HIMSS18 wrap-up: The cloud takes center stage for EHRs
Repurposing old technologies was an underlying theme for some 44,000 health IT professionals attending this year’s HIMSS18 conference in Las Vegas.
Former Google executive chairman Eric Schmidt may have summed it up best.
"Run to the cloud," Schmidt said during his standing-room only keynote address.
While spoken in 2018, attendees could've very well heard that same sentence in 2011. But now, EHR vendors are zeroing in on products that emphasize population health data and customizable platform services.
"What may be old in some sectors of the economy can appear new in healthcare, as this sector is woefully behind most other sectors, including migration to cloud and cloud-based services," John Moore, founder and managing partner at Chilmark Research, told Healthcare Dive.
"The traditional view has been that cloud services did not provide high enough reliability and [there were] HIPAA concerns. Those issues have been largely addressed. Healthcare providers, especially small ones, cannot afford large IT staffs to maintain on-premise systems so cloud is gaining traction and is worthy of discussion in this laggard sector."
Pop health as growth opportunity
Thanks to the federal Meaningful Use incentive program, most hospitals have adopted EHRs, with Epic and Cerner accounting for a little more than 50% of the market share.
A Sage Growth Partners survey published earlier this month found 65% of provider respondents are unlikely to replace their EHR in three years. However, 50% said they were likely to switch their population health management vendor in three years.
Therein lies the growth opportunity for EHR vendors.
Providers are looking to vendors to provide far greater IT-enabled services, Moore said. Part of the reason: The vast majority of providers don't have the bandwidth to maintain existing systems and transition to value-based care models.
"This provides the EHR vendors attractive growth opportunities going forward to provide these add-on services," he said.
HIMSS18 witnessed a litany of cloud-enabled EHR product news pointing to such a trend. Some highlights:
- Cerner teamed up with Salesforce to develop cloud-based population health tools;
- Allscripts launched its cloud-based Avenel EHR product and announced a partnership with Lyft to integrate NEMT ordering into Allscripts’ Sunrise EHR for physicians;
- Athenahealth prepped an introduction to Epocrates Connect, a provider-facing mobile app to connect to multiple EHR systems for documentation and care coordination;
- Epic integrated Nuance's AI-enabled virtual assistant into its EHR product; and
- Drchrono partnered with Ambra Health to integrate cloud-based imaging tools.
These efforts highlight a proliferation of healthcare data and cloud-based services as providers brace themselves for greater risk in a value-based world.
"External data as a macro theme is unavoidable" in healthcare, Vijay Venkatesan, SVP and chief data officer at Providence St. Joseph Health, told Healthcare Dive. Providers can't just think about how patients consume healthcare, but will need to understand their environment to help guide care pathways. "We think it's going to be more important than ever."
Cloud computing also allows more agile, nimble product services.
The Avenel product, for example, emphasizes machine-learning and integrates clinicians' treatment patterns and preferences to help speed documentation and decision-making.
Epic is working on voice recognition and natural language processing to assist documentation, President Carl Dvorak told Healthcare Dive.
“If we can eliminate progress notes from healthcare while still managing to get payers confident that the work was actually done and done with good quality, that’ll be a good thing," Dvorak said. "Part of my mission is to get rid of progress notes entirely.”
"[The] question is, are these services enough to justify the hefty valuations of some public companies now that the EHR-HITECH bloom has passed?" Moore said. "That is still a pretty big question mark."
Platform is the new black
The transition to a better digital connected healthcare system isn't just one killer app, Schmidt said during his keynote address. It'll be a system of killer apps working in concert.
Vendors, in efforts to create a stickiness to their products, are developing platform-as-a-service (PaaS) — a category of cloud computing — foundations to enable that reality and become the dominant platform player. They emphasize customizable apps to fit the needs of different types of customers.
It's disruption from within for legacy EHR vendors as they look to gain new revenue streams.
"The disruptive component we have baked into our vision statement is to be the open, connected community of health," Allscripts CEO Paul Black told Healthcare Dive. "Open means we're going to welcome third-party developers [and] other ideas that aren't our own. That's one piece that not only creates disruption but also an ecosystem of innovation."
Late last year at the Health 2.0 conference, Black said Allscripts will think differently about EHRs, physician interactions with the keyboard and interactions with the patient. One reason for the shift: Millennials will want to view medical records on a mobile device. They aren't going to call anyone.
He said the emergence of unfettered access to data could be disruptive, stating Allscripts encourages individuals to build apps on top of Allscripts. "That's the gamechanger," Black said at the time. "You can go on the on and off ramps of EHRs and build apps and bring value."
Athenahealth is also betting on platforms for its growth strategy, creating scheduling and directory apps and functionality to help ease administrative burden.
Epic early last year released its App Orchard platform for third-party developers to build software. "Having a common platform and standards like FHIR allows for more innovation from a wider variety of participants," Dvorak said. "Let’s create the standards to let other people harvest the opportunities of whatever niche specialty they can do."
It's not just about sharing data, but also sharing functionality.
"It’s a little naive to think one company is going to disrupt the entire healthcare game, especially when they don’t have all the data today," David Higginson, EVP and chief information officer at Phoenix Children’s Hospital, told Healthcare Dive.
A customizable, open platform helps Phoenix Children's pick and choose apps based on its business. Customizable features in a cloud-based setting can help providers add services that fit their needs and build as needed. A children's hospital's needs different functionality than an orthopedic practice, for example.
"We don’t feel like ... we’re forced to have one vendor’s products," Higginson said.
However, it's still not clear whether this strategy will work for all vendors.
"It will be challenging for smaller vendors to build to multiple EHRs and make it profitable," Moore said. "FHIR may help break this by creating a more open ecosystem of apps that can slot into any EHR, but something of that nature is at least [more than] 5 years away."
- Healthcare Dive HIMSS18: Eric Schmidt says future of healthcare lies in 'killer apps'
- Healthcare Dive HIMSS18: Separating AI hype from reality
- Stat News From app store to drug store, digital health is redefining pharma’s pipeline
- Health Data Management VA launches platform for developers to build apps for vets
Follow Jeff Byers on Twitter