QHR buys CLINICARE

It doesn’t take a PHD to see consolidation happening in the Canadian EMR vendor marketplace.  Scores of small(ish) vendors competing in a hyper-regionalized market of about 65K physicians. The question is does the recently announced purchase of CLINICARE by QHR (and sub Optimed) represent the first stage of mass market consolidation or is it a one off?

The questions I am asking myself are:

• Did QHR do this for an OntarioMD certification and entry into the US, or am I missing something?
• Which vendor will sell next?

The big issue (for me) that has always slowed a natural market consolidation in this space has not been on the seller side but on the buyer side. There are few EMR vendors that have the interest or financial muscle to buy 2-3 of their competitors. Why buy a small vendor for their install base, if you can try and convert their users to your product for a fraction of the cost. Unless an acute vendor or large multinational gets an EMR itch they have to scratch, I can’t see any of these guys acting as a consolidator.

I can only imagine the reaction amongst EMR vendors that are facing a declining market position (for whatever reason)…do we sell now while we can or do we really think we can survive in this market? Not an easy decision, as I doubt many vendors will get a premium valuation for their company.

Mark

 

 

 

Failure is an Option

One of the life lessons that I have tried to teach my kids is the value of learning from your mistakes. I frequently remind my daughter of Thomas Edison’s famous quote when, after numerous failures in developing an electric light bulb, he was asked if he was ready to quit.  Edison replied

“I have not failed. I’ve just found 10,000 ways that won’t work.”

Another quote that I have shared with her and even printed a copy to hang above her desk is from Winston Churchill

“Courage is going from failure to failure without losing enthusiasm.”

More recently, I was struck by President Barak Obama’s view on failure:

“Making your mark on the world is hard. If it were easy, everybody would do it. But it’s not. It takes patience, it takes commitment, and it comes with plenty of failure along the way. The real test is not whether you avoid this failure, because you won’t. it’s whether you let it harden or shame you into inaction, or whether you learn from it; whether you choose to persevere.”

I was reminded of my many discussions with my children about failure and mistakes when I read the federal Auditor General’s report on Canada Health Infoway.   Although I wholeheartedly support and endorse Canada Health Infoway, I have long felt that they don’t  share failures or anything less than positive news.  Given the number of investments that they are making it is not reasonable to assume that they will all be roaring successes and, given the statistics on IT projects across all industries, we can expect a number of failures and only partial successes.  How are we communicating these lessons learned from these failures?  In this current era of eHealth “scandals” no sane person would want to risk media attention by admitting that IT project for which they were responsible had failed.  Too bad.  If we want to get the best return on our investments I think that we need to openly share all lessons learned and to admit, without fear of recrimination, when something goes wrong so that other can benefit.  Failure is indeed an acceptable option provided that we learn from it.  Otherwise, we have squandered our investment and have not generated any value for the money spent.

Mike

Infoway audit results

Wow!

The results are in and it looks like Infoway got a passing grade from the AG. It is interesting to see the scope (focused on only the 5 core EHR blueprint components) and results from the report. I’m glad there is no lurking scandal that would derail wider support for eHealth in Canada, but I’m a little disappointed on the limited scope of the audit. If you are going to give CHI a passing grade, their credibility would be greatly enhanced if this also focused on all their net new initiatives (ie Consumer, EMR, etc).

The elephant in the room for me (to get to a higher level of automation) is still on radically increasing EMR adoption and real use by Canadian physicians. If 80% of the interaction for Canadians is with their physician, then how is CHI doing in regards to this effort? I realize that CHI have only recently starting focusing on this segment, and some would argue that it is too soon for the AG to comment. I would disagree due to the importance of getting the EMR piece right. Getting this right or wrong is going in determining whether we are closer to 17%  or 50%.

What does everyone else think?

Mark

New OntarioMD funding announced

Well, finally some good news for eHealth in Ontario:

https://www.ontariomd.ca/portal/server.pt?space=CommunityPage&cached=true&parentname=CommunityPage&control=SetCommunity&CommunityID=566&PageID=1787

Although long anticipated, new funding for physician office EMRs is an important component of the Ontario eHealth strategy. With all the talk about budget cuts and the delays to Infoway funding, I am very pleased to see the Ontario government commit to getting family physicians on-line. Given that nearly 80% of all healthcare interactions take place with a family physician, getting the health records associated with these visits in electronic form is a critically important step.

Mike

Waiting for the Infoway Audit Results

Ever since the eHealth Ontario scandal broke in mid-2009, the question I keep getting asked is “What about Infoway? Is there a scandal within this organization?” To date it has undergone quite a few audits, and has had few (if any issues) come up. On Nov 3rd, a larger report from the AG Sheila Fraser will give us some answers.

