Allscripts — Stabilize, then Proceed with Innovation

At the recent Allscripts Client Experience (ACE, #ACEHHS18) conference, the company gave us a day and a half deep dive into their current strategy and initiatives. As much as Allscripts positioned themselves as the innovative leader among the leading EHR vendors, the fundamental reality was far simpler. This is a company that is seeking to stabilize its base, and that is a good thing.

Figure 1: Allscripts’ Advances in the Last Five Years

As most readers know, when CEO Paul Black took over the reins at Allscripts he had quite a mess on his hands. Previous management had grown the company through a series of acquisitions, but little attention was paid to how these various acquisitions would be stitched together to provide a comprehensive and cohesive EHR that extended from hospitals (acute) to small practices (ambulatory).

Clients were not happy, and Allscripts increasingly lost ground to both Cerner and Epic.

Under Black’s leadership losses have been stemmed, costs brought into alignment, and the bottom line has improved. Today, Allscripts has an acute to ambulatory EHR solution in Sunrise, which now represents roughly half of Allscripts’ annual revenue.

The company has also continued its acquisition strategy, picking up two other EHR platforms –  McKesson’s EIS business (see our original take here) and Practice Fusion. While hearing little about Practice Fusion at this event – after all it was focused on Allscripts’s acute clients – we did hear from a number of former McKesson (Paragon) clients that they were quite happy to have Allscripts as their new parent. As one Paragon customer told me:

“We have been ignored for years. McKesson failed to address known problems with their software. At least now we have a voice and Allscripts is making progress.”

In another session with two Allscripts customers, each related their thorough evaluation and due diligence research of current acute care EHR solutions. Their conclusion: The EHR has become a commodity with comparable functionality across all major aspects that were important to them. Since EHR software is no longer a key differentiator, the relationship with the vendor and the need to minimize disruption to frontline users of the software become paramount. This is likely true across the industry and why the long purported EHR replacement market never materialized.

The EHR has become a commodity with comparable functionality across all major aspects that were important to them. Since EHR software is no longer a key differentiator, the relationship with the vendor and the need to minimize disruption to frontline users of the software become paramount.

Stabilization Done – Now Innovate

In a brief conversation with Black, he was passionate in stating that he wants this company to be seen as the true innovator of the big three EHR vendors. He pointed to their precision medicine efforts with 2bPrecise, a young company started by the founders of HIE vendor dbMotion, a company Allscripts had acquired several years ago.

2bPrecise is now embedded within EHR Sunrise workflow and the company is working with six beta customers, including the Mayo Clinic. Today, Allscripts is the only EHR company that offers the physician the ability to match medication treatment protocols with a patient’s genomic information (e.g., how well a patient can metabolize a given medication) – pretty futuristic and promising work. But there is a fly in the ointment: who pays for this second order derivative to define patient-medication matching? No clear answers yet, though the move to value-based care (capitation) may provide accelerated adoption for certain, complicated diseases (behavioral health, cancer, etc.).

Another innovation they announced at ACE was allowing clinicians from within Sunrise to directly order (prescribe) a Lyft ride for a patient (original partnership announced in March). The use cases for such are numerous, from setting up an appointment (25% of low-income patients cite transportation as a leading cause of missed appointments) to taking a patient home upon discharge. Nice feature for both clinicians and patients.

The company has also been quite progressive on the patient engagement front, first with its vendor agnostic patient portal – FollowMyHealth and its recent acquisition of HealthGrid, a patient engagement tool based on texting.

Lastly, the company is in the process to move its core portfolio of products to a common client user interface (UI) based on progressive web architecture. This effort is in conjunction with their move to hosting their solutions on Microsoft’s Azure platform. Note: the move to hosted cloud services has taken the healthcare IT sector by storm. Three years ago, few CIOs were willing to go “off-prem.” Today, there is literally a tsunami of interest among CIOs looking to off-load the care and feeding of their EHRs and other applications.

Challenges Remain

The EHR market is dead in the U.S. To grow, one must either acquire other EHR vendors and leverage their maintenance revenues aggressively while cutting SG&A costs or look to the next generation of solutions and services the client base will need.

Allscripts has done a little of both but what concerns me most is their lack of a clear and compelling solution suite to support the migration to value-based care. Their messaging around population health (CareInMotion) was generic and this solution suite to support value-based care modalities still lags competing solutions. They are working to rectify these shortcomings, but they are slow in coming.

