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In Nashville, a History of Collaboration is Spurring Healthcare Innovation at an Accelerated Pace

June 22, 2018
by Heather Landi
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While Nashville may be well known as “Music City” for its rich history of country music, the city also has gained recognition as an incubator of healthcare innovation and services.

Nashville is home to 400 healthcare companies, with 18 publicly traded healthcare companies headquartered there, generating more than $84 billion in annual revenue and more than 500,000 jobs. According to a study by the Nashville Health Care Council and Nashville Capital Network, the city is in the midst of a venture capital boom, with healthcare IT leading this surge in investment.

More than $940 million was invested in Nashville healthcare companies by venture capital firms from 2005 to 2015; that amounts to 60 percent of Nashville’s total venture capital investment dollars over that time period, according to the study. Venture capital investment in health IT companies has grown from $2 million in 2009 to a peak of $62.5 million in 2014. Health IT venture capital investment surpassed that of healthcare services companies in 2012, and now represents the largest share of VC investment in the Nashville healthcare market.

With the dynamic changes occurring in health care, new health care companies are being founded in Nashville at an accelerated pace. These innovative new companies are forming partnerships with the city’s healthcare community to address the new and evolving challenges brought about by the transforming regulatory landscape and the pressing need for cost and quality improvements in the U.S. healthcare system, according to Hayley Hovious, president of the Nashville Health Care Council.

Nashville has a legacy of healthcare leadership, entrepreneurship and innovation, Hovious says, and this has helped to foster collaboration and connectivity. The city has been making its mark on the national healthcare landscape since the founding of the Hospital Corporation of America (HCA) in 1968, and now companies such as Acadia Healthcare, Community Health Systems and LifePoint Health are headquartered in Nashville as well.

“Nashville is called the Silicon Valley of healthcare just because of the number of companies that have developed here. There is a really deep well of talent and knowledge about the delivery of healthcare here,” she says.

Hayley Hovious

The health IT innovation happening in Nashville, and around the country, will be explored during the upcoming Nashville Health IT Summit, sponsored by Healthcare Informatics, June 28-29. Learn more here.

The Nashville Health Care Council, which was founded in 1995, is helping to drive interdisciplinary collaboration within the healthcare market by serving as a catalyst for leadership and innovation. The council has an annual budget of $3.3 million and brings together top-level healthcare executives for meetings, public forums and networking events. The council’s membership includes leaders in hospital management, outpatient services, population health, behavioral health, senior living, pharmaceutical services, academic medicine, health IT as well as professional services firms.

The council also focuses heavily on leadership development through its Fellows program that aims to bring together select industry executives to explore new solutions that meet the challenges facing the U.S. healthcare system.

“In the Fellows program, we pair senior executives with other executives across the industry with the goal being to really break down silos and get them to think differently about healthcare,” she says. “We’re bringing people together who wouldn’t normally sit down next to each other and have a conversation on how we can change things. People who get together and say, ‘I’ve got an idea for how we can work together to change things.’ And, we’re starting to see that happen.”

Healthcare leaders in other cities are trying to replicate the success that Nashville has seen in its efforts to foster collaboration and advance technology development. In Austin, Texas, the Austin Healthcare Council launched in early 2017 to bring together executives in the medical and biotech fields to communicate and collaborate. In October 2016, the Health Care Council of Chicago was formed to foster connectivity in the Chicago-area health care community.

Hovious says the growth in healthcare-focused councils points to the recognition that there needs to be more collaboration in healthcare. “There is a growing awareness that there is a lot of value in bringing people together and convening the industry experts,” she says.

While the Nashville Health Care Council can serve as a model to other cities, Hovious contends that Nashville has a unique healthcare ecosystem that spurs innovation. “There is a long history of entrepreneurship here, and the market here has a long history of investing in itself. We’ve had the fastest growth in venture capital investment, while the rest of the nation is seeing growth of 40 percent, we’re at 400 percent growth,” she says.

There is a strong collaborative spirit among healthcare organizations in Nashville as well, she notes, particularly around sharing clinical best practices to improve patient care. “When we bring in executives, they are struck by how much people are willing to work together here, and that’s not necessarily the case in other cities. Even the hospitals that are providing care at the local level are far more willing to talk to each other and work with each other; it’s just a different kind of environment.”

And, she notes, “There are also vast quantities of data that reside here. As a data repository for healthcare, particularly on the clinical side, you can image having the headquarter companies here that have a national reach, like an HCA, a LifePoint Health, a CHS, and Acadia.” She adds, “Vanderbilt (University Medical Center) alone has one of the largest genomic sets in the NIH (National Institutes of Health), and that’s in addition to their clinical data.”

