On Episode 85 of Health in 2 Point 00, it’s our last night in Helsinki. In this episode, Jess asks me about GE selling off Ventures, Neurotrack raising $21 million to detect and track dementia, and Allscripts acquiring ZappRx, a prescribing tool. Also, find out my favorite things from Health 2.0 HIMSS Europe, including a cool pill tracker, Popit, and a great panel on femtech (even though there were not enough men in the room). —Matthew Holt
By MATTHEW HOLT, with OLIVIA DUNN & KIM KRUEGER
Today I’m happy to release an update to some unique data about a pressing problem–the ability of small health tech vendors to access data from the major EMR vendors and integrate their applications into those EMRs. For those of you following along, in 2016 when Health 2.0 first ran this EMR API survey, we confirmed the notion that it’s hard for small health technology companies to integrate with the EMR vendors. Since then the two biggest vendors, Epic & Cerner, have been much more aggressive about supporting third party vendors, with both creating app stores/partnership programs and embracing FHIR & SMART on FHIR.
In 2018, we conducted a follow-up survey to see if these same issues persisted and how much progress has been made. In this report, we break down the results of the 2018 survey and compare them to the results of our 2016 survey. As in 2016, survey response rates weren’t great, but in this year’s survey we asked a lot more questions regarding app store programs, specific resources accessed, troubling contract terms and much more. And if you look at the accompanying slides, we also pulled some juicy quotes.
The key message: In 2016 we said this, The complaint is true: it’s hard for smaller health tech companies to integrate their solutions with big EMR vendors. Most EMR vendors don’t make it easy. But it’s a false picture to say that it’s all the EMR vendors’ fault, and it’s also true that there is great variety not only between the major EMR vendors but also in the experience of different smaller tech companies dealing with the same EMR vendor.
In 2018, things are better but not yet good. A combination of government prodding (partly from ONC implementing the 21st Century Cures Act, partly in the continued growth of pay for value programs from CMS), fear of Apple/Google/Amazon, genuine internal sentiment changes at least at one vendor (Cerner), and maturity in dealing with smaller applications vendors from three others (Allscripts, Athenahealth, Epic), and the growth of third party integration vendors like Redox and Sansoro, is making it easier for application vendors to integrate with EMRs. But it’s not yet in any way simple. We are a long way from the all-singing, all-dancing, plug-in interoperability we hoped for back in the day. But the survey suggests that we are inching closer. Of course, “inching” may not be the pace some of us were hoping to move at.
All the data is in the embedded slide set below, with much more commentary below the fold.
Here’s the third episode of Health in 2 point 00, hosted by Jessica DaMassa. This week the tech and parties of HIMSS18 are looming on the horizon and she asks me as many questions as I can answer in two minutes. Hope you enjoy it! And if you have questions please leave them in the comments–Matthew Holt
Paul Black is CEO of Allscripts and he’ll be with me at Health 2.0 on October 1-4. Paul has been CEO of Allscripts for about five years, taking over from Glen Tullman who grew the company aggressively by acquisition over the previous decade. Paul has been steering Allscripts through a pretty big transformation for the past few years, and they’ve been the major EMR vendor that has most aggressively reached out to the startup tech community. This is an edited transcript of an interview we had in late August. — Matthew Holt
Matthew Holt: Paul thanks for talking with me today, but also we’re going to have you on for a quick chat when you’ll be on the main stage at Health 2.0, of which Allscripts has been a great supporter. Your colleagues Tina Joros and Erik Kins have been there for many years but not you, so I ‘m thrilled to have you coming in early October. Paul, welcome!
Paul Black: Thank you very much. It’s a pleasure to be on the call with you today.
Matthew: Let’s dive in to the current state of play. There’s been some changes over the last five to seven years since the HITECH dollars came in, as more and more physicians, and more and more hospitals put in electronic medical records.
Obviously, Allscripts, was, I think, it’s right to say, built by Glen and Lee Shapiro via lot of acquisitions, especially with the Eclipsys purchase, with the goal of becoming a big player in that meaningful use world. And obviously, you have your old company, Cerner, and your friends from Wisconsin, Epic, who have been very dominant becoming a single platform for many large integrated delivery systems. Can you give me your sense of where the mainstream enterprise EMR market is at the moment?
Paul: I think that the mainstream EMR market in United States is becoming a mature market. And by that I mean it’s a marketplace in which almost every institution, almost every hospital, almost every post-acute facility, almost every ambulatory facility, has some semblance of an electronic medical record system. And certainly, they have an electronic billing set of capabilities. So, from that standpoint, almost everybody has something with regard to the ordering the management of and the documentation surrounding a clinical series of events.
Matthew: Give me a sense of how you think that’s changing in terms of the split between the integrated systems which are covering in-patients and out-patients, with physicians using the same system on both sides of the fences were, and the continued, I would say growth, but probably more accurately the continued existence of a large ambulatory-only segment of the market? After all that’s different for not only the way that the health systems and medical groups organize, but also the way that they’re served by organizations like you and Epic and many others. Is that system integration continuing or do you think that trend is kind of stopping?
Paul: I’ll take it from a couple of different angles. One is from an integration at the industry level, what has been vertical integration of large integrated delivery networks, or large multispecialty groups, especially practices, or in some cases, payers who are acquiring assets. I tend to see that while there was a lot going on over the course of the last four, five years, I’m starting to see people be more focused on what they’ve already acquired, and looking at operational efficiency and looking internally to ensure that they’re gleaning the expected returns, both clinically and financially, of the original goals of how they built those enterprises. That means from a culture standpoint, from an operation standpoint, and from a financial standpoint.
