Beyond a Thousand Clicks

On March 18th, Kaiser Health News (KHN) and Fortune published https://khn.org/news/death-by-a-thousand-clicks/, a deep expose into all that has gone wrong with the adoption of Electronic Health Records (EHR) across the physician landscape in the U.S. The article was well researched – it is a good piece of journalism.

But are the findings in this article all that surprising?

Frankly, no.

Prior to the signing of the HITECH Act in 2007, which incentivized physicians to adopt EHRs, EHR adoption nationwide stood at a paltry 12-14% for hospitals and about half that for physician practices. Within a decade, however, EHR adoption soared to over 95% for hospitals. That is a massive uptake of a technology that most healthcare organizations were loathed to adopt in the first place.

What could go wrong? Plenty.

As the KHN article points out, we are still working our way through the muck of what became a false market created by the HITECH Act for EHR software adoption and use. The market became flooded overnight with EHR solutions. Despite the government’s best efforts to certify that these solutions met certain criteria – a lot of questionable software ended up in the market.

Yet, even some of the most popular, widely adopted EHR software deployed across the industry is not meeting the needs of end users. In two separate conversations I have had with physicians on my care team, one likened the EHR his large academic medical center is using to just a glorified billing system that does nothing for him in actually caring for his patients. The second physician turned to me after painfully clicking over and over again to make an appointment stated: “If anything is going to make me lose my love of medicine, it is this EHR software.” And note, this was a freshly installed EHR replacing this health system’s internally developed EHR.

Deploying a complex enterprise software solution, be it EHR, supply chain, enterprise resource planning (ERP), etc. is an extremely challenging endeavor regardless of industry sector. I watched first-hand as some of the largest manufacturers in the world did massive rollouts of SAP, Oracle and other systems and it was never, ever easy. Cost overruns, delays and extremely dissatisfied end users were par for the course. And this was an industry sector that willingly made the choice to invest and adopt such systems.

So yes, there is plenty to write about on how the digitization of healthcare has delivered results far, far less than first imagined when HITECH was passed. We still have a long road ahead in optimizing the technology for end users – a technology that was so hastily adopted in a market not fully sold on its intrinsic value. But that is a relatively easy story to tell, albeit limited in vision and scope

What tends to get lost in these discussions is that what we are doing today is laying the foundation for an entirely new change in how we will deliver care, change that will occur along the entire care delivery chain.

Keeping an Eye on the Prize

However, what tends to get lost in these discussions is that what we are doing today is laying the foundation for an entirely new, dare I say radical, change in how we will deliver care, change that will occur along the entire care delivery chain.

The field of medicine has never had such vast troves of computational medical data available to it as we are beginning to see today. The potential opportunity to do deep analysis on such data will open completely new discoveries on everything from the efficacy of therapeutics and clinical pathways, to advances in artificial intelligence for more accurate diagnosis, to discovering new treatment modalities to other advances that are only limited by one’s imagination. One need only look at some of the work Dr. Atul Butte is doing at UCSF to have an appreciation for what we are beginning to unravel today and what the future may hold.

This deeper, broader view of what the adoption and use of EHRs and other enterprise software to support the delivery of care – including new analytics solutions such as those profiled in our recent report – is truly the prize, as a society we are after. Let’s keep our eye on the prize.

Stay up to the minute.

Did You Know?

Healthcare Provider Analytics and Reporting: Expanding Beyond VBC Use Cases

We will release our newest report, 2019 Healthcare Provider Analytics Market Trends Report, in the next few days. This report reviews the current market for provider analytics and evaluates offerings from 23 different vendors.

Key Takeaways

  • Value-based care is the dominant business driver for adoption of analytics solutions by providers.
  • Reports and dashboards are still the main way that users experience and benefit from analytics technologies.
  • Advanced analytics capabilities are seeing increased interest, but mostly from large HCOs.
  • Deriving actionable plans from the data that goes into analytics solutions remains a challenge.

In recent years, providers invested in analytics technology to support the transition from fee-for-service (FFS) to val­ue-based care (VBC). Vendor offerings that support the variety of pay-for-performance (P4P), pay-for-reporting (P4R), and risk-sharing programs with payers have helped them better understand the interaction of costs, quality, and utilization in the populations they serve. But the applica­tions for analytics are broader than just VBC. Provider healthcare organizations (HCOs) are seeking to leverage these technologies more broadly to support a range of clinical, financial, and operational performance improvement goals and programs.

