Big Fish Swallows Another – Will it Choke?

fish2Rumors that have been floating around for months that Siemens planned to exit the health IT (HIT) market have come true. Earlier today, Cerner announced that it will acquire Siemens HIT business for a whopping $1.3B with expected close in Q1 2015. While we will be doing a more thorough breakdown of what this acquisition means to the two companies, the market and most importantly their customers in a research piece for clients, following is my back of the envelop analysis.

  • With this acquisition, Cerner now surpasses Epic in # of hospital clients, something I’m sure that makes Cerner’s CEO smile – Neal is a tough competitor.
  • Cerner will certainly support Siemens clients on Siemens clinicals, but there will be a time horizon on that support with Cerner’s ultimate goal of having Siemens clients ultimately switch to Cerner clinicals.
  • A weak spot for Cerner has been their financials. Siemens brings them a reasonably good financials solution that some existing Cerner Millennium clients are already using. The trick here will be to truly integrate the two systems (clinicals of Cerner with financials of Siemens) to be truly competitive in the market.
  • Acquisition gives Cerner a much stronger international presence, especially in Europe – a target growth area for most acute EHR vendors now that US acute care market is basically tapped out.

The price of $1.3B is quite high for what Cerner is getting, but Cerner is not a company known for wasting money. It is also VERY uncharacteristic of Cerner to make such a large acquisition. However, Cerner sees value here to leverage long-term, and they do look long-term.

Much of that future value is likely found in Cerner’s rapidly growing PHM activities (HealtheIntent). One of our analysts just came back from Cerner’s PHM Summit last week and was truly impressed with how aggressive Cerner is moving on this front. There is a huge untapped PHM market among existing Cerner clients and now Siemens clients – potentially huge up-sell opportunities if Cerner does it right.

This acquisition is also just the tip of the iceberg – we’ll see many more in the next 12-24 months as market is way overdue for consolidation.

Note: Our forthcoming 2014 Analytics for PHM Market Trends Report (to be released this month) provides a detailed look at this market including a detailed profile of Cerner and 18 other leading vendors. 




EpicRideWhat an epic (or is it Epic, or for that matter EPIC) ride where one seemingly goes in and out of noise tunnels on the exhibit floor all in the hopes of finding some meaningful signal as to what is really happening in the market. This is, for better or worse, what HIMSS is all about and like HIMSS conferences of yore, finding that signal could be excruciatingly difficult. But over the course of those few days wherein I was being bounced from one meeting to the next, patterns did emerge.

Thankfully, at this year’s HIMSS I was not alone and in fact, had the entire Chilmark team there, each focusing on gathering information/data points for their respective research domains. While I will highlight some of the bigger industry-wide patterns in this post, each lead analyst for our four research domains (analytics, EHR, HIE and patient engagement) will publish their own impressions over the course of this week.

Accelerating move to VBR: No doubt about it, the ACA train has left the station and we are halfway to Hicksville on the VBR train (VBR = value based reimbursement). In conversations with several senior HCO executives, there is no longer any question that the industry is moving to VBR and the train appears to be a high-speed one. Three payers I spoke with stated that roughly 50% of reimbursements in 2017 will be VBR-based. We may see a train-wreck among less savvy and astute HCOs as recent research we have conducted uncovered a market where the majority of HCOs remain ill-prepared for this transition – they are still in a reactive, tactical operating mode.

No one wants to be an HIE vendor: With the exception of one vendor, RelayHealth, every HIE vendor I met with no longer considers themselves an HIE vendor. This is partly due to the rapid commoditization of base interop technology and services and the need for these vendors to “move up the stack” and provide a higher value proposition. A few seem to be trending in the right direction but the majority of these vendors are currently pushing PowerPoint and buzzwords rather than truly reference-able clients and use cases. (Brian will take a closer look at HIE in follow-on post.)

