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Posts Tagged ‘RelayHealth’

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. But 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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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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iaas-paas-saasAn interesting, and somewhat overlooked press release came out last week from the health information exchange (HIE) vendor Axolotl wherein they announced that a third party independent software vendor (ISV), eHealth Global Technologies, would be available on top of the core Axolotl HIE application, Elysium Exchange.  The new app, Elysium Image Exchange allows for secure image exchange among HIE participants.  Though the new application may appear like nothing more than Axolotl contracting out the building of an app desired by its HIE customers, there is a more here than meets the eye.

HIE Vendors as Future PaaS for Clinical Needs

Independent HIE vendors (not part of a larger EMR vendor) such as Axolotl, Covisint, dbMotion, InterSystems, Medicity and RelayHealth are in a unique position to become more than just an HIE focusing on the exchange of clinical records but could become Platform as a Service (PaaS) vendors providing a wide range of services and apps on top of their core infrastructure, OS and App Server stack.  The following two figures illustrate what is possible should these vendors open up their application programming interface (APIs) to allow other ISVs to build apps on top of their HIE platform.

HIE1

HIE2

HIE vendors are in an ideal position to become a PaaS for they already have the key features necessary.  As aggregators and distributors of clinical data in a secure fashion, these vendors have the core infrastructure already in place.  They have the data repository, they have the master patient index (MPI) and they understand what is required to address privacy and security requirements of data exchange within a network.  What these vendors, by and large have not done is open their APIs to third party ISVs to truly create a PaaS.

In speaking with Axolotl’s president Glenn Keet he stated that they came to the realization that they alone could not move fast enough to meet the needs of the market.  While they currently offer an CCHIT certified “EMR lite” for small physician practices there are a multitude of other services that they foresee.  For example, within the “meaningful use” criteria that physicians will need to demonstrate to receive reimbursement for EHR adoption, there are a number of quality reports that must be created and filed with CMS.  Keet envisions ISVs leveraging Axolotl’s APIs to create services to automate such reporting.  Meaningful use criteria also will require physicians to sponsor a PHR for their customers.  Again, with an open API, PHR ISVs could sit on top of the Axolotl (or other HIE vendor) platform and provide such capabilities. Clinical decision support (CDS) tools are another app/service that would be ideally suited to sitting on top of an HIE PaaS.

Microsoft is another vendor who is now venturing in to the HIE market with its Amalga platform, which is the foundation for the Wisconsin HIE (WHIE).  Using its core Amalga UIS along with HealthVault, Microsoft could also create a clinical PaaS with a multitude of ISVs providing services to the physician market. To date and to our knowledge, this has not occurred but we’re pretty sure Microsoft is looking into providing such capabilities as it would be in alignment with other actions that they have done to date in the healthcare sector.

What this may portend is the creation of PaaS that support the concept of substitutable apps as laid out by Ken Mandle and Issac Kohane of Children’s Hospital Informatics Program (CHIP) Boston. Another proponent is David Kibbe with what he refers to as Clinical Groupware a concept he first described back in Febuary 2009.  In each of these examples, the dominant theme is the move away from monolithic EMR/EHR apps to small, lightweight apps that are invoked when needed.  More information on this concept can be found at the recently created site: ITdotHealth (Note: Unfortunately, at the recent meeting at Harvard Medical School, Health Information as a Platform, which was organized by Mandl and Kohane, outside of Microsoft, there did not appear to be any representation from HIE vendors.)

An Opportunity for RHIOs to Become Viable?

A lot of effort and money is now being poured into the build-out of public Health Information Exchanges (HIEs) that are commonly referred to as Regional Health Information Organizations (RHIOs).  While many see it crucial to build out this information exchange infrastructure to support care coordination (a key criteria for stimulus funding reimbursement for EHR adoption), the challenge for RHIOs has been to create a business plan that insures long-term viability of a RHIO once grant funding drys up.  The market is littered with failed, failing and simply struggling RHIOs.  Recently, while sitting in on a conference call where a State RHIO discussed their go-live plans a question was asked: Do you have a model for sustaining the RHIO long-term?  To which the Executive Director of the RHIO replied, No.

