While there’s a number of  large, publicly-traded EMR vendors out there — General Electric (NASDAQ: GE) and Cerner (NASDAQ: CERN) immediately come to mind — to date we haven’t seen many mid-sized or small companies kick off an initial public offering. But one medium-sized EMR/practice management vendor has broken the mold.

Today, Greenway Medical Technologies (NASDAQ: GWAY) took the plunge , pulling in $67 million to fund its operations. While the company had hoped to raise $100 million, its take is nothing to sneeze at. Health IT is a tricky investment, even for pros like yourselves, readers, and institutional investors in particular are a conservative bunch. The fact that they’re spending on a risky business means a lot.

Greenway, whose EMR is bundled with practice management software, had one heck of a ride today, with its stock climbing 30 percent during its first day of trading. The company sold 6.7 million shares at prices below its expected $11 to $13 range, diluting its intake somewhat, but the stock closed at a promising $13 per share.

The Carrollton, Ga.-based vendor has certainly done well in recent times. According to insider Wall Street blog Seeking Alpha, Greenway revenues shot up 55 percent, to $25.7 million, during the last quarter of operations. Operating margins went from negative to a positive 2 percent, which is at least a start.  Its biggest cash generator during the quarter was licensing revenue, which climbed 49 percent.

What’s interesting about this IPO isn’t just the fact that it ended well for Greenway. After all, it did take in less than planned, and the Wall Street crowd justifiably wonders how it will fare in a mind-boggling competitive market.  But it’s worth asking whether Greenway did better because it bundles both an EMR and practice management tools. Did the fact that Greenway wasn’t relying solely on EMR revenue contribute to its growth and financial success?  It would be interesting to find out, as that might help predict whether the bundled model is especially popular with physicians.

As for those who’d seek to imitate Greenway, they may have a chance if they move soon. Seeking Alpha editors think HITECH will still pump enough money into the EMR market to make these companies a reasonable investment. And given how many doctors and hospitals are still struggling to put EMRs in place, I have to agree.  In fact, given that an amazing number of hospitals and medical practices junk their first EMR, there may be a whole second wave of opportunity within three to five years.

All told, if the market’s response to a smallish IPO is any indication, you can expect a bunch of other EMR players to follow in its footsteps.  I’m thinking it will be companies in the $100m to $200m range, as they’re small enough to need capital (much cheaper capital than banks offer these days!) and nimble enough to benefit from the cash influx. Stay tuned and in coming months, I’ll tell you which other EMR and HIT companies I’m betting will climb onto the launch pad.

I got suckered into article-hopping on TechCrunch reading Dave Chase’s opinion piece on Microsoft’s recent joint venture with GE Healthcare, only Chase’s headline reads “Microsoft Ends Another Vertical Market Dalliance—This Time In Healthcare”. Two hours later, here I am with the post I should have written right away.

Regarding the joint venture, here’s what the Microsoft spin machine put out, and here’s the original New York Times blogpost that first broke the news.

To summarize: Microsoft and GE will be joining forces in a healthcare joint venture, if and when the deal gets regulatory approval. Some of Microsoft’s healthcare projects like Amalga, Vergence, and expreSSO will now form part of the joint venture. The new company has not been named, but there are plans to hire 750 people, sourced from Microsoft, GE and elsewhere.

- HealthVault still remains with Microsoft.

I’m not a Microsoft fan by any standards but I’m not so sure it’s a bad idea for Microsoft to want to join forces with GE, and keep HealthVault inhouse. And I’m also not sure I’d term the process an end to Microsoft’s healthcare plans. It seems more of a shift in gears. However, Chase, who worked with Microsoft for 12 years, believes it is a sign of an exit given Microsoft’s old exit patterns. (Chase’s list of all the verticals Microsoft has exited from makes for interesting reading. Did you know Expedia used to be a Microsoft company? Me neither.) Posting in the discussion following the Tech Crunch article, Chase also insinuates that there have been layoffs among Amalga employees, though he doesn’t give any numbers.