Acute and Ambulatory Use Cases

Provider-oriented analytics availability mirrors EHR penetration. Providers in acute and ambulatory settings have many choices for analytics across multiple use cases. Providers in post-acute settings and others with low EHR penetration have relatively fewer choices. While vendors have devised a number of ways to extend their offerings to underserved settings, not all providers take full advantage of such capabilities.

EHR vendors are often, but not always, providers’ first choice for analytics. Most EHR vendors sell analytics offerings almost exclusively to their existing EHR customers. Independent vendors – not owned by an EHR vendor or a payer – are a strong alternative to EHR companies for value-based care use cases. Claims analytics companies have deep experience with claims data sources or rely heavily on claims-related data to fuel analytics and reporting. Applications from many of these vendors emphasize cost and utilization control and feature deeply descriptive insights into risks, costs, quality, and utilization. Providers have historically been reluctant to adopt these offerings, but that is changing.

Mainstream Analytics

This report characterizes current analytics solutions as either “mainstream” or “advanced.” Most HCOs have experience with mainstream analytics – often cloud-hosted and reliant on relational databases that store historical data from the EHR, claims, and other sources. The resulting applications characterize and summarize performance along multiple dimensions. While this technology approach is well-established, mainstream analytics still faces challenges. Chief among these are data quality and variability. Diligence is required on the part of vendors and HCOs to ensure this data is accurate, high-quality, and up-to-date.

Data complexity challenges are only increasing because new data sources are on the horizon. The All of Us program (formerly known as the Precision Medicine Initiative) promises to unleash a torrent of novel and voluminous data types. In addition, the vast trove of unstructured data in EHRs will soon contribute to a better understanding of patient cohorts and risks. Social determinants of health (SDoH), data from smart health monitoring and fitness devices, and a variety of patient-reported and publicly-available data sets are also beginning to be used in provider analytics.

Mainstream analytics has yet to supply a variety of predictive and prescriptive insights; for that, HCOs are looking at advanced analytics.

Advanced Analytics

Advanced analytics consists of interrelated technologies, the most common of which are artificial intelligence (AI)/machine learning (ML), natural language processing (NLP) and extraction, and big data technologies. These technologies and techniques are not widely deployed in healthcare, but are used to varying degrees by most of the vendors profiled in this report. The expectation is that as these technologies mature, advanced analytics will offer more and better predictive and prescriptive capabilities. Many vendors now offer optional services to help providers take better advantage of advanced analytics technologies. Increased organizational familiarity with AI technologies and algorithms should naturally increase user trust as the technologies mature and become more widespread.

Conclusion

Many provider organizations, with experience gained from their VBC efforts, want more benefits from analytics. Whether it is from their legacy point and departmental reporting solutions, mainstream, or advanced analytics, provider organizations see analytics and reporting as a reliable way to pursue performance improvement goals across their enterprises.

HIMSS’19: Maturing Market Drives Pragmatism

Even the exhibit hall was calmer with vendors focused on solving specific problems instead of the latest buzzword

Frankly, I was dreading attending HIMSS this year. I’ve grown tired of the hype, the noise and just how little we have accomplished as an industry in the past few years. We have not contained costs, but have increased clinician burnout. We have made only a modest impact on quality, but the lack of interoperability has hampered care coordination. I had become increasingly cynical every year as we approached the big event, dreading more of the same, which is never a good thing.

Yet at the outset, while waiting to board my flight to Orlando, I started meeting many a compatriot in healthcare IT. This did not stop until I landed back in Boston five days later. Those brief meetings always included a hug, checking in with how each other is doing personally and then proceeding to talk about the industry – in that order. I have worked in a wide range of industries over the course of my career, only in healthcare have I experienced such genuine warmth and caring. These brief encounters renew my spirit pushing that cynicism back for this industry is more than just a business, it is about health, and it is about life.

HIMSS’19 Reflections

For the last eleven HIMSS conferences I have attended, there has always been one buzzword or acronym that virtually all vendors on the exhibit floor would latch onto, whether they could deliver those capabilities or not. There was no such word or acronym this year. The hype, the buzz may be behind us, which is welcomed by this analyst and I’m sure most in attendance.

I also noticed that conversations were less about whiz-bang features. Instead, conversations focused on specific problems that can be solved and value delivered to an organization. The industry is quickly moving beyond being strictly regulatory-driven (albeit CMS’s NPRM dropped Monday at HIMSS goes against that) to a more pragmatic market, which is a healthy sign of a maturing industry.

