Software Advice Articles» Medical Research and Survey Reports | Medical Software Advice Blog

Microsoft EMR: It’s Not Just a Matter of When, It’s a Matter of Who

Austin Merritt — Mon, 05 Apr 2010 19:55:27 +0000

Microsoft Dynamics is largely present in just about every software market but medical. And they’re missing out big time. The United States healthcare IT market is growing at about 13% per year and is expected to reach $35 billion in 2011¹. The biggest opportunity for growth in the industry is among ambulatory care physician practices, partly due to the Stimulus Bill requiring the use of electronic health records (EHR) systems by 2015.

You would think Microsoft would be in such a promising industry, but you won’t find a Microsoft EHR available. The primary reason why is that EHRs are highly specialized, and Microsoft’s main products (Dynamics, CRM, and SharePoint) don’t come anywhere near the needs of physician practices. It would be very difficult for Microsoft to build an EHR from scratch and introduce it to the market. So what should Microsoft do to enter the industry? Acquire a current player.

Such an entry into the medical market would mimic the acquisition spree that Microsoft conducted between 2000 and 2002, when it acquired Great Plains, Navision, Damgaard, and several related vendors. These systems were re-branded and offered as Microsoft Dynamics. Before these acquisitions, Microsoft was not present in the enterprise resource planning (ERP) application market. Its only ERP presence was as an infrastructure vendor, licensing SQL Server databases and related platforms to support application rollouts. However, this lack of application presence gave competitors such as Oracle and SAP the opportunity to squeeze Microsoft out of the ERP infrastructure market by pushing Unix, Oracle databases and IBM DB2. By acquiring several applications, Microsoft was able to drive sales of its SQL Server and Windows Servers directly, in addition to the Dynamics applications themselves. This strategy proved effective in giving Microsoft a multi-billion dollar share of the lucrative ERP market.

Setting its sights on the medical market, Microsoft is starting to squeeze its way in with a few smaller acquisitions and developments of its own, mainly Amalga and HealthVault. However, these current medical offerings are on the periphery of the market and do not really target the sweet spot: electronic health records for physician practices. An intelligent acquisition of a large EHR player would provide a key piece of the puzzle for Microsoft’s entry into the medical market.

Acquired by Microsoft in 2006, the Amalga family of products (Hospital Information Systems, Life Sciences, and Unified Intelligence System) addresses hospital administration, data aggregation for biotechnology firms, and information connectivity to large enterprises. Microsoft may be planning to expand Almaga’s presence or may be looking to acquire another vendor to complement it. Regardless of Microsoft’s strategy, Amalga still would not address the physician practice EHR market.

On the other end of the spectrum, HealthVault is a patient-managed, centralized health records solution. It is essentially designed to be a reference point for consumers, not a substitute for medical records. If Microsoft were able to introduce an EHR to the market and enable its users to make records accessible to patients, labs, specialists and pharmacies via HealthVault, then they would really be on to something. This synergy with its other products would just be an added bonus to having its own EHR.

So what would Microsoft prioritize as its key acquisition criteria when evaluating EHR targets? They would certainly want target vendors who possess the following:

Large market share and name brand recognition. Microsoft usually likes to be the largest name in the business, so they would definitely want to sell a “big-name” system with which most buyers are already familiar.
A scalable product for small and large practices. Microsoft would need to be able to cover a wide range of medical customers. While its bread and butter is always in the small and mid-size market, they would want scalability into the largest organizations.
A .Net architecture to drag along infrastructure sales. Reinforcing the position of .Net in the medical software marketplace would be important because it would drive further sales of Microsoft infrastructure while squeezing out Unix, Oracle and IBM.
An established, indirect sales channel. Microsoft historically favors selling through partners, including the existing Dynamics dealer network. An EHR vendor with a large dealer network would provide Microsoft an easily transferable sales channel and process.

So which EHR vendor should Microsoft acquire? This is where it starts to get interesting. We decided to examine Microsoft’s ten most logical targets in detail. Two very popular products, GE Healthcare’s Centricity and McKesson’s Practice Partner, did not make the top ten list. While these systems meet many criteria, the parent companies – General Electric and McKesson – are not really acquirable by Microsoft. The remaining ten are outlined below.

	MARKET SHARE	SCALABLE PRODUCT	.NET ARCHITECTURE	INDIRECT CHANNEL
NextGen
Greenway
Pulse
Aprima
Allscripts/Misys
eClinicalWorks
Eclipsys
athenaHealth
Epic
Cerner

