2013 – A Year of Surprises

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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Google Hits Reset Button on Google Health

Google Health has seemingly been stuck in neutral almost from the start.  Despite the fanfare of Google’s Eric Schmidt speaking at the big industry confab, HIMSS a couple of years back, an initial beta release with healthcare partner Cleveland Clinic and a host of partners announced once the service was opened to the public in May 2008, Google Health just has not seemed to live up to its promise. Chilmark has looked on with dismay as follow-on announcements and updates from Google Health were modest at best and not nearly as compelling as Google’s chief competitor in this market, Microsoft and its corresponding HealthVault.  Most recently we began to hear rumors that Google had all but given up on Google Health, something that did not come as a surprise, but was not a welcomed rumor here at Chilmark for markets need competitors to drive innovation.  If Google pulled out, what was to become of HealthVault or any other such service?

Thus, when Google contacted Chilmark last week to schedule a briefing in advance of a major announcement, we were somewhat surprised and welcomed the opportunity.  Yesterday, we had that thorough briefing and Chilmark is delighted to report that Google Health is still in the game having made a number of significant changes to its platform.

Moving to Health & Wellness

Today, Google is announcing a complete rebuild of Google Health with a new user interface (UI) a refocusing on health & wellness and signing on additional partners and data providers.  Google told Chilmark that the new UI is based upon significant user feedback and a number of usability studies that they have performed over the last several months. Rather than a fairly static UI (the previous version), the new UI takes advantage of common portal technologies that allow the consumer to create a personalized dashboard presenting information that is most pertinent to a consumer’s specific health and wellness interests and needs.  So rather then focusing on common, basic PHR-type functions, e.g., view immunization records, med lists, procedures and the like, the new UI focuses on the tracking of  health and wellness metrics. This is not unlike what Microsoft is attempting to do with MSN Health and their health widgets that subsequently link into a consumer’s HealthVault account, though first impressions lead us to give a slight edge to Google Health’s new UI for tracking health metrics.

A particularly nice feature in the new Google Health is the consumer’s ability to choose from a number of pre-configured wellness tracking metrics such as blood pressure, caloric intake, exercise, weight, etc.  Once a given metric is chosen, the user can set personal goals and track and trend results over time.  There is also the ability to add notes to particular readings, thereby keeping a personal journal of what may have led to specific results. And if one cannot find a specific health metric they would like to track, the new platform provides one the ability to create their own, for example the one in the figure below to measure coffee consumption. Nice touch Google.

On the partnership front, Google is also announcing partnerships with healthcare organizations Lucille Packard Children’s Hospital, UPMC and Sharp Healthcare and has added some additional pharmacy chains such as Hannaford and Food Lion among others.  On the device side, Google has the young Massachusetts start-up fitbit (novel pedometer that can also monitor sleep patterns) and the WiFi scale company, Withings.  On the mobile front, Google has added what they say is the most popular personal trainer Android app, CardioTrainer and mPHR solution provider ZipHealth (full disclosure, I’m an advisor to the creators of ZipHealth, Applied Research Works) which has one of the better mPHR apps in the market.

If any metric is a sign of pent-up consumer demand for what Google Health will now offer it may be CardioTrainer. In our call yesterday, the new head of Google Health, Aaron Brown stated that they did a soft launch of CardioTrainer on Google Health by just putting a simple upload button in CardioTrainer that would move exercise data to a Google Health account.  In two weeks, over 50K users have uploaded their data to Google Health. Pretty incredible.

Challenges Remain

Chilmark is delighted with what Google has done with Google Health.  The new interface and focus takes Google Health in a new direction, one that focuses on the far larger segment of the market, those that are not sick and want to keep it that way through health and wellness activities.  Today, within the employer market, there is a major transition occurring with employers focusing less on disease management and looking towards health and wellness solutions that keep their employees healthy, productive and out of the hospital. Google may be able to capitalize on this trend provided it strikes the right partnership deals with those entities that currently serve the employer market (payers and third party administrators).  Chilmark will not be holding its breath though as to date, Google has not had much success in the enterprise market for virtually any of its services.

And that is one of many challenges Google will continue to face in this market.

First, how will Google readily engage the broad populace to use Google Health?  Google has struggled in the enterprise market, regardless of sector, and will likewise struggle in health as well, be it payers, providers or employers. Without these entities encouraging consumers to use Google Health (especially providers as consumers have the greatest trust in them), Google Health will continue to face significant challenges in gaining broad adoption and use of its platform.  But as the previous example of CardioTrainer points out, Google may have a card up its sleeve in gaining traction by going directly to the consumer through its partners, but it will need far more partners than it has today to make this happen.

Second, the work that Google has done to re-architect the interface and focus on wellness, particularly the tracking and trending of biometric or self-entered data is a step in the right direction, but Google has not been aggressive enough in signing on device manufacturers that can automatically dump biometric data into a consumer’s Google health account.  Yes, Google is a member of the Continua Alliance but Continua and its members have been moving painfully slow in bringing consumer-centric devices to market. HealthVault, with its Connection Center, is leaps and bounds beyond where Google is today and where Google needs to be to truly support its new health and wellness tracking capabilities.  Google’s ability to attract and retain new partners across the spectrum of health and wellness will be pivotal to long-term success.

Third, Google has chosen not to update its support of standards and remains dedicated to its modified version of CCR.  While CCR is indeed a standard that has seen some uptake in the market, Chilmark is seeing most large healthcare enterprises devoting their energies to the support of the CCD standard.  In our conversation with Google yesterday we mentioned this issue and Google stated that they are hoping the VA/CMS Blue Button initiative will take hold and provide a new mechanism by which consumers retrieve their healthcare data and upload it to Google Health.  The Blue Button is far from a done deal and has its fair share of challenges as well. Google is taking quite a risk here and would be better off swallowing the CCD pill.

In closing, Chilmark is quite excited to see what Google has done with their floundering Google Health.  They have truly hit the reset button, have a new team in place and are refocusing their efforts on a broader spectrum of the market.  These are welcomed changes and it is our hope that with this new focus, this new energy, Google will begin to show the promise that we at Chilmark have always had for this company to help consumers better manage their health.

Addendum:
9/24/10 – Earlier this week, I was interviewed by SearchHealthIT.com. They have created a podcast of that interview that provides further “color” to the Google Health Reset story.

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