If you believe half the press or bloggers out there, things will not go well for them. I believe this general public mood has been directly created by the eHealth Ontario scandal. The public is not in a good mood about all things eHealth, and will not be happy about the perceived progress/value for money to date. Infoway set the target of 50% automation of health records by 2010, and by their own admission have only reached 17% automation…all at a cost of nearly $2B. Infoway has a public perception credibility gap of their own creation.

Some of the questions I am asking myself is:

• Should the Feds fund some or none of the $500M by next April?
• If 50% by 2010 was not realistic, then what is the next target? How do get to this target, and how do you measure it?
• What reforms (if any) are going to be suggested by the AG?
• If Infoway gets thrown under the bus, how else do we move the larger eHealth agenda forward?

I guess I will have to sit and wait just like everyone else to see the results from the AG report.

Mark

Here we go again?

The media is starting to bang the war drums about the upcoming Federal Auditor General report on Canada Health Infoway due out next week

http://www.northumberlandtoday.com/ArticleDisplay.aspx?e=2146961

I sure hope that there are no major skeletons in the closet and that we can have a meaningful discussion on progress achieved and value for money.

Mike

IT Matters to Your Health

Over the past few days I have been following articles in my local newspaper, the Ottawa Citizen, on the ballooning provincial deficit and the government’s plan to review all provincial spending. I thought to myself “I wonder if any of the eHealth budget will be cut, particularly given all the media attention regarding spending irregularities at the Ontario eHealth agency”. My fears were amplified when I watched the local news last night and they showed clips of “man on the street” interviews asking people what the provincial government should do to reign in spending. The first person interviewed stated that the government should cut spending on eHealth given the $1B that has been wasted to date (the interviewees perspective, not mine). Yikes!

While many members of the mainstream press may be doing a good job at convincing people that eHealth is boondoogle, I was pleased to see an article from the noted Globe and Mail columnist Andre Picard summarizing the highlights of the recently released “For Patients’ Sake” report commissioned by the Saskatchewan government.

http://www.theglobeandmail.com/life/health/heres-a-radical-health-care-idea-put-the-patient-first/article1333019/

As Mr. Picard points out, this report states that one of the areas in which “medicare falls down on the job” is “Lack of electronic health records: Patients hate repeating their medical histories over and over and tests are oft-repeated because of lack of modern records.”  If we ever hope to shift from the current “provider-centric” model of patient care to a more “patient centred” model it is absolutely critical that we put modern information systems in place to make patient information available to all healthcare professionals involved in the patient’s care.  Failure to do so will, in my view, severely limit our ability to ever achieve patient centred care.

Mike

Increased Acquistion and Mergers Among Healthcare IT Vendors?

Although the recent acquisitions by Dell and Xerox were headline news, mergers and acquisition activities among healthcare IT companies was actually down compared with the two previous quarters according to Healthcare Growth Partners:

http://www.healthdatamanagement.com/news/acquisitions-39225-1.html?ET=healthdatamanagement:e1054:15369a:&st=email

According to the article, “Although challenges remain, Healthcare Growth Partners believes the health I.T. mergers and acquisition market likely bottomed out during the second and third quarters. Activity now should increase as vendors attempt to augment growth to meet investor expectations.”

So, Mark, care to guess what announcement we might see over the next 12 to 24 months?

Mike

eHealth Board Chair Apologizes

The eHealth Ontairo Chair, Rita Burak, and Interim CEO, Rob Devitt, appeared today before the Standing Committee on Public Accounts. Ms. Burak’s opening remarks can be found at:

http://www.ehealthontario.on.ca/pdfs/news/OpeningRemarks_Rita.pdf?emc=el&m=311987&l=3&v=dfdbabfc5d

Of particular note, Ms. Burak apologized for untendered contracts, “The very serious issue of untendered consulting contracts at eHealth Ontario has unfortunately taken focus away from the important issue of patient care and progress toward an electronic health record. It has also undermined the public’s confidence in the agency. For this I believe the people of the province are owed an apology.”

I concur with Ms. Burak’s assessment that the issue of untendered consulting contracts have seriously detracted attention from moving the eHealth agenda forward. I encourage Ms. Burak, the eHealth Ontario board and eHealth Ontario executives to take proactive steps to keep the public informed as to progress against stated objectives and generally be as transparent as possible about how things are being done.

Mike

eHealth Ontario Diabetes Registry Short List

eHealth Ontario has released the names of the three organizations short listed to compete for implementation of the Diabetes Registry.

http://www.newswire.ca/en/releases/archive/October2009/21/c8969.html

The three companies are:

– CGI Information Systems and Management Consultants Inc.
– TELUS Health Solutions GP
– xwave, a Division of Bell Aliant Regional Communications, LP

Good to see eHealth Ontario moving forward on the Ontario eHealth strategy.

Mike