Circle Square | HIT Trends | Page 1

HIT Trends

June 2014

H E A L T H I N F O R M A T I O N T E C H N O L O G Y

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Contents June 2014

Electronic Health Records

Three hospital EMR vendors expand market share

40% of health systems are indifferent or dissatisfied with their

EHRs

Patient-centered medical home model gets results—EMRs are not

enough

Augmedix plus Google Glass frees physicians from EMR data

entry

Front end speech going ahead despite physician resistance

Two EMR and tech vendor alliances will pursue $11 billion DoD

EHR

Health Information Exchange

CommonWell and Surescripts platforms are achieving

interoperability

Pilot sites for e-prescribing of controlled substances show mixed

results

Japan will build a national healthcare network for its ageing

population

Government and HIT

Goals, example use cases and building blocks in ONC’s 10-year

plan

FDA new guidance on device data systems and social media

Government and HIT (continued)

States are creating all payer claims databases for analysis

International rankings of national health systems: US in 11th place

Care Communications

First national survey of ACOs finds physician leadership

Former HHS exec launches ACOs for independent physicians

EMR solutions are extending into interactive patient system market

Integrated patient monitoring links patient homes and hospitals

Pharma partnership and investment in care communications technology

Three continuing investments in care communications of significance

Healthcare Analytics

Health plans are learning how members shop

Clinical data analytics market will grow at 44% a year

Health Datapalooza 2014 winners leverage analytics in mobile apps

Google takes on autism research

Executive Summary

Electronic health records, health information exchange, government and HIT, care communications, healthcare analytics

Ed. Note. Please click the blue arrows to get to specific sections. Also check out the live links to original

source documents by clicking the underlined grey text on the bottom right of each story page.

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Three hospital EMR vendors expand market share

Epic and Cerner continue to expand market

share taking a combined 60% of new wins in

2013.

MEDITECH was the only other vendor to see

significant growth in share.

For the first time, Epic surpasses MEDITECH in

largest overall market share. See chart at right.

Epic: 1008 total hospitals (+101 in 2013)

MEDITECH: 962 total hospitals (+12 in 2013)

Cerner: 831 total hospitals (+79 in 2013)

Top three vendors also won two-thirds of the

community hospital market of hospitals under

200 beds. Vendors traditionally focused on that market

lost share.

Almost 1300 hospital EMR decisions have yet

to be made, most (60%) among MEDITECH

users. Cerner and Epic led in 2013 in capturing this

segment.

Source: KLAS Research

June 2014

Editorial. For the first time KLAS is showing vendor market dynamics across hospital size segments. MEDITECH and McKesson have

been leaders in the mid-sized market and are now challenged by Epic and Cerner. Note that even CPSI and Healthland are now losing

share to the bigger firms. The report includes details of the market dynamics for each participating vendor and each market segment.

Electronic Health Records

Hospital EMR Total Market Share by Hospital Size

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40% of health systems are indifferent or dissatisfied with their EHRs

Premier, Inc. reports that almost half of provider

executives surveyed plan to make their biggest

capital investment in HIT. Includes EHR, advanced

analytics, telecommunications. Clinical equipment is next

largest.

Yet over 40% report being dissatisfied or

indifferent regarding their current EHR systems. Small hospitals and rural hospitals had higher than average

dissatisfaction.

Additional findings in the Economic Outlook C-

Suite Survey.

Labor is the biggest driver of healthcare costs (42%)

Product standardization is the best answer to supply

chain performance (42%)

Physician shortages in primary care (80%) and

specialties (47%) are reported as concerns.

Almost 70% rate reimbursement cuts as most

impactful

Source: Premier

June 2014

Editorial. Health IT continues to be at the top of the agenda for most C-suite healthcare executives for another year. Providers are spending

money on HIT and not getting satisfying results, particularly in smaller and more rural settings.

Electronic Health Records

11%

30%

59%

Dissatisfied

Satisfied

Indifferent

59% of small hospitals

and 46% of rural

hospitals were

dissatisfied or

indifferent most often

HIT

Healthcare legislation/

mandates

Labor costs

Lack of clinical care

coordination

Top drivers of costs in the health system

Fall 2013

Spring 2014

Health system satisfaction with its EHR

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Patient-centered medical home model gets results—EMRs are not enough

A study by Weill Cornell shows that coordinated

team-based care plus EMR support is most likely

to get patients recommended screenings. The

study included 675 primary care physicians in 312 practices

and 143,489 patients in NY Hudson Valley, a 7-county region.

