HIMSS’19: What to Expect, What I Hope to Find
Next week, most of the healthcare IT industry will descend on Orlando to attend HIMSS’19. This is my 12th year attending HIMSS, an event for me that is more about networking and confirming assumptions than actually learning anything new.
For years now, HIMSS and the multitude of vendors exhibiting there have feasted at the trough of federal largesse ($35B plus), via the HITECH Act passed in 2008 to foster adoption of EHRs. The HITECH Act was successful, driving EHR adoption from the low teens to over 90% today. Though some may question the value of that investment, I personally believe that over time (another 7-10 years) we will reap benefits that far exceed that initial investment.
However, now that we’ve reached that level of adoption, the market has plateaued. Sure, there were hopes of a robust EHR replacement market, but that never materialized. Then there was the hope for huge gains (profits) to be made on the shift from volume to value through the sale of PHM solution suites. That didn’t pan out too well either as the fate of the ACA was left in the lurch with a change in administrations. Also, quite frankly, PHM is a complex sell, requiring significant change management that few healthcare organizations were ready to commit to and few vendors had the services to support.
The provider health IT market is going through a significant transition and it’s not going to be pretty. Clearly, the party is over and one has to wonder: Why does HIMSS continue to exist? Why are all these vendors here? Are we on the Titanic, seemingly blind to the economic icebergs that surround us?
But I digress.
What is important is that the EHR has become the central nervous system to provider organizations. Secondly, this market will continue to consolidate rapidly with few independent EHRs surviving the shakeout. Those left standing will attempt a number of different strategies to drive continued growth in a plateauing market.
It remains to be seen how successful these strategies will be but rest assured, even if successful, no EHR vendor is completely safe from a future acquisition.
This sets the stage for what to expect at HIMSS’19:
And what I hope to find at HIMSS’19:
May your trip to HIMSS’19 be a success, however you define it. And if you see us in the halls, do not hesitate to stop and say hello – maybe we’ll have a few quick on-the-fly notes to share.
Matt Guldin · 2 years ago
Liz Gavriel · 4 years ago
John Moore · 3 months ago
John Moore · 3 months ago
John Moore · 2 months ago
Health Catalyst: Good Vision but Short of Grand
Health Catalyst (HC) is arguably the strongest, best-of-breed vendor for clinical data analytics in the market today. And as a best-of-breed vendor, it has been able to stay one step ahead of its leading competitors, Epic and Cerner – though as former Intel CEO Andy Grove once pointed out, “only the paranoid survive”, certainly holds true for Health Catalyst as Epic and to a lesser extent Cerner, are heavily investing in their analytics solutions.
Brian Edwards and I had the pleasure to attend the recent HC Analytics Summit, providing us an opportunity to get a pulse on HC, their clients, and their strategy going forward.
The Health Analytics Summit (HAS) brought together about 1500 attendees. It was a geeky crowd of data scientists, analytics team leaders and a smattering of executives. Sessions were by and large well attended though the level of discussions in the few I sat in on was modest. Client testimonials were plentiful, most clearly showing significant savings. However, one has to question what were the sunk costs on a given project when claimed savings were a paltry ~$65k.
Health Catalyst has grown quickly with over 700 employees currently. A couple of secrets to HC’s continuing success are:
Unlike most vendor organizations that put their customers first, Health Catalyst goes to great lengths to ensure their employees are engaged – they are the number one priority. Their belief: an engaged employee is a happy employee. A happy employee will strive harder to make customers equally happy. I’m surprised more companies do not follow a similar strategy.
While all vendors want their customers to be successful, Health Catalyst takes it one step further by guaranteeing to clients a CFO-verifiable 2:1 return on investment (ROI). In speaking to one client, she mentioned how some in her organization have pushed back on the costs of Health Catalyst. I asked her are they seeing that expected 2:1 ROI? She gave an emphatic Yes! – which she went on to confirm hushes critics.
A key message from CEO Dan Burton to attendees is their desire to remain an independent company that is mission-focused – “to unleash data as a catalyst of dramatic healthcare improvements.” To date, that message has resonated well across their growing provider installed base. But I wonder: Is it enough if the company plans to do an IPO?
The provider market is just getting started in understanding how to effectively use data and its insights to affect care delivery – no doubt there is still plenty of runway here. However, there are enormous opportunities outside the confines of this market. While I never wish to see HC lose sight of its mission, its long-term success, including a future IPO, will require a far grander vision that goes beyond the provider market to serve all stakeholders in the healthcare industry.
