Editor’s Note: The following is a guest post by Jeremy Bikman. You can read more about the GE and Microsoft Venture on EMR and EHR.

Guest Post: Jeremy Bikman is Chairman at KATALUS Advisors, a strategic consulting firm focused on the healthcare vertical. We help vendors grow, guide hospitals into the future, and advise private equity groups on their investments. Our clients are found in North America, Europe, and Asia. www.KATALUSadvisors.com

Healthcare is being held hostage and it doesn’t even know it.

It is held hostage by burdensome regulations, by archaic practices, and (oddly enough) by technology itself. In this age of Facebook, Twitter, and LinkedIn, an age where anybody with internet access can connect to somebody else on the other side of the globe and share personal information and other data with the click of a mouse, it is impossible that you could visit a hospital in the next town over and they would be able to procure your personal health information as easily or as quickly.

Healthcare, globally and locally, is utterly huge and mind-blowingly complex, and thus absolutely needs the very best innovation of everybody involved. Yet, healthcare technology companies almost universally deliver products which are built on closed-minded concepts. They lock down their platforms, creating real barriers to interoperability, patient data exchange, and actual innovation. This is the present reality within, and across, practically every hospital on earth. The recently announced joint venture between GE and Microsoft offers hope of an alternate reality, one where hospitals can bring together data streams from all over the enterprise, while utilizing new innovations and technology as they see fit, including different best-of-breed sources.

Giving Hospitals a New Choice
There are huge flaws in how technology is delivered in healthcare today, flaws which impact quality of care within a hospital and across the entire industry irrespective of country or region. While the rest of the tech world is moving towards open platforms and collaborative delivery models, healthcare seems to be stuck in the dark ages of single-source solutions which compel all-or-nothing investments to the tune of millions and millions of dollars. Too often those investments fail. But, the more important question is why must hospitals be forced into all-or-nothing decisions in the first place? Why must they choose between integration and functionality, between a single platform, however mediocre, and a best-of-breed mix? We believe those are questions of the antiquated past and that brave new innovation can deliver a new avenue for hospitals who refuse to be painted into a corner. Hospitals shouldn’t have to choose between apples and oranges. They want, and should be able to get, both.

The Basics of the Joint Venture
Selected product lines from both companies’ health groups will be part of the new company. These products were chosen for their specific focus on “empowering connected patient-centric care.”

GE is contributing an interoperable clinical data model and decision support system via Qualibria. GE’s eHealth is an HIE solution in use at a large number of sites in North America. Microsoft is bringing Amalga to the table, which is a data aggregation platform which facilitates interoperability and a host of other advanced capabilities. Vergence and expreSSO come through Microsoft’s acquisition of Sentillion and provide strong context management and single sign-on solutions. The strategy appears to be one of leveraging Microsoft’s platform technology (Amalga) to underpin GE’s clinical depth (Qualibria, eHealth). Additionally, this model will allow hospitals and vendors to integrate best-of-breed 3rd party products into the ecosystem as they see fit. This mix of products and capabilities will enable a true best-of-breed environment emerge while still having the core elements of integration as well. This ecosystem will be powered by the partnership’s own applications and those built by ISVs. No other major vendor offers this unique model and set of abilities, although Allscripts is the one traditional EMR vendor that is building a strategy of accepting of 3rd party solutions.

Tackling the Big Problems

No one is saying that this joint venture is guaranteed to be a resounding success. However, we applaud the visionary model and risks this new team is taking. It looks like they want to address all the big hairy obstacles that every provider organization, region, and nation is facing. Big data? Absolutely. Enterprise analytics and business intelligence? Yes. Clinical decision support? For sure. Population management? You bet. Nobody else in the industry has shown they can tackle these issues even though every hospital is clamoring for this type of model. So why not this joint venture between GE and Microsoft? We say good luck, and more power to them.

The principals of KATALUS Advisors have worked with hundreds of healthcare organizations, vendors, and other consulting firms across the globe. The opinions expressed here are our own and are not intended to promote any specific vendor and do not reflect those of any other organization or individual.

Today I opened up a web browser and eventually made it to Twitter to see what was going on. I was greeted by the not so friendly Twitter site redesign. If you’re on the Twitter page at all, you won’t miss it. To be honest, it felt like going to a foreign land. I use a number of tools for Twitter, but my favorite is just going to the Twitter website to consume and send my @techguy tweets. Although, maybe I should say it WAS my favorite place.

