Health 2.0 Goes to HIMSS

Last week was the HIMSS conference in Orlando, and I spent hours and hours in the boat-show exhibit hall. I also finally made it to a keynote at HIMSS (it’s been a while). HIMSS Chairman and Cleveland Clinic CIO Martin Harris reported that HIMSS only made $2.4m in profit last year–where are they hiding the money? Certainly not by providing delay screens or speakers for the back of the aircraft hanger that we were crowded  into, so those of us in the back of the room were straining our necks to see HHS Sec Kathleen Sebelius as she waved the flag about how America owns the Internet (or at least has the biggest Internet companies) and extolled the growth of EMR use in the last two years. Sebelius had had breakfast with 15 small companies before her keynote and she even called the HIMSS’ attendees innovators. Don’t laugh quite yet.

Meanwhile elsewhere at the conference the fictional EMR vendor Extormity was revealed to be the creation of a couple of smaller SaaS-based vendors. (They told me about the unveiling and I just kept saying, “Don’t do it”) But it’s the real Extormitys out on the show floor that are both the bread and butter of the hospital IT sector, and dominate HIMSS…

Welldoc VitalHealth Athenahealth eClinicalWorks ClearPractice

So we need those Extormitys to change and we need real innovative technology companies to come into the market. What are the chances of that?

I’m biased and I believe that SaaS-based Web services are going to have to be the answer eventually. Customization at the sub-enterprise level is the death of software improvement. Ross Koppel at UPenn has detailed how several Extormitys virtually prevent UI improvement by their local customization and policies of opaqueness. On the web, non-customized services have aggressive user groups that help guide UI improvements. Google doesn’t customize Gmail, but it iterates and experiments with new features all the time, and it treats its users as co-developers. Frankly the EMRs that AHRQ and NIIST criticize for lack of usability do not. It’s only by getting more providers and patients on the same platform that we’ll get that iteration and improvement in health care.

On the other hand, in many markets and health care especially, it’s survival of the fattest. Hospitals are going to work with their current vendors and if they switch, it’s usually to Epic–if they can possibly afford it.

But there are more than straws in the wind suggesting hope for change. In several interviews at HIMSS with those more established vendors, I see two trends emerging:

First, the mantra of HIE (Health Information exchange or actually being able to see records from clinical transactions done somewhere else) is getting louder and louder. Some of the vendors who weren’t in the HIE business are now in it, and more importantly (I give the odd but by no means only examples in parens) are combining it with registries (Covisint), desktop look-up applications (GE), patient portals and care management (ICA, RelayHealth, and the newly megawealthy Medicity).

Increasingly bigger enterprise companies are bringing their heft to the market and starting to see opportunities. I met with the Oracle team which says health is the most important vertical for growth in the company, while Microsoft is spending more on health than any other vertical other than search (and I guess that’s just advertising for Bing!). Even Allscripts, one of the biggest vendors with lots of legacy systems in place following all those mergers despite its “one platform” mantra, has both shown an integration between those systems (yes they showed me data going from Allscripts to the old Eclipsys & back) and is adding a social networking function to connect all their users informally.

Second, the world is moving to SaaS and Health 2.0. athenahealth’s Jonathan Bush (who was on fire at the HISSies awards) was bitter that cloud computing won “buzzword of the year” but he’s having more influence than he thinks. Many big guys (GE, Ingenix) and medium guys (Navinet) are buying or deploying SaaS based EMRs for the smaller market. They’re joining the upstarts (Practice Fusion, 4medica, DrChrono, ClearPractice, VitalHealth) who are pushing these solutions already. Even more interestingly the most significant “small market” practice management/EMR vendor eClinicalworks has over the past few years has moved from mostly all client server to more than half SaaS. And they’re heading towards the bigger enterprise (as is Athenahealth which just appointed a head of Enterprise sales).

We’ve been tracking this at the Health 2.0 conference, and if several of these players (and the ONC SHARP grants) are serious, you can expect more of an ecosystem into which the smaller, most innovative companies can plug their applications (and unplatforms).

The final question is though, will the dogs eat the dog food? And by dogs I mean the American health care system (and I’m being a little rude to dogs). Sec Sebelius said it best–”Health Reform needs IT but Health IT needs health reform.” If the powers that be in the payer world don’t force real change on the system, the real innovation that we need will stay in the sidehalls and that amazing IT brought by the huge Internet only companies Sebelius was cheering won’t make it into health care.