Category Archives: Cloud Computing

Finding Few Answers at HIMSS’13

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Last week was yet another HIMSS, this time in the Big Easy – one of my favorite cities, despite the unfortunate decay occurring on Bourbon St. As with the many HIMSS I have attended before, this is the seminal event of the year where one has the opportunity to reconnect with friends, acquitances and countless others all in the hope of gaining a pulse on the healthcare IT (HIT) industry.

Having been barraged with countless invites in advance of the show to meet with this or that vendor, I winnowed down the number of meetings to a select few and even then, had far more on my plate then I could reasonably consume over the three plus days that I was there. And of course, there were the countless press releases I received during the week of HIMSS, nearly all of them barely worth the digital type and bandwidth used to create and distribute.

So easy to get lost in all this noise. I just can’t fathom how a healthcare executive is suppose to wade through it on their own, let alone the staff that reports up into them.

This year’s HIMSS pilgrimage was to seek knowledge within four core areas:

  1. State of innovation in HIT,
  2. Greater understanding on the state of analytics adoption,
  3. Market maturity with regards to population health management and
  4. Is the industry finally taking true patient engagement seriously?

Following are findings and musings on these four.

Innovation – Where is it?
For all the talk of innovation in this sector, it is astonishing just how little there truly is. I searched high and low for real innovation and came up dry. Even went to the Venture Fair on Sunday to see what a number of young companies are bringing to market and found little to capture my imagination. Either this is a sign that I have been in this market too long or maybe a sign of just how challenging this market can be for those who wish to truly be innovative, to be disruptive. Walking the halls of HIMSS, one certainly gets the feeling that this is a show that is not about leveraging HIT for disruptive purposes, but to maintain the status quo.

One of the few glimmers of hope for future innovation may come from an unlikely source; the consortium of five EHR vendors that have committed to the CommonWell Health Alliance. While one must be cautious in throwing one’s support behind such an initiative, I threw caution to the wind in a brief interview after the announcement.

Why the enthusiasm?

If CommonWell succeeds in its mission to create an information sharing platform across these five vendors – and others should they join – we’ll finally, as an industry, move beyond competing on data silos ultimately providing a higher level of functionality to the end user. On top of this sharing platform, we may then begin to see true innovation occur – innovation that taps the data that flows across the CommonWell network. Of course this is all dependent on just how “open” CommonWell will be and that is something we will not know for at least a year. – Yes, healthcare moves slow.

Analytics – Why is it?
The market for healthcare analytics has been hyped beyond imagination but beyond the hype is what appears to be a complete lack of why this industry is even pursuing analytics. There appears to be very little underlying justifications as to why a healthcare organization should be doing analytics in the first place.

Time and again, in one discussion after another, we found a very immature buyers’ market for analytics solutions. Most buyers cannot answer, with any degree of specificity, the simple questions: Why do we want an analytics solution? – What is the business case? And its not just the buyers as many vendors complained of the horrible RFPs that they are receiving which were drafted by some big name consulting firms. One vendor told us point-blank:

“We are no longer responding to RFPs as they are such garbage and a waste of time. If we can’t connect at the most senior strategic level of the organization, then we know that they do not have the maturity of thought to begin the conversation, let alone the journey.”

As most of you already know, Cora is working on the report: Analytics for Population Risk Management that will be released in April. It is our goal to help clear the air and educate this market and if anyone can do it, it is Cora.

Population Health – What is it?
And to think, I though analytics was an over-hyped market. Analytics has nothing on the next big market buzzword, population health management (PHM). Much like the fable of the blind men and the elephant, population health is whatever you wish to make of it or whatever part of the healthcare elephant you happen to be attached to.

What a mess. Despite all the hype on PHM, which comes under many guises including Accountable Care Solutions, Systems or Suite, I did not come across a single vendor that had a complete solution suite. Even those vendors that have significant pieces of a PHM solution, still have not knitted their portfolio together to be a seamless offering. Buyers of such solutions will be spending a lot of money on services to stich these things together for the next 2-3 years.