These patient-centered medical homes

outperformed practices with just an EMR and

those that were paper-based. See diagram at right.

Improvements of 1-9 percentage points were in

four of ten measures:

Eye exams and hemoglobin A1C tests for diabetes

patients

Chlamydia and colorectal cancer screening

University of Pittsburgh Medical Center

announced findings in similar research. It saved

$15 million due largely to medical homes having better

outcomes after six months.

Source: Weill Cornell

June 2014

Editorial. The Weill study looked at claims data from 2008-2010. The improvements were modest but significant. The model combines EMR

with organizational changes including roles and responsibilities of clinicians and staff. It is these changes in combination with an EMR that

makes the difference. Researchers didn’t understand why just four of ten measures showed the improvement. The study is good support for

the patient-centered medical home movement and in particular how it can be used in accountable care settings.

Electronic Health Records

Hudson Valley, NY

13 practices

PCMH + EMR

64 practices

EMR only

235 practices

Paper-based

PCMH + EMR

Best in 4 of 10 measures

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Augmedix plus Google Glass frees physicians from EMR data entry

Augmedix announced a partnership and investment

from Dignity Health expanding its recent investment

round to $7.3 million.

Results of a recent pilot at Dignity Health showed

strong results. See chart at right.

EMR charting time dropped from 33% to 9% of physician

time

Time with patients doubled from 35% to 70% of physician

time

Only 1% of the patients opted out of the study because of

discomfort with Glass

The solution reduces physician EMR data entry and

look-up time.

Glass records the visit and staff uses Augmedix tools to get

appropriate information into the EMR

Glass supports voice commands to look up information

from the EMR and display it in Glass over a physician’s eye

Augmedix is Glass-certified by Google. Another is

Wearable Intelligence, working with Beth Israel Deaconess.

Source: Augmedix; MobiHealth; YouTube; Healthcare IT News

June 2014

Editorial. The Dignity Health study involved three physicians working at a primary care clinic in California and 2,700 patient visits. DrChrono, an

iPad EMR vendor, also announced a Google Glass initiative with Box, an investor. Use cases include: taking pictures, recording videos and

streaming patient encounters, flipping through patient profiles, real-time alerts, reviewing chart data. See story at Healthcare IT News below.

Electronic Health Records

Time Allocation of Physician’s Day

Direct

Patient

Care

EHR

Charting

EHR

Other

Other

Without

Augmedix

With

Augmedix

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Front end speech going ahead despite physician resistance

KLAS Research report on physicians using

front end speech to dictate narratives.

It finds 50% of organizations have skeptical

users among the biggest barriers to adoption.

Benefits of lower costs, shorter documentation

times and better narratives are drivers. Note the

benefits that accrue to using speech with the Cerner EMR

versus Epic in the diagram at right.

Physician resistance comes from a change in

workflow. With front end speech physicians must correct

errors on the display in real-time. Upgrades to cloud-based

solutions will improve accuracy via accessibility of profiles.

Speech engines are now a commodity segment

with Nuance the dominant solution. M*Modal and

Dolby are challengers.

Source: KLAS Research; Healthcare IT News; WSJ

June 2014

Editorial. KLAS reports that larger hospitals are moving ahead with front end speed initiatives and are hopeful that improving technology will

lower physician resistance. It’s hoped that speech input can be an ultimate aid to getting clinical data into the EMR. In separate news Nuance,

who develops and supports the Siri voice app for Apple, is reportedly in discussions with Samsung and others about getting acquired.

Electronic Health Records

A = Documentation time; B = Patient narrative completeness; C =

Reduced transcription costs; Blue line = EMR with speech; Orange

line = EMR tools and templates without speech; Mostly large hospitals

Benefits of Front End Speech With Epic and Cerner

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Two EMR and tech vendor alliances will pursue $11 billion DoD EHR

Source: IBM; CSC

June 2014

Editorial. The DoD EHR deal is estimated to be worth $11 billion. The draft RFPs point to selecting an off-the-shelf EHR working with industry

standards. Additional bids are expected.

