October 23rd, 2009

Windows 7 will shine in medicine

Posted by Dana Blankenhorn @ 10:34 am

Categories: General, Hospital IT, IT Management, Medical IT, Medical Office IT, Medical Records, Windows

Tags: Touch Screen, PC, Doctor, Health Care, Microsoft Windows, Microsoft Windows 7, Tablets, Keyboards, Notebooks, Monitors & Displays

Windows 7 is finally here, and your doctor couldn’t be happier.

Thanks to its full support of multi-touch touch screens, Windows 7 is perfect for a tablet PC any doctor can use to record, update, and analyze your health records.

The big phrase you will hear this year is All In One. It means instead of choosing among a notebook, a tablet and a touchscreen, they are all one thing. As the standard PC becomes an All In One, the price drops toward the $500/unit level seen in standard laptops.

But wait, there’s more. Because the touchscreen is now supported within the operating system, applications will also get that support. This will also drop the price of solutions dramatically.

One problem doctors have long had with computerizing health records was the sloppy interface, when compared with clipboards. The clipboards always had the form they needed to use, and if it didn’t they could also slip another form into the clip and go.

Clipboards also support a doctor’s own handwriting. So now will standard PCs, once their optical character recognition software is trained. Nurses who “know what that scrawl means” will do the training, asking no more follow-up questions than they do . (Was that Percocet or prerequisite?) As the software learns the patterns, these annoying questions will start to go away.

Support will be needed to lead docs and nurses through the menus, so they can reach the right form, the right report, the right image. As with any PC application your mileage goes up as you get familiar with it.

But a virtual page is being turned here. There are no longer any excuses for doctors to have tablet PCs equipped with a pen-like stylus, an interface just as good as the clipboard and, over time, better.

This won’t overcome all objections. There is still a sort of protection in that bad handwriting. (No, your honor, I didn’t order Percocet — I asked what was the prerequisite.)

But now we will know where the objection comes from.

October 19th, 2009

Microsoft wins seat at health IT table

Posted by Dana Blankenhorn @ 7:00 am

Categories: General, Hospital IT, Medical IT, Medical Records, Physician Information, Windows

Tags: Information Technology, Health Care, Microsoft Corp., E-health, Healthcare, Vertical Industries, Benefits, Human Resources, Dana Blankenhorn

Microsoft got a seat at the health IT table last week as Caritas Christi, a Catholic-based hospital chain in Massachusetts and Rhode Island, decided to standardize on Amalga software.

The deal means that hospital networks in the northeast will have to deal with Microsoft’s health IT offering in their technical planning. The deal includes Microsoft’s HealthVault Personal Health Record.

Among Caritas’ competitors are Beth Israel Deaconess, whose innovative health It set-up run by GeekDoctor John Halamka has virtualized its health records using VMWare, and Partners Healthcare, which announced back in 2007 it would begin requiring using of Electronic Health Records (EHRs) by its physicians.

The market Amalga is entering, in other words, is a hothouse of EHR adoption, and integrating with its neighbors should give Microsoft the knowledge it needs to interoperate with all types of hospital IT systems.

July 6th, 2009

HealthVault clobbering Google in PHR race

Posted by Dana Blankenhorn @ 5:06 am

Categories: Consumer Information, General, Hospital IT, Insurance IT, Internet, Medical IT, Medical Office IT, Medical Records, Wellness, Windows

Tags: Google Inc., Microsoft HealthVault, Health Care, Microsoft Corp., Cerino, Vertical Industries, Healthcare, Benefits, Human Resources, Dana Blankenhorn

It’s hard to argue with Microsoft HealthVault’s market momentum.

Every week seems to bring another release in which HealthVault is partnering with some other major industry player. Walgreens. HealthPartners. CitiusTech. The American Medical Association. Etc. Etc. Etc.

David Cerino (right), general manager for the consumer health group at Microsoft, which includes HealthVault, credits the product’s tight integration with Microsoft’s Amalga software system, coupled with the fact this is not required, with helping HealthVault gain traction.

I really believe the way we’ve architected and built HealthVault, and the open platform, has excited a lot of partners.

It’s not only going to be consumers managing their health care on their own, but a lot of core data is sitting in source systems in hospitals, medical offices, pharmacies…a lot of people see we look at the ecosystem from the point of view of source data as well as consumers.

Translation. Google may be LeBron James but Microsoft is Dwight Howard, and you don’t pull on Superman’s cape.

The key to success in building a Personal Health Record (PHR) business, it turns out, is accessing the Electronic Health Record (EHR) data that hospitals, pharmacies, insurers and others have in their online silos. Microsoft and Cerino have done their homework.