In the second half of the year, Chilmark Research intends to devote a significant amount of resources to fully flesh-out what is meant by PHM, what are the critical components to enable such and where one might go to find them. Stay tuned.

Patient Engagement – How is it?
Anyone who has followed Chilmark Research and my ramblings for more than a couple of years knows that I have a soft spot for patient engagement. It was within this broad category that I got my start with the publication of the iPHR Market Trends Report in 2008. While that market has not developed sufficiently to support a full-time analyst, it is still an area we track closely and in addition to myself, both Cora and Naveen keep tabs on this market. Naveen will give some of his HIMSS impressions next week wherein he’ll focus specifically on patient engagement.

Waiting with bated breath for this market to take off is fraught with futility. Despite the quite vocal efforts of ONC to push patient engagement to the forefront, I still see most programs at healthcare institutions being funded by marketing departments. It is not about engagement, its about loyalty. Even HIMSS seems to recognize this as they had a number of screens scattered throughout the convention center that flashed four screens: 1) Healthy Patient, 2) Connected Patient, 3) Informed Patient, 4) Stronger Patient which left me wondering…

Where is the engaged patient?

Without engagement folks we are dead in the water for only an engaged patient will take the necessary steps to actively managed their health.

Wrap-up
HIMSS is what it is, a large conference that gathers just about everyone interested in the HIT market in one place. But in such a gathering, a significant amount of noise is created leaving one wondering: Does this conference provide real enlightenment and clarity to the market and the solutions therein, or does it just create greater confusion?

Reflecting on the conference and reviewing my notes for this post I find it is some of both, with a weighting towards noise and confusion. In the coming months, as we release our reports on HIEs, Analytics and later this year, those on population health and patient engagement, we intend to provide the clarity that all stakeholders need to have informed discussions and ultimately make informed decisions. That in a nutshell is the purpose of Chilmark and what guides us our research agenda.

 

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Reorg at McKesson, Will Docs Trust Predictive Analytics & Med Rec

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What a crazy week it has been. Yes, it was the week of all things HIT related with the big confab of HIMSS a the Big Easy. I’m literally still trying to sort out all that I saw, all the conversations I had to make some sense of it all. Needless to say, at times it seems that rather than providing enlightenment, the incessant noise of HIMSS just sweeps over one like a tsunami leaving behind debris of all matters.

But we’ll get to HIMSS next week – I promise.

In the meantime, below are just a few of the topics that we covered in our most recent Chilmark Advisory Service (CAS) Monthly Update. The research notes contained within this monthly provide you with a glimmer of some of our current areas of research interest. For example, the reorg at McKesson is but one example of the massive trend (which was readily apparent at HIMSS) of companies repositioning themselves for population health management in support of financially-linked communities of care (e.g., ACOs). Cora’s research in analytics has brought to light some of the challenges that well-meaning executives may face when trying to get clinicians to adopt and use predictive analytics. While Brian’s story delves into the vexing problem of medication reconciliation within a distributed healthcare community.

The abstracts below provide provide a few more details. But far better than abstracts is of course – drum roll please – becoming a subscriber to CAS where you not only receive a wide range of research content from us over the course of a year, but also direct access to our top-notch team of analysts. Want more information? Just drop us a line to info@ChilmarkResearch.com and we’ll be in touch.

Reorg at McKesson Points to Broader Repositioning
In early February, McKesson Technology Solutions went through a major reorganization and the primary beneficiary appears to be RelayHealth. Historically, RelayHealth has seemed little more than a staging area for McKesson-acquired HIT assets that did not fit logically into any other area of the broader McKesson Technology Solutions Group. With the reorg, RelayHealth not only grows in size, it finally appears to have been given a clear and overarching mission: to become McKesson’s solution to enable population health management. ACOs would be wise to take note.

Will Providers Ever Trust Predictive Analytics
Analytics vendors are approaching the clinical market with predictive models as end-alls for population health risk management. However, doctors, nurses, and case managers have their own ideas about what clinical variables really matter, and they can identify their highest-risk patients practically from memory — no fancy models needed. While there are reasons to be optimistic about PA adoption, vendors should brace themselves for a tough market in which clinical intuition will clash with statistics. One option will be to integrate provider-identified variables into vendor models, an approach that will likely infuri­ate the statisticians but could go a long way in overcoming clinician misgivings.