Electronic Health Records

IBM brings systems integration, change management

and operational expertise plus complementary

software and services.

Epic brings the most widely adopted and highest

rated enterprise health IT suite.

Epic customers cover 100 million patients exchanging

2.2M records monthly with EHRs and 20 billion

annual transactions. Customers include: Johns Hopkins,

Partners HealthCare, Cleveland Clinic and Kaiser.

IBM Federal’s CMIO, Keith Salzman, MD, will lead

the project.

CSC is the world’s largest systems integrator and

brings its commercial, government and global health

technology experience.

Allscripts brings its comprehensive, integrated and

interoperable EHR. Clients include: UPMC, North Shore-

LIJ, NY Presbyterian, and NIH Clinical Center.

HP brings HIT expertise and 50 years of government

tech experience. Its technology touch 200 million patient

lives and 2.8 billion health transactions annually.

CSC’s CMO, Robert Wah, MD, is AMA president and

commented in the release.

IBM will team with Epic to compete

for DoD EHR contract

CSC will team with HP and Allscripts

to compete for DoD EHR contract

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CommonWell and Surescripts platforms are achieving interoperability

Source: Forbes; NextGen

June 2014

Editorial. This is good progress at CommonWell (10,000 patients opting in) and interesting update details on patient ID. The NextGen

announcement is also significant in that it opens up increased exchange with other Epic customers.

Health Information Exchange

CommonWell’s interoperability process focuses first

on patient opt in to share their health record. Over

10,000 patients have consented to date in 12 pilot hospitals

and clinics in IL, NC, SC.

Patient identification is driver’s license, state-issued

ID, or passport. Stored at CommonWell.

Palmetto Health has deployed a Cerner EMR and can

interoperate with clinics using athenahealth and

Greenway EMRs.

CommonWell recommends that participants share

problems, meds, allergies, procedures,

immunizations.

NextGen achieved vendor agnostic interoperability by

exchanging clinical care information between disparate

technologies.

Arizona Community Surgeons is using NextGen to

exchange Summary of Care messages via C-CDA

protocols with Tucson Medical Center which uses Epic.

Surescripts clinical network enabled the interchange. It exchanges clinical care information such as immunization

summaries, CCDs, referrals, discharge summaries and lab

results between peers, practices and health systems.

Forbes updates on CommonWell pilot

implementations in South Carolina

NextGen announces interoperability

with Epic via Surescripts

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Pilot sites for e-prescribing of controlled substances show mixed results

AIR reports on three pilots for e-prescribing of

controlled substances (EPCS) via grants from CHCF. AltaMed Health Services, Rady Children’s Hospital and Shasta

Community Health Center and local pharmacies.

In two of three pilots 70%-80% of prescriptions for

controlled substances were submitting electronically. In

one pilot, system problems prevented adoption and use.

Two factor authentication was accomplished within the

prescribing workflow in all pilots. Two of the following three

factors are present:

Something one knows (password)

Something one has (hard token)

Something one is (fingerprint)

Three barriers are highlighted.

Lack of critical mass of prescribers and pharmacies using the

technology

Unreliability of the software

Confusion over security requirements

Source: CHCF

June 2014

Editorial. The reports were written in November 2013. Three consulting firms issued reports on aspects of the pilots and a CHCF issue brief

on the topic including two factor authentication are available at the link below. Adoption of EPCS software is on the rise as DrFirst and

NewCropRx are offering commercial versions.

Health Information Exchange

New EPCS prescriber workflow

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Japan will build a national healthcare network for its ageing population

Japan will connect all hospitals, clinics and

pharmacies nationwide through its Ministry of

Internal Affairs and Communications.

The government will also increase adoption of

EHRs by small and medium-sized hospitals

and is encouraging use of cloud technology.

Another area of focus is how HIT can be used

to collect and analyze healthcare data to

address issues in ageing.

Japan has 150 clusters of hospitals with clinics

around them to be integrated into a national

network.

There’s no official target for completion.

