Category Archives: consumer health

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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2013 – A Year of Surprises

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In the blink of an eye, a New Year has appeared and with it the need to look into our crystal ball (or is it a magic 8 ball) to make our annual predictions for the healthcare IT sector. Personally, I find this to be one of the more interesting and seriously fun parts of being an analyst.

Be forewarned, we’ve seen enough mealy-mouth, water-downed predictions as of late that simply state the obvious to last a lifetime. So let’s crack a few eggs and make some stretch predictions shall we. (Note: each analyst has contributed a prediction or two, which is noted).

1) Structured Data will Remain Gold Standard in 2013 – Cora
Despite Watson and all the buzz about mining unstructured data, the only data that will be analyzed in volume in 2013 will remain structured data. Forget about the 80% of health data that is unstructured. Simple key-value matching will continue but robust, rigorous pattern matching, NLP, etc, will have to wait.

2) The Need to Address Data Quality Moves to Forefront - Cora
Data quality issues (DQ) will become increasingly visible as more providers wonder why their clinical data is such garbage. Providers will be shocked they need to invest in DQ specialists/departments/processes (along with the security to support them).

3) Many ACOs Come to an “OMG, What Have We Done” Moment - Rob
For the first half of the year healthcare organizations (HCOs) will be all buzzy implementing, on paper, gain-sharing ACOs. By Independence Day these same HCOs will begin figuring out it is hard and expensive to set up an ACO and that their back office financial management tools are inadequate. By the end of 2013, just two years away from Risk Assumption ACOs (RAACOs) HCOs will take one of three paths: 1) realize ACOs carry all the risk and more of HMOs and bow-out; or 2) scramble to purchase and implement complex financial management software; or 3) cash-out and sell themselves to a payer.

4) Several HIE Vendors Pack Bags & Leave – John
Virtually all of the federal funds distributed to States to stand-up their statewide HIEs has been allocated. Without that federal largess we will begin seeing some vendors exit the HIE market. Who will they be? Think large companies with lots of brand equity and close ties to lobbyists but with only modest healthcare experience. Those vendors that remain must now contend with upping their value proposition beyond simple information  exchange (Direct Secure Messaging will take over that task). Some of the weaker HIE players with limited resources will be looking for a buyer.

5) HIE Market Growth Begins to Slow -John
Over the last several years the HIE market has been growing at a blistering pace well in excess of 30%. That growth will begin to taper off ever so slightly in 2013, say 18-22% CAGR as all who have adopted a solution continue down the arduous path deployment and on-ramping ambulatory providers to extract value from their HIE platform.

6) Despite Strong Growth in Direct Secure Messaging (DSM), Fax Isn’t Dead Yet - Brian
Volume growth in use of DSM sent via health information service providers (HISPs) in 2013 will exceed 100% driven primarily by integrated delivery networks (IDNs) seeking efficiencies and referrals. Despite this impressive sounding growth, far less than 5% of all care transitions will use DSM by end of 2013. And don’t forget, numbers lie. Much will be reported in 2013 on the growth in absolute number of secure email IDs issued by HISPs, but the majority of those accounts will remain inactive.

7) EHR Source Code Subpoenaed -Rob
We will see our first EHR software source code subpoenaed in a malpractice lawsuit this year – the developer will be named as a co-defendant.

8) Chorus Grows Louder, Politicians Weigh-in and MU Program is Put in Stasis – John
HITECH & meaningful use (MU) have done their job, by and large as EHR adoption and use has swelled dramatically throughout the healthcare sector. But there is also a dark-side. Deploying software so that it is effectively used takes time. Unfortunately, the provisions of ARRA do not allow for time to be taken, which is leading to a rapid cram-down of EHRs and associated MU requirements on clinicians. Early signs of a backlash began appearing in 2012. That backlash will come into full bloom in 2013 leading to Congressional hearings and ultimately someone in the White House being forced to hit the pause button on MU requirements.

