A common and somewhat unique aspect to EHR vendor contracts is that the EHR vendor lays claim to the data entered into their system. Rob and I, who co-authored this post, have worked in many industries as analysts. Nowhere, in our collective experience, have we seen such a thing. Manufacturers, retailers, financial institutions, etc. would never think of relinquishing their data to their enterprise software vendor of choice.
It confounds us as to why healthcare organizations let their vendors of choice get away with this and frankly, in this day of increasing concerns about patient privacy, why is this practice allowed in the first place?
The Office of the National Coordinator for Health Information Technology (ONC) released a report this summer defining EHR contract terms and lending some advice on what should and should not be in your EHR vendor’s contract.
The ONC recommendations are good but incomplete and come from a legal perspective.
As we approach the 3-5 year anniversary of the beginning of the upsurge in EHR purchasing via the HITECH Act, cracks are beginning to show. Roughly a third of healthcare organizations are now looking to replace their EHR. To assist HCO clients we wrote an article published in our recent October Monthly Update for CAS clients expanding on some of the points made by the ONC, and adding a few more critical considerations for HCOs trying to lower EHR costs and reduce risk.
The one item in many EHR contracts that is most troubling is the notion the patient data HCOs enter into their EHR is becomes the property in whole, or in-part, of the EHR vendor.
It’s Your Data. Act Like it.
Prior to the internet-age the concept that any data input into software either on the desktop, on-premise or in the cloud (AKA hosted or time sharing) was not owned entirely by the users was unheard of. But with the emergence of search engines and social media, the rights to data have slowly eroded away from the user in favor of the software/service provider.
Facebook is notorious for making subtle changes to its data privacy agreements that raise the ire of privacy rights advocates.
Today, GE and Microsoft announced a joint venture (JV) that will lead to the formation of a new company (NewCo) targeting the clinical healthcare market sector. The NewCo will be located near Microsoft HQ in Redmond, WA, start with roughly 700 employees and combine the remaining Microsoft clinical products, Amalga UIS and the former Sentillion products Vergence and expreSSO with GE’s eHealth and Qualibria suite. NewCo’s new CEO will be GE’s Michael Simpson, who has been heading up the combined Qualibria-eHealth group since earlier this year after a re-org at GE. Along with this announcement, Microsoft’s Health Solutions Group (HSG) leader, Peter Neupert stated that he’ll be retiring.
Combine the above announcement with Microsoft’s long anticipated sale of Amalga HIS, which went to Orion Health in October, and you are left with Microsoft completely pulling out of the clinical market. Sure, they’ll claim to be still in healthcare by directly selling their horizontal products (e.g., SharePoint, MS Office, various server products, etc.) into this sector and having a stake in this JV, but it is also exceedingly clear that Microsoft will no longer have any direct involvement in this market, that will be left to GE. That being said, Microsoft did state that they’ll hang onto HealthVault, but even here, that is more likely a by-product of no one wanting to take on HealthVault rather than Microsoft’s strong desire to continue to try and build a viable, revenue generating entity out of it. Do not be too surprised if, in a year’s time, HealthVault falls to the wayside much like Google Health did this year.
Little over a month ago, IBM and WellPoint announced an agreement wherein WellPoint will deploy IBM’s latest and greatest super computer and artificial intelligence mega-mind Watson. Watson’s claim to fame was its ability to beat the human Jeopardy champions much like Big Blue beat reigning chess champion Garry Kasparov in 1997. Since that Jeopardy match, IBM has been quite vocal about its desire to apply Watson in the medical arena, we’ve been buried in press releases and briefings, but the WellPoint announcement is the first one of any real consequence. Having interviewed both IBM and WellPoint, following is our review and assessment.
Watson is a relatively new form of artificial intelligence, based to some extent on neural networks. What is unique about Watson is that it has been developed (trained) to understand the nuances of language. It is a question & answer system that uses among other techniques, natural language processing, to extract meaning out of unstructured data. In developing Watson for the Jeopardy challenge, one of the key design parameters was for Watson to answer a question in under three seconds – plenty fast enough in a diagnosis/treatment decision scenario. This is a key reason why Watson may have enormous utility in the healthcare sector where so much data is unstructured, the pace of change is so high and the ability to chose the optimum treatment patient plan for a given diagnosis is less than ideal today.
There have been a number of research studies published that question the value of Electronic Health Records (EHRs), particularly as it pertains to improving quality of care and ultimately outcomes. Chilmark has always viewed these reports with a certain amount of skepticism. Simple logic leads us to conclude that a properly installed (including attention to workflow and thorough training) of an enterprise software system such as an EHR will lead to a certain level of standardization in overall process flow, contribute to efficiencies and quality in care delivery and ultimately lead to better outcomes. But to date, there has been a dearth of evidence to support this logic, that is until this week.
