

Salesforce to make big push into healthcare industry - dzhiurgis
http://www.reuters.com/article/2014/10/26/us-salesforce-com-health-exclusive-idUSKBN0IF0EA20141026

======
alelefant
I'm from Madison, WI where there's a well known company in town called Epic.
If someone says they are moving to Madison to work for a tech company,
everyone assumes it's Epic. I've never worked there and none of my immediate
friends have either, but I could see them being greatly impacted by a move
like this from Salesforce.

Anytime I visit the doctor, they always have Epic up on the computer. Granted,
I know I'm living in the city where it's made, but it's used across the
country. I even had a friend who moved out West and planned on just finding a
random job, and it ended up being Epic to help install the software at health
clinics in Washington.

I don't know their full stack of offerings, but I used some of their treatment
billing software when I worked at a health care insurance company during my
college summer vacation. It worked just fine, but certainly had an old
software feel to it. I don't know if they offer any cloud offerings right now
(their website sure doesn't make me think they do), but if they do I find it
hard to imagine it's anywhere near as powerful as something that Salesforce
could offer right out of the gate. I work with Salesforce every day where I
work now and I have to admit it's very well done, although they certainly fall
short in some areas.

I don't particularly care about Salesforce or Epic so long as my data is safe,
but I'm interested to see how it plays out since it impacts my community.

~~~
ch4s3
Well, Epic is the #1 EHR in the country (and several others), with something
like 30-40% of the market. They will absolutely crush anyone that tries to go
head to head with them. One of their top competitors did abour $1.2bn in
revenue last year and lost over $300m trying to compete with Epic. Their EHR
works well enough, but doctors hate it, and it costs a literal fortune to
install and maintain. So who know what will happen in 10 years.

However, my personal opinion as a healthcare software developer is that
SalesForce has gravely miscalculated if the intend to produce an EHR/EMR
system. Product lock in is on the order of a decade.

~~~
sswaner
You could replace every instance of Epic with Siebel and find hundreds of
similar quotes when Salesforce prepared to take out the leader in enterprise
CRM.

As a consumer, the EHR space seems ripe for revolution. 5 years from now, they
may not be the leader, but I expect they will own a sizable share of the
market and introduce a serious competitive threat to existing players.

I would count the following in their favor: 1- Their cloud design makes
rollout easy compared to a data-center installed product. 2- Their existing
and growing mobile offerings could be a disruptive option for both health care
providers and consumers. 3- The AppExchange Marketplace allows a wide spectrum
of 3rd parties to easily integrate into the core platform. This has proven to
be a very powerful added benefit in other markets (disclosure: I presented on
this topic at Dreamforce earlier this month). 4- Low overall cost of adoption.
It is very easy to develop custom solutions on Salesforce. I could see some
potential customers opting for a small pilot that proves the value of
Salesforce over an existing install. 5- A provider still adapting to changes
from ACA could use this as an opportunity to make a change. Ideally,
Salesforce would have done this a few years ago, but there may still be enough
Obamacare disruption to gain traction.

~~~
lnanek2
As someone who writes for one of the big EHRs, writing a CRM is like
generating a Rails CRUD template app, throwing out an open beta, then
convincing some people to try it out. Writing EHR is like then having to do
the same then white box test it with unit tests and integration tests, black
box test it, UI automation test it, meet ridiculous amounts of regulations
like defects per amount of code and auditing requirements about design and
meetings for every code change, getting certifications, deploying it to half a
dozen test environments before it hits production, live test runs at clients
who are all trying to competitors as well, and absolutely massive amounts of
bureaucracy in place for handling incidents and remediation and all the legal
mumbo jumbo and required response times that go with them, then finally maybe
getting someone to use it for real. Writing medical software is a nightmare
and difficult to enter into.

~~~
sswaner
Yea, very similar to rolling out Salesforce in financial services...

~~~
mericsson
fwiw Salesforce announced Merrill Lynch as their biggest customer in 2007 and
have added a few more since then.

[http://www.zdnet.com/blog/btl/why-salesforce-coms-merrill-
ly...](http://www.zdnet.com/blog/btl/why-salesforce-coms-merrill-lynch-move-
is-important/4563)

[http://www.computerworlduk.com/news/cloud-
computing/2049/mer...](http://www.computerworlduk.com/news/cloud-
computing/2049/merrill-lynch-becomes-biggest-salesforce-user/)

------
salesforce_wha
I've used salesforce as a development platform before, and still do not
understand the hype that surrounds it within enterprise. I found that it
actually slowed down development, costs where sky high and constantly worrying
about rate limits and working around the system.

The only people who seemed happy was the salesforce sales guy and management
who got the pitch from them.

~~~
ams6110
Very typical for enterprise software. The managers who make the purchasing
decisions are not the people who have to use or administer the software.

~~~
eitally
If it makes you feel any better, we went with SugarCRM instead of Salesforce,
and the primary non-financial reason was exactly this: my team actively pushed
against having to create interfaces to and program against Salesforce.

------
siculars
"With its new approach, Salesforce may have a tricky time convincing dominant
health record vendors like Epic Systems and Cerner Corp to share information.
Their cooperation would be vital in serving some major customers."

The only way Salesforce or anyone else will usurp entrenched players like
Epic, Allscripts, Cerner, etc. is if they can provide an equal or better
product (not that difficult) that ALSO is open in bidirectional programmatic
data access. Open access to EMR housed data is the next revolution in health
care as all current health data is locked in data silos. Open data is the only
real differentiator in the space. That said, it doesn't seem like Salesforce
is entering the market with an EMR. They seem to be providing ancillary
services like secure messaging.

Here are some of my thoughts on health data integration:

[http://siculars.posthaven.com/health-data-integration-
regula...](http://siculars.posthaven.com/health-data-integration-regulation-
and-incentivization)

------
sergers
Working for a fortune 20 health care company, one of the top 5 ehr among other
fields.

We are in the process of switching to sales force over ms dynamics for a new
crm and document management system.

Suprised to see them enter this space. Its growingly dominated by epic and
other big players.

~~~
FLUX-YOU
>Suprised to see them enter this space. Its growingly dominated by epic and
other big players.

It's still vulnerable IF they can push a solid product that looks modern and
offers many of the things that existing products offer, but that will require
a pipeline of product managers and docs/nurses who already know the landscape
because chances are, picking up developers already in this field will get you
more of the same quality the industry has to offer.

Okay, not TOTALLY their fault. Programmers != designers necessarily, and
designers are sometimes have their hands tied legally, but 2k line functions?
Ugh.

As an anecdote, optometry could also use better software (from my
optometrist).

------
ams6110
Health care is the last field I'd be targeting for the next couple of years.
There is going to be a lot of churn as the longer-tail provisions of obamacare
take effect, and as they are changed and/or repealed by future
administration(s).