Despite buzz, population health management (PHM) remains an amoeba. Last year the big buzz was around PHM. Well, the enthusiasm has not waned for PHM, at least from the vendors but try to get one to clearly articulate what it means and how it maps to their solution suite – good luck.

In every briefing I had with a purported PHM solution provider I asked a simple question: What is your process map to enable a client to effectively move to a PHM model of care across the community they serve with your solution suite? Only one vendor, Cerner, was able to articulate such a process map, everyone else just sort of waved their hands about and spoke of “high-level this, high-level that.” Ugh, I simply can’t stand high-level BS.

Patient engagement saw plenty of visibility but little reality. HIMSS made a big point this year to promote patient engagement, but from what I observed, that market is a mess – confusing messages, confusing positioning, questionable offerings. About the only thing that seems relevant today to most providers that I spoke to was meeting MU2 patient engagement requirements so they are simply using the lame PHR that their EHR vendor offers. For larger HCOs, there is additional interest in promoting customer loyalty. Beyond that, pilot-itis reigns supreme. (Naveen will go into far greater depth later this week.) 

Industry finally gets workflow religion. At my first HIMSS, I vividly recall the Davis Award recipient stating that he wished they had paid more attention to workflow in their EHR install. I about fell out of my chair as a CIO would have been fired in the manufacturing sector for making such a statement. Workflow considerations in that industry were part and parcel of any strategic deployment of IT – not an afterthought.

At this year’s HIMSS I heard plenty of talk about workflow integration but data-rich workflow tools that extend across a heterogenous EHR environment are still in PowerPoint. Likely the leading reason why many HCOs are rationalizing the EHRs they will support to a very select few or in the case of Epic shops, one.

Related sad story though: Met an old colleague who now leads a small ACO of 8,700 patients. She is now in the process of developing a strategic IT plan for the ACO, an IT plan that needs to take into consideration 22 different EHRs across the various practices. I don’t hold much hope for this ACO as I see no easy path to care coordination across such a disparate network.

A Few Parthian Shots
HIT spending will be flat in 2014 as HCOs focus on meeting ICD-10 and MU2 requirements. Speaking of which, there are lies, damn lies and then there are statistics. Sat in on HIMSS Analytics Leadership survey presentation, where I kid you not, according to their survey, 92% of the nearly 300 HCOs surveyed said they are ready for ICD-10 switch-over. That’s a very optimistic group they are surveying.

Not sure we’ll see any big announcements for EHR switches either in 2014 as HCOs look to stabilize their infrastructure in advance of ICD-10 conversion. Just too big a financial risk.

Spoke to a few senior executives from large HCOs that have moved to Epic. Each one stated that their strategy will be to move all physicians, owned and affiliated, acute and ambulatory, to Epic. If you want to be a participant in their contracts with payers, that will be the entry fee. They all admitted that they will allow specialists to keep their EHR but all stated this is an exceedingly small percentage (~5-8%) of physicians in-network.

Looks like CVS is dumping their longtime EHR partner for their MinuteClinics, a highly customized version of athenaclinicals (as I recall, CVS was athena’s first athenaclinicals customer) A thousand apologies athena, and thanks for informing us that CVS MinuteClinics use athenacollector, not athenaclinicals. Indeed it was a highly customized version of Allscripts that got the boot in favor of Epic’s ambulatory EHR. In a twist of irony though, CVS is now a member of Epic’s detested foe on the interop front, CommonWell.

Epic counters CommonWell by working with HealtheWay to stand-up the Carequality alliance. Details still extremely thin on this alliance with some vendors, like Greenway, a member of both CommonWell and Carequality (Is Greenway hedging bets?).

Caradigm has once again remade itself and its strategy, now calling itself a population health company. Much of their offering is the productization of Geisinger best practices. If you like what Geisinger has done to date on care coordination, Caradigm may be of interest.

Cerner’s Smart Registries, which was co-developed with Advocate and now live appears to be gaining traction with over half-dozen contracts signed so far. I like what they have done here and is much in alignment with our views on Clinician Network Management.

