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Subdued in Seattle

by John Moore | May 24, 2010

What was at one time an event focusing on visionary statements and a desire to attract the developer community has transitioned too much more of a true user conference and with this transition, Microsoft’s 3rd annual healthcare event, Connected Health Conference (CHC), was more subdued focusing on execution more than vision.

Microsoft’s first CHC was a highly energized affair with a lot of excitement and interest across the healthcare IT sector as to what Microsoft was looking to do in the healthcare.  This first event, occurred about 8 months after Microsoft announced its foray into healthcare with HealthVault. The event had a heavy focus on the developer community educating them on what it would take to become a part of the HealthVault ecosystem.  That seems so long ago.

The second event still had a lot of buzz and excitement about HealthVault, particularly its biometric device platform Connection Center. It was also at this event that Microsoft began expending more effort on describing what Amalga was and what problems this solution was intended to solve for healthcare providers. As in the first year, the second year had a high percentage of ISV development partners in attendance who were seeking further guidance and direction, but there was also a marked increase in the number of providers attending.

This year there were even fewer ISVs and even more representation from provider organizations. With this change in the attendance profile, excitement had dissipated replaced by a drier sense of duty to move forward and execute on what is required to meet meaningful use (MU). That is not to say Microsoft focused on this issue – to their credit, they did not instead looking further into the future of what the healthcare sector may become based on current and future pressures (e.g., bundled reimbursements, migration to ambulatory care, accountable care organizations, etc.).  But in discussions with many a provider in attendance (I use provider loosely here to also include the IT staff at healthcare facilities), MU was clearly on their mind.  Providers are currently devoting a significant amount of energy to meet MU requirements, this may help explain the lower attendance in comparison with years’ past.

So, without further adieu, here are a few highlights:

Peter’s Keynote

Peter Neupert, in his keynote, outlined Microsoft’s overarching healthcare strategy, which is founded on four core precepts:

  1. Sunshine the data
  2. Engage consumers
  3. Provide nearly infinite scalability
  4. Establish trust

Nice set of governing principles to guide development and go-to-market strategy.  Now it is up to Microsoft to demonstrate and articulate the business value of these precepts to the market.  Yes, there are incentives such as ARRA to help drive “sun-shining the data” and “engaging consumers” (patients) but such incentives are fairly one-dimensional extensions of today’s healthcare delivery model.   Disruptive transformation is both high risk, but potentially far higher reward. It is such disruption that Peter was attempting to articulate, though found that the Innovation Session on the following day did a better job of driving that message home.

Monolithic vs. Best-of-Breed

Peter also spent some time discussing the value of platforms, or what he called “Open Ecosystem” vs closed, monolithic ecosystems (i.e., Cerner, Epic, GE, etc.).  Microsoft has a partnership with Eclipsys wherein discrete Eclipsys apps can run on top of the Amalga platform.  Eclipsys’s CTO, John Gomez in another session was adamant in his belief that open ecosystem was the way to go stating that no single HIT vendor can adequately address the multitude of IT needs within a large healthcare organization. Now Epic, Cerner, GE, or most any other large EMR vendor would differ with that opinion, but it does raise an interesting question:

Is a best-of-breed, open ecosystem model the way of the future for HIT or closed monolithic systems?

One could easily argue for either approach at this stage of maturity (or lack thereof) in the HIT market, but if one looks around them and sees the number of large institutions still signing contracts with Epic and other large HIT vendors, we have yet to see a swing towards an open ecosystem.  Part of the problem may be the simple fact that is too difficult for a hospital’s IT staff to manage multiple apps, their upgrades, training etc. that is inherent in a best-of-breed approach.  A best-of-breed vendor needs to demonstrate a large value proposition to make this happen and outside of revenue cycle management, it is hard to find such in the HIT market today, particularly among clinical apps.  This is an area of particular interest at Chilmark Research and we will be doing a deeper dive on this topic via a research report on open ecosystems in healthcare that will be released later this summer.

Where’s the Money?

While I enjoyed the majority of Peter’s keynote, it was incomplete.  Rather than looking at the healthcare market in its entirety, the keynote focused on only providers and consumers.  Not addressing those that ultimately pay the bills, employers and payers, the keynote was incomplete and for thus hard to take seriously.  The continuum of care extends beyond the provider-consumer relationship and our convoluted healthcare system will not improve if we fail to talk about the other stakeholders in this complex equation.