Unlocking Healthcare’s Big Data with NLP-powered Ambient and Augmented Intelligence
It wouldn’t be a radical statement to say NLP bridges the human-computer divide more than many technologies. ROI has been elusive, leaving prospective adopters reluctant to embrace it despite the numerous opportunities for NLP-driven solutions. NLP technologies have reached an inflection point with the emergence of advanced deep machine learning methods that are on-par with humans for an ever-increasing list of core natural language skills, such as speech recognition and responding to questions. In our newest report, Natural Language Processing: Enabling the Potential of a Digital Healthcare Era, we profile 12 vendors, all with a track record in text mining and speech recognition, including 3M, Artificial Intelligence in Medicine (Inspirata), Clinithink, Digital Reasoning Systems, Health Catalyst, Health Fidelity, IBM Watson Health, Linguamatics, M*Modal, Nuance, Optum and SyTrue. Each has a reputation for delivering solutions that serve a particular set of use cases or customer groups, distinctions we capture using heat maps for each company.
NLP is particularly well suited to address two huge problems in healthcare – easing the clinical documentation burden for clinicians and unlocking insights from unstructured data in EHRs. Documentation consumes an ever-increasing portion of clinician’s time. Recent research has shown physicians spend as much as half of their work day (6 hours of a 12 hour shift) in the EMR. Another recent study showed clinicians spend two hours on clinical documentation for each hour spent face-to-face with patients. Unsurprisingly it is often cited as a key factor contributing to physician burnout. Ambient Intelligence refers to passive digital environments that are sensitive to the presence of people, aware context-aware, and adaptive to the needs/routines of each end user. The familiar virtual personal assistants (VPAs), such as Amazon’s Alexa and Google’s Assistant, are familiar examples.
Speech recognition technology is approaching 99-percent accuracy, a milestone that some argue means that voice will become the primary way we interface with technology. I am skeptical of this prediction, at least when it comes to the broader utility of voice-based interfaces for consumers. The visual display, with its links and rich media, is an indispensable element of the modern digital experience.
Smart speakers, the input device for speech recognition, are the hottest technology trend of the moment, with an adoption curve that exceeds even the smartphone (see graphic below from Activate). We expect the smart speaker to rapidly become a fixture in both the home and office setting, following a similar path to maturity as the smartphone, offering applications for consumers and enterprises.
Interest and adoption in healthcare is already apparent. In September Nuance announced a smart speaker virtual assistant that uses conversational cloud-based AI (Microsoft Azure) to engage physicians during clinical documentation. In late November a post on the Google Research Blog described internal research and a pilot at Stanford investigating the potential to use a similar smart speaker interface and Automatic Speech Recognition (ASR) technology to create a virtual scribe.
Startups are taking on this problem too. Saykara, led by former executives at Nuance and Amazon, is developing a virtual assistant similar to Google’s. The company claims to have far more advanced speech recognition technology than its heavyweight competitors. Other are developing ambient scribes to passively document patient encounters, including Suki.ai , Robin Healthcare, and Notable Health.
EHR vendors are also making investments in ambient intelligence. Epic has partnered with Nuance and M*Modal to embed their ambient scribe technology directly into clinical workflows. Allscripts and athenahealth have partnered with startup NoteSwift. eClinicalWorks has launched a virtual assistant called Eva. Eva operates is initially intended to respond to queries for things like recent lab data or past clinical note content.
Barriers remain on the road to ubiquitous adoption of NLP technology by healthcare enterprises. NLP provides HCOs a low-risk opportunity to experiment with advanced machine learning and deep learning technologies, but its not the type of technology that can be implemented optimally by just any analyst in the IT department, but instead requires specialized expertise that is in short supply. While free text and mouse clicks will dominate the clinical documentation landscape in the near-term, healthcare enterprises will soon expect their users to talk their applications.
Analytics – An Integral Part of Care Management Success
Last week, I attended the 3rd Health Analytics Summit (HAS). This was my first time attending an event that now attracts over 1,000 attendees. Providers were well represented at the event with nearly 80 percent of the attendees coming from various provider HCOs.
