At the Intersection of Obesity and HIT

We Americans are on a very terrifying path, health-wise, based on the latest obesity projections from RWJF.

Medical “innovations” around the obesity epidemic are unsettling, to say the least. Most recently, Dean Kamen (of Segway fame) filed a patent for a self-serve Stomach-Pumping Machine.

Disturbing medical devices aside, what does the obesity crisis mean to healthcare IT (HIT)?  Yes, increasing obesity rates means more metabolic syndrome, more intervention, more biometric data,more data stored in EHRs, more HIE to share that data, more clinical analytics and care coordination software, …

Does this sound interesting to you?  In my research I am more focused on how technological innovation can function as a solution to the obesity crisis. First let’s consider the payers — the large, innovative ones who continue to rally for behavior change.

Payer-Sponsored Wellness & Patient Engagement Soldier On

Payer-sponsored behavior change programs have never sustained results in the long term, but this doesn’t stop the early adopters from soldiering on.   For our 2012 Payer Benchmark Report, we profiled several large, innovative payers working to engage their members and the public through low-cost consumer technologies.

Some interesting new developments in this space include:

  • Aetna is looking to make running on a treadmill bearable. Its new ‘Passage’ app (storing data in CarePass), promises to make exercisers feel as if they are travelling within a city of their choosing.
  • Cigna has just released a ‘Healthy Living App Pack’, bundling the extremely popular FoodEducate app with 3 less-popular ones.  (Cigna didn’t develop FoodEducate, but licensed it from founder Hemi Weingarten).
  • Humana has begun offering the HumanaVitality rewards system to a group of Medicare Advantage members. Let’s hope that seniors will take more kindly to this program than to HumanaVille, Humana’s failed attempt at creating an online senior health education community.

Consumer Health Companies Need to Move Beyond Fanatics

If payer apps can’t motivate widespread weight loss, then maybe the consumer space can? Consumer companies are currently busy developing software and testing out motivational models on the fly.  This is not exactly the scientific method but it works for small agile environments…and is definitely something that large payers are less adept at.

There is a belief among many of the quantified-self set that just the act of presenting health data to the consumer affects behavior change.  I seriously doubt this, and believe that consumer health startups have played a miniscule role in affecting real behavior change.  So far, they have provided diet and exercise fanatics better tools to fuel their obsession.

In order to reach the ‘bottom of the pyramid’, must we then dole out dollars for weight loss? I recently spoke with Gregory Coleman, one of the founders of nExercise, which offers a gamified “rewards program” where users randomly accumulate points, similar to a lottery, which can be applied towards real world discounts.

(nExercise is also the driving force behind the recently formed FITco, or ‘Founders In Technology Combating Obesity’. FITco functions as a place for founders to form data sharing/interoperability partnerships, and aggregate marketing dollars).

Talking with Gregory, I found myself better understanding the challenges these consumer companies are up against as they seek to move beyond their core base.  In offering financial incentives, they must spark interest without destroying intrinsic motivation. Framing financial incentives in term of ‘rewards’ and ‘discounts’ helps, but the real goal is to wean users off of them.

Cash, Friends, and Coaching: A Pipe Dream?

Several academic studies have shown that a combination of financial incentives, social support, and coaching from a trusted ally, produced significant behavior change, at least in the short term.

I can imagine a day when I seamlessly upload exercise and diet related data into a CarePass-type platform, where:

  • my insurance carrier’s app notices that I have been working out, maintaining my BMI, and applies discounts to my premium.
  • my doctor’s app (motivated by value-based reimbursement), suggests that I keep my maximum heart rate below 160 BPM
  • I display achievement badges to my friends, and make my data available to health companies in order to receive discounts/free samples

Hmmm, what is that distant feeling of unease, the feeling like I am a pawn in someone else’s Grand Plan?  It might have something to do with the complete loss of privacy around my data.  However, if those premium discounts are steep enough, I can live with that.

