EXCLUSIVE: Allscripts’ CEO Paul Black on Interoperability, Cloud Technology and Bringing Machine Learning to the EHR | Healthcare Informatics Magazine | Health IT | Information Technology Skip to content Skip to navigation

EXCLUSIVE: Allscripts’ CEO Paul Black on Interoperability, Cloud Technology and Bringing Machine Learning to the EHR

March 8, 2018
by Heather Landi
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This week, Google announced the launch of its Cloud Healthcare API, which is calls a “robust, scalable infrastructure solution to ingest and manage key healthcare data types.” And during a keynote speech at HIMSS18 on Monday, Eric Schmidt, former executive chairman of Google, outlined his vision of a truly connected, fully AI-assisted learning healthcare system, and how cloud technology is a foundational building block to that.

“I’m going to start with, get to the cloud, run to the cloud. Take an airplane, fly to the cloud. Most of you sit in data centers that work on proprietary logic. We now have cloud technology available, from Google and others, that’s much safer than your data center, much more compliant than your data center,” Schmidt said during his speech to HIMSS18 attendees.

Allscripts CEO Paul Black also is bullish on cloud technology in healthcare: “There’s no question that the cloud is going to be a big factor in bringing down the total cost of ownership,” he said. “It’s something we’re focused on—Practice Fusion [an electronic health record platform] is cloud-based, many of our solutions are cloud-based. We recently put Sunrise into [Microsoft] Azure, so we’re actively moving applications to the cloud. There’s no question that in five years, 10 years, most of the applications that hospitals access will be cloud-based.”

In an exclusive interview with Healthcare Informatics Associate Editor Heather Landi at HIMSS18 in Las Vegas, Black discussed the company’s latest developments to incorporate machine learning into the EHR, interoperability efforts as well as how the Chicago-based EHR technology company is helping providers and government and public health leaders address the opioid crisis.

On Tuesday morning, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma announced a broad new initiative, called MyHealthEData, to empower patients to control their health data. In response to that announcement, Black said, “We welcome that, we encourage it. We have been talking about interoperability and open API (application programming interface) access for a long period of time. We’ve been doing that and offering that to our clients for the past 10 years.”

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He added, “We think to have true interoperability you need to allow that level of access to the data, allow patients to have access and to pull that data out. We also believe, at the end of the day, that it’s the patient’s record and they should have full access to it.”

Black continued, “This dialogue is a natural progression of the digital framework as a result of the stimulus act in 2009 [American Recovery and Reinvestment Act]. The good news is, we’re all digital; the bad news, or the challenge is, we have all these different EMRs, we now have 400 different EMRs. So, interoperability, from my position, is a high-class problem. We have technically solved it, so let’s now talk about workflow and how to make that data that resides in different EMRs more usable to the clinician and more useable to the patient.”

Black also said that “intra-operability” or interoperability within vendor networks is not sufficient. “So how does Epic interface with Epic? While that’s interesting, it’s not enough. Epic has 15 percent of the marketplace, globally, therefore, 85 percent can’t connect to that. You have to be able to pull information out and harmonize that information. There is a workflow component that harmonizes the information and that’s a piece of the interoperability discussion, let’s talk about the harmonization of that data.”

Allscripts touts its open platform as well as its relationships with entrepreneurs and healthcare providers. In December, the company announced it hit an industry milestone of one billion API data exchange transactions in 2017. The Allscripts Developer Program (ADP) has certified 200 distinct applications and devices for its users, which are available through the company’s application store.

Black also addressed a blog post he wrote, which was published last Friday, criticizing a recent report from Orem, Utah-based KLAS Research examining interoperability efforts by CommonWell and Carequality. The vendor is an original CommonWell member—but has not yet signed up with Carequality.

The report, “Interoperability: An Inside Look at Plug-and-Play Patient-Record Sharing,” concluded that CommonWell Health Alliance’s interoperability services currently lack value. The report asserted that CommonWell's interoperability efforts are being hindered by a lack of provider adoption, but when CommonWell and Carequality eventually connect, “instant value” will be created for users, the KLAS report stated.

In his blog post, Black said the report looks at interoperability through a specific lens—connectivity through “plug-and-play” services—and he called that approach, “short-sighted and dangerous.”

Expanding on that blog post, Black said, “To me, in that report, KLAS narrowed the classification of what interoperability was. The definition was too narrow, it didn’t incorporate point-to-point interfaces, local health information exchanges (HIEs) and APIs. To us, those are a wider and more accurate definition of what interoperability is, versus a narrow definition of ‘Do you connect to a plug-and-play network?’”