It was clear this year that the EHR war for buyers is over. Those EHR vendors offering a fairly limited, EHR-centric product with few extensions (e.g. analytics, RCM, PHM, etc.) were eerily quiet. EHR vendors with broad capabilities had their fair share of visitors, but the discussions focused on the extension apps and equally important, how to extract value from those significant EHR investments.

In speaking to one of the largest EHR vendors, they were surprised by the interest in PHM among their clients, which has been tepid in recent years. Clearly, CMS’s recent moves to get provider organizations to get serious and start taking on downside risk are being felt. But this vendor went on to say that most prospects simply want someone to tell them what to do to be successful. For companies like Aledade and Evolent this must sound like mana from heaven.

Some quick outtakes from HIMSS’19

  • Acute and ambulatory have been by and large taken care of, yet we still do a very poor job as an industry addressing the “community of health.” Good opportunity for a truly visual, intuitive platform.
  • Ada Health, a Berlin-based small company using AI for self-triage is just entering the US market and has landed Sutter Health as its lighthouse customer. Keep an eye on them – they are interesting.
  • Significant shift among provider-centric vendors who are now signing large deals with payers. Still plenty of mistrust between providers and payers, but if incentives are aligned – it can work.
  • Collective Medical out of Utah has been operating in stealth mode and racked up several payer and provider clients. Compelling value-prop but they will have to move fast as several much larger vendors are looking to do something similar.
  • Many a large health IT vendor does a poor job at data aggregation and digestion (normalization) and are seeking partnerships with a number of small innovative companies that focus on this problem.
  • Apervita, a company that has been around for several years with a business model I never was fond of has completely changed direction. I like what I saw at HIMSS this year. Their work with NCQA is pretty impressive.

The Wrap

HIMSS this year reflects a maturing market. With any maturing market, conferences like HIMSS begin to lose their luster, despite their own self-promotional hype. But what HIMSS does well is to bring together a broad cross-section of the industry and remains a fabulous place to reconnect and network. Does it need to be three and a half days (plus!), I do not believe so. In five years, HIMSS will still be here, but the high water mark was likely last year (barring any major federal incentives a la HITECH). The tide is going out.

HIMSS’19: What to Expect, What I Hope to Find

Next week, most of the healthcare IT industry will descend on Orlando to attend HIMSS’19. This is my 12th year attending HIMSS, an event for me that is more about networking and confirming assumptions than actually learning anything new.

For years now, HIMSS and the multitude of vendors exhibiting there have feasted at the trough of federal largesse ($35B plus), via the HITECH Act passed in 2008 to foster adoption of EHRs. The HITECH Act was successful, driving EHR adoption from the low teens to over 90% today. Though some may question the value of that investment, I personally believe that over time (another 7-10 years) we will reap benefits that far exceed that initial investment.

However, now that we’ve reached that level of adoption, the market has plateaued. Sure, there were hopes of a robust EHR replacement market, but that never materialized. Then there was the hope for huge gains (profits) to be made on the shift from volume to value through the sale of PHM solution suites. That didn’t pan out too well either as the fate of the ACA was left in the lurch with a change in administrations. Also, quite frankly, PHM is a complex sell, requiring significant change management that few healthcare organizations were ready to commit to and few vendors had the services to support.

The provider health IT market is going through a significant transition and it’s not going to be pretty. Clearly, the party is over and one has to wonder: Why does HIMSS continue to exist? Why are all these vendors here? Are we on the Titanic, seemingly blind to the economic icebergs that surround us?

But I digress.

What is important is that the EHR has become the central nervous system to provider organizations. Secondly, this market will continue to consolidate rapidly with few independent EHRs surviving the shakeout. Those left standing will attempt a number of different strategies to drive continued growth in a plateauing market.

  • Acquire other EHR vendors to gain market share (Allscripts, Cerner, CPSI, Harris)
  • All major EHR vendors are pursuing an extension strategy moving from EHR to supporting PHM, RCM, analytics, etc, though their capabilities in these adjacent areas vary wildly.
  • Expansion into new markets. Epic is looking to dentistry and insurance. Allscripts, life sciences and payers with Veradigm. Cerner, government and payers. All large acute/ambulatory EHR vendors are actively pursuing overseas markets, with Meditech particularly strong in Canada.

It remains to be seen how successful these strategies will be but rest assured, even if successful, no EHR vendor is completely safe from a future acquisition.

