mHealth in the Enterprise Set to Explode
The rapid adoption of smartphones and now touch-screen tablets (e.g., iPad) by clinicians will trigger enormous growth in the use of mHealth Apps within healthcare enterprises, with the market for mHealth in the enterprise projected to reach $1.7B by end of year 2014. Similar to the hockey stick growth for mobile shown in the slide by Morgan Stanley’s Mary Meeker in last week’s post, the mHealth App market will see a similar trajectory as healthcare enterprises strive not only to meet physician demands for mobile access to clinical information, but seek to improve workforce efficiencies in preparation of future healthcare and payment reform.
These findings and quite a bit more are part of Chilmark Research’s latest report that is being released today: mHealth in the Enterprise: Trends, Opportunities and Challenges. The report is the result of roughly three months of dedicated research by lead analyst Cora Sharma who has interviewed numerous leading adopters of mHealth Apps (Beth Israel Deaconess, Children’s Hospital Boston, UPMC and others) as well as both traditional HIT vendors, best-of-breed mHealth vendors and consultants.
While this report has plenty of charts and figures providing details as to what mHealth App categories will see the strongest growth in the healthcare enterprise and just how big those specific App markets will get, one area that will reach saturation in the very near future is medical content. Companies such as Epocrates, Medscape and Skyscape have been providing this capability for a number of years to physicians and we peg current adoption and use north of 60%. By the end of 2013, this market will reach saturation. This may partially explain Epocrates’ acquisition move yesterday, picking up Modality for $13.8M. Modality will provide Epocrates with critical relationships to many health content publishers and further solidify and strengthen its position in this market. But of Modality’s some 140 iOS-based Apps, only half are heath and life sciences related. Might Modality provide Epocrates the opportunity to expand into new markets now that the health content market is reaching saturation?
But we digress as health content Apps are strictly physician-driven – they do not connect into the enterprise’s health information systems (HIS) and are of limited value to a healthcare enterprise. What is of value to an enterprise is providing physicians with immediate access to the information they need to deliver the highest quality of care in the most efficient manner. This report specifically targets those enterprise mHealth Apps that link into a healthcare enterprise’s HIS including EHR, CPOE, eRx, CDS and Charge Capture. Providing physicians mHealth Apps that will enable them to deliver higher quality at the point of care will rapidly become an important competitive differentiator as healthcare enterprises look towards not only meeting meaningful use requirements and structuring themselves for payment reform, but also improve internal workflow leading to higher efficiencies and more competitive positioning in the broader market.
To obtain a copy of this report head over to the Chilmark Research Store.
Have received a few private comments requesting Table of Contents, List of Figures, Table etc., which is now provided below:
Table of Contents
Matt Guldin · 1 year ago
John Moore III · 2 months ago
Ramping Up for MU Rules, CMS Launches New Site
Today, the Center for Medicare and Medicaid Services (CMS) launched a new site that is basically an everything you wanted to know about meaningful use, ARRA, the HITECH Act, certified EHRs, etc., but were afraid to ask. This is a reasonable attempt by CMS to get as much information online, in one location, that addresses most of the nuances of the HITECH Act and its incentive programs for physician and hospital adoption of EHRs. Unfortunately, like most government websites, or at least those that seem to emanate from HHS, it is a drab site that presents information in a way that your mid-90’s era web designer would be proud of. (Note: inside sources state the problem rests with a chief web design honcho at HHS who is stuck on that old model much to the displeasure of others – oh well, that’s government.)
Needless to say, the site does provide a wealth of information, though you may have to dig to find what is most important to you. The site may also become prone to being dated, so be careful and double check other sources for more current info. For example, the section on certification of EHRs stated that certification rules will be released in “late spring/early summer” – well they are already out, having been released on June 18th. Hopefully, HHS, CMS and ONC can work more closely going forward to insure that information on this new, and what may become an important site, is truly current.
