As part of the Healthcare Informatics 100 questionnaire, health IT vendors were asked to estimate the percentage of revenue earned in each of their product segments. Beyond presenting the product segment revenues in each company listing, Healthcare Informatics editors took to further breaking down the top revenue earners in each of our seven segments: Financial Information Systems, Clinical Information Systems, Data Analytics, Data Management, Data Security, Data Exchange, and Consulting Services.
Following the release of the Healthcare Informatics 100 (The 100), we revealed the top 5 companies by revenue within these seven different categories. Serving as a supplement to the broader Healthcare Informatics 100 list, the goal was that this data, along with the content that accompanies it, would provide you, our readers, with a greater sense into the latest market trends within each of these respective product categories.
Those seven product breakout stories can be read in full right here, and as a follow-up to the Clinical Information Systems category, Healthcare Informatics sought out senior executive thought leaders from each of the five vendor companies that made this top-5 list, with the aim to take a deeper dive into the segment and get expert perspectives from the solution providers themselves.
The participants for these interviews, conducted over email, include: Bob Dudzinski, Pharm.D., executive vice president and medical officer, West Corporation (Omaha, Neb.); Garri Garrison, R.N., vice president, performance management, 3M Health Information Systems (Salt Lake City, Utah); Peter Durlach, senior vice president of strategy, Nuance Communications (Burlington, Mass.); Hoda Sayed-Friel, an executive vice president at MEDITECH (Westwood, Mass.); and Girish Navani, CEO, eClinicalWorks (Westborough, Mass.). Below are excerpts of the discussions we had with the various vendor thought leaders.
How do you see the clinical IT segment five years from now, in terms of the types of solutions that will be prevalent, and what will look different from now?
Garrison: First, we’ll see an increased focus on provider and payer collaboration. Providers must build stronger relationships with their payers and post-acute care partners to share data and ensure access to a holistic view of the patient’s care. This convergence of provider and payer segments will require IT systems that combine clinical, financial, and socioeconomic data at all sites of service. Sharing data to achieve mutual goals will ultimately improve care and directly benefit patients.
Over the next five years, clinical IT systems will transform and normalize disparate data sources, resulting in robust analytic capabilities that will significantly advance performance measurement. With advancements in machine learning and artificial intelligence, we’ll see the focus shift from descriptive analytics to predictive analytics, which will allow real-time impact on outcomes and costs. At the same time, new tools will make it possible for patients and consumers to better engage in and manage their health. These tools will leverage socio-economic determinants of health, offering more options and information to consumers so they can make better choices.
We also believe that virtual health/telemedicine, along with consumer-directed care, will become mainstream, and healthcare organizations will continue to find innovative ways (Internet of Things, wearable sensors, home monitoring, and more) to improve efficiency and care access for improved convenience and lower cost.
Durlach: We will see a couple of big trends accelerate over the next few years to help address the amount of administrative work and burnout we are currently seeing from physicians and nurses. These shifts will allow the care team to spend more time with patients, caring for their needs and ultimately improving physician satisfaction.
We are already seeing this narrative being played out at major provider organizations, who are relying on things such as virtual scribes, artificial intelligence (AI), virtual assistants and voice recognition software. Doctors are looking to leverage offerings to optimize electronic health record (EHR) workflows that will help them worry less about the ins and outs of the EHR, and provide real-time decision support. By making significant changes to the way these systems currently work, it will allow physicians to stay more balanced and happier, while reducing the pressures the executive teams are facing to retain and recruit doctors and nurses.
Sayed-Friel: The dynamics of what vendors need to provide will shift rapidly. The demands from patients and consumers will increase the adoption of new tools and technologies to better engage and communicate with them. More convenient communication tools for clinical staff are also in high demand. This is interesting because these are not the typical applications EHR vendors have spent much time creating. Reliance on apps from outside vendors who specialize in building apps for smartphones and other mobile devices is on the upswing. As this shift continues, EHR vendors will allow more access to their data stores for those app creators, however, they will also get in the business of creating their own apps.
Managing outcomes and population health will be at center stage. In order to move forward with achieving those goals, patient engagement is crucial. The industry has to change how patients interact with the healthcare system, and the next step will be looking at what we can do to change habits and encourage and reward healthier lifestyles, using the consumer apps that I mentioned.
Five years from now, healthcare information will be living in a very different space. Any vendor that thinks they are going to be in control of all the patient’s healthcare information is sorely mistaken. Patient data will live not only in EHRs but in a variety of other places—for example, genomics labs, 23AndMe, ancestry.com, and even social media. EHR vendors will need to shift their perspective, meaning we are not the harbinger of every piece of data about a patient. That is where interoperability comes in. The foundational EHRs will continue to exist but with built in abilities to find and share information about a patient wherever it may be stored, and use it as needed to provide the best treatment.
Navani: Clinical IT is gradually shifting towards cloud computing, along with machine learning, which will transform the future of clinical IT. Leveraging the cloud, physicians and patients will have increased access to vital health information in real-time from anywhere, anytime. In turn, it will improve patient outcomes and experience, offering enhanced flexibility and transparency.
Dudzinski: There are several key trends that will impact the way that healthcare is delivered. First, the advent of consumerism in the healthcare industry—the days of a “patient” patient are over. Patients are ultimately healthcare consumers and expect the same type of treatment from their healthcare organization as they receive in the commercial market. This includes timely and on demand service, clear understanding of diagnosis and treatment options, and finally communication via digital channels. The need for a “digital conversation” in a “channel of choice” will be prevalent. Second, as patients take on more financial responsibility for their healthcare cost, understanding the diagnosis and treatment options will be critically important to the decision making process. Third, more and more, the role of medication adherence is becoming front and center to reducing healthcare costs and improving patient outcomes. As such, the value of the pharmacists will continue to rise in the value chain of healthcare services. They are also a natural service site to extend a digital conversation to the patient since pharmacy has the luxury of engaging the patient more frequently than about any other provider. And fourth, there will be a heightened degree of integration between disparate data sources. EHR vendors will allow for greater integration as more robust applications are brought to the market.
