Lab Info Tech Mar09 Ss
-
Upload
john-moore -
Category
Health & Medicine
-
view
894 -
download
0
description
Transcript of Lab Info Tech Mar09 Ss
3/18/09 Copyright: Chilmark Research
For internal use only, not for distribution1
Lab Data, PHRs, Platforms,&
Consumer Engagement
By: John Moore, Managing Director
3/18/09 Copyright: Chilmark Research
For internal use only, not for distribution2
Three Take-Aways
What is State ofPHR Market Today
Advent of HealthClouds
Implications
Trajectory
Drivers
Challenges
What to Watch
3/18/09 Copyright: Chilmark Research
For internal use only, not for distribution3
Macro Trends Reshaping Healthcare
Growing Consumerism in HealthcareEmployee Accountability
Rise of CDHPs, ever increasing co-pays
Disintermediation of CareRetail Clinics, eVisits, MedTourism, Virtual Labs
Information LiberationTraditional: PubMed, Mayo, WebMD
Crowd-sourced: Wiki(s), Blogs, Twitter,Communities
Stimulus Bill & Healthcare ReformUnprecedented $$$ to Digitize Healthcare
Too much, Too Fast?
Comparative EffectivenessData Driven Care = Rationed care?
3/18/09 Copyright: Chilmark Research
For internal use only, not for distribution4
While Consumers Increasingly GoOnline for Health Info…
Source: Pew Research 2006
74% of all adults are online
3/18/09 Copyright: Chilmark Research
For internal use only, not for distribution5
Few Manage Their Health RecordsThat Way
Source: Forrester Research Q2’08 Survey
n= 5,242
Today, Meager 3.3% iManage PHI
3/18/09 Copyright: Chilmark Research
For internal use only, not for distribution6
iPHR Adoption is Widely Dispersed
Mix
Provider
Provider
Payer
Payer
ISV
Provider
Provider
Type
Client defined, claims-basedHRA & alerts Rarely portable
WebMD500KWebMD
Countless
RYO
MyChart
HealthAtoZ
ActiveHealth
RYO (VistA)
MyChart
PHRPlatform
Similar to KP
Portability w/Google
100KCleveland Clinic
Highly variable, most simpletemplates Little portability
2.5MAll Others
Aging portal w/email Portability w/Google & HealthVault
40KBIDMC
Claims-based, part of newOptumHealth Div.
Portability w/HealthVault
~200KUnited Health Grp
Focus on HRA, DM, aggressivebuild-out Portability w/HealthVault
~700KAetna
EMR portal, Not portable650KVeteran’s Admin
EMR portal w/email &transaction servicesPortability w/HealthVault
3.0MKaiser-Permanente
FeaturesNo. ofUsers
Entity
3/18/09 Copyright: Chilmark Research
For internal use only, not for distribution7
iPHR Market has Moved to B2B Model
High Barriers toEntry inProvider Market
Employer &Health PlanMarkets Similar
Consumer Playsare OftenLegacy
B2C is Road to Ruin
3/18/09 Copyright: Chilmark Research
For internal use only, not for distribution8
Three Dominate iPHR Models
Direct to Consumer => Manage RecordsConsumer has Full Control
Consumer self-populates, disconnect
Small ISVs with Little Market InfluenceCapMed, Medikeeper, PassportMD
Payer or Employer Sponsored => Lower MLRsConsumer has Limited Control
Trust issues, portability
Focus on HRAs, Health & WellnessIncentives common to drive adoption
Provider Sponsored => Customer Retention
Consumer has Limited ControlLittle portability, modest tools, thin slice
Present Labs, Meds, DischargeFacilitate transactional processes
3/18/09 Copyright: Chilmark Research
For internal use only, not for distribution9
Utility Service Model for PHRs:Creating an Ecosystem
Multiple tools/widgets, communications???Very GoodTools
Perceived value?HighAdoption
Farther down the roadHighPersonalization
Still under developmentMediumPortability
Adoption of Open Systems and standardsHighInteroperability
Strong consumer control of dataHighControl
Virtually any pertinent data sourceNAData Source(s)
NotesPotentialAttributes
Dat
a Sou
rces
Secure
Repository
Applic
atio
ns
Incl
ds
PH
Rs
3/18/09 Copyright: Chilmark Research
For internal use only, not for distribution10
Utility Service Model for PHRs:A Health Cloud Ecosystem
Dat
a Sou
rces
Secure
Repository
Applic
atio
ns
Multiple tools/widgets, communications???Very GoodTools
Perceived value?HighAdoption
Farther down the roadHighPersonalization
Still under developmentMediumPortability
Adoption of Open Systems and standardsHighInteroperability
Strong consumer control of dataHighControl
Virtually any pertinent data sourceNAData Source(s)
NotesPotentialAttributes
3/18/09 Copyright: Chilmark Research
For internal use only, not for distribution11
Dossia: An Employer Health Fog
Purpose: Ecosystem to Support Health
Model: $1.5M from Each Founding MemberFollow-on Subscription Fees
Technology: IndivoHealth from CHIPsStraight Platform, Open Soource
Little to Show After 2yrs+Extremely slow Roll-out
Only one ISV & member live today
Governance Challenges
Still Lacking APIs for ISVs
“Where’s the Value?”