Making an HIE Play

Microsoft is making a play in the HIE market with Amalga currently supporting the DC RHIO and Wisconsin’s HIE WIHIE.  They also recently won a contract to provide HIE capabilities for Hawaii.  When sitting in on the HIE session the DC RHIO discussed the development and roll-out of their HIE that encompasses 8 hospitals and 20+ facilities in that region. Great story here in that within 2 hours of go-live, the DC RHIO was able to identify a MRSA outbreak at two hospitals and alert others within the network to minimize the spread of this potentially deadly virus. Now that is delivering community value, so why was so much attention during this session devoted to models of sustainability?  Both the DC RHIO and WIHIE spent precious time discussing their efforts to create long-term sustainability models.  Honestly, Chilmark is getting quite tired of this discussion and has begun wondering why the hell we, as a nation, cannot just simply accept that putting in an interstate-like system for secure healthcare data transmission is critical to this country’s long-term health and wellness.  Seriously, is it really any different than President Eisenhower’s desire, after returning from Europe, to establish the US Interstate Highway system that has done so much to improve the movement of goods across this country?  I think it is time we just accept the fact HIEs are critical and just establish a clear set of guidelines, similar to AASHTO for highway design and get on with it.  It’s that important.

Strong Interest in HealthVault Community Connect

The technical session on one of Microsoft’s newest products, HealthVault Community Connect (HVCC) was packed, standing room only and out into the hallway.  Clearly, providers in attendance are seeking solutions that they can effectively use to engage the populations they serve and HVCC is a compelling concept.  Unfortunately, that message may not have been effectively communicated during this session.  Granted, it was a technical session but based on audience Q&A, what the audience really wanted to know was how might this solution fit into their organization, what critical pieces of the MSFT HSG stack do they have to buy/adopt (Amalga, SharePoint and HealthVault – note that MSFT has developed a stripped down version of Amalga to insure that HVCC is affordable to smaller hospitals and clinics) and what does the future roadmap look like for this solution suite (right now all it really addresses is pre-registration and patient discharge processes).

The Wrap:

Unfortunately, due to time constraints was unable to attend a number of other sessions, including that on one of MSFT’s newest modules for Amalga, “Connected Imaging”.  This does not appear to be a solution that will immediately compete with the likes of such upstarts as LifeImage, as it appears to be structured to operate within the enterprise but in the future could easily branch out into HealthVault, via HVCC and possibly become a disruptive technology in this huge sector of the market (imaging is massive, but frankly, Chilmark just has not had the bandwidth to delve deeper).

But what Chilmark was able to capture at CHC2010 was a rising level of maturity on the part of Microsoft in its go to market strategy for HIT.  Yes, there are a number of areas where Microsoft is still feeling its way around (HIEs is certainly one of them), but progress is being made in a methodical fashion.  Though the energy and excitement that filled the air in past events has dissipated, it is being replaced with greater clarity of purpose and direction, which is not necessarily a bad thing in a market that is seeing far greater hype than what is healthy.


MSFT’s HSG leader Peter Neupert’s own impressions of this event.

5 responses to “Subdued in Seattle”

  1. John Lynn says:

    Great post. Thanks for sharing. I think it’s really interesting to see the change in positioning. I too remember when Google health and Microsoft Healthvault both came out. There was a tangible excitement in the air. Now that’s kind of rubbed off and we’ll have to see what’s waiting underneath that excitement.

    P.S. This easily could have been chopped into 3 posts and scheduled out over a couple days;-)

    • John says:

      John, you are the master, one of these days I’ll “get it” and break up these long posts into something smaller, more digestible over the course of a week.

  2. […] Article John Moore, Chilmark Research, 24 May 2010 SHARETHIS.addEntry({ title: "Subdued in Seattle", url: "http://articles.icmcc.org/2010/05/25/subdued-in-seattle/" }); […]

  3. Michelle W says:

    Lots of great material, thanks for posting. Now, if I might offer a devil’s advocate response to the sustainability question?

    Correct me if I’m wrong, but the US Interstate system is a project founded and maintained by the Department of Transportation, a government entity. There’s no question of road sustainability because tax dollars at the state and federal level pay for upkeep; some states have higher gas taxes, some have toll booths, but ultimately all this income is managed by an appointed official who awards reliable contracts to construction crews.

    In the case of the HIEs, I’m not sure who is supposed to ultimately bear the responsibility and/or cost of upkeep. Will it be the states, and will they receive federal support? Will funds come from tax appropriations (during a cash-strapped time for the states), and exactly who will manage this system? Will there be a specific office within HHS, ala the Federal Highway Administration within the DOT? What about at the state level?

  4. Brian says:

    MRSA is a bacteria not a virus, is ubiquitous, and is rarely deadly, most commonly causing easily treated skin infections.

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