But might not a RHIO that is actually a PaaS for a given region or State, become a provider of Clinical Groupware including a range of services and applications such as multiple lightweight EMRs to choose from, say one for pediatrics, another for orthopedists, a third for general practioners, quality reporting services, a range of CDS apps, etc. charging a small transaction fee for the use of such services and thereby begin to create viable service-based business? We think so and see this as the next evolution in the HIE market.

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Couple of weeks back Microsoft’s HealthVault announced a strategic partnership with McKesson’ RelayHealth for which I wrote a short post.  Following up on the announcement, I recently had the opportunity to speak with RelayHealth’s General Manager, Ken Tarkoff, who provided further background on this partnership.

Key Points from Interview:

A strategic partnership, there is co-development commitment to create new capabilities. One of those capabilities will be a “HealthVault Provider Directory” listing providers currently using RelayHealth that one can access through HealthVault. Another will be the ability to enable bi-directional data flow between RelayHealth and HealthVault.  As there are literally thousands of physicians using RelayHealth today, this has the potential to significantly increase the clinical data that a consumer may control within their HealthVault account, data provided by their RelayHealth-enabled physician.  This capability will be available in about 6-9 months.

One can also expect these two partners to work closely on enabling RelayHealth to accept biometric data (something it cannot do today) from a consumer’s HealthVault account.  This will go along way towards enabling telehealth within RelayHealth that physicians could leverage to further their value proposition to the end consumer.

Last and certainly not least, I believe these these two will work on developing the capability to enable a consumer to initiate secure communications from within their HealthVault account to schedule appointments, request prescription refills and even have an e-Consult, or in RelayHealth parlance, a webVisit.

Partnership extends beyond co-development and includes leveraging respective channels to market.  RelayHealth has no intention of going direct to consumer, they target physicians and to a lesser extent health plans.  Microsoft knows consumer marketing.  Together, they will go to these markets to gain market acceptance and growth.

This is not exclusive and RelayHealth will be seeking partnerships with other Personal Health Systems, e.g., Google Health.

RelayHealth is now in the process of identifying a select group of physician practices (>10) as part of an early adopter program.  These early adopters will assist in development by providing critical feedback over the next 6-12 months.

Putting on my analyst hat…

I have the following observations:

Secure, digital communication is a feature that is highly valued by many consumers, but something that to date has not been readily enabled within any of the PHSs.  Sure there is Medem who sells to physicians a communication platform and is a partner of HealthVault as well, but their platform is not as sophisticated as the one from RelayHealth and their market penetration is small.  Kryptiq is another HealthVault partner who also provides similar functionality, but does not have near the presence or installed base of RelayHealth.  With RelayHealth, Microsoft has signed on one of the largest, pseudo-independent, (it is a part of McKeson but is installed in a multitude of different EMR environments) physician-consumer communication providers in the market.  This has the potential to significantly increase the cache of HealthVault among the physician community.

RelayHealth in turn now has the opportunity, through strategic co-development, to build some pretty exciting capabilities into the RelayHealth platform that leverage the HealthVault data repository.  Primary among them is the ability to accept biometric data, but beyond that, there is an ability or the consumer to share a more complete record that is stored in HealthVault with their physician via RelayHealth.  This may become a significant value-add for their physician customers as it enables physicians to extend their service offerings via telehealth services as well as provide a higher level of service.

For the consumer and the physician, the future ability to have bi-directional flow of data into and out of a consumer’s HealthVault account (of course the consumer would initiate such actions) will significantly contribute to automating workflow for both parties by auto-populating specific data fields increasing data liquidity.  Without the data, actions can not be instigated and the goal here, be it care, disease or wellness management is to provide actionable data.

The most significant challenge that both will face is to get physicians comfortable with sharing data beyond the confines of their practice.  It is one thing to share data in the secure RelayHealth environment that physicians use today, quite another to get physicians comfortable with the idea of moving that data into a consumer-controlled environment such as HealthVault.