Their analytics story, quite surprisingly, was nowhere in evidence – little discussion during the sessions I attended nor highlighted in their product pavilion. Contrasting this with what I experienced this past week at Cerner’s own user conference, CHC, or at Epic’s UGM in late August, was striking.

The innovative efforts at Allscripts are heartening, especially those regarding patient engagement. Yet these efforts will not keep the lights on for most healthcare organizations as we migrate to data-driven care delivery models. The industry migration of clinical care from an art (little to no data) to a science (data-driven) is readily apparent – Allscripts’ own story on this, however, is currently not quite as clear.

Stay up to the minute.

Did You Know?

Free Research: Migration to Clinician Network Mgmt

CNMLast summer we published another edition of our popular Health Information Exchange (HIE) Market Trends Report. Over the years, this report has for many, become the “authoritative source of information on the HIE Market.” That’s not me talking, that is exactly what we have heard from those who have purchased this report.

This, of course, makes us feel quite proud as our mission here at Chilmark Research is pretty straight-forward:

Provide research that will assist Healthcare Organizations (HCOs) in their understanding, assessment, adoption, deployment and use of IT to improve the quality of care delivered. 

This is what get us up in the morning. This is what motivates us for everyone here at Chilmark wants to make a contribution to improving this crazy, at times frustrating, market sector.

With the release of the latest 2013 HIE Market Trends Report, however, I had an uneasy feeling. The vast majority of the market continued to view HIE as just that, moving basic health information from point A to point B. If anything, HIE has been further dumbed-down with the advent of Direct Secure Messaging, which is really nothing more than secure, point-to-point email – a far cry from interoperability and query-based information exchange.

Another issue was that I was not seeing much thought going into what is next for HCOs and their investments in HIE. Recent reports such as HIEs reduce ED visits is something we have been talking about for years. Seriously, is this the best we can come up with? What new capabilities will HCOs want (or be able) to enable across their HIE? What is the next level of value realization beyond basic records exchange and lab orders/referrals?

I increasingly came to the realization that the vocabulary of how we talk about HIE needed to change. Language is powerful and our current fixation on HIE and the vocabulary associated with it may be preventing this industry from looking beyond this limited construct. For the purposes of that 2013 HIE report, we used the term HIE 2.0 (did I ever mention I have never been a fan of 2.0 attached to any acronym) to signal a change.

In late fall of 2013, after some discussions with clients, consultants and HCO executives, we decided there was the need to test these ruminations. Chilmark put together a prospectus for a research project on Clinician Network Management (CNM) and found five willing sponsors for this research (CareEvolution, McKesson, Optum, Orion Health and one that prefers to remain anonymous). The research objective was to conduct primary research to determine the state of the market in moving to enable CNM, which goes under many guises including physician alignment, clinically integrated networks, etc. but none of these terms have quite the scope that we envisioned for CNM.

Some of the results of our CNM research are quite telling.

  • The market is roiling under massive structural changes.
  • Most HCOs are ill-prepared for the move to from fee-for-service to value-based reimbursement (VBR), though all see it coming.
  • Those select HCOs who are now preparing for VBR are looking to be quite prescriptive in their requirements of affiliated and owned physicians – that will be supported via a CNM model.
  • There remains a divide (level of distrust) between payers and providers that will take time to mend despite the need for both to work more closely together.
  • HIT vendors are, by and large, not keeping up with the needs of HCOs to support CNM initiatives.
  • A best-of-breed approach is seen as only path forward today to enable CNM.

Of course, we learned far more than the above which you’ll find in the report itself. Since this report was sponsored with the intent of helping to educate the market, it is being offered for free. I encourage you to grab a copy – you won’t be disappointed.

 

Analytics, Pop Health & Painful Feet at HIMSS14

rollerHIMSS14….  brought me to the highest of highs and the lowest of lows. As in HIMSS past, I found myself surrounded by people genuinely committed to fixing our defunct healthcare system — and the population health management group-chant was louder than ever.

At the same time, I died a little inside as I witnessed healthcare execs smoking, eating gluttonous amounts of salt-sugar-fat, and struggling to walk long distances in heels that would give podiatrists nightmares. Is pop health mgmt. the solution to all of our human failings? Probably not, but more IT might just keep some diabetics compliant, risk better managed, and doctors more aware of care delivery variation.