Source: FutureGov

June 2014

Editorial. The Japanese national plan stresses connecting clusters of cloud-based EMRs in the smaller hospitals, clinics and pharmacies

so they can get access to the data to help with population health. We’ve seen how cloud-based EMRs, like Practice Fusion and others,

can make connectivity and analytics easier for smaller clinics in the US. And larger hospitals are hosting EMRs for smaller ones and for

clinics, like Epic customers and others.

Health Information Exchange

Future Japanese

National Healthcare Network 150 clusters

Cloud technologies encouraged

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Goals, example use cases and building blocks in ONC’s 10-year plan

Source: ONC

June 2014 Government and HIT

Individuals regularly contribute

information to their EHRs for use by

members of their care team.

Individuals integrate data from their EHR

into tools that enable them to better meet

their own health goals.

PCPs and others can understand how

well controlled is a diabetic population

and how often patients are hospitalized.

Clinical settings and public health are

connected through bi-directional

interfaces that enable seamless reporting,

feedback and decision support.

Individuals look up their electronic

immunization histories when needed.

Primary care providers share a basic set

of patient information with specialists

during referrals.

Specialists “close the information loop” by

sending updated basic information back

to the primary care provider.

Hospitals automatically send an electronic

notification and care summary to primary

care providers when their patients are

discharged.

Individuals manage information from their

own devices and share that information

seamlessly across multiple electronic

platforms.

PCPs can select effective meds for

patients with certain conditions based on

their genetic profiles and results of

comparative effectiveness research.

Individuals, care providers, public health

and others contribute and learn from

information shared across the health IT

ecosystem, with rapid advancement in

methods for deriving meaning from data

without sharing PHI.

Send, receive, find and use

health information to improve

health care quality

Use information to improve

health care quality and lower

cost

The learning health system

Privacy and security

protections and health

information

Supportive business,

clinical, cultural and

regulatory

environment

Rules of engagement

and governance of HIE

Certification to

support adoption and

optimization of HIT

products and services

Core technical

standards and

functions

Building Blocks

3-year agenda 6-year agenda 10-year agenda

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FDA new guidance on device data systems and social media

Source: iHealthBeat MDDS; FDA MDDS; iHealthBeat SocMedia; FDA SocMedia

June 2014

Editorial. FDA relaxing the requirements for medical device data systems should add additional fuel to investments in population health

and care communications. The fact that the agency shows flexibility in reconsideration of this area given additional experience is

encouraging. Its guidance in social media will have wordsmiths composing very efficient tweets.

Government and HIT

The draft guidance is a shift in FDA policy

which reflected that MDDS’s are among the

highest risk technologies in 2011. The easing

comes from additional recent experience.

MDDS’s do not alter the functions of medical

devices. They facilitate data exchange, store data,

convert formats and display device information.

MDDS’s such as software that collect data

from glucometers or scales no longer need

FDA approval.

These guidelines are consistent with health IT

risk-based guidance FDA issued in April 2014.

The draft guidance requires drug and device

makers to disclose risks if benefits are

presented even with limited character space.

An example may clarify:

NoFocus for mild to moderate memory loss may

cause seizures in patient with a seizure disorder

www.nofus.com/risk (117 characters)

FDA wants specific uses (mild to moderate in the

example), risks balanced with benefits, and a place

to go for more info

Companies may present simple reminder

messages that feature the name of the product

without benefits or risks.

FDA does not plan to regulate medical

device data systems (MDDS)

FDA unveils draft social media

guidance for drug and device makers

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States are creating all payer claims databases for analysis

What are all-payer claims databases (APCDs)?

Includes nearly all medical, mental health, pharmacy and dental

claims for all providers

Commercial insurers, Medicaid, Medicare and large employers

in some states.

Codes are used instead of patient names and addresses

Median prices are provided by specific service instead of actual

prices paid per individual case

Some states have cost comparison web sites

Which states have them?

Up and running: CO, KS, ME, MA, MN, NH, OR, TN, UT, VT

In development: NY, RI, VA, WV

Voluntary by insurers and employers: CA, WA, WI

Considering laws to create APCDs: AK, AR, AZ, DE, FL, IL, HI,

IA, ID, KY, LA, MT, MI, NM, NE, NJ, OH, PA, SC, TX, WY

What information can be derived from the data?