While Health Catalyst focuses on analytics, my observations were largely focused on the care management related aspects of the conference. Here are some of the main impressions from the event:
Line between analytics and care management has blurred further: In our Care Management Market Trends Report, there were some analytics-focused ratings criteria with ‘Risk Identification and Stratification’ being the most straightforward analytically-oriented criterion.
More HCOs though are moving beyond simply importing a risk score from a claims-based risk grouper solution as explained in our Insight Report on the topic. They use this as a starting point, utilizing other data types (mainly clinical and utilization data) to define their own proprietary risk groups including sub-groups within high-risk patients.
Additionally, HCOs are leveraging analytics to measure the effectiveness of their care management programs ‘early and often’ – instead of waiting 9-12 months to examine clinical and cost-based outcome measures. They are also looking at more implementation and process-based measures to assess program effectiveness of particular care plan elements before expanding them to other patient types.
New data are ‘sexy’ but existing data issues consume lots of bandwidth: One of the first poll questions asked was which new data sets were the attendees most interested in for analytics-related projects with the top 3 being: social determinants, patient-reported outcomes, and external demographic data (e.g., credit scores). There was not much difference between the three although most of the conversations I had or heard really focused on the gathering additional social determinants of health especially related to the patient’s home after discharge and what resources were available to a patient.
But clinical data quality and to a lesser degree claims data still remain the biggest issue. HCOs are spending 30-40 percent of time on this single issue during the first several months of a project. Combine this with a multitude of varying and ever-growing value-based performance (VBP) measures, it is no wonder that incorporating additional new data sets into various analytic initiatives is challenging.
Provider-led care management adoption reaching a tipping point: One of the more difficult things to determine is just how many HCOs have actually put a care management program in place in their outpatient settings. There are several different ways we have heard HCOs define this but the most standard definition is having care teams headed by an outpatient nurse care manager who actively manages some percentage of an HCO’s patients through a care plan.
At the Partners HealthCare session on their care management strategy, which Health Catalyst has licensed the IP of, nearly two-thirds of the respondents indicated they had a high-risk primary care management program already in place at their HCO. The conference attendees likely represent some outliers but it would not surprise me if the actual adoption rate for care management among hospital-based HCOs is already at or exceeds 50 percent by early 2017. This number is likely considerably lower in rural settings, community hospitals, or among physician-based HCOs.
There is not some clearly-defined threshold in which an HCO decides to put in place a care management program but the two most useful anecdotal metrics seems to be: number of primary care lives under value-based reimbursement programs (VBR) (est. >15 percent of primary care lives) and percentage of total revenue in VBR arrangements (est. >20-25 of total HCO revenue).
HCOs actually engaging in longitudinal care management for a cohort of patients: While more HCOs have put in place care management programs, the overwhelming majority of these programs are not truly long-term, continuous care management programs. Instead, the vast majority of them are based around enrolling a patient for a finite duration of <30 days, <90 days or <120 days.
This should not be surprising given that HCOs are rationally responding to the measurement periods of various VBP programs most notably the Hospital Readmissions Reduction Program (HRRP) program from CMS. Partners Healthcare detailed how they are engaging in care management for a cohort of high-risk patients from several different payer types including Medicare Advantage, Commercial, Managed Medicaid, and their own employees and dependents.
If provider-led care management programs are going to bend the cost curve, continuous care management including palliative care for end-of-life patients is going to be necessary. Simply focusing on inpatient admission rates is going to be insufficient given early ACO results. The question is how many HCOs have the financial and clinical resources, geographic coverage, and economies of scale to accomplish this lofty goal especially in regions where there is considerable patient churn (e.g., +20% annually).
Broader integration is key for care management: Time and time again access and timely integration with behavioral health services is becoming a critical issue for the success of care management programs. Partners Healthcare reported that nearly 40 percent of their patients in care management program had at least one behavioral health issue. This is not uncommon and several other HCOs have reported to us that 30-50 percent of their patients have at least one behavioral health issue beyond something that can be treated by a primary care provider (PCP).
It is critical that when these patients come in for an office visit to their PCP or seek access to behavioral health services that these resources are available in-person or via a telehealth consult. Other additional areas that are coming up as being critical to provider care management programs for high-risk patients, are tighter integration with substance abuse, pharmacy, and palliative care resources.