As I continue to focus on how analytics is being adopted as part of pop health strategies, here are some of the learnings that came out of my HIMSS14 trip:

A common analytics/pop health tech stack is emerging. The larger HIT vendors are now offering more comprehensive pop health solutions, as detailed in my CAPH Tech Stack diagram. These consist of (1) A data integration piece (2) Performance Management Analytics (3) Care Management Workflow apps.

Lots of small vendors are implementing pieces of this stack, e.g. they specialize in data integration, quality measures, predictive analytics, care management, … On everyone’s mind is how the best-of-breed approach vs. single vendor solution will shake out in the long run.

Vendors that are missing a piece of the puzzle want to fill this gap quickly, e.g. analytics-heavy vendors want to offer care management apps on top; care management vendors are looking for a strong analytics partner.

Data integration is hard to do and even more difficult to explain to the market. I continue to talk to anyone who cares about how challenging clinical data integration is at this point in time. Analytics vendors are in a precarious position where both the data sources underneath them and the business rules on top are ever-changing.

However, I noticed that vendors have all but given up on marketing their data integration capabilities (of course there are a few exceptions, e.g. Health Catalyst, Forward Health Group), with a few still saying that they “take care of the plumbing”. Most vendors, however, are positioning their offerings and messaging in terms of app-level capabilities, e.g. care management and physician benchmarking and seemingly ignoring data integration, or at least not talking about it.

Risk-management still means very different things across payer & provider lines. Prospective, claims-based risk scoring/risk adjustment systems have been employed by payers for many years. When I asked physician leaders and clinical-centric vendors about risk, they tended to discuss LACE for readmissions, or ways of figuring out who will be high risk in the future based on clinical variables and patient-reported outcomes. (I especially heard about the following 3 variables as being crucially important: living alone, chronic condition co-morbid with depression, and zip code). (Editor’s note: And a fourth, education level).

These clinical-centric folks generally knew little about and distrusted claims-based risk models — disregarding them as only prospective-based and lacking crucial variables.

Combining clinical + claims data: as fuzzy as ever. I liked to ask vendors how they are combining clinical and claims into the longitudinal patient record. What is the source of truth?  For example, is a diabetic defined by the ICD-9 code from adjudicated claims, or meds/labs/problem list from clinical data? What if there is a discrepancy?

There are only a few options here: (1) claims data is source of truth, enrich this with clinical outcomes data; (2) clinical data is source of truth, possibly use claims to verify quality of clinical data; (3) keep clinical and claims separate, maybe feed clinical data into claims-based risk models; (4) Maintain duplicate data and do whatever the heck the client wants.

Well, I heard (4) over and over again. This claims-clinical issue is a good example of just how heterogeneous and to a certain extent immature, end-user needs are at this point in time, leading vendors to build highly customizable systems that require services-intensive engagements.

A few dissenters are coming out against care management workflow tools. Caradigm has just laboriously built a care management workflow tool with Geisinger Health Plan. Other vendors (Optum, McKesson) have been offering payer-based care management workflow tools for a long time and are repositioning and rebuilding these for the provider market. The thinking goes that by standardizing care management into a series of steps against a common care plan, there will be less variation and fewer FTEs will be required.

Smaller vendors without the $$$ or inclination to build out humongous workflow tools are asserting that these tools are already obsolete and still require too many FTEs (e.g. Phytel, Explorys). One common idea is that if we get good enough at predicting risk and automating patient outreach, then workflow tools will no longer be needed. I don’t envision care management workflow to be shelved anytime soon but am definitely not ruling out the anti-workflow camp long-term.

Ladies & men alike hated walking in their shoes. Wow, I wasn’t prepared for how many people had read my barefoot post — who then proceeded to complain about how much their feet were killing them (ladies especially felt they had no choice but to wear high heels). Next year, I hope to see others join me in wearing a barefoot-like shoe so we can discuss pop health without the distraction of foot pain.

 

Breaking New Ground

Today is a great day for Chilmark Research and hopefully the world of healthcare IT.

At long last, the much anticipated Market Trends report Clinical Analytics for Population Health (CAPH) has been published. Coming in at slightly more than 100 pages with in-depth profiles on 14 vendors, it is our hope that this report will be instrumental in advancing the discussion of how analytics can be effectively used to drive strategic population health management initiatives.