Compare prices local hospitals charge; track statewide

spending over time, provider performance for specific diagnoses

Value analysis by employers, insurers, managed care

Consumer price comparisons (increasing with high deductibles)

Primary care evaluating specialists for referrals

Source: USA Today

June 2014

Editorial. USA Today tracks how states are creating all-payer claims databases. The insurers are supporting the idea and agree with the

transparency goals, but urge caution related to patient privacy and related to how the data is collected so it’s not costly and burdensome.

Government and HIT

Up and running In development Voluntary

Status of All-Payer Claims

Databases by State

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International rankings of national health systems: US in 11th place

Source: Commonwealth Fund; The Atlantic

June 2014

Editorial. The US health care system is the most expensive in the world, but comparative analyses consistently show the U.S. underperforms relative

to other countries on most dimensions of performance. Among the 11 nations studied in this report, the US ranks last, as it did in prior editions of the

report, Mirror, Mirror. The United Kingdom ranks first, followed closely by Switzerland.

Government and HIT

Overall Ranking (2013)

Quality Care

Effective

Safe

Coordinated

Patient-centered

Access

Cost-related problem

Timeliness of care

Efficiency

Equity

Healthy Lives

Health expenditures / capita**

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First national survey of ACOs finds physician leadership

More than half (51%) of ACOs are physician led and a

third (33%) are jointly led by hospitals and physicians. 3% are hospital led; 13% other.

Physicians constituted a majority of governing boards

of 78% of ACOs.

Physicians owned the equipment and employed the

staff in 40% of ACOs. 58% report extensive involvement of

physicians in ACO discussions and decision-making.

More physician-led ACOs report care management

and technology capabilities and monitoring and

reporting capabilities compared to others. See charts at

right.

Challenges focus on capabilities to reduce

readmissions, assess ED issues and smooth care

transitions.

Source: Health Affairs

June 2014

Editorial. The National Survey of Accountable Care Organizations was

led by Dartmouth and fielded 10/13 to 5/14. 170 out of 292 ACOs

identified participated. Researchers conclude that the challenge of

moving away from fee-for-service payment will not be achievable

without strong physician leadership.

Care Communications

Care management and technology

capabilities of ACOs, 2012-2013

Monitoring and reporting

capabilities of ACOs, 2012-2013

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Former HHS exec launches ACOs for independent physicians

Farzad Mostashari launches Aledade to help

independent primary care physicians form

accountable care organizations. It is backed by a $4.5

million investment by Venrock.

The business model is to provide consulting and

technology to stand up an ACO in return for 40% of

the savings paid by health plans. Big differentiator is no

upfront costs.

The technology amplifies the ambulatory EMR that

is typically implemented in a primary care practice

with predictive modeling and patient outreach. See

summary of article from AJMC for highlights.

Aledade has signed 3-year partnerships with

primary care physicians in DE, AR, MD and NY.

The company may form relationships with Regional

Extension Centers as they transition from helping

primary care physicians with EMRs. It will also work

with EMR vendors to optimize their solutions.

Source: Information Week; AJMC; HISTalk; Aledade

June 2014

Editorial. Aledade and Venrock are making a big bet that they can take the risk to create ACOs out of independent physician practices with a back-end

split of the savings. They are looking for 30-50 of the right physicians to launch in NY. An ACO requires $1.5 million to launch. If it has 100 primary care

physicians with panels averaging 2,000 patients and average annual healthcare costs of $5,000, then it is managing $1B in healthcare expense.

Care Communications

Four Key Technologies for

Physician-Led ACOs

1. Risk stratification. Description →

diagnosis → prediction → prescription.

2. Advanced network management. Creating and enforcing compacts with

specialists, ancillary providers, hospitals and

post-acute care.

3. Event surveillance. Understand patient

activity outside the practice (ER visits and

hospital ADTs)

4. Patient outreach and engagement. Bring patients in for wellness visits and

strengthen therapeutic relationships.

Mostashari, MD and Colbert, MD, March 2014

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EMR solutions are extending into interactive patient system market

KLAS Research uncovers an emerging trend in

a market that has been dominated by niche

suppliers. GetWellNetwork, Skylight, TeleHealth

Services, Sonifi Health and TVR Communications. See

KLAS rankings at right.