That is now paying off, as Microsoft moves from hospitals and pharmacies to insurers, the big dogs in the health data business. “We have a partnership with Aetna that moves data into HealthVault. We’ve announced Health Partners and a couple of the Blues.”

Fort those companies, “The value proposition can’t be that if you leave we hold your data.” Not with health reform on the way. But since Microsoft has proven it’s a player in health care data, the insurers turn to it first.

Cerino compares what is happening with PHRs with what happened earlier this decade with online banking, which is the territory he covered before this.

So far, however, most of what has been happening in the PHR world is market “push,” owners of data pushing patients to take possession of it online. What seems to be lacking is market “pull,” which could come from social networks devoted to specific diseases and conditions.

” We’re always talking about it and looking at it. We look at a site like Diabetic Connect expanding and putting an application online, which we could integrate with. It could integrate healthcare devices and allow a different type of health management, and connect that to the provider.”

So Cerino not only has success and momentum, but a definite strategy. Eventually, push meets pull and HealthVault is at the center of it.

“Social networks are the consumer swell. If they demanded physicians deliver data electronically it would have happened. Then there’s the professionals’ side.  What’s the value for them? The two will start to converge.”

Microsoft is putting itself in the position to be the only answer to that question of convergence, once it is asked by enough people.

June 1st, 2009

Microsoft-Merck alliance boosts Amalga

Posted by Dana Blankenhorn @ 11:19 pm

Categories: General, Hospital IT, Medical IT, Medical Office IT, Physician Information, Windows, genetics

Tags: Software, Alliance, Merck & Co. Inc., Microsoft Corp., Tools & Techniques, Asset Management, Management, Operational Planning, Business Operations, Dana Blankenhorn

Microsoft is getting into genetic data management through an agreement with Merck.

Microsoft takes assets from Rosetta Inphamatics, a Merck unit, genetics and protein data it can use to build the lab section of its Amalga hospital software suite. Specifically the assets come from the Rosetta BioSoftware unit.

(Why Rosetta? Think Rosetta stone, translating between technical data and news doctors can use.)

The deal also creates an alliance with Merck, the drug giant, that should help Amalga compete for hospital lab software contracts against outfits like Cerner, which last year one the Veteran Administration’s lab software contract.

It’s a win-win-win. Microsoft gets a jump-start into a profitable niche within hospital software. Merck gets out of a business outside its strategic plan. Rosetta customers should get better software and service down the road, from a company serious about the space and scaled to gain share.

Expect more deals like this aimed at muscling McKesson, Cerner and the other specialist outfits in the market for hospital and medical office software.

April 23rd, 2009

Why it is always 1986 in health IT

Posted by Dana Blankenhorn @ 9:15 am

Categories: General, IT Management, Medical IT, Medical Office IT, Medical Records, Physician Information, Windows

Tags: Information Technology, Health Care, Training, Netsmart, Vertical Industries, Benefits, Healthcare, Strategy, Enterprise Software, Software

Newcomers to the health IT business, whether individual reporters or giant companies like Microsoft, often find themselves in a time warp.

It’s always 1986 in the health IT business.

By that I mean there is an enormous and growing ecosystem of consultants, suppliers, software, service and peripherals outfits the likes of which has not existed in the mainstream PC business for over 20 years.

Submitted for your approval, a press release from Netsmart Technologies, a supplier of medical software. announcing a relationship with Lori Hack of Object Health, a consulting company.

Netsmart is a Microsoft OEM, but you won’t learn that easily on its Web site. That’s because the operating system is such a small part of the sale. Each module Netsmart sells lives in its own regulatory environment, with its own target customer and its own training requirements.

When the company brags of its “high quality software, comprehensive services, deep domain expertise, and strong customer support” this is not just boilerplate. It’s hard-won knowledge that cost money to get, and will cost you money to access.

It was not hyperbole when I commented earlier about the health IT opportunity being worth “trillions” of dollars. It has an enormous number of moving parts, each requiring its own, complex, detailed sales and training cycle in order to work.

Simplifying payment structures and standardizing treatment protocols will transform health care, but many of the things we have to do will remain fiendishly complex and, thus, marvelously profitable, for many years to come.

The 21st century will not be easy to reach in health IT.

April 23rd, 2009

Behind the Microsoft skepticism on Health IT

Posted by Dana Blankenhorn @ 8:53 am

Categories: Finance, General, Government, Hospital IT, IT Management, Insurance IT, Medical IT, Medical Office IT, Medical Records, Payment Processing, U.S., Windows

Tags: Electronic Health Record, Health Care, Microsoft Corp., E-health, Healthcare, Vertical Industries, Benefits, Enterprise Software, Software, Human Resources

Peter Neupert, corporate vice president for the health systems group at Microsoft, is out with an editorial questioning the wisdom of putting Heatlh IT in the stimulus.

