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Interview with Paul Black, CEO, Allscripts

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…

As Ohio Goes, So May Go the Nation:  The Patient Access Expansion Act

According to recent Ohio statistics, 1.3 million people have limited or no access to primary care physicians. Based on the 2015 Ohio Primary Care Assessment, 60 of 88 Ohio counties have medically-underserved populations.  The Patient Access Expansion Act (HB 273), co-sponsored by Representative Theresa Gavarone (3rd District) and Representative Terry Johnson (90th District), specifically addresses healthcare access by prohibiting physicians from being required to comply with maintenance of certification (MOC) as a condition to obtain licensure, reimbursement for work, employment, or admitting privileges at a hospital or other facility. 

Recently, I spoke with Representative Gavarone on the critical importance of this legislation for Ohio.  Physician family members have grumbled about the expense of MOC compliance however, a practicing cardiologist better clarified the connection between MOC regulations and the growing physician shortage.  “He shared his frustrations at the time and money involved participating in a program that has absolutely no scientifically-proven benefit for patient outcomes,” said Representative Gavarone.  The cardiologist discussed numerous hours wasted preparing for an exam with little to no bearing on his day-to-day work serving his patients.

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Maintenance of Certification: Who’s Regulating the Regulators?

When four physician certification boards founded the American Board of Medical Specialties (ABMS) in 1933, those forward thinking organizations—and their professional society sponsors—launched a national movement toward ever increasing physician accountability. Back then, quackery was rampant, so “board certification” meant a lot to patients. The ABMS has since grown to 24 member boards, all ostensibly dedicated to serving “the public and the medical profession by improving the quality of health care through setting professional standards for lifetime certification.”

Because information and technology now advance so rapidly, those one-time lifetime certificates from years ago may no longer be enough. A doctor who passed a test in 1990 isn’t necessarily competent today. The boards have thus changed their approach to certification; for newly minted physicians, time-limited (e.g., 10 year) endorsements now replace the lifetime ones granted to their predecessors. Initially contingent on additional examinations each certification cycle, these newer time-limited endorsements now additionally require ongoing participation in Maintenance of Certification (MOC®) programs.

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How the Government is Failing Health Tech Startups and What to Do About It

As the Senate debated the fate of the Affordable Care Act (ACA) in Washington this past summer, healthcare was front and center in newspapers and conversations around the country. While insurance coverage and the affordability of care certainly warrant the level of nationwide attention they received, they comprise only one dimension of the systemic deficits in US healthcare: access to care. Meanwhile, the pressing need to reform our broken delivery and payment structures and address the more than $1 trillion of waste in our system was being overlooked by lawmakers in DC.

Luckily, on the other side of the country, entrepreneurs and venture capitalists throughout Silicon Valley are paying plenty of attention to opportunities to improve the efficiency of healthcare. In the first quarter of 2017, while policymakers fought about repeal-and-replace, investors poured almost $1.5 billion into digital health startups (mostly in the San Francisco Bay Area). This is on top of over $29 billion invested in healthcare startups between 2010 and 2016. Many of these budding companies are poised to significantly improve the way healthcare is administered and enhance the experience of providers and patients in novel, tech-enabled ways. Unfortunately, in addition to the myriad barriers facing any new startup, healthcare startups also encounter several unique obstacles rooted in policy failures that severely limit their potential to disrupt a system badly in need of disruption.

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Larry Weed’s Legacy and the Next Generation of Clinical Decision Support


The following originally appeared as a guest post at the blog of the director of National Library of Medicine (NLM) and NIH Interim Associate Director for Data Science, Dr. Patti Brennan.

“Patients are sitting on a treasure trove of data about their own medical conditions.”

My late father, Dr. Lawrence L. Weed (LLW), made this point the day before he died. He was talking about the lost wealth of neglected patient data—readily available, richly detailed data that too often go unidentified and unexamined. Why does that happen, and what can be done about it?

The risk of missed information

From the very outset of medical problem-solving, LLW argued, patients and practitioners face greater risk of loss and harm than they may realize. The risk arises as soon as a patient starts an internet search about a medical problem, or as soon as a practitioner starts questioning the patient about the problem (whether diagnostic or therapeutic).

Ideally, these initial inquiries would somehow take into account the entire universe of collectible patient data and vast medical knowledge about what the data mean. But such thoroughness is more than the human mind can deliver.

This gap creates high risk that information crucial to solving the patient’s problem will be missed. And whatever information the mind does deliver is not recorded and harvested in a manner that permits organized feedback and continuous improvement.

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Giving a Voice To Healthcare’s ‘Unacceptables’

Humans are aspirational by nature.

We dream big and invest tools that help us dream bigger. But we forget—sometimes willfully—that many of us are being left behind—because of racial, cultural or gender biases; poor access to connected technologies; or social stigmas associated with loneliness and sexual assault.

But if working in healthcare over the past 10 years have demonstrated anything, it’s that we are ready and willing to do something about the problems that keep all of us from looking to brighter futures.

It’s why I am proud to introduce a special session at the 11th Annual Health 2.0 Fall Technology Conference—The Unacceptables. Healthcare has too many innovators, too many dreamers, to empathizers to tolerate forgotten populations.