Interactive patient systems are bedside

solutions that entertain, educate and

communicate with patients.

Almost all Cerner and Epic EMR customers

who plan to get an interactive patient system

plan to get it from their EMR supplier. Those that

already have a niche solution are not planning on switching.

The most requested improvement is EMR and

patient location integration where Cerner and

Epic have an obvious edge.

Use is largely contained inside the hospital, but

use in clinics and at home is promoted.

Source: KLAS Research

June 2014

Editorial. This is a market that is potentially transitioning from a niche market to an EMR extension. EMR vendors are getting pulled into it

because of integration needs for access to current ADT information, patient education and other issues. EMR vendors also want to

potentially use patient engagement in the hospital and extend it to clinics and to the home.

Care Communications

Interactive Patient Systems Vendor Performance

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Integrated patient monitoring links patient homes and hospitals

University of Missouri researchers are developing in-

home health monitoring and alert systems that

stream data between homes and hospitals.

The researchers have been working with sensors for

over a decade

Detect falls and walking patterns

Pulse and respiration rate

How often use the restroom

Uses video-game technology

The system monitors elderly at home and alerts the

hospital if the patient falls and can analyze video to

understand why.

For patients returning home after a hospital visit, they

are monitored there and the hospital alerted if certain

changes are detected.

The research was presented as a demonstration of

Closed Loop HealthCare, part of the SmartAmerica

Challenge Expo.

Source: University of Missouri; Closed Loop HealthCare

June 2014

Editorial. The University of Missouri technology leverages emerging sensor technologies to enrich communications between care venues.

These integrated solutions will likely gain traction as the sensor technology matures and providers continue on a path toward accountable care.

Care Communications

Demonstration of Closed Loop HealthCare

Images from the home can be

analyzed to understand falls

Remote sensors alert hospital

staff to patient status at home

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NantHealth capabilities include a cancer clinical trials

search engine, database of trials and access to genomics

analysis. Its SaaS decision support platform is deployed in 2/3

of US oncology practices.

Pharma partnership and investment in care communications technology

The goal of the alliance is to improve adherence,

simplify insulin treatment and help diabetics manage the

condition.

Sanofi brings its extensive insulin portfolio and drug

development expertise.

Medtronic brings its expertise in insulin pumps and

continuous glucose monitoring.

The alliance will focus on three areas initially, but will

explore others in the future.

Drug-device combos with new form factors that are

more affordable, easier to use with better outcomes

Focus on issues in difficult to control diabetes

Care management during transition from oral to

injectable insulin therapies

Sanofi and Medtronic collaborate on

insulin-device combos and care

management services for diabetes

Celgene invests $25 million in

NantHealth to leverage its COS

technology for oncology research

Source: Medtronic; NantHealth

June 2014

Editorial. Medtronic announced separately acquisition of Covidien, a medical device company based in Ireland for $42.9 billion. NantHealth had

prior investments from Kuwait and Blackberry. Its entrepreneur founder has committed $1 billion of his own.

Care Communications

Celgene, a

biopharma,

previously

invested $75

million in a sister

company,

NantBioScience.

NantHealth also closed an additional $16 million from

investors bringing the total to $151 million.

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Three continuing investments in care communications of significance

Source: Proteus; Grand Rounds; ClearCare

June 2014

Editorial. The Proteus positioning as an Internet of Things company seems like a trend in marketing communications. It has raised over $200 million

to date. The Castlight partnership with Grand Rounds fueled its funding as it finds a strong distribution partner. ClearCare is the early leader in a

segment that will likely be very large in the future.

Care Communications

Grand Rounds announced a milestone

of 1 million covered lives. Greylock led

the round with participation from Venrock

and Harrison Metal bringing total raised to

$51 million.

A week earlier, Grand Rounds

announced an alliance with Castlight. Castlight works with employers to inform

employees of costs and health benefits.

Grand Rounds connects patients with

specialized care options from its

national network.

Proteus Digital Health is developing a

new platform for digital health driven by

ingestible sensors.

The new investors weren’t named.

Current investors include: Carlyle, Essex

Woodlands, Kaiser Permanente, Medtronic,

Novartis, Otsuka, Oracle, ON

Semiconductor and others.