Most attendees at the Population Health Summit indicated their HCOs were in the early to middle stages of integrating analytics across their organization with varying degrees of success. Attendees overwhelmingly felt these efforts were having overall positive effects on quality even if ROI remains challenging to determine. Most surprisingly, attendees self-reported that adaptive leadership and culture was the highest-scoring attribute in Health Catalyst’s recently-released Organizational Improvement Readiness Assessment with analytics and best practices being the lowest scoring attributes.
What stuck with me though was just how pervasive analytics are to not only defining the foundational requirements for a care management program but the crucial role they play in helping to set up, refine, and support a care management program over time. Unless a care management program is using analytics to actively measure ‘early and often’ and using this feedback to effectively optimize care management processes, results will be limited.
Top Three Factors Driving Growth in Cloud Analytics for Healthcare
So here is a scary thought for all those who fear the move to cloud services due to cybersecurity and privacy breach concerns – Data as a Service (DaaS) is coming to your community, to your healthcare system soon. Heaven forbid you may scream, but the simple, economic benefit to risk profile will force your hand. It’s in the cards.
This fall I have traveled extensively talking to providers, payers and vendors and one of the clearest trends I see is the migration to cloud-based data/analytic services. Several vendors – Cerner, Health Catalyst, Transcend Insight, IBM, and a host of others – are now bringing such solutions to the market, typically as a multi-tenant, cloud-based service. And there are a host of vendors who have this on their product roadmap with the intent of going GA in 2016.
Organizations such as the uber-large HIE in California, Cal Index and the Blue Cross Blue Shield Association (BCBSA) are moving to provide DaaS capabilities to their constituents, leveraging the data that they have access to. In the case on BCBSA, it is an all claims database (Axis) that Blues across the country will be able to use for such things as benchmarking costs and quality.
Three critical factors are driving this:
1) Budget & Resources: The challenge of healthcare IT departments to get more $$$ for capital expenses after their mega-EHR install just sucked all the air (and budget) out of the room. DaaS provides the ability to scale demand to need and subsequently scale cost. DaaS is also priced based on usage and can be expensed, rather than a capital cost.
2) Talent recruitment: Increasingly DaaS providers are offering wrap-around services that allow provider organizations to tap top data science talent, without having to directly recruit them. This moves the DaaS model one step further to Analytics as a Service.
3) Technology: Advances in technology are enabling highly secure cloud-based services that far outpace anything a provider can pull together on their own. Couple this with recent advances such as FHIR and algorithm portability and an organization can now leverage some highly sophisticated analytic tools that would be near impossible to gain access to just a few short years ago.
I’ll add a bonus factor that is technology-related as well – visualization tools.
Having attended the recent Tableau user conference, I was astounded by the stories of business line owners being able to use Tableau for rapid queries and report generation. No longer were they waiting for someone in IT to generate a report, with subsequent latency if report doesn’t check all the boxes. Rather, business owners are directly using these powerful visualization tools, that are fairly intuitive to learn, to directly ask questions of the data, iterate on those questions and gain insights quickly. It also removes a heavy burden on many an IT department.
What to look for in 2016? Yes, it is already that time…
Increasingly, there will be a decoupling of the data warehouse/EDW and the algorithms that an organization may wish to use to improve clinical, operational or financial efficiencies. Decoupled algorithms will tap the DaaS via a FHIR API as a common web-based service call to the data store. The advantage to HCOs, an ability to leverage best-in-class algorithms and other resources that are beyond their financial and technical reach today that will enable their organization to more effectively deliver services to their community.
Don’t expect a massive move in this direction in 2016, but do watch those HCO industry leaders who are typically at the forefront of tech adoption as to their movement in this direction – much will be learned from their experiences.
Health Analytics Summit Full of Surprises
Last week, the analytics vendor, Health Catalyst (HC) invited me to the Health Analytics Summit (HAS), which to put it simply, was full of surprises and a few validations. With over 900 attendees, not counting Health Catalyst employees, this was a very active and engaging event.
Among the Surprises:
There was virtually no mention of Health Catalyst, despite HC actually hosting this event. This was not your typical user conference with product demos and sales pitches, this was a conference with an objective to educate the market.
There were a few direct competitors of HC in the audience. This further validated Health Catalyst’s stated goal that this was not a sales event, but an educational one.
The audience was very upbeat – arguably the most upbeat healthcare provider audience I’ve ever encountered in my eight plus years in the healthcare IT market. People were there to learn from one another and the positive energy was contagious.
