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Healthcare IT from the Investor’s Chair 3/28/10

March 28, 2010 News 3 Comments

March 2010 HIMSS Health IT Venture Fair, a View from the Room

Now that the dust from HIMSS2010 has settled, all the follow-up e-mails sent, and the trinkets and swag carefully filed away, I wanted to delivery my (sorry) overdue thoughts on the Venture Fair that was held on the Sunday before the full festivities got underway. Truthfully, I think Mr. H’s primer on common mistakes was outstanding, but he asked me to share my thoughts from the room and the day in general.

Overall, I think the event was both well done and well organized (though how there turned out not to be enough books which listed the companies and their business summaries was an annoying mystery). I’ll first note that the Venture Fair is primarily sponsored by companies looking to service the attendees, and that’s also how the panels were developed. That’s not necessarily a bad thing, as the would-be entrepreneurs could well benefit from hearing the views of practiced attorneys, bankers or recruiters who can provide critical advice and services to companies of all stages.

A key challenge of the day, however, is that there are really two customers/stakeholders in attendance — entrepreneurs and sources of capital. For the former, I’m sure the three panels were invaluable and I hope they paid close attention to them. For the latter, let’s just say I saw a lot of wandering eyes and smart phones being none-too-surreptitiously used. Financial sponsors were there to see potential investments, and many likely could have been on the panels themselves.

I thought the most interesting and helpful panel was the one that combined entrepreneurs with bankers and lawyers to talk through issues such as types of financing, sources of capital, and how valuations are typically determined. The candor of both the agents (Healthcare Growth Partners) on why or why not to engage them and the entrepreneurs on mistakes they’d made (MEDecision) were thoughtful and sometimes things that can only be learned the hard way (i.e., consider where a potential investor is in their fund’s lifecycle).

A panel discussing legal issues around intellectual property and risk management trended towards the arcane to me (HIPAA galore), but many audience members seemed to find it more relevant. The lunch discussion on how early stage companies can work with the Office of the National Coordinator was also likely helpful for companies interested in dipping their toes into the taxpayer trough for funding.

Bottom line, much of the morning could have been called “An Introduction to Venture Financing 101”, and for most early stage companies, this fairly quick and easy way to gain knowledge about sources of funds, types of investors, use of an agent, and the highly critical difference between terms and valuation (plus the ability to ask questions), was time well spent. I’d encourage entrepreneurs seeking knowledge in these areas to consider attending in the future.

After lunch, with a rousing “Play Ball”, the pitches began. Each company was given the podium and the PowerPoint projector to provide a 15-minute or so introduction to and overview of their business and prospects. Each investor, incidentally, was given a blue dot sticker for their name badges to facilitate the speed dating. After the presentation, the investor left the stage and the room, and in many cases, the swarms of funders followed for outside conversations. I’m sure it was a tough call – “If I follow this guy to impress him and potentially have a call option on funding, do I miss something even better?” I confess I missed a few presentations myself for sidebar chats with friends and colleagues in attendance.

Overall, I have to say the caliber was mixed, as is often the case for events such as this. Rather than comment on all 21, let me hit a few high points directly, a few lower points more obliquely:

  • Projections – Show Some Realism. With very few exceptions, the projections were overly aggressive, in some cases approaching absurdity. Yes, I know you’re a growth company, I know investors like to see a “hockey stick” income statement, but in my experience, a bit of realism goes a long way towards establishing credibility. I hope I’m wrong, but I just can’t see the company that projected over $120 million in Year 5 revenues hitting their forecast. Other noteworthy five-year forecasts ranged from $36 million (with 83% EBITDA margins), $42 million, and a company with a product still in alpha reaching $47 million in three years. As Grace said on LA Law, “Goes to credibility your honor”. That said, I actually liked that particular company’s concept and management team.
  • · Exit – Be Thoughtful. As a good friend of mine who’s an active banker in the space says, “Where there’s outside capital, there’s a need for liquidity”, and that’s always something both investors and entrepreneurs should bear in mind. This, too, goes to credibility: for example, saying “An investor in [XXX] can expect to see a return of 10 times their investment in three to five years.” Well, maybe they can, depending on the value and terms, but I was surprised to see that very sentence on a page that (as each page did) listed the two sponsoring law firms. Similarly, one company predicted the exit would be via sale to a Fortune 500 HCIT Company. I’ll personally go out on a limb here and say I don’t think McKesson will bite (but again, hope I’m wrong).

