BBI Contributing Editor

NEW ORLEANS, Louisiana – This year's Healthcare Information and Management Systems Society (HIMSS; Chicago, Illinois) meeting was a time for rethinking product positioning by the vendors who have been in the market for some time. There also was no lack of newcomers offering their first products. Hospitals are squeezed, and they simply aren't looking at products that don't offer a concise and definitive value proposition.

In the wake of Y2K last year and the Health Insurance Portability and Accountability Act (HIPAA) this year, no one has discretionary funds to invest in a point-of-care charting/documentation system, just for the sake of having one, nor in a physicians' office system or any other clinical information product. What medical providers are looking at are products that help them do something they are currently doing, but do it better, quicker, less expensively or with fewer mistakes. As a result, many niche applications are appearing that are web-based or pocket PC-based, or both.

If the Internet has become the conduit to the solution, the issue has become connecting to it by a mobile physician working around his practice, en route to the hospital, and within the hospital. Most companies are betting on some type of hand-held, PDA device such as the Compaq (Houston, Texas) Ipaq or the 3-Com (San Francisco, California) Palm Pilot, with its wireless networks. In the pocket PC arena, there were several new products being offered for the first time on the new Compaq Ipaq hand-held. This device, with its outstanding color display, faster processor and additional memory, and Microsoft (Redmond, Washington) CE 3.0 operating system, provides more infrastructure for developers to base their applications upon. Its secure socket layer (SSL) hooks into an Internet protocol (IP) stack, and mini-browser, make it an excellent package for medical applications, particularly those that need to be HIPAA-compliant.

Pocket Script (Mason, Ohio) was typical of the many vendors offering applications to help doctors write and renew prescriptions. Its advantage is that it uses physician voice commands, a technique that minimizes the need for script recognition or menu selection. However, those features also are included, for those who would prefer to point and touch, rather than to speak. Drug interaction crosschecking is included. The device works wirelessly using a standard PC card RF radio to the back-end computer that hosts the voice recognition and Rx databases. These can be located in the physicians' office, or across the Internet at a remote location. Other services offered on this same device included review of lab results, transcription services, and recall of medical content. These few applications are far less than a point-of-care, computer-based patient record system, but they are specific applications tailored to expedite and automate specific "pieces" of the overall office documentation puzzle, and that is precisely their appeal. Moreover, the low cost and convenience of the Pocket PC platform makes the value proposition fairly clear. Pocket Script went further, and enlisted Compaq to do nationwide service for it. Pocket Script is privately held, employs 67 and has more than 1,400 contracts with physicians.

Providing the back-end document translation service for Pocket Script is Lernout & Hauspie's (L&H) Dictaphone division. L&H was not particularly present at this year's HIMSS gathering, quite a change from its high visibility in previous years. Having acquired Dictaphone and rival Dragon Systems last year, and then going into bankruptcy due to serious accounting irregularities, the future of voice dictation and transcription has been cloaked in uncertainty. Hopefully, some sort of reorganization and re-emergence from bankruptcy under new corporate management will occur this year, so that speech recognition medical market can get back on track. Clearly, Dictaphone would benefit from that, as it has a prominent position in the medical transcription markets, estimated to account for $5 billion in revenues for equipment, and an additional $10 billion in revenues from the transcription labor component, according to the Medical Transcription Industry Alliance.

McKesson HBOC (Alpharetta, Georgia) has been about redefining itself and its products under the leadership of Graham King, who came to HBOC when it acquired US Servis. The company was showing its Horizon technology, which includes both a portal and some foundation services. The suite provides the means to make existing applications, web enabled. HBOC is moving quickly to web-enable itself, and thereby remain in the mainstream of that trend which is emerging in U.S. health care. By doing so, HBOC hopes to sustain its market share across a variety of clinical and business applications that are under constant attack from new suppliers entering the market with competitive applications, designed from the ground up as web-based, Internet-enabled applications. The company also wants to remain visible to the over 50 million health care consumers who use the Internet for medical care research.

