HIE Market Trends:

Where We Are Today

What We’ll See Tomorrow

John Moore
Managing Partner
Chilmark Research
April 28, 2011
About Chilmark Research

• Founded in 2007
• Based in Cambridge, MA

• Chilmark’s Sole Focus is Healthcare IT

• Current Research Areas Include:
• Cloud Computing, Connected Health (biometrics, Clouds, & HIS), Health
Information Exchanges (HIEs), mHealth, Platform as a Service (PaaS),
Analytics/BI in Healthcare, Patient Engagement Strategies

• Services Offered:
• Market Research - Adoption & Technology Trends
• Self-sponsored and client sponsored reports
• Strategic Advice
• Market landscape, trends, vendor viability, business plan development, go-to-
market strategies

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 Significant, Unprecedented Money
Flowing Into Market

• Billions in Federal Funding

• EHR Incentives
• Establish State HIEs
• Beacon Program & Others

• Healthcare Reform
• Bundled Payment Models
(ACO)
• Shared risk/reward
• Manage transitions in care

• Business Alignment
• Align Affiliates to Mothership
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 Two Distinct Markets: Public & Enterprise
Attribute Public Enterprise Observations

Messaging & XXX XXX Critical to both entities (incld. results, clinical
Results Dist. notes, meds, alerts, etc.)
Eligibility XXX XXX Simplify & automate process to lower costs

eRx XXX XX Less of concern for enterprise as incentives target

single physician
Disease/Care XX XXX New payment models (ACO) driving importance
Mgmt for enterprise
Orders Mgmt X XXX Hospitals/IDNs look to have lab orders placed with
them
Referrals Mgmt X XXX Hospitals/IDNs see referrals as key part of
retention
EHR XXX XX Public look to engage all, enterprise, just those in
IDN
PHR XX XX Low interest today, but will change with Stage 2
MU and future ACO rules
Analytics X XXX Increasing importance for reporting under new
payment models
Public Health XXX XX Track community/regional health initiatives, MU
requirements will push enterprise HIEs to adopt

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Multitude of Vendors Claiming They Have
the HIE Solution for You

• HIMSS’11 Lists 189 HIE

Vendors
• Service Providers
• EHR Vendors
• PACS Vendors
• Tools Vendors
• ISPs
• Etc.
• Core HIE Vendors

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EHR Vendors

• Target: Existing Clients

• Walled Garden
• Some Exceptions

• Examples:
• Allscripts, Cerner, eCW,
Epic, GE, McKesson,
NextGen

• Prognosis:
• Limited Traction for
Closed Systems
• Others Must Prove
Openness
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Service Firms

• Target: Public & Enterprise

• Slight Edge to Pubic

• Focus on Services
• Software Secondary
• Partner or Acquire
• Play on Customization

• Large Firms Dominate

• ACS, AT&T, Dell, Harris,
IBM/PWC, Verizon, etc.

• Prognosis:
• Success in Large, Complex
Environments
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Core HIE Vendors

• Target: All Markets

• Partner for Large HIEs

• Focus on Software
• Services Secondary

• Dominated by Small Firms

• Rapidly Consolidating

• Prognosis:
• Large Firms Dominate in 18-
24 Months
• Resources to invest

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Looking Ahead: Top Three Trends in HIE

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1) Information Exchange Becomes
Commodity
• HIEs Move to Higher
Order Functions
• Beyond Moving
Information
• Deliver Services

• Data=>Analytics=>
Intelligence
• Reporting
• Attestation
• Operations
• Decision Support…

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2) HIEs Become App Platform

• HIE Moves to Utility, PaaS

Model
Im1 H1 Ph1 Ph2 H2 Im2 • Open API Layer
• May have SDK
L1 L2 • Apps are interchangeable

Pa1

EMR-1
CDS-1

EMR-2
CDS-2
PHR-1

PHR-2
Quality
Viewer

Rpt’ng
Image
Pa2

App
App
Rx1 Rx2

API Layer (SDK?)

Utility (PaaS HIE)
Messaging

Database Layer
(labs, images, clinical notes, etc)

HIE Vendors Must Partner Aggressively to Keep

Pace with Client Needs 11
3) Two Markets, One Leads, One Follows

• Enterprise Market will Lead

• Innovation
• Adoption
• Growth/Size

• Public Market will Follow

• Lightweight
• Network of Networks

In Near-term, Tension & Struggle Between

These Two Markets

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Take-Aways

• Two Distinct Markets

• Different Strategies
• Little Overlap in Operational Structure
• Some Overlap in Needs

• No Dominant Vendors
• Rapid Consolidation to Select Few
• Most EHR Vendors are Out

• Migration to Services
• Exchanges Move Beyond Exchange
• Analytics the “Next Big Thing”
• Payers Stepping Up to the Plate

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 “We are only as good
as the information we
have delivered at point of
decision.”
- Dr. David Blumenthal
Director ONC, April 2010

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