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.
My big brother Bill, may he rest in peace, taught me a valuable lesson four decades ago. We were gearing up for an extended Alaskan wilderness trip and were having trouble with a piece of equipment. When we finally rigged up a solution, I said “that was harder than it should have been” and he quipped in his wry monotone delivery, “There are no hard jobs, only the wrong tools.”
That lesson has stuck in my mind all these years because, as simple as it seems, it carries a large truth. It rings of Archimedes when he was speaking about the simple tool known as the lever: “Give me but one firm spot on which to stand, and I will move the earth.”
Enter the Electronic Medical or Health Record (EMR or EHR) as it exists in most forms today. As information tools for clinicians, most EMRs have been purchased by administrators who know nothing of patient care or workflow, and most of these EMRs have been reverse engineered from billing and collection systems, because the dollar drives all.
There’s so much happening in the Health 2.0 world of new technology in health that it’s hard to keep up. AI, VR, AR, Blockchain–and they’re just the buzzwords keeping the VCs happy. So this year I’ve decided to try to interview more interesting new companies to keep you in the know. We’ll see how long that resolution lasts but first up is Kyna Fong, CEO of ElationHealth. Yes, she left a Stanford tenure-track professorship to start an EMR company, and no, she doesn’t sound crazy! This is an in-depth interview including a decent length demo, and it hints at how companies like hers might solve the conundrum of EMRs being necessary but impossible to use.
Just in case you didn’t realize there still is a world going on despite last week’s election. Back in health technology, a systemic change is happening as older client-server companies (like McKesson) retreat or open up their technology (Allscripts) while investors still believe that there’s a big market for SMAC technology and cloud-based systems to run the next generation of American health care. More evidence of that today with the news that CareCloud has raised another $31.5 million to double down on the already large bet placed on it by its investors as a platform for growing medical groups. I talked to CEO Ken Comee about the company, the state of the market, and what he expects to do with the money! — Matthew Holt
Today I’m happy to release some really unique data about a pressing problem–the ability of small tech vendors to access health data contained in the systems of the major EMR vendors. There’ll be much more discussion of this topic at the Health 2.0 Provider Symposium on Sunday, and much more in the Health 2.0 Fall Annual Conference as a whole.
Information blocking, Siloed data. No real inter-operability. Standards that aren’t standards. In the last few years, the clamor about the problems accessing personal health data has grown as the use of electronic medical records (EMRs) increased post the Federally-funded HITECH program. But at Health 2.0 where we focus on newer health tech startups using SMAC (Social/Sensor; Mobile OS; Cloud; Analytics) technologies, the common complaint we’ve heard has been that the legacy–usually client-server based–EMR vendors won’t let the newer vendors integrate with them.
With support from California Health Care Foundation, earlier this year (2016) Health 2.0 surveyed over 100 small health tech companies to ask their experiences integrating with specific EMR vendors.
The key message: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. All the data is in the embedded slide set below, with much more commentary below the fold.
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.
I want to put this essay in the context of my day job as co-chairman of Health 2.0, where I look at and showcase new technologies in health. We have a three part definition for what we call Health 2.0. First, they must be adaptable technologies in health care, where one technology plugs into another easily using accessible APIs without a lot of rework and data moves between them. Second, we think a lot about the user experience, and over eight years we’ve been seeing tools with better and better user experiences–especially on the phone, iPad, and other screens. Finally, we think about using data to drive decisions and using data from all those devices to change and help us make decisions.
This is the Cal Pacific Medical Center up in San Francisco. The purple arrow on the left points to the door of the emergency entrance.
Cal Pacific is at the end of that big red arrow on the next photo. On that map there’s also a blue line which is my effort to add some social commentary. To the top left of that blue line in San Francisco is where the rich people live, and on the bottom right is where the poor people live. Cal Pacific is right in the middle of the rich side of town, and it’s where San Francisco’s yuppies go to have their babies.