Medications Reconciliation Continues to Challenge HIE Vendors
In best-case scenarios, medications reconciliation can help avoid adverse drug events by pointing out discrepancies such as missing medications, unneeded medications or incorrect doses at patient discharge. Yet even now that HIT solutions built to support safe hand-offs have been widely deployed, the AHRQ attributes 770,000 deaths per year to ADEs. Meaningful use gives PCPs the responsibility for post-discharge medications reconciliation and as of yet, insufficient tools to do so. Thanks to inconsistent process and technologies across providers, the medications lists PCPs have to work with are riddles with irrelevant medication data, (e.g. a three-year old prescription to treat foot fungus) and missing information (e.g. medications paid for out of pocket). Before medications reconciliation lives up to its promise, serious gaps like this will need to be addressed.

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 

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Four Diverse Research Notes in Jan Monthly Update

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As Chilmark has grown, so has our areas of research which is best represented in the following four research notes that our analysts put together for Chilmark Advisory Service (CAS) clients. The following four abstracts provide you perspective on some of the most critical and pertinent developments int his market sector.

We will be at HIMSS this year and likely have a few copies of this Monthly Update in our bags. If you want to get together to discuss the CAS service, just let us know, but be quick as our calendars for this event are rapidly filling up.

Fair Warning For Healthcare CFOs
The office, duties, and functions of healthcare CFOs will begin a major upgrade this year. Such changes have been a long time coming, but with only three years to take on Risk Assumption ACOs (RAAs), time is short. The difference between what is coming in, in fees for service, or capitation fees, has become dangerously close to what it costs to “keep the lights on.” Something has to be done. Fortunately there is plenty of mature software and a number of best practices CFOs can borrow from other industries to insure the solvency of our healthcare system. The four primary domains where CFOs should begin are:

  1. Formalized Budget & Planning
  2. Activity-based Costing
  3. Performance Monitoring and Measurement
  4. Contract Management

EHR Data is More Untrustworthy Than You Think
The healthcare industry, in its rush to adopt medical records and fervor to keep medical records HIPAA-compliant, has completely underinvested in ensuring the quality of the data that is entered into those medical records. Poor data quality stemming from human error and a pervasive lack of validation has enormous consequences for treatment decisions at the point of care and for secondary uses of patient data, particularly analytics. This research note takes a close look at the problem of data quality and what other industries have done to address it.

Keeping Track of Wearable Health Tech
Up until now, the $2 billion wearable tech market has focused primarily on wellness and fitness, and barely skittered around the edges of the broader healthcare market. In the past, devices such as quantified-self tools, fitness peripherals, movement trackers, and the like were not up to the task of tracking complex healthcare data but this is rapidly changing. Thanks to a confluence of growing interest, increasing market maturity, more robust, multi-dimensional devices and good timing, Chilmark Research believes wearable tech stands ready to make significant inroads into a value-driven healthcare market.

Learning to Like Direct
Despite a strong market and federal incentives, this is an uneasy time for HIE vendors, and Direct (Direct Secure Messaging) tops the list of HIE headaches. Direct doesn’t just sequester data in silos. In many HIE vendors’ view, it sends clinical information to some bunker underneath the silos of healthcare data. Add to this the fact that the legion of EHR-enabled providers is growing and these providers want information from their HIEs, including secure messages sent through Direct, integrated into existing EHRs. From a workflow perspective, this makes sense, but established EHR vendors have little to no incentive to make things easy for the new HIE kids. This article looks at Direct and what its rise portends for the future of HIE vendors and their product development and go to market strategies.

 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.

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Big Data Clarified, Providers, HIT & Obesity and ACA’s Impact on HIE Market

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With the ramp up to healthcare reform, Chilmark Research sees signs of a potential slow down in HIE innovation. This is but one research note of three that were provided as part of our latest monthly update for Chilmark Advisory Service subscribers in the December Monthly Update. Below are abstracts of the three topics covered in this issue.