NextGen – One of the “biggest names” in EHRs, NextGen focuses on medium to large enterprises. However, its system is certainly able to scale down to smaller practices. While it is often too expensive for groups with less than ten physicians, it has a strong position in the sweet spot of the market. Its .Net-based system is sold both directly and through a channel network, so NextGen is a good fit for Microsoft.
GreenWay – GreenWay has a nice product, but is toward the smaller end of the companies on this list. It sells primarily directly and has some channel partners. PrimeSuite 2008, its EHR and practice management sytem, is .Net-based and is popular among small and mid-sized groups. Microsoft could leverage its resources and Greenway’s technology to become a major force in the industry. Moreover, Greenway doesn’t come with any legacy of old architecture or acquired customers.
Pulse – Pulse has quickly climbed its way into the ranks of bigger EHR vendors and will likely stay here for some time. They were one of the first vendors to achieve 2011 CCHIT certification and are receiving a lot of buzz as a result. While the system is scalable and .Net based, Microsoft would likely want to pursue bigger fish for now.
Aprima – Aprima (formerly known as iMedica) has focused on its .Net framework and N-tier architecture from the beginning. As a result, its modern platform and interface make it widely received among physicians across a broad range of specialties. While Microsoft would likely focus on larger companies first, Aprima could be a nice additional partner to champion .Net.
AllScripts/Misys – A large brand and a publicly-traded company, it is a logical first place to look. After all, the company claims to have 160,000 physicians using its products. However, the 2008 merger between AllScripts and Misys presents the usual integration challenge, which might keep this firm busy for quite a while. Although we think the future of AllScripts/Misys is very promising, Microsoft probably wouldn’t get involved at this point.
eClinicalWorks – This system is probably the most ubiquitous of the list, especially among smaller practices. The recent deal to sell eClinicalWorks through WalMart will definitely increase its brand recognition and share of the market. However, the system is built in Java, an open programming language that is the traditional enterprise alternative to Microsoft .Net. Microsoft would most likely rather acquire a pure .Net system or one that is at least close to it, especially with Oracle, IBM and SAP all embracing Java.
Eclipsys – Eclipsys acquired MediNotes in 2009 in an attempt to move users to its Peak Practice EHR. While Eclipsys is fairly popular among hospitals, Peak Practice has not achieved similar success among small to mid-size outpatient practices. Existing MediNotes users are not thrilled about being forced to purchase Peak Practice and we’ve seen quite a few seeking a new solution from a new vendor. We think the success of the MediNotes deal is unclear and Microsoft would steer clear for now.
Athena – The youngest company on this list, Athena’s product offering is slightly different from the others. Its system is offered via software as a service (SaaS) and is combined with outsourced billing and revenue cycle management services. This offering is indeed unique, but not a suitable target for Microsoft due to its SaaS offering and labor-intensive service component.
Epic – This company possesses an interesting niche in the market. It has only 190 clients, but 150,000 physicians using its products. This is due to its focus on only the largest healthcare organizations in the United States. While this focus is great for Epic, it wouldn’t be effective for Microsoft. Epic will never be able to achieve the ubiquity in the small to mid-sized market where Microsoft dominates. It also sells direct, contrary to Microsoft’s traditional indirect sales mode.
Cerner – Cerner’s cash cow is Millenium, a product designed primarily for hospitals. PowerWorks, its outpatient EHR, does not possess the market share among physician practices that Millenium enjoys among hospitals. While Cerner is a recognized name, few practices consider PowerWorks. It is also an older system. Cerner would need to improve its PowerWorks offering before becoming a suitable target for Microsoft.

Although NextGen is not currently dominant amongst small practices, Microsoft could bring them downmarket. NextGen is unable to serve these smaller buyers for two reasons: 1) small practices cannot afford an enterprise expenditure; and, 2) NextGen does not want to (and maybe cannot) devote resources to chasing smaller deals. If Microsoft owned NextGen, they could double down on pursuing smaller practices, perhaps through their channel partners. They may even lower prices to buy market share and make up the difference with revenue from services, SQL licenses, and maintenance.

Which EHR do you think Microsoft should acquire?

Healthcare Wants a Tablet, But Not Apple’s iPad | Survey Results

Chris Thorman — Thu, 04 Feb 2010 23:14:37 +0000

Last week, during the fever pitch surrounding the announcement of Apple’s iPad tablet, Software Advice surveyed 178 physicians, nurses, medical students and healthcare IT professionals about what the healthcare industry’s ideal tablet would look like. This isn’t our first time talking tablets and healthcare. In April of last year, we wondered if the Apple tablet would become the ideal device to run electronic health record (EHR) software.

Our goal with this survey: Find out what healthcare professionals want in a tablet and how well Apple’s iPad fulfills those wants.

Let’s see what we found out from our survey results:

Majority of Healthcare Professionals Are Likely to Buy a Tablet

This chart shows how likely respondents are to purchase a tablet for healthcare use in the next year.

When nearly a dozen new tablet devices were shown at the Consumer Electronics Show earlier this year, it looked like 2010 was going to be the year of the tablet’s emergence as a consumer gadget.

Judging by the survey data above, 2010 also may be the year of the tablet’s emergence in healthcare. Of the respondents to the survey, 54% said they were either very likely or somewhat likely to purchase a tablet for healthcare use over the next year. That’s good news for tablet makers.

Tablet Tasks

This chart shows what percentage of respondents want to use a tablet for a particular task.

Healthcare workers want to use tablets for a wide variety of tasks. A majority of our respondents said they wanted to use a tablet for all of the above tasks except for billing, coding and claims.

Ease of Use and Software Selection are Top Reasons for Tablet Selection

This chart shows what criteria is most important to survey respondents when purchasing a tablet.

