TL;DR Accessing and using APIs from major EMR vendors has proved a real problem in the past — in 2016, Health 2.0 (with support from CHCF) collected the data to prove it. This year, we’re updating the survey and are asking again: how hard is it for smaller tech companies to integrate their solutions with big EMR vendors? Take the survey here.
In 2016, Health 2.0 conducted a survey of health tech startups on behalf of the California Healthcare Foundation (CHCF) to shed some light on the difficulties around integrating third party applications–mainly from a new generation of health technology companies–into major electronic medical records (EMRs). The data was revealing, and confirmed that much of the anecdotal gossip was true: it is a challenge for smaller health tech companies to integrate their solutions with the major EMR vendors. There is no clear path to integration or data access, fees are sometimes involved, and even without fees, the lengthy process is too complicated and costly for small companies to handle. Of course, the problem of integration and data access is not limited to major EMR vendors. Healthcare providers and other data custodians may well be complicating the process, too.
In 2016, this survey found an incredible diversity of experience across the major EMR vendors (i.e. working with Epic is different than working with athenahealth), as well as an incredible diversity of experience across different tech companies dealing with the same EMR vendor. We want to know more. Now, Health 2.0 is reprising our previous work, looking once again to collect concrete data around this problem. Will the data reinforce what we found in 2016 or will there be some measure of progress in the past few years?
Much has changed since the first version of this survey, including a flurry of activity around Epic and Apple’s Healthkit integration, Cerner’s Ignite initiative, and the Carin Alliance. We want to know if any of that has made an impact for those looking to integrate. If you are a tech company that has experience with these issues, take this survey. Help us understand where we stand.
The data and commentary collected here will be used to generate a set of slides, charts, and graphs that will be shared on THCB and at Health 2.0 Conferences, and will provide another year of data and much-needed transparency around the issue of integration. Responses will be kept anonymous by Health 2.0
Matthew Holt is Publisher of THCB & Co-Chairman Health 2.0.
Trust is essential for interoperability. One way to promote trust is to provide transparency and accountability for the proposed national system. People have come to expect email or equivalent notification when a significant transaction is made on our personal data. From a patient’s perspective, all health records transactions involving TEFCA are likely significant. When a significant transaction occurs, we expect contemporaneous notification (not the expectation that you have to ask first), a monthly statement of all transactions, and a clear indication of how an error or dispute can be resolved. We also expect the issuer of the notification to also be accountable for the transaction and to assist in holding other participants accountable if that becomes necessary. Each such notification should identify who accessed the data and how the patient can review the data that was accessed. Each time, the patient should be informed of the procedure to flag errors, report abuse, and opt-out of further participation at either the individual source or at the national level.
By now, you’ve heard of the Hawaii False Alarm, and about the blowback and blame as people try to sort out how this could have happened. In government circles, however, there have been empathy and knowing cringes. It is the norm, not the exception, that government systems are confusing and hard to use. Horrible mistakes happen when people use clunky government systems — they just usually don’t make the news.
In fact, the last time a government technology failure was so thoroughly plastered across the news was when healthcare.gov failed to launch. At the time, I was working for the Chief Technology Officer of the United States in the White House. It was a difficult, frustrating time — but the media glare and public outrage opened up an opportunity to make some criticalprogress on changes that governmentworkers had been asking for, for years, to prevent it from happening again. Government design is news right now, so I thought I’d share some thoughts on what people working on this problem could do next.
Value-based healthcare is gaining popularity as an approach to increase sustainability in healthcare. It has its critics, possibly because its roots are in a health system where part of the drive for a hospital to improve outcomes is to increase market share by being the best at what you do. This is not really a solution for improving population health and does not translate well to publicly-funded healthcare systems such as the NHS. However, when we put aside dogma about how we would wish to fund healthcare, value-based healthcare provides us with a very useful set of tools with which to tackle some of the fundamental problems of sustainability in delivering high quality care.
What is value?
Defined by Professor Michael Porter at Harvard Business School, value is defined as a function of outcomes and costs. Therefore to achieve high value we must deliver the best possible outcomes in the most efficient way, outcomes which matter from the perspective of the individual receiving healthcare and not provider process measures or targets. Sir Muir Gray expands on the idea of technical value (outcomes/costs) to specifically describe ‘personal value’ and ‘allocative value’, encouraging us to focus also on shared decision making, individual preferences for care and ensuring that resources are allocated for maximum value. This article seeks to demonstrate that the role of data and informatics in supporting value-based care goes much further than the collection and remote analysis of big datasets – in fact, the true benefit sits much closer to the interaction between clinician and patient.
