By John P. Desmond
Healthcare software is riding the wave of U.S. government efforts to expand healthcare, including the Affordable Healthcare Act (ACA) of 2010 and the American Recovery and Reinvestment Act (ARRA) of 2009, with large, established companies and innovative startups all getting a lift and seizing opportunity.
ARRA is a $787 billion stimulus package that includes the Health Information Technology for Economic and Clinical Health (HITECH) Act, which directly impacts growth for technology suppliers in the healthcare information technology (HIT) sector.
At the same time, the involvement of the federal government poses a paperwork burden and litmus test screens to prove worthiness. For example, ARRA authorizes the Centers for Medicare & Medicaid Services to provide incentive payments to eligible professionals (EPs) and hospitals that make the decision to adopt, implement, upgrade, or demonstrate meaningful use of certified electronic health record (EHR) technology.
Meaningful use of EHRs is defined in stages, with stage one being data capture and sharing, rules released in 2011 and 2012; stage two being to advance clinical processes, with rules to be released in 2014; and stage three being to improve outcomes, with rules scheduled for release in 2016. The rules are promulgated by the Office of the National Coordinator for Health Information Technology.
To meet the meaningful use criteria, EPs and hospitals must adopt certified EHR technology and use it to achieve specific objectives.
The International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization, also influences healthcare software. It codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases. The 10th revision of the list—referred to as ICD-10—is the most current.
The classification set allows more than 14,400 different codes and permits the tracking of many new diagnoses. The codes can be expanded to over 16,000 by using optional sub-classifications. The detail reported by ICD can be further increased with a simplified multi-axial approach by using codes meant to be reported in a separate data field.
Disruptive technologies including big data and cloud services also affect healthcare software markets—albeit slowly, given the sensitivity of healthcare data.
Here is a look at how established and up-and-coming players in the healthcare software market of 2014 respond to trends.
McKesson Corp. Tops Software 500 in Healthcare
McKesson Corp. is the top company in the healthcare software sector of the 2013 Software 500, coming in at number 41 with $3.2 billion in revenue. The company has a long reach in pharmaceuticals—the backbone of its business—ranging from pharmacy operators to pharmaceutical manufacturers, hospitals, physicians’ offices, insurance providers, and healthcare sponsors, which are referred to as payers.
“Those of us in the healthcare industry know that many patients are at a significant disadvantage with pharmaceuticals because they can’t keep track of what they are taking, why they are taking it, and what the correct dosage is,” says John Hammergren, president/CEO, McKesson. “Addressing all of these compliance and adherence issues is central to creating a better healthcare environment for the patient and a better economic environment for the payer and the healthcare system as a whole.”
Outside of the pharmaceutical focus, McKesson offers a range of related software for hospice management, home health, retail independents, and pharmacy management.
McKesson’s VITAL Platform, for example, is designed to support case and disease management services for health insurance providers or healthcare sponsors.
Recent enhancements in version 7.2 help payers analyze patient populations to identify at-risk and high-risk members, understand gaps in care, and prioritize members for outreach efforts. Version 7.2 assesses 41 condition or disease states, helping payers deliver member-centered programs.
“In this era of healthcare reform, payers look for robust solutions that help coordinate care and put members on the road to better health,” says Naoise Colgan, VP, Care Management Solutions, McKesson Care Management. “The VITAL Platform supports that need by integrating utilization, disease, and case management into a single workflow.”
Version 7.2 of the VITAL Platform includes the latest version of InterQual Coordinated Care Content, which uses evidence-based clinical content to develop an integrated care plan specific to each member to support whole-person health management. InterQual Coordinated Care Content version 4 helps manage the care of patients with high-risk conditions and complex cases as well as mitigate readmissions, enabling payers prioritize members for outreach and objectively measure care management program performance over time.
Integrated with the VITAL Platform 7.2 is the data output from the VITAL Identification & Stratification service, which identifies and stratifies those high-risk members who will benefit the most from a care management program. The service, which is customizable and specific to each payer or health plan, uses a proprietary predictive model to give payers the business intelligence they need to more effectively leverage care management resources.
Also offering wellness software is Cerner Corp., a company that reported a growth of 21 percent in the ranking year. The firm came in at number 46 in the 2013 Software 500, reporting $1.1 billion in revenue. In late 2012, Cerner acquired Anasazi Software, a developer of EHR software and related technology.
