November 6th, 2009

Canadians get a taste of American medical system with IMS Health buy

Posted by Dana Blankenhorn @ 7:28 am

Categories: Finance, General, Government, Medical Office IT, Payment Processing, Research, SaaS

Tags: IMS Health Inc., IBM IMS, CPP, CPP Investment, Sales Strategy, Sales Force Management, Personal Finance, Benefits, Payroll Solutions, Sales

You have likely never heard of IMS Health, but they’re a big deal in the current IT environment of American medicine.

IMS buys prescription records in bulk from big pharmacies, strips out the patient names but identifies the doctors, then tells drug companies of the doctors’ prescribing habits. This lets the drug companies target their sales efforts.

The picture at the right, taken from IMS’ current home page, illustrates the firm’s view of it. The little blue ball represents sales, and the nice lady has IMS knowledge to shoot it accurately.

Critics have their own view. New Hampshire sought successfully to stop IMS data collection in court, and the American Medical Association (AMA) runs a program through which doctors can opt-out.

Regardless of your view, it’s a data processing company that makes money. IMS earned $311 million on sales of $2.3 billion last year. This made it attractive, and a leveraged buy-out of the company was announced yesterday.

Which is where the Canadians come into the story. The main player here is TPG Capital, run by the renowned financier David Bonderman, but his partner in this deal is the CPP Investment Board.

CPP is the investment arm of the Canada Pension Plan, which you might compare with a privately-run Social Security system. CPP Investment seeks a return on the pension contributions of Canadians. The CPP collects the fees and pays the pensions.

Out of the CPP’s $116.6 billion in assets, private investments like this represent “just” $18.4 billion. But that’s enough money, and the law offers CPP Investment enough leeway, for it to get into some very interesting deals.

Like this one.

All of which means that Canadian pensions may be riding on the success of an American company performing computing feats that would be incomprehensible in their own country, which is a single-payer system run through the nation’s provinces.

August 28th, 2009

SaaS puts small medical foundations on fast forward

Posted by Dana Blankenhorn @ 12:47 pm

Categories: General, IT Management, Internet, Research, SaaS

Tags: Software-as-a-service, IntraLinks Inc., Software As A Service (SaaS), Managed Hosting, Cloud Computing, Emerging Technologies, Dana Blankenhorn

Running a medical foundation that funds cures can be very expensive.

You need the security and audit trails over information of a big outfit, but you may in fact be a very small one.

The cure for Fast Forward, which funds research for the National Multiple Sclerosis Society, has been software as a service, or SaaS.

It contracted with Intralinks for a SaaS service that lets it move all its work online, at modest cost, while maintaining full security.

Fast Forward President Tim Coetzee explained.

“We’re going to ask companies to give us a lot of sensitive information. We’re looking for a strategy where we can provide assurance that data will be handled securely. We needed something that was also easily used and accessed by the people evaluating. We use volunteers who are expert at science or business, and we need them to access data remotely.

“Instead of requesting papers we scan it’s straightforward. We give people a diligence package and questions, give them access to the data flow and they put it. It streamlines the workflow. It saves time and money. It streamlines our review process. It enables our volunteer evaluators to do their work anywhere.”

In addition to its own $3 million in “venture philanthropy” funding, Coetzee also has influence on $19 million from Merck Serono which is also focused on MS therapies. “It’s high risk high reward,” just like regular venture funding, Coetzee says. Only with a different bottom line.

Allison SherrillAlison Shurell, a vice president for product manager with IntraLinks, explained how it works from their end.

“When you invite participants you can vary the permission level. You can vary what they do within the exchange, which is what we call the workspace.

“Perhaps they can post documents, or add other users, or perhaps you just want them to review information. You can change this on the fly. You designate a manager and they’re given ultimate control of what happens on the exchange.”

SaaS lets more small charities like Fast Forward get into the game of searching for cures, by eliminating the costs of moving paperwork back-and-forth while dealing with sensitive information. If one of Coetzee’s investments does pay off, this kind of technology deserves a bit of the credit.