He added, “The report had a narrow focus on a much broader, important topic of interoperability, and especially in light of what happened with the CMS [announcement]. We need to make sure there is a broad definition of what interoperability is,” he said.

EHR Innovation, and Using Data to Address the Opioid Crisis

In the past several years, EHR vendors had to devote resources and energy to developing clinical information systems that met Meaningful Use requirements and obtain Office of the National Coordinator for Health IT (ONC) certification. Now, many EHR vendors are focused on innovating in areas such as population health, patient engagement platforms, care management and post-acute care.

Back in January, Allscripts announced it was acquiring Practice Fusion, a cloud-based EHR platform, which significantly expands its EHR business, as 30,000 ambulatory practices currently use Practice Fusion’s EHR. Allscripts leaders said the acquisition would expand the company’s big data insights and analytics, data sharing technologies, and clinical trial solutions. That deal came six months after Allscripts announced it would pay $185 million to acquire McKesson’s hospital and health system IT business, Enterprise Information Systems, which included the Paragon EHR. That deal expanded Allscripts’ footprint in U.S. large practice health systems.

This week, during the HIMSS18 conference, Allscripts announced the launch of a mobile, cloud-based EHR solution that uses machine learning to reduce time for clinical documentation. The solution is designed to work like an app instead of traditional software, the company said.

The new EHR product, Avenel, is named after Virginia Avenel Henderson, considered to be one of history’s most powerful women in nursing; she was also a researcher, theorist and author. Built on Microsoft Azure, the Avenel solution streamlines workflow and integrates clinicians’ treatment patterns and then provides reminders of preferences to facilitate faster documentation and decision making.

“There is a growing concern in the marketplace about physician fatigue and issues around how they are spending an increasingly large amount of time with the computer versus the patient. We felt that it was time for a brand new EMR to be built where the EMR would actually work for the physician, versus the physician having to work with the EMR. From an end-user design standpoint, we felt that this could be disruptive,” Black said.

The cloud-based solution also delivers a shared record to facilitate care coordination, Black said. “For primary care, we think this is an extraordinarily important application,” he said.

Black also shared how Allscripts is working to help address the opioid crisis, as the Centers for Disease Control and Prevention (CDC) reports that prescription opioid use and overdoses have quadrupled since 1999.

As a result of its technology solutions, Allscripts has access to a large volume of prescription information, from 70,000 primary care physicians throughout the U.S. “We can see where opioids are being prescribed, and by de-identifying the patient data, we can see where opioid hot spots are and see how many times a prescription has been given and also see the progression of opioid dependency,” Black said. Predictive analytics using prescription data can help predict the progression of the path to addiction, from less addictive opioids to more additive opioids, such as fentanyl, he noted.

“We can see geographies by zip code, by county, to see where there are issues. We can look at the total population of a county with a high incident of opioid usage and plug in the county or state data from registries. And, we’re taking that data back to state governors so they can take it to their opioid task forces to help identify opioid hot spots,” he said.

Black noted the potential to better leverage technology to expand the response to the opioid crisis to be more proactive, and ultimately, predictive. “State governments are tamping down on the electronic prescription of controlled substances; there is a fair amount of technology that you can utilize to help with abusive practices. The technology is there, and it can help with reducing the number of prescriptions,” he said, adding, “The technology is in place and we can leverage that technology to get people connected to the social fabric that already exists, such as addiction treatment centers and behavioral health, to help people in need.”

Black also addressed the recent developments around technology firms, such as Apple, Amazon and Google, making big health care moves. “There’s a lot of big players coming in and they are coming in with a different focus than what folks have done in the past. They are going to be focused on data, on AI, and population health, which we welcome. We also think those are capabilities that we share, so in some cases, we will be competing.”

He continued, “They are also focused on consumers, and that’s also something that we welcome as getting consumers engaged in their healthcare is needed for us to break the overall cost of healthcare.”

 


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UC Davis Health’s Physician-Specific Approach to Addressing Burnout

October 16, 2018
by Rajiv Leventhal, Managing Editor
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To combat the physician burnout epidemic, one health system is taking matters into its own hands

Physician burnout has long been a significant healthcare challenge, but in recent years with the advent of various technologies into clinical workflows, along with an array of regulatory requirements, the problem seems to be getting worse.

