcare via reform, new payment models etc., analytics will become an increasingly critical need for providers and HIE vendors are ideally positioned to provide such capabilities. Yet based on our research, virtually all HIE vendors have weak analytics capabilities. Microsoft is one of those at the forefront in this area with their Amalga platform, but their overall HIE solution is still a work in progress.

Glasgow also went on to state that Ingenix sees the HIE market moving to a PaaS model and Ingenix will continue to support Axolotl’s current development efforts to open up its APIs to third party vendors. The move to PaaS in the HIE market is still a nascent trend but one we believe will stick. Chilmark is planning to do a deeper dive on the subject in a future report. In the near-term we will be talking to Medicity later this week getting a deep-dive briefing on their forthcoming iNexx platform, which is at the forefront of among HIE vendors in creating a PaaS for the HIE market.

Some Challenges:
With any acquisition, there are always challenges, from alignment of staff (and even rationalization), to setting priorities for future R&D, to soothing customer and prospect fears as to what the acquisition means to their current or future investment. Challenges we foresee include:

Recouping their investment. Ingenix paid dearly for Axolotl, a company with a strong brand in the market, but also a company with an older platform that has proven difficult for some to implement and maintain. Axolotl clearly recognizes that Elysium needed to be re-architected and is well down the development path to address this need. Thus, Ingenix needs to continue to invest in Axolotl beyond the purchase price to insure Elysium transitions to a modern platform to support a PaaS model. This is not easy work, nor is it inexpensive and it is likely that there will be changes to Axolotl’s pricing structure to compensate for this investment.

Quelling market fears, part one. Ingenix has a mixed history with providers, having been sued by the NY Attorney General, and dragged before Congress last year for reportedly providing data to payers that shortchanged patients and providers. Ingenix has tried to come clean on the issue, but it has left a bad taste in the mouth of many. Now that Ingenix is jumping into  the very public arena of HIE, they will need to convince state agencies, providers and consumers that their intentions are noble, that data will be used to help improve care and ultimately outcomes while insuring that personal health information will remain secure and private.

Quelling market fears, part two. An acquisition nearly always generates some consternation on the part of existing customers and future prospects, with the number one issue being: Is their investment safe (i.e., the acquirer will not sunset the product and continue to invest in R&D)? With over 50 acquisitions in 14 years, Chilmark assumes that Ingenix is pretty savvy at how to acquire a company, leverage the assets, keep customers happy and build from there. But against that backdrop, Ingenix must address a market that has a lot of concerns over vendor/product viability. It is incumbent on Ingenix to educate the market that it indeed has a clear strategy for Axolotl and its Elysium platform. That the strategy aligns with market needs. that it includes continued support (R&D $$$ to modernize Elysium) and that they will continue to offer the level of support (if not better) that customers have come to expect from Axolotl.

Final Assessment:
Ingenix’s strategy for the HIE market is in very close alignment with what Chilmark Research is seeing as well: The move from simple messaging, i.e., pushing lab data around, to higher order capabilities such as analytics and the move to a PaaS model for HIEs.  While these are clearly the future trends for HIEs, the timing as to when these trends take hold is still very much in question.  The HIE market remains convoluted, messy and difficult, if not near impossible to make sense of.  Adding to the issue of complexity is market maturity wherein many buyers are often just looking for the most basic of capabilities.  Even Axolotl recognizes this releasing Elysium Express a few weeks back to address this basic market need.  Hopefully, Ingenix is a very patient company and fully understands the nature of the market it has just paid a princely sum to enter as it may be sometime before they recoup their investment in Axolotl.

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Seattle Bound

Tomorrow, I’ll be heading to Seattle to attend Microsoft’s annual Connected Health event.  Last year’s event provided some useful insight’s into Microsoft’s international intentions which were most recently reflected in their partnership with Siemens to take HealthVault to Germany.  Last year’s event was also prophetic in Microsoft’s deepening intent to serve the provider market.  Based on the agenda I’ve seen for this year’s event, that intention has only increased.

So what do I hope to get out of this year’s event?

A deeper understanding of how providers are actually using the Health Solutions Group (HSG) of products that MSFT is now taking to market.  Particularly interested in learning more about the HealthVault Community Connect product which is basically a productization of its work with New York Presbyterian that resulted in myNYP.org.

A clearer picture of the HSG strategy to facilitate a physician/hospital in meeting forthcoming meaningful use requirements.  In particular, wish to learn how HSG will extend its partnership with Eclipsys and other ISVs with regards to modular apps on the Amalga platform, which looks to be morphing into a Platform as a Service model similar to HealthValut.

