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EMRs, APIs, App stores & all that: More data

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Olivia Dunn
Kim Krueger
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.

Health 2.0 EMR API report 2018

It’s getting better but….EMR Vendors are still a bottleneck
Continue reading…

Health in 2 Point 00, Episode 43

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Jessica DaMassa cracks her whip and in just 2 minutes gets answers out of me about the bidding for #athenahealth, the new clinics at #Amazon, the #FDA approving #NaturalCycles as a contraceptive, and the tech giants getting on stage unprompted at ONC’s Blue Button 2.0 day to tell the world that they are going to fix the interoperability problem. Oh, and a shout out to THCB’s 15th birthday–Matthew Holt

Health in 2 Point 00, Episode 30

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Jessica DaMassa asks me about Jonathan Bush’s exit and the future of Athenahealth, celebrity suicide and the future of mental health apps, and who Amazon/Buffet/Chase should choose to be their CEO — Matthew Holt

Apple, Cerner, Microsoft, and Salesforce

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By JACOB REIDER

… all rumored to be in the mix to acquire athenahealth.

Nope.

Why not?

a) Apple doesn’t do “verticals.” It’s that easy. Apple sells products that anyone could buy. A teacher, a doctor, my mom. Sure – they have sold high-end workstations that video editors can use, but so could a hobbyist filmmaker. Likelihood of Apple buying athenahealth? ~ .01%

b) Cerner? Nah. While (yes) they have an aging client-server ambulatory EHR that needs to be replaced by a multi-tenant SaaS product (like the one athenahealth cas built), they have too much on their plate right now with DoD and VA and the (incomplete) integration of Siemens customers. Likelihood of Cerner buying athenahealth?  ~ 1%

c) Microsoft. Like Apple, it’s uncommon for MSFT to go “vertical.” They have tried it. (Who remembers the Health Solutions Group?) But the tension between a strong product-focused company that meets the needs of many market segments, and a company that deeply understands the business problems of health (and health care) is too great. The driving force of MSFT, like Apple, is to sell infrastructure to care delivery organizations. Owning a product that competes with their key channel partners would alienate the partners – driving them to AMZN, GOOG and APPL. Likelihood of Microsoft buying athenahealth?  ~ 2%

d) Salesforce. I’d love to see this. But it’s still unlikely. athenahealth has built a product, and they (now) have defined a path to pivot the product into a platform. This is the right thing to do. Salesforce “gets” platform better than everyone (aside from, perhaps, Amazon). But Salesforce has struggled with health care. They’ve declared n times in recent years that they are “in” to really disrupt health care, and with the evolution of Health Cloud, and their acquisition of MuleSoft, they have clearly made some investments here, but the EHR is not the “ERP of healthcare” as they think it is. (Salesforce’s success in other markets has been that they dovetail with – rather than replace – the ERP systems to create value and improve efficiencies.) The way that Salesforce interacts with the market is unfamiliar (and uncomfortable) to most care delivery organizations. So if Salesforce “gets” platform, and athenahealth wants to be a platform when it matures, could these two combine? It’s the most likely of the three, but I still see the cultures of the two companies (I know them both well) as very different, and not quite compatible. Likelihood of Salesforce buying athenahealth?  ~ 10%

e) IBM. yup. I forgot that one. Many recent acquisitions. This would fit. I don’t think it would work very well, but it could happen. ~6%

Others?Continue reading…

Health in 2 point 00, Episode 29

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It’s Nicer in Nice, which is where Jessica DaMassa is hanging out as she asks me about health tech in Finland, Teladoc’s foreign foray and the trials and tribulations of Athenahealth’s Jonathan Bush in this edition of Health in 2 point 00 — Matthew Holt

Update–I’m indeed a tea leaf reading soothsayer. When I said Jonathan Bush would be gone by the Fall, apparently I meant by the start of summer!

Health in 2 point 00, Episode 23

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In this start your weekend off right edition, Jessica DaMassa asks me about Andy Slavitt’s new Town Hall venture fund announced at HLTH, the ATHN buyout, Novartis paying Michael Cohen, Trump’s drug price speech & Lyra Health’s $45m raise….all in 2 minutes–Matthew Holt

Health in 2 point 00, Episode 22

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In this edition of Health in 2 point 00 the tables are turned! Jessica DaMassa is at the upstart HLTH conference, which will make those of you with long memories of the first ehealth bubble laugh. So today I’m asking Jessica the questions, including whether Jonathan Bush likes the buyout idea, what Alex Drane (Walmart’s most extraordinary cashier) said, and whether there was anything about sex at HLTH or whether that was just at YTHLive!–Matthew Holt

Interoperability: Faster Than We Think – An Interview with Ed Park

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By LEONARD KISH

Screen Shot 2015-11-10 at 9.34.40 PM

Leonard Kish, Principal at VivaPhi, sat down with Ed Park, COO of athenaHealth, to discuss how interoperability is defined, and how it might be accelerating faster than we think.