How can end-user hospitals and health systems best prepare for this future?
Navani: Preparing for the eventual shift towards the cloud, healthcare decision makers need to ensure they leverage elastic cloud computing. An elastic system is adaptable, allocating necessary resources when demand increases. Without, health systems would be ill prepared for an emergency or any situation where there is a demand for dynamic user access.
Dudzinski: If the direction continues to require accountability on the patient’s part, then a health system needs to self-access on their patient experience to change patient behavior, promote a brand experience, and compete on value delivered. Understanding where they are and investing in the technology and communication infrastructure for communication and education will be key factors in the success of a healthcare system. Many healthcare organizations focus on the latest and greatest MRI machine, lab equipment, etc.; however, the power comes in the timely and relevant communication with the patient. A patient can have the best MRI in the country, but if the patient fails to follow through with treatment and medication requirements, the outcomes will be sub-optimal.
Garrison: Faced with surging uncompensated care and competition, most hospitals and health systems are already focused on transforming their business models. Whether through acquisition or strategic partnerships, many hospitals are not just hospitals anymore. They are healthcare delivery organizations, part of integrated systems with ambulatory care centers, medical groups, skilled nursing facilities, home health agencies and health and wellness programs. Not only is the expanded scope better for population health management, it can help the health system increase market share.
Until there is resolution on federal mandates and funding, we’ll continue to see uncertainty in the market. However, removing cost and improving quality will stay at the forefront for all healthcare organizations, regardless of healthcare policy changes at the federal or state level. Hospitals and health systems should focus on identifying waste and inefficiencies within their care delivery and revenue cycle processes. This includes ongoing performance measurement to identify outliers by physician and service line, which will help organizations avoid payment penalties for readmissions and complications. Hospitals and health systems also need to focus on the fundamentals – clinical documentation and coded patient records must accurately represent case mix index and patient health risk since this determines payment rates for Medicare and other payers.
Durlach: These groups can prepare for the future by continually optimizing their EHR workflows. Everyone is well aware that many healthcare organizations rushed their EHR rollouts and are trying to figure out best practices on the fly. We need to make sure that the care teams’ interactions with the EHR are enhanced, allowing them to focus on patient care and being medical experts, rather than worrying about being coding experts.
On the reimbursement side of things, we need to allow providers to have a better understanding of what the quality is for acute management of populations. Tools need to be put in place to mine this critical patient data to not only ensure the best possible treatment is given to the patients, but to also help the care team receive positive scores and correct payments. Currently, we are seeing that some doctors aren’t documenting the right level of acuity for patients, and unless they are leveraging important prompting tools that are integrated into the workflow, they are at an unfair advantage because their patients look less sick than others—which has a significant effect on how they are being measured in terms of comparable quality reports. Moving forward, care teams should look to implement technologies that can extract key information from the patient data or prompt the physician in a non-obtrusive way to ensure no steps are missed.
Do you have any other predictions/insights you would like to share regarding the next few years of the clinical information systems market?
Durlach: Moving forward, I believe we will see an explosion of patient-facing technologies and the patient journey will change quite a bit. Providers are going to be measured more on patient satisfaction and experience and as competition in the healthcare industry increases, patients will see the benefits. As we continue more towards value-based care, the health organizations that provide the best patient experiences and implement these new technologies will come out on top.
Garrison: Given healthcare’s complexity and ongoing economic and regulatory pressures, we expect to see further consolidation, acquisitions and companies exiting the space. The population health market in particular will continue to be fragmented until payers and providers bridge their data silos.
Looking ahead five years, we will see the next wave of healthcare leadership take on the many challenges facing provider and payer organizations, and they will set a vision for healthcare over the coming decades. We also predict that machine learning will fulfill its promise over the next few years, and a hybrid approach that combines machine learning or AI with risk stratification methodologies will create a new set of analytic capabilities for next-generation population health.
Sayed-Friel: The increased demands from the government, clinicians, customers, and patients are going to make it untenable for building big infrastructures from scratch, so you will see smaller EHR vendors drop out of the healthcare space. The ability to share information between the remaining EHR vendor systems, as well as creating a secure infrastructure to access genomic information, is going to be critical to the survival of healthcare. You’re going to see an increase in smaller players piggybacking new ideas and designing specialty apps for existing EHR platforms, leveraging the infrastructure to build new patient facing health applications.
As much as I talked about having a platform that can run on any device, I think the other part of the equation is that devices are going to go away in general. I think people are going to be talking to machines, rather than typing, tapping, and swiping. You can certainly imagine a physician-patient interaction where there is something listening in the background and pulling out the salient pieces of information to file into the electronic health record.
Navani: Over the next few years, telehealth will gradually become more mainstream. With the rise of cloud computing, telehealth visits are becoming the logical solution to expand the access to care. Convenient and secure, providers will have the ability to deliver the same quality visit virtually as they would at the office. Using existing computers, networks, webcams, and smart phones the service improves the ease of access for physicians and patients, allowing a patient visit to occur anytime, anywhere.
Dudzinski: Aside from legislative outcomes, competition for patients will escalate in the next five years as healthcare systems vie for the healthcare consumer revenue. Healthcare organizations that can differentiate themselves by orchestrating strong patient relationships and implement patient interaction strategies that are both administrative and clinical will be the most successful.