Who will be the Salesforce.com of Healthcare IT?

Last week was the massive Salesforce.com user conference Dreamforce (massive in that there were more attendees at Dreamforce then this year’s HIMSS!). We’ve been reviewing more than a few articles and writings written by those who attended the event. In the few short years of its existence (~13yrs) Salesforce.com has become one of the leading Customer Relationship Management (CRM) vendors in the market and basically pushed the previous leader Siebel to the brink and into the arms of Oracle. Salesforce is arguably the leader in the Software as a Service (SaaS) market and thus someone to pay close attention to on all things “Cloud Computing.”

So what makes Salesforce.com so compelling and what are some parallels to the healthcare sector?

Similar Market Demographics: From the beginning Salesforce has always been structured as a SaaS and targeted the hard to reach and highly distributed sales forces of companies of all sizes. Actually, they first targeted the small to medium business (SMB) market and once successful there, went after Siebel in big enterprises. In healthcare, the vast majority of care is provided by small, 1-3 physician practices that are highly distributed across the country – perfect target for a hosted SaaS offering.

Deliver Value, Not Pain: Since most sales people get a large portion of their salary via commissions, the last thing they want to do is hassle with software that is cumbersome to use. Salesforce.com’s user interface (UI) is very intuitive and surprisingly customizable (within limits) for an SaaS offering. This allows a sales person to configure the the solution to their specific needs. We hear time and again from physicians that the EHR they are being forced to use doesn’t fit their workflow and is often painful to use. (Having been demo’d more than our fair share of EHR solutions, it still shocks us just how awful the UI is for these solutions.) Like their sales brethren, physicians need solutions that fit their processes and do not slow them down.

Fold in Rich Communication Tools: At this year’s Dreamforce, Salesforce.com CEO Marc Beniof spend a substantial amount of time focusing on the rich communication tools that Salesforce is embedding to tap the move to social networks. Right now, the US Government is dumping over a half billion dollars to stand-up HIEs in every State and enterprises are easily spending double that amount to facilitate information exchange in support of referrals, lab distribution, orders, etc. What if a Salesforce for healthcare arrived on the scene allowing physicians to securely exchange information in the same manner that those on Salesforce.com use that platform for secure ad hoc communication with internal and external partners to meet customer needs?

Provide Robust Security – No Leakage: Sales leads are a sales person’s bread and butter and they guard them with their lives for it truly is their livelihood. Thus, Salesforce had to build a system that ensured a sales person’s leads were their own with no possibility of a breach (leakage) to a competitor. If Salesforce can meet this strict requirement, is it such a stretch to preserve the integrity of personal health information (PHI) on such a system?

Focus on the Data & Deliver Simple Yet Useful Analytics: Sales is often a numbers game. This requires superior, robust data management and ultimately the ability to create a wide variety of pre-configured and customizable reports. As we move towards value-based contracts, providers of all sizes will be asked to provide reports as well (typically on quality metrics) to those paying the bills (CMS, payers, etc.).

Provide an Ecosystem: Salesforce has a vision to provide an ecosystem of third party apps on top of their platform but to date, like most companies, they have struggled to make much headway here. But in time, as more and more IT functions move to the “Cloud” to support an increasingly mobile device centric world, an ecosystem is inevitable. In healthcare, where one might successfully argue that physicians are one of the most mobile of professions, accessing apps via mobile devices is quickly becoming standard practice. Increasingly, the healthcare market and in particularly those far-flung physician practices, will look to ecosystems of apps delivered over the Web to their mobile device (touch-screen tablet) to support their practices.

Adhere to KISS Principle: Like sales professionals and for that matter just about any other professional worth their salt, physicians in private practices are extremely busy and the last thing they need is to fuss around with software maintenance and upgrades. Subscribing to a SaaS takes that big upgrade headache and slams it with a double dose of Excedrin.

This got us to thinking…

Who in the Healthcare IT (HIT) market might become the Salesforce.com of HIT?

EHR Vendors: We can’t think of a single vendor in the EHR market that has the foresight, the vision, the chutzpa to pull off a Salesforce.com move. Sure, one can point to PracticeFusion (who happens to have received backing from Salesforce) but we don’t see the vision there. What about athenahealth you might ask? Yes, they like to portray themselves as such, but honestly, their bread n’butter solution is not a SaaS play but more of a straight services play delivered via the Internet and a lot of old school back office processing in a warehouse in Maine. All the other EHR vendors? Either they’re too small to matter or chained to their legacy business models that they can not break free of to deliver the scale and gravitas of a Salesforce.com like solution for healthcare.

HIE Vendors: Increasingly, HIE vendors are providing simple EHRs targeting ambulatory practices, they certainly have the information exchange piece covered (to highly varying degrees) are beginning to fold in analytics (big reason why UHG acquired Axolotl) and some are looking to provide an ecosystem play such as Medicity with its iNexx platform, Covisint with its AppCloud or even Microsoft’s somewhat aborted attempt with Amalga. Yet, despite these efforts, we do not see any one HIE company really grasping the reigns and running away with the prize. Each of the aforementioned vendors have their own reasons why they haven’t quite captured the imagination of the healthcare sector and we are not holding our breath waiting for someone to breakout.