Indeed, there is no shortage of research that backs up the notion that physicians are overburdened, with some surveys having found that 30 to 60 percent of clinicians report symptoms of burnout, which can threaten patient safety and physician health. What’s more, EHRs (electronic health records) are consistently cited as the top burnout factor, largely due to the time one must spend in them documenting and performing other administrative tasks. To this point, a commonly referenced study published in the Annals of Internal Medicine in 2016 found that for every hour physicians provide direct clinical face time to patients, nearly two additional hours are spent on EHR and desk work within the clinic day.

Although federal health officials have been outspoken about the need to combat these issues while improving physician satisfaction, some hospitals and have health systems have been taking matters into their own hands. In Sacramento, not long ago, clinical and IT leaders at the University of California, Davis (UC Davis) Health were eager to get funding to develop and roll-out a program to improve physician efficiency levels within the EHR.

Scott MacDonald, M.D., the health system’s EHR medical director, says that in order to get that funding, his team needed to show the organization’s leadership, via a pilot project, that a program designed around improving physician efficiency in the EHR was worthwhile and valuable. They ended up getting a small team together, mostly volunteers from various UC Davis Health locations, and piloted two high performing clinics and two low performing ones, based on efficiency data from Epic, MacDonald recalls.

In order to determine which clinics were doing well with their EHRs, and which ones were not, the UC Davis Health team looked at a number of factors. For one, they would examine a given individual physician to see if he or she was spending more than the average amount of time on certain EHR “in-basket” tasks, explains MacDonald. “We would then look and compare that data to others in that physician’s department and specialty to see if there were outliers. So that’s a useful tool for us to recognize that this person is efficient with chart reviews but inefficient with writing notes, [for example].”

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MacDonald says that they would also survey the physicians to see what they personally feel they are most inefficient with in the EHR. “We wanted to make sure that we address their biggest areas of frustration,” he says, noting that the organization is also looking to add a chief wellness officer to help accomplish this.

Problems in the Trenches

MacDonald says that his team, based on anecdotal conversations with physicians, believes that it’s “patently obvious that doctors are frustrated by EHRs and IT, as well as the other factors from the changes in the healthcare system over the last few years, as well as the regulatory environment.”

That said, MacDonald doesn’t believe that EHRs are hurting the physician-patient relationship; more so that they are “blamed” for hurting it. “Because of what’s happened over the course of the last decade, with lots of regulatory requirements, even going back to the 1990s with CMS [the Centers for Medicare & Medicaid Services] billing regulations, all those things have been addressed in a lot of organizations through the EHR. So people tend to shoot the messenger and blame the EHR for these ills. But the EHR is really just a tool, and if that tool is built and trained well, it’s certainly a real boon to the quality of care we deliver,” he says. “If people know how to use the tool effectively when they are seeing a patient, [it will] become a partner in the care with the patient, rather than a mediator of the care,” he emphasizes.

Providing some more context, MacDonald believes that if doctors have the computer screen up between them and the patient, and all the patient sees are the wires coming out of the back of the monitor, that doesn’t make for a good experience for the patient. “But if you are in a triangle with the patient and the monitor, and you are engaging the patient in the data you are looking at, then it could be a real positive. Across the U.S., we have not trained our physicians in that aspect of modern medicine. How we use the tool is part of the relationship with the patient,” he says.

A Program Designed for the Physician

UC Davis Health’s Physician Efficiency Program (PEP), modeled after the pilot project in the four clinics last year, tapped program manager Melissa Jost, who oversees six analysts. Teams of three are deployed to clinics to train and build features within the Epic EHR platform. What’s more, Jost supervises two builders and four trainers, an approach that MacDonald believes makes this program particularly unique. “We integrate the building and training in one team. So when we go out to the clinics and work with [physicians], we can not only show them how to use the tools that exist, but also build the tools if one doesn’t exist and there is something that is workflow-specific that’s needed.”

Each team spends up to six weeks in a clinic monitoring workflows, reviewing EHR-use metrics and working one-on-one with each physician to personalize and optimize their use of EHR tools. Clinics also reduce each physician’s patient schedule by 50 percent to allow time for the training sessions right in the clinic during normal clinic hours, with team members also available for follow-up questions or sessions on site, according to officials, who also note that the goal is to engage all primary and specialty care ambulatory physicians by 2020.

MacDonald admits that to date, the data isn’t perfect, but it gives his team broad strokes about how effective individuals, clinics and groups are using the EHR system. Nonetheless, officials point to some encouraging results from the program—namely a 12-percent increase in physician satisfaction, 24-percent increase in physician efficiency, and an average reduction of 25 hours less per month in time spent working after hours per physician trained.

And in terms of anecdotal physician feedback, MacDonald says that they love the program so far. “We have been getting rave reviews,” he notes, noting that he recently asked physicians at one clinic their feelings about the program and how it can improve, to which the near universal response was, “When are you coming back?”