Yes, change is always hard, but isn’t that kind of the point? Was there any announcement about the change before it happened? Nope! Did they give users a chance to try the new interface before they made a wholesale swap to the new interface? Nope. Google’s actually done this really well recently with things like Gmail. They’ve made the new interface available, but you can always click back to the old interface if you don’t like. That way they can solicit feedback and improve the new interface while still not alienating those that love the old interface.

In my example on Twitter, I quickly was able to identify the thing that annoys me most. When I click on someone’s Twitter name it gives me a pop up box for that person. Before it use to have that appear on the side. It’s a small subtle change, but makes a huge difference since on the side I can continue consuming tweets, but in a pop up box I have to remove it before I continue on.

I could go on about the new Twitter, but the point is that software vendors have to be careful when they change the user interface. Maybe this new Twitter interface will even grow on me. I didn’t like the last time they changed the Twitter interface either, but once I found some of the secret features I came around for the most part. Maybe I’ll come around on this too, but it would have been nice if I knew it was coming.

What does this have to do with EMR?

The connection seems quite clear to me. EMR and EHR companies have to be really careful and considerate when they change their EHR interface. Give users options to be able to try it and to adapt to it over time. With a sort of limited opt in release of a new EMR interface to an active user base, you’ll likely get a lot of pointed feedback for the new EMR interface. Certainly you’ll get the useless “I hate the new look” emails without any value. However, you’ll also get the pointed emails that provide constructive ideas on things you probably didn’t realize were important in the old EMR interface.

Most SaaS EHR companies are constantly considering this since they’re rolling out changes to their software all the time. Client server based EHR software also takes it into account, but this can be shown and taught as each client is upgraded.

The main point is to be thoughtful of and upgrade to your EHR user interface. Get feedback and whenever possible let them opt in and out of the new interface so you don’t alienate your users.

While I may not be totally enamored by the new Twitter interface, I do always love new features in software. For example, as part of the new Twitter interface there’s a feature that lets you embed tweets. Here’s a few EMR related tweets to see how it works.

Need marketplace to reward good design & doc reimbursement for social@jacthong @AtlasMD How to close gap between EMR & consumer tech? #hcsm

— borborygmi (@nickgenes) December5, 2011

And then some big news from GE and Microsoft that just came out:

G.E.-Microsoft Venture to Create ‘Windows’ for Health Care. #ehr #emrnyti.ms/u8ttTu

— Andrew Herman Heller (@andrewhheller) December8, 2011

Hmmm…still looks like they have some work to complete on their embedded tweets (UPDATE: The preview looked different from when it’s posted. It’s not too bad in the actual post). Sounds like many doctors talking about EHR features that get rolled out.

Let’s face it, I haven’t actually been nice to Google of late when it comes to healthcare (or maybe I have, just once). While I believe the criticisms are justified, I can see why some people might think I’m beating a dead horse, namely Google Health. But there are some unresolved questions in the area of privacy that Google really should answer.

Google’s ill-fated attempt at a PHR isn’t completely dead. The company won’t “retire” the online service until January, and will allow users to download their data through Jan. 1, 2013. Naturally, others have stepped up to try to fill the (tiny) void left by Google Health’s demise. To nobody’s surprise, Microsoft is helping the remarkably small number of Google Health users transition their accounts to HealthVault, Microsoft’s own overly hyped, underutilized PHR platform.

What concerns me is what will happen to data already on Google’s servers. Will records be archived? Will sensitive patient health data stay on Google’s servers in perpetuity? Nobody has said for sure.

Are records safe from Google’s data-mining juggernaut? Google has consistently said that it would not use health records for anything other than to steer traffic to its core search engine, but let’s face it, Google’s primary source of revenue is from algorithm-driven advertising.

But, you say, HIPAA protects patients from unauthorized uses of their data, right? Well, remember back to 2009, when the American Recovery and Reinvestment Act expressly made third-party data repositories, health information networks and, yes, personal health records, into HIPAA business associates, effectively holding them to the same rules as covered entities under HIPAA.

Wouldn’t you know, both Google and Microsoft came out and said they were not subject to this provision. No less an insider than former national health IT coordinator Dr. David Brailer, who was a part of the legislative negotiations, told me then that lawmakers had Google Health and HealthVault specifically in mind when they crafted the ARRA language. As far as I know, there haven’t been any reported data breaches involving either PHR platform, so there’s been no need to test whether ARRA actually does apply to them, but if I had my data on Google’s or Microsoft’s servers, I’d be concerned. I’d particularly want to know what Google plans on doing with the data it’s been holding once Google Health does shut down.

Perhaps it’s time for me to make some phone calls.

A blog post today by Microsoft’s Dr. Bill Crounse got me thinking again about the cloud.

