In the healthcare IT electronic health record (EHR) market, consolidation amongst vendors is not a new trend, but the speed and acceleration at which the mergers and acquisitions are occurring has significance. Last summer, a report from market researcher Kalorama Information noted that as companies in this space jump in and out of the market, end-user consumers are left wondering if the vendor of the product they just purchased will be around for much longer.
As one of the few major EHR vendors sitting at the top of the market, Chicago-based Allscripts is finding itself trailing Epic and Cerner in terms of market dominance, according to most industry analysts, but is still one of the prime go-to vendor options for hospitals and health systems. In an exclusive interview with Healthcare Informatics Managing Editor Rajiv Leventhal at HIMSS17 in Orlando, Allscripts CEO Paul Black notes that the consolidation that has taken place in the EHR market "is a natural evolution." He adds that that if there is another stage of Meaningful Use, there won't be anything close to 500 ONC (Office of the National Coordinator for Health IT)-certified EHRs. "I don't know what the number [of certified EHRs] will be, but it will be greater than five and a lot less than ," Black says. "It's a large industry and it's becoming a more mature one, so there are haves and have nots in regards to the amount of money that one really has to spend on R&D to stay relevant and ahead of where the industry is going, and also to be a global player."
Black, who has held his CEO role at Allscripts since 2012, credits the vendor as having "open" platforms, or in other words, having the ability to integrate across systems and settings. But how this fits into the discussion around healthcare data blocking—an area in which many in the sector place blame on vendors—is an important question.
Soon after ONC issued its much-discussed report on data blocking in health IT to Congress in 2015, Black testified before the Senate Committee on Health Education Labor and Pensions (HELP) to share his thoughts on the issue. In his testimony, Black questioned the federal agency's anecdotal evidence of information blocking occurring. Black further said in his testimony that the lack of a strong business case or a true market driver for interoperability are the industry's biggest barriers for seamless data sharing, while also noting to Congress that not all stakeholders are motivated to make information liquidity a reality, though there are examples of health information exchange working.
At HIMSS17, Black said that those data blocking hearings on Capitol Hill "created a fair amount of activity" and led to some people "changing their business practices as a result." Black further explains: "So there would be a charge for a CCD [continuity of care document] or C-CDA [consolidated clinical document architecture] if it was going outside of a certain supplier's architecture, but that business practice changed, literally overnight. There are others who we interface with that we try to get data from, and they are very difficult to work with, and our ability to access the data in that EHR on behalf of our clients has gotten easier because of this [Congressional] focus and the penalties associated with data blocking. So I think it was very real issue and I think because of the spotlight that has been on it, some of those folks who were not as eager to participate have changed their games." Nonetheless, Black says there is still data blocking today, referring to an unnamed EHR supplier that makes it very difficult to get data in and out of its system, which is "very unfortunate, at a minimum."
To this end, Black says that Allscripts has operated in an environment for a period of 10 years, where it has advocated the concept of openness, in which it has published its APIs (application program interfaces) and has allowed "a large number of people to build businesses on top of platforms, which is what our application development program allows." He notes, "Our exposure of our APIs to create that interoperability has been there for a long period of time. We're able to work with the folks, those right here on the HIMSS show floor, and there are [some] 482 distinct companies who we interoperate with today with our dbMotion [interoperability] platform, so if the third-party organization adheres to any sort of standard, we will figure out ways to pull that data out, harmonize it with other data, and present it back to a clinician in a workflow that makes it useful to them."
What's more, Black additionally points to the deployment of new strategies at Allscripts which he says will differentiate itself from vendor competitors. This involves offering an array of different platforms, other than its EHR, including: a consumer/patient engagement platform, a population health platform, an interoperability platform [dbMotion], a precision medicine platform, and a post-acute care platform. "These platforms are all EHR-agnostic, so we can put them on top of ours and others, and we can go live in the real world of what's out there circa 2017," says Black. "We are making investments in each one of those platforms to make them robust and relevant to the workflows and types of business problems out there today that manifest inside of those areas," he adds.
Speaking specifically to 2bPrecise, an Allscripts subsidiary with a cloud-based genomics and precision medicine solution, Black says the idea is to make the precision medicine platform available to a primary care physician group, as well as to a large academic research organization, in an EHR-agnostic manner. "And we want to do it in a way that's not cost prohibitive, actually adds value, and also creates a workflow-centric capability to embed the phenotypic information that's in the EHR with the genotypic information that would come off some sort of sequence," he says. Black adds that he thinks it's very real from the standpoint of there are some 57,000 gene sequencing panels that one can order today, from a two-gene panel for a specific type of arthritis all to a full genomic sequence. "There is need for it today, to be able to take that information back, distill it and put it into a common vernacular so that a busy doctor who's trying to see 40 patients a day can utilize it. That's the use case we're trying to solve," he says.