Whether we get people sharing their health data or tempt them with financial incentives for weight loss, the systematic nature of the obesity problem remains a force to contend with. In the end it will be up to all of us to push back against the institutions that make us fat. Seeking out motivational consumer solutions is a low cost place to start.

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Looking Back on 2011 – What A Strange Year It’s Been

It is almost becoming the norm to say that it has been another tumultuous year in the healthcare IT market. Market consolidation, pushback on timelines, growing chorus from IT departments that enough is enough against the backdrop of the political circus in Washington and across the land as we prepare for the 2012 election year. If 2011, was a bit bumpy, believe we will see craters in the road to HIT enlightenment in 2012. But we’ll save that discussion for our future predictions for 2012 post, which we hope to get to next week. (Editor’s Note: Don’t hold your breath though, if the snow flakes are flying, we’ll be on the slopes next week.)

Today’s post takes a look back on 2011 by reviewing our predictions earlier in the year and assessing where we hit the mark, where we missed and if there is such a thing, where we came close. So without further adieu…

1. MU Initiatives Move to Tactical 
Hit This did come true as meaningful use, while still top of mind for the CIO, is not top of mind for others in the executive suite who are now looking at how to compete in the future as reimbursement models shift from fee-for-service to value-based contracts.

2. C-Suite Strategy Focuses on New Payment Models 
Hit An admittedly “softball” prediction, this was a natural fall-out of prediction numero uno. And yes, the consultants are making out like bandits as we predicted they would helping senior execs figure out their future competitive strategy.

3. RCM & Charge Capture Systems Require Overhaul 
Miss By and large, most vendors in this sector have not done a whole lot yet as they await to see how the market develops. With most healthcare organizations struggling to get the basics done (e.g., meet MU requirements, ICD-9 -> ICD-10, apply analytics, etc.) we are not seeing big demand from customers and subsequently, not a big push by vendors.

4. Mergers & Acquisitions Continue Unabated
Hit Another “gimme” of sorts for we had this prediction in 2010 and it was a “hit” and need only look at this market with its some odd 300+ EHRs to choose from, everyone wanting to call themselves at HIE vendor (last we checked, HIMSS listed some 189 HIE vendors alone), countless other HIT solutions to see that this market is far from mature. But arguably the biggest news in 2011 was Microsoft’s capitulation that despite the billion dollar plus investment, it wasn’t cut out or the clinical market and dumping its HIT assets into a new joint venture with GE. What we are also seeing is some rationality return as valuations have moderated. This may have led to Thomson Reuters’ recent decision to not sell-off its healthcare division – no one was willing to pay the high price tag they had on this property.

5. Federally Funded State Initiatives Struggle
Toss-up There has been some progress and there are those that would vehemently argue that Beacon Communities, RECs and state HIEs are moving ahead briskly. But then again, we do get some disturbing reports that all is not progressing as once envisioned, one might even go so far as to say some of these programs are beyond just struggling, but clearly going off the tracks. We’ll reserve judgment until we see clear evidence of such pending disasters, which will likely be prevalent, but highly distributed.

6. Changing of the Guard at ONC
Hit Not long after we posted our 2011 predictions, Blumenthal announced his resignation from ONC. We could not have been more prophetic if we tried.

7. Physicians will continue to go Ga-Ga over the iPad and the fast-following touchscreen tablets much to the chagrin of CIOs.
Hit Enabling physicians access to health information systems via their hand-held mobile devices, including touch-screen tablets is still a struggle for most organizations. At first, IT departments turned to Citrix as stop-gap measure, but the UX was far from ideal. In our recent research we found many an IT department still struggling to address this issue. mobile enablement of physicians is a top priority.

8. Apps Proliferate: Consumer-facing First, Private Practice Second, Enterprises Dead Last
Hit In hindsight, another admittedly easy prediction to make. What may be a more interesting prediction is when will mHealth Apps really become a truly viable market? Does the profitable exit of iTriage/Healthagen, which was picked up by Aetna portend such? By our standards, no. Go back to our recent post from the mHealth Summit for more in-depth analysis.