3/18/09 Copyright: Chilmark Research
For internal use only, not for distribution12
Google Health: A Thin Cirrus Cloud
Purpose: Increase Google “Stickiness”
Model: Ubiquitous Google on Net
Technology: Proprietary w/ Developer SDK
Platform with Basic PHR Functionality
Supports modified CCR standard, CCR-R
Modest Efforts to Date
Very Small Team (est. 25> total)
Few, New Partners
Limited to Structured Data Only
No Journals, Notes, Advanced Directives…
Is CCR-R holding them back?
“How Serious are They?”
3/18/09 Copyright: Chilmark Research
For internal use only, not for distribution13
HealthVault: A Thunder Cloud
“Where’s the Consumer Education?”
Purpose: Dominate Healthcare Market
Model: Drive Consumer Traffic,Sell More MS Products
Technology: Microsoft Stack
15,000+ Downloads of SDK to date
Very Aggressive StrategyHuge Resource Investment
Targeting Data SourcesAmalga as aggregator
CCD standard support instrumental
Biometrics - Brilliant Move
Still CumbersomeUI is Challenging
3/18/09 Copyright: Chilmark Research
For internal use only, not for distribution14
Looking Into the Future…
HealthVault No Longer StandaloneProperty
Consumer: Embedded in MSNHealth
Maintains Strong Clinical Underpinnings
Google Focuses on Wellness“Healthy” Consumer-centric
Turns to Ad-rev Model for SupportAds outside private domain
Dossia FadesGovernance Challenges Hamper Advances
New Members Fail to Appear
New Entity ArrivesMany circling today
Biggest Challenge: Sourcing Data
3/18/09 Copyright: Chilmark Research
For internal use only, not for distribution15
HIEs & RHIOs as Data Sources?
Hundreds of Millions in Stimulus Funding
“Shovel-ready” Regional Health Information Organization(RHIOs) Programs
More than doubles current market size
Strong State Support for RHIOs
Health Information Exchanges (HIEs) Sponsored by IDNs
Strong growth in HIE Market
Numerous Federal Agencies Getting Involved
Social Security Admin & Other Fed Agencies
Aggregate Data at Local Level
Standards Often Used
Demonstrated success with lab results & meds
Lab Data One of First to Go “Liquid”
3/18/09 Copyright: Chilmark Research
For internal use only, not for distribution16
HIEs & RHIOs are Challenged
Few RHIOs Actually Exchanging Data
Less than 7% Live
Governance, Data Ownership & Liability Issues
HIPAA Extension in Stimulus Bill Complicates Issue
State A.G.’s right to file suit
No Compelling Reason for HIEs to Participate
HIEs are Established for Competitive Reasons
Data sharing perceived as defeating core purpose
Liability Issues for HIEs as Well
Little Consistency Nationwide
Sustainability Models for RHIOs Remain Elusive
Biggest Challenge: Liability of Data
3/18/09 Copyright: Chilmark Research
For internal use only, not for distribution17
Are Health Banks the Answer?
Consumer Controlled, Govt. Sponsored
Hybrid Tackles Data Ownership Issues
Liability moves to consumer
Consumer Defines Access Rights
Health data unalterable
Clear audit trail
WA State Go-live March ‘09
Three Sites
One Google Health, Two HealthVault
Will Other States Follow Suit?
Biggest Challenge: Consumer Engagement
3/18/09 Copyright: Chilmark Research
For internal use only, not for distribution18
Is Mobile the Key to Engagement?
Explosive Growthin Use
Over 800M iPhoneApp Downloads
iPhone Rep. 0.5% ofAll Internet Traffic
Over 20K Apps
Nearly 1K are HealthFocused
Every Major MobileOS Now has AppMkt
And Still OnlymHealth1.0
3/18/09 Copyright: Chilmark Research
For internal use only, not for distribution19
Evolution Accelerates PHR Adoption
2008
Gen 3: Data Aggregation
(Health Clouds Form)
Gen 4: Personal,
Actionable, &
Connected
Gen 2: Online
2011
Gen 1: Isolated
20031992 Time
Use
r V
alu
e P
rop
osit
ion
Adoption
2000
(Online)
20
1992
40
80
Users(Millions)
Low
High
3/18/09 Copyright: Chilmark Research
For internal use only, not for distribution20
Generation 4: “Convergence”Personal, Actionable, Connected
Value: About Me, By Me, With Me, For Me
3/18/09 Copyright: Chilmark Research
For internal use only, not for distribution21
What to Watch
Traction of Platform Plays
Data Sources (agreements)E.g., Cleveland-Google, KP-MS
New HIPAA Extensions
Consumer AdoptionSub-group types
Developer AdoptionPopular apps/services
Employer Successes
Demonstrable ROI
All Things mHealthSmartphones change equation
Biometrics play key role
3/18/09 Copyright: Chilmark Research
For internal use only, not for distribution22
Final Thoughts…
“Liquid” Lab & Medication Data
is Where it Begins
Highest Demand
Easiest to Go-live
Core to “meaningful use”
Quick Payback
Lower ADEs, Reduce duplication
Without Consumer Engagement, HIT Adoption DOA
Stimulus Funding is Not Enough to Move Needle
Govt. Sponsored NHIN is Folly
Health Clouds will Rain on NHIN Parade
3/18/09 Copyright: Chilmark Research
For internal use only, not for distribution23