As we prepare for the Health 2.0 conference in the Fall and get stuck into demo after demo, it’s interesting to step back and look at the bigger picture. Clearly the cloud/SaaS trend is going beyond the obvious places–consumer tools, online communities and the data utility layer–to those where client-server architecture has been dominant and successful, such as practice management. Carecloud and athenahealth are examples in that environment (and athenahealth offers a lot of services to go with their on-demand software) and of course the SaaS-based EMR space is burgeoning with not only web-native applications like Practice Fusion, Clearpractice and athenaclincals, but also several of the bigger players like GE with Centricity Advance, OptumpInsight’s Caretracker (United) and even eClinicalworks adding SaaS offerings into the mix. Even the AMA is in the game, with its Amagine service offering a fully hosted SaaS version of NextGen, as well as several other tools and packages.
But then we get up to the walls of the “enterprise.” In health care “enterprises” are called hospitals. Every week it appears that HISTalk is reporting that yet another hospital is uninstalling one client-server EMR product and going with another–almost always Epic. But–with the exception of an odd announcement I don’t understand from McKesson–there doesn’t seem yet to be the healthcare equivalent of large enterprises going with a Salesforce.com approach, where core parts of their infrastructure are put in the cloud. And every installation is a separate custom installation, leaving groups of users needing to be literally banded together by consultants to humbly petition the wizards of Madison County to make particular interface changes. (I’m not kidding–there really is at least one consultant putting together such a group of Epic users). Cloud-based systems of course can roll out these changes much more easily, and receive feedback from their users much more quickly.
It’s tempting to ask, in a world in which major corporations are ditching client-server email systems to go onto Google Apps and hosting entire businesses on Amazon Web Services, what’s the path to SaaS in hospitals? My guess is that it’s not through the front door of the clinical data entry/EMR, but it’s probably going to come in around the side. It’s worth looking at the people who service a lot of hospitals to figure out what’s coming next.
ACS, the diversified data corporation that’s now a subsidiary of Xerox, has an analytics product suite called Midas+. Midas+ is used in around 1500 hospitals to assess patient throughput, resource optimization, performance improvement, patient safety, accreditation, care management, physician profiling and other core reporting that might be useful to case managers and administrators. It’s mostly used, you’ll have guessed, after that data’s been integrated, and it ends up that most of its use is post discharge to help the coders living in the hospital basement improve reimbursement on DRGs.
Last February ACS bought a tiny 12 person company founded in Nashville just two years before called CredenceHealth, and renamed that product Midas+Live. Like Midas+ it takes data feeds such as lab, pharmacy, finance, et al, but it takes them into the cloud and makes analytics available on that data in real-time. That means clinicians rather than coders can use it for clinical surveillance & core measures while the patient is still in the hospital. Hospitalists use it 2-4 times a day to course correct on patients, and charge nurses and floor managers use it more frequently for surveillance.
Midas+Live is then an active clinical management decision support system. Because it takes in vitals, lab results, radiology and more in real time, it’s able to give clinical alerts. It does that by appearing on a patient dashboard, or on a header across the top of the screen the clinician is working on, or pinging the nurse via text, pager or email. ACS claims that Midas+Live is only one of a handful of systems that’s CCHIT certified for inpatient clinical quality measures for phase 1 meaningful use (which has been driving sales), and that hospitals are able to use the product while they’re installing an EMR (or swopping one out for Epic!).
We’re starting to see a few very early other cloud-based services sneaking into the core functionality of that enterprise called the hospital, including Heath Data Source, a cloud based data service, and YourNurseIsOn, a scheduling service–but with its acquisition of CredenceHealth and its addition of Midas+Live to the Midas+ suite, ACS (and Xerox) is making a serious play to be one of the drivers behind the real move to the health enterprise cloud. Watch this space.