Friday, June 15, 2012

The EMR Race is Over, Long Live EMR Extender Tools!

I've been increasingly talking about the concept that the EMR race is over, and that EMRs now serve as the infrastructure and platform upon which innovative companies will develop "EMR Extender Tools", in areas such as: Physician Productivity (e.g. healthfinch), Decision Support (e.g. Zynx), Business Intelligence (e.g. DrEvidence), and Patient Outreach (e.g. Healthloop).  This seems to resonate well with mature EMR users since they often feel like the EMRs they have are rather stagnant - and the vendors will be focusing for years on just getting basic things right and fulfilling Meaningful Use, and thus has no ability to add innovative features.

This is particularly relevant as a recent article came out asking, "What is the future of healthcare innovation now that Epic has become the dominant EMR player?"  The author offered a variety of scenarios, but I think Mr. HISTalk had the best analysis when he said:  "Companies should stop fixating about mounting a full frontal attack on Epic that’s sure to fail and instead innovate on building products and services for Epic’s large client base just like the companies that coexist successfully with Meditech."

Oh yeah!  Now we are talking about an ecosystem that will really let innovation flourish (I think it will be Epic and a few others).  Big Kudos to Allscripts and Greenway for walking the walk and being the first to launch official "platforms" for allowing third parties to build tools upon them.  And nod of the hat to other EMR vendors who are at least talking the talk - even if their "Platforms" are not quite launched yet... such as GE, NextGen, AthenaHealth.  And here is hoping that Epic and ECW will eventually come around and create official platforms to encourage innovation... I think they will eventually move to this, and/or their customers will do it for them.  Finally, I'll be closely following a few other companies trying to build "Uber-Platforms" in this space, including Optum, Aetna's Medicity and the GE/MS spinoff Caradigm.

Of course, how cool would it be if we had one platform upon which any third party vendor could integrate their tool... and it would magically work with any EMR?  Oh wait, we actually do have the government sponsored SMARTPlatform... now we just have to get the vendors to agree to work with it!  The geniuses behind this platform (Kenneth D. Mandl, M.D., M.P.H., and Isaac S. Kohane, M.D., Ph.D.) just wrote another NEJM article (Escaping the EHR Trap — The Future of Health IT), if you are interested in hearing what they think the future should look like.  Here are a few good quotes from their article:

  • “[T]here’s a clear path toward better, safer, cheaper and nimbler tools for managing healthcare's complex tasks.
  • “Programs should not be held hostage to EHRs that reduce their efficiency and strangle innovation,” the authors concluded. “New companies will offer bundled, best-of-breed, interoperable, substitutable technologies … that can be optimized for use in healthcare improvement. Properly nurtured, these products will rapidly reach the market, effectively addressing the goals of ‘meaningful use,’ signaling the post-EHR era, and returning to the innovative spirit of EHR pioneers.”

Getting back to reality (meaning we don't have seamless platforms to do all this yet)... I do think we are seeing an explosion of small companies creating great niche products and figuring out how to work with EMRs.  So whether there is an official platform or not, the EMR Extender Tools are here to stay and they are only going to grow bigger and better!

Past Blogs on this topic
* Rise of the EMR Extenders (March, 2011)
* EMR Apps Taking Off (April, 2012)

Monday, June 11, 2012

Six Steps to Saving the Country with Preventive Care

Joe Flower is one of the best healthcare futurists an authors out there… which is why I quote him so often!  In his recent article, "Save the Country with Preventive Care", he explains how we can save the healthcare system by focusing on the treasure in plain sight: "It is those thousands and millions of patients with poorly treated and untracked chronic disease that flood our EDs every day. We can mine those cases to reduce health care costs drastically, put our hospitals and health systems on a sound economic footing, make people healthier and, by the way, save the country."

He then goes on to describe the SIX WAYS to do this, which I will help summarize:
1.      Coverage. Everyone needs to be covered, even illegals and those who won't pay for it - because otherwise they just cost everyone more later on.  He notes, "If they are covered, it is much easier to fashion preventive and outreach programs to keep them from your door."
2.      Shift in risk. He explains this well, "Shift from the standard model (fee-for-service, with all financial risk in the payer) to various models in which the provider takes on some risks (as with bundles, warranties, capitation, minicaps, alternative quality contracts and other models) and the patients take on some risk for making a good decision (going to a clinic or an urgent care provider instead of the ED with a minor matter).
3.      Incentivized wellness. These types of programs "give people financial rewards (such as lower premiums) when they participate and meet simple goals. Correctly done, these programs reduce the actual costs for covering the whole population (including those who do not participate) by 10 percent or more."
4.      Targeting. "Find and go after that 5 percent, that 1 percent who are costing the most money. Some of the cost will be recoverable, some will not; but go after them anyway, because the costs spiral out of control once they cross your threshold."  This includes putting in more clinics in high risk sections of town, as well as "HotSpotting" individuals, as popularized by Dr. Atul Gawande.  There is a lot of energy and momentum to do this - which is a good thing.  I'd just point out at the same time we pour resources into these folks, we need to efficiently take care of the other 95% to make sure they stay stable and healthy (which is a focus of a lot of my recent work).
5.      Public health. Consider how you can better work with your federal, state and local public health officials to address the health needs in your community.
6.      Healthy Communities. "Finally, at the furthest remove from your ED threshold is the Healthy Communities movement. There are local groups in most places across the country, supporting programs dealing with everything from effluents to traffic to education to AIDS awareness. The return on investment is always large because the investment is so small compared with the ED visits, surgeries, premature births, and NICU and ICU use that they eventually prevent."

He finishes with:  "We will save much more money, shore up our finances and help solve the deficit problem when we stop waiting passively for people to cross our threshold and begin aggressively exporting health to those who need it the most."