According to survey results, ease of use is the major purchase reason for a majority of healthcare professionals. That may fare well for the iPad. Why? The iPad runs on the popular iPhone operating system. Thousands of doctors are already using iPhones in clinical settings.

In addition, the iPad has a finger touchscreen. Of our healthcare respondents, 63% said they preferred a finger touchscreen over styluses and voice dictation when asked about their data input preference. Many of those same people said that the speed of the data entry was the determining factor when noting a preference for the finger touchscreen.

How important is quick data entry in healthcare? Here’s what one respondent had to say:

As an MD in the ER, I am the most ‘expensive’ employee … doing data entry. The available software for data entry for my physicians is rudimentary at best. Speed is the key. I need to be able to see 30 patients in 8 hours and FULLY document the visit in a time-efficient fashion.

In the case of healthcare workers, ease of use could appears to at least partially equate to speed of use. The iPad’s operating system and touchscreen would appear to have both criteria.

In terms of medical software selection, the iPad lags far behind virtually every other tablet on the market. Despite having over 5,000 medical apps immediately available for download through Apple’s App Store, none of those apps are a functional EMR system or even remotely close to one. The vast majority of EMR software on the market today will not run on a Mac OSX operating system. Most require a Windows-based operating system to function.

The iPad may have an easy to use operating system helped by a finger touchscreen but those pros are nullified by that system’s inability to run the vast majority of medical software on the market today.

What Healthcare Wants, the iPad Doesn’t Have

After reviewing dozens of tablets on the market, both consumer focused and healthcare focused, we came up with the above list of “must-have” features for healthcare tablets. We asked our survey respondents to check all of the features they felt were “must-have” features in a healthcare tablet device.

This chart shows what percentage of respondents thought a feature was a “must-have” in a tablet.

Unfortunately for the iPad, as we found out last Wednesday when Steve Jobs unveiled the tablet’s features, it only has a few of the top “must-have” features for healthcare use.

The iPad has Wi-Fi access; lightweight hardware (1.5 pounds); and arguably an ergonomic design. That’s it from this list.

It lacks a large number of features that healthcare professionals deemed important, such as resistance to dust and hospital fluids and disinfectants (the iPad does not have sealed ports); fingerprint access to the system (HIPAA compliance); barcode scanning (patient safety); and an integrated camera (documenting diagnosis). In fact, you could argue that the iPad’s difficulty in being disinfected or kept clean of hospital fluids is a deal breaker for healthcare workers.

Peripherals, such as an RFID reader and barcode scanner, may be available in the future. But because they’re not native to the iPad, they’re just more cables and cords a busy healthcare worker has to lug around. That’s another negative mark for the iPad.

Also, as we mentioned before, the iPad does not have a wide selection of medical software because of interoperability issues with it’s operating system. A wide selection of medical software was voted as a must-have feature by 70% of our respondents. Most medical software on the market, EMR software especially, will only operate in a Windows-based environment. This presents a huge problem for the iPad in healthcare.

The Verdict

Healthcare wants a tablet. Healthcare likes the iPhone. That does not translate into healthcare liking the iPad.

Simply put, the iPad lacks many fundamental features necessary to function in the healthcare field. From the difficulty disinfecting the device to its lack of interoperability with the majority of Windows-based healthcare systems and software, the iPad in its current state suffers from many of the same problems that previous, failed healthcare tablet PCs have suffered from.

The iPad may be sleek and simple to use. But that doesn’t translate into widespread adoption by the healthcare industry. In fairness, it doesn’t appear that Apple was targeting the healthcare vertical; their bread and butter market remains the consumer.

Survey Comments

In our final survey question, we asked the respondents, “Why haven’t tablets become mainstream devices in healthcare?” Here are a few of the more interesting responses we received. They touch on a few topics we didn’t address here today. They are sure to spark more discussion.

“Shoehorning a desktop OS into a tablet does NOT work. This has been the approach of Microsoft and hence no uptake. A modal interface like the iPhone is more suitable to touchscreen use and makes more sense in this setting.”
“Why use a new product when old ones are properly doing their jobs?”
“Lack of a streamlined, polished UI for task specific functions inclusive of each practitioner’s duties.”
“I have worked in ERs that have them and they never seem to work. Low battery life? Unstable software? Limited functionality, too (not integrated with imaging).”

What are your thoughts on tablets in healthcare? Is the iPad the tablet healthcare workers have been waiting for? Or is it another tablet that just isn’t quite there yet for the healthcare industry in terms of functionality?

Demographic breakdown:

Health IT Professional: 29% (52)
Physician: 28% (50)
Nurse: 16% (29)
Other: 14% (23)
Student: 12% (22)
Admin support: 1% (2)

What Does it Take to Qualify for the EHR Stimulus Funds?

Guest Blogger — Wed, 23 Dec 2009 01:30:38 +0000

We talk with hundreds of physician practices each month. Their biggest question: “What does the economic stimulus package mean for me?”

Practices understand that up to $45 billion is allocated to provide incentive for physicians to adopt EHRs. However, many questions remain about how and when providers will receive stimulus funds.