Orion Health continues to roll, in fact rolling much faster than I imagined having grown enterprise clients by 200% in 2013. Orion struggled in the past to move beyond the public HIE market but that issue is now in the rearview mirror. Their challenge though is to move even faster to build out functionality on top of their base infrastructure.

In closing, HIMSS is exhausting and I need fuel to move. My preferred fuel of choice is a double shot cappuccino. I sampled many on the show floor, thank you one and all for providing. But there is only one vendor that truly stands out in providing the absolutely best expresso – Agfa. So big thanks Agfa and your professional baristas for providing me the fuel for HIMSS. See you next year.


What’s in Store for 2014?

zoltarThat time of year once again where we collectively look into our crystal ball, or throw the sticks or maybe even look at the coffee grinds dripping down the sides on our coffee cup to see what may be in the year to come. Making these predictions for the coming year is almost a rite of passage for any self-respecting analyst firm and what the heck, from our vantage point, we may have a slightly better view into the future than most.

So in keeping with some sense of tradition here at Chilmark Research, the following are our ten predictions for 2014, plus one (think of it like a baker’s dozen).

Meaningful Use (MU) stage two delay provides little relief to IT departments. Many breathed a sigh of relief when HHS announced that stage two timeline would be extended. Yet despite that extension, IT departments will remain overwhelmed in 2014 coping with a host of other initiatives, from ICD-10 to HIPAA compliance to preparing the organization for changing models of reimbursement and of course MU 2.

Best-of-breed solutions proliferate. Despite the desire to have as few as possible IT vendors and their solutions within an organization, department heads take it upon themselves to adopt new solutions as IT departments are not able to meet all the needs of the organization at this time, nor are EHR vendors capable of delivering new offerings in a timely manner. We anticipate analytics and care coordination to be high among list of adopted best-of-breed solutions. This will create its own host of problems several years hence.

Consolidation continues unabated in mid-market. Much to the concern of payers, large provider organizations will continue to purchase their smaller brethren to extend their reach and improve care coordination. Payers will fight back with lawsuits (monopolistic tendencies of providers) and by making their own acquisitions. Payers will be particularly attracted to the dual eligible market.

Bloom is off the rose as physician dissatisfaction with chosen EHR rises. OK, yes this is a no-brainer as we have been seeing discontent rise throughout 2013. But this discontent will escalate as smaller organizations increasingly realize that their EHR is ill-suited to address the needs of tomorrow in a value-based reimbursement world.

Limitations of deployed HIE becomes increasingly apparent. It’s one thing to put in an HIE infrastructure, quite another to embed HIE capabilities into clinician workflow, especially across a heterogeneous EHR community. Couple that with a growing realization among leading HCOs that to truly support clinicians at point of care, far more data is required to flow through the network and you end up with a lot of future head scratching as to where the real value realization will be derived from the HIE now in use.

Re-prioritization moves patient engagement to back burner. Despite the strong efforts of ONC/HHS to promote the concept of patient engagement, providers, no longer having the stage two gun to their head, will reset priorities on other, more pressing matters.

One third of stage one, MU-certified EHRs do not or choose not to certify for stage two. The HITECH Act created a false market for EHRs that led to the proliferation of vendors and their solutions. Unfortunately for many an ambulatory practice, their chosen EHR vendor will not have the resources to refine their product for stage two certification leaving smaller practices with the unenviable task of having to find a new vendor. Thankfully, a price war is anticipated as vendors look to build customer bases and subsequently valuations before inevitable acquisition.

Clinical analytics remains a hot, yet immature market. Leading HCOs are all clamoring for analytics to help run their operations and improve care delivery processes. But despite the high demand for such solutions, EHR vendors are still behind the curve in delivering such capabilities, the buyers still are not quite sure exactly what they want and rarely have the resources to begin asking the right questions. The best of breed vendors themselves struggle to keep up with market demand, leading to longer then anticipated deployment times.