The NYT post states that the aim for the new company is to provide a Windows like platform which developers can then use to create healthcare related apps and services on. It also rightly points out that EMR vendors like Epic and Cerner are not going to be falling head over heels building products for the new platform.

One of the most trenchant comments (to me at least) on the NYT post comes from a commenter called Manuel Albarracin:

“Also, beyond Epic or Cerner, there will be others who will resist change along these lines, for this resistance comes not only from (legitimately) wanting to protect market positions and commercial interests; it also comes from a subtle but entrenched (and not so legitimate) mentality to reinvent the wheel at every healthcare organization, to ‘control things our way’, thus creating ‘walled-gardens’ in each of them.”

Which is probably what Microsoft has in mind – to provide the framework that the apps are built on. If the Windows experience is anything to go by, we should be in for an interesting ride.

Amid all the dog-bites-man type health IT news, here are some not-so-positive EMR/EHR stories that have been reported:

- An EMR in Lifespan hospital group gave incorrect prescriptions to some 2000 patients. The article in the Providence Journal says that

The hospitals have placed calls to nearly all the affected patients, although not all have called back, Cooper said. Most patients reached had already obtained the correct medication because the error was noticed by someone at the hospital, or a pharmacist or doctor outside, she said. So far, Cooper said, there is no evidence that any- one was harmed.

Thank goodness for that.

- Incorrectly calculated MU thresholds (GE Centricity). I’m not going to rehash the story, but you can check out Neil Versel’s article in InformationWeek, the spirited discussion on my previous EMR and EHR blog post and John’s EMR and HIPAA blog post.

It might be just be my skewed viewpoint, but GE Centricity related issues are nowhere on par with people being prescribed the wrong prescription. In one case, a few practices may not be able to demonstrate Meaningful Use. Wrong medication could actually be life-threatening to you. So if I had to rank my problems, I’d rather be short by 44K than worry about my EMR inadvertently killing my patients off.

What we need is a governing body, similar to the National Transportation Safety Board, to police EMRs, says Paul Cerrato in a recent InformationWeek Healthcare article.

Cerrato writes:

“An NTSB-like organization for EHRs would at the very least provide a reporting mechanism to keep track of incidents and life-threatening consequences of misusing e-records. More importantly, it could police vendors and healthcare providers who repeatedly ignore these dangers.”

Cerrato goes on to say there are only 120 EHR-specific problems reported to the FDA over the last 18 years. That figure, if correct, to me shows:

• EMR users don’t know how/where they can report EMR related errors or don’t expect any action to be taken – this certainly is credible, because from all quarters, it seems as if the focus is just to get the healthcare field into electronic data capture, not on whether the experience delivers any tangible and useful benefits
• Maybe they’re willing to give EMRs a pass assuming the healthcare IT to be in infancy
• They’re too overwhelmed with the EMRs’ capabilities/inabilities to really see what’s going on

For a national database of EMR problems to be truly relevant, here’s the information I would look for, on problems I’m facing:

• How critical was the error? How many people did it affect, and in what ways – medically, financially?
• How was it handled?
• How common is it – are there others who’ve faced similar problems?
• If the problem was not sorted, what raps on the fingers did the vendors face?

Read the article here.

At least that’s the case that was made in this blog post on the Software Advice website. The post is a few months old which is centuries in the tech world, but I have to disagree with them on their take that EMR vendors are slow to move their products to the iPad platform. In fact, I mentioned in their comments that I think every single EMR vendor has an iPad strategy.

They do get it right that doctors are adopting the iPad at a really dramatic pace. Here’s my reasons why it’s been so popular:
1. Battery life that lasts a full shift
2. 3G and Wireless Connectivity
3. Intuitive interface
4. $500 price point

We’re still waiting on some enterprise features that it seems like the Blackberry Playbook is trying to implement for healthcare. However, I’m pretty sure they’ll get there in time or someone will create an app that will create those features anyway.

Back to the iPad, the article only states 2 companies that have an iPad EMR offering. There are many more than that. I’ve seen some from Practice Fusion, GE, and VitalHealth to just name a few.