Last week the New England Journal of Medicine published the research paper: Electronic Health Records and Quality of Diabetes Care, which provides clear evidence, albeit a little fuzzy around the edges, that physician use of an EHR significantly improves quality metrics over physicians who rely on paper-based medical record keeping processes.
The research effort took place in Cleveland as part of Better Health Greater Cleveland from July 2009 till June 2010 and included 46 practices representing some 569 providers and over 27K adults with diabetes who visited their physician at least twice during the study period. Several common quality and outcome measures were used to assess and compare EHR-based care to paper-based. On composite standards of quality, EHR-based practices performed a whooping 35% better than their paper-based counterparts. On outcome measures, which are arguably more difficult for physicians as patients’ actions or lack thereof are more integral to final outcomes, EHR-based practices still outperformed their paper-based peers by some 15%. The Table below gives a more detailed breakout.
PHRs are much like the tides, news about them ebbs and flows. Right now, with the relatively recent demise of Google Health, Dossia’s attempts at rebirth, and the significant inquiries we are receiving regarding meaningful use requirements to host a PHR (patient portal). But in and amongst all this Chilmark has heard on more than one occasion the following statement: “The problem with PHRs is that they are a technology in search of a market.”
This statement is simply wrong for the following reasons:
1) As we have said countless times before in previous posts, very few people are interested in a digital filing cabinet for their health records. Unfortunately, many PHRs in the market today are just that, digital filing cabinets. In this case it is not an issue of a technology in search of a market, it is just a bad product that really has no market.
2) Technology adoption does not occur for its own sake, it occurs when there is perceived value by the user that leads to adoption. PHRs, PHPs (personal health platforms), patient portals, etc., is certainly a technology, that when well-designed, and implemented can deliver significant value and subsequently see high adoption rates. Just look to Kaiser-Permanente’s instance of MyChart, where patient adoption is well over 40%. Up in the Pacific Northwest, the Group Health Collaborative (GHC) is seeing PHR adoption that is well over 50%. That’s a market!
Payers, as with the rest of the healthcare industry, have a lot on their plate right now. Healthcare reform, via the Affordable Care Act (ACA) continues its march forward despite legal and political uncertainty. Struggling to define the payer role in Accountable Care Organizations (ACOs), understanding the impact of Health Insurance Exchanges (HIXs) on their business (McKinsey survey results likely have many payers wondering how to market to what may be an enormous uptick in individual purchasers of coverage – something that most are ill-prepared for), and how to better engage consumers/members in proactively managing their health are a few of the top issues that were addressed at the AHIP Institute last week.
But when one sits back and reflects on the AHIP Institute – all of the sessions, all the discussions, the chatter in the halls, underlying messages within the message, the exhibit hall – it boils down to three key themes that this sector of the healthcare industry is grappling with, which much like the three stages of meaningful use, build upon one another:Continue reading…
The recent post on Google Health going into the deep freeze has solicited a number of emails, including some from the press. In one of those emails a reporter had spoken to several industry thought leaders to garner their opinions which follow:
Consumers will not sign on to most Personal Health Platforms (PHPs) or services due to the issue of trust.
– Leading researcher and developer of an open PHP.
Provider sponsored PHPs and patient portals will dominate the market for they offer services that patients/consumers want such as appointment scheduling, prescription refill requests, etc.
– Leading CIO who is also actively involved in HIT policy development.
The only people who care about a PHP, PHR, whatever you wish to call it are those who are struggling with a life-changing illness. – Co-founder of leading site for those with serious illness to gather and share experiences.
Chilmark’s thesis is an amalgamation of the last two statements (we’ll get to the first one shortly).
By and large, people do not care about their healthcare until they have to, either for themselves or a loved one. Even then, if they are very sick, it may be far more than they are capable of to set-up and maintain a PHP. These systems are still far too hard to create and manage, let alone trying to get doctors and hospitals to feed complete records and updates into them in some automated fashion. There may be an opportunity in providing a system for baby boomers to help manage their aging parents health issues from afar. We have yet to find a PHP, PHR, whatever you wish to call it that ideally fits this market need and may be an opportunity for an enterprising entrepreneur.Continue reading…
About a year ago we posted a piece that basically summed up Google Health as on its death bed. Google, of course was quick to defend itself saying that Google Health was very much alive and well. We even had a long conversation with the senior leadership of Google Health who told us they were taking Google Health in a new direction, had been doing a significant rebuild of the underlying architecture which culminated in a “new” Google Health which had far greater focus on health and wellness. They even went so far, in very uncharacteristic fashion to give adoption numbers. Granted, those adoption numbers were only those from users of the Android App CardioNet, but hey, it was something.
