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Will Meaningful Use Affect M&A In The EMR Space?

As some of you may recall, Allscripts is said to be floating the possibility of selling out to a venture capital firm. This follows several months of tumult at the board level, including some who might have been helpful in keeping its merger with Eclypsis moving forward.

I’ve been thinking about this deal for a while, wondering whether it would come to fruition and if so, what would make it happen. And I’ve realized an Allscripts deal, or other EMR company sale, might give us a window into just how valuable Meaningful Use criteria have proven to be. Let me explain.

If I was a EMR vendor looking for an acquisition or merger, I’d certainly look at the usual metrics, including the customer list, code base my target had in house, maturity of the product line, the extent to which in-house programming talent could support the roadmap and so on. (Naturally, I’d go over its books in depth too.)

But that’s not all. These days we have some new perspectives from which to evaluate the success of EMR vendors, a set of standards which are fairly unique in the software business.  Two important examples: We can look at how successfully a vendor’s customers have been able to meet Meaningful Use goals to date, and how far along the HIMSS EMR Adoption Model customers are as well.

While both are interesting, Meaningful Use is more important, as it’s such a politically fraught, complicated and rapidly evolving set of standards. In short, I’d argue that if a vendor’s customers are doing well with MU, then it’s likely the vendor is doing something right.

Now, you can’t draw a straight line between the quality of a vendor’s product and how well its customers  have done in qualifying  for Meaningful Use. Implementation is ultimately the hospital or doctor’s responsibility, even if the provider pays for EMR vendor consulting to get things going. And there’s lots of ways things can go wrong that have little or nothing to do with the product.

Still, I predict that Meaningful Use success is going to become a more important metric in EMR vendor M&A as time goes by. After all, the more bragging rights a company has regarding Meaningful Use success, the more they can improve the acquiring vendor’s profile. That’s gotta matter.

November 19, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

EMR Value Diminished If Patients Can’t Access Care

A new study from the august Commonwealth Fund has just come out, offering a portrait of primary care practices in ten countries. The study had a lot of interesting data to offer, including news of primary care reforms to meet the needs of aging populations and improve chronic disease care.

One of the key data points drawn from the CF study was that two-thirds of U.S. PCPs reported using EMRs in  2012, up from 46 percent in 2009. That’s obviously a big improvement, though the U.S. still lags behind the U.K.,  New Zealand and Australia in EMR implementations and use of IT generally.

At the same time, it seems that U.S. citizens still face serious financial obstacles in getting primary care. Fifty-nine percent of U.S. physicians surveyed said that their patients often have trouble paying for care. That’s a big contrast with other countries included in the study, including Norway (4 percent), the  U.K. (13 percent) and Switzerland (16 percent). These numbers make sense when you consider that the U.S. is the only country surveyed that doesn’t offer universal health coverage.

Putting aside humanitarian reasons to be troubled by money obstacles to PCP access, there are other issues to consider. To me, the most obvious is the selection bias imposed by financial barriers to care.

Consider one of the big goals a medical home hopes to accomplish, managing chronic conditions effectively across the primary care practice’s population.  PCPs can make great use of an EMR to work on such goals, from issuing reminders to get preventive care to tracking patient progress across different demographics to test the impact of new interventions.

The thing is, the power that is a well-tuned EMR is not at its best if the interventions are mostly aimed at those who fit a certain socio-economic profile.

Admittedly, few small PCPs need to be worried about selection bias from a scientific standpoint, as they’re seldom gunning for the next journal article presentation, but looking at the country as a whole, we’re missing out on the collective learning we can generate with clinical data analytics.  It seems to me that we’re going to have to address this problem directly if we want to leverage EMRs for the greater public good.

November 16, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

Could Patent Conflicts Choke mHealth Growth?

This week I caught a very interesting piece in MobiHealthNews which took a look at the possibility that the mHealth world is ripe for patent clashes.

Orion Armon, an attorney with Cooley LLP’s IP litigation practice, notes that companies in medical device, computer, networking and communications markets are busily patenting mHealth innovations, and that sooner or later, these patents will overlap.  The result: nasty turf battles which cost everyone involved boatloads of time and money.

While the number of patent lawsuits currently being filed in these industries is nowhere near the levels seen in say, the smartphone and computer  business, a few significant cases have emerged, Armon reports:

  • CardioNet filed lawsuits against MedNet Healthcare, MedTel 24, Rhythm Watch, AMI Cardiac Monitoring, ScottCare, and Ambucore Health Solutions;
  • Robert Bosch Healthcare filed lawsuits against ExpressMD, MedApps, Waldo Health, and Cardiocom; and
  • BodyMedia filed a lawsuit against Basis Science.

