Last week we attended the 2011 Healthcare Information and Management Systems Society (HIMSS) conference and exhibition in Orlando, Florida, and met with many senior executives as well as different business line managers. We discussed developments as they relate to the HIT companies, and provide below our thoughts and an overview on some new alliances and products announced at the HIMSS Conference. While in recent years we believed HIMSS attendees were focused on meaningful use criteria and exploring different HIT solutions, topics of interest this year also included health information exchanges (HIEs), ‘cloud’ offerings and data security. As a reminder, Health Information Exchanges are defined as the mobilization of healthcare information electronically across organizations within a region, community or hospital system. HIE provides the capability to electronically move clinical information among disparate health care information systems while maintaining the meaning of the information being exchanged. The goal of HIE is to facilitate access to and retrieval of clinical data to provide safer, more timely, efficient, effective, equitable, patient-centered care. After walking the exhibit floor, we noticed the most buzz around Allscripts’ and Epic’s (private) booths. Excitement over Allscript’s acute and ambulatory offering (and its integration) seemed partially responsible for heavier traffic. Once again we heard positive feedback regarding Epic’s offering; in fact, one executive at a competitor said Epic has been “eating everyone’s lunch” in its targeted acute setting. Despite using older technology, Epic’s acute and ambulatory system runs off of one database and appears to have a very user friendly ‘look and feel.’ In spite of Dr. David Blumenthal leaving the head HIT post this spring, we heard little about potential replacements, although Farzad Mostashari (Blumenthal’s chief deputy) was a name mentioned. One executive we met stressed some uncertainty regarding the direction and discussion around Stage 2 meaningful use, which we expect to begin in earnest later this year. A newer focus on ‘usability’ or UX (which refers to interface design / user experience) could add complexity to Stage 2 or Stage 3 meaningful use definitions. Allscripts (MDRX) hosted an investor meeting at HIMSS that showcased the integration between Sunrise (acute EHR from Eclipsys) and MDRX ambulatory EHR. In our view, John Gomez (President of Product Strategy and Development) did a good job showing and explaining real-time integration between the products for a patient visiting their primary care physician and in the hospital setting. While some have criticized the fact that their acute and ambulatory systems still run off different databases, we thought the seamless and rapid information transfer between the modules was impressive. The newly-integrated offering is expected to begin shipping by end of 1Q11, with ‘go lives’ later this year. The MDRX investor meeting also included a panel discussion featuring executives from Hartford Healthcare (HH), a healthcare system featuring 5 hospitals and hundreds of employed and affiliated physicians. In our view, the biggest takeaway from this discussion was that HH CIO estimated that creating a single inpatient and outpatient database could be extremely costly (~ 5x cost of adopting the MDRX solution) and take multiple years to develop. Quality Systems (QSII) had a few new innovations on display at HIMSS, including the NextPen. NextPen is a digital pen device equipped with a camera that ‘reads’ words, numbers and figures written on forms coded with tiny dots (using standard printers/paper). The written information is easily and quickly transferred into the NextGen EHR (with very high accuracy) and automatically highlights any questionable data. The NextPen (from Anova) felt natural in our hand, is quite durable and has an extended battery life. In our view, the NextPen offers a more traditional (and perhaps more personalized) patient interaction option at a time when healthcare is moving to a fully digitized platform. List pricing for the NextPen is $750, and in our view, is a differentiated addition to the strong NextGen technology platform. Emdeon’s (EM) clinical initiative was on display at HIMSS as the new strategic alliance with LabCorp (LH) (announced last week) and offers a lab agnostic EHR product (vs. DGX’s single lab EHR solution). While Emdeon may benefit from LabCorp’s provider relationships, we do not expect any revenue sharing and believe LH is promoting this product as a free ‘benefit’. That said, this clinical initiative is still in its early stages and we do not expect to potentially see a meaningful contribution to LabCorp’s results for a few years. Emdeon’s (EM) licensing deal with IBM (announced at HIMSS), in our view, takes advantage of EM’s vast provider/payer/pharmacy network. IBM Initiate Patient allows for a virtual view of patient data, pulling data from both Emdeon’s network and over 100 healthcare systems and 40 HIEs through a ‘google-like’ search function. While still very early, we think this technology could add value to providers who need real-time data without having to navigate through many different (and evolving) HIEs. Athenahealth’s (ATHN) new alliance with Microsoft Amalga, allows for a more robust enterprise HIE connected to ATHN’s cloud-based electronic health record (EHR) services. This finalization of a ‘go to market’ strategy is more focused on the inpatient side of the market and will initially be used by Steward Health Care System and Cook Children’s Health Care System (Texas), who were both already athenahealth and Microsoft Amalga customers. While there still appears to be some confusion by healthcare providers (and investors) over what truly constitutes a ‘cloud’ offering, HIMSS attendees appear to be getting more comfortable with ATHN’s business model. That said, the security of patient information contained in the cloud (and online in general) was a high interest topic during breakout conference sessions. One ‘standing room only’ session we attended titled “Securing Health Information in the Cloud” focused on the challenges of storing information in a ‘cloud’ versus traditional data centers and helped attendees define what truly is a cloud offering and what is most important when managing that data.