By MICHAEL LAKE

This is a summary of the HIT Trends Report for November 2010.  You can get the current issue or subscribe here.

Hospitals continue to drive HIT dynamics. According to a report by SK&K, more than half the physicians in health system- or hospital-owned practices are using EMRs, a jump of more than 10% over last year. This is further validation of the importance of hospitals and systems in the current adoption dynamics.  The relaxation of Stark rules, the influence of provider incentives and potential hospital participation in medical home and accountable care may be driving interest. KLAS reports that smaller hospitals are ignoring typical suppliers in favor of more traditionally large hospital vendors.  They likely feel the companies serving bigger organizations will be getting the best experience in helping clients meet federal criteria to get the incentives.  And according to an executive of a firm providing lab technology writing in Becker’s, all this hospital EMR activity presents new opportunities for hospital laboratories.  They may be able to leverage new connections with community physicians into increased business opportunities.

Market activity in the practice EMR segment includes EMR products from DrFirst, known for its e-prescribing, and NaviNet, known for its health plan physician portal.  Both initiatives are worth tracking.  The DrFirst announcement is focused on providing a lite EMR with a national patient registry software provider. It will be interesting to assess if this kind of lighter alternative will appeal to smaller practices that have had the most difficulty getting their arms around HIT practice alternatives.   The NaviNet announcement marries its leading health plan portal with a web-based EMR powered by CureMD.  We wonder whether this combo might also be of interest to smaller provider offices.  If so it’s a natural way for health plans to communicate gaps in care information right into an EMR and get this information “behind the exam room door.”

Roadmap to HIT consolidation. Marlin & Associates expressed a comprehensive vision for HIT consolidation into a few, super-firms who integrate infrastructure, applications and analytics for payers, providers and patients.  They see an analog to financial services and Bloomberg or Thomson Reuters.  They forecast that the companies that are working on healthcare finance and revenue cycle management will first consolidate with administrative applications such as claims clearing.  The example they cite is Availity buying RealMed.  Although it’s equally likely the HITECH and Affordable Care legislation are also pushing consolidation on the clinical side, as in Allscripts/Eclipsys and the recent Ingenix acquisitions.  Their graphical view of the landscape (at right) is helpful.

“Incentives plus information leads to transformation.” This quote is from Todd Park, HHS CTO, who has been particularly articulate about the elegance of the federal HIT strategy.  He connects the dots between HITECH incentives, physician payment reform, and data liberation in an interview for Federal News Radio.  The incentives get us moving toward physician adoption of usable EMRs.  Parks thinks the meaningful use rules put the vendors on notice to make software that helps care for patients.  The next leg is in the Affordable Care Act that envisions compensating physicians for value as opposed to volume of services.  And the third element is liberating the data from its silos.  And HHS is playing its part by making its aggregated patient data available for research and software testing, in a similar way to how it treats weather data, allowing weather.com and The Weather Channel to develop consumer products. Another aspect of its industry outreach that seems successful is its HealthIT Buzz blog.  In recent entries it is revealing its thinking about consumer HIT policy and is getting good feedback from the industry that is coloring its thinking.

Cell phones and smart phones are the next wave of health technology.  Diversinet announced that the Army will use its mobile platform to keep in touch with the health needs of returning vets.  The solution will allow care teams to monitor and track body weight, mood, energy, sleep patterns, physical pain, relationships, anger management, and overall sense of well-being.  While the Army considers this patient-care team exchange “pre-clinical,” it looks forward to expanding into clinical programs with adjusting medications and documenting in the EMR.  The University of Toronto reported on results of a study that found significant results in using cell phone technology to improve blood pressure.  AT&T is taking notice of mHealth activity by announcing it is organizing a separate health unit. Its new strategy includes moving from just the infrastructure to support HIEs to broader cloud-based and mobile services in support of care communications.

The Art of HIT. The art this month is Two Ways to Organize, Leslie Shows, from 2009.  A natural market consolidation that feels top down is joining grass roots innovations that are more bottoms up.  We’re beginning to see the convergence.

Michael Lake has been a healthcare technology strategist for over 30 years.  He is President of Circle Square Inc., a San Francisco-based strategy, business development and market research firm, focused exclusively on the healthcare information technology market. The company works with healthcare, life sciences and technology companies on developing strategies, products and business models for complex multi-stakeholder healthcare environments.  He publishes the HIT Trends Report monthly.  For more information, please see www.michaellake.com.