But that’s just the tip of the iceberg. Consider the patent ambitions of Airstrip, a tech vendor offering a mobile patient monitoring platform. The company’s President and Chief Medical Officer, Dr. Cameron Powell, told MobiHealthNews that his company’s patents cover “taking any type of physiologic data—whether that’s from a sensor in the shoe, a home monitor, a blood pressure cuff, or a monitor in the hospital—and then re-rendering it on a native or HTML5 application on a mobile device.”  (My jaw dropped when I read that one.)

Since that interview, Airstrip has filed a lawsuit against mVisum Inc. alleging that four of the other vendor’s products infringe its patent.  It’s asking the court for an injunction barring future infringement, treble damages and attorneys’ fees.  These are standard provisions in a patent lawsuit, but from where I sit they’re pretty intimidating, and if the injunction is ordered mVisum has a heck of a battle on its hands.

As provider interest in mHealth applications continues to expand, I can only imagine that the patent battles are going to get uglier and more widespread.  It’s only logical, given the explosion of innovation we’re seeing in this space. But I do hope that patent wars don’t slow the introduction of new products too much at such a critical time in the mHealth industry’s growth.

November 2, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

What Your EMR Would Say If It Could Talk

In this column we spend a lot of time talking about EMRs, but do we ever listen to them?  Maybe it’s time for an ”EMR Whisperer” to turn up and tell us what EMRs are trying to tell us. Or since I don’t know where to find one, I’ll do some listening myself.

Here, for your consideration, are some messages EMRs are trying to share. Don’t take offense…they’re only trying to be honest.

-Anne

* Too many clicks?  I’ll bet you never say that to your World of Warcraft host.

* There’s not enough expansion slots in all of China to integrate that mess.

* So, I went down for a few hours.  Don’t I deserve a break now and then?

* Don’t lie — you’re planning to tear me out and replace me with a younger upgrade.

*  I wish you’d stop telling me F/U.

*  I’m not user-friendly?  What about that smiley I put at the end of that 600-page data dump?

* I thought you loved me for my intelligence, not my interface.

* Your doctors have been saying mean things about me. My feelings are hurt. :-(

*  Sure, I interoperate, but I always come back to you…

October 25, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

Vendor Hopes To Create Market For Windows 8-Based Tablet EMR

So far, Microsoft  has played its cards pretty close to the vest when it comes to the launch of its new tablet line (and iPad wannabe Surface. But news is trickling out on Surface, which will officially go to market October 26th.  That includes news of the first EMR built for the Surface, EMR Surface, which appears for sale in the new Microsoft Windows Store online for $499 a download.

EMR Surface is produced by a company called Pariscribe, based in Toronto, which says it was key in building Canada’s first Web-based EMR. Its existing products include a radiology system, physiotherapy suite, dental suite, patient registration software for kiosks and an EMR.

What makes EMR Surface interesting isn’t just that it’s based on a new tablet. Far more interesting is that it runs on Windows 8 which, according to a piece in  MobiHealthNews, the company sees as a major competitive advantage in the corporate world.

As readers know, the majority of mobile devices in healthcare run on iOS or Android, and last I checked, there’s been little discussion of the notion that a Windows 8 device could slip between the cracks.  That doesn’t mean Pariscribe is whacky to think so, however; in fact, it’s an intriguing idea.

According to article author Neil Versel, Pariscribe president and CEO Manny Abraham believes that Surface and Windows 8 and Surface will do a better job of bridging the gap between mobile and desktop computing.  If he’s right, the company is really on to something.

The thing is, iOS and Android have an iron grip on the mobile device market right now. Even the might of Microsoft might not be sufficient to break the market’s preference for these two operating systems.

That being said, if Pariscribe has come up with a particularly nifty solution, it could give Surface-based (and Win 8 based) EMRs a foot in the door. I’m eager to see how they do!

October 17, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

EMR Interfaces Gone Wrong, Or The Tale Of The Albanian Patient

Today, for your consideration, we have the tale of the Albanian patient who wasn’t Albanian.  More broadly, I’m here to discuss the perils of adding an extra interface consideration to the workflow of busy EMR users, and the impact that has on data quality.

Scope, a blog published by the Stanford School of Medicine, shares the case of the Merced County, California physician who, exasperated with the requirement that he identify the ethnicity of each patient, chooses “Albanian” for all of them. Why? Simply because “Albanian” is the first item of the rather long list in the pulldown menu.

