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.

  • Acquire other EHR vendors to gain market share (Allscripts, Cerner, CPSI, Harris)
  • All major EHR vendors are pursuing an extension strategy moving from EHR to supporting PHM, RCM, analytics, etc, though their capabilities in these adjacent areas vary wildly.
  • Expansion into new markets. Epic is looking to dentistry and insurance. Allscripts, life sciences and payers with Veradigm. Cerner, government and payers. All large acute/ambulatory EHR vendors are actively pursuing overseas markets, with Meditech particularly strong in Canada.

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:

  • All vendors will continue to tout the momentum they have in the market as if this market will remain forever on a hockey stick trajectory, but very few can back it up.
  • AI/ML will be just as pervasive this year as last, permeating all aspects of health IT, but likely very little demonstrable proof of scale.
  • A multitude of disease-specific, chronic management solutions but no vendor with a true portfolio of best-in-class solutions on a single platform. Resmed appears close to enabling such a platform for respiratory ailments.
  • More FHIR use cases.
  • Plenty of patient-centric this, consumer-centric that but all a head fake as it is really about capturing patient revenue via online bill pay and filling vacant appointment slots.

And what I hope to find at HIMSS’19:

  • An AI/ML company that has truly scaled its solution across an enterprise in at least two customer deployments.
  • Clear metrics from EHR vendors on the level of adoption and use of FHIR across their client base.
  • An engagement solution that is looking beyond the near-term volume/revenue needs of a healthcare organization to how to truly engage patients/consumers in their health e.g. Aetna/Apple’s Attain app.
  • How vendors are assisting their customers in achieving demonstrable, defendable ROI from their solutions. Health Catalyst stands out here.

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.

Stay up to the minute.

Did You Know?

MEDITECH Look Ahead: Building on Steady Progress

Key Takeaways from MEDITECH’s Physician and CIO Forum 2018:
  • MEDITECH is moving its customer base to Expanse, the latest iteration of their EHR
  • Expanse has significant inducements for hospitals seeking to support value-based care and be more interoperable

Photo: Courtesy of MEDITECH

Last week, we had a chance to attend MEDITECH’s Physician and CIO Forum, an event the company uses to give its customer executives a look forward.

The more concrete developments described over the course of this two-day event include:

Voice Support

A lot of attendees were talking about a new capability planned for Expanse called the Virtual Assistant. The idea is to voice-enable aspects of the physician’s workflow. Even as MEDITECH, and all the other major EHR vendors, slowly improve the interface design of their EHRs, users still want fewer clicks and swipes and less data entry. MEDITECH, seeing the rapid adoption of voice in consumer markets, wants its users to be able to retrieve results or review charts hands-free. It indicated that it is experimenting with this Nuance-sourced technology at a customer site with a phased roll-out planned once it gains more experience. Sometime next year it will begin work on using voice in physician documentation as well.

Interoperability and FHIR

MEDITECH came out strongly in support of FHIR. It has three live customers who have implemented FHIR servers that support REST-style access. MEDITECH facilities will soon be able to offer FHIR-based access on the CommonWell network. It is also looking at more complex transactions from Project Argonaut to support patient questionnaires and scheduling that will rely on write access to MEDITECH EHRs. You can read our full analysis of their support for API access in the MEDITECH profile in our App Store report.

Mobile developers will soon have access to a new capability called MEDITECH Greenfield to develop patient- or clinician-facing apps. It will serve up a set of APIs based on MU’s common clinical dataset with plans to add other data types down the road.

Clinical Decision Support

MEDITECH will rely on CDS Hooks to offer Stanson Health’s content for a variety of purposes. It will be used to push some of the most common care gap alerts. It will also push recommendations to physicians based on the Choosing Wisely campaign.

MEDITECH’s approach to introducing new functionality allows its customer to keep the lights on and support the onrushing changes to U.S. healthcare.

Population Health Management

MEDITECH’s PHM story is a little clearer than it was this time last year. The company’s collaboration with Arcadia.io means that its customers will soon have access to an aggregated patient record of MEDITECH and non-MEDITECH EHRs married to paid claims. Customers will get access to a new suite of dashboards and reports that provide risk scores, care gaps, attribution, utilization, and costs on a per patient or per cohort basis. The company plans to roll this out to early adopters before the middle of next year.

Patient Engagement

The company talked a lot about its new downloadable app for patients: MHealth. This app will permit patients to manage a lot of administrative and payment tasks in connections with office visits. It also will offer questionnaires that will help with reconciling meds and allergies to the clinical record in the EHR.

Upshot

MEDITECH hospitals are under the same pressures to adapt to value-based care that the rest of the industry continues to struggle with. Many of the company’s actions over the next year will help them in different ways. MEDITECH’s approach to introducing new functionality allows its customers to keep the lights on and broadly support the onrushing changes to U.S. healthcare.

athenahealth Acquires RazorInsights: Can athenahealth Succeed Where Others Have Failed?

Success?

On Wednesday, January 14, athenahealth announced it will acquire the cloud-based EHR & RCM company, RazorInsights. RazorInsights’ target market is rural, critical access, and community hospitals (25-50 beds), which aligns well with athenahealth’s strategy to move upstream into the inpatient market. As a part of the acquisition, athenahealth gains ~25 hospital clients currently running RazorInsights’ ONE EHR solution. athenahealth did not disclose any transaction details although early estimates are for a $40 to $50 million purchase price.

Even though athenahealth is already working on developing additional services for the inpatient market, the RazorInsights acquisition represents an effort to fast forward this process. The acquisition opens up a new segment of the market, albeit one that has modest growth prospects that are far below athenahealth’s targeted 30% bookings growth goal. This market also has some well-entrenched competitors e.g., CPSI and Meditech, and others targeting this sector – Cerner with its own cloud-based solution, CommunityWorks. If athenahealth/RazorInsights is successful though in continuing to add additional small hospital clients at a steady clip and additional sales of their population health and care coordination solution (athenaCoordinator), it will present a compelling blueprint for other ambulatory EHR vendors and validates some of Jonathan Bush’s broader vision of what athenahealth represents.

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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!

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