Provider Risk Will Drive Vendor Caution on HIEs
As the Accountable Care Act goes into effect, financial concerns and a host of unanswered questions will play a decisive role in how HIEs are developed and implemented. HIE innovation could slow in the coming year based on what providers are willing and able to pay for. Although Stage 2 meaningful use requires that providers include a summary of patient care records with any referral to an outside setting, most providers will take Direct as the path of least resistance to this end. Meanwhile, questions such as which entities within large IDNs will have final decision-making power on spending, and whether HIEs should have any role in sharing claims data, remain unresolved.

Big Data for the Rest of Us
Big data has become a hot buzz word in health IT, mainly because it remains largely undefined and can be molded to fit individual needs and circumstances. In the absence of a clear definition, big data has been used to disparage existing database technologies, especially SQL. Nonetheless, leveraging existing end-user tools is the clearest path to gaining broad appeal for a new technology, and the existing tools in analytics rely on SQL. This update looks at the efforts of vendors like Teradata, Oracle, and IBM to develop big data solutions, and what that could mean for HIT.

New HIT Markets for Tackling Obesity 
Payers have taken the lead in using health IT to turn the tide on rising health costs related to obesity and overweight. Innovative health insurers are using social media, mobile apps, and gamification to engage members and promote healthy behaviors. So far at least, providers have not joined payers on the new frontier of technology-based weight loss programs. Considering who currently bears the cost of weight-related health issues, this is not terribly surprising. Fee for service remains a disincentive to providers taking an ongoing role in patient behavior change, but healthcare reform could change that. One ACO quality measure, for instance, requires physicians to follow up with patients who have abnormal BMI. This update takes a look at the problem of obesity, where things stand with consumer engagement technologies, and how those technologies might develop.

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.

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Will Surescripts Become De facto NwHIN?

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Just as Healtheway looks to ween itself off the federal gravy train, Surescripts comes along and in a couple of quick strokes looks ready to drive a stake into the heart of Healtheway or at least any desire Healtheway may have to become the Nationwide Health Information Network (NwHIN).

It all started when Surescripts acquired collaborative HIE messaging vendor Kryptiq in late August. This was quickly followed a week later with Surescripts’ announcement that it would become Epic’s vendor of choice for cross-EHR connectivity. It appears that Epic has finally succumbed to the inevitable; that it will need to open up its system (Epic’s purported Epic Elsewhere, to address cross EHR connectivity was in reality Epic Nowhere – just vaporware) to communicate in a heterogeneous EHR environment. The Surescripts Clinical Interoperability (CI) network solution will become an “Epic Unit” and on Epic’s price sheet. The details of this story were covered in our September Monthly Update for CAS subscribers. Continue reading →

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Another HIE Purchase by a Payer

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Today, national health insurer, Humana, announced that it has acquired Certify Data Systems (CDS). This marks the third HIE vendor (UHG acquired Axolotl & Aetna acquired Medicity) that has been acquired by a payer in the last couple of years. Not that surprising when one looks at how aggressively payers are moving into the accountable care arena and seeking to form tighter links with physicians in their network, particularly those in the ambulatory sector, where CDS has done particularly well.

A key part of CDS’s success in the market was through its partnership with Cerner where it provided the technology stack for connecting ambulatory practices. The Certify HealthLogix is a well architected platform that has seen strong adoption. While terms of the deal were not disclosed, it is our guess that Humana paid a pretty penny for CDS, likely all cash deal at about 6-8x estimated 2012 sales.

While it is good to see that CDS leadership will stay in place, at least for now – serial entrepreneurs, such as CDS founder Marc Willard, typically do not last too long in large corporate entities such as Humana- we do have some concerns with Humana’s ability to actually manage a software company. This is way outside their core competency and hopefully they know well enough to provide CDS the resources to scale but also the wisdom to let CDS call most of the shots.

We will be providing Chilmark Advisory Service (CAS) clients with a more detailed breakdown of this deal later in the week after we have had a chance to speak with some key contacts/stakeholders of this acquisition. This will be pushed to subscribers via an Alert.

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