In launching this site, CMS is trying to get ahead of the curve and likely onslaught of requests for information once the final meaningful use rules are released. While this website states that these rules will be released, again, “in late spring/early summer,” we are now placing our bets that these rules will be released at 4:55pm on July 3rd, unless of course someone in the administration decides to postpone such an announcement until the opportune moment comes along to generate some positive press for what is currently an embattled administration.
AllScripts+Eclipsys, Who Loses?
Today, leading ambulatory EHR vendor AllScripts announced that it will merge (it’s really acquire) with one of the larger acute care EHR vendors, Eclipsys creating one of the largest EHR vendors in the market with some 180,000 physicians using their solutions. This acquisition is being driven not by ARRA and all the taxpayer dollars flowing into healthcare, but by healthcare reform and the trend towards bundled payments, patient centered medical home models and the move by hospital networks to become Accountable Care Organizations (ACOs). Large healthcare organizations will increasingly be looking to HIT vendors who can provide the full suite of solutions for both acute and ambulatory requirements. This merger is simply an acknowledgement of that need. It will be interesting to see what impact this merger will have on other ambulatory EHRs, such as NextGen and eClinicalWorks.
Now there will be plenty of others writing about this merger and its implications to the market so rather than focus on the obvious issues regarding EHRs, rationalization of product portfolios, go to market, etc., Chilmark Research will look into one small and important piece:
What might this acquisition mean to these companies’ respective HIE partners, dbMotion and Medicity?
We’ve spoken to both HIE vendors and are on track to release our HIE Market Trends Report (includes in-depth profiles of the twenty leading HIE vendors in the market) by the end of June so we are uniquely positioned (at least we think so) to provide an educated assessment.
In April 2009, AllScripts and dbMotion announced a go-to-market partnership wherein dbMotion would be AllScripts go to partner for all things HIE. This partnership is both marketing and R&D with both companies working together to deliver what is called the AllScripts Community Record powered by dbMotion solution. This partnership did not make a lot of sense to us as dbMotion is a fairly sophisticated solution that is more suitable for large IDNs and academic medical institutions like its US lighthouse customer, UPMC, which also happens to have a significant equity stake in dbMotion. dbMotion is also not exactly an inexpensive solution. So how does this fit in the ambulatory market that is the sweet spot for AllScripts?
Speaking to Peter McClennen, dbMotion’s North American President, Peter stated that he is both “excited and humbled” at the thought of this merger. Excited in the future prospects, humbled in its implications to the broader market. Peter went on to state that to date, the partnership has seen a number of market successes such as that at UMass Medical Center, and most recently the win at Thomas Jefferson University. Today, AllScripts/dbMotion have about a half dozen customers that are leveraging the dbMotion suite to enable, as Peter put it, “actionable semantic interoperability” between an acute care facility and affiliated ambulatory practices. What Peter means by actionable semantic interoperability is basically an ability to create an on-demand view of a patient record (drawing from all data sources in a dynamic fashion), which is quite similar to Microsoft’s Amalga platform. This is an important factor which we’ll come back to later.
So getting back to the question: How does dbMotion fit in the ambulatory market that is the sweet spot for AllScripts? Looking at those joint sales, large mothership institutions (UMass, Jefferson, etc.) are making the investments in dbMotion to more closely tie affiliated practices who are on AllScripts. These large institutions have the need and the resources to make this happen.
In June 2009, Eclipsys and Medicity likewise announced a a go-to-market partnership. Unlike the AllScripts/dbMotion partnership, the Eclipsys/Medicity partnership is far deeper wherein Medicity is the underlying technology powering the Eclipsys’s branded HealthXchange. This requires a deep level of technology integration between the two respective platforms. It also requires a higher level of sales and marketing investment by Eclipsys as HealthXchange is on the price sheet that their sales force takes to market. It’s no easy task to back-out of such a deep integration.