Progress on HSG’s international efforts.  Yes, they’ve landed Telus in Canada, Siemens in Germany and some EMR sales in Southeast Asia, but what is next?  Also, with regards to Telus and Siemens, what progress has been made to date, what have been some of the challenges.

Now if there is anything in particular that you, dear reader, woul like to know more about, please feel free to add something to the comments section below and I’ll see what I can do to get some answers.

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Awhile back, Chilmark received a briefing from Medicity about their forthcoming iNexx platform.  We liked what we saw. iNexx fit our model of where the HIE and more broadly, the HIT market is headed, particularly for the far-flung small ambulatory practices that make up the vast percentage of where most people receive their care.  It is these small practices, where sister-in-law Gertrude is running the front office and the physician’s high-school age son may trouble-shoot IT issues, when he is not out with his friends at the local movie theater.  These small practices are an ideal candidate for HIT delivered via a hosted Platform as a Service (PaaS) model that iNexx is designed to serve.  (Note: HIE vendors Covisint and Axolotl also have their own PaaS plays, though have not been promoting them quite as heavily as Medicity.  One could even position Microsoft’s Amalga & Eclipsys relationship in this venue as well, though in this case, the target appears to be hospitals.)

So it was with some anticipation that we saw the press release from Medicity this week announcing that iNexx will go GA (general availability) in August.  We wanted to know more about exactly what would be provided to physicians as Medicity is promoting iNexx as a free platform for physicians to adopt and use.

Imagine our disappointment when we clicked on the Medicity iNexx link to find very few concrete details as to what the platform would offer, how it would enable a physician to meet meaningful use, (e.g., who is the certified EHR vendor(s) they reference even though we still do not have certification rules in place?), who would be third party partners on the platform, what specific functions and activities would iNexx enable, etc.  We also weren’t too crazy about the iNexx platform only enabling care coordination within its own network (one can only share with others who are also on the iNexx platform)- hardly an open exchange network.

Now don’t get us wrong, we understand marketing and the need to create buzz in the market to generate a sense of excitement, but when does marketing cross the line to pure wasted digital ink?  Medicity may have crossed it on this one.

Please Medicity, back-off on the marketing hype, remove the Health 4.0 term, and release PRs with links that provide one the opportunity to truly drill down and learn something about what you intend to offer.  We’ve seen your slide deck, you have some excellent content, now just put it to good use so others may understand more fully what is iNexx and how it may offer a viable route to meaningful use that is outside of what most HIT/EHR vendors are promoting today.  We know you have the beef – deliver it.

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Coming back from HIMSS and really scratching my head trying to think of what incredible new and novel thing(s) did I see, hear about or experience at the conference.  Nothing stood out.  Here it is just my third HIMSS and I am already getting a bit bored, struggling to find those truly exciting advances that get my juices flowing.

Come on vendors, I can’t be getting bored that quickly can I? Was there really nothing new on display at HIMSS this year?  Or is it that I am still wet behind the ears and am unable to recognize the subtle differences occurring in the market that for others are truly significant?  Tend to believe it is the former for the simple fact that after some 15 years as an IT analyst, (I’ve put in over the 10K hours Malcolm says I need to be a virtuoso) I have developed a sixth sense, knowing intuitively when there are truly some significant innovations and introductions taking place in a market. There were none this year at HIMSS’10.

Sure, there was the ubiquitous Meaningful Use banter everywhere with even athenahealth, the oft-times perceived outsider and free-market champion succumbing to the MU lure with a huge banner at their booth proclaiming a guarantee to those adopting its solution that they will meet MU criteria.  But honestly, that is hardly new nor is it innovative.  Heck, with the exception of Blumenthal mentioning new changes to CLIA (halleluiah! about frickin’ time) his keynote was nothing more than a rehash of what has already been stated/reported combined with a couple of personal anecdotes.

That is not to say that HIMSS was completely devoid of any happenings or at least something worth reflecting and commenting upon. Following are a few of those reflections and observations.  No tsunamis, just ripples on a pond.

So Many EHRs, So Little Time: Simply amazing that this market can support so many EMR/EHR companies. How they all survive or will survive is a mystery to me and rationalization will occur.  Big potential risk here as providers look to purchase an EHR as many of these vendors will go belly-up or be acquired within the next 5 years.  Vendor viability is going to a major issue in coming years.

One the EHR front, three interesting stories.

1) SRSoft will flat-out tell you that their solution is not certified nor will it help a physician meet MU criteria.  But what SRSoft does provide is a very streamlined EHR optimized for specialists with high patient thru-put. Specialists seemed particularly drawn to this solution, with Evan, their CEO telling me that they saw 35% growth in 2009, which is quite the contrast from what most EHR vendors were telling me (0-5% growth in ’09).