Cloud-based EHRs become de facto standard for small, ambulatory practices. Pricing pressure will grow fierce in the ambulatory market and in an effort to lower cost of sales, shorten product lifecycles and improve customer service, ambulatory EHR vendors will move to cloud-based services for their solutions. Some push-back will occur over concerns of data governance and privacy. Physicians taking this path will need to review terms and conditions of such contracts carefully.

Payers increasingly become part of HIE fabric. In mid-2013, payers became increasingly involved in the HIE market partnering with leading providers in some communities to share data and improve care coordination. While providers have instinctively been reluctant to partner up with payers, the move to value-based contracts and the strong skills and critical data that payers can provide is forcing providers to re-evaluate their previous stance. falls short – payers wring their hands. has far more sign-ups than detractors anticipated but falls short of administration goals, especially for the young and healthy. This leads to payers to continue wringing their hands over adverse selection of new enrollees and the likely higher risk profile as a result.

There you have it folks. Now let’s see how the year plays out and just how close these predictions are to reality come early 2015. Either way, never a dull moment in this market for the foreseeable future.




Has Avado Acquisition Awakened the WebMD Giant

gaint2WebMD, the once-darling of consumer health who seemingly lost its way following pharma dollars, may at last be coming back to its roots. Last week, WebMD made headlines by announcing it had purchased the young patient engagement start-up, Avado, for an undisclosed sum.

, based in Seattle is a product of a healthcare accelerator, Start-up Health. Their core focus is Patient Relationship Management (PRM), which honestly, is just another term for patient engagement via a patient portal or traditional Personal Health Record (PHR). Like its top competitors MEDSEEK, RelayHealth, Medfusion, who was recently spun-out from Intuit and NoMoreClipboard, these solutions are EHR agnostic and typically deployed at enterprise sites where there are numerous legacy systems in place across the enterprise (e.g., EHRs, radiology, labs, etc.). Providing a patient with a single longitudinal view of their record along with an the ability to conduct some transactional processes. PRM solutions seek to accomplish two objectives – meet regulatory requirements and drive loyalty.

Within the healthcare sector patient engagement is becoming an increasingly hot topic. While we at Chilmark Research have been following this sector since our founding, only in the last 6-12 months have we seen interest significantly accelerate. Healthcare organizations (HCOs) of all sizes are now looking to deploy a patient engagement/PRM strategy, partly in response to stage two meaningful use requirements and increasingly, an understanding among HCOs that value-based reimbursement will necessitate a more engaged and loyal patient – can PRM facilitate.

But this acquisition is less about Avado than it is about WebMD, who has signaled their intent to diversify the business by adding some teeth to their own consumer portal offering in the near term. In the longer term, WebMD’s strategy will hinge on execution of their B2B platforms and their ability to turn informed consumers into engaged patients.

Short Term: An Investment in Diversification
WebMD has led the online consumer health information market since 1999, growing steadily into a publicly traded company (market cap: just under $1.6B) and a household name. Unsurprisingly, advertising and site sponsorship comprise 84 percent of their revenue; they enjoy over 138M unique monthly Web visitors and 22M mobile views. Remaining revenue comes from a provider-geared information network (Medscape being the best-known brand), and a private portal service, through which they create and manage customized health portals for self-insured employers and health plans.

WebMD has been milking these revenue streams for years, bringing little innovation to market. Frankly, they didn’t have to as the pharmaceutical industry with their fat marketing coffers kept WebMD fat and happy, for awhile.

That all changed when the pharmaceutical industry started hitting the wall with fewer new blockbuster drugs in the pipeline, while their breadwinners start coming off patents and succumbing to inevitable, low-cost generic competition. Marketing budgets crashed and with them, WebMD’s once highly profitable model. Of course it didn’t help that WebMD began seeing increasing competition from the likes of Everyday Health, Patient Conversation Media, and Demand Media (who runs

After six quarters of being unprofitable from 2011-2013, WebMD is beginning to come out of its drug-induced stupor finally posted profits in Q2 and Q3 of this year. Consequently, it appears that WebMD has also come to realize that it will need to diversify. Hence, the Avado deal.