We teamed up with Justin Barnes, Chairman of the HIMSS Electronic Health Record Association and Vice President of Greenway Medical Technologies, to help answer these questions. The original presentation was delivered last week, however you can view the entire webinar above. In this hour webinar, you’ll learn:

How the stimulus money will be paid out
What it takes to qualify for funding
Which specialties qualify for funding
How “meaningful use” is defined
What constitutes a “qualified EHR”

Obama’s EMR/EHR Stimulus of 2009 – Creating Buyers or Tire Kickers?

Houston Neal — Tue, 27 Oct 2009 14:16:16 +0000

October 30th marked the close of the first reporting period for grants, loans and contracts awarded under the Recovery Act. If you don’t already know, healthcare is one of the industries eligible to receive funds (Read, The Stimulus Bill and Meaningful Use of Qualified EHRs / EMRs).

At Software Advice, we have noticed a big jump in the number of medical practices researching electronic health records (EHR). But are these practices ready to purchase, or has the Stimulus only reinvigorated research?

Are more doctors buying electronic medical records than before? Or, has the Stimulus bill only brought out the tire kickers?

Last week we posted a survey to find out what the industry consensus is. We sent a message to our favorite medical bloggers and posted a few tweets to help spread the word. Thanks to all who participated!

We tallied up the results this morning and a clear winner has emerged. Roughly half of our participants believe the Stimulus Bill has only reinvigorated research among doctors and health IT staff, creating a growing pool of “tire kickers.” 20% of voters think more doctors are buying EHRs, while 19% think the bill has had no affect on purchase decisions. Finally, another 12% of voters answered “other” and left us with a comment. Here are their remarks:

Medical practices have until 2014 to take advantage of the HITECH Act incentives. We’ll be keeping track of EHR buying trends until then, so be sure to check our blog for new reports. In the meantime, if you have a firsthand account of how the Stimulus has affected EHR adoption rates – or if you just want to speculate – feel free to leave us a comment below.

SaaS v. On-premises Software: Which One is More Green?

Chris Thorman — Tue, 22 Sep 2009 14:16:22 +0000

In case you haven’t heard (or aren’t obsessively following IT trends like we are), the great trend in software is the evolution from traditional “on-premises” software (e.g. client/server software installed at the office) to Software as a Service (SaaS) (i.e. web-based applications that are managed in the vendors’ data center and accessed “on-demand” through a web browser).

Given what’s at stake for software companies in either camp, debating the merits of each model has led to some fiery discourse. We thought we’d fan the flames by introducing another angle: which model is “greener;” that is, better for the environment.

Understanding the Models

On-premise software is what most people think of when they think of a software system. You pop in a CD or download a big file from the Internet and the install begins. Files are copied to your computer and/or a server machine, where they are stored and run. Because the client and server software components are both doing a lot of computations, a fair amount of power is required.

With SaaS, there is no local installation of software because the vendor manages all the code and the data in their data center. Users access the system through a web browser and its primary role is to present the user interface – not a very computationally intensive function.

On-Premise Energy Consumption

Now let’s dig into the power consumption of the on-premise model. We’ll use the example of a typical physician practice, since electronic medical records (EMR) software is a market we know well. The “On Premises” side of the graphic below illustrates a four-physician medical practice, running EMR software on their own in-house server.

The HP ProLiant DL server, one of the most commercially popular servers on the market today, will consume 7,008 KW of server energy per year. That’s running 24 hours a day, 365 days a year.

In addition, each user is using a Dell desktop 546, Dell’s most popular starter desktop. A single 546 Dell desktop will consume 600 KW of energy a year, running 8 hours a day for 250 days a year (an average work year).

A four-physician practice will consume 9,408 KW of power each year just to run EMR software on-premise. Each user will personally consume 2,352 KW of power each year.

SaaS Energy Consumption

Now let’s see how the energy consumption of SaaS software stacks up. Rackspace, one of the largest providers of cloud computing hosting services, lists the Dell PowerEdge 2950 III as one of it’s most popular server choices. And since a data center would have a redundant server in addition to the PowerEdge, our SaaS applications are powered by two of these servers.

Running 24 hours a day for 365 days a year, the total energy consumption for these two Dell servers running SaaS applications would be approximately 6,570 KW/yr each, or 13,140 KW/yr total.

However, in a modern SaaS data center there are economies of scale that enable the software vendor to run many customers on the same server (or small number of servers). The first way they might do this is to develop a “multi-tenant” architecture. That is, much like many people can share the same apartment building, SaaS customers can share the same software application and server. Extending the analogy, each SaaS user has their own passwords and permissions just like each tenant in an apartment building has their own set of keys.

Running this server in a SaaS data center allows the SaaS EMR vendor to tens or hundreds of customers on one server. When a new customer goes line with the application, the incremental computing requires – an power consumption – increase only marginally.

How does this affect energy consumption by our physicians?

Now our physicians are only using 131.4 KW (1/100th) of the Dell PowerEdge server energy each year because of the multi-tenant architecture. Also, because SaaS applications require less computing power on the client, the physicians are able to switch to more efficient Dell netbooks, which only consume 120 KW of power each per year.

Using SaaS, our four physician practice now only consumes 611.4 KW per year running their EMR software. That’s 152.85 KW per year, per physician.