This sets the stage for what to expect at HIMSS’19:

  • All vendors will continue to tout the momentum they have in the market as if this market will remain forever on a hockey stick trajectory, but very few can back it up.
  • AI/ML will be just as pervasive this year as last, permeating all aspects of health IT, but likely very little demonstrable proof of scale.
  • A multitude of disease-specific, chronic management solutions but no vendor with a true portfolio of best-in-class solutions on a single platform. Resmed appears close to enabling such a platform for respiratory ailments.
  • More FHIR use cases.
  • Plenty of patient-centric this, consumer-centric that but all a head fake as it is really about capturing patient revenue via online bill pay and filling vacant appointment slots.

And what I hope to find at HIMSS’19:

  • An AI/ML company that has truly scaled its solution across an enterprise in at least two customer deployments.
  • Clear metrics from EHR vendors on the level of adoption and use of FHIR across their client base.
  • An engagement solution that is looking beyond the near-term volume/revenue needs of a healthcare organization to how to truly engage patients/consumers in their health e.g. Aetna/Apple’s Attain app.
  • How vendors are assisting their customers in achieving demonstrable, defendable ROI from their solutions. Health Catalyst stands out here.

May your trip to HIMSS’19 be a success, however you define it. And if you see us in the halls, do not hesitate to stop and say hello – maybe we’ll have a few quick on-the-fly notes to share.

Revisiting Our 2018 Predictions

As is our custom here, we like to look back on our predictions for the closing year and see just how well we did. Some years we do amazingly well, others we over-reach and miss on quite a few. For 2018, we got seven of our 13 predictions spot-on, two were mixed results and four predictions failed to materialize. If we were a batter in the MLB we would have gotten the MVP award with a .538 batting average. But we are not and have to accept that some years our prediction average may hover just above the midpoint as it did this year.

Stay tuned, 2019 predictions will be released in about one week and it is our hope that they will inspire both rumination and conversation.

(Note: the bigger and plain text are the original predictions we made in 2017, while the italic text is our review of 2018). 

Merger & acquisition activity continues; Humana or Cigna acquired.

Major mergers and acquisitions that mark the end of 2017 (CVS-Aetna, Dignity Health-CHI and rumored Ascension-Providence) will spill over into 2018. Both Humana and Cigna will be in play, and one of them will be acquired or merged in 2018.

MISS – neither happened. However, Cigna did pick-up PBM service Express Scripts and rumors continue to swirl about a possible Humana-Walmart deal or more recently, even a Walgreens-Humana deal.

 

Retail health clinics grow rapidly, accounting for 5 percent of primary care encounters.

Hot on the health heels of CVS’ acquisition of Aetna, growth in retail health reignites, albeit off a low overall footprint. By end of 2018, retail health clinic locations will exceed 3,000 and account for ~5% of all primary care encounters; up from 1,800 and ~2%, respectively, in 2015.

MISS – Modest growth in 2018 for retail health clinics with an estimate of around ~2,100 by year’s end. Telehealth, which is seeing rapid growth and on-site clinics may be partially to blame.

 

Apple buys a telehealth vendor.

In a bid to one-up Samsung’s partnership with American Well, and in a bid to establish itself as the first tech giant to disrupt healthcare delivery, Apple will acquire a DTC telehealth vendor in 2018.

MISS – Apple continues to work on the periphery of care with a focus on driving adoption of its Health Records service in the near-term with a long-term goal of patient-directed and curated longitudinal health records.

 

Sixty percent of ACOs struggle to break even.

Despite investments in population health management (PHM) solutions, payers still struggle with legacy back-end systems that hinder timely delivery of actionable claims data to provider organizations. The best intentions for value-based care will flounder and 60% of ACOs will struggle to break even. ACO formation will continue to grow, albeit more slowly, to mid-single digits in 2018 to just under 1,100 nationwide (up from 923 as of March 2017).

HIT – MSSP performance data showed only 34% earned shared savings in 2017 (up from 31% in 2016) and by year’s end it is estimated there will be ~1,025 ACOs in operation.

 

Every major EHR vendor delivers some level of FHIR support, but write access has to wait until 2019.

While some of the major EHR vendors have announced support for write access sometime this year and will definitely deliver this support to their most sophisticated customers, broad-based use of write APIs will happen after 2018. HCOs will be wary about willy-nilly changes to the patient record until they see how the pioneers fare.