In speaking with Medicity’s CEO, Kipp Lassetter earlier today, Kipp stated that Eclipsys informed him that they remain “fully committed to the partnership.” Kipp went on to state that in addition to several wins to date, the partnership has a “number of deals in the works.” As with the AllScripts/dbMotion partnership, the objectives are the same, help large IDNs and hospital networks better link acute to ambulatory. HealthXchange is based more on Medicity’s MediTrust and layered in their some of their Novo Grid technology.
AllScripts+Eclipsys, Who Loses?
In any acquisition/merger there is a natural rationalization process, rationalization of staff, products and of course partnerships. The combined entity will now have two HIE partners and some rationalization may occur with one HIE vendor remaining at the alter, while the other walks away with the groom.
In their investor slidedeck, AllScripts, on slide 22, clearly shows HealthXchange in the Eclipsys solution portfolio stack. Looks like AllScripts certainly acknowledges the importance of HealthXchange, though it is curious that they have the solution under the columns of financial and administrative transactions and not clinical. Evenmore curious is that there is no mention of dbMotion and the AllScripts Community Record solution on this slide.
So does this mean dbMotion is the one that will be left standing alone at the alter?
Well, if anyone was left standing alone, it would likely be dbMotion, however, we do not believe this will happen for a couple of reasons:
First, though the relationship is barely a year old, AllScripts and dbMotion have benefited from landing a number of key wins, so why stop now?
Secondly, dbMotion has one of the more technologically advanced HIE solutions in the market today. It’s not cheap, but it does provide some pretty impressive capabilities that are not easily matched. And remember what we said earlier, dbMotion is more akin to Microsoft’s Amalga than it is to the traditional HIE solutions in the market today, including Medicity’s solution suite. Thus, there may actually be more opportunities to create synergies between these two companies and their offerings. The wildcard in this scenario is Microsoft’s partnership with Eclipsys wherein Eclipsys is now offering modular apps on top of the Amalga platform. Will this have any influence on the dbMotion partnership? That’s anyone’s guess today.
In closing, we see polygamy occurring with both Medicity and dbMotion playing a role in the combined AllScripts/Eclipsys organization. If done properly, everyone will benefit, especially customers. If done wrong, a major cluster f*ck in the making. These are capable companies with capable leadership, our bet is on a successful polygamist relationship.
Subdued in Seattle
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 Neupert, in his keynote, outlined Microsoft’s overarching healthcare strategy, which is founded on four core precepts:
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).
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.
Shedding a Light on HIT – Beacon Awards
Last week, the White House finally announced the 15 Beacon Award recipients who will split the $220M (roughly $15M each) to effectively leverage HIT to improve healthcare delivery in their communities. While many a community waited patiently for this announcement that was originally scheduled for sometime in March, it appears that the feds, and in particular the White House, took their own sweet time in getting this announcement out, which reads more like a $$$ for jobs announcement than one about improving the quality of care through the judicious use of HIT. White House must be getting some heat about where are all the jobs that were to be generated from ARRA, of which this particular program is but a tiny piece. Sad thing here is, despite the heavy “jobs” messaging in this press release, the program provides funding for only three years, after that party’s over and so might those new jobs this program will create.
Over 130 proposals were received with only 15 given the green light. Everyone seems to be looking to Washington there days for a hand-out.
Communities are geographically broad-based, a number of them are rural and range from behemoths like Geisinger, Intermountain and Mayo, to the Delta Health Alliance in Stoneville, MS. Good to see such a broad cross-section of the US receiving awards though seeing big institutions receiving federal largess does make at least this analyst cringe.
One of the factors used in choosing these communities was the level of current HIT adoption where there needed to be above average EHR adoption and an existing exchange mechanism in place to facilitate care coordination. This is not, thankfully, another program to pay for HIT, but to look at applying existing HIT infrastructure to improve care in specific disease communities.
Awards are heavily weighted to diabetes, with nearly 75% having some diabetes program associated with it. Why diabetes, hard to say but one could make the conjecture that diabetes is one of the leading chronic diseases in this country and secondly, that it has relatively straight-forward metrics to measure and quantify. This is myopic. Seriously, if this program is to look at healthcare in its entirety and explore novel models for HIT deployment and use, should we not cast the net a bit broader? Likely, the three-year scope of this program limited more innovative models that may have had difficulty showing clear, demonstrable results.