That’s an 93% reduction in overall energy consumption for a four physician practice using SaaS EMR software over on-premise software!

Beyond Power Consumption

Power consumption isn’t the only area where we found that SaaS is greener than on-premises. Here are a few more considerations.

Remote IT support. Whether or not your IT support is in-house, they’re going to consume energy traveling to and from an office to perform maintenance and fix problems. Since there really isn’t much of anything to maintain at the office, SaaS vendors are able to provide remote IT support, reducing travel and CO2 emissions.
Less frequent replacement of PCs. Given that SaaS applications just require a web browser on the client machine, you really don’t need a very powerful PC. SaaS customers can keep their old machines in place or get a longer life from any new machines they buy. This compares to on-premises software, where customer will often upgrade hardware to support the computing resource requirements of new client software.
Telecommuting. Accessing on-premise software remotely is typically slower and more technologically complex than a SaaS application. With SaaS applications accessible from any computer with an Internet connection, employees can work remotely, saving fuel and energy costs in the process.

Survey Results: Which Smartphone Will Own the Healthcare Market?

Chris Thorman — Thu, 30 Jul 2009 15:10:08 +0000

Last week, Software Advice set out to try to answer the question: Which smartphone will own the healthcare market?

Doctors, nurses, students and many others in the healthcare industry responded to our survey and provided results that are bound to be conversation starters.

Which smartphone won out? Read through our results to see.

Smartphone Use by Profession

Right off the bat, the preference for the iPhone is clear across a number of professions. The most patient-centric healthcare roles – physicians and nurses – clearly prefer an iPhone over other smartphones.

The most tech savvy of our respondents – healthcare IT professionals – liked to mix it up with their smartphone choices but most preferred an iPhone.

Our “Other” profession category included consultants, hospital administrators and pharmacists to name a few, so it’s not surprising that their smartphone choices reflected the diversity of their jobs.

One question our survey didn’t address is: Is any particular healthcare profession driving the use of smartphones? For example, if physicians overwhelmingly adopt the iPhone in the next few years, does that mean that nurses, students and everyone else has to follow suit?

It’s All About the Apps

Question: Why did you choose your current smartphone?

Across every role in the healthcare industry, software was the major reason for purchasing a specific phone. With the exception of our small sample size of administrative personnel, each group surveyed showed that more than a majority of respondents felt software was the most important factor when buying a smartphone.

Doesn’t that make sense? The fanciest hardware in the world will quickly get old if it takes you four clicks to access your e-mail.

Time and time again in our survey comments, people said that they really enjoyed the simple user interface of the iPhone.

“The iPhone is probably the best – it has an amazing number of applications that are growing day by day. It also is fast and responsive and ‘just works.’”

As the pricing and coverage area of major phone carriers becomes similar, a smartphone’s software has to become it’s most important feature to stand out in a crowded industry. The same is true for phones in the healthcare market.

Satisfaction High for Smartphones in General

Question: Are you satisfied with your current smartphone?

Most people, regardless of brand, were satisfied with their phones. If you’re reading this article thinking about whether or not you should even purchase a smartphone, take comfort in knowing that it would be tough to completely blow your purchase.

Google phone users were especially excited about the future of Android, the phone’s open source software:

“The Android platform is the only other platform that seems to have the potential to inspire the entrepreneurial fire and get developers all over the world to start building software, for medicine and countless other industries.”

The only unsatisfied group of users were those not using one of the popular phones listed above.

For example, our lone Samsung Blackjack respondent said he wasn’t happy with his phone and that the only reason he was using it was because it was required by his employer.

Smartphone Uses

Question: Which of the following tasks do you use your phone for in the workplace? Check all that apply.

E-mail and note taking are obvious smartphone uses that have been adopted by over 70% of our respondents.

Prescription drug reference is another popular use. This is bolstered by the popular drug reference program Epocrates, which has versions on the iPhone, Blackberry, Palm and Windows Mobile devices.

Actual hospital or clinically related tasks – lab results, e-prescribing, etc. – have been very slow to integrate with smartphones. The desire to use smartphones for tasks like that is huge, as you’ll see.

Desired Smartphone Functions

Question: Which of these tasks would you like to be able to do on your phone in the future? Check all that apply.

In addition to asking what tasks the healthcare industry currently uses smartphones for, Software Advice also wanted to know what physicians and others want to use their phones for in the future.

The top two desired tasks, medical image viewing and patient records, are interesting to note because very few physicians and healthcare professionals currently use their phones for that.

Will Any Smartphone Become a Necessity?

Our survey respondents leaned heavily towards the iPhone, both in number of users and satisfaction rates. One physician said, “The iPhone seems to dominate due to sheer numbers of willing ciders.”

The iPhone is the current favorite according to our results, but the results also made us skeptical about smartphone adoption in general.

Many of our respondents didn’t think that any smartphone would become a necessity in the healthcare workplace.

“None of them really work unless there is integration with the software your facility is using. To my knowledge, McKesson or Cerner and the other big players are not building interoperability with smartphones into their Health Information Systems (I’d be happy to be wrong) but unless they do, the smartphone becomes a limited standalone device.”