HIT FHIR-based read APIs are available from all of the major EHR vendors. Write APIs are still hard to find. To be fair, HCOs as a group are not loudly demanding write APIs.

 

Cloud deployment chips away at on-premises and vendor-hosted analytics.

True cloud-based deployments from name brand vendors such as AWS and Azure are in the minority today. But their price-performance advantages are undeniable to HIT vendors. Cerner will begin to incent its HealtheIntent customers to cloud host on AWS. Even Epic will dip its toes in the public cloud sometime in 2018, probably with some combination of Healthy Planet, Caboodle, and/or Kit.

HIT – adoption of cloud computing platforms is accelerating quickly across the healthcare landscape for virtually all applications. Cloud-hosted analytics is seeing particularly robust growth.

 

True condition management remains outside providers’ orbit.

Providers will continue to lag behind payers and self-insured employers in adopting condition management solutions. There are two key reasons why: In particular, CMS’s reluctance to reimburse virtual Diabetes Prevention Programs, and in general, the less than 5% uptake for the CMS chronic care management billing code. In doing so, providers risk further isolation from value-based efforts to improve outcomes while controlling costs.

HIT – Awareness of the CCM billing code (CPT code 99490) remains moderate among providers and adoption is still estimated at a paltry less than 15%.

 

Mobile-first becomes the dominant platform for over 75% of care management solutions.

Mobile accessibility is critical for dynamic care management, especially across the ambulatory sector. More than 75% of provider-focused care management vendors will have an integrated, proprietary mobile application for patients and caregivers by end of 2018. These mobile-enabled solutions will also facilitate collection of patient-reported outcome measures, with 50% of solutions offering this capability in 2018.

MIXED – While the majority of provider-focused care management vendors do have an integrated mobile application (proprietary or partnership), collecting PROMs is still a functionality that remains limited through an integrated mobile solution.

 

Solutions continue to document SDoH but don’t yet account for them.

A wide range of engagement, PHM, EHR, and care management solutions will make progress on documenting social determinants of health, but no more than 15% of solutions in 2018 will be able to automatically alter care plan interventions based on SDoH in 2018.

HIT – despite all the hoopla in the market about the need to address SDoH in care delivery, little has been done to date to directly affect dynamic care plans.

 

ONC defines enforcement rules for “data blocking,” but potential fines do little to change business dynamics that inhibit data liquidity.

The hard, iron core of this issue is uncertainty about its real impact. No one knows what percentage of patients or encounters are impacted when available data is rendered unavailable – intentionally or unintentionally. Data blocking definitely happens but most HCOs will rightly wonder about the federal government’s willingness to go after the blockers. The Office of the National Coordinator might actually make some rules, but there will be zero enforcement in 2018.

MIXED – Last December we said, “The hard iron core of this issue is uncertainty about its real impact.” Still true. Supposedly, rulemaking on information blocking is complete but held up in the OMB. The current administration does not believe in regulation. So “data blocking” may be defined but there was and will be no enforcement or fines this year.

 

PHM solution market sees modest growth of 5-7%.

Providers will pull back on aggressive plans to broadly adopt and deploy PHM solution suites, leading to lackluster growth in the PHM market of 5% to 7% in 2018. Instead, the focus will be on more narrow, specific, business-driven use cases, such as standing up an ACO. In response, provider-centric vendors will pivot to the payer market, which has a ready appetite for PHM solutions, especially those with robust clinical data management capabilities.

HIT – PHM remains a challenging market from both payment (at-risk value-based care still represents less than 5% of payments nationwide) and value (lack of clear metrics for return on investment) perspectives. All PHM vendors are now pursuing opportunities in the payer market, including EHR vendors.

 

In-workflow care gap reminders replace reports and dashboards as the primary way to help clinicians meet quality and utilization goals.

This is a case where the threat of alert fatigue is preferable to the reality of report fatigue. Gaps are important, and most clinicians want to address them, but not at the cost of voluminous dashboards or reports. A single care gap that is obvious to the clinician opening a chart is worth a thousand reports or dashboards. By the end of 2018, reports and dashboards will no longer be delivered to front-line clinicians except upon request.

MISS – Reports and dashboards are alive and well across the industry and remain the primary way to inform front-line clinicians about care gaps.

 

At least two dozen companies gain FDA-approval of products using machine learning in clinical decision support, up from half a dozen in 2017.