A third of those receiving awards will have some component of consumer outreach ranging from basic patient education (hasn’t this been done enough already – by now we should know how to do this effectively) to a program in North Carolina that will include a Health Record Bank and another in California that will leverage mHealth to “…empower patients to engage in their own health management…” OK, so we have 75% of all awards focusing on diabetes but it appears that only a third focus on consumer engagement? Odd, very odd and hardly innovative. Granted, this assessment is based on the White House PR, but still, to have what appears to be such a relatively small percentage of programs focusing on consumer outreach and the effective leveraging of HIT in these communities is a BIG PROBLEM. After all, it is the citizen consumer footing this bill, should they not see some direct benefit?
This is not not a grant program but a three-year cooperative agreement where the feds will work closely with these 15 communities in developing, deploying and ultimately measuring the success of these programs. The tricky part will be to take the lessons learned and apply them more broadly to other communities. Not an easy task and based on our limited observations to date, something the feds are not been very good at performing.
Many of the recipients plan to focus on the use of such technologies as mHealth, telemedicine and remote monitoring technologies to create new care models particularly with regards to chronic diseases. Great to see support for these new technologies/approaches to care delivery. Hurray! But there is one small problem with this (OK, it’s a REALLY BIG PROBLEM), ultimately, without CMS’s support (i.e., willingness to reimburse for the use of such technologies in the delivery of care) these potentially great ideas will end up on the proverbial shelf of great ideas with no sustainable business models. But there may be a silver lining in recently passed Health Care Reform (Sec.3021) legislation that requires CMS to establish by 2013 an “Innovations Center” to look at new funding/reimbursement models. Still looks pretty fuzzy from here, but keeping our fingers crossed that the Innovations Center will drive payment reform at CMS and open up the gates for innovation to blossom.
The Beacon Community Awards are not perfect but they are an attempt by at least one branch of HHS to support the innovative use of HIT at the community level. The challenge for this program though will not so much be the deployment and use of the technology, but rather how to extend the likely successes in these communities more broadly across the US. And while success is certainly measured in improved outcomes, the more important factor in the success of this program and others similar, is in the net benefit to clinicians and the institutions that employ them. Thus, without payer and subsequently, payment alignment to these programs, their long-term success will likely not extend much beyond this limited three-year window of opportunity.
Even with Incentives, Docs May Forgo EHR Adoption
The federal government, via the HITECH Act, and many an EHR vendor are hoping for broad adoption of EHRs in the goal to digitize the healthcare sector, which today is honestly, pretty abysmal. And why is EHR adoption so low? Pretty simple really, EHR vendors have not adequately demonstrated to the market that there is indeed value creation for the end user after adoption and go live. In fact, one could easily argue the exact opposite occurs when one looks at the productivity hit a practice typically takes (20-30%) in the first year. Practices get paid by throughput, how many patients are seen in a given day, so if an EHR hits a practice with a 25% productivity hit, where does one make that up, working extra hours, laying off an employee or two? Not exactly attractive options.
Yes, hospitals will adopt and meet meaningful use requirements as the future CMS penalties will simply be too painful to do otherwise. Private practices, however, may just forgo adoption and decide to not serve CMS (Medicare/Medicaid) patients. It remains to be seen what direction this will take but as I stated in a recent keynote at the PatientKeeper User Conference, the focus of EHRs and their successful deployment, adoption and use needs to be based on what is the value that is delivered to the end user, the physician/clinician. For too long and even today, all the grand talk of EHRs and adoption thereof focuses on the broader public good. Yes, there will be a broader public good but if we don’t get back to focusing on delivering true, meaningful value to the end user all this talk, incentives and promotion will fall on deaf ears and many a tax dollar will be wasted.
