Author Archives: markd73

eHealth Ontario is read the riot act

Not sure where I stand on this issue. The current management of the agency continues to pay for the sins of the past. Doesn’t seem terribly fair, but this is all about political perception.


EMIS exits the Canadian market

On the heels of the Healthscreen management change, there is news that EMIS is leaving the Canadian market.

Although I’m not surprised at the “fragmented market” challenges facing EMR vendors in Canada, I’m a little surprised that EMIS has decided to exit entirely in the next three months. After searching for more details online, the parent company CEO, Mr. Riddell, was quoted by analysts as saying part of the reason for the exit is “We were hoping that there would be a federal accreditation programme in Canada, but that didn’t happen so we had to deal with different rules in every province.

Alan Brookstone at CanadianEMR has an excellent post on the EMIS situation, and according to his post he will be interviewing the former CEO Eric Gombrich in the near future.


Where is the vendor consolidation wave in Canadian Healthcare IT?

I feel like I’ve been sitting around waiting for this to happen forever. When I was working as an analyst, I was once asked by one of my favourite vendors (you know who you are) “when is the consolidation going to start in the EMR market? “ Being the genius that I am I predicted in the next 12-18 months…this was in 2007. Ummm not exactly a home run.

This got me thinking lately, not just about EMR market consolidation, but the whole Canadian Healthcare IT market. I’ve always had an abiding interest in all things merger and acquisition, and on the surface the Canadian healthcare IT market seems ripe for consolidation. For the sake of this post, I am going to assume that consolidation is good and inevitable thing. You may agree or not as you see fit.

Many CIOs and others on the provider side would be just as happy dealing with a smaller number of large vendors than hundreds of smaller guys. Combine this with a highly fragmented geographic distribution of vendors and market share and the big guys “should” be buying companies left and right.

I think there are a number of systemic issues that are preventing this from happening.

1)      The most logical buyers (the big companies) are largely branch plants of US or International companies, and they have to compete with the head office for acquisition resources. I know who would get the first crack at resources if I was running one of these companies, the US market. Why by Vendor A in Canada that sells into a small market, when you can buy the same kind of company and sell your stuff into a market 10 times bigger. Simple math wins every time.

2)      The Canadian market has hundreds of small companies, with most selling into highly regional markets. Many of these small companies have limited access to capital, a record of building things themselves and an unrealistic view of the dollar value of some of their targets.  This makes for reluctant buyers or unrealistic ones, not a good situation if you are looking at consolidation.

3)      In terms of the EMR market, have the provincial certification programs actually slowed down market consolidation? Given that it did happen, then it is pure speculation as to the alternatives, but I love speculation.

  • Would the market have consolidated already if all vendors were equal with no certification? Perhaps. I think one of the big reasons there is less activity is that with a 70% discount to switch vendors, it makes it awfully hard to buy another EMR for their user base.
  • Would the market have consolidated already if there had been a single national certification program created years ago? Again I would say perhaps. It would be easier to source acquisition capital to do a national play than to do 4 or 5 regional plays. This would also be more attractive to the big players who are only interested in selling nationally with their other stuff.

I wonder what those who have done a recent acquisition think about my logic? Did I get it right or am I missing something?


Why did Intel pay so much for McAfee?

I have been puzzling over this deal for the last day or so. For those who have been at the cottage and not reading the news, Intel is paying a 60% premium for McAfee…yes you read that right McAfee.

Many of the articles on the subject are asking why would Intel want to buy McAfee. Intel is a hardware guy and McAfee sells software. Good question, and I’m sure it has a lot to do with a change in direction for Intel as they see baked in security at the hardware level as the next “big thing” in the mobile market. I’m  not sure I buy into the logic, but for arguments sack lets say that this is a genius move. My question is why did they pay a 60% premium on closing price? Typically companies pay a premium to make it too expensive for rivals to trump their initial bid. This keeps a bidding war at bay…smart business move. I’m just not sure anyone else was as interested in buying them as Intel, and the premium was unnecessary. The other issue that has me scratching my head is why buy when you can partner on this stuff? I must be missing something.

I know this blog is supposed to be about healthcare IT, so I would ask the readers if they think buying mobile hardware with Anti-Virus baked in would affect their decision on which hardware to buy?


Spending priorities

I have been spending the last few days thinking about the relatively meager amount of money the Feds, and to some extent the Provinces, have historically allocated to eHealth technologies. I’ve always wondered why these governments, who say that runaway healthcare spending is one of their top priorities, spend on average between 1%-3% of operating healthcare budgets on eHealth. This spending level doesn’t seem to change much regardless of the flavor of the political parties in power.

When a federal government is willing to spend $16B on fighter jets, but only around $2B on Infoway I have to start wondering about priorities. Is eHealth just to hard a concept to sell to the Canadian public, or is it something else?