Arterys, Quantitative Insights, Butterfly Network, Zebra Medical Vision, EnsoData, and iCAD all received FDA approval for their AI-based solutions in 2017. This is just the start of AI’s future impact in radiology. Pioneer approvals in 2017 — such as Quantitative Insights’ QuantX Advanced breast CADx software and Arterys’s medical imaging platform — will be joined by many more in 2018 as vendors look to leverage the powerful abilities of AI/ML to reduce labor costs and improve outcomes dependent on digital image analysis.

HIT – With about a month left in 2018 the count of FDA approved algorithms year to date is approaching 30 and could potentially hit three dozen by year end. This is a significant ramp up in the regulatory pipeline, but more is needed in the way of clear guidance on how they plan to review continuously learning systems and best practices for leveraging real-world evidence in algorithm training and validation.

 

What do you think of 2018 for health IT?

The Rise of APIs and App Stores In Healthcare

Two years ago, we published a report on the promise of open APIs in healthcare. In APIs for a Healthcare App Economy: Paths to Market Success (available as a free download), provider organizations told us that developing and using APIs was low on their list of priorities. Modern REST-style APIs were still not on the radar for most providers and payers.

doctor using smartphone app

Back then, HCOs large and small said they expected their EHR vendor to build an API infrastructure for them. Two years ago, only Allscripts and athenahealth offered an app store along with a comprehensive developer support program. At that time, the other EHR vendors were slow-walking FHIR support and had vague plans for app stores and developer support programs. We found that:

  • Small HCOs were completely dependent on their EHR vendor.
  • EHR data was the most valuable data resource in healthcare.
  • Large IT vendors had varied beliefs about the role and contribution of third-party developers.
  • Large and small IT vendors had strong faith in open APIs.
  • Small and independent IT vendors were thinking way beyond the EHR.
  • Physician dissatisfaction with EHRs was an unsolved problem.

Since then, market conditions have continued to change. EHR vendors are now more vocally rolling out the API infrastructures that will bring healthcare into the mainstream of 21st century computing. Every major EHR vendor has delivered a variety of proprietary, HL7, FHIR, and SMART APIs along with the ability to leverage REST to improve their products.

Each of these companies sponsor, or will soon sponsor, an app store for third-party innovation. This has seen a concurrent rise in interest for using APIs within provider organizations. A recent Chilmark report, Healthcare App Stores: 2018 Status and Outlook, examines some of these platforms and the progress that has been made to date in more depth.

That said, some things have not changed. EHR data remains the most valued data resource in healthcare. All but the largest provider organizations are dependent on their EHR vendor for API enabling technologies. Small and independent developers struggle to participate in app stores and EHR developer support programs, despite great ideas for better apps to improve care delivery. And physician frustration with EHRs continues to grow.

Developing and using APIs is a priority for healthcare stakeholders who want to get more from their EHR investments as they identify opportunities for workflow improvements, real-time analytics dashboards, and more. While EHR vendors are leading the charge, our more recent research suggests that many other stakeholders hold or control access to other key data sources that could underpin such efforts.

The opportunity to capitalize on data already collected to provide advice and predictions is too big to ignore, and the easiest way to do this efficiently will be with integrated apps that can pull data from any relevant resource to provide the necessary insights at the right time.

Where do we go from here?

The number of apps in EHR app stores grows monthly. To date, the idea of the potential role and benefits of an independent certification body has not entered the discussion about APIs and app stores since the collapse of Happtique’s efforts in 2013. Currently, EHR vendors certify apps for their customers based on rigorous internal evaluations, but the process varies by vendor. An independent and impartial body could do more than just provide information for prospective users. Instead, it could deliver tremendous value if its assessments were multi-pronged and supplied information about the ongoing use of the app, as well as a consistent way to think about safety, security and dependability. While a certification authority could make it easier for decision-makers, the real value could be in delivering users more information about how the app delivers value across its install base.

Sometime in the next few months, the ONC will issue new rules on information blocking and what constitutes an API that does not require “special effort” to access and use. While these actions may seem like a watershed moment for health IT, the provider market has moved perceptibly since ONC began its rulemaking. Just two years ago, providers were curious about APIs and app stores but they weren’t ready to make any commitments.

Slowly and inexorably, healthcare is embracing the downloadable app as a tool for innovation and improvement. One-size-fits-all platforms are not meeting the needs of the industry and apps can do more to assist with care provision needs than just provide supplemental functionality – to read more about opportunities for apps to have significant impact, take a look at the infographic we developed to accompany our more recent report, or read more in this deep dive post from June.