As a result, there are many healthcare companies in the Nashville market working on data-driven initiatives, she says. “They are using AI (artificial intelligence) and pairing it with natural language processing to go back through doctor’s records and start to identify problems at the point of care. We have a number of other companies that are taking data around opioids and working to be able to predict and prevent opioid abuse using this data.”

Hovious also points to the Center for Medical Interoperability, which opened its headquarters in April 2017. The center is a cooperative research and development lab founded by health systems to simplify and advance data sharing among medical technologies and systems. In an interview with the Nashville Business Journal, the center’s CEO Ed Cantwell said Nashville was the ideal location for the center due to the proximity of the area’s major health systems, namely HCA Holdings, Inc., Community Health Systems, LifePoint Health, Vanderbilt University Medical Center and Ascension Health (represented here by its local system, Saint Thomas Health).

“The ‘procurement power’ of those groups makes it more likely they can influence vendors to work with the center to achieve its goal of solving the interoperability problem, Cantwell said in the article.

Looking ahead, with the unprecedented pace of change occurring in healthcare, the need to break down silos and to spur collaborative thinking and innovation will only continue to grow, Hovious says. Among the health IT and digital health companies in the Nashville market, Hovious is seeing a growing focus on the patient experience. She points to healthcare startups such as Narus Health and Aspire Health which are both focused on providing a personalized approach to palliative care through a digital platform.

“We’re starting to see more of that patient focus. How do you give people access to their data? How do you help people have a more personalized path in the system? How do you make sure their care treatment paths are tailored to them?” she says, adding, “The problem we struggle with in healthcare is always that the pace of change in technology is exponential. Everyone sees all this potential happening, and the question is, ‘How are companies focusing on the really important things?’”

“What we’re seeing In Nashville certainly is a focus on the consumer, and also a focus on how you use data. The great thing is that we have so much of it, but how do you make that data something that you can harness and use to improve care?” she says. “There is so much healthcare delivered out of Nashville. I do think we have an opportunity to work with others, such as Silicon Valley, because there is such a deep well of knowledge here on how to drive efficiencies and improvements at scale to actually affect patients and make care better.”

2018 Raleigh Health IT Summit

Renowned leaders in U.S. and North American healthcare gather throughout the year to present important information and share insights at the Healthcare Informatics Health IT Summits.

September 27 - 28, 2018 | Raleigh


At Partners HealthCare, Bringing Digital Transformation to Clinical Care

September 18, 2018
by Rajiv Leventhal, Managing Editor
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Last spring, Partners HealthCare, founded by Brigham and Women’s Hospital (BWH) and Massachusetts General Hospital, and California-based software company Persistent Systems, announced a strategic collaboration to develop a new industry-wide open-source platform with the goal of bringing digital transformation to clinical care.

Indeed, with the digital platform, Partners’ leaders hope to enable greater exchange of information across healthcare providers everywhere, and make available open source applications to any health system. At the time of the 2017 announcement, officials said that the co-developed digital platform will be based on Substitutable Medical Applications & Reusable Technologies (SMART), an open, standards-based technology platform along with Fast Healthcare Interoperability Resources (FHIR). “The platform will enable provider systems across the country to rapidly and cost effectively deploy industry-leading best practices in clinical care across their ecosystems,” according to the announcement.

Healthcare Informatics Managing Editor Rajiv Leventhal recently spoke with Sandy Aronson, executive director of information technology at Partners Healthcare, about this collaboration, its specific goals and outlook, and how things have come along so far. Below are excerpts of that discussion.

What would you say is the greatest significance behind this collaboration?

I have been at Partners for about 15 years, and the first 13 of those years were primarily focused on the clinical use of genetics and genomics. In that space, we created a suite of applications that was architected differently than health IT applications are typically architected. These were applications that helped with the generation of interpreted reports for genetics and genomics sequencing test results. So, where normally in health IT applications you create a transaction system and then try to bolt a knowledge base on top of it to the extent you can, we decided to architect this in the opposite way.

We built a knowledge base that deeply modeled the tests that a laboratory offers, the genes that are covered by that test, variants known to exist in these genes, variants that are learned over time, and the state of knowledge linking those variances to clinically relevant facts—so disease states, drug response, drug efficacy, etc. So we built this deep knowledge base and built a transaction system on top of it, and made a rule that you can’t report out test results unless you keep the knowledge base up-to-date and consistent with your test results. And that enables you to automate the generation of reports.

But as a result, we wound up with this continually-updated knowledge base, so based on that we created what would now be a SMART on FHIR app that plugs into the EHR [electronic health record] and provides clinicians with alerts if something new and potentially clinically relevant is learned about a variant previously identified in one of their patients. So it created this notion of a knowledge base alert being interjected into clinical care.