Avado has no strong brand, and fewer than a dozen customers, but it does have a vision that WebMD sees strong potential in. Coupling WebMD’s massive scale with a compelling PRM vision and platform could open new, untapped markets for WebMD, particularly among smaller ambulatory provider networks where Avado has gained traction and WebMD has strong presence. There is a huge opportunity here.

This is not to take anything away from Avado, who had not-so-quietly emerged over the last couple of years as a flag bearer for patient engagement through health IT. Dave Chase, Avado’s co-founder and CEO, has been one of the most vocal proponents of a business case for patient engagement, rooted in the growing realization that getting serious about between-visit care will be pivotal in bending the cost curve by managing the health care needs of an aging, and increasingly chronically ill population.

WebMD’s extant portal was/is somewhat rudimentary, with an HRA tool, access to some claims data, education/information features, and some health coaching functionality. They will likely fold these capabilities in with the Avado platform, which consists of the usual spate of tech features bundled into a PRM platform: secure messaging with Direct, a dashboard and visualization tools, administrative support (scheduling and billing), integration with existing practice management/EHR systems, and Blue Button+ compatibility.

Rather than going after a more established vendor, such as a MEDSEEK, this move allows, for relatively little money, an opportunity for WebMD to augment their portal offering with more sophisticated functionality without breaking the bank (some reports put deal value at $20-30M range, though our guess is closer to $8-10M). By choosing Avado, WebMD has opted to get a batter on base rather than swing for the fences.

More Than a Website…Or Are They?
It is unlikely that this deal vaults WebMD to the top of the patient engagement market – they will continue to be an information website above all else. However, they have steadily matured their platform over the last few years with improved, diversified content, a flagship mobile app (over 20M downloads), and a more personal, customized user experience.

More recently, they have incorporated a provider search function and begun integrating with their MedScape network so clinicians can push specific information (e.g. discharge instructions or care plans) directly to patients. At HIMSS they announced a partnership with Qualcomm Life’s device ecosystem so consumers could manage device-generated data directly through their WebMD accounts.

Yet with all these developments, some of which have been little more than announcements, the proof is in the pudding, which in this case isn’t out of the kitchen yet. Many questions remain: There hasn’t been a peep about the Qualcomm deal since March. How well do/will the provider tools work, and how many patients will use them? How is this going to integrate into clinicians’ workflow, and/or broader population health management solutions? And with any such offering, how will it be packaged and delivered to market?

Looking Ahead: Has the Giant Awakend
This is likely just the start for WebMD, which has a tradition of being a highly acquisitive company. Providing PRM solutions to ambulatory providers through their existing network is an easy first step, though success will be defined by execution and rationalization across the multitude of WebMD B2B offerings. Design, usability, and functionality will be crucial.

Next will be layering in additional functionality that is of high interest to consumers and physicians alike. Expect to see such features as pricing transparency, quality scores, and enabling additional transactional processes that simplify a consumer/patient’s interaction with the healthcare system. For the physician practice, WebMD may develop or acquire solutions that facilitate referrals, care coordination and possibly even administrative functions such as eligibility checking. Look for future acquisitions here as WebMD still has many gaps to fill.

The biggest implication of this acquisition is, however, that a sleeping giant may have awoken and has decided that too many mice have been eating from its plate. The market is awash in small companies who are all looking to tackle some aspect of consumer/patient engagement. Some of these, like Avado, may ultimately be acquired, but many, many others may be squashed underfoot. The next 6-12 months will show whether or not the giant has truly awakened, or simply was walking in its sleep.


Here an HIE, There an HIE, Everywhere an HIE

In late March, I headed down to Belize with a bunch of high school students to do some service work. Joining the crew was a parent, Harry (not his real name), who happened to be a urologist sharing a private practice with five other urologists. We got to talking about the industry, the rapid changes that are occurring and of course HIT, where the conversation quickly turned to health information exchanges (HIE).