The opportunity to capitalize on data already collected to provide advice and predictions is too big to ignore, and the easiest way to do this efficiently will be with integrated apps that can pull data from any relevant resource to provide the necessary insights at the right time.

Cerner Health Conference 2018: Interest in PHM Solutions Remain ‘Healthe’

By Matt Guldin and John Moore

Recently, we and 12,000+ others attended the Cerner Health Conference 2018, where the theme was “Smarter Care.” Overall, the event focused on building on top of the EHR, while much of the floor space and conversations focused on population health and revenue cycle.

Cerner Smarter Care CHC18

Key Takeaways

  • New CEO, Brent Shafer, is not the visionary that Neal Patterson was, but he is highly focused on customer success and operations. Expect Cerner to become more acquisitive (Lumeris) and pursue partnerships such as that with Salesforce.
  • Rising client interest in population health management (PHM) solutions – Cerner’s HealtheIntent platform – but uncertain timeframe as to when these solutions will truly scale across client base.
  • The event reinforced our view that Cerner is well positioned to capture a growing wallet share from its hospital & health system customers over time as well as adding new potential customers (e.g., payers, state Medicaid agencies, self-insured employers) via its HealtheIntent platform.

HealtheIntent platform

For several years now, Cerner has been focusing on moving beyond the EHR with its HealtheIntent PHM platform. At CHC18, Cerner was doubling down on this bet with the message “Smarter Care” with numerous sessions and a significant amount of exhibit space dedicated to this theme and platform. Today, Cerner has signed ~160 clients of which ~90 are currently live.

HealtheIntent is well positioned as an EHR agnostic solution that will give Cerner the ability to invest resources into developing solutions that think beyond the hyper-competitive zero-sum game of EHR contracts. Two major flagship HealtheIntent customers are also two major Epic customers (Advocate and Geisinger) and there is a clear opportunity to work with these customers to better integrate Cerner’s evolving platform with Epic’s similarly expanding universe of products.

A key challenge for any PHM vendor is developing strong services capabilities to assist clients in extracting the highest value from their PHM solution deployments. In August, Cerner made a significant investment in Lumeris, a company with a strong services offering that Cerner will leverage.

Integration with Salesforce provides Cerner with a strong competitive advantage

In line with the company’s shift toward consumer-focused healthcare, Cerner is partnering with Salesforce to offer providers an integrated patient engagement solution. Through this partnership, HealtheIntent data, which is collected from numerous sources, will feed directly into Salesforce’s Health Cloud.

Once the data is in Health Cloud, from within their EHR a clinician can quickly identify patient populations based on various criteria via a queried search. Once identified, a campaign can be initiated. Cerner plans to launch this product in 2019, and will be the only EHR company to have Salesforce directly embedded in its EHR and HealtheIntent workflows.

Revenue cycle still in flux

Cerner understands the importance of getting revenue cycle (billing) software right. Cerner has penetrated, to varying degrees, about 40% of its hospital clients with billing software, but those are mostly small facilities. Cerner’s software still appears visually outdated and lacking functionality, particularly for ambulatory practices.

One need only walk through the CHC18 exhibit area of third-party software vendors to see the demand for RCM solutions that work in the Cerner environment. Roughly 40 percent of all vendors were RCM vendors. Clearly, Cerner is missing out on fully capitalizing on this opportunity.

RevWorks interest robust, ITWorks continues to grow

Cerner is seeing strong demand for its RevWorks offering among smaller hospitals, and the firm is still hiring aggressively to support growth into 2019. Cerner has about 100 RevWorks clients, compared to 30-35 two years ago. One of the main reasons for Cerner’s early success in outsourced revenue cycle solutions is that the product comes with a demonstrable return on investment for clients with specific targets outlined before any deal is signed.

The ITWorks business is growing but acquiring clients at a slower pace than RevWorks.

DoD/VA

Now that MHS Genesis is up and running across the first wave of an initial 4 sites, the company took important lessons learned for future Department of Defense (DoD) rollouts as well as Veteran Affairs (VA) deployments. Cerner noted that the VA is not yet in the implementation phase as it is currently planning the largest install in the industry’s history.

Of these two massive installs, the one at the VA bears watching closely. A significant portion of veterans receive their care via Tricare (local healthcare providers under contract to VA). How Cerner drives interoperability across multiple venues of care nationwide, the potential role of HealtheIntent, the embedding of telehealth functionality and the list goes on will all be pressure-tested by the VA. The results of that pressure-testing will, in time, roll out to the broader Cerner client base.