9. The Poor Man’s (doctor’s) HIE Takes Hold
Miss We thought that the Direct Project would quickly take hold and see rapid adoption among smaller physician practices and those organizations looking to “connect the last mile” to small affiliated practices in their network. Not happening yet though the current administration is doing its best to push this technology by requiring all state designated entities that are standing up statewide HIEs to include Direct in the strategic operating plan.

10. Analytics & Business Intelligence Perceived as Nirvana 
Hit, kind of… 
In retrospect, not even sure this was really a prediction but simply more of a statement as to where healthcare organizations are headed with their HIT investments. We have a long ways to go, though there is certainly no lack of vendors that now are touting some form of analytics capabilities. Our advice, tread carefully as most solutions today are half-baked.

11) The Buzz at HIMSS’11? Everything ACO! 
Miss 
While some vendors were discussing ACO enablement at the 2011 HIMSS, the vast majority were not with the key focus continuing to be meeting Meaningful Use requirements. As mentioned in previous prediction, we see MU as a tactical issue with the strategic issue being: How do we leverage IT infrastructure to support communities of care? Maybe at HIMSS’12 we’ll see more discussion of this issue, but we’re not holding our breath.

This may have been our best year yet with our predictions having only 3 clear misses out of 11 predictions made. Granted, some of those predictions were not exactly the most profound or shall we say big stretches, but we do take some satisfaction in really nailing a few.

And while we intend to provide our own 2012 predictions, no time like the present to begin the process. So we ask you dear reader, what is your 2-3 top predictions for 2012? Will Todd Park stay on at HHS? Will forced budget cuts decimate HITECH? Will the Supreme Court’s ruling on ACA have any impact on HIT spend by either payers or providers? Will mHealth Apps such as WellDoc’s for diabetic care finally receive a CBT code thereby accelerating adoption of such tools?  We look forward to your input.

And of course we wish everyone a Joyous holiday season and wish you and yours continued good health in the new year to come.

Home for Christmas by Thomas Kinkade

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Dr. Watson I Presume

Little over a month ago, IBM and WellPoint announced an agreement wherein WellPoint will deploy IBM’s latest and greatest super computer and artificial intelligence mega-mind Watson. Watson’s claim to fame was its ability to beat the human Jeopardy champions much like Big Blue beat reigning chess champion Garry Kasparov in 1997. Since that Jeopardy match, IBM has been quite vocal about its desire to apply Watson in the medical arena, we’ve been buried in press releases and briefings, but the WellPoint announcement is the first one of any real consequence. Having interviewed both IBM and WellPoint, following is our review and assessment.

Background:
Watson is a relatively new form of artificial intelligence, based to some extent on neural networks. What is unique about Watson is that it has been developed (trained) to understand the nuances of language. It is a question & answer system that uses among other techniques, natural language processing, to extract meaning out of unstructured data. In developing Watson for the Jeopardy challenge, one of the key design parameters was for Watson to answer a question in under three seconds – plenty fast enough in a diagnosis/treatment decision scenario. This is a key reason why Watson may have enormous utility in the healthcare sector where so much data is unstructured, the pace of change is so high and the ability to chose the optimum treatment patient plan for a given diagnosis is less than ideal today.

WellPoint is the largest payer in the US with some 34.2M members and 14 Blues across the country. Despite this impressive size (or maybe because of it), WellPoint has been far less aggressive than others in the HIT realm, especially for those systems used by providers. In signing this deal with IBM, WellPoint is signaling to the market, and likely those on Wall Street, that they intend not to be left behind. In asking WellPoint about their HIT strategy, WellPoint CIO Andrew J. Lang told Chilmark that WellPoint’s intent is not to create a new line of business (as is the case with UHG and Aetna) but to improve the quality of health delivered to their members by providing physicians the best tools possible. Certainly a noble goal, but only time will tell as to how closely they adhere to such a goal.