We studied this and found that clinicians liked it, but the rate at which this learned was dependent on the number of transactions that flow through the system, because that’s how geneticists would gather the data that would enable them to improve their assessment of variants. So we registered this as a medical device, distributed it outside of Partners, and networked the different instances together, so it could learn not just based on our volume, but other folks’ volume as well. Ultimately, we sold that to Sunquest [Information Systems]. The thing we feel was most important was creating this infrastructure that facilitated new clinical processes and captured, shared, and federated data in a way that enabled learning to care.

After having done that, we took a step back and said OK, what should we do next? The infrastructure we built was very specific to issues where genetics and genomics are the major components to deciding what to do for a patient. So we wanted to look at all of the things that made that infrastructure hard to do, and build a platform to make it easier to build things like GeneInsight [an IT platform company owned and developed by Partners], and then distribute that platform, so that in addition to building examples of a similar infrastructure, others can build those examples, too. We wanted that platform to make it easier to distribute apps that are created by different folks in different organizations, ultimately with the goal of networking those apps together.

We are at a unique point in time where you have these new data types coming online that can be helpful to the care delivery process, you have algorithmic-based medicine starting to come into use, both machine learning-based and not, and you have people looking at transformative ideas on how to alter clinical processes where in order to incorporate these new data types and incorporate algorithmic-based approaches to care, you need new kinds of IT support in order to enable these transitions to occur. And that creates an opportunity, not only related to the specific transitions, but also to start collecting data for specific clinical problems in a much finer-grained way that lays the groundwork for these networks that can build the data that’s required to underlie continuous learning processes.

All of this is happening in a time with incredible cost pressure in healthcare, which does constrain internal investment but also makes organizations far less resistant to change. The goal here is to fundamentally enable clinicals to evolve their practices, their care, new data, ideas, and techniques in ways they haven’t done in the past.

Sandy Aronson

And how are you working with Persistent Systems on this, specifically?

We are building this platform together. The platform is called HIP, or health innovation platform, and the platform itself will be open-source, and it sits on top of the current clinical IT ecosystem. You interface it to underlying systems, and then it handles things like some aspects of security, authentication, and HIPAA, but also access to data as well as incorporating shared algorithms.

The goal is having different places hook up the platform, and once it is hooked up, it should create a uniform surface on top of the platform so that apps built on top of the platform become more shareable and distributable. We are now focused on both building the platform and building certain apps. And the apps get interjected to the EHR as SMART on FHIR apps.

Can you give some examples and details of the apps that are being built?

One example is that we have been working with BWH’s cardiology [department] on this program that they have, where if you look at heart failure, which affects about 2 percent of the population and has a very high mortality rate with a great deal of costs associated with it, there are guidelines that have been shown to really be helpful, yet very few people are treated in a way that actually adheres to guidelines. And that’s because the process of getting them to guideline-based care involves this drug selection and titration process that requires a lot of interaction, some of which can make patients unconformable.

But as it turns out, you can instantiate a process where you use patient navigators to take patients through this drug selection and titration process, interacting with them far more frequently than a cardiologist would ever be able to, to get them to guidelines. It’s a data-intensive process. So we are providing support for that program through the HIP platform today and we are really focused on deepening that support.

What are your goals in the next 12 to 24 months regarding this partnership? What would you like to see happen?

The ideal world is that our group and Persistent Systems will continue to add more capabilities to the platform, and that the platform is reducing costs. So many clinicians have ideas on how to fundamentally improve care but they can’t put those ideas into use without these kinds of IT interventions.

One thing I hope is that this will continuously reduce the cost of building those interventions and as a result, our team, and others, too, will develop more of these apps. We hope to see some cross-institutional adoption of apps built here and elsewhere, that the sharing will begin at the app level and ideally, in two years or so, we will be having real conversations about how we can get the networking between apps really going.

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Cigna to Invest $250M in Venture Fund with Eyes on Healthcare Startups

September 17, 2018
by Rajiv Leventhal, Managing Editor
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Cigna, the Connecticut-based health services company, has announced the launch of Cigna Ventures, a corporate venture fund focused on investing in promising healthcare startups and growth-stage companies.

Cigna has specially committed $250 million of capital to Cigna Ventures to invest in transformative and innovative healthcare companies “that are unlocking new growth possibilities in healthcare and will bring improved care quality, affordability, choice, and greater simplicity to customers and clients,” officials said in a press release.