“Where the company has truly led the EHR market is with HealtheIntent. Rather than a walled-garden approach, Cerner’s HealtheIntent is architected for a more open future and its capabilities continue to expand even though market has been tepid. Cerner accurately saw the future and invested early for the inevitable move to value based care.”

Looking Forward

Cerner has been an innovative company since its founding. While not all innovations have been a success (much to some clients’ chagrin), the company has nonetheless made progress and continues to push forward. Their ambulatory EHR is gaining significant traction with larger IDN clients, and RCMwhile not there yetis closing the gap with competing solutions.

Where the company has truly led the EHR market is with HealtheIntent. Rather than a walled-garden approach, Cerner’s HealtheIntent is architected for a more open future and its capabilities continue to expand even though the market has been tepid. Cerner accurately saw the future and invested early for the inevitable move to value-based care.

Visionary leadership made Cerner what it is today. Hopefully, the company’s new leadership fully appreciates this key attribute. Only time will tell if the future focus of Cerner is operational efficiency at the expense of vision. While operational improvements are common in a maturing market, our hope is that Cerner continues to look beyond the near term.

MEDITECH Look Ahead: Building on Steady Progress

Key Takeaways from MEDITECH’s Physician and CIO Forum 2018:
  • MEDITECH is moving its customer base to Expanse, the latest iteration of their EHR
  • Expanse has significant inducements for hospitals seeking to support value-based care and be more interoperable

Photo: Courtesy of MEDITECH

Last week, we had a chance to attend MEDITECH’s Physician and CIO Forum, an event the company uses to give its customer executives a look forward.

The more concrete developments described over the course of this two-day event include:

Voice Support

A lot of attendees were talking about a new capability planned for Expanse called the Virtual Assistant. The idea is to voice-enable aspects of the physician’s workflow. Even as MEDITECH, and all the other major EHR vendors, slowly improve the interface design of their EHRs, users still want fewer clicks and swipes and less data entry. MEDITECH, seeing the rapid adoption of voice in consumer markets, wants its users to be able to retrieve results or review charts hands-free. It indicated that it is experimenting with this Nuance-sourced technology at a customer site with a phased roll-out planned once it gains more experience. Sometime next year it will begin work on using voice in physician documentation as well.

Interoperability and FHIR

MEDITECH came out strongly in support of FHIR. It has three live customers who have implemented FHIR servers that support REST-style access. MEDITECH facilities will soon be able to offer FHIR-based access on the CommonWell network. It is also looking at more complex transactions from Project Argonaut to support patient questionnaires and scheduling that will rely on write access to MEDITECH EHRs. You can read our full analysis of their support for API access in the MEDITECH profile in our App Store report.

Mobile developers will soon have access to a new capability called MEDITECH Greenfield to develop patient- or clinician-facing apps. It will serve up a set of APIs based on MU’s common clinical dataset with plans to add other data types down the road.

Clinical Decision Support

MEDITECH will rely on CDS Hooks to offer Stanson Health’s content for a variety of purposes. It will be used to push some of the most common care gap alerts. It will also push recommendations to physicians based on the Choosing Wisely campaign.

MEDITECH’s approach to introducing new functionality allows its customer to keep the lights on and support the onrushing changes to U.S. healthcare.

Population Health Management

MEDITECH’s PHM story is a little clearer than it was this time last year. The company’s collaboration with Arcadia.io means that its customers will soon have access to an aggregated patient record of MEDITECH and non-MEDITECH EHRs married to paid claims. Customers will get access to a new suite of dashboards and reports that provide risk scores, care gaps, attribution, utilization, and costs on a per patient or per cohort basis. The company plans to roll this out to early adopters before the middle of next year.

Patient Engagement

The company talked a lot about its new downloadable app for patients: MHealth. This app will permit patients to manage a lot of administrative and payment tasks in connections with office visits. It also will offer questionnaires that will help with reconciling meds and allergies to the clinical record in the EHR.

Upshot

MEDITECH hospitals are under the same pressures to adapt to value-based care that the rest of the industry continues to struggle with. Many of the company’s actions over the next year will help them in different ways. MEDITECH’s approach to introducing new functionality allows its customers to keep the lights on and broadly support the onrushing changes to U.S. healthcare.

[bestwebsoft_contact_form]