Crounse cited a new CDW poll showing that 30 percent of healthcare organizations could be considered “cloud adopters,” and for good reason. “The flexibility, scalability and lower costs associated with moving certain line of business applications to the cloud are compelling, especially for an industry like healthcare. After all, the primary focus of hospitals and clinics is caring for patients, not running an IT empire. There’s not a CIO, CFO, CEO, COO, CNO, CMIO, or CMO who wouldn’t love to shift some of their IT spending to delivering better care to the communities they serve,” Crounse wrote.

They were more likely to turn to the cloud for “commodity” services such as e-mail, file storage, videoconferencing and online learning. “Moving your ‘commodity’ applications to the cloud is an excellent place to start,” Crounse said. “I’d suggest first reaching out to your health industry peers and professional organizations to get a better sense of who’s doing what. I think when you’ve learned about some of the best health industry practices in cloud computing, you’ll be ready to explore what might be possible in your own organization.

But the fact that 30 percent of healthcare organizations use the cloud means that 70 percent do not. I suspect a lot of hospitals and physician practices still run aging, legacy client-server management systems in-house, just because that’s how people did things when those systems were first installed. As they replace their legacy technology, expect more healthcare organizations to opt for cloud services for these commodity-type services.

And what about clinical services?

At HIMSS11 back in February, Athenahealth honcho Jonathan Bush, a longtime fan of the cloud, told me he wanted to lead the “Cloud Cavalry” into Las Vegas (there’s no better place for an over-the-top spectacle, of course) next winter for HIMSS12. (See the second video for that.) Athenahealth, which has a certified, cloud-based EHR, straddles the line between clinical and administrative, and it’s not alone. I can’t think of a single ambulatory EHR vendor that doesn’t offer at least a cloud option if not a full-fledged SaaS product.

But is the cloud truly reliable for critical applications such as inpatient EHRs? In the wake of April’s Amazon EC2 cloud outage, I can imagine more than a few CIOs, practice managers and, especially, physicians are a bit skittish now.

What do you think?

I live in Chicago, a highly competitive healthcare market with some world-class medical schools (Northwestern, University of Chicago, Loyola, Rush) and a pretty decent record of EMR adoption. At least four major institutions/health systems run similar Epic EMRs: University of Chicago Medical Center, Northwestern Memorial Hospital, Rush University Medical Center and, in the northern suburbs, NorthShore University HealthSystem (formerly Evanston-Northwestern Healthcare).

Three NorthShore hospitals–Evanston Hospital, Glenbrook Hospital and Highland Park Hospital–were among the first in the country to reach Stage 7 on the HIMSS Analytics EMR Adoption Model.(NorthShore’s Skokie Hospital since has reached Stage 7). Several others, notably Rush, Advocate Lutheran General Hospital in northwest suburban Park Ridge, Mercy Hospital & Medical Center and  Swedish Covenant Hospital, have gotten to Stage 6.

But there’s been very little effort to interconnect these institutions and affiliated physician practices. Even during the RHIO heyday of 2004-07, I don’t recall much interoperability talk in the Chicago area. (In fact, one family physician, Dr. Stasia Kahn, in far west suburban St. Charles, got so frustrated that she formed her own group to promote EMR adoption and health information exchange, Northern Illinois Physicians for Connectivity. I had heard talk for a while of some south suburban hospitals joining in an HIE with counterparts across the state line in Northwest Indiana since Illinois was moving too slowly.)

All of that non-action at the state and regional levels happened under the not-so-watchful eye of one Gov. Rod Blagojevich, who apparently was more preoccupied with his own vanity and “giving healthcare to kids” (while also allegedly trying to blackmail the CEO of Children’s Memorial Hospital into donating to his campaign fund and also slowing Medicaid payments to pay for his All Kids program) than in, you know, actually improving healthcare for everyone by promoting HIE.

In February 2009, shortly after Blagojevich was removed from office and a couple weeks before the federal American Recovery and Reinvestment Act became law, new Gov. Pat Quinn signed a law allocating $3 million to the state’s Department of Healthcare and Family Services for HIE planning. That laid the groundwork for this week’s widely publicized announcement that the not-for-profit Metropolitan Chicago Healthcare Council had chosen technology from Microsoft, Computer Sciences Corp. and HealthUnity to build what could be the largest big-city HIE in the country, potentially serving 9.4 million people in nine Illinois counties and small parts of Indiana and Wisconsin.