Cigna Ventures is particularly focused on companies across three strategic areas: insights and analytics; digital health and retail; and care delivery/management. Officials say the venture fund was created to help Cigna identify, assess and sponsor early-stage innovation ideas that warrant deeper exploration through focused pilot and test-and-learn activities with the goal of realizing meaningful business value.

“Cigna’s commitment to improving the health, well-being and sense of security of the people we serve is at the front and center of everything we do,” Tom Richards, senior vice president and global lead, strategy and business development at Cigna, said in a statement. “The venture fund will enable us to drive innovation beyond our existing core business operations, and incubate new ideas, opportunities and relationships that have the potential for long-term business growth and to help our customers.”

As an article in Bloomberg noted, “Health insurers have been starting venture-capital arms to find new ideas to improve their businesses and generate financial returns. UnitedHealth Group Inc., the biggest health insurer, said in November that its Optum unit was creating a venture arm with $250 million in funds. Humana Inc., Kaiser Permanente, and a group of Blue Cross and Blue Shield insurers all have venture units.”

According to officials, the venture fund builds on Cigna's existing venture activity, including collaboration with five venture capital partners and an equal number of existing direct investments. These include leading the C1 round of financing with Omada Health, investments in Prognos, Contessa Health, MDLIVE and Cricket Health.

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The Shock of the New: The Paris Art World of 1916—and the U.S. Healthcare Landscape of 2018

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This year’s “Top Ten Tech Trends” cover story package looks at the emergence of new disruptors to the industry

I’m currently absorbed in a very compelling book, Picasso and the Painting That Shocked the World, by Miles J. Unger, and published this year by Simon & Schuster. This book traces the trajectory of one of the greatest artists of the 20th century, Pablo Picasso, as he moved towards creating a painting that shattered all the artistic conventions of the time: “Les Demoiselles d’Avignon,” a cubist rendering of several women in erotic poses, but with a jagged, savage, pseudo-primitivist artistic treatment that sent shockwaves through the European art world. In choosing an implicitly controversial subject, and moving towards a revolutionary treatment, influenced very strongly by exhibits of indigenous African art that he had recently seen, Picasso relished the opportunity to shock the middle classes—as they say in France, épater les bourgeois. But he also faced a complex set of artistic challenges and dilemmas.

As Unger notes, “By taking up [poet Charles] Baudelaire’s challenge, he was setting up a deliberate contrast, proposing an alternate version of modernism that would not simply substitute a cramped naturalism for the tired formulas of the Academy.” This revolutionary painting, Unger writes, “would have all the metaphysical ambition of a Salon set piece while delivering its message in a language that was completely new: iconoclastic rather than conventional; radical rather than conservative; subversive rather than reassuring.”

Working on and off from late 1906 through late summer 1907, the Spanish artist endured self-doubt, recrimination, and stumbles; work on the painting “consumed him for more than eight months, months of unremitting labor, personal hardship, and spiritual anguish,” Unger reports. And then, when it was finally publicly exhibited in Paris in 1916, “Les Demoiselles” caused shock and furor, before it ultimately became one of the touchstone works of the 20th century. As art critic Hilton Kramer wrote in 1992, “Whereas [Pierre] Matisse had drawn upon a long tradition of European painting—from Giorgione, Poussin, and Watteau to Ingres, Cézanne, and Gauguin—to create a modern version of a pastoral paradise… Picasso had turned to an alien tradition of primitive art to create in Les Demoiselles a netherworld of strange gods and violent emotions.”

And while healthcare industry innovations emerge out of a completely different context from modernist paintings, there is something of the “shock of the new” (to reference art critic Robert Hughes) about some of the new partnerships and delivery and payment innovations taking place these days in U.S. healthcare. Even as the leaders of hospitals, medical groups, and health systems evolve forward into newfangled accountable care organizations and other value-based contracts, unprecedented new business combinations like the planned CVS-Aetna merger and the Amazon/Berkshire Hathaway/JP Morgan Chase initiative, as well as forays by technology giants like Google (Alphabet), Apple, and Microsoft, threaten to shatter l ong-held assumptions about how the healthcare industry will be organized and operated.

This year’s “Top Ten Tech Trends” cover story package looks at the emergence of new disruptors to the industry, as well as a host of other issues facing the industry right now, from the sprint forward towards true interoperability, to the need for patient-generated data to support value-based care delivery, to the question of how industry consolidation will impact physicians in practice. As we’ve done for years now, we editors at Healthcare Informatics bring you the bold, the innovative, the shocking, and the speculative, in a stimulating package of articles that will help you consider some of the top trends impacting the entire industry right now.

No cubist paintings here; but, like the art galleries of Paris in the first decade of the 20th century, a chance to peer into the future of our world.

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