As an aside, we have stated before on this site, the consumer/citizen may play an important role in the future. As the first comment in response to this Boston Globe article this week puts it, he/she would not go to a doctor that did not have an EHR in place. This is something that the digital natives of this nation who are beginning to get married and settle down with families of their own will increasingly demand. EHR adoption will come, the question is how fast and what will be the forcing functions. Right now, just not convinced that HITECH Act $$$ will do it at the practice level.
And just by way of example regarding those youthful digital natives, my 25yr old son found both his doctor and dentist via the online user community Yelp. He’s quite happy with both.
New Leadership for CCHIT – Will it Make a Difference?
The organization that Chilmark Research has had, at times, a trying relationship with, CCHIT, otherwise known as the Certification Commission for Health Information Technology has appointed a dear friend, Dr. Karen Bell as its new leader.
Dr. Bell, who I first met while doing research on the PHR market, was instrumental in having me present to then Sec. Leavitt on consumer-facing healthcare technology trends – still one of the highlights of my relatively short career as a healthcare industry analyst. Since that presentation in 2008, my relationship with Dr. Bell has deepened and she has been one of several key mentors who have assisted me in understanding the healthcare IT market.
So, now that Dr. Bell has accepted this position to take over the reigns at CCHIT immediately, what might we expect:
Dr. Bell knows Washington DC and HHS quite well from her many years there. She is effective in a highly politicized environment and will be able to effectively lead CCHIT through that political minefield.
She also knows the issues and is fairly competent on the technical side of the fence, though certainly not a coder. Dr. Bell may be one of the better choices for CCHIT as she can advocate for this organization at a time when many still call into question its very existence. Of course, that existence has been somewhat guaranteed by ARRA legislative language (was this put in by HIMSS/CCHIT lobbying efforts?) that states organizations will receive incentive reimbursement for “meaningful use of certified EHRs“.
Dr. Bell will put up a Chinese Wall between CCHIT and the HIT vendor organization, HIMSS. She is fully aware of the perceived conflicts of interest between CCHIT and HIMSS and will seek to create some distance between these two organizations.
A strong advocate of consumer control of PHI, interoperability of EHRs, and the need for “open” HIE platforms/apps one can expect Dr. Bell to put extra emphasis on these issues at CCHIT within the context of certification requirements. This actually works out just fine with HHS as that is just what they are looking to foster with ARRA funding.
But what is less clear about Dr. Bell’s future role at CCHIT is how she will lead this organization forward in bringing together those that truly know HIT (reaching beyond the vendor community), the challenges of adoption (e.g., workflow), the cumbersomeness of many apps (plenty of them already having been blessed in the past by CCHIT), the need to create a certification structure and pricing model that fosters innovation rather than stunts it (CCHIT certification is still too expensive for many young, innovative companies) and finally, insuring that CCHIT does not over-reach (as it was doing under Mark Leavitt’s leadership) and focus where it can make the most meaningful impact.
This is a very tall order for anyone and while I still question even the very existence of CCHIT (have yet to see any demonstrable proof that CCHIT certification has moved the EHR/EMR adoption needle in any statistically meaningful way), I do have faith in Dr. Bell. If anyone can right this listing ship, it is her at the tiller.
Congratulations Dr. Bell and may you see smooth sailing in the not so distant future.
Anthony Guerra of HealthSystemCIO has a podcast interview with Dr. Bell now up on his website.
iPad in Healthcare: A Game Changer?
There have been a lot of discussions on the Net regarding the potential impact of the iPad in the healthcare sector. At this point, there is very little agreement with some pointing to the ubiquitous nature of the iPhone in healthcare as a foreshadowing of the iPad’s future impact, while others point to the modest uptake of tablet computing platforms as a precursor for minimal impact.
Our 2 cents worth…
We believe the iPad will see the biggest impact in two areas: medical education and patient-clinician communication.