Audience was engaged and we still had a full house for last speaker on Day Two. Of course it was Ed Catmull, President of Pixar and author of Creativity Inc. so little wonder so many people stayed on. Turns out, he was my favorite keynote speaker at the event – truly inspirational.
Customers doing the selling. There were a lot of customers in the audience, but also quite a few prospects who came to look more closely at HC. Health Catalyst set-up the program to have their customers talk about their own analytics journey. As virtually everyone I talked to stated their primary objective was to benchmark where they are in comparison to others, this was quite useful. But it also gave prospects a feel for how actual end users were using HC solutions in their own institutions.
And Those Validation Points:
Use of analytics in healthcare is still extremely immature. Two thirds of the attendees at the HAS stated that they still do not have a comprehensive analytics strategy. This validates our own research to date that healthcare providers still have a long ways to go in creating a comprehensive strategy, let alone actually executing on it.
Best practices are few and far between. While we are seeing some agreement on management models for analytics initiatives, there remains a wide gulf in how organizations are prioritizing their analytics initiatives, where they begin and consequently use analytics in the context of their operations.
Most analytics initiatives remained constrained. There are a handful of healthcare organizations doing some pretty interesting things in the analytics realm, but these are clearly outliers. Even at an event such as this where you have a self-selected audience of leading edge adopters, it was somewhat surprising to see that the majority of organizations are doing relatively simplistic analytics today.
If you are a healthcare IT vendor, you could learn a lot from Health Catalyst. They have done a superior job in educating the market and attending to their customers’ needs. In return, they now have a very dedicated and loyal following. It is not always about you and your product, it is really about what your users can do with your product.
If you are a provider starting your own analytics journey, fear not. Many organizations are in a similar situation as yours and you are not too far behind if you get started now. But this will not be an easy journey so be sure to get executive support for you will ultimately ruffle some feathers with your analytic insights.
And for everyone, if you are even remotely interested in analytics, make it a point to get to this conference. It is uplifting, educational and you are with kindred spirits – all looking to transform and improve healthcare.
HIMSS’15 Pilgrimage: Impressions and Takeaways
Another year, another HIMSS conference. While I often may gripe about this event; the seemingly endless parroting of buzzword(s) de jour, the countless press releases that really are much ado about nothing and highly questionable surveys and research results, that have little founding in reality, there is a silver lining to all of this…
HIMSS affords me the opportunity to meet with so many people I’ve come to know in this sector. Some are my mentors, others clients or partners and all have become friends. That friendship extends from a shared desire and dedication to improve healthcare delivery through the effective adoption and use of IT.
While HIMSS is utterly exhausting it is also incredibly invigorating – kind of a Yin/Yang thing. I always return from the event with a ton of ideas as to where Chilmark can further assist this industry, because frankly, finding good objective research and insights in this sector sure seems tough to come by.
The “Big Data” hype cools to a simmer. Thankfully, the number of companies quoting, referencing or inferring how they address big data has subsided. This sector needs to get the little data right before it can step-up in any meaningful way to big data.
PHM is a too vague a term. The challenge with population health management (PHM), as a term, is that it is so broad. This results in virtually any vendor laying claim to it – though they may only be solving a very small piece of the PHM puzzle. No vendor at HIMSS’15 has a solution that can fully enable a PHM strategy. Met with many a CIO who has come to same conclusion, but every CIO struggled with same problem: Where best to start and with who?
Everyone does Care Management. In his post prior to HIMSS, our analyst Matt predicted that care management/care coordination would be the new buzzword term de jour. He was spot on. Countless vendors had banners promoting their ability to address care management processes. Unfortunately for users, when one takes a deeper look at these care management apps, one typically finds a glorified spreadsheet. Surely we can do better than this!
Clinical analytics is cool, but financial and clinical analytics together insures long-term survival. Saw plenty of vendors promoting their latest analytic wares and virtually all the demos focused on clinical analytics. Only a few vendors have taken the next step and are co-mingling clinical and financial analytics – which will be absolutely critical for HCOs. Unfortunately, most of these solutions make it far too difficult to perform such a simple task as: At the patient level, identify the most costly patients, what is driving the high costs of care for these patient(s) (visits to specialists, procedures, labs, meds, etc.) in order to determine what may be done to reign in costs.
A couple of companies I spoke with, Arcadia and Health Catalyst, did talk about the co-mingling of clinical and financial data, but as mentioned previously, they were in the minority.