Blue Cross Blue Shield of Massachusetts (BCBSMA), rated among the nation’s best health plans for member satisfaction and quality, recently selected Cerner Wellness as its new wellness engagement technology partner. BCBSMA chose Cerner Wellness to benefit from its flexible program design and ability to deliver customizable, incentive programming for employers in the market while also leveraging existing assets.
Cerner participated in a highly competitive selection process held by the MA-based health plan for a wellness technology solution during Spring 2013.
“We understand each employer has a unique set of programmatic requirements based on the health profile of their employee population,” says Cathy Hartman, VP, prevention and wellness, BCBSMA. “We believe it is imperative to the success of a wellness program to take into consideration these unique needs when designing and implementing a wellness solution. Cerner’s wellness platform gives us the flexibility to do this, while providing the end user with a dynamic, intuitive, and seamless wellness experience,” adds Hartman.
The Cerner Wellness platform was introduced to BCBSMA clients in January 2014 as part of a series of enhancements the health plan is making to its wellness offerings.
athenahealth, a provider of EHR, practice management, and care coordination services to medical groups and health systems, reached number 141 on the 2013 Software 500 ranking, reporting revenue of $422.3 million, a growth of 30 percent over the previous year.
In a recent win, athenahealth’s EHR and practice management services were selected by Rush Health, a clinically integrated network of physicians and hospitals in the Chicago, IL area with more than 300 affiliated private physician members following an evaluation process that took over a year. Rush Health aims to deliver efficient healthcare services covering the spectrum of patient care from wellness, prevention, and health promotion to disease management and complex care management.
“We believe the EHR and practice management services from athenahealth will support our goals for true clinical integration, and make things like physicians’ transition to ICD-10 and compliance with Meaningful Use simple for our affiliate network,” says Brent Estes, president/CEO, Rush Health. “When it comes to HIT, a one-size-fits-all approach isn’t feasible. athenahealth provides a nimble set of cloud-based services that our affiliate physicians can operate within and connect with the rest of the Rush Health physician and hospital members. We provide our physicians with options that we believe to be the best in HIT services so they can focus on care delivery in a truly integrated and innovative environment.”
Rush Health plans to use athenaClinicals, supporting ambulatory electronic medical record; and athenaCollector, the company’s practice management service, will be available to all Rush Health private physician members. Today, athenaCollector is used to process more than $11 billion in client collections per year.
“Physician practices and healthcare enterprises of all sizes, including leaders such as Rush Health, realize the value of service-backed, nimble, cloud-based solutions that don’t require up front capital, have a very short onramp to get up and running, and are always improving based on knowledge learned across the network,” adds Jonathan Bush, CEO/president/chairman of the board of directors, athenahealth.
Quality Systems, number 154 on the 2013 Software 500, grew 19.3 percent to reach $382.5 million in software and services revenue.
The company promotes the use of its NextGen Healthcare and QSIDental Web units to help hospitals and physicians qualify for ARRA financial incentives for adopting and using EHR technology.
“We view the HITECH portion of the economic stimulus plan as a potentially significant opportunity for Quality Systems,” says Steven T. Plochocki, president/CEO, Quality Systems.
One example is at Blackstone Valley Community Healthcare, a federally qualified health center in Pawtucket and Central Falls, RI. The organization provides a range of services in pediatrics, internal medicine, family medicine, midwifery, and OB/GYN, as well as dental and behavioral health services. The center’s goal is to provide the highest quality, lowest cost healthcare possible to the patients in its community.
The center found the paperwork burden to be onerous and slow and administrative tasks time consuming, making it more difficult to concentrate on delivering quality care. The company evaluated software options and chose NextGen EPM and NextGen EHR from Quality Systems to streamline office administration, improve documentation, and qualify for quality based incentives.
The effect is dramatic. Dr. Sam Ambewadikar, pediatrician, Blackstone Valley, says, “We work in an extremely under served and poverty stricken environment. NextGen EHR software helped improve the efficiency of my documentation and our overall office workflow. Not only am I using time more intelligently now, but I’m delivering better care to my patients. I like to say that NextGen software is so easy and logical, if you can use a computer mouse, you can use it.”
The Shenandoah Community Health Center is another example of a NextGen user. Located in Martinsburg, WV, the organization is a federally qualified health center with about 30,000 patients that averages 129,000 visits per year, working on implementing EHR and achieving meaningful use.