August 5th, 2009

Practice Fusion aligns with Salesforce.com

Posted by Dana Blankenhorn @ 1:14 pm

Categories: Consumer Information, General, Internet, Medical Office IT, Medical Records, SaaS

Tags: Salesforce.com Inc., Practice Fusion, Sales Force Management, Sales, Dana Blankenhorn

I was writing earlier today about the need for health IT to become mainstream. This afternoon I got an example of how that is happening.

Practice Fusion said Salesforce.com has taken a minority stake in the company, added an executive to its board, and will roll out its online patient health record on the system as early as this fall.

The rest of the company’s offerings will follow.

Practice Fusion CEO Ryan Howard told ZDNet that sales calls were previously hampered by questions about his firm’s financial viability and the safety of customer data. “This solves both problems.”

Howard said “80% of doctors are in practices with fewer than 10 physicians,” and that most Salesforce customers are also small to medium sized businesses, so the fit looks very good. “We’re very happy.”

Before this announcement most speculation about Practice Fusion’s future involved a rumored partnership with Google. But this was only an advertising relationship. Practice Fusion was trying to monetize page views on its free software.

On the company’s blog vice president for clinical affairs Glenn Laffel emphasized data security, writing “users gain access to $100 million worth of technology infrastructure for free.”

The deal may be as important for Salesforce as for Practice Fusion. The company is known for serving salesmen. Now it adds doctors. Who else might it add?

July 1st, 2009

WellAWARE of watching grandma

Posted by Dana Blankenhorn @ 11:43 am

Categories: Aging, Always On, General, Home Health Care, Home Health Care Equipment, Internet, SaaS, Wellness

Tags: Woman, Sensor, WellAWARE, VOA, Dana Blankenhorn

Working with two of the largest faith-based nursing charities, WellAWARE of Charlottesville, VA has begun delivering on the promise of passive monitoring just weeks after its official launch

That is partly because the company has been in the development and trial for nearly five years, said CEO Jeff Noce. But it’s also because its two key customer-partners can deliver significant market share quite quickly.

At this writing, 60 facilities have the WellAWARE system, company officials told ZDNet. (Note: This actually refers to 60 units in assisted-living facilities, home healthcare and memory care, the company says.)

WellAWARE is offering a system of sensors that track a patient’s movement throughout their residence, comparing their activities to a baseline of normality, and alert caregivers to changes.

Noce explained how this worked recently with an 81 year old client aging-in-place in a Good Samaritan facility in Hastings, NE:

There was an alert that the woman had not slept for 26 hours. The woman was evasive, but we were able to be proactive, and the nurse was able to visit, knowing she hadn’t slept.

The woman finally admitted she’d been hallucinating. The nurse asked about medication, the woman said she had some, and the nurse found that one of the side effects of one medicine was hallucination. She was able to fix the situation in a day.

The patient didn’t have to do anything. The care giver was then able to provide an interaction that got correction.

The Hastings case was detailed at a recent forum sponsored by Volunteers of America, one of the company’s key customers, featuring Newt Gingrich, Tom Daschle, and Donna Brazile. VOA serves over 500 government housing and hospice communitiessenior care facilities, where it believes it can cut costs substantially improve care through WellAWARE and improve care.

The other key customer is the Evangelical Lutheran Good Samaritan Society, known as Good Sam. Between them the two have a fair share of the faith-based care market. (The other two segments are profit and non-profit care groups.)

From a technical standpoint, the offering features a proprietary wireless sensor array, a SaaS Care Engine that collects and analyzes data from the sensors, and screens for care givers’ mobile devices that offer alerts.

Proprietary sensors were developed, Noce said, so that WellAWARE can run up to 6 months on a battery. Components running on the Zigbee standard are being evaluated, he said, especially as the company prepares to look into active systems that might feature blood pressure or glucose monitoring.

Noce said the company is also buoyed by the pending entry of GE and Intel into the market, believing it will legitimize what WellAWARE is doing.