Sidenote:

While flying down to DC earlier this week, I sat next to Brian, a systems engineer from MITRE.  We got to talking when I asked him about his iPhone, which led to discussions of HIT and ultimately learned that his physician practice uses RelayHealth,  which he really appreciates as it simplifies interaction with his physician.

Using the iPhone, we went to his physician practice’s website and onto the RelayHealth portion. He added the link to his iPhone creating a small icon of the website.  Pretty slick but could have been much better as the icon was tiny, ill-descriptive and certainly not optimized for the iPhone.

Brian tells me the Apple SDK is very elegant and it is quite easy to develop apps for the iPhone. So RelayHealth, when will you have a special iPhone app that one can pick-up at the AppStore?

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Today, Microsoft’s HealthVault group announced a strategic partnership with RelayHealth. RelayHealth, a company acquired by the huge healthcare company McKesson a couple of years back, brings to HealthVault a very large physician customer base that leverage the RelayHealth SaaS platform for physician-consumer communications.

RelayHealth has a very impressive platform that led them to receive one of the top rankings in our recently published iPHR Market Report. Here is a RelayHealth Profile (caution PDF) from that report.

Hope to have an interview in near future with key execs to get more details on announcement and will post a follow-up.

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Late last week, Intel announced that it had received FDA approval or its consumer/caregiver centric health device, the Intel Health Guide.

The Health Guide is a single purpose platform to facilitate telehealth by collecting data from devices (heart rate, weight, glucose, etc.) and securely transmitting the data for remote monitoring by a clinician or other caregiver. Intel also states that the Health Guide will also enable secure email communication and delivery of health-related content to the end user (consumer). This is the second product to come out of Intel’s Digital Health Group, the first being a clinician-centric, mobile computing platform, the MCA.

The release of Health Guide follows last month’s announcement by Intel of the social caregiver’s website, ConnectingforCare, which was formed in partnership with the National Family Caregivers Association. This site is still very immature and lacking critical content thus begging the question – Do we really need another social community website such as this when we are already inundated with numerous, healthcare centric social sites?

Reading through some of Intel’s documents (caution PDFs) on their health care evolution and design philosophy, it is clear that Intel has every intention to move from a passive player in the market, supplying microprocessors (chips) to any and all takers, to becoming a direct developer, marketer and seller of devices such as the Health Guide. Intel sees a huge opportunity in the telehealth market to serve an aging baby boomer population that will increasingly use technologies such as this to manage their health, in conjunction with their physician, from the comfort of their home.

Savvy move on Intel’s part as there is indeed a significant opportunity and I see no single dominant player in the market today. Sure, Philips is there as well as Omron and Panasonic, along with GE giving it a close look but no one has taken a commanding lead. Thus, there are no formidable barriers to a new entrant such as Intel. It is still a wide open market.

But in reading the announcement I am struck by the lack of reference on Intel’s part as to how the Health Guide fits into the broader context of care and in particular, electronic records, be they PHR, EMR or EHR. No reference whatsoever on this front which has me quite puzzled as Intel is a key partner in the Personal Health System (PHS) Dossia, which Colin Evans, formerly of Intel, is now leading. This raises a number of questions:

  • How will the Health Guide fit into a consumer’s existing PHR such as one from RelayHealth which already has secure physician-consumer communication embedded in the PHR?
  • Similarly, how will Health Guide interface to a solution like ICW’s LifeSensor PHR that has a significant number of interfaces to existing biometric devices?
  • How might Health Guide integrate into a clinician’s existing workflow and EMR solution and if the clinician offers a patient portal, will Health Guide automatically populate the patient portal with biometric data and any communications that occur electronically?
  • What might be the connection between the Health Guide and a PHS. For example, Microsoft’s HealthVault is in many ways similar to Health Guide (at least from a software perspective) in that it offers secure communication of biometric data to a secure server for storage and retrieval? Are these competing solutions or complimentary?

In making the announcement of FDA approval, Intel also stated that the product would not be released to market until late this year or early next. That should give Intel enough time to further clarify the positioning of Health Guide and address the questions above. Otherwise, despite all the bells & whistles, Health Guide will struggle.

For a more positive spin on the Health Guide, here’s a brief interview with the Health Group WW Director of Marketing and Sales.

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