What it is:
While IBM is pursuing a number of potential vertical markets for Watson, including financial services, this is the first actual “Win” for IBM’s Watson. Money is changing hands with WellPoint paying an undisclosed amount to deploy Watson.

Watson will be deployed as a “cloud-based” service. Actual pricing for accessing this service has yet to be determined but as WellPoint put it to us, they do not want to create barriers to physician use. Thus, don’t be too surprised if it is offered virtually free to in-network providers, clinics and hospitals.

The Watson intelligence service will focus first on three oncology domains (breast, lung and colon cancer) that WellPoint’s internal clinical staff have determined most promising. These three were chosen for they are areas where WellPoint’s claims data shows high variability in treatment; there are significant, on-going advances in research and treatment; and a high likelihood for demonstrating the utility of a system such as Watson.

WellPoint does not intend to displace physician decision making, but augment it. WellPoint states that physicians will still be able to ultimately make their own decision as to the best course of action (treatment) for a given patient. As CIO Lang stated:

Watson is intended to be a doctor’s assistant, the doctor is still in the driver’s seat.

Watson is currently undergoing “training” with reams of data (research, claims data, etc.) in the three oncology domains being fed into it, questions being posed, answers evaluated against real clinical evidence to bring Watson up to a significant “confidence level.” The Watson service will be released in the first quarter of 2012.

Implications:
Among the multitude of announcements that pass across our computer screen on a daily basis, this is one that really piques our interest. Like any exceedingly powerful technology, Watson has the potential for good and likewise the potential for harm. If WellPoint follows its stated intent of deploying Watson as a service, as an assistant to the practicing physician, facilitating the care process with more rapid and accurate first time diagnosis and suggesting a treatment plan that is most relevant to that specific patient, then Wow, this could be truly game changing and far in excess of what other payers have done to date in the HIT realm. If, however, WellPoint’s deployment of Watson becomes prescriptive wherein physicians are no longer in the driver’s seat, then “Houston, we have a problem.”

Having personally seen what can happen when someone is misdiagnosed, when appropriate treatment is delayed, particularly for an aggressive form of cancer, the anguish and subsequent anger is nearly unfathomable. If Watson can indeed short-circuit the diagnosis and guide physicians to the most appropriate treatment in an expeditious manner, well then hat’s off to IBM for developing Watson and WellPoint for taking the risk to be the first to deploy Watson in the healthcare sector.

Dr. Watson, do you accept house calls?

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Trickle Down Health or Health 2.0 Impressions

Another year, another Health 2.0 under the belt. This being the fourth time attending it is interesting to see how this event and its participants have evolved. Like many things in life, some things at Health 2.0 have changed, some have not, most for the better, but there remain some troubling aspects to this event that cannot be ignored.

When thinking back on the demos of countless vendors of years’ past, this year’s Health 2.0 had two distinguishing characteristics:

Demos are cleaner, with better user interfaces (UI). The companies demoing at Health 2.0 are spending a lot more time and resources on creating inviting, clean and engaging interfaces that are a welcome change from the cluttered messes of demos past. As with Mark Twain’s famous quote: “I would have written you a shorter letter if I had the time.” reducing an application to its core elements takes time. Clearly, the majority of Health 2.0 vendors this year have spent the time and resources necessary to create a simple and engaging environment for the end user.

Business models are more sophisticated. At the first Health 2.0 event, just about every single vendor there stated that their business model was going to be based on some mix of Freemium and advertising revenue. Needless to say, just about every Health 2.0 start-up from that conference has either gone out of business, is among the walking dead (takes a lot to completely kill a company – trust me, I’ve been there) or has changed their model to survive. This year, the business models presented are more creative and for some, likely to see success in the market.

The contributing factor to these two changes is the amount of money now flowing into the health IT sector. Investors smell opportunity and are placing some pretty big bets as represented by the investments in Castlight (~$80M), ZocDoc ($50M) and CareCloud, who announced a $20M round at the event. That’s some serious cash and with all the investors that were present at this event, quite sure there are more investments in the wings.