Ben, Head of Digital at Medical Educator, did a good job summing up our survey’s comments, with a healthy dose of skepticism about smartphones in general:

“Although the Blackberry is probably a better business-use smart phone, it doesn’t have the richness of user generated applications and add-ons that the iPhone does. The iPhone is also easy to understand, accessible, and has its marketing spot on. In terms of devices, I see the iPhone leading the way.

“However, the hardware is only part of the equation. The key driver in take up is the richness of the applications that are developed for these platforms. Only when genuine value-add tasks can be actioned via a smartphone we will see mass take-up.”

Coverage and carriers will continue to be an issue as well, says Todd from Pharmacy Technology Resource:

“iPhone needs to be available via multiple networks. The AT&T monopoly is prehistoric.”

For now, our survey showed that the iPhone has the most momentum. The essential smartphone, if there is one that will become a necessity in healthcare, will have to be adoptable across a wide range of professions. Is that the iPhone?

What do you think about our survey results? Which smartphone will own the healthcare market?

Which Smartphone Will Own the Healthcare Market?

Chris Thorman — Tue, 21 Jul 2009 12:21:59 +0000

The smartphone industry is on fire. iPhone, Blackberry, Palm Pre and Google are all in the hunt for dominance. We want to know one thing: Which phone will become the device of choice for healthcare providers?

Please take our short survey and forward it on to your friends and colleagues. If you’d like to be notified by e-mail about our survey results, please enter your e-mail address in the form below.

Update Tuesday PM: Our survey has closed. Please go here for the More ...

Twitter: Growing Virally But Can It Stop Viruses?

Chris Thorman — Tue, 30 Jun 2009 15:42:47 +0000

As evidenced by Twitter’s front-and-center role in the “Second Iranian Revolution,” the micro-blogging tool has emerged as a serious communication channel. At Software Advice, we think Twitter is every bit as relevant in medicine as it is in politics, business and personal communications. Specifically, we’re convinced Twitter could play a big role in epidemiology – the branch of medicine that deals with the study of the causes, distribution, and control of disease in populations.

The combination of Twitter and epidemiology presents an interesting opportunity: What if doctors twittered about symptoms they observed and diagnoses they made? What if that information was aggregated in a way that helped track disease outbreaks in real-time, share treatment plans, and save lives?

Combining health data with social media tools to track disease outbreaks is a simple concept. Executing this in the real world, however, is extremely difficult. Dr. John Snow, the father of epidemiology, tracked the 1854 Broad Street Cholera outbreak in London’s SoHo district. Dr. Snow recorded the locations of the 600 cases of Cholera on a spot map, spoke with SoHo residents to learn more about how the disease spread, and finally concluded based on the locations of the cases and personal encounters that the Broad Street water pump was the main agent responsible for spreading Cholera.

Fast forward to 2009. How can we combine social media tools with electronic medical records (EMRs) to help track disease outbreaks like the Swine flu?

Getting Reliable Data

Today, Dr. Snow’s interaction with SoHo residents could theoretically have been done via his Twitter feed. The modern day equivalent of Dr. Snow’s spot map may look something like this Google Map/Twitter “mash up”, which combines the visual affect of a digital map with the real time tweets from Twitter users talking about the Swine flu. However, when looking at that mash up, you’ll see that there is no filtering of the tweets’ relevance to an epidemiologist’s needs. Any communication referencing Swine flu, from jokes to local news stories, appears on the map.

Bio-surveillance company Veratect is trying to track diseases in a similar way by monitoring social media traffic on blogs and Twitter feeds talking about the Swine flu. Even though Veratect’s project is much more robust than the Swine flu map mash up, it still suffers from a high signal-to-noise ratio.

What exactly constitutes evidence of a disease outbreak when you’re monitoring social media traffic? How can doctors and epidemiologists verify the information being sent in?

@YourDoctor

Imagine this. Doctors around the world are conducting their rounds and examining patients on electronic medical records, which document diagnosis codes. As the physician makes a diagnosis or documents symptoms, he has the option to “tweet” that observation. This allows other doctors to follow that feed and observe trends. Even better, epidemiology-specific analytics can be layered on top of the feeds to recognize patterns as they develop.

Here is a fictionalized example of how analysis of a disease outbreak might unfold if doctors adopted Twitter as a method of communication:

This adoption by doctors would need include a verification system that only allows trusted or authenticated users to tweet about information contained in the EMRs. What we’re trying to avoid is aggregating a whole mess of data related to a particular disease. Authenticating users to make sure they are who they say they are avoids this problem.

With a uniform set of diagnosis codes and a proper authentication system, suddenly the trending data sent out by these verified doctors’ tweets goes from speculative to extremely reliable.

Unique diagnosis codes could also be translated into other languages, making worldwide tracking of diseases a reality. Personal communication between doctors and epidemiologists would still be hampered by language barriers but at least every user of this system would have access to the same reliable information in their native language.

Twitter users employ “hash tags” to help group their tweets together. By using the # symbol before a word, that word becomes a hash tag and links each tweet of said tag together. Twitter groups these hash tags together as trending topics, allowing anyone to click on a hash tag and bring up every tweet that references it. Epidemiologists could aggregate disease data coming from doctors in a similar way, substituting the Twitter hash tag search for a diagnosis code search.

