A little over a week ago Google stated that it was putting a stake through the heart of their personal health platform (PHP) Google Health. We at Chilmark had been expecting this for some time, it was just a manner of when it would become official. Thus, we were somewhat taken aback by all the publicity surrounding this final chapter with our own post on the topic receiving well over 40 comments and link-backs (that may be a record – thanks everyone for contributing to the story). With the closing of Google Health, we postulated in that post that Microsoft really had no other worthy competitor that will challenge them to continuously make enhancements to HealthVault. We may have spoken prematurely.
Stepping in to take the place of Google, is none other than an ol’school EHR company (and one of the largest), Cerner, who provided their own commentary on the demise of Google Health and their future intentions. Last week we had the opportunity to talk with the Cerner Health and learn more about those intentions but before getting to that, some quick background.
Taking a different tack:
Cerner has been in the HIT business now for 31+ years having grown to one of the leading EHR vendors in the market. You’ll usually find their systems (EHR: Millenium) in large healthcare organizations. This sector of the EHR market is seeing fierce competition as Epic seems to pick up one win after another at the expense of others, including Cerner. While continuing to go head-to-head with Epic, it appears that Cerner has also chosen to take a different tack, adopting a philosophy of: if you can’t beat them straight up, change the rules of the game.
In this year’s Annual Report, co-founder and chairman Neal Patterson spoke of Cerner’s origins, its staying power in the market but most importantly, the desire to transpose Cerner from a “care company” to a “health company” stating his belief that
…the business of health may eventually become a bigger business than the business of care.
In conversations with several Cerner executives, it becomes pretty clear that this company is truly looking to remake itself into one that adopts an open approach to not only sharing information (Cerner was very instrumental in the Direct Project) but provides a foundational “network of services” to enable “communities of care.” Those communities can be within a city, a region, an employer or a State. On the HIE front, Cerner recently won the Missouri State contract (not too surprising, it is in their backyard) but Cerner is also looking to land additional multi-stakeholder, HIE contracts with their partner Certify Data Systems. Unlike virtually all other EHR-derived HIE solutions, Cerner’s is actually pretty open and can interface readily with any EHR provided the EHR uses common data standards (e.g., CCD, CCR, etc.). But what may be even more interesting then what they have done in the HIE market, is what Cerner intends to do in the broader consumer market.
Last year at Health 2.0 a couple of representatives of Cerner made a fairly simple but engaging presentation on some of the gaming concepts they were developing which reminded one of some of the earlier developments at what is now Humana’s defunct skunkworks, Crumple It Up. Though a bit gimmicky, the presentation caught one’s attention as it was certainly out of character for any EHR vendor, let alone one of the leaders.
Now, some nine months later Cerner announced its intention to take Cerner Health beyond what Google Health was (not too hard to do). The leadership team at Cerner Health graciously hosted a call with Chilmark Research to further discuss exactly what those intentions are which are outlined below:
Provide a wide range of health & wellness services for employers.
Cerner has been eating its own “dog food” for the past year using Cerner Health to promote health & wellness among their employees who to date have lost a combined 12 tons of fat (take that Biggest Loser). This weight loss program will be rolled-out across Cerner’s home town of Kansas City (employers, providers, etc.) in two weeks. Cerner Health will target a number of other health & wellness areas, with programs that include built-in incentives. Clearly, Cerner is targeting WebMD in the employer market, a market that has seen very few comprehensive solution suites and WebMD has been milking that market for a longtime and is vulnerable.
Facilitate population health management – address “communities of care.”
For some time now, employers and payers have been looking to better manage their populations to lower medical loss ratios (MLRs). Providers will be looking to do the same as they take on a greater share of the risk via new contracts (e.g. BCBS-MA’s Alternative Quality Care contract) and future Accountable Care Organizations (ACOs). Cerner Health intends to serve both employers and provider needs in this regard with “Health Graphs,” a conceptual analytics framework that combines multiple data streams to provide an accurate view of population health at the community level. The Health Graphs concept is still a bit fuzzy (as are most data analytics models to address this issue) but what we do like is the focus on communities. To be truly successful at addressing population health, one must operate from that community level. Cerner Health correctly perceives health as a community issue where within a given community, be it an employer, a hospital, a specific condition, a town, a region, etc., there are unique needs requiring a focused approach.
Provide a PHP with an ecosystem of third party apps and go direct to consumer.
Cerner Health will go head-to-head with HealthVault by offering a PHP with a published software development kit (SDK) for third party independent software vendors (ISVs) by year-end. This will enable an ecosystem of applications to potential sit on top of the Cerner Health stack. Currently, the SDK is undergoing testing with a limited set of beta ISVs to fully flush-out capabilities, documentation etc., before a broader roll-out. In addition to releasing the SDK at year-end, Cerner will also open the doors to any and all consumers/patients to store their personal health information (PHI) on the Cerner Health PHP. Similar to HealthVault, Cerner Health will support all leading data standards, Project Direct protocols, and certainly allow one to upload their Blue Button files to the PHP.