Consolidation during 2000 touched all segments of the health care information technology (IT) markets, including mature niches like electronic payment and procurement. It was a year of joint marketing initiative and consolidation of services. This will ultimately benefit the industry by simplifying the myriad of different e-procurement systems available. Sun Microsystems (Palo Alto, California) is a hardware supplier that teamed up with Lawson Software (St. Paul, Minnesota) and Digex (Beltsville, Maryland) to offer a simplified, more integrated e-procurement system, based on Lawson's Lawson.insight e-procurement service. The new solution will be web-based and hosted by Digex. This sort of integrated solution has been estimated to allow the reduction of procurement costs in health care by nearly half, according to studies conducted by the Efficient Healthcare Consumer Response organization. Sutter Healthcare (San Joaquin, California) was a pilot site for the development of this solution.

As health care information systems companies sought those "killer" applications that would excite the interest of providers, adverse drug events (ADEs) was one of the hot applications that they hit upon. McKessonHBOC presented its Strategies for Medication Management brochure and systems that combined drug-drug, drug-food, drug-allergy checks with systems that submitted staff drug orders to a set of user-defined expert rules designed to minimize errors. Its system also included point-of-care capture of administered drugs with point-of-care identification of the patient receiving the drugs. All of these features are good, and yet this response is typical of information technology companies that often offer the solution before they fully understand the problem. A presentation at last fall's Microsoft Healthcare Users Group meetings identified age, sex, and such lab factors as liver and kidney function as the key contributors – after known drug allergic reactions – contributing to undetected ADEs. Had the majority of computer-based patient record system companies understood these factors, they could have easily tailored their systems to prevent them. The most effective means of detecting ADEs is not to depend on voluntary staff reporting, or even to employ retrospective chart reviews, but instead to simply have the computer track the orders for drugs required as antidotes when a drug overdose has occurred. With the 3.75 billion drug doses administered in hospitals each year, and the $2 billion-plus spent on treating ADEs, there is ample room for vendors who have engineered viable solutions to make the economic case for their entire point-of-care computer-based patient record systems using this benefit alone.

The other theme of this year's HIMSS conference was the Internet-enabling of almost all applications, and the movement of these to an application service provider (ASP) hardware and revenue model. McKesson formed iMcKesson to host the development of such services, and iMcKesson was showing its new PracticePoint suite of ASP-based products for automation of physician offices. This suite combines external information, such as clinical guidelines, with prescription services, lab test orders and results, and financial and administrative services. IMcKesson claims to provide information solutions to more than 1,000 U.S. practices that include 50 or more physicians.

The third part of the HIMSS holy trinity this year was disease management. The health care information system companies, like the large drug companies, have realized that there is gold in managing patients with chronic diseases for large HMOs, with the goal of preventing or delaying unplanned visits to emergency departments that result in expensive hospitalizations. Top diseases these companies are focusing upon are diabetes, heart failure and asthma – all of which, if not tightly controlled, result in increased emergency department appearances. What separated the iMcKesson approach from many of the others seen on the HIMSS exhibit floor was the concrete, specific results it could cite as outcomes of using its disease-management ASP services. IMcKesson cited 58%-plus increases in ACE-1 compliance, improving patients in heart failure; 14% decreases in episodes of hyperglycemic reactions for diabetics; and a 33% decrease in asthma symptoms, again achieved by better medication compliance monitoring.

Cardiology Domain (Boston, Massachusetts) was a new Internet-based ASP involved in bringing peer-reviewed content on disease management to physician group practices, with content aimed at both patients and providers. For the physician, Cardiology Domain provides prescription writing services, apparently the universal starter application for such products. The practice portal allows patients to enter history and demographic profiles, and receive content the provider has authorized for them. So far, content is focused on cardiology, urology and vascular practices. The service has been beta tested at 30 sites by about 300 physicians. It went live early this year for its first paying customers.

While most early applications used the Palm OS platform, at HIMSS almost everyone had ported or was about to port these applications to the Pocket PC (Windows CE 3.0) environment. The availability of devices like the Compaq Ipaq that offer faster processors, more memory, outstanding color displays and are compatible with industry standard PC cards (rather than the smaller footprint cards required by the Palm Pilot devices), makes them attractive for medical applications. So do the full TCP/IP stack and secure socket layer (SSL) hooks built-into Windows CE 3.0. Realizing that most purchases of these PDA devices are made by individuals, Ubiquio (Plymouth, Minnesota) has started a business of procuring, managing and providing training on these devices, helping them to be used on the hospital's LAN backbone.

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