For what is now an annual tradition, we are once again attempting to be healthcare soothsayers. We are proud to share with you our 10 healthcare predictions for 2018. In 2017, amaz-ingly, eight of our predictions came true.
For 2018, we are betting on the following:
1. Another Theranos
We think at least one healthcare information technology company with an enterprise value of more than $1 billion (not including Outcome Health, which we could not have predicted tanking so spectacularly quickly) will be exposed as not having product results to support their hype. It will also expose embarrassed investors who did not do careful diligence and founders with poor integrity.
2. Hospital hiring slows
After a decade of sustained hiring every month, hospitals will stop. Many will downsize their administrative staffs as admissions continue to slowdown and reimbursement pressures intensify. We expect multiple months with net healthcare job losses which would be the first time this has occurred since the Bureau of Labor Statistics started tracking the data.
3. Successful HCIT exits
After a long wait, and more than $10 billion of venture capital invested in startups over the past five years, we will begin to see successful IPO and M&A exits. These will reassure growth investors to keep pouring money into companies with traction.
4. Amazon does not disrupt PBMs
Despite daily rumors, we think Amazon will not shake up the PBM sector. Instead, Amazon will limit its healthcare market footprint to its existing consumer products and distributing non- regulated healthcare goods to healthcare providers (adopting a B2B and not B2C strategy).
As I walk into the building, the sheer grandiosity of the room is one to withhold — it’s as if I’m walking into Grand Central station. There’s a small army of people, all busy at their desks, working to carry out the next wave of innovations helping more than a million lives within the Greater Philadelphia region. However, I’m not here to catch a train or enjoy the sights. I’m at the office of the President and CEO of Thomas Jefferson University, Dr. Stephen Klasko, currently at the helm of one of the largest healthcare systems in the U.S.
Let me backup a little.
The theme of nearly every conversation about the future of technology now revolves around Artificial Intelligence (AI). Much weight is placed on the potential capacity of AI to disrupt industries and change them to the very core. This pressure has been felt to a large extent within nearly every aspect of healthcare where AI has been projected to improve patient care delivery while saving billions of dollars.
Unfortunately, most discussions exploring the implications of AI only superficially look at either the product or the algorithm that powers these products. The short-sightedness of this approach is not an easy one to fix. Yes, clinical studies validating AI backed products are vital but AI cannot be viewed just like any other drug or a medical device. There’s much more to be considered when we examine the broader role of this technology, because this technology can shape the entire healthcare system. To place the impact of a far reaching technology, you need an even longer sighted vision. It’s a rare breed of people that have experienced the tumultuous history of change within medicine but can still call upon the lessons learned to execute innovations and bring meaningful results.
Get set for a new exciting conference experience coming this spring from Health 2.0 and HIMSS, focused on the collaboration between developers and healthcare providers on building emerging digital health technologies: Dev4Health.
Join hundreds of developers, innovative leaders, designers, chief technology officers, chief innovation officers, start-ups, and health tech enthusiasts for two days of strategic networking, idea generation, and innovative workshops – plus live demos some of the newest health tech start-ups.
Top Reasons to Attend Dev4Health:
Innovation Leaders: Hear cutting edge ideas to infuse your technology strategy with the latest insights and methodologies.
Developers: Benefit from immersive content and hands-on learning by sharing open-source code, applications, interfaces and other resources with like-minded developers.
Health Systems: Discover the latest health tech products to hit the market with live demos by some of the most innovative start-ups in healthcare.
All Attendees: Join in-depth panel sessions focusing on health tech trends, including open tools in the U.S. healthcare server; healthcare focused developer programs; artificial intelligence and machine learning; blockchain; and more!
What are you waiting for? If you’re looking to collaborate with developers on building new applications
or discover new tools to enhance the healthcare experience, then Dev4Health is the place to be this spring.
Last Tuesday, a trio of corporate heavy weights announced they were joining forces to fix the U.S. healthcare system. The CEOs of the three—Jeff Bezos of Amazon, Warren Buffet of Berkshire Hathaway, and Jamie Dimon of JP Morgan, vowed to create “an independent company that is free from profit-making incentives and constraints..to provide simplified, high-quality and transparent healthcare at a reasonable cost.”