I bring all of this up because I met yesterday with executives from the Metropolitan Chicago Healthcare Council, a 76-year-old coalition of healthcare organizations in and around the city. It just so happened that the 2011 Microsoft Connected Health Conference was in town this week, so it was the perfect time and location for Microsoft to drop the news. According to MCHC Vice President Mary Ann Kelly, more than 70 percent of the council’s 150-some members have made a commitment to participate, and they seem to have a plan to make the HIE effort sustainable.

The exchange will operate on a subscription model, with the vendors taking on some of the risk, Kelly said. “The subscription fee will be based on the benefit each member derives,” Kelly explained.

Initially, the exchange will involve 22 hospitals in nine organizations, said Teresa Jacobsen, the council’s HIE director. “We want to get one or two use cases running first,” she said. They will start by linking emergency departments to exchange clinical summaries and for syndromic surveillance, according to Jacobsen. Once that’s going, the HIE plans on adding medication and allergy lists, diagnostic testing results and Continuity of Care Document reports, as well as additional elements for public health, including immunization records.

It all sounds great, and it’s a good idea for them to start slowly, but I wonder when and if smaller physician practices will get involved. My own physician has had an EMR for a while, but not every doctor in the practice uses it. (The four-physician practice recently upgraded to the Meaningful Use Edition of Sage Intergy and has started the 90-day clock for qualifying for Stage 1 Medicare incentives this year, but there’s essentially zero interoperability with other healthcare entities, unless you consider faxing records to others straight from a computer interoperability. I sure don’t.)

My guess is that scenarios like this are playing out all over the country. I wish them luck, but I’m not counting on nationwide interoperability for many years. For one thing, the federally funded, state-chartered Illinois HIE Authority held its very first organizational meeting Wednesday afternoon. “That’s the biggest wild card we don’t know,” MCHC CFO Dan Yunker said.

It’s key to getting payers—particularly Illinois Medicaid—on board with HIE and linking metropolitan exchange networks across the state and beyond. “Our hospitals in Chicago are responsible for the snowbirds who are in Naples (Florida),” Yunker noted. They’re also responsible for patients who come from places like Rockford, Springfield, Champaign, Carbondale and the Quad Cities for certain specialized services only available in the big city.

Yeah, this interoperability thing isn’t so easy.

I previously posted about the EHR stimulus tour (no link since I don’t want to promote them). Today I saw what seems to amount to a press release that talks about the “EHR Stimulus Alliance” and their tour to “educate 500,000 U.S. physicians about opportunities aligned with the American Recovery and Reinvestment Act (ARRA) of 2009.”

This type of puffery just makes me sick. No. Not the educating 500,000 physicians. That’s a good thing and part of the motivation for this blog. The thing that makes me sick is this seems like just a big marketing campaign for Allscripts. Sure they have a list of other partners, but they’re basically partners of Allscripts. Check out the list: Allscripts, Cisco, Citrix, Dell, Intel, Intuit, Microsoft Corp., and Nuance. The press release calls it a “broad coalition of healthcare and technology companies.” Too bad Allscripts is the only true healthcare company in that list. All the others are technology companies that sell some healthcare products.

I just don’t like when an “education tool” is really just being used as a marketing tool for a certain EHR company. If they really wanted to help adoption, they’d sponsor a tour with a whole variety of EHR vendors where they can help doctors to be able to see the wide variety of EHR vendors that exist.

Someone recently emailed me about any conferences that exist for a doctor to be able to evaluate EHR companies all in one place. I know there have been a number of other ones in the past that no longer exist. The only one I know is still going is HIMSS. Does anyone else know of other places where doctors can see a bunch of great EHR? I ask this knowing that many really great EHR just haven’t seen the benefit of these types of shows.

Also, if anyone has a chance to go to one of these EHR Stimulus tour stops, I’d love to have you do a guest post on the experience. I sent them a tweet asking if they can stop in Las Vegas so I can check it out.

Turns out the fish are starting to feed. Check out this website that talks about the “EHR Stimulus Tour: Educating the Nation.” Ok, I don’t really want you to check out the website, since I think it’s kind of sad. At the bottom it lists the “EHR Stimulus Alliance.” The following companies are listed in this EHR alliance:
Allscripts
Cisco
Citrix
Dell
intel
intuit
Microsoft
Nuance

What a group of large companies trying to sell a bunch of product. I guess we should have expected something like this, but maybe I’m just a little surprised that they made a website for an EHR stimulus tour and everything. Interestingly the twitter link on the site goes to an Allscripts twitter account. I think we can clearly see who’s behind this website.

Honestly, this reminds me of an Amway or other MLM convention. Is it any wonder the type of information that will be given at this type of tour? I guess $18 billion is a lot of motivation to market your EHR software. I just wish they were stopping in Las Vegas so that I could go and check them out.