The Advantage of Real-Time Information

During any disease outbreak, time is of the essence. Many government and health agencies around the world aggregate their data on potential outbreaks but do so on a weekly or semi-weekly basis at best. The technologically primitive nature of the vast majority of the world’s health care systems prohibits catching most outbreaks in their infancy. Even if a disease outbreak is discovered, that outbreak may only be realized at the local or regional level. When you’re talking about potentially killer diseases – Swine flu as a recent example – an advance warning of even a couple of days could mean thousands of lives would be saved.

The real time nature of a Twitter EMR system would allow epidemiologists to get a jump on disease outbreaks. Much like the trending topics section of Twitter, symptoms and diagnoses could be tracked by their frequency as they’re submitted by doctors. Algorithms can be developed to push relevant diseases and their diagnosis codes to the top of epidemiologists’ tracking lists.

Limiting Privacy Concerns

Naturally, there are going to be privacy concerns about doctors tweeting patient information out into the digital world. However, no personal identifying information is required to track diseases in this scenario. The only name associated with the posting of this health information would be the doctor’s. Even that may be an alias.

The combination of social media and EMRs, in some form or another, will undoubtedly be part of the future of tracking disease outbreaks. The how and when of that process remains complicated, dependent on health agencies, governments and the doctors themselves to implement the appropriate systems. However, the “viral” spread of Twitter leads us to believe that physicians may not have to wait around for bureaucracies to organize an epidemiological social network. Like the Iranian opposition party, they may organize it themselves with Twitter.

Coming Soon: Recovery Act Grants for Medical Informatics

Houston Neal — Thu, 21 May 2009 12:29:12 +0000

The American Recovery and Reinvestment Act of 2009 (the ARRA, also known as the Stimulus Bill) allocates $51 billion to healthcare. Universities that want to establish and/or expand health informatics programs are entitled stimulus bill funds. But what’s available? Who qualifies? And how can universities take advantage of the funds?

We recently called the Office of the National Coordinator for Health Information Technology (ONC) to learn more. All they could tell us is funding will be available, but the details have yet to be confirmed and set in writing. We quickly learned we were not the first people to call; many others are wondering the same things as us.

While we can only speculate about when and how much will be available, one thing is for certain: there will only be so much to go around.

Here’s what you need to know and what you need to do to be prepared.

Who is Eligible?
There are two different grant programs described in the stimulus bill. The grants are for universities that wish to:

Carry out a demonstration project to develop academic curricula integrating certified EHR technology in the clinical education of health professionals (section 3015), or;
Establish or expand medical health informatics education programs (section 3016).

The grants will be available to the following institutions of higher education:

A school of medicine, osteopathic medicine, dentistry, or pharmacy;
Graduate programs in behavioral or mental health, or any other graduate health professions school;
Graduate schools of nursing or physician assistant studies;
A consortium of two or more schools described in the lines above;
An institution with a graduate medical education program in medicine, osteopathic medicine, dentistry, pharmacy, nursing, or physician assistance studies, and’
Certification, undergraduate and masters degree programs for information technology.

Also among this group are universities that want to integrate EHRs into community-based clinical education. That is, clinical education in an outpatient setting at a community health center or Federally Qualified Health Center (FQHC).

The application process and requirements for each grant are generally similar. Though there are a few provisions to be aware of. Let’s take a look at the first program.

Section 3015 - Demonstration Program to Integrate Information Technology into Clinical Education
Grants under this section will be awarded to universities that carry out a “demonstration project” to develop curriculum using electronic health records (EHRs). Funding will be provided by the Secretary of Health and Human Services and will cover up to 50 percent of costs.

To apply, universities will need to submit a plan that explains how they will integrate EHRs into their program. This must include details on how students will be instructed to use EHRs to reduce medical errors, increase access to prevention, reduce chronic diseases and improve quality of care. The plan must be accompanied by a formal application.

Grantees will also be required to provide data on the program’s effectiveness in improving patient safety, efficiency of care delivery, and in increasing the likelihood that graduates will use EHRs in the delivery of future health care.

Limitations and Provisions
Before applying, there are a few requirements to be mindful of. First off, grants will be awarded on a competitive basis and will be subject to peer review. Secondly, the EHR used in the demonstration project will need to meet certification standards set by the Office of the National Coordinator for Health Information Technology. The National Coordinator is slated to have the standards finalized by January 2010.

Section 3016 – Information Technology Professionals in Health Care
Grants awarded under section 3016 will go to universities that want to establish or expand medical health informatics programs. Financial assistance will come from the Secretary of Health and Human Services – in consultation with the Director of the National Science Foundation – and will cover the following activities:

The development and revision of curricula in medical health informatics and related disciplines;
The recruitment and retainment of students to the program;
Acquisition of equipment for student instruction, including installation of testbed networks, and;
Establishment and enhancement of bridge programs between community colleges and universities.

One thing to keep in mind, priority will be given to existing programs or programs designed to be finished in six months.

