The future of CCHIT

During the year of 2009, when the HITECH act allocated stimulus funds and assigned the responsibility for specifying the criteria for physicians to qualify for these funds, people in the Healthcare IT business have been wondering what would happen to CCHIT (The Certification Commission for Health IT) which is a non-profit consortium made up of among others the traditional large EMR vendors.  If the government wanted to make HIT easier, cheaper and more effective, it could not just adopt the CCHIT methodology which hadn’t been very effective in promoting EMR adoption.

From the start, it was clear that the requirement for Meaningful Use would not fit neatly into the CCHIT requirements, so the relevance of the organization was in doubt.  Centers for Medicare & Medicaid Services (CMS)’s Notice of Proposed Rule Making (NPRM) on January 13, 2010 made it clear that the government wanted to be vendor neutral in its requirements.  Thus, CCHIT had to do something to play a role in this new development in the EHR marketplace.

This article from InformationWeek reports the first steps being taken by CCHIT since the January 13 rules (which were actually released on Dec 30, 2009).  Basically they have introduced a scaled down version of their “Comprehensive” certification program called the “Modular” program.  They also offer to certify for ARRA stimulus those vendors who have already spent a huge amount of money to pass their Comprehensive program.  Of course, such certification program does not really exist yet because the rules for certification have not yet been finalized.

To make this situation even more interesting is the perspective from Practice Fusion.  You probably already realize that nobody speaks without self-interest in this muddy puddle we call Healthcare IT.   As an upstart in the EMR/EHR space, Practice Fusion obviously enjoys watching the established vendors in the CCHIT organization squirm.  The fact that the National Institute of Standards and Technology has contracted with Booz Allen Hamilton to develop testing methods and process of certification of EHR will keep the squirming going a while longer.

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Yodlee, a shrewd platform strategy or missed opportunities?

For those not in the business of financial software, Yodlee might not be a familiar name.  However, if you use online bill pay or one of the popular online personal financial management software, you probably have been using Yodlee without knowing it.  The issue I want to explore in this post is whether Yodlee has missed a great opportunity to provide vertically integrated solutions that end users use or that they have been smart to stay away from the trench warfare in the end consumer products space.

Yodlee has spent over over 10 years to build out its business relationships, technological capability and dominance in the financial data aggregation space.  It makes little sense now for anybody building personal financial software to go sign individual agreements with each of the likes of Citibank, Fidelity and Chase.  As the go-to platform, Yodlee now earns a platform tax from every Personal Financial Management software provider that needs to integrate with banks, credit card companies and investment firms.

At the same time, one cannot help but wonder what would have happened if Yodlee’s end user facing business was a lot more successful and most people actually subscribe to Yodlee to do their bill and financial management, as opposed to doing it through their banks or using services like Mint.com.  Given the number of new product launch and M&A activities across the US, UK and India in the news, Mint.com, Artha Money, Kublax and MoneyDashboard, DebtGoal are just a few of them, there must be significant opportunities to be realized.  However, it appears that Yodlee will not become a dominant player for end users.

Yodlee is in every one of these Personal Financial Management software but it is staying in the background.  That might well be a very comfortable commercial position.  However,  this article from bankingtech.com, Where’s the money in Personal Finance? indicates that Microsoft (after killing its MS Money software) is teaming up with Citi to build a vertically integrated solution to rival Mint/Intuit called Bundle.  If they are successful, they will have a platform that competes with Yodlee as well.  I said earlier that it made little sense for anybody to replicate Yodlee, but then Microsoft is not anybody.  It has cash and it needs growth stories.

This just goes to show no matter where you are, you cannot stay still with a successful product.  What do you think?

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Meaningful Use Challenges – software or process?

Responses continue to roll in after the Dec 30, 2009 final rule proposal from The Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC).  As expected, there are some positive and some critical comments.  From reading them, one cannot help but wonder what percentage of the challenges raised are due to poorly designed EMR (or EHR) software and what percentage are due to clinical processes that resist change.  I suspect a good portion the problems are due to software.

EMR and EHR software have been in the market for many years, though many have not  delivered on their promises.  In fact, a friend in the business once said the product he sold probably bankrupted a number of medical practices due to problems with the billing and other modules.   Those who have purchased these software and experiencing problems are rightfully concerned that they not only have to spend money to swap out their current EMR, but they may also lose out on the EHR incentive money.

However, from an objective observer and healthcare consumer’s point of view, I believe the Meaningful Use goals are worthy and necessary.  What needs to happen is for the software vendors to respond to the complaints of the purchasing doctors as well as Meaningful Use requirements.  This press release by research firm KLAS points out some of the feature gaps that need to be plugged.

There is indeed a market opportunity for EHR and Health 2.0 tools delivered as SaaS as The Health Care Blog says.  They are more flexible, more integration friendly and less costly to implement (at least from an infrastructure perspective).  Those who have already implemented a clunky and inflexible system, ironically these are probably hospitals and financially endowed practices, can be seen expressing concerns such as “unreasonable threshholds for some meaningful use criteria, including computerized prescription order entry, electronic claim submission and electronic insurance eligibility verification”.

This will continue to be a space to watch, whether you are a technologist or a medical professional.  There is hope yet EHR will learn from consumer web innovations that millions have been using for a number of years.

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