Emdeon has a huge presence in the market as a clearinghouse for claims processing and having just been taken private by private equity firm Blackstone, they may try to make such a play. At the most recent HIMSS sat down with Emdeon for a briefing where they hinted to a desire to move more directly into clinicals, but to date, we’ve seen nothing materialize and it is unlikely to happen anytime soon. Emdeon also has the very real issue of their existing business model (did you no their number one capital expense is postage stamps?) that will keep them on the sidelines.

NaviNet is similar to Emdeon in that they already have a direct connection into the physician’s office with some one million plus healthcare providers using their service. NaviNet has the links but it does not appear that they want to get into the nitty gritty of providing a host of other services and offerings on top of their existing platform. It appears that NaviNet will add small incremental services to their platform rather than go for the whole enchilada keeping the platform simple and streamlined.

Surescripts is making a play in the HIE market with its Kryptiq partnership offering the Clinical Interoperability platform. While still early in its development. the Surescripts play is the closest thing we have seen to date to match the existing Salesforce juggernaut and the one to watch.

Now we certainly do not claim to have all the answers, never have. That is why we have a comments section below. So dear readers, we’ve given you are analysis and now it’s your turn. Who do you think is in the best position to become the Salesforce.com of the HIT market?

7 replies »

  1. Is it a bad sign that Margalit’s objection (followed by a couple of ‘me, too’s) is that no one uses SaaS for their ‘core’ business? -The implication of that objection is that HIT is ‘core’ healthcare, rather than the actual delivery of care? I agree that I wouldn’t run my heart monitors and ultrasound machines over the internet, but isn’t a lot of HIT interfacing with insurance companies, managing referrals and storing records? If that is ‘core’ healthcare business, aren’t we in trouble?

    Is that too many rhetorical questions for one comment?

  2. Thank you, John and Matthew, for including NaviNet. We are excited and honored to be included among the key healthcare technology enablers of physicians’ offices. Over the past 13 years, we have grown our platform and offerings, and are quite proud of the impact that our solutions for unified patient information management (UPIM) have on today’s busy physicians and their support staff. We’ve added new EMR and practice management solutions – NaviNet EMR and NaviNet PM. We are now in the hands of physicians with our e-prescribing and mobile health alert capabilities via NaviNet Mobile Connect, and we offer secure provider-patient communication solutions through NaviNet Patient Communications alongside our insurer-provider solutions such as NaviNet Insurer Connect, NaviNet Medicare Connect, and NaviNet Extended Eligibility. We welcome inquiries from physician offices as well as healthcare IT providers interested in utilizing our network of close to a million physicians, clinicians and healthcare professionals. Connect with us on our Website, Twitter, Facebook, and blog.

  3. To add to Margalit’s point, the elephant in the room here is reliability. Didn’t we have a major episode earlier this year when a few hospitals that used a cloud-based EMR had a connection problem and were completely down for a few days? That’s completely unacceptable in a health care setting.

  4. LOL. I forgot, you can’t use sequential open/close “NE” characters (above your comma and period keys). This blog’s comment html interpreter chokes on them (common, but I keep forgetting that). Duh.

  5. “we do not see any one HIE company really grasping the reigns and running away with the prize.”

    Well, i’m not clear on what you deem to be “the prize.” Could you clarify your vision of that? Maybe even a via a few hypothetical “Use Case” examples?

    ONC makes us use Salesforce (the RECs), but I’m rather underwhelmed with it, in RDBMS depth terms (It’s OK within its parameters, but I have to agree with Margalit). We have just gone to great lengths to to develop our own internal concurrent CRM using Microsoft Dynamics (even IT has its own RDBMS liabilities, IMO), in part because of Salesforce’s limitations, but also because the Salesforce platform goes away with the eventual end of REC funding, so we can’t afford to lose all that business intelligence, duplicative effort notwithstanding.

    My company is also now the not-for-profit community stakeholder HIE (just in Nevada), and our HIE ops vendor is Axolotl. We’ll see how all that goes.

    “The prize.” I’m just not clear on that. Depends to a significant degree on which stakeholder’s POV, no? Divergent needs and concomitant complexity of workflows, no?

    “The Cloud.” I’m sorry, that has become such a fuzzy cliche’. “SaaS” “Cloud” axiomatically. Maybe I’m just too pedantic (among my other noted flaws).

  6. Nobody, because there is no valid parallel model in Health Care.

    Why should there be a Salesforce.com in the HIT market?

    Salesforce.com is indeed used by many companies to manage their sales efforts, but it is not used to manage the core business.

    Financial institutions do not use salesforce to calculate interest rates and manage accounts. Manufacturers do not use salesforce on the production lines in factories. Retailers do not use salesforce to manage inventory. Transportation companies do not use salesforce to manage fleets.
    They use other software products, mostly not cloud based and usually very proprietary, to manage, track and document their core business.

    Wherever it is managed by software, the core business of health care is managed pretty much the same way that it is managed in other industries. Why should we expect a different approach?