This urologist’s practice has been using eClinicalWorks (eCW) for several years now and despite their proficiency with using this EHR, the practice has never fully recovered the productivity it once had. Regardless, they have come to accept this hit on productivity as just the cost of doing business. (Note: In Massachusetts all physicians must adopt and use an EHR to be credentialed, regardless of meaningful use or any other programs.)

Harry spends two days a week in surgery with most operations taking place in one of four facilities: local, unaffiliated hospital Winchester (who uses Meditech), Beth Israel Deanconess (has a home-grown EHR but encourages affiliate practices to adopt eCW), Childrens’ Hospital (a Cerner shop that also promotes eCW in ambulatory) and Partners which is now moving from its homegrown EHR solution to Epic (BTW, in a recent conversation with a contact at Partners learned that they are spending $1M/day for next five years on Epic switch - ouch!).

All of these hospital organizations want a closer affiliation with these urologists in support of future value-based payments and of course just getting these physicians to do more surgeries at their respective institutions. Thus, all of them want the urologist practice to adopt their interoperability model. Harry stated that Partners, the biggest healthcare organization in metro-Boston and arguably New England, is pushing particularly hard for them to switch to Epic as Epic does not have an HIE offering (Epic Everywhere is not an HIE in our definition nor apparently in ONC’s) and encourages its customers to put all ambulatory affiliates on Epic instead. In addition to these organizations, the Commonwealth is also encouraging this practice to join the statewide HIE.

After the pain and suffering Harry’s practice went through to become proficient on eCW, they are loathed to switch to Epic. Besides, switching to Epic would limit their ability to connect with other healthcare organizations they work with as Epic does not play well with others.

Harry’s situation is not unique and is likely being played out across the country, especially in urban areas where there may be a number of competing healthcare systems each trying to establish their own HIE. In such a situation what is an independent physician practice to do?

Certainly they could sell the practice, as many physicians have already done, to the highest bidder. Not an option for Harry and his physician partners as they like their independence and plan to keep it that way.

They could turn to the statewide HIE and hope that it will provide the depth of services (interoperability) to enable them to connect and share records in support of care coordination with all hospital systems they work with. Ideally, this may be the best approach but unfortunately they’ll be waiting a very long time for this to happen, if it happens at all. Today, most statewide HIEs, including Massachusetts are focused on enabling Direct secure messaging, a simple, political expediency that those in D.C. can point to as a shiny example of information exchange for the nearly half billion dollars spent on statewide HIEs. It is unlikely that most statewide HIEs will evolve beyond Direct providing the type of deep connectivity between a practice and an healthcare system to coordinate care effectively. That’s not to say we are throwing out the baby with the bathwater as there are some states that are doing exemplary work e.g., NY, IN

Then there is the option of just staying the course and hoping that lightweight connectivity directly into eCW will miraculously occur. For Harry and his partners, both Childrens and Beth Israel currently support eCW and interoperability with the acute care EHR will be supported. Partners may be left with no other option then to purchase a third party HIE solution to connect affiliate practices in the highly competitive, metro-Boston market. As for community hospital, Winchester, this hospital is unlikely to survive as an independent and will either be acquired or eventually be forced to shut its doors.

Still Waiting…
While the vast majority of ambulatory practices will ultimately be acquired, there will be a significant number of specialists who will continue to operate independently and with a number of healthcare institutions. The current hodgepodge of HIEs being stood up in various communities and the multitude in a given urban area will put increasing strain on physician practices such as Harry’s, who like any of us, given too much choice will simply forgo a decision.

Maybe, just maybe the efforts of the Interop Workgroup will take practices such as Harry’s to the promise land that will allow them to support coordinated care, in a simple streamlined fashion, amongst a wide range of healthcare organizations in their community irrespective of underlying HIT infrastructures. We have not heard of any such examples to date, but we remain hopeful as the current model being deployed today, while likely addressing the all too familiar 80% of the problem, still leaves a very critical 20% unresolved.