New execs have backgrounds at HP,

HSBC Bank and Novartis.

The CEO positions Proteus in his

comments as part of the Internet of

Things (IoT) phase of computing.

The company is the dominant software

provider to home care agencies. 1,300

agencies, including three of the top five

national franchises.

ClearCare software supports agencies

and caregivers.

Web and mobile architecture

Scheduling and Integrated telephony

Two-way caregiver messaging

Marketing

Bessemer and Cambia Health led the

round. Voyager, Qualcomm, Harbor Pacific

and City National participating.

Proteus Digital Health raises

another $120 million from

new investors and names

new executives

Grand Rounds raises $40

million Series B for its

medical opinion services

post alliance with Castlight

ClearCare raises $11 million

Series B to expand its home

care agency software and

services leadership

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Health plans are learning how members shop

University of Pittsburgh Medical Center (UPMC)

upgraded its analytics to include non-healthcare

consumer data. Household income, education level, marital status,

race or ethnicity, number of children at home, number of cars, and

others.

UPMC gets its data from Acxiom, a marketing analytics

company.

For example, mail-order and Internet shoppers use more

emergency services

Goal might be to pinpoint high risk asthma patients not yet with

inhalers

Acxiom can discern potential inheritor, adult with senior parent,

diabetic focus, senior needs.

Predilytics is a healthcare analytics company that taps

into consumer data for insurers. Patients who couldn’t get

timely appointments or lacked transportation are more likely hospitalized.

MedSeek is a healthcare analytics company that is

working with Trinity Health on consumer tools. It tailors

messages by sex, age, race, income, risk assessment, culture, religious

beliefs and family status.

Source: NY Times

June 2014

Editorial. Companies that track and categorize consumers based on internet activities are winding their way to healthcare applications. The

Times raises issues around data errors that the industry admits and privacy / transparency. Acxiom has put up a site, aboutthedata.com where

consumers can see some of the data it has collected about them.

Healthcare Analytics

reviews health plans like

Use of consumer analytics

from companies like

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Clinical data analytics market will grow at 44% a year

Research and Markets predicts the clinical data

analytics market will grow at 44.2% CAGR over

the next five years.

The current market size is estimated at $2.25

billion.

The market is predicted to reach $12.26 billion

by the end of 2019.

The following vendors are reviewed:

Athenahealth

Caradigm

CareEvolution

Cerner

Explorys

IBM

Intersystems

McKesson

Truven Health Analytics

Wellcentive

Source: Research and Markets

June 2014

Editorial. Here is another data point forecasting a white hot clinical analytics market over the next five years. The vendors of focus in this report

include big tech, EMR. and healthcare niche solutions. The overall HIT market is expected to grow at around 9%-10% per year.

Healthcare Analytics

2014 2019

$3B

$6B

$9B

$12B

$2.3B $12.3B

44.2%

CAGR

Clinical Data Analytics Market Growth (2014-2019)

Circle Square | HIT Trends | Page 24

Health Datapalooza 2014 winners leverage analytics in mobile apps

Source: NPR; LyfeChannel; karmadata; Accordion Health; 22otters

June 2014

Editorial. Three startups are among the winning solutions at Health Datapalooza 2014 for visualization tools. Accordion Health and karmadata

leverage the open health data directly with creative user interfaces, while LyfeChannel integrates the analytics on the back-end to inform its patient

instruction mobile app. A similar effort is being launched by Khosla-backed 22otters, led by Bob Quinn, formerly CTO at Epocrates.

Healthcare Analytics

The data is standardized into common

healthcare entities enabling users to

visualize and query. For example:

physicians, clinical trials, clinical

investigators, hospitals, pharmacies, drugs,

diseases, geography.

Karmadata offers private sandboxes so

organizations can keep their data

private.

The app is free with premium editions

offering unlimited visualizations and no

ads.

Lyfechannel programs cover “new to”

chronic conditions, preventive health

and protocol management.

The programs are delivered in a patient

attention window of 30 seconds to three

minutes.

The programs are integrated with EMRs

to communicate patient progress

between visits.

A social network is integrated for

support team engagement.

Analytics bring in information about

costs.

The big idea behind Accordion Health is

to help families estimate future

healthcare spending.

