Allscripts CEO on interoperability, Lyft and social determinants of health
Healthcare Dive sat down with Paul Black to discuss what's in store for the EHR and practice management tech giant.
Allscripts had a busy 2018.
The EHR and practice management company partnered with ride-hailing giant Lyft on a healthcare platform called Lyft Concierge to link patients to free transport to their appointments, sold its stake in a behavioral health IT provider for $525 million and partnered with Microsoft on a cloud-based clinical trials model.
Allscripts plans to report its full year results Thursday, and analysts only expect revenue to grow.
Healthcare Dive sat down with seven-year Allscripts CEO Paul Black at the health IT vendor's bustling booth at HIMSS to chat about the government’s new interoperability rules, opportunities in the industry and its high-profile partnerships.
This interview has been edited for clarity and brevity.
HEALTHCARE DIVE: What are you most excited about in the industry right now?
PAUL BLACK: Well, I think the big picture in the U.S. is in the regulatory things that came out this last week. The policies that came out furthered a theme that's been advanced by the government and, quite frankly, has been advanced by us for over 12 years around openness and about access to data. And about access to data by consumer/patient, as much as access to data by EMR to EMR, or by EMR to doctor or by EMR to a company that's trying to build a platform or build an ecosystem on top of this now-digital platform. So I think that's all pretty exciting.
Many of us in this industry have been participating in those discussions with the government, with [CMS] Administrator [Seema] Verma, and they have solicited a fair amount of input from us. We've been pleased with the receptivity to include people that actually have to go make whatever that policy is work — to invoke it, quite frankly. And that's how we stay certified. And that's how they enforce the certification and that's how people actually get their reimbursement is by utilizing a certified platform.
Do you think the new CMS and ONC regulatory rules are going to be a lot of burden for health IT systems currently?
BLACK: I think anytime there's a new unfunded mandate, if you will, there's a bit of a burden on us. And I think that's one of the reasons why we've also been advocating and making the point that scale matters in this industry, and that a large R&D budget is actually required for regulation, for innovation, for cybersecurity, for just adding features and functions and adding new technologies and platforms.
So those are all things that we have said since I've been here that you need to grow. We need to have a certain amount of scale. I think that now that everyone has, 90 plus percent of people have actually adopted an electronic medical record, it should be easier for the government to invoke new regulatory capabilities around a platform that's digital, versus trying to enforce a new regulation through a paper base. Then you say, well, how much change is required in the software in order to be compliant? And then what kind of additional data are being collected that aren't already collected in order to give the government the additional information they want to advance whatever initiative that they have decided to support?
So in this case specifically, we on the burden side of the physician, the government has been pretty tuned to the current state of affairs and the current state of affairs being a growing crescendo of discontent from all physicians about the burdens or the amount of time that they spend documenting versus the amount of time that they're having to have face-to-face time with their patients.
And then the last one is, if there's a way for us to collectively model the impact that has on a physician's day in the life, and then again with a digital platform, which should be able to model that, to model a massive change in workflow, or a minimal change in workflow, who actually can collect the data — does it have to be a physician or can it be staff, an administrator, someone else. Did you gather that data through AI? I mean, just let's make sure that we understand what the burden would be in that case from a workflow standpoint for the doc.
But you're pleased with how CMS and ONC framed their rules?
BLACK: I think that they've been extremely attentive to us. In our case, this is a bit of a manifestation of what went on in 21st Century Cures Act. So we were heavily involved in that two or three years ago and it got passed with bipartisan support. And then, you know, we've been rolling that out. This to me is patient gets their data. Full stop. And that's what the Administrator Verma said yesterday also. And we've been saying that too. It's the patient's data. We've been advocating that since I've been here for seven years and we've been advocating open systems in the API component of this act for 12 years. I wasn't the guy that invented open [APIs] at Allscripts, but I've been guy that's absolutely pounded the table for it.
Execs at HIMSS have been saying the government put the rules out at a really hectic time.
BLACK: Yeah. We knew it was coming though. I haven't seen all thousand pages, but I got the quick debrief. We also liked how they defined further what is not information blocking. That was all helpful for providers as well as for us. These things do not constitute information blocking. And then they went through a pretty pretty decent list of things in a logical way, but in a way that also provides clarity, versus just saying, 'data blocking is bad, if you're blocking data, don't do it,' you know. What do you mean? Things like did have been a bugaboo, like interfaces — so we actually have said for quite a while that we actually have to do work in order to provide the connectivity between these things. It doesn't just magically happen. And to the extent that you can rationalize the cost and that's not information blocking. The fact that you have an interface that has humans that have to perform work and you have to charge for that, does not mean it's blocking.
Regarding the Lyft partnership that was announced last year — how do you see that developing in the future?
BLACK: The Lyft partnership has three factors. One is, what are we doing with them to impact a patient's ability to get to their appointment. This is just in general the patient focus or the consumer focus. The second one is, what does it do for our employers?
And then, the one that we started with was, being able to from a registration conversation ask the question, 'Do you need a ride?' And from that conversation you can determine yes or no. And if yes, then it goes into the Lyft Concierge assistant and they get scheduled either as a point in future or immediately to get a Lyft car ride. The benefits, you know, I think we talked about that in the past, but the people actually know if they didn't get in the car, there's no way they're gonna be there and there for the appointment and that this slot just opened up, that appointment slot just opened up, makes a physician office every day much more inefficient.