Who will regulate mHealth? Patient Engagement at Crossroads; New Alliance Takes On Interoperability

We came back from HIMSS and got right to work on the March Monthly Update for Chilmark Advisory Services subscribers. As we’ve reported in a previous post, HIMSS13 afforded enormous buzz and less enlightenment regarding the state of health IT, particularly the four key areas we see as essential to this industry making a true difference in patient care. In our March update, and the reports currently underway, Chilmark Research does the opposite: provide insight without buzz. Below are abstracts from this month’s update. To find out how you can receive the full update, send an email to: info at chilmarkresearch dot com

Public vs. Private Oversight of Mobile Health
John Moore III

mHealth, known for rapid innovation and iteration, has a tendency to buck at the snail’s pace of FDA regulation. Last month, during a series of hearings considering whether smartphones and tablets with medical apps qualify as medical devices and thus require FDA approval, many charged the FDA with stifling innovation. After all, how many developers or investors want to sink resources into an industry that will be regulated in ways that have yet to be determined?

Enter Happtique and its Health App Certification Program. Happtique intends to complement the work of the FDA, and has introduced a set of standards for health apps that fall into the grey area between apps that are clearly medical and those with a clear consumer focus. This could herald a new age of credibility for mHealth. However, as both regulator and marketplace for many of the apps that it regulates, Happtique could end up in a very sticky situation. They will need to tread carefully to maintain their objectivity in both certifying apps while at the same time providing a marketplace for mHealth apps.

The March Toward Better Patient Engagement
Naveen Rao

The open question in health IT these days is whether patient engagement will gain traction or if it will suffer the same fate as PHRs. One thing is certain; healthcare needs far better patient engagement methods, processes and techniques than what one finds today as most current efforts in engagement have very little to do with helping a patient manage a condition. Time and again in our discussions with healthcare institutions of all sizes we find the same scenario being played out – engagement today is focused on building patient/customer loyalty to the institution – they are simply no more than marketing efforts.

Stage 2 meaningful use is requiring a deeper level of patient access to their records via view, download and transmit requirements and there is even a requirement for some email messaging between provider and patient. But there is a bigger issue at play, payment reform wherein providers will be taking on more risk for the patient populations they manage. Without deeper engagement with the patient regarding a chronic disease, providers will struggle with these new payment risk models.

Several related markets, such as telemonitoring and wearable tech are taking off. Chilmark analyst Naveen Rao spent near-exclusive attention to the patient-engagement tracks, vendors, and sessions at HIMSS13. In his article for the March update, Naveen identifies three factors that will define if and how well the patient-engagement market will stay afloat in the coming years.

CommonWell Alliance Intends to Tackle Interop
John Moore

The announcement of CommonWell Health Alliance was likely the biggest story to come out of HIMSS (Allscripts acquiring longtime HIE partner dbMotion may have been a close second). The group’s stated purpose is to enable interoperability across the five founding members’ EHRs. For starters at least, this includes: Allscripts, athenahealth, Cerner, Greenway, and McKesson’s RelayHealth division. In its simplest form, CommonWell will establish a set of standards and services that enable query-based health information sharing in a heterogeneous EHR environment.

Part of the challenge with interoperability within a community of heterogeneous EHRs is that standards are useless when it comes to things like patient matching, consent management, or locating records, all of which are fundamental to interoperability and all of which require standardized services model. CommonWell founders know this and have plans to address it. The greatest challenge facing CommonWell, however, may be the market itself as adoption of HIE tech within the ambulatory sector remains a challenge.

Each month, subscribers to the Chilmark Advisory Services (CAS) receive an update of our research on the most transformative trends in the healthcare IT sector. Exclusive to CAS subscribers, monthly updates are part of the continuous feed of information and analysis we generate to keep subscribers on top of the rapid-fire changes in this market.