The big challenge for Cerner on the PHP front is soliciting ISVs to join. Many will perceive Cerner as a competitor to their own initiatives and one should not expect competing EHRs (Allscripts, eClinicalWorks, Epic, GE, Nextgen, etc.) to readily partner either. Where Cerner Health draws the lines of what it intends to take to market and what it will look to partners to provide remains unclear. In what is still a very immature market, this is not necessarily a bad thing but it will prove challenging for Cerner to build-out that ecosystem on the PHP without clearer articulation of intentions.
Cerner’s entry into the health market is a bold move and hardly a slam-dunk. Reading between the lines, Cerner Health has an extremely broad charter that will likely bring it into competition with a wide range of vendors outside its traditional EHR haunts including Microsoft, Intuit and WebMD to the multitude of disease management firms and of course population health analytics firms such as Ingenix, Thomson Reuters, SAS and IBM. Have they bitten off more then they can chew? That’s a very real possibility. But one thing this company does have going for it is staying power and one would be foolish to discount them this early in what will be a very long race.
Thanks for the great analysis & update John!
Cerner and many other companies are attempting the transformation to become a ‘Healthcare company’ with a broad range of services. The entrants into this space are coming from across healthcare (Insurers, Distributors, Healthcare Providers, etc). It will be very interesting to see which starting point will enable the best consumer/patient/community centered approach.
Great update and great scoop. Sage advice not to discount Cerner too.
Cerner solutions are licensed by about 9,000 facilities globally, including more than 2,500 hospitals; 3,500 physician practices covering more than 30,000 physicians; 500 ambulatory facilities, such as labs, cardiac facilities, ambulatory centers, radiology clinics and surgery centers; 800 home health facilities, and 1,600 retail pharmacies.
Question is – can yet another big ($10B mkt cap), publicly traded HIT vendor (quarterly focused), with a long and rich history around provider solutions make a long-term and expensive commitment to the consumer side? Maybe – but history suggests otherwise and big companies aren’t the best at innovating consumer solutions generally. They tend to do better when they let smaller companies innovate – and then acquire. Case in point outside of healthcare is Intuit ($16B mkt cap). They wound up almost forced to buy Mint – then had to completely ax their own Intuit product because they couldn’t integrate into/with Mint.
As consumers – there’s a certain vendor fatigue that comes from large vendor solutions that get the heave-ho. Post Mint acquisition, Intuit had not trouble throwing their consumers under the bus – and we’ve seen that in healthcare too (Revolution Health and Google). The consumer market is certainly tempting for all these big guys – but can they really commit? Definitely anxious to see what the Cerner solution will look like.
Earlier this year we had someone from Google take a demo of DoctorBase.com’s Panda software and he said, “Wow, that’s brilliant…. we’re somewhat disappointed by Google Health’s adoption rate.”
As an organic, non VC funded start-up in San Francisco (where startup costs are astronomical) we’ve been able to sell our solution – which is complementary to EHR solutions – by figuring out what doctors and IPA admins are willing to pay for, and how to get the front office to adopt the software.
By combining game mechanics and social media, we are now servicing 1.5M patients on our platform sending 250k messages a month between docs and their patients. And that’s organic growth.
I say this not to schill for our company, but to illustrate that there can be room get market traction without being a behemoth. Actually, the solution is rather simple – don’t expect Americans to suddenly get interested in their healthcare. Start by owning a piece of the doctor’s desktop and begin a behavior change from within the doc’s office that radiates out to the patients. Not the other way around.
John — great sleuthing. I look forward to seeing what they come up with — and I think it’s a good sign for the future of prevention/health promotion/wellness/whetever when deep pockets open.
Leave your wallet at home.
For anyone who’s been in the space for a while you might remember Cerner’s $25M ‘donation’ to support PHRs for families with kids and type 1 diabetes.
That marketing project was so thinly veiled that very few of the regional children’s hospitals ever took them up on their offer and the ones who did asked them to leave after less than a year in most cases.
Press Releases are one thing. Committing to changing health care is entirely another.
The Cerner strategy to focus on specific populations coupled with the fact that Cerner will have these groups as Cerner customers has merit. My question is what is the business model – who is going to pay for the PHRs – patients, hospitals, etc.?
[…] Health Calls It Quits; Lessons Learned about PHRs or Not). Here is a link to John's note (see: Stepping in Where Google Health Left Off) and below is an excerpt from […]
Well it’s good to know that Microsoft won’t be the only large PHP out there! John, do you think that Cerner will be starting a trend among other Behavioral health software companies that pushes them to integrating PHP into their systems or will EHR and PHP remain fairly segragated?
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Hmm… I didn’t even know there was a Google Health. This makes me sad, as I would have liked to check it out, but now it looks like I won’t be able to. You should do an article on Google Health alternatives for people like me that never even got to see Google Health. Just a suggestion.