Monday, June 30, 2014

A Cloudy Future Is Actually Brighter

Last week there was an announcement that I found very exciting: Salesforce and Phillips announced a strategic alliance in health care.  Big deal?  I think so.

Their effort aims to deliver a cloud-based healthcare platform, connecting a variety of health-related devices and systems, including EHRs, wellness apps, and various monitoring systems.  Their target is chronically ill patients, as the relatively small percentage of these patients account for a disportionately large share of health care spending.

Their initial release, slated for this summer, includes two apps: Phillips eCareCompanion and Phillips eCareCoordinator.  The former will collect and monitor data from various home monitoring devices, and send alerts to caregivers if any indicators are out-of-line.  The latter will allow clinicians to monitor a large number of at-risk patients (such as in a population health management program), and take action when appropriate.

The apps are being piloted at Banner Health, a large health system headquartered in Arizona and a Pioneer Medicare ACO.   

Phillips -- Royal Phillips NV -- is well known in the health care world (and for light bulbs, oddly enough) -- but Salesforce perhaps not so much.  That's what made the announcement so interesting to me.

Salesforce has only been around since 1999, but in that time has blazed a leadership role in customer relationship management (CRM) software, based on a cloud platform.  They were using a cloud computing platform before that term entered the public discourse, competing against more traditional CRM systems.  Salesforce has worked in the health industry, especially on the sales and marketing side, but the alliance with Phillips takes their focus to a whole new level.

According to The New York Times, the initiative is part of a growth strategy that aims at solutions that target specific industries, rather than that span multiple industries (like sales contact management).  The architect of this strategy, Vivek Kundra, was the former CIO for the federal government in the Obama Administration.  Kundra told The Times that he hopes their new platform will "unleash a wave of innovation," especially since he believes we are "...moving into a post-EMR world."

I like the sounds of that: a post-EMR world.  It's about time.

Several weeks ago I wrote Always Fighting the Last War, in which I talked about the "medical-industrial complex" and its desire to keep the status quo.  I referenced a PwC report: Health's new entrants -- Who Will Be healthcare's  Salesforce wasn't listed in that report, but they might as well have been.  It comes from a different background, in terms of technology and markets,  and -- most importantly --  it has a very customer-focused background.  As Judy Hanover, an IDC health care analyst, told The Wall Street Journal, "health care organizations have this blind spot when it comes to seeing the patient as a customer."

Salesforce won't have that blind spot.

I've long been an advocate for more use of CRM in health care (e.g., Should We Spell ACO CRM?), so that's one reason I think Salesforce can make a real impact, but I'm equally enamored by their commitment to a cloud platform.

It seems like everyone is jumping onto the (virtual, I assume) cloud bandwagon.  Like Salesforce, Amazon has been into cloud computing for a while, and its Amazon Web Services is estimated to use five times as much computing power as its five largest competitors combined.  Amazon's CEO Jeff Bezos thinks that AWS might end up generating more revenue than its retail business.

Google came late to the cloud game, but is furiously trying to catch up with Amazon.  They and Microsoft are both pushing hard in the cloud storage business,  In at least Google's case, though, the storage is a means to get access to more data they can analyze.  As Scott Johnson, Google product manager for their storage business told The New York Times,

"Cloud storage is a temporary market.  In the future it will be about elevating productivity: How do we look for patterns? What does it mean if a document is read by 10 percent of the company? What does it mean if you haven’t read it yet?
It doesn't take too much effort to connect these dots to health care.

Google, of course, is famous for its aborted Google Health service, but that doesn't mean they've given up, and they know the cloud is their route there.  Google Fit is their new approach for health, collecting and storing a wide set of health data from consumers, and it comes in the wake of similar moves from Apple and Samsung.  It's all about the data.

As Google CEO Larry Page also told The New York Times, "Right now we don’t data-mine health care data. If we did we’d probably save 100,000 lives next year." 

Maybe that's arrogant on their part -- but maybe not.

The cloud is nothing new in health care.  HIMSS reports that 83% of the institutions it surveyed  are already using some type of cloud services, which I have to admit surprised me.  They're using it to host applications (86%), disaster recovery/backup (79%), primary data storage (79%), and archived data 977%). 

To be sure, the largest EHR vendors -- by far -- are "traditional" solutions from Cerner, Epic, and Allscripts, but scrappy, cloud-based newcomers like athenahealth, eClinicalWorks and Practice Fusion have been shaking up that market.  Hospital-based systems such as Epic have been benefiting from the hospital acquisition of physician practices, but if one only looks at only physician office EHRs, the race is much closer. 

Connecting patient data from all the applicable silos created by traditional solutions has been problematic, as the eHealth Initiative 2013 Survey on Health Data Exchange highlighted.  A recent report found that only 30% of U.S. hospitals have engaged in health information exchange with unaffiliated providers.  Maybe that's why they're so busy trying to "affiliate" them.

Hopefully cloud platforms can help bridge these various silos.

To be sure, not all is sweetness and light in the cloud.  Security of the data is issue number one, and recent security breaches such as with Target illustrate how easy it is for malicious hackers to gain access to protected data.  Health care heightens these concerns even further; you can swap out credit cards if you've been hacked, but once your health history has been breached there's not much you can do about it.  Some pundits even point to health data privacy concerns as the heart of the recent Supreme Court ruling on cellphones.

Personally, if I have to decide who can better protect my data against hackers --my local hospital or a company like Google -- well, I've seen how my local hospital runs.  It's not a hard choice.

To be sure, many non-health care companies have dipped into health care, such as financial services companies, only to be stymied by the sheer complexity, messy data, and perverse incentives inherent in our health care system.  That's not going to change overnight, and Salesforce may be in for a rude awakening...but I don't think so.

CRM is coming to health care.  Some would say it is already here.  The New York Times reported on how UPMC and other health plans and providers are using a variety of non-traditional data sources -- catalog shopping? -- to profile, market and target consumers.  We were doing that at Highmark ten years ago, and I'm sure UPMC and others are much more evolved than those early efforts.  Still, the performance bar for CRM is probably pretty low within health care.

Salesforce is actually good at CRM -- not just good-for-a-health-care-company -- and doesn't have the mainframe/legacy systems burdens most health care companies do.  That's why their entry has the real potential to make things interesting.  This initial effort with Phillips isn't groundbreaking in itself, but I'm eager to see where it goes next -- and what it inspires from others.

Here's hoping Salesforce can help shake things up.

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