LK: Ed, how do you define interoperability?

EP: Interoperability is the ability for different systems to exchange information and then use that information in a way that is helpful to the users. It’s not simply just the movement of data, it’s the useful movement of it to achieve some sort of goal that the end user can use and understand and digest.

LK:  So do you have measures of interoperability you use?

EP: The way we think about interoperability is in three major tiers. The first strata (1) for interoperability can be defined by the standard HL7 definitions that have been around for the better part of three decades at this point. Those are the standard pipes that are being built all the time.  So lab interoperability, prescription interoperability, hospital discharge summary interoperability. Those sort of basic sort of notes that are encapsulated in HL7.  The second tier (2) of interoperability we are thinking about is the semantic interoperability that has been enabled by meaningful use. The most useful thing that meaningful use did from an interop standpoint was to standardize all the data dictionaries. And by that I mean that they standardized the medication data dictionary, the immunizations, allergies and problems.

Continue reading…

The Time-Warp

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By JONATHAN BUSH

jonathan bushJohn Gage, Sun Microsystem’s fifth employee and its former chief researcher, famously said “the network is the computer.” The majority of us experience this every day through interactions with a wide variety of highly-intelligent, super-connected networks including Facebook, which remembers our friends’ birthdays better than we do; ATM networks, which know instantly if we have the cash that matches our request; and the complex, yet seemingly simple interweaving of phone networks, which allows us to communicate smartphone-to-smartphone regardless of carrier. Sadly, healthcare struggles to grasp this important concept.

Earlier this month, I flew to Utah for a conference hosted by KLAS, a major healthcare research outfit, about interoperability. Interoperability is a clunky word that’s talked about endlessly in healthcare, but at its root is an important notion: health care information needs to flow freely. Interoperability means that important information isn’t stuck in proprietary enterprise software that a hospital spent millions of dollars buying years ago. Having this information in the right place at the right time equates to reduced risk of medical errors and makes the delivery of health services more efficient and less costly. I’m convinced more than ever the only way to free information from the silos where it’s currently stranded is for the industry to embrace connectedness by switching to cloud-based, open networks.

The goal is clear. Yet healthcare IT executives and those buying their products remain stuck in the old ways of thinking. In their minds, software is still the computer, and sunk costs keep it so. As such, health information is largely trapped on technology islands that are maintained at great expense onsite at hospitals across our country versus flowing across the care continuum via a universally available information network. Just how bad is the data jam? An Epocrates’ survey earlier this year of nearly 3,000 physicians found that only 14 percent of physicians can access usable electronic health information across all care delivery sites and six out of 10 doctors, even when in the same organization, aren’t effectively sharing information.Continue reading…

It’s “Slack for Health Care”- athenaText

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By MATTHEW HOLT

 

Screen Shot 2015-07-22 at 11.52.00 AM

By now it’s not a secret that EMRs are “records” and yet we’ve been trying to cram communication functions down their throat. Meanwhile the hottest tools in enterprise tech are souped up versions of AIM (remember that, you AOL fans?)– with companies like Slack & HipChat providing group-based instant messaging and changing the way teams work. As health care becomes a team sport, you’re going to see many approaches from the major EMR vendors and new entrants in the coming months to fix the communication problem. And yes at Health 2.0 this Fall I’ll be running a full panel on the topic that the Clinical User Experience Sucks–how do we fix it?

This week athenahealth, one of the few big cloud-based players in EMR-land introduced athenaText. (Don’t bother asking why there are no caps in the company name yet the simple word “text” gets a capital T in the middle of the product name! It’s as you’d expect an instant message product (rather than SMS one) but with some differences. For a start it integrates direct into the athenaClincals EMR, but it also pulls in both drug info and physician contacts from the Epocrates product that athenahealth owns (and which has several hundred thousand physicians on it). The goal is to spread the product virally (think Skype or Slack). But first things first. What is it and how does it work? I spoke with VP of UX at athenahealth, Abbe Don, to find out more and to get a demo, which you can see below.

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