Leveling the Playing Field

As our society grows increasingly diverse and gaps in health among different populations increase, there is an urgency to develop solutions for underserved communities and diversify the population of innovators who are creating these solutions.

Diversity in Healthcare. As part of its mission to improve health for all, the Robert Wood Johnson Foundation (RWJF) has placed special emphasis on creating diversity in healthcare leadership. Last year, RWJF launched four new leadership development programs to engage people working across a variety of sectors to build a Culture of Health. Hear Michael Painter, Senior Program Officer, discuss how RWJF engages professionals, community advocates and organizers, doctoral scholars, clinicians, and researchers across multiple fields, represented by participants with diverse backgrounds, perspectives, and specialties.

Women in Health IT. The numbers are startling. Women make up 80% of the workforce, but only 4% of CEOs. Women in health IT earn 20% less than their male counterparts, according to HIMSS. Progress has been made, but more could be done (hello, booth ‘girls’, for a start) to address gender roles in our industry. Lisa Suennen, Senior Managing Director Healthcare Investing, GE Ventures, lead Venture Valkyrie LLC, a publishing, and business advisory firm and is a founder of CSweetener, a not-for-profit company focused on matching women in and nearing the healthcare C-Suite with mentors who have been there and wish to give back, and which she writes about here.

Read my full article here

Bringing Behavioral Health into Primary Care Settings

The integration of behavioral health into the primary care setting has resulted in a number of benefits. Traditionally, behavioral health and medical health operated separately, but in recent years, the integration of these two systems has improved access to care, ensured continuity of care, reduced stigma associated with seeking care and allowed for earlier detection and treatment of mental health and substance abuse issues. By bringing behavioral health specialists into primary care facilities, healthcare systems have streamlined care and brought down costs, working collaboratively and reducing the number of appointments and hospital visits.

At Carolinas HealthCare System, we use technology to take behavioral health integration one step further. A robust behavioral health integration project was developed through myStrength, using virtual and telehealth technology to ensure that every primary care practice has the capabilities for early detection of mental illness and substance abuse and upstream intervention, easing the connection between behavior health specialists and patients who might otherwise be averse to seeking professional help.

Mental illness touches each of us personally: one in five individuals struggles with mental health issues, yet access to care is one of the biggest issues facing North Carolina residents today.Continue reading…

In Which We Wonder Where the Graham-Cassidy Bill Came From and What It All Means

The latest Republican attempt to repeal and replace the ACA looks a lot like what they were trying to do in May, June and July—and failed to do.

But actually, the framing of the current effort—the Graham-Cassidy bill—is much more deeply grounded in the perennial debate over where political power resides in the U.S.:  the federal government or the states.   Graham-Cassidy also more starkly reflects what many conservatives are trying to achieve in health care policy.   And what they are trying to achieve is, to put it euphemistically, not nice.  

On both counts, this renewed debate resonates politically beyond health care.  It’s no coincidence that the two Senators behind this new push, Lindsey Graham and Bill Cassidy, are from southern states—South Carolina and Louisiana, respectively.   Before the Civil War, during the Civil War, and up to the present day, southern conservatives like Graham and Cassidy—more passionately than their northern counterparts—have pushed to devolve power to the states and weaken the federal government.

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What Does an Ideal Healthcare System Look Like?

Austin Frakt and Aaron Carroll recently approached me about a New York Times UpShot piece aiming to rank eight healthcare systems they had chosen: Australia, Canada, France, Germany, Singapore, Switzerland, the United Kingdom, and the United States. This forced me to think about a pretty fundamental question: what do we want from a healthcare system?

I would argue that most people want a healthcare system where they can get timely access to high quality, affordable care and one that also promotes innovation of new tests and treatments. But underlying these sentiments are a lot of important issues that need unpacking. First, what does it mean to be able to access care when you need it? A simple way to think about this is being able to see a doctor (or other healthcare professional) quickly and easily and in cases where there are follow-on tests, procedures, and treatments, you can get them without much delay. This brings up one important point: while experts often discount the importance of timeliness, regular people generally don’t: anyone who has waited weeks or months for a follow-up after an abnormal test result or to get a needed surgery knows that waiting times are not just an inconvenience. Delayed access can be stressful, agonizing and in some instances, downright harmful.

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How Consumers Are Shaping the Next Gen Wellbeing Experience

Our day-to-day interactions with technology are changing expectations and aspirations for almost every touch point in modern life. We want instant feedback and action at the push of a button, from the digital shopping cart to the doctor’s office. That is part of why there is a constant stream of new apps and tech services being released across every industry, including wellness. But the barrage of options can be a problem of its own nature.

To better understand what people want and how to deliver resources that resonate and stick, we spent time studying how real people engage (or don’t) with personal health and well-being. What we found was instantly familiar yet full of deeply personal insights that made the struggle real and the solution obvious.

So often we design towards an end-goal or finish line. As we were reminded through our research, health is not static. For the healthy, those with chronic conditions, those actively managing to avoid serious health issues, the issues are all the same: it’s a challenge to live your healthiest life every day. It’s a daily struggle to avoid the foods we shouldn’t eat; it’s a daily struggle to exercise; it’s a daily struggle to live in the “white space” between doctor appointments.Continue reading…

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