The iPad’s rich user interface, native support for eReading, strong graphics (color) capabilities, ability to use various medical calculators (there are a slew of them already in the AppStore) and numerous other medical apps (most of these are iPhone apps and will need to be updated to take full advantage of the iPad’s larger 9″ screen) provides an incredibly rich ecosystem/learning environment for medical students. Nothing else comes close – a slam-dunk for Apple.
That rich, graphical user interface, it’s inherent e-reader capabilities and portability also lends itself as possibly the best patient education platform yet created to foster patient-clinician interaction. At bedside, a clinician has the ability to review with a patient a given treatment, say a surgical procedure, prior to the operation showing rich anatomical details (e.g., a patient’s 64 slice color enhanced 3D CAT scan), potential risks, etc. Heck, one could even show a video clip of the procedure right there on the iPad. Now that is cool and sure beats the common approach today, some long lecture that oft-times is difficult to follow.
Beyond those two compelling use cases, other uses in healthcare for the iPad include its use by nurses and hospitalists to provide bedside care, tap multiple apps (hopefully multi-tasking will come in OS v4.0 to be announced on April 8th), in an intuitive environment. As to how the iPad may extend beyond these limited boundaries for support of say charge capture and CPOE remains to be seen but in the immortal words of many an Apple iPhone advertisement:
There is an app for that.
And based on some of our initial conversations with mHealth app developers, many are already working on just these types of applications for the iPad, which they hope to bring to market within next several months.
One thing is certain, from at least one data point we received this past weekend, there is strong, initial interest in the medical community as to what the iPad may facilitate. Speaking to one of the technical folks at the local Apple store this past weekend we learned the following: Of the 1,000 iPads sold on Saturday (this store did sell-out), 700 were sold off the floor and 300 were reserved for business customers. Of those “business customers” a significant share of those 300 iPads (north of 30%) were sold to local medical institutions.
One of those local healthcare institutions appears to be Beth Israel Deaconess Medical Center (BIDMC) where an ER doc has provided his own iPad review, based on actual use during a shift. Particularly like his comment about using it for patient education. Might the iPad truly bridge the information gap between patient and clinician? One thing is for certain, it will make it much easier for patient and clinician to confer over a given diagnosis, results and creation of a treatment plan with supporting documentation/graphics.
Read into that what you may but one thing is for certain, there is significant interest in the healthcare sector to at least understand how the iPad may be used within the context of care delivery in a hospital. It remains to be seen as to how end users will actually use these devices and what apps will be developed to serve this market (might Epocrates see stronger uptake for their EMR on the iPad vs. the iPhone?) that take advantage of the larger, 9″ screen, but based on what we have experienced with the iPhone, there are likely more than a few developers right now working on novel applications that clinicians will find valuable. Question is: Will they be valuable enough to augment the extra weight and volume of lugging the iPad versus a smartphone?
Only time will tell.
That being said, based on initial impressions of physicians, such as the one from BIDMC (see above) and our own limited experience in using the iPad this week, the iPad is pretty incredible and could usher in a whole new approach to healthcare IT (interfacing to and interacting with an EMR/EHR system) that may result in physicians adopting and using such technology, willingly. Could we even go so far as to say that the iPad will be a bigger contributor to HIT adoption and use than the $40B in ARRA funding that the feds will spend over the next several years as part of the HITECH Act?
Again, only time will tell.
Some other perspectives on the iPad in healthcare:
Article in HealthLeaders with some interviews with med professionals buying an iPad at Apple store in SanDiego.
ComputerWorld article looking at various business sector (including healthcare) uses of iPad.
Post by iPhone iMedicalApps on some of the current challenges for those adopting an iPad for medical use (virtually all the problems listed will be resolved within next few months)
Another post, this time at iPhoneCTO looks at the iPad in the med space for workforce mgmt.
Well look at this! Children’s Hospital here in Boston announced today (4/8/10) that it has received one of the recent HHS innovation grants to “…investigate, evaluate, and prototype approaches to achieving an “iPhone-like” health information technology platform model…”
Another ER doc writes a review of the iPad.