2) MIE was one of many to introduce (or now has) an SaaS EHR.  Their WebChart EHR Now is quite simple to use and will be offered at $250/physician/month. One of the features I liked was its ability to automatically track your compliance to all 25 MU criteria and alert you if there are any areas where you may not be fully meeting MU.  This is particularly important as HITECH Act reimbursement is an all or nothing proposition.

3) One of the most popular iPhone apps is Epocrates. Epocrates is now looking to leverage that popularity by offering an EHR (will go GA in fall of this year) to the 250K+ users of its mHealth app. Certainly an interesting move on their part, big question is: how many of their users actually need an EHR?  I’d bet at least 80% of users, it f not more, already have something.  Still, that gives Epocrates 50K potential subscribers.  This move also reinforces just how important mHealth is becoming and expect even more activity with the forthcoming release of iPad.

If Not EHR, than HIE: Everywhere I turned, if I did not see someone promoting their latest and great EHR, than they were claiming to be an HIE vendor.  Heck, even Dell had a section of their booth dedicated to HIE and Igenix had an ongoing presentation about their HIE capabilities.  Frankly, found it worse than all the MU & certification claims from the EHR vendors.

As Chilmark is preparing to release an HIE market report in the next month or so, we did interview numerous HIE vendors at HIMSS and paid attention to any special announcements.  Some take-aways were:

1) Big vendors are paying a lot of attention to HIEs. McKesson, which could have discussed any number of products in its portfolio at a special media event chose to focus solely on its HIE product suite RelayHealth. GE had a special section dedicated to its HIE offering (they are partnering with ICW).  IBM, which recently acquired Initiate told us in a briefing on Wednesday that they have every intent of being a major player in the HIE market, both here in the US and abroad.

2) Telecom is making a move. Both AT&T and Verizon had portions of their booths dedicated to HIEs with AT&T announcing its HCO, basically an extension and productization of their previous work with Covisint.

3) There is the growing presence of multi-stakeholder, private HIEs. Until recently, most private HIEs were sponsored by a single IDNs to drive referrals back to the sponsoring entity. These new HIEs are about facilitating care across the community, often times without ROI justification – its just the right thing to do and community physicians are demanding it.  But these private HIEs are looking at many state-run, federally funded HIEs with a jaundice eye. A couple of big hospital CIOs told me that they are not interested in paying the fees to support these top-heavy, government run initiatives. This may lead to a delicate political balance, even brinkmanship in determining how State HIE initiatives will interface and work with existing private, multi-stakeholder exchanges.

Platforms are In, Might Monolithic be Out? Over the past several months there have been a number of announcements regarding Platform as a Service (PaaS) offerings by HIE vendors (Axolotl, Covisint and Medicity).  Then the week before HIMSS, Microsoft and Eclipsys announced their partnership to provide distinct modular Eclipsys apps on top of the Microsoft Amlaga platform.

The big question with PaaS is which platform will be most compelling for developers being both easy to develop upon and more importantly, has a broad customer base to serve.  There is no clear winner today but aggressive moves are being made to create these vibrant ecosystems with Axolotl announcing that EHR vendor Greenway would offer a modular EHR on their PaaS and Medicity announcing that Emdeon would be a part of theirs. (Don’t even get me started on the Health 4.0 branding by Medicity – ughh.)

But what may be an even more significant move was that made by one of the largest EHR vendors, Eclipsys, with their announcement of Helios.  This is the first time that a major EHR vendor has opened up their platform to others. This is quite the antithesis to the other dominant EHR vendors in the market, especially Epic, which is notorious for its closed monolithic approach to serving the market.  How the market responds will be critical to watch as it may portend how this market will develop in the next 3-5 years.  (Note: In April, Chilmark will launch a research project looking more closely at the PaaS model, the vendors supporting it, including their architectures and business models and future market implications.)

Patient Engagement is Growing: Most vendors had some form of messaging within their booth on patient engagement. This is an area that is still very much in its infancy as most “engagement” offerings remain pretty simplistic, offering few patient control options and little if any portability.  By and large, they are simple portals with very few if any interactive features.  The industry still has a long ways to go here to create truly useful, compelling and ultimately engaging patient engagement offerings.

