Windy City, Turbulent Times

by | Apr 26, 2011

Special Note:
When this post first went up an image of a tornado was used as a metaphor for the very turbulent times that the healthcare sector is currently experiencing. Little did we know that this week would see the most devastating tornados the Southern US has seen in three decades with hundreds of lives lost. Our prayers go out to those who have suffered loss this week as a result of these storms.

Yesterday was the annual Harvard School of Public Health Event, Public Health and Technology (PHAT2011) and today in Chicago getting ready for the Microsoft Connected Health Conference (CHC). First some highlights from PHAT, followed by expectations for CHC. Will follow up with more detailed review of CHC if warranted at end of week.

The PHAT event holds a special place in my heart as this was the third one and I was on the planning committee of the original. The event is put together by the grad students at the Harvard School of Public Health and I am always amazed at how fine a job they do under the close tutelage of Professor Ashish Jha and others. Following are a few of the key take aways from this event:

Health Information Exchange is the big elephant in the room. In his remarks, Dr. Jha stated that his research has found that only 3-5% of doctors/hospitals have exchange any EHR data and that the broader desire to improve quality while lowering costs is a non-starter if EHR data can not be readily exchanged. Significant policy and competitive issues need to be ironed out before we’ll see progress. When I asked Dr. Blumenthal (or is it Professor now) what it felt was the biggest challenge for his replacement at ONC, Dr. Mostashari, Blumenthal stated without hesitation HIE. Chilmark couldn’t agree more and is one of the reasons we made HIE one of our primary research areas for the next couple of years.

Too many EHRs, too few adopters (and does anyone validate/certify viability?). There are now over 500 EHRs and EHR modules certified from some 300 plus vendors. Of those 300 plus vendors, nearly two thirds have less than 50 employees. Simply mind boggling and rather than the certification process separating the truly viable and worthy EHR vendors from the get rich quick poseurs, we have an absolutely nightmare of choices. Where is Consumer Reports when you need them? And don’t go looking to RECs for assistance as their focus and knowledge is limited. Please someone with deep pockets come into this market and deploy a roll-up strategy similar to what Infor has done in the ERP market. (BTW, Infor just acquired Lawson who was struggling to remain independent – not sure what that might mean to the future of Lawson’s healthcare business, including forays into HIE. Word to wise: if considering Lawson, ask hard questions.)

Big battle brewing between enterprise and public funded HIEs. One State HIE rep characterized enterprise HIEs as almost a pox on the industry and nothing but more silos of information. She has a point, but a limited one. It is time for the statewide and even regional HIEs to see what they are really meant to do, address public health issues and not over-reach. Both enterprise and public HIEs have a reason for being. Enterprise HIEs have little issue with sustainability as there are clear business reasons to create and support an HIE, reasons that only become stronger with ACO rules. For public HIEs, sustainability is reoccurring problem whose only solution may be a recognition that this is a public service for the public good and needs to be government funded. Not a very palpable proposition in today’s political climate.

Lots of smoke on topic of ACOs but still can’t find the flame. Last session at PHAT looked at innovative care models which of course can not be spoken about in the same sentence today without mentioning Accountable Care Organizations. Despite a lot of talk about the need to improve quality, make patients take on more personal responsibility, etc., there was still very little clarity on how all this knits together to create a viable and profitable ACO. There are some promising studies (healthcare seems to have plenty research studies to throw about) but how it all comes together, what are the technical underpinnings and most importantly, how does all this fit into existing workflows and where needed how are workflows re-architected to support new care models – one could go on and on and quite sure many will for the foreseeable future.

Tomorrow I’ll be moderating a panel here at the CHC event – a bit of a “What if” panel that looks at what might be possible in a major metropolitan area if health data could be integrated and shared. Looks to be a good panel and will be particularly interested to hear more about the Chicago HIE, which just announced its award to MSFT (and partners) yesterday. One of those partners is yet another HIE, HealthUnity which we know little about except that it is based in Seattle and started by MSFT alumni in 2004. During our research for the HIE Market Report, not a single HIE vendor mentioned HealthUnity as a competitor so they must be operating in stealth mode – something that is likely to change after this big win. Getting harder and harder to track all of these HIEs that seem to keep popping up like mushrooms in the forests of the Pacific Northwest. At this rate, by the end of 2012 we’ll have as many HIE wannabes as we have EHR vendors today.

Following is the presentation I will use tomorrow to kick-off the panel session. Enjoy.

[scribd id=53995115 key=key-1lx9osd4jkva4et5s2i3 mode=list]


  1. Jenny Rita

    In response to your paragraph “Too many EHRs, too few adopters (and does anyone validate/certify viability?).”, I too question viability. It is my understanding that ARRA Compliance and EHR meaningful use Compilance are not easy for vendors to aquire. Do these compliance measures help determine viability?

  2. John

    You are partially correct Jenny. The process to gain certification for full EHR suite (vs modules) can be a long and possibly an expensive process. However, a vendor can have EHR modules certified, a far less costly process and overall, the certification per ONC-ATCB rules is not as onerous as previous certification process (pre-HITECH) thereby lowering the cost barrier and keeping so many EHR companies in play despite what may be questionable long-term viability.

    • John Lynn

      Not that the pre-HITECH act was really a barrier either. In fact, I can’t imagine government or anyone fashioning an EHR certification that would manage to certify long time viability and usability of an EHR. Those 2 things are really hard to measure. Although, if I could think of a way or came across the way, I’d be all over making it happen.

      Looks like it was a great event. Wish I was there.

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