When asked if physicians feel that the core problem with EHRs is the documentation requirements, or technical flaws in the systems themselves, MacDonald chalks it up to a “mix of everything.” He says that this type of tension is common in informatics, and people ask, “Why can’t Epic just do [X]?” But MacDonald notes that oftentimes the system actually can do that thing and the physician might not know how to do it. “Often, people’s frustrations can be easily met with simple training because the tools are already there from the vendor. But that’s not always the case, and that’s why we do additional build work to customize it,” he says.

MacDonald adds that in healthcare, there is always this “undercurrent of external requirements that don’t appear to people to have much clinical value,” such as reporting on quality measures, data collection, and regulatory requirements, but most physicians do reluctantly accept the necessity of these things by working in the modern healthcare system. “But if we can mitigate [the burden] by giving them a faster way of doing it, they will appreciate it,” he says.

 


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Report: athenahealth Has Multiple Bidders for Sale of the Company

October 15, 2018
by Heather Landi, Associate Editor
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Watertown, Mass.-based health IT company athenahealth has attracted interest from at least five potential bidders for a possible sale of the company, people familiar with the matter told Bloomberg.

In an article posted Friday, Bloomberg reports that private equity players including Bain Capital, Hellman & Friedman, Clayton, Dubiliar & Rice and TPG are considering bids for athenahealth, the people said, asking not to be identified because the matter is private. Elliott Management Corp., the sometimes-activist fund run by billionaire Paul Singer, is also weighing a bid, people familiar with the matter told Bloomberg.

Elliott, which owns 9 percent of athenahealth, may keep that stake if it is unsuccessful in acquiring the company, the people said.

“athenahealth has received indications of interest above $135 a share, the people said, with final bids due by the end of the month,” Bloomberg reported.

As previously reported by Healthcare Informatics, in May, Elliott Management made an all-cash takeover offer to buy athenahealth, at a valuation of $6.9 billion. The investors sent a letter to athenahealth’s board proposing to acquire the company for $160 per share. In the letter, the investors criticized leadership at the electronic health record (EHR) vendor for failing to make the changes necessary “to enable it to grow as it should and to create the kind of value its shareholders deserve.”

The story continued to take turns throughout the summer, particularly following the resignation of CEO and President Jonathan Bush in June. Bush’s resignation came just a few weeks after Elliott Management’s takeover bid, and just a few days after reports surfaced that the athenahealth chief had allegedly assaulted his ex-wife more than a decade ago, and also created a “sexually hostile environment” at the company.   

Following the news, various companies, both inside and outside of healthcare, were brought up as possibilities to buy athenahealth, including the Kansas City-based EHR giant Cerner Corp.

According to a report in the New York Post published in early September, Elliott Management was cited as the favorite to win the athenahealth takeover bid, reporting that Cerner and UnitedHealth declined an opportunity to acquire the health IT company.

The Sept. 6 report noted that “The healthcare companies that would most logically be interested in athenahealth, including Cerner Corp. and UnitedHealthcare, have taken a pass…” As such, Elliott has now teamed up with investment firm Bain Capital on its bid, the New York Post noted at the time.

Bain Capital owns Waystar, a healthcare technology company that was recently formed by combining Navicure and ZirMed, two revenue cycle management vendors. Waystar may benefit if Bain buys athenahealth, an industry banker told the New York Post.

However, almost two weeks later, another report in the New York Post indicated that Elliott Management had backed away from its $160-a-share bid for athenahealth. “As a result of Singer’s retreat and the lack of robust interest from others, athena has extended a final bid deadline by 10 days — to Sept. 27, sources said. Singer backing off the promised bid is a stark turnaround in the battle for the health care tech company,” the New York Post article stated.

According to an October 11 article in the New York Post, suitors whose offers were deemed too low months ago are being invited to take a second look, according to sources. Bids are now believed to value the company at no greater than $135 a share.

“athena first sought final bids by a Sept. 17 deadline. Then, it extended that deadline by 10 days. Now, the company will likely not make a decision until next week at the earliest on how to proceed, two sources said,” according to the article.

“The seller is deciding between a full sale, a merger with Pamplona Capital’s NThrive or to continue as a listed company,” the New York Post article reported.

The New York Post article also reports that if the company decides not to sell or merge, it will have to find a new CEO to replace Bush, sources said. Former GE chief Jeff Immelt has been running Athena as its executive chairman since the summer.