What Can Universities do to Prepare?
As we anxiously await details of the grants, there are key steps you should take to prepare to apply:

Register for electronic submission – Institutions are required to register with both Grants.gov and NIH eRA Commons before submitting an electronic application.
Do your homework – You should familiarize yourself with the grant application process by visiting Health & Human Services’ grants website.
Claim your originality – Make sure your program will be truly unique. By law, grants cannot be awarded to a project if it already exists and is being funded.
Be on the lookout – Details of the grants will be released on the HealthIT/Recovery page of the ONC website. You should check this page often for updates.
Sign up for Alerts – Monitor keywords like “medical informatics” and “recovery act grants” using Google Alerts. Every time your selected phrase appears on a website or in the news, Google will email you a notification. This might be the tool that gives you a one-up on other colleges competing for the grants!

Wal-Mart + eClinicalWorks Electronic Medical Records | An Odd Couple with Good Intentions

Don Fornes — Tue, 31 Mar 2009 14:31:10 +0000

The Wal-Mart / eClinicalWorks (eCW) partnership to sell electronic medical records (EMR) software in Sam’s Club strikes us as an odd couple. While we think eCW will benefit from this marketing coup, we don’t see the relationship lasting over the long term.

Certainly, the intent is good: simplify a traditionally complex and expensive purchase by distributing through a low-cost distribution channel. Moreover, eCW is as good a partner as any for Wal-Mart:

The product is a comprehensive system built on solid technology;
eCW has great momentum and viability; and,
eCW has already succeeded as a value leader.

However, we don’t think EMR software presents the same economies of scale that Wal-Mart relies on to deliver “everyday low prices.” Wal-Mart can sell a wide range of products at low prices because they negotiate massive bulk purchases, run dramatically efficient logistics and efficiently manage inventory.

Those strengths may make a difference for the Dell hardware they are selling as part of this deal, but it doesn’t mean much when it comes to software. Software is essentially intangible – it can be delivered on a CD or via the Internet – and it is easily “manufactured” such that there is almost no variable cost of goods to be whittled down.

As a result, transportation and inventory optimization are irrelevant when it comes to eCW software. Sam’s Club members may assume they’ll get better prices through this deal, but from what we can tell, the $25,000 price tag is about the same as what they would pay through any other channel (i.e. eCW resellers or direct from eCW) for the same bundle of software, hardware and services.

Furthermore, we do see some very real sales and services challenges arising from this partnership. Simply put: sophisticated, $25,000 EMR systems don’t sell themselves. Get a Wal-Mart “greeter” involved and things could get ugly. Wal-Mart has already stumbled a bit trying to support the relatively complex sale of iPhones. EMRs are a far more complex sale. My mind goes to the horribly awkward image of a brilliant, yet intolerant, cardiologist interrogating a greeter about eCW functionality. The mismatch of intellect and clinical expertise could be incendiary.

A $25,000 EMR is a “considered purchase”; for example, a physician practice needs to consider if the system meets their functionally requirements, integrates to other systems (e.g. RHIOs or diagnostic systems) or qualifies for subsidies such as the recent economic stimulus package. eCW certainly does meet many, many providers’ needs; however, a physician will not likely buy the system if there isn’t a highly qualified representative available to give them comfort through a consultative sales process.

Sam’s Club has over 600 locations, which is almost how many employees eCW has. It is highly unlikely that Wal-Mart or eCW would be able to staff up fast enough or effectively enough to provide sales support across a majority of these locations. Nor does that level of staffing seem efficient; I doubt there would be enough physicians coming through Sam’s Club door to keep that staff busy.

When eCW is available in Sam’s Clubs this spring, we expect that thousands of physicians will stop by to check it out. But they won’t buy on that visit. Instead, they’ll go back to the office, Google the system and start considering their purchase. They will seek out answers by calling eCW directly and eCW will find itself performing the sales process as usual. The Wal-Mart buzz may drive sales, but it won’t lower the inherent cost of sales, which is the critical element for an effective Wal-Mart partnership. Competing EMR companies, meanwhile, will enter the fray one way or another, and the economics of software will allow them to match the Wal-Mart price.

The bigger challenge for eCW will come from the impulsive buyer. We expect that a significant number of physicians will fail to consider their purchase. For one reason or another – a peer recommendation or the Wal-Mart endorsement – will give impetuous buyers enough comfort to buy the system.

Unfortunately, it is highly likely that these buyers will purchase with irrational expectations. They will expect to open the box and be ready to go and they will be disappointed when they see how much work lays ahead, even with a great product like eCW.

In these cases, the eCW product will not be to blame. Instead, it will be the product’s inability to meet the expectations of a buyer that never had their expectations set by a straightforward representative. They won’t realize that templates need to be configured, data needs to be migrated, staff need extensive training, etc. I fear for the eCW support reps that have to field those calls.

We don’t expect this partnership to be a failure. Instead, we think it will accelerate eCW’s already impressive growth and position in the market. The awareness generated by the relationship will be well worth it for eCW. As for Wal-Mart, we expect them to realize sooner rather than later that they can make more money elsewhere. They’ll give this program a year or so, and then put something a little more traditional on the shelves.