Our research philosophy at Chilmark Research is relatively simple relying on three dominant criteria:

  • First, target sub-sectors of healthcare IT that have the potential to be truly transformative to the delivery of care.
    Clinical analytics certainly fits that criteria.
  • Second, look for areas where there is a significant amount of turmoil and rapid evolution that thereby make it exceedingly difficult for end users/adopters to make sense of.
    And I thought HIE market was a confusing mess, analytics even more so!
  • Third, is the market potentially large enough (will we be able to sell enough studies to recoup our investment) that it is worth our effort.
    We have been receiving a slew of inquiries from healthcare organizations of all sizes on state of clinical analytics, who is doing good work, who less so. 

If all the above are in alignment, we dig in and dig deep for ultimately we wish to produce a report that will lead to a better, more educated market.

As is the case in this particular report, Cora and I began first mapping out a strategy to address healthcare analytics last summer. Over the ensuing months we continued to refine our thoughts (well it was really Cora refining the thoughts and passing it by me and Rob). Ultimately, we narrowed down the research effort to focus on CAPH as this was the one sector of analytics that best met the criteria above. In the months following, Cora did a tremendous amount of research that has resulted in an excellent report that is on par with our well-respected research on the HIE market and may readily become the defining report on this subject area.

Like the HIE Market Trends Report that we first started publishing several years ago, the CAPH report creates a vendor neutral framework and vocabulary for the industry to adopt and use in their internal discussions and decisions. The report also provides a close look at a number of influential vendors in the market, sizing up their relative strengths and challenges. Lastly, we plan to update this report on an annual basis to insure that the market stays well-informed on the trajectory of the market, the advances taking place and ultimately insure that the market is well-educated on the topic prior to making critical, strategic purchasing decisions.

A big thanks to all organizations and individuals we interviewed over the last year who assisted in developing our thoughts and perspectives on the clinical analytics sector – we couldn’t have done it without your valued inputs.

Reorg at McKesson, Will Docs Trust Predictive Analytics & Med Rec

What a crazy week it has been. Yes, it was the week of all things HIT related with the big confab of HIMSS a the Big Easy. I’m literally still trying to sort out all that I saw, all the conversations I had to make some sense of it all. Needless to say, at times it seems that rather than providing enlightenment, the incessant noise of HIMSS just sweeps over one like a tsunami leaving behind debris of all matters.

But we’ll get to HIMSS next week – I promise.

In the meantime, below are just a few of the topics that we covered in our most recent Chilmark Advisory Service (CAS) Monthly Update. The research notes contained within this monthly provide you with a glimmer of some of our current areas of research interest. For example, the reorg at McKesson is but one example of the massive trend (which was readily apparent at HIMSS) of companies repositioning themselves for population health management in support of financially-linked communities of care (e.g., ACOs). Cora’s research in analytics has brought to light some of the challenges that well-meaning executives may face when trying to get clinicians to adopt and use predictive analytics. While Brian’s story delves into the vexing problem of medication reconciliation within a distributed healthcare community.

The abstracts below provide provide a few more details. But far better than abstracts is of course – drum roll please – becoming a subscriber to CAS where you not only receive a wide range of research content from us over the course of a year, but also direct access to our top-notch team of analysts. Want more information? Just drop us a line to info@ChilmarkResearch.com and we’ll be in touch.

Reorg at McKesson Points to Broader Repositioning
In early February, McKesson Technology Solutions went through a major reorganization and the primary beneficiary appears to be RelayHealth. Historically, RelayHealth has seemed little more than a staging area for McKesson-acquired HIT assets that did not fit logically into any other area of the broader McKesson Technology Solutions Group. With the reorg, RelayHealth not only grows in size, it finally appears to have been given a clear and overarching mission: to become McKesson’s solution to enable population health management. ACOs would be wise to take note.

Will Providers Ever Trust Predictive Analytics
Analytics vendors are approaching the clinical market with predictive models as end-alls for population health risk management. However, doctors, nurses, and case managers have their own ideas about what clinical variables really matter, and they can identify their highest-risk patients practically from memory — no fancy models needed. While there are reasons to be optimistic about PA adoption, vendors should brace themselves for a tough market in which clinical intuition will clash with statistics. One option will be to integrate provider-identified variables into vendor models, an approach that will likely infuri­ate the statisticians but could go a long way in overcoming clinician misgivings.