Last year, on August 26, 2014 at about 1 am to be precise, I drove into this entrance rather fast. My wife was next to me and within an hour, we were upstairs and out came Aero. He’s named Aero because his big sister was reading a book about Frankie the Frog who wanted to fly and he was very aerodynamic. So when said, “What should we call your little brother?” She said, “I want to call him Aerodynamic.” We said, “OK, if he comes out fast we’ll call him the aerodynamic flying baby.” So he’s called Aero for short.
Thus began the Quest for Intra-Aero-Bili-ty –a title I hope will grow on you. The Bili part will become obvious in a paragraph or two.
Something had changed since we had been at Cal Pacific three years earlier for the birth of Coco, our first child.
If you look carefully at the top of Amanda’s head, there’s now a computer system. Like most big provider systems, Sutter–Cal Pacific’s parent company–has installed Epic and it’s in every room or on a COW (cart on wheels). Essentially we have spent the last few years putting EMRs in all hospitals. This is the result of the $24+ billion the US taxpayer (well, the Chinese taxpayer to be more accurate) has spent since the 2010 rollout of the HITECH act.Continue reading…
The immersion research he conducted was fantastic. Bob interviewed just about anyone you’ve ever heard of and a few you wish you hadn’t (more on that later). And in fact he’s been running interviews on THCB and elsewhere sharing some of the stuff that didn’t get in the book. But I’m still wrestling a little with what I think about the book itself. And I think it’s because I largely agree with him and his angst.
There is lots of wonderful stuff in this book. The change in the role of radiology post PACS, how patients are using open notes, whether Vinod Khosla agrees with Vinod Khosla about algorithms replacing doctors–all this and much more are here. But the book is largely about the introduction of the current generation of EMRs into the everyday practice of ordinary clinicians. There are by and large three camps of opinions about what’s happened.
One is that the EMR is a pox visited on physicians that costs a fortune, has worsened quality, heightened medical errors, blown up successful processes, and ruined the lives of doctors–unless they were given scribes. The second is that because of the “rush to judgement” caused by the HITECH Act and Meaningful Use, we put in EMRs that were based on 1990s client-server technology but they were the only ones mature enough for the job. Most of this camp thinks that they were way better than paper, will slowly improve, and that doctors and patients will find that these technologies will soon integrate with easy to use iPhone-like apps as their APIs open up–and that if we hadn’t mandated EMRs when the great recession gave us the chance, nothing would have happened. The third camp agrees that EMRs are better than paper but felt that the way HITECH was rolled out kept a bunch of dinosaurs in business, and is preventing the health IT equivalent of Salesforce displacing Siebel (or Slack displacing email).Continue reading…
Contrary to what you may think, most doctors do want to make eye contact. They aren’t antisocial. They want to engage. But they can’t. They’re too distracted by one of the worst computer games ever invented—the electronic medical record (EMR).
You may be surprised to see the EMR compared to a computer game, but there are many similarities. Both offer a series of clicks with an often-maddening array of tasks to solve. There are templates to follow, boxes to fill in & scoring. However, unlike most electronic games, the points accrued in the EMR often translate into payment—real dollars for either your doctor or the hospital.
Although these clicks and boxes may be necessary to document your visit, it’s distracting. And your doctor begins to feel more like a librarian cataloging information rather than, say, a historian capturing your story.Continue reading…
The rush to implement patient portals to meet Meaningful Use Stage 2 deadlines has focused most attention on getting the technology up and running, and convincing patients and providers to move to shared communication online. Hospitals and health systems have implemented portals with the help of incentives from the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, and patients and providers have been migrating to them at a slow but steady pace.
I am one of the patients eager to see this move to transparency, and have been a user of my health system’s portal from the start. But I’m far from a happy customer and my experience leaves me scratching my head. Sure, I can get online without a problem, and I can read my results.
Recently, I read online that my results were “probably benign (not cancer)” and it would be important to follow up with retesting in six months. This news, delivered with no phone call or follow up from the hospital or my primary care provider, was disconcerting. The specter of cancer was anxiety producing, as it would be for many, especially with no clinical context for interpreting my test results.
I never received human follow up. When finally I reached someone at the hospital to set up an appointment for a retest, I asked about the portal and the message and was referred to the hospital IT Department. Hmmm…I wondered. What does this mean? Is this what patient engagement is all about?Continue reading…
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