It’s a good piece. It warns that we need to focus on the goals and not the technology. Electronic medical records (EMRs) won’t solve the problem of chronic disease or our problems with the way we pay for care, he writes.

Absolutely.

But why is it, with everyone who went to HIMSS now praising the money and lining up for their share of the spoils, is Microsoft being the skunk at the picnic?

The reason is Microsoft is not yet the leader in this market. IBM is better-positioned in many ways. If there’s a rush by hospitals and medical clinics to quickly install EMR software, Microsoft is not going to get its customary lion’s share.

Better then, to lay down a marker saying “it’ll never work” because, in the short run, it won’t. EMRs by themselves don’t solve medical problems. They are just a small piece of a much larger solution:

• They have to be fully integrated with Personal Health Records (PHRs) in order to be of use to patients. That doesn’t just mean PHR systems like HealthVault, but applications built on those systems.
• They have to share data structures if research is to be done with them. The real health IT battle is going to be fought in the clouds, not on the ground.
• They don’t change the rules of the health care game by themselves. They point to the direction of reform, but the big contracts come once the direction of reform is set.

Yet at the same time EMRs are a wrenching change for a hospital or medical practice. In the short run an EMR system actually reduces productivity, until everyone in the office learns the new system and adapts to it.

Think of the EMR opportunity as round one in a long fight over health IT, something worth not $19 billion but trillions of dollars. Neupert is positioning Microsoft for the larger game.

April 21st, 2009

Microsoft launches its Mayo-branded Healthvault

Posted by Dana Blankenhorn @ 7:05 am

Categories: Consumer Information, General, Hospital IT, IT Management, Internet, Medical IT, Medical Records, Wellness, Windows

Tags: Mayo Clinic, Health Care, Microsoft Corp., Vertical Industries, Healthcare, Benefits, E-health, Enterprise Software, Software, Human Resources

Microsoft announced it has finished integrating its Healthvault PHR with the Mayo Clinic’s EHR system, which it will market to Mayo patients under the name Mayo Clinic Health Manager.

NOTE: A Microsoft spokesman writes to note the Health Manager is not tied directly to the Mayo Clinic’s files, just the file formats. Patients must ask the hospital to transfer data on their behalf and remain in charge of both the process and their data.

This fulfills market promises first made in January, 2008.

At the time I compared it to the Martha Stewart agreement with KMart. That deal worked because Martha was a bigger brand than KMart. In health Mayo is a bigger brand than Microsoft.

The press release emphasized this is a Version 1.0 offering:

In its initial offering, Mayo Clinic Health Manager will include tools and features that help manage: pediatric wellness, immunizations, adult wellness, pregnancy and asthma. Additional features will be incorporated in the upcoming months that will help users manage Type 2 diabetes, high cholesterol and high blood pressure. In addition, Mayo Clinic and Microsoft will work to add new functionality and health guidance.

Short version, watch this space.

Full integration of Personal Health Records, which are controlled by patients, with Electronic Health Records controlled by hospitals, insurers or doctors puts your medical data in front of the HIPAA firewall and exposes it to all sorts of interesting Internet services.

But as Google Health learned recently, this can have unintended consequences if the data transfer program is not properly managed.

Score one for Microsoft.

April 21st, 2009

What Obama promised open source health IT

Posted by Dana Blankenhorn @ 6:45 am

Categories: Finance, General, Government, IT Management, Medical IT, Medical Records, Networking, Open Source, SaaS, U.S., Windows

Tags: Information Technology, Microsoft Windows Vista, Health Care, Open Source, Dana Blankenhorn

So far as I can tell, the President has promised open source a shot at health IT stimulus and government contracts.

He has not guaranteed anything.

George Lauer of iHealthBeat wrote last week that the President “chose” VistA and open source Connect for its military records program.

That is not the case.

Sun’s work on the NHIN-CONNECT system was contracted for under the Bush Administration. The President promised to “link” the VA’s current VistA system with the military’s AHLTA system, and he promised our heroes interoperability, but that is all.

The same is true in the larger health IT stimulus plan, HITECH. CCHIT still controls functional requirements needed for certification, which in turn is needed to get paid. But as Fred Trotter notes, whether CCHIT will actually certify open source solutions remains unclear.

Important questions remain unanswered:

1. Will VistA be upgraded or replaced with a proprietary system?
2. Will AHLTA be moved to the VistA platform or just connect with it?
3. What hoops will open source have to jump through in order to participate in HITECH?