“They definitely need a CEO that is not Jeff Immelt,” the analyst said in the article. “If I’m the candidate, I would want to know what Elliott’s perspective is going forward.”

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KLAS Report: Behavioral Health EHR Vendors Demonstrate Poor Performance

October 10, 2018
by Heather Landi, Associate Editor
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The behavioral health electronic health record (EHR) vendor market has shown poor performance, to date, according to customers, who cite slow development, implementation challenges and lackluster customer support, according to a KLAS Research report.

A recent KLAS report examines behavioral health EHR performance, based on interviews with 149 unique organizations to get their perspective on the performance of these solutions. According to the organizations interviewed, the settings in which behavioral health EHRs are used are primarily outpatient/private practice (78 percent); intensive outpatient/residential day program (64 percent); inpatient residential treatment center (42 percent) and acute psychiatric services (22 percent).

The report, KLAS’ first on behavioral health EHRs, is intended to give executives at behavioral health organizations a high-level overview of the market and to shine a spotlight on where vendors can improve. Specifically, the report dives into the behavioral health vendors used most frequently (in both inpatient and outpatient settings) and their performance in product quality, development, and service and support. 

Organizations who offer behavioral health services need robust IT solutions that can support their efforts, however, on average, the overall performance of behavioral health vendors is very low. According to KLAS, the average overall score for behavioral health vendors is 70.8 (out of 100), putting behavior al health in the second percentile of all software market segments that KLAS measures (about 100 total).

Several factors contribute to this low performance, KLAS researchers note in the report. Organizations’ needs vary greatly based on the types of services they offer and the states they operate in, and this latter factor specifically impacts reporting. What’s more, a one-size-fits-all solution isn’t adequate for most organizations. Also, behavioral health vendors often overcommit on what they can deliver and are slow to develop the functionality organizations need and request.

According to KLAS “While vendor performance is low across the board, most frustrated customers plan to stay with their behavioral health vendor due to limited resources and a lack of compelling alternatives,” the researchers wrote.

Among the vendor solutions covered in the report are Cerner’s Community Behavioral Health solution, Cerner’s Millennium Behavioral Health, Core Solutions, Credible, Harris Healthcare, Netsmart, Qualifacts, Valant and Welligent.

Credible, a Rockville, Md.-based vendor that provides web-based EHR software for behavioral health providers, is leading what, so far, is an underperforming segment with wide variation, according to the report. KLAS researchers also note that Valant, a Seattle-based company that behavioral health HER software, is strong among private practices.

“Credible and Valant manage to give their customers a more consistent experience,” the report authors wrote. “Of the vendors used broadly in both outpatient and inpatient settings, Credible is most consistent thanks to their stronger implementation and training process, which has helped most customers find success with the easy-to-use, cloud-based system. Valant, whose customers are mostly private practices, also has an easy-to-use product, which was designed by a licensed psychiatrist. Valant’s multi-pronged approach to training (which includes a train-the-trainer program as well as online tools, such as webinars and blogs) helps private practices feel they get good value for their money.”

Despite the challenges, few are planning to replace, KLAS notes. One CIO interviewed for the report said, “Our CEO was considering other options a while ago. That person spends every spare minute trying to figure out what is best for us, and the CEO's research suggested that there really isn't anything better than [our current EHR] on the market.”

KLAS researchers also found that most behavioral health vendors have been slower to develop than customers would like or have failed to keep development promises. “Missed development timelines are referenced by almost all customers who say their vendor hasn’t kept promises,” the report authors wrote. “Even Credible, the overall top-performing behavioral health vendor, has overcommitted on timelines, specifically for new treatment-planning and state-reporting functionality.”

Cerner is the most mature of the enterprise health system EHR vendors when it comes to behavioral health, according to the report. Cerner has been developing their go-forward Millennium platform and incorporating learnings and content from their acquired Anasazi product (renamed Community Behavioral Health).

KLAS researchers found that overall customer satisfaction with the two products is comparable. In regard to Millennium, health system clients report higher satisfaction; relatively strong support and previously unattainable benefits, like integration across service lines, make up for product inadequacies mentioned by some behavioral health–specific Millennium customers.

Looking at other health system EHR vendors, Meditech has customers live with their integrated behavioral health solution, though adoption is light to date. Epic recently released a behavioral health–specific module, but no customers were yet live at the time of this research. Several of Epic’s inpatient EHR customers say they would have to pay an additional fee for the behavioral health module, according to the report.

Allscripts has no specific platform for behavioral health and recently sold their stake in Netsmart, making them the only EHR vendor—among those in use at large health systems—with no behavioral health–specific solution, the report authors state.

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