Today on Health in 2 Point 00, we have SoftBank Money! I managed to beat Chrissy Farr to this piece of gossip by about 3 weeks, but digital pharmacy startup Alto raises $250 million from SoftBank. Medloop raises 6 million euros doing communication with patients, and mental health startup Spring Health raises $22 million as well. Turning to the EMR drama, I also give a rundown on Judy Faulkner’s letter, and explain the cautionary tale that is Practice Fusion & the Purdue opiate promotion. —Matthew Holt
Health in 2 Point 00, Episode 76 | Facebook releasing an EMR? Jim Cramer Going to Epic? #AprilFools
Facebook is releasing an EMR? Jim Cramer is going to work at Epic? April Fools! On today’s actual Health in 2 Point 00 Episode 76, Jess asks me about the follow up from Health Datapalooza, which ended with the government saying they will be changing the world and that everyone should join them in their initiative to innovate digital health. AHRQ & CMMI ran digital health challenges, and CMMI will be doing an AI challenge for $1 million for startups in the space. Speaking of the government, Seema Verma was in the news for her PR spending and as I said “Evil Twin Seema” and “Good Seema” are joined at the hip and they should “not screw around on the PR front”. In other news, MountSinai launched a digital health institute to develop advances in artificial intelligence and other emerging health care technologies spaces. Clover Health laid off a ton of people, and according to me, they are starting to get serious because running a Medicare Advantage plan is hard work — Matthew Holt
EMRs, APIs, App stores & all that: More data
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…
In Search of Intra-Aero-Bili-ty
Another one of my favorites, although this one is much more recent than those published so far–dating back to only March 2015. It was the written version of a talk I gave in September 2014 following the birth of my son Aero on August 26, 2014. So if we are discussing birthdays (and re-posting classics as, yes, it’s still THCB’s 15th birthday week!) we might as well have one that is literally about the confluence of a birthday and the state of health IT, health business, care for the underserved and much more!
Today is the kick-off of the vendor-fest that is HIMSS. Late last week on THCB, ONC director Karen De Salvo and Policy lead Jodi Daniel slammed the EMR vendors for putting up barriers to interoperability. Last year I had my own experience with that topic and I thought it would be timely to write it up.
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…
Integrating with EMR vendors? Tell us More! The 2018 Health 2.0 API Survey
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.
Kim Krueger is Research Director at Health 2.0
HIT Newser: We Need Interoperability, Says HELP
Judy Faulkner pledges to donate her wealth
Epic founder and CEO Judy Faulkner announces plans to give away 99% of her estimated $2.3 billion wealth to charity. Faulkner joins 136 other individuals and families in the Giving Pledge, which was launched by Warren Buffett and Bill and Melinda Gates to encourage billionaires to give the majority of their wealth to philanthropic causes.
What’s not to like about that? Good to know that if Epic wins the $11 billion bid for the VA’s EHR system, some of the government’s money will eventually trickle back down to charity.
Are EHRs creating disparity in care?
A study from Weill Cornell Medical College looks at “systematic differences” between physicians who participated in the Meaningful Use program and those who did not, noting that the differences “could lead to disparities in care.”
The researchers suggest that providers participating in the MU program may provide higher quality care to their patients as physicians using paper records “have less reliable documentation and weaker communication” between providers and won’t benefit from EHR-enabled quality improvements.
I suspect that physicians relying on paper records would balk at the suggestion that the care they provide is inferior to their more digitally-equipped peers. However, it’s hard not believe that the overall care process would be enhanced if all providers could electronically share critical patient information.
News Flash: Government is wasteful in its spending
The Government Accountability Office releases a report calling for urgent action on federal IT Continue reading…
HIT Newser: Will Stage 3 Meaningful Use Be Delayed?
CMS Releases Final Update to ACO Program
CMS releases a final rule updating the Medicare Shared Savings Program, which includes a new higher-risk, higher-reward Track 3 option; streamlines data sharing between CMS and ACOs; and adds a requirement that ACOs applying for the program describe how they will promote the use of health IT to boost care coordination.
Organizations Urge Stage 3 Delay
The AMA and MGMA join the AHA and CHIME in calling for a delay in finalizing Stage 3 Meaningful Use requirements. The current version is largely viewed as too burdensome for providers with the potential to impede the use of health IT to improve quality and efficiency.
Quite simply, Stage 3 will not be successful without provider buy-in. There have been delays before; look for another oneContinue reading…
In Defense of Epic. No, Really!
Today THCB is delighted to feature an excerpt from Robert Wachter’s much-talked about new book “The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine’s Computer Age“ (McGraw Hill, 2015). If you enjoy this piece, be sure have a look at the director’s cut interviews Wachter did for the book with Atul Gawande: “Computers Replacing Doctors“, and John Halamka: “Black Turtlenecks, Data Fiends & Code.” — John Irvine
That Epic would find itself labeled a monopoly is in itself an extraordinary turn of events. In 2000, after 21 years in business, the company had only 400 employees and 73 clients, and did not appear on a list of the top 20 hospital EHR vendors. Its big break came in 2003, when the 8 million–member Kaiser Permanente system selected Epic over two far better known competitors, IBM and Cerner. The cost to build Kaiser’s electronic health record: $4 billion.
Today, Epic has 8,100 employees, 315 clients, and yearly revenues of approximately $2 billion. The system is now deployed in 9 of the US News & World Report’s “Top 10” hospitals. In 2014, the company estimated that 173 million people (54 percent of the U.S. population) had at least some medical information in an Epic electronic record.
Epic Founder and CEO Judy Faulkner’s vision, built on several central tenets, has been vindicated many times over. The first principle was that the winning EHR vendor would be the one that solved the most problems for its customers.
While Apple’s App Store has made a modular environment seem feasible and even desirable, most healthcare decision makers want a single product that does everything they need right out of the box (physician notes, nursing notes, drug ordering and dispensing, billing, compliance, and population health) and does those things everywhere, from the newborn nursery to the urology clinic to the ICU.
In Search of Intra-Aero-Bili-ty
Today is the kick-off of the vendor-fest that is HIMSS. Late last week on THCB, ONC director Karen De Salvo and Policy lead Jodi Daniel slammed the EMR vendors for putting up barriers to interoperability. Last year I had my own experience with that topic and I thought it would be timely to write it up. (I’ll also be in the Surescripts booth talking about it at 3.45 Monday)
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…
Epic Systems’ Open Platform Will Bring U.S. Health Care Delivery Into the 21st Century
Epic Systems, the market leader in electronic health record software (EHR), recently made a quiet but potentially transformative announcement that may finally shake the healthcare industry out of its technological doldrums.
Epic said it is prepared to support the creation of a more open interoperability platform for integration with other diversified healthcare applications. This will attract substantial investment to create software that operates, hopefully seamlessly, within the Epic EHR infrastructure. Expect Epic’s competitors to follow suit, eventually opening up the marketplace of installed EHRs to third-party software developers and the efficiencies of modern, post-EHR technology ecosystem.
Epic’s critics have often denounced the company for selling a mostly closed technology, dampening hopes for the creation of an ecosystem of best-of-breed applications that work together with the EHR to automate much of the care delivery infrastructure beyond patient intake and billing. The value of such an infrastructure is extremely compelling and so the company is under enormous pressure from its customers to become more open.