It's like an airline. An airplane leaves with empty seats. You just wasted potential to have those seats in revenue. In this case, it's not only that. I've got a clinic schedule that happens every day and unused slots of time are wasted revenue but it's also a wasted opportunity for somebody who may need to get in, who's got a three month wait to actually occupy that slot. So the access and the ability to actually get in and be seen as a result of somebody else not being able to make it in that day, for whatever reason, I think is very important. And then the social determinant component to me is also quite important in that not everybody has a car and not everybody can get to their appointment because of their bus route or something like that.
And therefore, there are a number of Medicaid organizations throughout the United States where the Medicaid organization actually pays for the transportation. So, where I grew up in Kansas City, the safety net hospital there actually pays for that transportation and it is a Lyft dispatch there that occurs and that will help guarantee that those people are going to make it in and those people that are coming in for that Medicaid appointment — the reason for them to miss that appointment, you just took another piece away. So it makes it easier for them to come in. Not everybody loves to go to the hospital and not everybody wants to go to the hospital but people need to be seen. And if they're a chronic fill-in-the-blank diabetic or have some other issue, or they usually have multiple issues, they really do need to be seen or else they end up in the ED when things go really bad.
Are there other social determinants of health factors that Allscripts is taking a look at?
BLACK: Probably one of the next biggest determinant is nutrition. When you think about people who live in a food desert and don't have access to food, can they get to someplace where they can? Or can you have food delivered? And to me, the new thing there would be having food delivered. That would be a way for you to have a little bit more control over the protocol around the total mind, body, soul stuff, right? So if you have four bucks in your pocket and you got off work and you're on a bus and you got four kids at home that hopefully made it home from school, and you've got to feed them. And on one of your stops is an inner city convenience store and you go in there and you see gallon jugs full of sugar water and you've got four bucks, that's what you buy. You've got to do something for these kids.
When I was on the board of a safety net hospital, that's what we used to do. You don't have to go to Peru, you can go four blocks downtown in Kansas City and this is a different world. So to me it's that promise of not just making those things, not just making those better food choices available at work, at some stand, but actually have people delivering food. So will that happen? I don't know. What would it be possible? Yes. When I ask the drivers, if you're the Uber guy, what else do you deliver? Food. But what's the most popular food you deliver?
BLACK: Yes. Exactly. It's just disgusting, but it's cheap. That's the main thing.
How somebody makes money doing that, God only knows. But it is what it is. So to the extent that that exists today, it's great. But the underlying assumption to all this is that somebody has a phone and the true social determinants of care — sometimes they don't have phones. That's one of the things we used to give out at the safety net hospitals.
You get into the reality of that world when you're really into social determinants, when you're really going into your ZIP code that has more bearing on your life expectancy then your DNA code, right. There's all sorts of data proving that to be true. Then you got to go in there, find out what the hell is really going on and then build something that works for that population.
What about the Microsoft clinical partnership with your life sciences arm Veradigm announced during JPM early this year? What do you see as the output of that venture?
BLACK: So, as a byproduct of all this deep process clinical that we have, both on the inpatient as well as the outpatient standpoint, we have all this data and the data are very important clinically, very important financially, about what the health and wealth of the population of the people we serve are, what conditions are broadly out there. What medications people are on, how long they've been on these things, how long they've had these conditions, what protocols were they on, what protocols were they on that were effective, what protocols were they on that were not effective, what's the drug safety issues out there now that there are known issues with certain medications that have been recalled. There's all sorts of really, really, really valuable data that are out there that pharma is extraordinarily interested in, as are insurance companies. And so we have been doing this mining and de-identifying and putting into broad data lakes, I call them 'vats,' but these big old drums of data.
And we've got things that look through them. Humans look through, PhDs look through them, AI machines look through them, data crawlers, machine learning — all of them looks through them and tries to find correlations between things that exist in that data.
The correlations between things that exist out there to me are important because I think that the computer might look for different correlations that a human may not understand or may not have historically looked at.
So here we are circa 2019 and all these data are available to us, which I just think it's fascinating for first time. And the only thing you can do is because of who we are inside of Veradigm, once we have this 'Aha!' moment it's like, now what? How do you take that insight that you just had and make it actionable at the bedside or the clinic? And that's what we do. We put that information back down into the EMR to the doc and that's how you close the loop and bring it back down into the workflow. If you do it six months later, it's too late. If you do it three months later, it's too late. You have to do it right then.
We just announced this partnership with NextGen, a competitor, which maybe doubled the size of our data. Pharma companies are going to dig that because they like large pools of humans, not small pools. When you think about it, if you're doing a clinical trial, that's something that usually needs to be pretty large and then if you have a drug that got approved, you'd like to go be able to sell that drug or move that drug into broad mass adoption sooner. And the best way to do that is having some sort of electric connection to them either directly to the patients or directly through the doc to the patient.
God is on the side of big armies when it comes to data. And he or she is also on the side of big armies when it comes to connections. And we have a lot of connections.
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