Broad Categories – Investors are Careful. Apologies if I sound jaded or am fighting the last war, but I’m sure I’m Little Mr. Sunshine compared to many in the venture community. Here are a few of my views and biases:

  • I think the office-based physician market ship has sailed and I’d be loathe to fund a start-up with simply a better mousetrap. I’d want to see significant sales before investing, so friends and family or Angels might be the best road to pursue. Exit will be a challenge. While I maintain EMRs have destroyed more venture dollars than anyone will admit, I confess I’ve been wrong here before (but was right more often).
  • I think the RIS/PACS software area is even more difficult. Most of the larger players filled their dance cards during the days when Merge, Amicas, and Emageon were high flyers instead of one small-cap company.
  • Maybe I’m missing something, but I’ve yet to see a PHR with a remotely compelling business model. More scarily and interestingly, I’ve yet to meet more than one person who actually uses one. If any readers who use and maintain a PHR for themselves or their family would indicate in the comments section below, I’d be grateful. Incidentally, the concept of sample bias suggests if the readers here don’t, not many random people/patients will.

A Few Stand-Outs. If I had a checkbook, I’d likely want to have a conversation with a few companies. Before naming them, I want to remind readers that: (a) I might have been out of the room chatting with someone or attending to imperatives like coffee, so might have missed the best in show, please don’t be offended if it was you; (b) ST Advisors, LLC has not done business with any of the companies mentioned, but that could change (old banking habits die hard); (c) I’m just a guy with an opinion. I have a space limit of only five so, without further ado and in alphabetical order:

  • EDMIS. Despite an absurdly sized booth at HIMSS for a company of its size and focus, I think the ED is an area that needs fixing more than most and point solutions can work particularly well in that environment.
  • Logical Images. A unique idea that brings visual diagnostic decision support for clinicians with a subscription model. Projections that appear realistic suggest thoughtful management. Sadly, the company appears to be only seeking strategic investors. I’d pay extra attention to exit, however.
  • MedCPU, Inc. Appealing model that “rides on top of existing hospital systems to bring real-time decision support and brings evidence-based medicine to the point-of-care. “ Also a team with a track record, which is always a huge plus in my experience.
  • YourNurseIsOn.com. Despite a name that, frankly, reeks of 1999 and projections that I’d dial down, I like businesses that solve a real and difficult problem like the nursing shortage. I saw the company at Health2.0 (where it was also one of the standouts), and like how the story evolves. My primary concern would be around entry barriers (i.e., what’s proprietary about its offering?)
  • Prodigo Solutions and Sentient Health. I missed part of their presentations, but I continue to find supply chain and related areas interesting as well. Lots of money floating around, not enough attention being paid, multiple buyers for an exit, and a tendency towards high recurring revenue models all appeal to me.

As ever, thank you for your attention and comments, please drop me a note if there’s a topic you’d like me to address or have questions for Ask the Chair.

Ben Rooks
The Chair

Ben Rooks is the founder of ST Advisors, a strategic consultancy offering long-term and project-relationships to companies and financial sponsors. He earned an MBA in healthcare management from The Wharton School of the University of Pennsylvania, has done healthcare IT equity research, and has worked as an investment banker in over 25 successfully closed healthcare and medical technology transactions valued from $40 to $365 million.

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Currently there are "3 comments" on this Article:

  1. I do use my PHR….have for years. I can renew prescriptions and do referrals very easily and with out ever being put on hold. I look at my lab results in the PHR because I can go back and see previous values and that is helpful. I have usually seen lab results before I get a copy in the mail or get a call from my doctor. I also email my doctor with questions through the PHR.

    Use of my PHR has actually become a very important feature for me. I only wish my mother’s health system had one – it would make my life a lot easier!!

  2. So were you at the same Venture Fair that I was? The opening panel to me was nothing more than a sales job for the sponsors, and their commentary and advice was very basic. If the people in that room found the fair to be valuable then they must be new to business. The presentations were way overblown in their projections, value proposition, and market acceptance. It’s not that easy people to break into healthcare as you presented. You do not need lawyers, VC, angels just a good product or service and develop a positive cash flow, and go see a bank to get your business going. Sure you will have to put up collateral, maybe guarantee the note, but you are free of handcuffs and commentary fro people who only want to maximize their return and leave you with crumbs.

    I would have gotten more out of a program that was modeled after Shark Tank minus the guy from informercials that never invests in anything. At least it would have been entertaining.

    Run your own business, and learn as much as you can in what makes it tick and grow! Good luck,

  3. Can’t agree with your views of ED being good place for”point solutions”. KLAS reported in 2009 that trend swinging in opposite direction, toward integrated ED. With >60% of revenue (national average) generated via admissions from ED, and problematic/error prone “ED” to “EHR” interfaces, many believe this is an area where integration is key.

    EHR vendors don’t deliver robust ED functionality of point solutions (some better than others). If integration not a primary concern or EHR ED module poor, then several established “point solutions” offer mature, feature rich alternatives, e.g.iBex/Picis, WellSoft, MedHost. Not sure there is room for more ED vendors.

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