Omnicell, number 173 on the 2013 Software 500, grew 28 percent to reach $314 million in revenue. The company provides automation and business analytics software for patient-centric medication and supply management across a range of healthcare providers, from acute care hospitals to post-acute skilled nursing and long-term care facilities to the home.
In a recent announcement, Omnicell announced an interoperability between the Omnicell automated dispensing cabinets and Cerner Corp.’s Millennium EHR, via the CareAware iBus, resulting in more efficient medication administration. This enables nurses to save time and increase patient safety.
The Billings Clinic of Billings, MT, a 285-bed hospital featuring a 90-bed skilled nursing and assisted living facility, is the first hospital to implement the latest functionality. “At Billings Clinic, one of our primary missions is to ensure that we get medications to our patients safety and efficiently,” states Kyle Townsend, director of pharmacy, Billings Clinic. “We are excited to partner with these two leading healthcare technology companies to find innovative ways to improve our medication delivery and demonstrate the efficiencies that interoperability is bringing to healthcare.”
Additionally, the Great River Medical Center in West Burlington, IA is a 378-bed hospital seeking to optimize efficiency, control costs, and improve care. Previously, it could take up to 1.5 hours for patients to receive medication.
“We found that we needed to increase automation,” says Darwin Cooley, pharmacy director, Great River Medical Center. “We were doing too much manually, which wastes both pharmacy and nursing time. We were overwhelmed by the number of calls from nurses and physicians waiting for medication.”
Great River implemented Omnicell’s G4 automated dispensing cabinets with Anywhere RN and integrated Medication Label Printers at nursing stations, a pharmacy carousel with WorkflowRx inventory management software, and Anesthesia Workstations in the heart and vascular catheterization labs.
The results showed reduced patient medication delivery time from 1.5 hours to 30 minutes, a $400,000 reduction in inventory costs and expected ongoing annual savings of $300,000. In addition, pharmacists spend less time on routine tasks, freeing up valuable clinical time that can promote better patient care.
Medidata Solutions, number 208 on the 2013 Software 500, grew 18.4 percent, reporting $218.4 million. This could be credited to the strength of its cloud-based offering supporting clinical research in life sciences. The Medidata Clinical Cloud is focused on clinical testing of promising medical treatments, from study design and planning through execution, management, and reporting. The firm’s customers include more than 90 percent of the top 25 global pharmaceutical companies; biotech, diagnostic, and device firms; leading academic medical centers; and contract research organizations.
The recently announced Medidata Clinical Cloud Study brings the firm’s cloud-based platform to single studies as an option that is ready in weeks, providing unified planning, setup, and execution of a clinical trial.
“The Medidata Clinical Cloud Study is a new clinical research solution designed to produce immediate, measurable value by bringing the Medidata Clinical Cloud to a wider set of life sciences organizations,” says Glen de Vries, president, Medidata Solutions.
Customers include U-Systems, a leader in dedicated breast ultrasound systems. U-Systems selected Medidata Rave as its standard for electronic data capture (EDC) systems to perform a clinical study of an automated breast imaging ultrasound system for early detection of breast cancer. U-Systems started a six-site, 20,000-patient study using Rave in six weeks. U-Systems sought to replace its paper-based data collection with an affordable EDC system that would increase efficiencies across its clinical trial process.
“After evaluating several EDC solutions, we found that Medidata was the only vendor that could meet our specific requirements,” says Kathy Quiroz, director of clinical programs, U-Systems. “With Medidata, we are getting a state-of-the-art EDC tool and the service and support our team needs, and we are also able to eliminate unnecessary costs and manage the project on a lean budget.”
Greenway Medical Technologies
Greenway Medical Technologies, offering patient population management services, is number 256 on the 2013 Software 500 with revenues of $124 million and growth of 38 percent. The company offers services to improve financial performance and automated clinical and administrative workflows. More than 100,000 providers in over 20 specialties partner with Greenway via more than 13,000 medical organizations.
Greenway recently introduced Intergy version 9.0, an enhanced version of its clinical and financial product set that prepares providers for the ICD-10 transition, charts progress with other regulatory measures and helps document patient visits in a more intuitive way.
Intergy 9.0 was developed by Vitera Healthcare Solutions, which recently combined with Greenway. “The way ICD-10 is handled within Intergy 9.0 is impressive,” says Dr. Richard Beane of Family Medicine of Carthage, NY, a practice currently coding in ICD-10 with Intergy 9.0. “With all the tools added to the product, I feel well equipped to handle the transition from both a clinical and financial perspective,” he adds.