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 18th, 2009

Medsphere transformation appears complete

Posted by Dana Blankenhorn @ 10:43 am

Categories: General, Hospital IT, IT Management, Medical IT, Medical Records, Open Source, Physician Information, SaaS

Tags: Hospital, Health Care, Healthcare IT, Open Source, Healthcare, Dana Blankenhorn

By getting right with open source Medsphere has gotten right again with the market. (Picture of CEO Michael Doyle by Stephen Ryan.)

When I first wrote about the company, back in 2006, it was suing its founders and taking the public domain VistA software into a proprietary direction.

The turnaround began in 2007. It brought in a new CEO (right), settled the lawsuit, and rededicated itself to the open source process and community.

Last year it partnered with Tolven to commercialize a complete hospital information suite and finished installation at a key customer, Midland Memorial Hospital in Texas, which bragged it got an $18 million system for just $7 million.

Now, with the Obama stimulus in place and new offices in the San Diego area, CEO Doyle called to say the company has opened its training “university” and that business is firing on all cylinders.

“We doubled our bookings last year and will double it again. We have made substantial progress and are just at the tip of the iceberg,” he said.

Much of the credit goes to following through on open source promises. “10% of our new product development last year came from outside Medsphere’s four walls,” he said.

The company has now trained consultants at MaxIT Healthcare, certifying them to deploy its OpenVista. “We are proud of that. It helps us scale and leverage our model,” Doyle said.

But the real news is that Doyle is reaching back to his own heritage, running the online billing company AHS. The result should mean a SaaS version of Medsphere coming available later this year.

“Every hospital under 100 beds is a candidate for a SaaS offering.,” he said. “Hospitals that size don’t have IT guys.” And many still aren’t automated.

So what is responsible for the turnaround? Medsphere changed and began riding the wave of reform.

“Healthcare IT should be collaborative, not siloed,” Doyle concluded. “In medical research people collaborate to improve welfare and share it openly. Healthcare IT is 180 degrees away from that. We think open source by its nature, being collaborative, is the right approach.”

By making those words real, Mike Doyle has both done good and done well. Hospitals that need to fulfill their obligations under the Health IT stimulus now have multiple, valid open source options.

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.

February 17th, 2009

The gigantic opportunity of mHealth

Posted by Dana Blankenhorn @ 7:57 am

Categories: Consumer Information, General, Home Health Care, Home Health Care Equipment, IT Management, Networking, Open Source, Research, SaaS

Tags: Mobile, Advertising & Promotion, Entrepreneurship, Marketing, Management, Dana Blankenhorn

In the developed world broadband is king. If faced with a simple dial-up line you can hear the complaints for days. (Picture from Flickr and the UN Foundation.)

But in most of the world mobile is the only way to go. Cellular links reach deep into the bush of even the poorest nations, connecting people and markets. It is as revolutionary as the telegraph because the service comes to you.

I have an abiding interest in mobile health, especially in Africa. The idea that you can take a diagnostic image with a mobile phone, and get a report back, I find amazing.

So the launch of the Mobile Health Alliance by the Rockefeller Foundation, Ted Turner’s UN Foundation and Vodafone is a milestone.

The aim is to create scalable, sustainable and standardized projects, meaning lower costs, more uniformity, and faster take-up.

The work will not be easy. Some countries see mobile links replacing the taxes which once made phone calls so expensive. Others see it as a concession to sell, a source of graft. As a result regulations and distribution channels vary widely, Vital Wave Consulting notes.

The work is being launched with a study of what is happening, which hopefully can quickly turn into an action plan. Information on the work is being hosted at the UN Foundation’s Web site.

My hope is these groups can create compelling business models that result in mHealth entrepreneurship. That’s how mobile telephony first succeeded, small entrepreneurs taking phones into the bush and charging a fee for each call.

Adding value to what this entrepreneurial infrastructure already provides would be ideal.

February 11th, 2009

Nursing at center of medical home concept

Posted by Dana Blankenhorn @ 9:14 am

Categories: Aging, Consumer Information, Finance, General, Home Health Care, IT Management, Insurance IT, Internet, Medical Records, Networking, Payment Processing, Physician Information, SaaS

Tags: Payment, Patient, Insurance Company, Care, Portico Systems, Insurance, Government, Business Operations, Corporate Insurance, Dana Blankenhorn

Even for the chronically ill, nurses empowered with technology are at the heart of the hot new medical concept, the medical home.