As a result of this interface issue, any attempt to mine this veteran doctor’s data for population health analysis is weakened, writes Anna Lembke, MD, asssistant professor of psychiatry and behavioral sciences at Stanford.  And this physician’s choices should give the “big data” users pause, she suggests:

Misinformation in electronic medical records, whether accidental or otherwise, has far-reaching consequences for patients and health care policy, because electronic medical records are being actively ‘data-mined’ by large health care conglomerates and the government as a basis for improving care. This is an important downside to consider as we move forward.

Dr. Lembke’s observations are important ones. If government entities and health organizations would like to mine the increasingly large pools of data EMRs are collecting, it’s important to look at whether the data collected actually reflects the care being given and the patients being seen.

I’m not suggesting that we audit clinicians’ efforts wholesale — they’d rightfully find it offensively intrusive — but I am suggesting that we audit the interfaces themselves from time to time.  Even a quarterly review of the interfaces and workflow an EMR demands, and results it produces, might help make sure that the data actually reflects reality.

October 16, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

Will Big EMR Vendors Use Healthcare Standards As A Weapon?

Standards are a tricky thing. Some times, they bring a technical niche to its senses and promote innovation, and others, they’re well-intentioned academic efforts which gain no ground.  From what I’ve seen over the years, the difference between which standards gain acceptance and which end up in trash bin of history has more to do with politics than technical merit.

But what the EMR industry did neither? From the mind of my crafty colleague John, here’s a scenario to consider.  What if rather than going with an industry-wide standard for interoperability, the big EMR vendors agreed on a standard they’d share and more or less shut out the smaller players?

Yeah, I already hear you asking: “Wouldn’t that be an antitrust violation?”  While I am not and probably never will be a lawyer, my guess is if a bunch of big vendors deliberately, obviously shut the smaller players out, it would be. But standards are so slippery that I bet it’d be a while before anyone outside of our industry saw something funny going on.

Besides, the government is doing everything in its power to get EMR vendors to help providers achieve interoperability. Right now ONC is not getting much cooperation — in fact, I’d characterize the big vendors’ stance as ‘passive aggressive’ at best.  So if Epic, Cerner, Siemens, MEDITECH and their brethren found a way to make their products work together, they might get a gold star rather then an FTC/DoJ slap on the wrist.

Besides, it would be in the interests of the bigger firms to include a few smaller players in their interoperability effort, the ones in the big boys’ sweet spots, and then “oops,” the smaller companies would get acquired and the knowledge would stay home.

Right now, as far as I can tell, it’s Epic versus the rest of the world, and that rest of the EMR world is not minded to play nicely with anyone else either. But if John can imagine a big-EMR-company standards-based coup d’etat happening, rest assured they have as well.

John’s Comment: Since Anne mentions this as my idea, I thought I’d weight in a little bit on the subject. While it’s possible that the big EHR vendors could adopt a different standard and shut out the small EHR vendors, I don’t think that’s likely. Instead of adopting a different standard, I could see the large EHR vendors basically prioritizing the interfaces with the small EHR vendors into oblivion.

In fact, in many ways the big EHR vendors could use the standard as a shield for what they’re doing. They’ll say that they can interface with any EHR vendor because they’re using the widely adopted standard. However, it’s one thing to have the technical capability to exchange healthcare information and a very different thing to actually create the trust relationship between EHR vendors to make the data sharing possible.

Think about it from a large EHR vendor perspective. Why do they want to be bothered with interoperability with 600+ EHR vendors? That’s a lot of work and is something that could actually hurt their business more than it helps.

My hope is that I’m completely wrong with this, but I’ve already seen the large EHR vendors getting together to make data sharing possible. The question is whether they’re sincerely doing this out of a desire to connect as many health records as quickly as possible or whether it is good strategy. My gut feeling is that it’s probably both. It just works out that the first is better to say in public and the second is just a nice result of doing the first.

October 9, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

Allscripts May Sell Out To Private Equity Buyer

Update: You might be interested to read this post on Allscripts Plans to Discontinue MyWay.

Having just gone through the hell of a board gone wild, perhaps Allscripts’ leadership doubts it has the ability to govern.  Or maybe it’s just bracing for the fresh hells that EMR companies will face when the industry’s Big Consolidation begins (something we all know will happen, though not when). Either way, it seems that Allscripts is ready for a change in ownership.

Earlier this week, Bloomberg Businessweek reported that the company has retained Citigroup to explore selling out to a private equity buyer. According to published reports, Allscripts is considering a leveraged buyout, which would take it private but leave it holding a ton of debt. It sure must be eager to avoid scrutiny by curmudgeons on Wall Street!