IMS Health applies analytics and applications (apps) based on the IMS One intelligent cloud to connect more than 10 petabytes of healthcare data on diseases, treatments, cost, and outcomes to enable clients to run its operations more efficiently. In August 2013, IMS Health acquired the assets of Diversinet.
IMS Health draws on information from 100,000 suppliers, and on insights from more than 40 billion healthcare transactions processed annually. The firm has over 5,000 healthcare clients globally, including pharmaceutical, medical device, and consumer health manufacturers and distributors.
The company recently announced AppNucleus, a customizable, cloud-based hosting platform that enables developers to build secure, industry compliant healthcare applications at very low cost, leveraging IMS Health’s comprehensive data on diseases, treatments, costs, and outcomes. The product addresses the growing demand for secure mobile apps that drive patient engagement and enhance the delivery of care.
“Today, there is growing recognition of mobile health’s potential to transform healthcare—to advance doctor/patient engagement and empower consumers to better monitor and manage their own health,” says Stefan Linn, SVP, strategy and global pharma solutions, IMS Health. “IMS Health establishes an intelligent, secure infrastructure for mobile health, backed by our market-leading real-world evidence, capabilities, and the most advanced technology platform in healthcare.”
Medicity of Salt Lake City, UT, provides software to power health information exchanges (HIEs), with more than 800 hospitals and 250,000 physicians connected to its product. Medicity, which is part of the Healthagen business unit of Aetna insurance, offers the iNexx platform that customers use to build their own apps.
“Third-party developers and Medicity customers can use the iNexx platform to develop apps that can be accessed or purchased by physician practice and leverage the health information being exchange in the Medicity customer base,” says Lynne Dunbrack, research VP, IDC Health Insights.
Medicity customers include Banner Health System in AZ, BayCare Health System in FL, and statewide HIEs in DE and VT. “As the system of healthcare reimbursement evolves, HIE networks, both public and enterprise, will play a key role in helping care providers manage risk and lower costs. Medicity remains the company best positioned to deliver an exchange foundation that can help healthcare organizations successfully coordinate care and manage patient populations,” says Nancy Ham, CEO, Medicity.
Some are skeptical about the potential of EHRs to deliver on the promise to create efficiencies that lower healthcare costs. Recent IDC research showed that 58 percent of providers were dissatisfied or neutral about their EHR system and 22 percent have already replaced their original EHR. In addition, providers are looking beyond the EHR suppliers for analytics, mobile, cloud, and financials.
Security remains a top concern. “There is ample evidence that healthcare organizations need to do more,” says Dunbrack. For example, the HITECH Act requires the government post a list of breaches of health information affecting 500 or more individuals. The breaches are posted on the health.gov Web site.
Still, the government programs are spurring software innovation. “The changing care delivery and reimbursement models are driving the need for certain types of technologies,” says IDC’s Dunbrack. “Specifically, analytics to monitor and measure clinical, operational, and financial performance.”
Catamaran Corp., a pharmacy benefits manager, is number 234 on the 2013 Software 500 with revenue of $155 million and grown of 33 percent. The firm, which helps organizations take control of prescription drug costs, manages more than 250 million prescriptions each year on behalf of 25 million members.
This fall, Catamaran acquired Restat, also a pharmacy benefit manager, for $409.5 million in cash. Restat provides prescription claim processing for self-funded employers, workers’ compensation plans, and unions.
Another organization, e-MDs, offers products to support EHR and practice management. The company announced that its e-MDs Cloud Solution is EHR 2014 compliant and is certified for meaningful use Stage 1 and 2.
“As more healthcare organizations look to the cloud for their EHR solutions, we are excited to have achieved this latest Meaningful Use 2014 certification,” says David Winn, MD, CEO/Chairman of the Board, e-MDs. “With this certification, healthcare providers can now demonstrate attestation to qualify for 2014 Medicaid and Medicare incentive payments. e-MDs Cloud Solution will also help providers to be successful as they work with emerging, value-based care models such as Accountable Care Organizations and shared savings programs.”
Healthcare is an important software segment poised for much innovation in the coming years as the latest trends advance in terms of security and functionality. SW
Feb2014, Software Magazine
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