Medications Reconciliation Continues to Challenge HIE Vendors
In best-case scenarios, medications reconciliation can help avoid adverse drug events by pointing out discrepancies such as missing medications, unneeded medications or incorrect doses at patient discharge. Yet even now that HIT solutions built to support safe hand-offs have been widely deployed, the AHRQ attributes 770,000 deaths per year to ADEs. Meaningful use gives PCPs the responsibility for post-discharge medications reconciliation and as of yet, insufficient tools to do so. Thanks to inconsistent process and technologies across providers, the medications lists PCPs have to work with are riddles with irrelevant medication data, (e.g. a three-year old prescription to treat foot fungus) and missing information (e.g. medications paid for out of pocket). Before medications reconciliation lives up to its promise, serious gaps like this will need to be addressed.

Each month, subscribers to the Chilmark Advisory Services (CAS) receive an update of our research on the most transformative trends in the healthcare IT sector. Exclusive to CAS subscribers, monthly updates are part of the continuous feed of information and analysis we generate to keep subscribers on top of the rapid-fire changes in this 

ACO Here, ACO There, ACO, ACO Everywhere & Vendor Response

In less than two years we have gone from Accountable Care Organization (ACO) as a concept, to ACO as a new model of care delivery. With the January announcement that there were 106 more added to the Medicare ACO program, we now have 254 ACOs nationwide. David Muhlestein of Leavitt Partners has done some of his own research and puts the total number of ACO-like entities at over 400. And let’s not forget that commercial insurers are putting forth their own contracts with providers to set-up similar accountable delivery systems where there is some element of gain and risk sharing with providers.

Now it is one thing to say you have signed on to become an ACO and quite another to actually execute on the contract. Among the numerous challenges that an ACO model presents, is the need for more sophisticated IT systems that will support distributed care management across a diverse care team that extends from the primary care physician, to the specialists, to the care manager, the patient and others. EHRs today will simply not get you there.

Today, there is no such out of the box solution from any one vendor that will enable an ACO model. But there are several vendors positioning themselves to be that one stop shop to enable your ACO strategy.

Following are some vignettes of several vendors looking to enable an ACO strategy and what they have on offer. (Note: This is our proverbial toe-in-the-water as we’ll be doing a comprehensive report on this market later this year)

Aetna: A commercial payer, Aetna is looking for new high-growth revenue opportunities and has targeted healthcare IT. Shortly after acquiring leading HIE vendor Medicity, and soon after leading mHealth App iTriage the company announced its ACO-enablement suite that combines the two above with analytics/managed care solution Active Health.
Strengths: Strong HIE brand, good consumer/patient engagement tools
Weakness: Predictive analytics and care management tools are not as competitive

CareEvolution: A privately owned HIE targeting the private, enterprise market, the company has built its own analytics engine, Galileo. Galileo provides deep dive capabilities into clinical, operational and claims data contained within a given network of providers.
Strengths: State of art HIE solution, good analytics capabilities
Weaknesses: Consumer/patient engagement tools are almost non-existent, low recognition in market

Cerner: Cerner’s HealtheIntent is part of the company’s broader strategy to move beyond being an IT company to becoming a health company. Like most EHR companies, ability to move as fast as market requirements is a challenge.
Strengths: Leading EHR, strong brand, leading visionary among EHR companies, has a good HIE solution, has broad suite of consumer engagement tools
Weaknesses: Analytics is lagging, resources to respond quickly is a challenge, distributed care management tools still work in progress

Epic: Company has one objective, rule all and do so through a highly proprietary and closed model. With Epic Everywhere, their HIE solution for Epic sites, company is able to provide exchange across entities as long as they are using Epic. Recently signed deal with Surescripts to allow exchange with other EHRs. Epic’s MyChart is the leading patient portal in the market.
Strengths: Growing dominance in market, solution suite is tightly integrated from ambulatory to acute care settings, patient portal is widely adopted
Weaknesses: Epic continues to follow a dated model of highly controlled, closed system that while providing high integrity, will ultimately yield a lumbering dinosaur – think Wang circa 1983

RelayHealth: Part of McKesson, RelayHealth has always been a catchall for various acquisitions that McKesson could not find an appropriate home for. A major reorg occurred a couple of weeks ago that will reposition RelayHealth as McKesson’s ACO-enablement suite.
Strengths: Strong consumer/patient engagement tools, a leading HIE solution in the enterprise market and with the reorg, the addition of new assets including the recently acquired analytics solution, MedVentive
Weaknesses: Still does not have a good story to tell around distributed care management, how MedVentive will be folded in remains to be seen.

