Salesforce's move into the health IT world just ahead of the company's immense Dreamforce 2015 event signals the entry of a major enterprise software vendor into a new and potentially lucrative market, but one that is also fraught with challenges, including overcoming interoperability barriers.
With the announcement of Salesforce Health Cloud, the company touted a content aggregation system that it said will link patient data from electronic health records (EHRs) and other sources, and present it to patients and providers in a single view.
While other enterprise software vendors have tried, with varying degrees of success, to crack the health IT market, the move by the cloud customer relationship management (CRM) giant is notable due to growing acceptance of customer-centric approaches in healthcare, as well as the company's open architecture, cloud-based technology, flexible pricing structure and host of third-party partners, analysts said.
Some health IT insiders, however, were skeptical, saying the technological challenges confronting the company are larger than it anticipates, and the Health Cloud system is still largely conceptual and dependent on development partners, including one with an unknown track record in healthcare.
And although ambulatory providers and some small hospitals have started to adopt cloud-based systems -- such as those from athenahealth, Inc. and eClinicalWorks LLC -- the bigger inpatient market has been resistant to cloud EHRs.
Salesforce's healthcare strategy
The San Francisco-based company, founded in 1999 by former Oracle executive Marc Benioff, said Health Cloud is still in development with several partners, particularly MuleSoft, Inc., and has not given a date when the product will be commercially available. Salesforce said Phillips Healthcare also is a major partner.
Meanwhile, Salesforce's chief medical officer, Joshua Newman, M.D., gave a series of media and analyst briefings in early September focused on the idea of bringing the company's popular CRM technologies to a healthcare world that Newman characterized as rigid, closed and dominated by "legacy" EHRs.
"We've been selling into healthcare for a while now. We didn't wake up one morning and decide that we wanted a piece of the $3 trillion pie that is healthcare in the United States," Newman, who is also general manager of Salesforce's healthcare and life sciences division, told SearchCRM.
Neman added that while Salesforce has experience selling into the pharmaceutical, medical device and diagnostics markets, it also has roots in clinical information and patient management because of its links to providers and payers. For example, Salesforce has signed business associate agreements to get HIPAA compliance for its customers, he said.
Newman also emphasized the Salesforce "ecosystem" of some 2,800 apps in the company's app exchange, and thousands of independent developers that customize and implement different versions of Salesforce systems as a strength going into the healthcare world.
"It's not just a theory. People have been using Salesforce to do relationship management for years," Newman said. "We're educating the market and it's going to take a little while for people to really believe us … to see how valuable we are in healthcare."
Move lauded for logic, decried for hype
Reaction to the Salesforce initiative in the health IT world has been mixed.
Chris McCord, managing director and partner at Healthcare Growth Partners LLC in Elmhurst, Ill., said that unlike some enterprise companies trying to penetrate health IT, Salesforce is doing it organically, without acquisitions.
"It's a very logical thing they're doing, a logical next step," McCord said in an interview with SearchHealthIT. "CRM is where healthcare is going. We are moving to a time where more information is being made available to consumers."
However, McCord said the biggest challenge for Salesforce could be linking health data records from big EHRs and health information exchanges, a task that has bedeviled many health IT vendors and providers -- and one that is bound up in the debate over interoperability and portability of patient health records.
Chris McCordmanaging director and partner at Healthcare Grow Partners LLC
"Can they get the appropriate integrations? Can they play nice with the big EHRs, Cerner [Corp.] and Epic [Systems Corp.]?" he said.
Another prominent health IT consultant and analyst, John Moore, founder and managing partner of Chilmark Research in Boston, was considerably more critical.
Moore said he believed the timing of the announcement was marketing-driven and keyed to the Dreamforce 2015 event, which is expected to draw 115,000 Salesforce users and developers to San Francisco. And he maintained that the Salesforce gambit was no different than those of other big enterprise companies, such as Microsoft and Google, which have not had great success in health IT.
Salesforce Health Cloud is "long on vision and short on details. It looks like something they pulled out of the recycle bin. It's buzzword-compliant," Moore said. "They discounted the challenges it would take to create a true, longitudinal health record."
As for MuleSoft, the San Francisco-based company that Salesforce is relying on to create the APIs and interfaces to EHRs and other data sources, it is "unknown in healthcare," Moore said.
Also, respected health IT companies, such as Orion Health Ltd., are already expending great effort to do the sophisticated integration work Salesforce intends to offer and have found it difficult, Moore noted.
Even so, Moore did not completely discount the Salesforce move, saying its affordable pricing, constellation of third-party partners and fully realized cloud are advantages.
Reaching across various healthcare channels
Securing cooperation and interoperability among various health IT vendors is an immediate goal that Salesforce faces, said Doug Brown, managing partner and president of Black Book Market Research, a healthcare market research company in Tampa, Fla.
"Salesforce's success will lie in their ability to scale all the other activities happening in the arena of provider connectivity and interoperability," Brown said in an email.
Brown noted that enterprise software and cloud competitors Oracle, SAP and NetSuite have attuned their systems to healthcare provider and payer organizations, "so it's critical that Salesforce integrates these vendors' models, along with integrating EHR information, retail healthcare transactions, and data from wearables and remote monitoring to get the competitive advantage."
"It's a big task, because the same challenges that keep the leading EHR, CRM and analytics vendors from that same goal exist for Salesforce," Brown added. "Most patient information is trapped in proprietary software and silos and data warehouses, obstructing the capacity to relate data across the care spectrum."
In the meantime, at Dreamforce 2015, Salesforce also introduced an Internet of Things (IoT) cloud system, which could also have health IT applications because of increasing interest in IoT in healthcare. The company also touted a new financial services cloud.
He compared Salesforce's approach to precision medicine and genomics, but instead called it "precision healthcare," and said the goal is patient management instead of customer management.
"Instead of using genetics to treat cancer, it uses peoples' demographics and lifestyle information to understand who they are," he said. "It uses clinical information and biometric information -- and sometimes device data -- to understand what's happening with healthcare."
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