9) Quantified Self (QS) Crosses Over into Healthcare – Naveen
The peripheral, biometric, consumer market is starting to bloom. In addition to completely new products and companies, we will see development of more flexible platforms driven by a focus on open APIs. Employers will start to incentivize the QS movement as part of their benefits programs. There will also be a shift from wellness-only into light medical use of these devices for such things as physical therapy/rehabilitation programs, mood tracking, sleep tracking and simple pain reporting.

10) Providers Take Interest in Health & Wellness Solutions – John 3
Payers and employers are the traditional markets for health and wellness solutions. But in 2013, those healthcare organizations (HCOs) that are moving towards capitated care models will markedly step up their interest in and adoption of these solutions. This will also result in new hires (health coaches, nutritionists, etc.) as clinicians balk at taking on added responsibility.

11) Emerging Conflicts Over Patient Generated Health Data - Cora
Conflicts will emerge between EHR data and user-generated health data.  Early adopting QS-type patients (see prediction 10) will be bringing in their mobile-app-generated data to their doctors. Majority of doctor(s) will declare that the data doesn’t match up to their records and will not accept it. Resulting conflicts over how/if to get this data into the medical record will ensue.

12) Patient Experience Begins Being Factored In to Treatment – John 3
With increasing attention on patient/customer satisfaction and need to improve adherence to treatment plans, innovative HCOs will begin adopting mHealth solutions that enable patients to track, in real-time, their treatment experience. Treatment plans will be modified “on-the-fly” based on these “experiences” to improve adherence.

Of course there were many other predictions that we mulled over that ultimately landed on the cutting room floor. What remains are predictions that we felt will create the greatest disturbances or ripples in the industry. Predictions that are generally not all that obvious or maybe it is just that there are not many who wish to state such in writing (we’re not shy).

Whatever the case may be, these are our predictions. we’ll stick by them unless someone has some incredibly brilliant argument as to why we have it completely wrong (that’s what comments are for).

So have at it everyone, are we on target, or will we completely miss the mark in 2013?

 

 

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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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One Step Forward, Two Steps Back

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mHealth12Be careful what you wish for sure did apply to this year’s mHealth Summit, which was held last week in Washington D.C. Of the some 4,000 in attendance, I was one of the 10% or was it even 1% of those present that have attended all four events in succession. It is with that perspective that I came away from this year’s mHealth Summit more disappointed than ever.

At previous mHealth Summits, I often bemoaned the lack of organization of the conference, the often bizarre exhibitors one would find (couple of years back one exhibitor, and I kid you not, was marketing herbal aphrodisiacs) and basic necessities one would find at virtually any event, breaks with coffee, maybe a snack here and there. This disorganized, but charming event was mHealth Alliance Summits of years past. Continue reading →

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Cerner Takes a Road Less Traveled

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Cerner is embarking on a journey of transformation. That transformation, if successful, will culminate in Cerner becoming more than a health IT company to becoming a health company. They’ve tested much of this strategy internally with onsite campus clinics, health and wellness challenges, the creation of rich consumer/patient engagement tools, heck, they have even created their own third party administrator (TPA) as Cerner is self-insured. The company wishes to take these lessons learned, these solutions that have been developed, to transform their company into a health company to address not only the patient experience in a clinical setting, but the patient/consumer health experience throughout the community.

This is all a part of Cerner’s Healthe Intent strategy, a strategy we received a deep dive in during our recent attendance to the Cerner User Conference in early October. Healthe Intent is a big, grand, bold vision in an industry where there seems to be a dearth of such visions. Whether or not Cerner is successful, Healthe Intent certainly has its fair share of challenges, rests more with Cerner than any other outside force. Continue reading →

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Moving to HIE 2.0

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This week I had the pleasure to be the keynote speaker at Orion Health’s HIE User Conference in the beautiful state of my youth, Colorado. In preparing for this conference I was struck again by just how quickly this market continues to evolve and just how messy evolution can be. By the time my slide deck was completed, I came to the conclusion that the health information exchange (HIE) industry is moving from HIE 1.0 to HIE 2.0. While no trend happens over night, certainly the release of Stage 2 meaningful use  (MU) requirements had a significant impact.