This is by no means an exhaustive list of those HIT companies looking to offer an ACO-enablement solution suite, but simply meant to provide some perspective on what is currently on offer in the market.

As we prepare to head to HIMSS a week from Saturday, on the top of our list of things we wish to learn more about is exactly how companies such as those listed above and others not listed are meeting the current and future needs of the 400+ ACOs across the country and more importantly, how they intend to become the leaders in this rapidly developing field.

Thanks to KramesStayWell.com for the image

Dipping Into the Waters of Mobile Health

Introductory Remarks: Chilmark Research is pleased to welcome a new addition to our staff, Cora Sharma.  Cora will be leading our research efforts in the mobile health app market (mHealth) and below is her first post on the subject.  Cora has a great background having received a BSc in Computer Science, worked in the software sector for several years and recently graduated from MIT’s Sloan School of Business. While at Sloan, Cora did an internship with McKesson where she found her calling, HIT and the desire to become an analyst.  She’s a great addition to Chilmark Research and I’m confident she’ll produce some excellent research. – Stay tuned.

The concept of mobility in healthcare is nothing new to providers, vendors, and to Chilmark Research alike.  The current media and investor buzz surrounding mHealth stems from the belief that: 1) mobile technology has finally matured to a point where age-old healthcare processes can finally be revamped; and 2) mobile technology has not only matured but has actually been adopted en-mass by physicians and shows no signs of abating.

Doctors Love Smartphones, but are GaGa over the iPad
Recent reports from SpyGlass Consulting and Manhattan Research show that the vast majority of physicians already use smartphones. Pamela Dolan at the AMA has a nice commentary on these latest numbers. Chilmark Research’s recent talks with industry folks shows that the iPad is also gaining significant traction with physicians.  At a recent conference in Denver where Chilmark Research attended and spoke, the CIO of Catholic Health Initiative (CHI) sees providing their doctors with mobile apps (in CHI’s case on the iPad) as critical to the success of complying with meaningful use requirements.

mHealth Apps in Acute Care
Given that physicians have now ‘gone mobile’, does this imply that they will no longer be satisfied with computers-on-wheels (COWs), demanding mobile access to every piece of data buried in Health Information Systems (HIS)?   If yes, providing doctors with mobile access to patient and hospital data could be just the perk needed to attract more affiliated physicians, satisfy existing ones and ultimately drive the adoption and use of HIT by clinicians.

Here is a brief look at the mHealth acute care vendor landscape:

  • Pure play inpatient mobile solutions companies like PatientKeeper and MedAptus have built their businesses on providing clinicians with mobile apps, each having started with charge capture and quality measures.  PatientKeeper expanded into CPOE with a limited roll-out that is scheduled to go GA in 2011. As the mHealth market continues to gain momentum, it will be interesting to follow the fate of these two companies.
  • The big boys of HIS (Cerner, Eclipsys/Allscripts, Epic, GE Healthcare, McKesson, MEDITECH, Siemens) all have mHealth stories, albeit weak ones that revolve mostly around mobile browser access to their core EHR.  Early this year Epic released the Haiku app to Apple’s AppStore, resulting in some fanfare from the tech community.   Also, the Citrix Receiver app makes it possible to run Windows-based apps like McKesson and Cerner securely on the iPhone/iPad and Android, though with obvious usability issues associated with being a non-native app.
  • Potential entrants/disruptors from outside the industry face a battle with the big boys, who seem to want to reduce mobility to an extra feature on their systems.  Diversinet is making a play in secure doctor-doctor and doctor-patient communications for the enterprise. The company has made extensive investments to the tune of some $80M spent over the last decade developing IP in encryption and identity management.

mHealth Apps in Ambulatory
There are a multitude of physician content and productivity apps in the AppStore, from anatomical diagrams to medical calculators to ICD-9 lookup and arguably the most successful category, medical content apps.

Mobile medical content companies such as Epocrates and Medscape have had a presence on physicians’ phones/PDAs for years.   We are closely following Epocrates’ expansion into the SaaS EHR market.  If mobile EHR access is a truly compelling value proposition for ambulatory physicians (we aren’t convinced it is), then Epocrates may be able to leverage the brand’s mobile association and large, existing installed base to stand out from the 400+ competing EHR vendors.