At least one research type has already given such a move the thumbs up. According to Bloomberg Businessweek,  David Windley, an analyst with Jefferies & Co., the move makes sense despite the inherently high costs.  Allscripts “continues to climb a steep product integration hill that would be more comfortable out of the public eye,” the site quotes Windley as telling his clients.

Investors seem pleased with the  prospect of an Allscripts sale too. Shares of the company (MDRX) rose 14 percent when the news that Allscripts had tapped Citigroup hit the press last week.  Clearly, they don’t have complete confidence that the stock is headed for success as the company is constituted today.

There’s no doubt that Allscripts is on a challenging path in creating new, unified product offerings for a feverishly competitive market. The product integration effort Windley is referring to, and it’s a massive one, is the integration of Allscripts products with those of rival Eclipsys Corp., which it acquired in 2010.

Whether integration has been proceeding smoothly or not, it can’t have been a big confidence builder six months ago when Allscripts fired Chairman Phil Pead, who’d come on board when Eclipsys was purchased, and three board members resigned.

Plus, the rumors are swirling about Allscripts planning to sunset MyWay and move users to their Allscripts Professional product. More details on that change as it develops.

October 5, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

HIMSS Pushes For National Patient Identifier System

Well, here’s some trade organization efforts that aren’t just a lot of smoke and mirrors and self-interest. Apparently, HIMSS is pushing Congress hard to establish a national patient identifier system usable for sharing digital records between facilities.

HIMSS execs estimate that as many as 14 percent of all medical records include wrong, potentially dangerous information due to patient misidentification, a problem which is likely to get worse as more systems transition data from paper to EMRs, according to a story in InformationWeek magazine.

As if that wasn’t bad enough, HIMSS says, when organizations begin to share data under Meaningful Use Stage 2, the problem is likely to get much worse. (And doesn’t a system that makes mismatches and lost data likely more or less completely defeat the purpose of setting up HIEs in the first place?)

In reality, a single patient identifier won’t do the job on its own. In fact, it could contribute to errors of its own, HIMSS notes, so adding biometrics and probabilistic matching records will be necessary to really get things right. But getting moving on the identifier is a start.

To get things standardized, HIMSS would like to see Congress request a report from the Government Accountability Office on the subject to help legislators better understand the issues. (They got so far as getting the House to file a resolution in support of the concept last year, but no further.)  HIMSS has since been working with other associations, think tanks, CMS and ONC to raise awareness of the issue.

To get what it wants, HIMSS will have to convince Congress to change existing law, reports InformationWeek. Since 1999, it’s been illegal to establish such an identifier, as Congress apparently felt the public would view it as a privacy risk.

October 2, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

Blue Button Initiative Picking Up Speed

The idea of the “Blue Button” has been gradually filtering into the consciousness of EMR proponents for a while now. As readers may know, the concept comes from the VA, where the idea has been to offer a single-click “blue button” allowing patients to get their VA treatment data into the hands of civilians healthcare providers.

Lately, a next gen approach known as the Automated Blue Button Initiative (ABBI) has come into focus as the right way to bring the Blue Button to the healthcare world at large. Given the energy behind ABBI, and the profile of the people involved, my guess is that it will catch fire quickly.

GE Health Standards Architect and ABBI member Keith Boone told an audience at HealthCamp Boston, where Blue Button was a very hot topic, that the button will evolve from a flat ASCII text download to more flexible formats such as XML, according to SearchHealthIT.com.

Along these lines, I was interested to note that as ONC head Farzad Mostashari sees it, the ultimate goal for the Blue Button is to give patients more control. “The killer enabler is actually patient online View-Download-Transmit, esp with #ABBI.” he tweeted this week.

The ONC’s Standards & Interoperability Framework community, meanwhile, is working on standards and tools to push personal data to a specific location. These include using Direct secure messaging protocols and Consolidated Clinical Document Architecture, according to Douglas Fridsma, MD, director of ONC’s Office of Standards and Interoperability, who spoke with Healthcare IT News.

The standards and  specs will allow patients to both download health information to their computer and route data from their provider to PHRs, e-mail accounts or other preferred applications.

All told, it looks like a key set of Meaningful Use Stage 2 required technologies are coming right along. Will patients actually use them? Hard to say, as we haven’t exactly seen a huge groundswell of PHR love or demand for EMR access to date. But progress toward making sharing possible never hurts.

October 1, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.