Self-service optometry…there is an app for that

Leave it to the folks at MIT. They have created an Android App for turning a Google Nexus One into a cheap mobile platform for creating eyeglass prescriptions. The authors of the article claim that they can take what is a $50 procedure, and with the addition of a $2 eyepiece, create prescriptions for the majority of people. Even when you add the cost of the Google phone (north of $500 US), it makes for a potential business “mobile optometry without the optometrist” business.

What does it have to do with the Canadian healthcare market you ask? My answer is that I’m not sure, but it shows that mobile technology is going to disrupt traditional service delivery models in healthcare, whether we like it or not.


Off to the show

Mike and I are attending the eHealth show in Vancouver for the next few days. We will try and live update from the show when time permits. It will be great to see all of my friends and peers in the industry.

I am looking forward to discussing what we learned (good and bad) from the show.


Has the eHealth show jumped the Shark?

For those of a certain age, the image of the Fonz jumping a shark tank in a leather jacket is a defining moment in pop culture. The jumping episode highlighted the truism that everything peaks at some point. Happy Days peaked as a show during this episode, and what I’m wondering is has the eHealth show in its current form already jumped the shark?

I’ve been going on an off to this show since about 2000, and every year I hear the same variation from the vendors on the tradeshow floor “I’m not meeting any customers, and all I speak with are vendors”. The comments stay the same from year to year, but what is worrying to me is the ever increasing amount year after year.

Are vendor expectations are out of wack, or does the eHealth show format need a change? I have always seen the show as a great networking opportunity, but if I owned a company I would have a hard time seeing any sales value in having a booth. There may be some value in terms of reinforcing your brand, but unlike the HIMSS show in the US, this is not a direct sales opportunity.

I’ve always felt that more value could be generated for booth buying vendors, if all the attendees had to either pass through the tradeshow floor between sessions. Another somewhat cheesy alternative is to have a big prize give away at the end. To qualify each attendee would have to get a stamp on a card from each vendor booth. I saw this in action at a Medical Office Assistant show in BC, and although some people try and game the system it did lead to a lot of interesting sales conversations.

We have to keep in mind, that the vendors who buys booth space are paying a large portion of the bill for everyone else. If they don’t get some value for their marketing/sales dollars then this event will wither away.


Can someone explain why I should care about the iPad?

Let me get this out of the way right of the top… I’m a luddite.

It took me 8 years from the launch of the iPod to get one. Why would I buy a device to play all of my music in yet another format after I invested thousands of dollars in CDs. They work and more importantly don’t cost me extra money. For goodness sake I still don’t even own an iPhone or any cell phone right now…shocking I know. Some people have said I’m cheap, but I prefer the term frugal. 🙂

I turn on the TV the other day, and the talking head is droning on about Apple. I ignored him until he mentions that their earnings are up 90%. Now he has my attention. These numbers are huge, largely due to iPhone and to a lesser extent iPad sales. The iPhone I kinda get, it’s a phone with all kinds of apps and looks cool. Can someone explain to me why I should care about the iPad? Is it a phone or the Apple version of a netbook. I’ll admit that sometimes I am “temporarily incorrect” when it comes to some products, but I am mystified about this iPad thing.

To put it into a larger context should healthcare IT decision makers, in Canada or elsewhere, take it seriously. I have read about many of the serious misgivings that CIOs (in healthcare and other verticals) have about Apple products. Less so about the iMac, but more about the iPhone and it’s perceived issue around security and suitability in a corporate environment vs as a consumer device. I would be surprised to hear if Hospital and RHA CIOs have not been approached by staff/doctors about integrating their iPhones into the corporate IT environment. It is not like doctors are afraid of telling you what they think or want.

What exactly can an iPad do in the Canadian healthcare IT market that can’t be done by existing hardware devices. Apple may be successful in selling these to consumers, but what real value does it actually bring to healthcare IT environments?

When I ask these questions, I feel like the teacher from Ferris Bueller’s day off…”anyone anyone…Bueller?”


Infoway to get their $500M

Looks like Infoway will be getting their $500M…at least according to the official 2010 Federal budget document

Pulled from the actual document (highlighting provided by me):

The Economic Action Plan provided $500 million to Canada Health Infoway to support the goal of having 50 per cent of Canadians with an electronic health record by 2010 and to speed up the implementation of electronic medical record systems for physicians. Canada Health Infoway has developed an action plan to strengthen accountability in response to the Auditor General of Canada’s Report of November 3, 2009. The Government is moving forward with the transfer of the $500 million that was announced in Budget 2009 to Canada Health Infoway. This $500-million investment will both enhance the safety, quality and efficiency of the health care system, and create thousands of sustainable, knowledge-based jobs throughout Canada.