Beginning in late March 2011, we started hearing the rumors of the impending demise of Google Health once again (is this becoming some sort of annual thing with Google Health?). We waited a few weeks to see if the rumors would die down, they did not. We put a call into Google Health to set up a briefing, get an update. Response back was slow (one yellow flag). When they did get back to us, they said it will be at least a couple of weeks (two yellow flags). Next, our Google contact told us by email that they were going to hand Chilmark’s inquiry off to Google’s PR department (screaming dark orange flag). And now today, we received an email from one of Google Health’s most visible spokespersons, Missy Krasner that she is leaving Google.
There is now no doubt in our mind that the Google Health development team has been dis-banded and Google Health has been placed in a cryogenic state until the moribund consumer adoption of such tools comes to life. It would be far to big a PR nightmare for Google to completely pull the plug on Google Health as they have done in the past with other less then stellar launches. No, they’ll put an engineer or two on Google Health to keep it up and running but don’t expect anything new out of Google Health for at least the next 5 years. This baby is frozen.
John Moore is an IT Analyst at Chilmark Research, where this post was first published.
Microsoft’s Health Solutions Group (HSG), which has straddled the fence with consumer-facing (HealthVault) and corporate-facing (Amalga), is increasingly moving to the corporate side of the fence. Not that surprising considering that the consumer market continues to struggle (Google Health is in virtual mothball state, consumer adoption of HealthVault is nothing to write home about) and that HSG has now moved out of R&D and is now under the business solutions group, Dynamics. At the end of the day, HSG head Peter Neupert has to show that he can deliver the goods and Amalga is the horse he’s betting on (Note: Sentillion is there as well, but think of Sentillion as the gate-keeper to accessing Amalga).
Yet Amalga has gone through its share of birthing pains with some in the industry beginning to question its value.
Amalga has suffered from two significant problems, both inter-related. The first is that Amalga is an extremely powerful set of data aggregation and analytical tools, but it is more of a toolset then a product and this leads to long implementation time-frames and subsequently an inability to extract value quickly (ROI for Amalga is measured in years). For example, in 2009 Golden Living signed on to adopt Amalga and HealthVault. At last week’s Connected Health Conference, (CHC) Golden Living presented some remarkable results of how they are transforming long-term care through the use of Amalga. But in their presentation, Golden Living also stated that they knew full well when signing on to Amalga that this was going to be a multi-year effort and their implementation team has been given 5 years to put Amalga in place. Five years to fully implement a software solution is a very long-time and similar to the installs of the largest EHR systems. Unfortunately, many early Amalga customers did not have the foresight of Golden Living. In recent conversations with Microsoft, Chilmark has been told that significant resources are now being dedicated to improving time to value for Amalga. We’ll have to wait and see as the CHC sessions we attended on Amalga and HealthVault Community Connect, did not make this readily apparent.Continue reading…
When Chilmark Research was founded, the primary area of focus was healthcare IT that was consumer facing, consumer enabling – tools that would help consumers better manage their health and the health of loved ones. This led to our first major study on Personal Health Records (PHRs) published in May 2008. But alas, I was idealistic in the belief that there was enough interest in this area, enough of a market to sustain and grow this young company. Sure, there are loads of small companies trying to make a consumer health play and there is certainly plenty of hype surrounding it but at the end of the day when one takes a close look at this market one finds a multitude of small companies struggling to break through. Exceedingly few companies have been able to really capture the consumer market potential and scale to a size that would support the kinds of services that Chilmark Research offers. This led to a rethinking of what Chilmark Research would focus upon.
Stepping back and looking at the market one sees several critical technical gaps:
Lack of Data: Despite all of the incredible medical advances taking place and the amazing technologies that are being used today to practice medicine, the industry as a whole is a laggard in adoption of IT. One can point the finger in many directions but the bottom line is that there is simply not a lot of clinical, personal health information (PHI) in a readily computable digital format that a consumer can tap into.
Data Liquidity: A consumer’s PHI, even when it is in digital form is most often scattered across a multitude of silo’d applications making it virtually impossible for a consumer to readily and securely access and manage their complete health records using the data contained therein to personally guide them to make better health decisions. There are a number of contributing factors at play here, primary among them lack of clear standards & terminology as well as reluctance of healthcare organizations to release data to the consumer.
Ease of Access: Providing the consumer with “on-the-go” access to their health information allowing them to easily call up or input data to their personal health system, via a mobile device. Today, most mHealth apps in this category are rudimentary and it is not necessarily the fault of the app developer but often the lack of good data as a result of points 1 & 2.Continue reading…