Snap-shot impressions of demos:

  • Mobile remains hot but no one seems to have figured out a way to rise above the noise.
  • Big data is the new hot phrase but few understand its implications. Most demos simply demonstrated even more fractionation of data into distinct silos with no clear path towards aggregation.
  • Many see the key to success as becoming the facebook of healthcare with a Zynga Farmville thrown in for good measure. By the end of two days, just about ready to strangle the next demo that started with some reference to facebook and/or gamification.
  • Pricing transparency is a big area of focus for many but seriously doubt most will get past their first round of angel funding as this is already a competitive market. Speaking of which, almost as frustrating as short vacuous demos is the lack of clear arguments by those giving these demos as to why they’ll succeed.
  • Demos never get into details, thus rarely instructive.
  • Many platform plays, ala PaaS, but like big data, few truly understand what that means and how to get there.

While Health 2.0 can get overwhelming with the number of rapid fire, albeit  shallow demos from the multitudes of vendors who are all trying to make their mark in a market that has experienced a significant amount of churn, the event is invigorating for the passion that is shown. Sure, everyone is hoping to make a living on their next greatest innovation, but unlike virtually any other health IT related conference, those at Health 2.0 have passion. They are on a mission. They want to truly change healthcare. They want to make a difference. That passion is contagious. Unfortunately, that passion appears to be confined to the digerati.

Looking around at the Health 2.0 audience one sees a sea of almost exclusively upper, middle class professionals that are tapping away on their iPad, smartphone or laptop. When one sits back and thinks about the many demos seen, virtually all of them seem to be designed for this audience. Maybe the most disturbing part of the event was the on-stage interview with a mother of eight kids (she was white, middle age and clearly upper middle class) showing how her family is tapped into the quantified self movement with the various Apps they use to track their health and fitness. This is not representative of the broad swath of the American populace who are the ones that will drive our healthcare system off the proverbial cliff. It is that grandmother in Indiana who is caring for her diabetic, overweight husband, two grandchildren, a daughter suffering from an addiction and a son-in-law who is unemployed and has no health insurance that we need to talk to, have up on stage to tell us what they need to better manage their health and interaction with the healthcare system. And we need not go to that extreme, how about just having someone from a safety-net clinic talk about their needs? Sadly, no such representatives were to be found at Health 2.0.

It is this detachment that has Chilmark most concern with this passionate movement. Yes, virtually all Health 2.0 participants are passionate about helping all healthcare stakeholders but if we do not start talking to a broader cross-section of the populace, this movement may be much like the barricade scene in Les Miserables wherein the students leading the call for a revolution end up dead and with little to show for they had not engaged the populace-at-large. Some may argue that like this technology will indeed trickle down to the masses in much the same way that smartphones are now replacing feature phones in the mobile market. This “trickle-down theory may indeed come to pass but then again, we could just as easily end up with something very similar toPresident Reagan’s trickle-down theory for wealth distribution and we all know what the end result of that has been.

 

 

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RIP Google Health

Chilmark Research has not had a very good feeling about Google Health for well over a year now. Back in early May of this year we felt that Google had all but given up and had put Google Health in stasis. Today, Google made it official, Google Health has a little more than six months to live, then it will get the Kevorkian treatment with Larry Page administering the final lethal dose.

First yellow flag
Going back to the hey days of mid 2007, Google seemed to be chugging along quite nicely with its plans to enter the consumer health market. They had Adam Bosworth leading the team, excitement filled the air and then, seemingly out of nowhere, Bosworth up and quits. Google stumbled along under Marissa Mayer, but it just didn’t seem to have the same level of excitement. Microsoft, who was busy with their own consumer health play, HealthVault, seemingly wanted to jump the gun and have the limelight shine on them releasing HealthVault in October 2007. A premature launch as HealthVault was far from being ready for prime time – it was painful.

Yellow flag number two
Google went along at a methodic pace and finally unveiled Google Health at HIMSS’08 during Google CEO Eric Schmidt’s keynote presentation. (Google threw a great party that year at HIMSS, one of the better ones.) It was a limited beta release with Cleveland Clinic wherein they had hoped for 10,000 users, but far fewer actually signed on.