So far, under the Obama Administration, open source has been riding momentum generated during the second Bush Administration.

Its acceptance by the military is based on performance under past contracts. VistA’s survival seems to have depended more on Dr. Robert Kolodner, a Bush appointee, than anyone on the Obama team.

What open source seems to be getting from the Obama Administration is a shot, a chance, a foot in the door. But there is a big distance between being allowed to present and being given a contract.

Proprietary vendors, especially in the health care space, are experts at creating Fear, Uncertainty and Doubt (FUD) concerning open source. They will offer government “proven solutions” while open source advocates will offer tools the government might build on.

If this now becomes a standard contracting process, in other words, open source can still be shut out. The other guys have more salesmen. They can schmooze whoever needs schmoozing, and grease whatever palms need greasing to get what they want.

What we need are policy statements favoring a “build” process over a “buy” process, and demanding open standards, preferably royalty-free standards, for government contracts.

We don’t have them yet, so the jury is still out on the Obama Administration and open source in health IT.

March 17th, 2009

Is Microsoft Amalga in trouble?

Posted by Dana Blankenhorn @ 10:29 am

Categories: General, Hospital IT, IT Management, Internet, Medical IT, Medical Records, Physician Information, Windows

Tags: Health Care, Microsoft Corp., Vertical Industries, Healthcare, Benefits, Enterprise Software, Software, Human Resources, Dana Blankenhorn

The folks at Microsoft send word that Virtua Health, a four-hospital chain in New Jersey, has chosen their Amalga system as its health data platform.

Goody. What else have you got?

According to the Microsoft Amalga Web site, not much.

Since its unveiling at HIMSS 2008 in Chicago, I count six releases from Microsoft concerning the introduction of Amalga at various hospitals.

These include deals in Washington, D.C., in Mountain View, Calif., two deals near its Seattle home base, and a hospital in Malaysia, in addition to the new deal.

That would appear to be great, but it’s actually behind the pace of the previous year, when under the name Azyxxi (a name designed to fly under the radar) it announced agreements with the St. Joseph’s Health System,  Johns Hopkins, and Novant. Fewer deals, but bigger.

Then consider all the excitement now surrounding health IT, the size of the Obama stimulus aimed at health IT. More should be happening.

Now it is very possible that Microsoft is about to spring a bunch of really, really big deals on us. It could be I’m going to be named People’s Sexiest Man Alive for 2009.

Possible, not likely.

Meanwhile, IBM swooped in and grabbed Kaiser Permanente, Cerner grabbed the VA’s laboratory work, and on and on and on.

Health is going to be a business where you either get big fast or you get out over the next few years. A shake out is coming.

Is Microsoft going to get shook?

March 13th, 2009

Wal-Mart selling Windows health records

Posted by Dana Blankenhorn @ 9:13 am

Categories: General, IT Management, Medical IT, Medical Office IT, Medical Records, Physician Information, SaaS, Windows

Tags: Software-as-a-service, Wal-Mart Stores Inc., Health Care, eClinicalWorks Web Site, Software As A Service (SaaS), Managed Hosting, Cloud Computing, Microsoft Windows, Emerging Technologies, Operating Systems

Wal-Mart is getting into the Electronic Medical Record (EMR) market, hoping to push small practices to buy a bundle it has put together with Dell and eClinicalWorks of Westborough, Mass.

It’s a Windows system, but it is also offered on a hosted basis.

An online demo available at the eClinicalWorks site emphasizes that this is a complete system, built for payments and pharmacy integration, with modules from the front office and back office, not just physicians.

The company has about 700 employees and recently signed big deals in New York, New Jersey, California and North Carolina.

The idea seems to be that eClinicalWorks will continue focusing on the big accounts that need integration services while Wal-Mart will focus on small practices that can pay for their gear partly with stimulus money.

The bundle will be sold exclusively through Wal-Mart’s Sam’s Club warehouse stores, with prices starting at $25,000 ($10,000 for each additional doctor) and maintenance payments of about $5,000/year.

Wal-Mart made the move into distribution after trying out the software at its own in-store clinics and apparently being satisfied.

Our own James Urquhart says the company has missed a great opportunity to push a SaaS model. It’s true much of the software’s value is delivered via SaaS but the Sam’s Club bundle includes hardware many small practices lack and need.

The eClinicalWorks Web site touts its own SaaS offering, with prices starting at just $400/month for a full practice system.

In addition to pushing Windows hardware, eClinicalWorks emphasizes that it supports J2EE technologies and XML for data transfers.