ICW was back after a five year hiatus from HIMSS. They’ve gone through a major restructuring to refocus their development efforts on HIE and care management. They’ve always had some pretty decent technology under the hood – their challenge has been channel(s) to market. Not easy for a company from abroad.
Humana announced Transcend Insights (combo of Certify Data Systems, Anvita and nliven), yet another payer-led solution suite. They’ll be challenged to compete with Aetna’s Healthagen and UHG’s Optum. Humana’s deep expertise in Medicare may be key differentiator.
Caradigm looks to be finally gaining some traction and their booth was very busy. They are beginning to get some wins for their Care Management suite, which they co-developed with Geisinger Health.
Orion Health has the most visionary architecture for CNM that I have witnessed to date. Now they have to execute on that vision.
RelayHealth now has both performance analytics (HBOC) and MedVentive under its wing. They will be combining RelayHealth’s data aggregation capabilities, these analytics solutions and hosting in Microsoft’s Azure Cloud. Going beta this summer at ten sites and G.A., by end of summer.
Apervita was one of the more interesting briefings, as they are a company trying to create a marketplace for analytic algorithms that an HCO can source and apply to their EDW. Recently landed Series A round – one to watch.
Aetna’s Healthagen is targeting self-insured employers as well. In North Carolina, the PHM program Healthagen rolled-out across the 680K state employees realized a savings to the state of some $450M over three years. Not sure how those savings were calculated, but a number even half that is impressive.
Kryptiq, which recently spun-out from Surescripts, is taking to market Care Manager, an app originally developed at Providence Health in Portland. Solution automates many of the tasks required for CCM reimbursement under Medicare.
The EHR bubble is over but big question is: Will bolt-on sales of PHM-enabling modules be enough to sustain this market? Cerner is seeing very good traction for its Healthe Registries product, but a contract sale of that product likely pales in comparison to a Millennium sale.
The EHR vendors with the biggest, most elaborate booths are also the ones that are struggling the most in today’s increasingly competitive market.
Athenahealth had by far some of the best marketing booth panels I’ve ever seen at HIMSS.
InterSystems is jumping into the patient portal business. We’ve never been fans of EHR-tethered portals and Intersystems’ move is welcomed.
Health Catalyst continues its momentum, both in raising funds and landing new clients. They are moving fast knowing that the likes of Epic, Cerner and other best of breed vendors are in pursuit.
Lumira, management buy-out of Wellogic from Alere, is building out a solution suite combining engagement, data exchange, biometrics and analytics. Lumira sees itself as a becoming an “Outcomes Company”. How that differs from a traditional MCO is hard to gauge right now.
Everyone wanted to know the implications of IBM’s big announcements at HIMSS. Certainly thought provoking, but IBM has a ways to go to convince the market, especially providers, of what value they can deliver.
The record winning CCD file that Medicity has seen fly over its network was 100MB – that’s HUGE! By way of comparison, one of our 100+pg market trends reports averages about 1.3MB. Is it any wonder that this industry struggles with interoperability.
Plenty of talk and wringing of hands over issue of interoperability, but saw nothing at HIMSS that gave me hope that this issue will be solved across the country in the next 12-18months. Think 3-5yrs at best.
Box had a small booth at HIMSS and unbeknownst to me, acquired a start-up that has a pretty slick DICOM image viewing and medical grade mark-up application that now resides on Box.
BluePrint Healthcare IT’s Care Navigator is a nicely packaged app for care coordination. Children’s Specialized Hospital in NJ have been able to derive some high value from its use in caring for its pediatrics patients.
Of course, with 42K+ attendees, some 1.2K+ exhibitors there is no way any one person can take it all in. One needs a plan and a highly targeted one at that to be able to really get any value out of this event. As they say, practice makes perfect and this being my eighth or so HIMSS, I am getting a little more practiced at how to navigate this event. Never easy, always exhausting, at times depressing, but also never boring. See you in Las Vegas – the site of next year’s HIMSS.
The Future Evolution of the HIT Market
The healthcare IT market is not much different than other software markets. It has its own particular nuances such as regulatory oversight and a recent, massive infusion of federal funds to drive adoption of EHRs. Beyond that, however, the basic mechanics of how this market will evolve in the next five years will reflect what has occurred in other software markets, particularly the enterprise ERP market.