Each year, to accompany our Healthcare Informatics 100 list of the largest companies in U.S. health information technology, we pick six fast-growing companies that we think could have a significant impact on the industry in the years ahead. Indeed, some of our picks have gone on to much bigger and better things. A 2013 pick, Health Catalyst, is having a major impact in the data warehouse and analytics space. Another from that year, Explorys, is now part of IBM Watson Health. One of the companies we chose in 2014, Evolent Health, is now publicly traded. This year, promising approaches include applying machine learning algorithms to clinical variation and the move to web services to address interoperability.
Two founders of Sansoro Health remember an early phone conversation in late January 2014. Sansoro CEO Jeremy Edes Pierotti was serving as CIO for Leidos Health at the time. He got a call from friend Dave Levin, M.D., who was chief medical information officer for the Cleveland Clinic Health System and is now Sansoro’s chief medical officer.
Jeremy Edes Pierotti
Levin told Pierotti about meetings he’d had with two EHR architects who had figured out technically how to create an application programming interface (API) middleware layer to create bidirectional web services-based integration with EHR platforms. One of those architects, John Orosco, had spent nearly a decade creating elegant Cerner EHR integrations using web services. Now Sansoro’s chief technology officer, Orosco drove the company’s technical direction from the outset. A fourth co-founder, Mike Pietig, had worked with Pierotti at Leidos Health as a vice president, and counted Levin as a client. Pietig serves as Sansoro’s chief operating officer.
Pierotti recalls telling Levin, “Dave if you have lined up the people who know how to do that technologically, we could completely change health IT, and I am on board.” At the time Leidos had 1,500 consultants in the field every day, many of whom were dealing with EHR integration. “I knew this problem backwards and forwards,” Pierotti says. “I had run the Epic implementation at Stanford Health and worked with many other large health systems advising on EHR implementations and it was always the integration team that struggled the most.”
Dave Levin, M.D.
Levin says that at Cleveland Clinic they began to look at web services and open APIs as an alternative to the traditional interface approach to integration. “As I looked across the country, there were other skunkworks that were beginning this type of experimentation, and when we looked outside healthcare at the rest of the digital economy, this is how it works. With the experience I had at Cleveland Clinic and others doing similar work, it seemed like the time was right.”
Sansoro markets its Emissary middleware product to both provider organizations and software vendors looking to integrate with EHRs. Its first vendor partner was AirStrip, which makes mobile care collaboration software. “AirStrip is a fabulous company with a great team, and yet typical of the industry, struggling with this integration problem,” Levin says. “The conversations we have with vendors is they had a really cool idea and started to build out a product and then realized they had to become integration experts, and that is not what they got in this to do.”
The use of web services reduces interface maintenance costs. The EHR serves as the system of record, and real-time data exchange reduces the need for external databases and interface monitoring.
Pierotti says Sansoro is focused on established health IT vendors with a strong customer base that know they need a simpler way to do EMR integration and need better integration capabilities to offer better functionality to customers. They are currently talking to three vendors of clinical surveillance applications that need real-time medication administration data and don’t want to have to go through the pain of developing a custom HL7 interface with every single one of their customers.
On the health system side, CIOs and CMIOs want to have different conversations with innovative vendors rather than talking about how difficult, time consuming and costly the integration is going to be. “They want to say, ‘here is this layer of APIs you can use to integrate with our EMR; go to it,’” Pierotti says.
The 14-employee Minneapolis-based company bootstrapped itself and has earned revenue to fund operations so far, but is currently lining up a seed round of funding to allow it to make some key investments.
The industry-wide attention being paid to the FHIR (Fast Healthcare Interoperability Resources) protocol and open APIs has been great for Sansoro. At the 2016 HIMSS conference, the company won the 10th annual Venture+ Forum pitch competition for startup companies in the healthcare technology industry.
“The healthcare community is realizing that the rest of the digital economy works with an API web services model, and there is no reason healthcare shouldn’t work that way also,” Levin says. “So it is very nice for us that two years after we started the company that there is a big public conversation about APIs as an integration method. We are really pleased that we have been able to contribute to that conversation by demonstrating that this is not theory; this actually works. It shifts the terms of the debate to why the industry wouldn’t pursue this type of solution. It is now incumbent on those who haven’t understood or who have resisted this to explain why not.”