The Surprise

BRIAN KLEPPER

Check out this March 3rd article - see the image - from the recent HIMSS conference, in which Dave Garets, President and CEO of HIMSS Analytics, "gazes into the future and predicts major trends for the next 12 months." HIMSS Analytics is the research and consulting arm of the health IT vendors' association, and presumably on Health IT's leading edge.

From the article:

"Q: What will constitute the surprise of 2010 - the one technology or policy or X-factor that no one saw coming."

"A: Clinical groupware in the ambulatory market that may be the disruptive innovation of ambulatory EMRs."For the uninitiated, "Clinical Groupware" is a term that is rapidly gaining traction and that describes a new wave of inexpensive, ergonomic, useful Web-based care management tools. David Kibbe coined the phrase and articulated Clinical Groupware's conceptual framework on this blog early last year - see here and then here. He noted that it:

"...captures the basic notion that the primary purpose for using these IT systems is to improve clinical care through communications and coordination involving a team of people, the patient included. And in a manner that fosters accountability in terms of quality and cost."
Dr. Kibbe formulated his ideas, not in isolation, but in continual discussions with innovators developing great new care management tools - e.g., Docsite, Keas, Relay Health, VisionTree, Medicity/NOVO, Salesforce, Practice Fusion - that were realizations of the concept in one form or another. A group of these like-minded developers founded the Clinical Groupware Collaborative, led now by Steve Adams, the founder of RMD Networks. If you're working in this or an aligned area, consider joining.

Which is all by way of saying that it is a stretch to say that "no one," especially HIMSS, saw this coming. From the moment that HIMSS became aware of Clinical Groupware - it's newfound religion on Web-based and modular approaches notwithstanding - influential members were concerned about the trend's disruptiveness. After all, if you're selling EHRs for $25,000 per physician and a new competitor comes along with complete systems or highly useful modular components for a fraction of that - or even free! - the pricing shift will wreak havoc on your revenue and market cap. It's enough to give even the most enthusiastic free marketeer the willies.

That concern found expression through HIMSS influence over CCHIT's - the Certification Commission for Health Information Technology - certification process. CCHIT's criteria were initially spun to favor HIMSS members' products, mostly old-fashioned client-server tools that are complex and not interoperable, and to stifle support of newer, more streamlined solutions like Clinical Groupware. Remember that, early on, everyone thought CCHIT certification would be the criterion for receiving ARRA HITECH stimulus funding, so the criteria could be used to steer the money, conflicts of interest notwithstanding. Fortunately, cooler heads prevailed on the HHS Policy Committee and that heist was averted, or at least it seems so at this point.

The good news is that Dave is right. Clinical Groupware is evolving rapidly and will seamlessly link tools, care teams and patients. It does look disruptive and undoubtedly is the future. If they're watching, this should give serious pause to all those investors driving up Allscripts stock price.

Because, in the end, many old-guard EHRs - the ones Clinical Groupware will replace - produce dreadful customer experiences like the one described recently by John Moore. His article described a market begging for innovation, where the old guard is locked into its past market domination and excessive pricing, and the users are increasingly frustrated.

Of course the irony here is that Clinical Groupware will most surprise and disrupt HIMSS' member organizations, the core of Mr. Garet's constituency, who thought the matter was settled a year ago.