Details about the proposed venture are limited but it nonetheless sent shock waves across the industry. Stocks for industry mainstays like United Health, CVS, Express Scripts, Mylan and others plummeted. And, on the heals of mega-deals like CVS’ $69 billion acquisition of Aetna two months ago, speculators theorized it might be Armageddon for healthcare as we have known it in the U.S.
First, what we know for sure:
The new venture will focus on the collective buying power as employers of healthcare for the 1.15 million employees in their organizations. Their approach features five strategies widely. widely used by large self-insured employers to contain their employee health costs. This one is expected to leverage technology in a unique way:
Primary care gatekeepers: Large employers vest considerable responsibility in primary care services that appropriate preventive health, manage chronic populations and control referrals to specialists and hospitals. Promotion of healthiness and wellbeing, the integration of physical and behavioral health and alternatives therapies that reduce dependence on unnecessary access prescription drugs are mainstays of the primary care gatekeeping model.
Narrow networks: The networks of hospitals, allied health professionals, hospitals and others will be tight. Those providing high quality, low cost services will be contracted, and employees will be empowered with data to monitor their performance.
Supply chain management: Every line item fixed and direct cost will be lean. Prescription drug use, for instance, will be accessed through a restrictive formulary, and so on. Amazon is known to be hyper-efficient in its operating budget: employees are expected to fly economy class and office opulence is a no no.
Employee choice & risk sharing: A key to the venture’s uniqueness will be the tools and responsibility given employees to select plan options that align with their needs and preferences. High deductible plans will be options, but technologies that equip them to make informed choices of doctors, treatments, hospitals, drugs and others will be a central feature.
Technology: Technologies that allow employees to own their medical records, interact with Alexa for information and counsel, integrate smart devices and engage with their providers are the backbone of the venture. Knowing treatment options, their costs and where the highest and best value is accessible in the employee’s provider network is central to the venture’s success.
None of these five is new, but together, they’re powerful IF implemented aggressively and at scale.
Let’s face it. Healthcare’s ripe for disruption: we cost too much, hide prices that bear faint resemblance to their underlying costs, avoid accountability for outcomes, complain we’re underpaid and over-regulated, protect our silo’s so each gets a piece of the pie, mark everything up and pass-it-through and declare we’re the best system in the world.
Tuesday’s announcement about Amazon, Berkshire Hathaway and JPMorgan (A/BH/JPM) was short on details. The three mega-firms will form an independent company that develops solutions, first, for their own companies’ health plans and then, almost certainly, for the larger health care marketplace. But the news reverberated throughout the health care industry as thoroughly as any in recent memory.
Health care organizations were shaken. Bloomberg Markets reported that:
Pharmacy-benefit manager Express Scripts Holding Co. fell as much as 11 percent, the most intraday since April, at the open of U.S. trading Tuesday, while rival CVS Health Corp. dropped as much as 6.4 percent. Health insurers also fell, with Anthem Inc. losing as much as 6.5 percent and Aetna, which is being bought by CVS, sliding as much as 4.3 percent.
As expected, these firms’ stock prices rebounded the next day. But you could interpret the drops as reflections of the perceived fragility of health care companies’ dominance, and traders’ confidence in the potential power of Amazon’s newly announced entity. Legacy health care firms, with their well-earned reputations for relentlessly opaque arrangements and egregious pricing, are vulnerable, especially to proven disruptors who believe that taming health care’s excesses is achievable. Meanwhile, many Americans have come to believe in Amazon’s ability to deliver.
Despite (some might say, because of) a raft of new biological methods, pharma R&D has struggled with its EROOM problem, the fact that the cost of successfully developing a new drug, including the cost of failures, has been relentlessly increasing, rather than decreasing, over time (EROOM is Moore spelled backwards, as in Moore’s Law, describing the rapid pace of technology improvement over time).
Given the impact of technology in so many other areas, the question many are now asking is whether technology could do its thing in pharma, and make drug development faster, cheaper, and better.
Many major pharmas believe the answer has to be yes, and have invested in some version of a by-now familiar data initiative aimed at aggregating and organizing internal data, supplementing this with available public data, and overlaying this with a set of analytical tools that will help the many data scientists these pharmas are urgently hiring to extract insights and accelerate research.