The Glass is Half-Full…of S.H.I.T.*

by | Feb 19, 2014

glass-half-full1(*Super Health Information Technology)

I’ve had the good fortune of working with John and the Chilmark Research team in some capacity since 2011. As expected, I’ve learned a lot about the field, the technology, the policy, and so on and so forth. I’ve also picked up a great deal about what it takes to be a good analyst in a technology market that is rapidly growing, constantly shifting, and in many ways uncharted.

As an individual, I am a relatively optimistic guy – I get excited by new ideas, the potential for real improvement in healthcare, and well-crafted solutions. A solo shot of a Mostashari keynote or a Todd Park Youtube clip is all I need to get me all fired up.

Yet as an analyst, I am constantly reminded by my colleagues that it’s important to maintain a healthy disconnect from such an optimistic purview when looking at the world around us. At no time does this become more evident than at the annual HIMSS conference and expo, where we are cajoled by every company spokesperson and marketing team claiming to have the most Super Health Information Technology that has ever existed.

One of the most discerning tools in a health IT analyst’s utility belt is a good old-fashioned BS meter. In working in the health IT field as an analyst, one deals almost exclusively with sales and marketing folks from organizations that run the gamut of solo entrepreneurs to mega multinational corporations to taxpayer funded cheerleading squads. This is not a problem, per se; it is just the nature of the business. I get it, I know – it’s HIMSS, after all. Don’t hate the player, hate the game.

Reading between the lines in this rosy world is an acquired skill. In tracking a particular market – in my case, patient and consumer engagement, you quickly learn which individuals from which companies can really chop it up and share their insight, and which ones simply have an eye on your upcoming report as a sales tool. In paying attention to what’s not said, you can learn volumes about what’s not real. The interoperability showcase is much more valuable than the expo floor (unless you’re looking for free hacky sacks). We are naturally wary of the buzzword compliant vendors (I’m already bracing myself for “Patient Relationship Management”), as well as those who are caught up on meaningful use as the primary drivers of health IT adoption. Because even though MU2 is leading many CMIO’s patient engagement agendas, our standard for best in class vendors is those who build to meaningful use as a tactic, not a strategy.

So heading into Orlando in a few days, I’ll be doing my analyst-best to balance a natural, Disney-like enthusiasm for some truly amazing technology, with the grounded, cautious skepticism of the HIMSS mainstay health IT vendors that seem to have become too big to fail (more on them in a second.)

 The Good (Optimism)

Based on the 2014’s research so far, I am developing a more positive outlook on the startups and small-to medium sized outfits who are building modular patient engagement solutions, from specific care management task-lists (Filament Labs), to communication platforms (Conversa), to data integration (Validic), to video visit technologies (American Well). To be sure, they have their work cut out for them, and by analyst standards most of these companies are difficult to truly peg, with only one to two clients under their belt. So, call it a cautious optimism.

 As the healthcare system’s demand for innovation increases, legacy vendors’ ability to supply it seems to be plateauing. Chilmark suspects it will come from these smaller, nimbler “NewCos.” As EHR vendors seek to build bridges out to patients, we fully expect to see them partner with or gobble-up the best of these startups in the next 18 to 36 months.

The Bad (Skepticism)

Patient-Generated Health Data outfits: From what I saw at the mHealth Summit in December and online since then, there have been innumerable patient data plays, from device makers to app platforms to sensors and wearables that have not put an ounce of thought into how to pool, stage, present data at the appropriate level to a care manager or other medical practitioner.  In a word, workflow. What is okay for the fitness tracker is not okay for the mood tracker or the Bluetooth blood pressure cuff. Data collection is old news, and is now a component of the engagement loop that is necessary but not sufficient. It’s making that data actionable that creates the value we need in healthcare.

The Ugly (Pessimism)

This dubious honor goes to the corporate hippos who frequently succumb to the same groupthink and reactive positioning that has gotten the healthcare industry so far behind the 8-Ball in the first place. In my domain, this is the legacy EHR vendor who is putting lipstick on a pig by dressing up a patient portal that still has less functionality than a free app like iTriage. It is the insurance conglomerate with the “Blue Button Pledge” proudly displayed on their corporate website, whose company portals tirelessly fail to let patients select a doctor, pay their bills with credit cards, or set-up appointments online. It is the mega corporations who have bigger marketing budgets in their healthcare vertical than many reasonably sized office practices have in their IT budget – and still struggle to produce anything of merit (looking at you, TelCos.) It’s time to stop checking off federal mandates and telling everyone it’s “innovation.”

So while we’re well aware that HIMSS is a giant party for most, let’s not lose sight of the valuable in-person learning opportunity it can be for everyone. For vendors, instead of showing off your S.H.I.T., provide open access to your delivery system clients who are willing to show us real results, talk openly about some of their frustrations and challenges, and provide a more grounded perspective from where the rubber hits the road. For attendees reading this blog, keep a keen eye on promising developments but don’t be afraid to ask the tough questions. If you see anything you’d like to share, make sure to tweet us @ChilmarkHIT!




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