It analyzes 100 million healthcare

records to predict costs for specific

patients via analysis of similar patients.

It provides an easy way to submit

queries. For example, users would enter

that Grandpa has hypertension, Mom has

diabetes and one of the kids has asthma. It

would predict future family costs.

LyfeChannel builds mobile

patient programs that

communicate physician

instructions to patients

Karmadata is a collection of

the world’s healthcare data,

standardized and linked for

easy access

Accordion Health pairs big

data analytics with simple and

intuitive user interfaces to

help understand health costs

Circle Square | HIT Trends | Page 25

Google takes on autism research

Google will collaborate with Autism Speaks and

house 10,000 genome sequences and other data

from children with autism and their families. One

digital genome takes 100 gigabytes.

The database will become an element in AUT10K,

a genome-mapping program by Autism Speaks. It

is considered the largest collection of whole genomes available.

The companies expect to give researchers an

easy-to-use portal using Google tools in a year. Raw data will likely be available sooner.

There are many forms of autism and whole

genome sequencing hopes to understand how

these differences are related to genetics.

Source: WSJ

June 2014

Editorial. Centralizing digital whole genome sequences in the cloud makes sense if the storage costs can be shared. WSJ notes that

researchers who were sharing 800 whole genomes had to buy large disk storage units and ship them around. In another example ,

researchers used Amazon cloud services to store the data and would download results matching people with a certain disease to those

without it. This cost the institutions around $200 per genome.

Healthcare Analytics

Circle Square | HIT Trends | Page 26

Executive Summary June 2014

Electronic Health Records. KLAS Research reports that

Epic, Cerner and Meditech are the only three hospital EMR

vendors to expand market share. Premier reports that 40% of

health systems are indifferent or dissatisfied with their EHRs.

Researchers at Weill Cornell report that patient-centered medical

homes get results, while EMRs are not enough. Dignity Health is

piloting Augmedix plus Google Glass to free physicians from EMR

data entry. KLAS Research reports that front end speech

solutions are going ahead despite physician resistance. Two EMR

and tech vendor alliances will pursue $11 billion DoD EHR: IBM

and Epic versus CSC, HP and Allscripts.

Health Information Exchange. CommonWell and

Surescripts platforms are making progress in achieving

interoperability among major vendor EMRs. American Institute for

Research reports that pilot sites for e-prescribing of controlled

substances show mixed results. Japan will build a national

healthcare network for its ageing population connecting its 150

clusters of hospitals and clinics.

Government and HIT. ONC announces its 10-year plan for

an interoperable HIT infrastructure with goals, example use cases

and building blocks. FDA issues changed guidance on medical

device data systems and new guidance on use of social media.

USA Today reports that many states are creating all payer claims

databases for analysis. The Commonwealth Fund reports on

annual international rankings of national health systems with the

US placing last of eleven countries.

Care Communications. Kaiser Dartmouth researchers field

the first national survey of ACOs and finds more than half are led

by physicians. Farzad Mostashari, former head of ONC, launches

Aledade to help independent primary care physicians form

accountable care organizations. KLAS Research reports that

EMR solutions are extending into the interactive patient system

market, now dominated by niche suppliers. University of Missouri

researchers report on using integrated patient monitoring to link

patient homes and hospitals. Sanofi and Medtronic collaborate on

insulin-device combos and care management services for

diabetes. Celgene invests $25 million in NantHealth to leverage

its COS technology for oncology research. Proteus, Grand

Rounds and ClearCare get additional investment for their care

communications technologies.

Healthcare Analytics. The New York Times reviews how

health plans are using consumer analytics companies to inform

their decisions about members. Research and Markets estimates

that the clinical data analytics market will grow at 44% a year to

$12 billion by 2019. Lyfechannel, karmadata and Accordion

Health, Health Datapalooza 2014 winners, leverage analytics in

innovative mobile apps. Google will collaborate with Autism

Speaks and house 10,000 genome sequences and other data

from children with autism and their families.

Circle Square | HIT Trends | Page 27

HIT Trends © 2014 Circle Square Inc. Michael Lake | Publisher | www.circlesquareinc.com

Note: If you would like to receive this report monthly via direct e-mail, please click this link.

Joshua Aster, Wovenscript,

2013

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