The most significant announcement in this space came from Microsoft with its HealthVault Community Connect (HVCC).  HVCC is basically a “productization” of the work Microsoft did with New York Presbyterian for myNYP.org.  While HVCC is a stand-alone product built using MSFT’s popular SharePoint portal suite, it is ideally suited for those using the Amalga platform.  This product could become an important application for large hospitals with complex, legacy IT infrastructures in their efforts to meet MU stage 2 criteria which calls for a PHR for all patients.


Now these are the musings of just one person who was rushing from one meeting to the next and may have missed something in all of those scrambles. Welcome you to add your own impressions, thoughts big and small to the comments below as to what you saw, what you liked and what you didn’t.  The more that chime in, the broader the knowledge we all share.

And if you want to see thoughts and comments of HIMSS in 140 characters or less, head over to Twitter and do a search on the “hashtag” #HIMSS10 as there were quite a few using this medium to communicate their observations.

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Been a lot of talk over the last year or so regarding the move to smaller, more modular, substitutable apps (think iPhone) to address healthcare IT sector needs, particularly for providers. This discussion has progressed to the point where HHS, in looking to certify EHRs, is also looking at how these small modular EHR apps might also be certified in the broader context of meaningful use.  Now how the hell HHS and in particular CMS will be able to determine whether or not a provider is using a host of modular HIT apps to meet meaningful use requirements remains a mystery and probably better left for some future post.

Chilmark has been seeing a progressive movement by a number of HIT providers, especially among HIE vendors (Axolotl, Covisint and Medicity) to open up their HIE platform (publish APIs) to potentially support a multitude of modular apps to meet various provider needs.  Basically, these vendors are moving to a Platform as a Service (PaaS) model, each taking a slightly different spin on a PaaS that will likely require Chilmark to produce a separate report to explore further.  What is important though for this industry is that this is a fairly nascent trend that will likely accelerate in the future.

And today, we can add one more vendor to the PaaS mix, Microsoft, who announced a partnership with EHR vendor, Eclipsys who has built several modular apps (Data Connectivity, Quick Order Entry and Visual Workflow) on top of Microsoft’s Amalga UIS.  Eclipsys will be demonstrating these apps next week at HIMSS.

What’s in it for all Stakeholders:

Microsoft is taking Amalga UIS from simply being a data aggregator/reporting engine to becoming a platform similar to HealthVault thereby making the data that it aggregates actionable by the apps that ride on top of it.  This creates a higher value proposition for Amalga UIS in future deals with large hospitals and IDNs.

Eclipsys & other HIT vendors now have an opportunity to enter accounts that may have been dominated by large, monolithic solutions from such companies as Cerner and Epic.  It may also provide smaller HIT vendors an ability to rise above the noise and gain some traction in the market.

Hospital CIOs & end users will no longer be strictly tied to only those apps provided by their core HIT vendor(s), but may now be able to “flex-in” certain “best-of-breed” apps as needed to meet specific internal needs/requirements.  In our briefing call with Microsoft yesterday, Microsoft stated that the Amalga UIS APIs will also be made available to customers allowing them to build their own apps, further increasing the utlity of Amalga UIS.

Sounds great, doesn’t it?

On the surface yes, but there are certainly risks, primary among them…

How will the hospital CIO and IT staff manage a multitude of these modular apps over time?  Yes, small modular apps give one flexibility and the opportunity to use best-of-breed apps but managing such can be become incredibly resource intensive and ultimately negate any net benefit.  There is also the issue of having “one throat to choke.”  When you have one or even just a selet few vendors, if anything goes wrong, it is easy to just put the pressure of them to fix it.  Not so easy when you may be using 20 or more modular apps from 15 or more vendors.

Next week at HIMSS, one of our research goals is to better understand the PaaS trend in healthcare from both the perspective of end users and vendors.  We’ll keep you posted.

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While conducting research for the long overdue and nearly completed report on Personal Health Clouds (Dossia, Google Health and HealthVault) came across a recently published report by the European Network and Information Security Agency (ENISA) addressing cloud computing security.  Though quite long (over 120 pages) the report provides a very comprehensive overview of cloud computing, its benefits, risks and some very good risk assessment tools to assist one in evaluating a cloud solution offering including segmentation by SaaS, IaaS and PaaS.

With the rapid migration to the “cloud computing” paradigm in the healthcare sector, be it personal health clouds, HIE vendors transitioning to PaaS vendors (note: Medicity made their own PaaS announcement yesterday – more to follow in near future), EMR vendors offering hosted solutions, to move to manage and store images in the cloud, and various niche vendors such as Medcommons, who uses Amazon to host its service, a report such as this is quite valuable and instructive both for potential users of cloud services as well as those offering them.

If you have even a remote interest in this subject, trust me, just get the report as it is one of the best I’ve come across to date.

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