That’s the conclusion I draw after sleeping on the notes of an interview I held yesterday with Sam Muppalla, chief operating officer for Portico Systems, which is helping drive the concept.

A big part of the appeal is that nurses do more, while doctors control the process and those who pay the bills save money. The chronically ill also get better care, because they have what all clients want, accountability.

“We work with plans to scale the medical home program without placing an undue burden on providers, allowing providers and nurses to participate in collaborative care.”

In English, Portico is working to help the coaching concept make financial sense, using technology to tie insurance carriers, doctors, nurses and patients together.

“A nurse can be a head coach for care of the patient, but they need intelligence, they need tools for secure messaging, they need EMRs in place,” Muppalla explained. Portico seeks profits by providing this glue.

A lot of glue is needed. Portico needs sophisticated links with carrier payment systems so it can reduce paperwork and assure payment. It needs EHRs to be shared by doctors and nurses, with secured messaging, so docs retain control while nurses do the heavy lifting.

And it needs to deal with evidence-based best practices, both to guide nurses and make it all affordable.

This is an awful lot of technology. Portico, which began 10 years ago as a provider management outfit, helping carriers gain greater control over hospital expenses, is not dictating anyone’s technology choices, except its own.

“We have an end to end platform, but we can also interoperate with whatever they have. There’s a Web based alternative, or we can interoperate with another vendor.” The flexibility helps give Portico value to all sides in the transaction.

For those who see EMRs as a bogeyman, or fear outside control of doctor decisions, a talk with Portico is a wake-up call.

What is the difference between an insurer running an evidence-based system, in order to improve outcomes and control costs, and creating such a system every patient and professional can use?

Government.

Will fighting evidence-based healthcare, or comparative effectiveness, really result in doctors being able to do what they want and ignore the needs of those paying the bills?

No.

The industry does not want this trend slowed. This trend promises both better care and lower costs. That’s the goal of whoever pays the bills, whether that be government, an insurance carrier, or a patient’s family.

Evidence based healthcare is a trend whose time has come. Seeking to stop it, on whatever pretext, is a losing proposition.

February 6th, 2009

Is Google Health corrupt?

Posted by Dana Blankenhorn @ 8:53 am

Categories: Consumer Information, Ethics, General, Internet, Networking, SaaS, Wellness

Tags: Google Inc., Advertisement, Google Health, Business Model, Health Care, Plain Fact, Vertical Industries, Benefits, Healthcare, Enterprise Software

No.

There seems to be an intense campaign to make it appear that Google Health is the most dangerous site on the Internet.

I described one such approach yesterday, the idea that Google is some sort of Big Brother that wants to sell your heart rate to insurance companies and your employers, so they can fire you.

This line of attack tracks a key fact, one that bears repeating.

Under their current business models both insurers and employers have an incentive to get private data on you, so they can game the system to their advantage. It’s in the business model. The way to protect us from this is to change the business model.

Then there’s the line of attack that Google Health is a secret plan to capture our specific health data and use it to send us ads.

Google denies this, but what if it’s true? Would it be worse than HealthCentral? More evil than Healthline?

Plain fact is the business model of every major health information site, from WebMD to the present day, is reliant on advertising. Advertising from drug companies, from device makers, from hospitals, from physicians. Not juse mass media, but ads targeted specifically toward you based on your condition and health interests.

How can it be OK for Steve Case to try and sell me Lipitor when I click over to a page on cholesterol, yet it’s evil for Google to even consider doing the same?

So far Google Health has not made a move to monetize what it is doing, just as Google has made no attempt to put ads against its Google News service. Yet just as idiot newspapers think Google should pay for linking to their ad-filled pages, we have activists laying false charges aimed at pushing it out of the Personal Health Record (PHR) business.

Would it be too much to ask if, before anyone prints another such release, a reporter look into the possible motives of the complainant? Some will easily withstand the scrutiny. Others will prove to be competitors’ Astroturf.

In either case it’s a better story.