We went into Chicago for this year’s HIMSS with an eye on the engagement space, and left with a sense that the market is undeniably moving forward. That being said, engagement is still a messy, immature area for healthcare, which was typified (and perhaps exacerbated) in the chaotic, unorganized jungle of the trade show floor. What follows here are some of our high level observations and light musings based on a very busy week of meetings, presentations, press releases, and criss-crossing the exhibition hall.
The concept of “portal sprawl” driving market appetite for a “portal of portals” was ubiquitous. Intersystems is the latest HIE outfit to leverage their back end capabilities into a singular point of patient access, following the likes of Orion, NoMoreClipboard, RelayHealth/McKesson, Jardogs/Allscripts, and others. Across the board, portal design and functionality is slowly but surely getting better – MedFusion’s new mobile app, Orion’s beta healthkit integration, Epic Mychart’s overhauled UI, and so on.
Yet: Successful engagement is more about how tools are used rather than which ones are bought. Put differently, engagement is a question of culture, not just technology. And today, it’s rarely the patient-facing stuff driving market acceptance of untethered portals, it’s the bigger interoperability issues between disparate systems. So while it’s nice to see greater attention being given to design, mobile features, and so on, health systems out there are still not moving much further past the VDT/e-mail type use cases for now. This is why vendors like IMS Health are still spending most of their time educating the market, three or four years after the concept of “app-prescribing” was promised by the likes of Happtique. This is also one of the reasons that there was such outrage at CMS’ proposed changes to Stage 2 requirements – leaders like Farzad know that the market will not do a lick more than the minimum mandated by the Feds.
But, some good news: there are (finally) vendors moving past the portal! Platforms like RoundingWell, Patient.IO, Conversa, and other care management/engagement plays continue to intrigue as they gain traction in the market, bit by bit. Conversa for example has built a virtual care coach that understands patient chat language (a very welcome upgrade from clunky secure e-mail platforms), responds intelligently with medically vetted messages, and records the whole thing in the record. This sort of approach-driven engagement tool, which puts as much focus on the “how” as the “what” seem like big steps in the right direction – even if it’s too early to look at outcomes.
Zooming out, a panoply of point solutions indicate a rift in how vendors serving outpatient vs inpatient facilities conceive engagement. For the former, vendors’ futures lie squarely in between/post-visit tools for communication, self-management, etc. For the latter– GetWell, OneView, Emmi – engagement’s value proposition is mostly about better HCAHPS scores and operational efficiencies. Each of those hospital-focused vendors claims to be moving out towards the patient with their product roadmap, but these appear to be halfhearted attempts; the last thing health system CIOs want today is another portal to manage. Beyond those traditional segments, home-based care is still somewhat of a mudpit with no clear winners on the vendor front. Telemonitoring, healthkit use cases, and so on are things that will probably start getting broad traction as modular components of big-box EHRs like Cerner and Epic, not as standalone solutions. We’ll hope to see and learn more at ATA in a couple of weeks.
Encouragingly, we did see a few signs of holistic thinking by vendors. West Corporation has been hard at work at re-vamping the dreaded call center experience (among other things). Rather than settle for an incomplete clinical record, a handful of vendors are starting to turn consumer data (age, tech savviness, geography, much more) into fodder for engagement. Influence Health just made a very interesting acquisition, Caradigm just partnered with Eliza, and a handful of other vendors ranging from payer-owned to clinical analytics whom we spoke with showed interest and signs of having performed basic due diligence. Much more to come here by next HIMSS.
In general however, healthcare, particularly on the delivery side, continues to settle for bunts when it comes to consumerism. Watching the outpatient segment flounder and refuse to move past sharing lab results, it’s been a welcome change to see the aggression of retail care outfits in entering this market. Walgreens had much bigger presence this year than in years past, from their keynote to the ongoing digital partnerships they’ve been announcing. Big Pharmacies could emerge as a provider-neutral, payer-neutral, and even vendor-neutral Switzerland. Pharmacists are cheaper than nurses and doctors, are younger and more tech savvy, and may play a big role in care coaching and real-time support. Our eyes are peeled for innovations and alternative approaches from the world of employers, payers, and consumer tech (if you see anything cool, let us know!). Also, outcomes – patient engagement desperately needs more of those.
Beyond the meeting itself, HIMSS was as always, an invigorating, socially-driven week to catch up with peers over overpriced churros or complimentary cocktails. The growth of social media over the last few HIMSS as a sort of glue to connect attendees, share ideas, find out trending topics, and find the best shwag is great to see (even if the HIMSS mobile app left a lot to be desired). We hope that the powers that be continue to improve the design, layout, and “digestibility” of the conference moving forward – there are no shortage of ideas. Thanks to all those individuals who took the time to meet with us – looking forward to the next one.