A number of ambulatory EHR vendors (AllScripts, eClinicalWorks, Greenway and NextGen) have recently introduced their own EHR mobile apps, most built for Apple’s mobile OS. Currently, it appears that little is on offer from EHR vendors for Google’s Android mobile OS, though that may change as Android becomes an increasingly compelling alternative to Apple.

Onward Ho!
Dipping our research fingers into the mHealth market, Chilmark Research is launching a new initiative that will culminate in the report: Enterprise Adoption of mHealth apps: Trends, Issues and Challenges. Over the course of the next couple of months (target release date is in advance of NIH’s mHealth Summit in DC) we will interview executives from the major HIS vendors, best-of-breed vendors, tech entrants, and leading Hospitals/IDNs. Through both primary and secondary research we will answer such questions as:

  • What top mobile apps are currently being adopted in the enterprise?
  • What are the priority unmet needs among leading Hospitals/IDNs?
  • What challenges are currently hindering adoption of mHealth apps in the enterprise?

In the meantime we will be posting every other week specifically to give updates on our mHealth research.  Onward Ho!

With Merger, Is WebMD Now in Play?

This morning, along with announcing very good 4th qtr growth at WebMD, a concurrent announcement was made that Healtheon and WebMD have agreed to merge, putting the value of the combined entity at about $2.3B. Due to the structure of the deal, WebMD will also end up with a hefty war chest estimated at $700M.

While I am no financial analyst, what I do know is that the past ownership structure of WebMD (84% owned by Healtheon) made WebMD a difficult acquisition target. Now that the two have combined WebMD may become much more attractive to a potential suitor.

WebMD is an attractive property for a number of reasons including:

Brand Recognition – They are the 800 pound gorilla in the personal health and wellness market, no one comes even close in numbers of page views and unique visitors.

Customers – WebMD has a long list of enterprise customers, both employers and health plans that is the envy of the industry.

Hot Market – Seems like everyone is clamoring for a piece of the action in the personal health and wellness space including the big boys Microsoft and Google.

Cash – A $700M war chest is nothing to sneeze at.

So who will come courting? Some likely suspects include:

RevolutionHealth could benefit with some added breadth and depth from WebMD and would love those WebMD customers. Also, WebMD had a relationship with AOL (discontinued last year) and RevolutionHealth is run by former AOL head, Steven Case. There will, however, be a lot of overlap that will need to be rationalized. Probability: High

Google may like the content and some of the tools WebMD would bring, but they are also pretty far along in their own plans/development and Brand, well Google has plenty of that. Probability: Low

Microsoft is much like Google, but has a greater propensity to make an acquisition to keep Google at bay. Microsoft might acquire WebMD as a defensive move. Also, Microsoft might like to have all those enterprise customers, not that they don’t have them already, but it could sure extend their presence in enterprise accounts. Probability: Medium

Intuit has taken a decidedly low profile approach to the PHR market. If they wanted to dramatically boost their visibility and further strengthen their product portfolio, this would be a good move for them. Unfortunately, it takes Intuit outside of its sweet spot/core competencies, thus they are unlikely to make a move. Probability: Low

Yahoo? Why not, though they seem to be ignoring the health & wellness market and have enough issues to deal with right now, primary among them the beast from Redmond. Probability: Low

Large insurers like WellPoint or Cigna could make a move similar to Aetna’s acquisition of ActiveHealth or UntiedHealth’s acquisition of HeathAtoZ and acquire WebMD. Thing is, the scale of a WebMD acquisition is massive in comparison and it could get quite messy as a lot of health plans (over 100) have some form of a relationship with WebMD and may bolt if WebMD goes to a competitor. Probability: Medium-low

Other HIT vendors such as McKesson, GE, Siemens, etc., are focused on business to business sales and in particular sales to hospitals. While WebMD gives them future paths for growth and could be leveraged in innovative ways (connecting clinicals to PHR and decision support tools), falls outside their current sales and distribution channels and is simply not in their DNA. Probability: Low

I’m sure their are other suitors out there, but this is just a quick hit list off the top of my head. And while I can give no definitive answer as to who the suitor will be, WebMD will have new ownership in 12-18 months. Probability: Very High

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