So, I don’t sense that there is as much of a, if you will, a go-go attitude to the continuation of acquisitions. I don’t think it’s necessarily been a conscious pause, but in some cases there’s been a lot of affiliations and acquisitions that have caused people to really have to make sure that they’ve done the things they need to do to really operationalize and to optimize the assets and the people that they are now a part of a new overall enterprise. I think from an industry standpoint of the people that serve that marketplace, us and some of the companies that you mentioned today, I see it’s just a natural progression of the other point that you’ve started with about where do we find ourselves in the state of the industry.Continue reading…
AMGA requests funds and policies to support care for chronically ill
In a letter to members of the Senate Finance Committee Chronic Care Workgroup, the AMGA asks Congress to consider policies and financial and operational technologies that support care for the chronically ill. The AMGA stressed that clinical data from EHRs and details from administrative claims are valuable for analyzing trends on utilization and outcomes.
The AMGA supports the development and use of sophisticated predictive analytic software that have the potential to improve care coordination, cut hospital re-admissions, and reduce the overall cost of patient care. The organization is also encouraging the use of telehealth to care for the chronically ill, as well as financial incentives to encourage provider investment in care management tools.
And now back to us
On the heels of the Supreme Court ruling on the ACA, several health IT organizations express hope that Congress will renew its focus on interoperability, telehealth, Meaningful Use, and other HIT-related issues. Politico reports that Health IT Now Coalition executive Joel White is hoping for a “continued bipartisan focus on interoperability and telemedicine,” while HIMSS believes the decision will create more predictability in the healthcare sector, which may facilitate the advancement of its IT agenda.
It’s great to be optimistic, but I’m sure no one will be shocked if lawmakers find alternative distractions.
Epic Scores Another Big Win
Scripps Health selects Epic to replace its existing GE Healthcare’s Centricity Enterprise (inpatient) and Allscripts Enterprise (outpatient). The San Diego-based Scripps includes five acute-care campuses, 26 outpatient clinics, and 2,600 affiliated physicians.
No doubt that this is one that Cerner had hoped to win.
Marlin Equity Partners Acquires e-MDs
Marlin Equity Partners acquires ambulatory EMR provider e-MDs. Marlin will merge e-MDs with its existing portfolio company MDeverywhere, a provider of RCM and credentialing services for physicians. e-MD founderContinue reading…
Epic’s Faulkner Shares Charitable Foundation Plans
In an interview with Modern Healthcare, Epic founder/CEO Judith Faulkner reveals that she will leave much of her wealth to a specially created charitable foundation that will operate and fund not-for-profit organizations in healthcare and other areas. The 71-year-old Faulkner says that almost all her shares of Epic stock will go to the foundation upon her death, or sooner if she chooses.
The plan is also designed to keep Epic private. “My stock will go to the foundation,” Faulkner said. “The foundation will control the stock. This plan is designed to preserve the company as a private company forever.”
Faulkner, who has an estimated worth of $2.8 billion, says she never wanted the money personally or for her family and wonders, “What would you want with all that money? It doesn’t seem right and I can’t tell you why.”
What’s not to like about Faulkner’s values or her plan?
CMS reports that the majority of physicians who will be penalized this year for not having met MU requirements will lose less than $1,000 of their Medicare reimbursement; 34% of the penalties will be $250 or less, while 31% will exceed $2,000.
The adjustments will impact approximately 257,000 eligible providers. While no one likes losing money, the CMS penalty “stick” is pretty small compared to the overall cost of implementing an EHR.
Mayo Provides Dr. Google with 2nd Opinion
Google consults with the Mayo Clinic to expand its healthcare information for 400 medical conditions.
Given that 20% of all Google searches are related to health conditions, the change will no doubt shake up what Americans find when searching for medical information. The update includes the addition of illustrations for each condition, plus a full list of search results from sites such as WebMD and Wikipedia.
Allscripts is one of the biggest companies in Health IT. Glen Tullman built it from almost nowhere and then last year after one bad quarter and a power struggle in the boardroom (which he initially won), he left–and he stresses it was his decision. Along the way there were lots of interesting choices made, and he and Allscripts ended up with a sweep of all the negative awards at this years HISSIES (including his first time as “Industry figure in who’s face you’d most like to throw a pie”).
But despite all the abuse, what Glen did over the past 15 years is pretty remarkable given the stagnant state of the enterprise HIT market. I’ve interviewed him almost every year since THCB started and he was never shy in giving his opinions. Last month I got him for a long retrospective. THCB will be running that in parts over the next week or so, and he dishes on the Allscripts’ record, on Epic, on the future of health IT and more.
But here’s a teaser…
Almost 20 years ago close to 4,000 people from 200 companies gathered in San Diego for a conference to discuss the future of health-care information technology. This was before the Web. This was back when computers in physicians’ offices, to the extent they were present at all, were used only for scheduling and billing patients. Paper charts bulged out of huge filing cabinets.
It was one of the first big conferences held by the Healthcare Information and Management Systems Society (HIMSS). I was among a grab bag of physicians, technologists, visionaries, engineers and entrepreneurs who shared one idealistic goal: to use information systems and technology to fundamentally change health care.
We didn’t just want to upgrade those old systems. We imagined a future that looked a lot like what we were being promised throughout the economy as it sped into the Internet era. Computers would enable improvements in the practice of medicine—and make it safer, higher quality, more affordable and more efficient—all at the same time. We wanted people to be healthier.