HIE 1.0: All About the Message
Within the realm of HIE 1.0 the primary focus is on fairly simple, message-based, transactional processes. Large healthcare organizations (HCOs) adopted HIEs to facilitate orders and referrals with the hope that by making it easier for an ambulatory provider to place an order and receive timely access to lab results, that the provider would be more inclined to push business to that HCO, rather than a competing HCO in the community. It was all about physician alignment. Countless HCOs installed such HIEs, which are typically based on a lightweight, federated model. It was simple, inexpensive and relatively quick to deploy.

In the public sector, most HIE’s were meant to serve public health reporting functions and facilitate physician access to records to minimize duplicate tests and deliver better care. The objectives of public HIEs are far harder to reach, the value far harder to articulate and have contributed to a lack of sustainability and ultimately failure of may a public HIE. In a somewhat bizarre twist, last summer Health and Human Services (HHS) sent forth new mandates to all statewide HIEs to focus first and foremost on Direct Secure Messaging (DSM). DSM is little more than secure email, thus the original grand plans of public HIEs have been whittled down to much more modest goals.

With the release of Stage 2 meaningful use, which will require EHR vendors to embed DSM functionality within their EHR to become certified, messaging solutions provided by HIE vendors have now become commoditized. Messaging in the context of HIE is now passe.

HIE 2.0: All About Delivering Care
It has always been Chilmark Research’s opinion that the enterprise market will lead the public market in adoption and use of new, innovative HIE technology. With the move towards value-based contracting and associated reimbursement models, accountable delivery systems (ADS) (note: we don’t like to use the term ACO unless we are specifically talking about CMS), of all sizes are now looking to adopt an HIE platform and those that adopted a messaging-based HIE are looking to replace it. This will result in a high level of turnover in the HIE market, which we began seeing during middle half of last year.

The move to an ADS model requires a HCO to manage a given patient across all care settings. To meet these objectives, HIE 2.0 solutions will have such common attributes as data normalization services, patient disease registries, care management tools (care plans, templates and workflow) and some form of patient engagement capabilities. In adopting and deploying an HIE that goes beyond simple federated messaging, the HCO hopes to insure that appropriate care is delivered to a patient across all care settings and that all individuals (patient, loved one, case manager, nurse, doctor, etc.) that are a part of a given care team have the most current and relevant information associated with that patient, at their finger tips.

This is the goal of an HIE 2.0 but we are still quite a ways from getting there. Our latest end user research finds a market that is full of frustration. Despite all those Stage 1 certified EHRs that have been deployed, very few of them can actually create and/or parse a CCD. We are still in the land of simplistic and cumbersome HL 7 messaging. Some pretty big steps forward were made by the feds in Stage 2 to rectify this now well-known, but also fairly well-kept secret that HIEs today simply cannot readily support care management processes across care settings in a heterogeneous EHR environment. This week’s announcement to further push the envelop, via certification of HIE/EHR in conjunction with efforts that are being led by NYeHC are also a welcomed sign.

Ultimately, though, it will be market need that presses this issue forward, not the efforts of HHS, NYeHC and others. As HCOs continue their acquisition spree to build a robust ADS to serve their communities, these organizations will begin to have the marketing clout to force vendors to change their ways. For example, while Stage 2 may have had some impact on Epic’s decision to finally admit Care Elsewhere would forever be vaporware and have them strike a partnership with Surescripts, it is our belief that Epic’s customers were the ones that really forced Epic’s hand. Now if we could only apply similar clout to those ambulatory EHR vendors who hold their clients hostage with exorbitant interface fees – maybe this is where the feds can play their greatest role and Stage 2 is a strong step in the right direction.

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