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.
Caveat:
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.
John, good take. I thought it was just me.
A few things that I noticed were:
As you mention Microsoft has stepped it up with HVCC which is good for me because we just become HealthVault partners.
Platforms: Makes total sense, add software engineering to healthcare and you get platforms. BEA, ATG, WebSphere just to name a few that modernized Internet sites. If they build platforms like these, it will revolutionize the building and customizing of health care systems.
Google Health: Looks like Google is moving from “science project” to a real PHR. They have also removed their beta label from the site. I spoke with one of their engineers and they told me that they are adding things like full compliant CCR and CCD compliance. They are also planning more support for developers with has been an issue in the past.
Regardless of what you think about Google in the PHR space it will help bring overall exposure to the concept.
Even though I saw a lot and learned a little less than I expected, I really enjoyed the show and look forward to the next one.
Next year I predict will be the year of wireless innovation across the spectrum, from home healthcare to in-patient devices, which are currently in majority RS-232 (unbelievable)
Jeff Brandt
http://www.hieconnect.net
John, thanks for the nice review. Since the ‘80s we’ve seen the exchange of clinical data being proposed under any number of acronyms at HIMSS – CHIN’s in the 90s and more recently RHIOs and HIEs. All suffered from solving one major hurtle only to find that their efforts offered a better view of the next under-anticipated problem. Through all of these formulations, the struggle to prove adequate economic benefit to cover the cost of pulling together a highly fractionated system has not been won enough times to seed a movement, let a lone a sustainable business model for all. Yet, much of the discussion centers on trying to sell an HIE like they were selling a super highway — difficult to do when the average provider community only sees, wants or can afford a cow path. Add the temptation/mandate of money for EHR and the jam starts getting pretty thin on the bread.
Be patient – thing move in big slow waves in healthcare.
Cooperation as a community seems to be the trick…read more @
http://iagllc.blogspot.com/2010/02/should-cowpaths-of-cooperation-be-first.html#more
Really, could not agree more on this topic. Great post, flushed out many of the certification , cost and implementation issues in this incentive era.
I feel today medical practitioners are looking to avail of this federal incentive by trying to comply with the definition of meaningful use but at the same time EHR providers are looking at their own set of profits.
This misunderstanding is mostly I believe as a result of wrong interpretation of the federal guidelines.. The EHR providers need to look at these guidelines from the prospective of the practitioners who deal with different specialties.
Each specialty EHR has its own set of challenges or requirements which I believe is overlooked by in most EHR vendors in a effort to merely follows federal guidelines. This is resulting in low usability to the practitioners, thus less ROI, finally redundancy of the EHR solution in place.
I think ROI is very important factor that should be duly considered when look achieve a ‘meaning use’ out of a EHR solution. Though one may get vendors providing ‘meaning use’ at a lower cost, their ROI / savings through the use of their EHR might be pretty low when compared to costlier initial investment. Found a pretty useful ROI tool that is pretty customizable and easy to use. It also accounts for the different specialty EHR’s too.
Also the introduction of REC’s through the HITECH act. is a great way to avail of quality EHR solutions at competitive prices. The stiff competition among not only these REC’s but also among EHR vendors ( to become a preferred vendor of a given REC) will result in lot of positives to medical practioners.
Looking the funding provided to the REC’s, the staggered grant allocation system also promises to be an unbiased way of allocating funds. It will also help in the concept of REC’s helping out each with their own unique business models. It can be one of the possible answers to the ‘safe EHR vendor’ challenge as discussed by many critics.
Sorry to have diverted a bit from the topic but I feel this HITECT act and the REC’s are going to play an important role, as discussed above in the successful EHR implementation in the medical practices in our country.
As far as implementation challenges goes, the federal guidelines for certification and usability are pretty much clear. Useful improvisation on these lines can make ones EHR’s friendly to most practices of varying specialties.