Three yellow flags and counting
Google Health was formally released to the public in May 2008. It was an elegant solution, very Google-like, obviously, with easy navigation, uncluttered screen, simple to understand, simple to use. Like their competitors to the north, Google had signed on a number of partners to create a health ecosystem of services/apps that a consumer could leverage to assist in managing their health and wellness. But there were also a few problems, the biggest one being that Google only supported a bastardized version (they modified it) of the Continuity of Care Record (CCR) standard thereby limiting what a consumer could actually import into their Google Health account. So despite having a blue ribbon advisory board, Google Health seemed to not want to fully connect to the healthcare community, the doctors, the hospitals, etc. – the ones holding the data! Google also struggled to sign-on additional partners to create a richer ecosystem and were way behind Microsoft in importing biometric data..

A bouquet of yellow flags
And as one observed Google Health in the ensuing years, one got the sense, that is if you were observant, that the Google Health team of engineers was very small and the leadership at the top of Google Health was a revolving door. Without consistent leadership, without a sufficiently large team and without the business development folks to strike partnerships, Google began struggling for legitimacy in less then a year. And now, by January 1, 2012, Google Health will go into the dustbin of the consumer health movement joining the likes of Revolution Health (at least Google didn’t waste as much money as Steve Case did) and a host of others.

Lessons Learned and Implications:

Healthcare is a tough market in and of itself and the consumer health market is even tougher. There is a paucity of consumer health information in structured, machine computable format. Maybe in a few years once we get doctors comfortable using EHRs and readily sharing records with their patients that may change, but that is still a few years out.

Few consumers are interested in a digital filing cabinet for their records. What they are interested in is what that data can do for them. Can it help them better manage their health and/or the health of a loved one? Will it help them make appointments? Will it saved them money on their health insurance bill, their next doctor visit? Can it help them automatically get a prescription refill? These are the basics that the vast majority of consumers want addressed first and Google Health was unable to deliver on any of these.

Without a worthy competitor, will Microsoft no longer feel the need to further invest in enhancements and features for HealthVault? Will Microsoft reassign those engineers elsewhere and basically put HealthVault in its own form of stasis? It’s not like HealthVault has been a screaming success in the market and Microsoft has some major work to do on Amalga to improve its own track-record there. Also, since Microsoft is no longer under the protective wing of R&D and now in Microsoft Business Solutions (MBS), thus it now has clear sales targets to reach and a more restrictive P&L. Don’t be too surprised if HealthVault goes into its own quiet period for the next 18-24 months. The only thing that may change our opinion is Microsoft’s success overseas with HealthVault.

Engaging the consumer/patient most often begins at the doctor’s office. If you do not get the physician(s) involved, actively promoting the patient to use such tools as Google Health and likewise do the hard work of creating value for the physician it may be nearly impossible to gain real traction. WebMD takes a slightly different approach, getting employers to actively promote (most often through incentives) to employees to use WebMD. But again, it takes someone advocating on your behalf. Google thought that if they built it, consumers would come on their own to Google Health. Sorry Google that was a gross mis-calculation, one may even call it arrogant.

Who ya’ gonna trust. There is still a significant portion of the populace that is reluctant to trust Google, Microsoft or just about anyone else up there in the Internet Cloud with such personal information as their health records. The reality of privacy and security of health records is far more nuanced and a consumer’s records may actually be safer in Google Health or HealthVault but that is another conversation. Bottom-line, consumers remain quite wary of putting their records into these types of services which hinders adoption.

Though we saw it coming, it is still a sad day to see the passing of Google Health. May she Rest in Peace.

Addendum:
Sean Nolan, Chief Architect at MSFT has some words of his own on the demise of Google Health as well as clear instructions on how to export your Google Health data to HealthVault. Worth the read.

