By MICHAEL LAKE
This is a summary of the HIT Trends report for April 2011. You can get the current issue or subscribe here.
Europe. European progress reports on HIT show us that it’s evolving along many similar lines to current US efforts. One report highlights beacons of e-prescribing in Sweden and Estonia where scripts are stored centrally and available from any pharmacy. European states are also pursuing funding national centers of excellence in HIT. They are implementing EMR-like systems mostly less comprehensive than the US (34 countries); telehealth, most notably in the UK; and ID cards (24 countries). Governments are funding and because of that, also assessing results.
There are also success stories in cross-border health information exchange on a new website that gives us a comprehensive view into European HIE activities. There’s a report by the European standards community exploring barriers to personal health device interoperability, an issue that is holding back the world’s telehealth market. And CSC announced it is buying iSOFT, a subcontractor that’s been struggling, in hopes of faster progress in the UK’s National Programme for IT.
Incentives. Provider incentives have been in the news. CMS released a report on its quality (PQRI/PQRS) and e-prescribing (MIPPA) incentive programs for 2009 with providers earning $5,000 on average. Disincentives for the e-prescribing program begin in 2012 and the quality program in 2015. Quality data will be available over time on the CMS Physician Compare website.
The bigger incentives for EMR meaningful use, according to a KLAS report, are driving 20% of hospitals (and likely practices too) to dump current vendors to go with market leaders. These community hospital EMRs typically take at least a year to implement and in many cases longer. Those hospitals that are jumping to a new vendor now will likely struggle with the timeline for incentives.
In another KLAS report reported by Medscape, analysts are encouraging physician practices to take a reality check on their EMR vendor to make sure it can get them to meaningful use. They report physician overconfidence about meeting criteria associated with patient access to health information and clinical alerting systems. Patient access and clinical alert tracking are in different HIT domains than most of the meaningful use rules that focus on practice automation. Patient access deals with connectivity and alerts with clinical decision support. These are typically implemented later in a systems life-cycle. The quality reporting also requires more advanced solutions.
Leaders. These market reports cite Epic and Greenway as safe bets for physician practices; McKesson and MEDITECH safest for community hospitals. Epic solutions are also at the core of Sutter Health strategy to fund up to 85% of the costs of EMRs for community practices. A number of IDNs like Sutter are using the relaxation of Stark laws to support EMR services to affiliated independent physician practices. Allscripts has a similar program at North Shore LIJ in NY. Dell and HP have comprehensive services that support these programs. This could be on a path to creating accountable care arrangements.
Five HIT-leading health systems collaborate on a national network to exchange patient information. Care Connectivity Consortium has been formed by these HIT pioneers: Geisinger Health System (PA), Kaiser Permanente (CA), Mayo Clinic (MN), Intermountain Healthcare (UT), and Group Health Cooperative (WA). This is a boost to the health information exchange initiative. It’s interesting that it’s the non-profit providers that are taking the initiative under the banner of safer care, as a medical ethics issue. These large organizations have not announced that they are pooling data for analysis; just point-to-point for individual patients.
And the VA leads again with ideas for point-of-care clinical trials and by creating a billion dollar bridge to innovators in home health. Each of six companies is awarded $150M to $372M over 5 years with a one year base and 4 possible renewals. The Intel GE venture, Care Innovations™, is one notable name in this segment on the sidelines of this deal.
Innovators. Industry innovation is getting funded and launched. Practice Fusion, a leading SaaS EMR, raises another $23M in a Series B round. This round brings total funding to $30M. The company reports it is signing 300-400 users a day. Additional senior management has been added to the team with deep Internet marketing experience. This is additional validation that a SaaS platform can effectively serve smaller practices.
Humedica, clinical analytics services, added $20M in funding bringing its total to $50M. Humedica is offering services to hospitals, ambulatory centers and pharma. The team built PHARMetrics, another clinical analytics data services company, and sold it to IMS in 2005. It’s CMO and board director, developed Phase Forward, a clinical trials software company that was sold to Oracle last year. Its chairman was Vice Chairman at AOL and Time Warner.
Stat Health, online care for employers, launched. Another entrant in online care is welcome. The self-insured employer segment is a good one. Saving a small percent of employee ER visits will deliver ROI.
Gartner picks its Cool Vendors that include AxSys Health, collaborative care; Health DataWorks, clinical analytics; Shareable Ink, digital pen. And RockHealth launches an incubator in SF for health apps.
Art of HIT. The art this month is Airplane over a Train, Natalia Goncharova, 1913. It speaks to a fusing of the technology on the ground with the technology from the sky in a rapidly changing environment. It’s been nearly 100 years since it was painted and both technologies have developed along their own paths and still survive.
It seems we are in a similar period as the Internet and mobile communications combine with core healthcare operating systems to transform the next 100 years of healthcare.
Michael Lake has been a healthcare technology strategist for over 30 years. He is President of Circle Square Inc., a San Francisco-based strategy, business development and market research firm, focused exclusively on the healthcare information technology market. The company works with healthcare, life sciences and technology companies on developing strategies, products and business models for complex multi-stakeholder healthcare environments. He publishes the HIT Trends Report monthly. For more information, please see www.michaellake.com.
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ICD-10 Finally on the Agenda for Mid-Sized to Small Hospitals
After almost two years since software and service vendors started gearing up to support the transition to ICD-10, hospitals are finally starting to turn their attention towards the same.
Large systems that have had success with managing large programs are well on their way in developing ICD-10 transition roadmaps and performing initial investigations (e.g. number of ICD-10 affected systems, major business process flows affected by ICD-10, etc.). Some large systems have made purchases of specialized tools, such as Reimbursement Simulators, to aid in analyzing the impact of ICD-10. Given large systems’ ability to find the budget to get things done quickly, most should be in good shape by 2014, when ICD-10 is supposed to be live.
It’s the mid-sized to smaller hospitals that have been conspicuously silent on ICD-10, until recently. Many have only formed their ICD-10 steering committees this year, and some have appointed or hired an ICD-10 Transition Program Manager. This is an important step. These groups’ first major undertaking should be to size the ICD-10 transition and many are doing so as reflected in the sharp increase in the number of inquiries and RFQs related to ICD-10 program planning, budgeting, and initial assessments coming to Infosys. The good consultancies have built ICD-10 transition roadmap templates that greatly assist with planning and budgeting. These templates, used over a 3-4 week period, are very useful for uncovering hidden traps as well as opportunities for streamlining the transition. Expect 2011 to be the year for planning, budgeting, assessments, and team building. Unlike the large systems that have already started buying accelerator tools, the mid-sized to small hospitals probably will try to do without, or wait until 2012 to start making those purchases.
Still, much will depend on the HIS/EHR vendors readiness and the product/services that they will soon roll-out. Many CFO/CIOs are hoping that these vendors can handle the systems, process, and data conversion tasks in a packaged transformation service. It is my sincere desire that we find out soon what the vendors are capable of handling; discovering in late 2012 that the HIS/EHR vendors offerings are incomplete could pose serious operational and financial risks to the mid-sized and small hospitals that can ill-afford them.