What I haven’t yet seen is how well doctors like the use of their EMR iPad interface. Is it really that usable for a doctor doing his rounds? Does it work well for clinical documentation? Is it a nice compliment to a desktop environment?

Sadly, I still can’t give my first hand account of using an EMR on an iPad. I got my refund from HIMSS since despite all the free iPad giveaways I came home without one. Oh well, the iPad 2 is out now and it would have been a shame to only won a first generation iPad. I’m told by Christmas there may even be an iPad 3, but I digress.

What might even be more interesting than EMR use on an iPad is the other creative ways that people are using iPads in healthcare. For example, I’ve heard of people using an iPad as a check in device for their clinics. There’s something cool about handing over an iPad instead of a clipboard for your patients to fill out their paperwork. I’m sure some patients would hate it, but I for one would be much happier feeling out the stack of paperwork electronically.

Few would argue that Epic is one of the two or three most visible enterprise EMR vendors on the market today. There’s little doubt that these days, Epic is shortlisted when hospitals plan an EMR rollout, alongside of giants like GE and Cerner.

It’s hard to imagine that Epic isn’t in a sweet financial position, practically stuffing warehouses full of the revenue they’re generating in this pivotal period of HIT history. (For a sense of the scale involved, bear in mind that Kaiser Permanente’s reportedly $4 billion to $6 billion EMR rollout was an Epic installation.)

That being said, we really don’t know. Why? Well, while Cerner and GE and McKesson are public companies, Epic remains privately held. Looked at another way, health systems that sink half a billion dollars over five years to implement Epic know far less about its financial situation than they would about Cerner’s.

So, maybe I’m wandering out on a limb here, but if I were a big health system, wouldn’t it be a little bit concerning not to know some details on how robust the company’s financial picture is? Does it really make sense, despite its strong reputation and impressive customer list, to spend a staggering sum on Epic without some third-party analysis of its prospects?

After all, when you spend the kind of money health systems are spending, that vendor becomes an incredibly important partner. But if the vendor’s not open to Wall Street scrutiny , it might get away with fibbing about its ability to deliver.

Mind you, I’m not saying that health systems that go with Epic — or any other privately-held vendor — are behaving irresponsibly. It’s just that in this climate, more information can’t hurt.

P.S.: I began thinking about this when I saw a question (posted on Quora.com) asking what Epic would be worth if it went public. Could the poster know something we don’t?

I find it interesting that I was sent another EMR YouTube video. No doubt YouTube can be a great tool for getting the word out, but so far the views on EMR videos are pretty low. However, I must admit that this video by GE Healthcare is much more interesting than the previous meaningful use video I posted. Plus, they focus on physicians number 1 concern: productivity and reimbursement. Take a look for yourself.

GE has announced a new VC fund for healthcare to the tune of $250 million. They’re calling it the GE Healthymagination Fund. I wonder how long it took them to come up with that name. Here’s some more details on what areas the VC fund will target:

The formation of the fund is part of GE’s $6 billion Healthymagination initiative, a global commitment to deliver better healthcare to more people at lower cost. The fund will target three broad areas for investment:

-Broad-based Diagnostics, including imaging, home health, patient monitoring, molecular diagnostics, pathology, novel imaging agents and other technologies for disease diagnosis.
-Healthcare Information Technology, including electronic medical records, clinical information systems, healthcare information exchanges and value-added data services.
-Life Sciences, including tools for research and development in biopharmaceuticals and stem cells, and technologies for manufacturing of biopharmaceuticals and vaccines.

The fund will draw on capabilities from across GE Healthcare, GE Capital and GE Global Research, and will have a global footprint.

No doubt GE has a ton of capital available to them. One thing that I find interesting is how GE will balance the funds goals of investing in high quality products and the challenge of funding something that might compete with an existing GE product. I think the EMR example is a simple and good one. Will GE fund an EMR that competes with Centricity EMR. This is nothing new for large corporations, but is definitely a challenge they’ll face.

One thing is certain. There are a lot of really great opportunities to invest in the healthcare space right now.

Thanks to Shahid for pointing this out.