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Microsoft HSG Bets Future on Amalga

Microsoft’s Health Solutions Group (HSG), which has straddled the fence with consumer-facing (HealthVault) and corporate-facing (Amalga), is increasingly moving to the corporate side of the fence. Not that surprising considering that the consumer market continues to struggle (Google Health is in virtual mothball state, consumer adoption of HealthVault is nothing to write home about) and that HSG has now moved out of R&D and is now under the business solutions group, Dynamics. At the end of the day, HSG head Peter Neupert has to show that he can deliver the goods and Amalga is the horse he’s betting on (Note: Sentillion is there as well, but think of Sentillion as the gate-keeper to accessing Amalga).

Yet Amalga has gone through its share of birthing pains with some in the industry beginning to question its value.

Amalga has suffered from two significant problems, both inter-related. The first is that Amalga is an extremely powerful set of data aggregation and analytical tools, but it is more of a toolset then a product and this leads to long implementation time-frames and subsequently an inability to extract value quickly (ROI for Amalga is measured in years). For example, in 2009 Golden Living signed on to adopt Amalga and HealthVault. At last week’s Connected Health Conference, (CHC) Golden Living presented some remarkable results of how they are transforming long-term care through the use of Amalga. But in their presentation, Golden Living also stated that they knew full well when signing on to Amalga that this was going to be a multi-year effort and their implementation team has been given 5 years to put Amalga in place. Five years to fully implement a software solution is a very long-time and similar to the installs of the largest EHR systems. Unfortunately, many early Amalga customers did not have the foresight of Golden Living. In recent conversations with Microsoft, Chilmark has been told that significant resources are now being dedicated to improving time to value for Amalga. We’ll have to wait and see as the CHC sessions we attended on Amalga and HealthVault Community Connect, did not make this readily apparent.

Secondly, the flexibility of Amalga led Microsoft to pursue a number of different strategies and markets. One apparently aborted strategy was for Amalga to become a Platform as a Service (PaaS) when it announced at the 2010 HIMSS its partnership with Eclipsys wherein specific Eclipsys modules would run on top of the Amalga platform. Well a platform is not a platform if it does not support an ecosystem of third party applications. To date, Microsoft has announced no additional partnerships similar to that of Eclipsys for Amalga so this strategy has stalled.

This was also looking to be the case for Microsoft’s HIE strategy. In the profile we did of Microsoft for the HIE Market Report we questioned whether or not Microsoft would stick with this market as they had not had a significant HIE win in nearly a year. In a conversation with a CIO of a large academic medical center at CHC, he also brought up the question of whether or not Microsoft was committed to supporting HIE functionality within Amalga, so clearly we were not alone in our opinion. Those fears were put to rest last week when Microsoft announced the Chicago HIE contract win, which is a monster representing some 70% of the healthcare facilities and a population of 9.5 million in the Chicago metro area. The Chicago HIE is a very visible win for Microsoft and a clear signal that they intend to be a major player in the HIE market.

It was also clear at CHC that Microsoft HSG is very focused on Amalga. The majority of sessions were dedicated to various aspects of leveraging Amalga (clinical decision support, care transitions support, comparative effectiveness, etc.). Virtually all users we spoke to at CHC were there to learn more about Amalga. And maybe the most telling sign was the list of exhibitors. Unlike CHCs of the past, there was not one EHR company, very few third party software vendors (~14%), and only a couple of exhibitors with clear connections to HealthVault.  Consulting and service firms, however, were there in force representing over 50% of exhibitors.

While the Chicago HIE win is a strong vote of confidence in Amalga sending a clear signal to the broader HIT market, Amalga is not out of the woods yet. Broader adoption of Amalga will be highly dependent on Microsoft’s ability to further “productize” Amalga to insure faster installs and accelerate time to value. In today’s market, where senior IT executives of healthcare organizations are literally swamped in various initiatives (e.g., 5010, ICD-10, EHR/meaningful use), the last thing most want to adopt is an Amalga toolset. Developing Amalga to address specific use cases will go a long way towards seeing broader adoption of this potentially powerful solution.

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