Paul Black, CEO of Allscripts, has spent his career in the health IT space focused on the big disruptors in healthcare and supporting better care delivery.
On March 9, HHS released its final rule to support the interoperability and information blocking rules from CMS and ONC, which stemmed from the 21st Century Cures legislation. Mr. Black outlines his support for the final rules, as well as his thoughts on the evolution of the EHR industry, big factors driving innovation and how the coronavirus will affect the healthcare delivery system in the future.
On the 21st Century Cures Act. Allscripts supports the legislation and applauded the final rule. Many of the interoperability principles are already built into Allscripts systems, and it is working to become completely compliant with the final rule.
"We've been clear for a long period of time that we are entirely supportive of the 21st Century Cures Act. The legislation reflects our input during the comment period. Because it was a bipartisan effort, we don't consider the law controversial, especially around expanding API availability and giving patients more control over their medical records. We have been supportive of that going back to 2007; we were one of the key leaders in the industry declaring the need for open API access. It’s been a central part of our culture since."
On interoperability. The Allscripts PHR is built to allow patients to control their own medical records without going through their providers, health system or EHR vendor to access those records; this aspect of the PHR distinguishes Allscripts from its competitors. "The fact that we actually have this PHR in the market and working today at scale absolutely gives us a lead," said Mr. Black. "Not all aspects of the final rule are incorporated into production yet, but the components especially around interoperability and patient consent are there. We are operating for delivery networks across the U.S. today."
APIs are also central to the new rules from both ONC and CMS. They are foundational for the requirements freeing data for individual patients, for population data, and those pushing health plans and payers to make the extensive data they have on patients more readily available, too. “This validates the work Allscripts did more than a decade ago to invest in an Open API platform and to build the Allscripts Developer Program, the largest network of third-party app developers in the industry. They help us improve, and they certainly help our clients.”
On the evolution of EHR vendors. Allscripts has been, and continues to be, EHR-agnostic, layering technology for information exchange, population health and analytics on top of virtually every EHR in the market, but it’s clear – based on the recent rules and general market trends – that successful companies are going to need to think bigger than that to reflect the flexibility requested by purchasers.
"The longstanding health IT organizations that will stand the test of time will have to offer not only an EHR platform and revenue cycle management, but likely IT outsourcing, managed services around application management, remote hosting, and cloud capabilities," said Mr. Black.
Further, said Mr. Black, “One thing that’s clear that the information blocking rules, in particular, are likely to put an end to the argument that providers need to rely on only one vendor to be able to sufficiently and effectively exchange patient information. I would not be surprised if we see the market move back towards best-of-breed – the EHR the clinicians value the most for its usability, coupled with the information exchange platform that works best in the clinical workflow and offers the most effective analytics, added to the sharpest revenue cycle management or personal health records out there. If the market is leveled by regulations that simply do not allow vendors to put up any obstacles to data liquidity, we’ll all have to compete on functionality and ease of use.”
On how the coronavirus will change the U.S. healthcare system. "There are a lot of learnings that will come out of this," said Mr. Black. "Clearly, the country is learning a lesson in general pandemic preparedness, but we’re also working with public health and the federal government to identify how we in the health IT industry can help not only now but in such a way as to be ready for the next public health emergency. For example, the data housed in clinical systems can be immensely useful to policy makers as they try to evaluate what action is needed next. There was not yet industry-wide reporting ready to go in our products, though, because we had never faced a situation like this. Next time, however, we will have the benefit of having written the reports that we are working on now – how many tests are being run for COVID-19, and what are the results stratified by various demographic categories? How many patients are in the ICU on any given day? How many are being put on ventilators. Data is knowledge, as they say, and I am confident that whenever the next similar situation arises – though hopefully not on this scale – we’ll be able to apply that data to the decision-making earlier in the process."
On the big factors driving innovation in healthcare today. Two big demands from health systems are the need for mobile capabilities and applications that can lower costs. Allscripts aims to support health systems from a cost accounting standpoint by optimizing the resources they have throughout their current asset base, so they don't have to turn to traditional growth and expansion strategies for more capital. Health systems are also increasingly interested in telehealth and televisits.
"Telehealth has become a large and permanent part of our trajectory as a result of what is going on with the coronavirus," said Mr. Black. "Telemedicine and televisits are not new concepts, but they haven't historically been adopted for several reasons, including the low reimbursement levels and little interest of physicians to embrace the technology. That has been changed overnight. Frankly, it’s one of the positive things that is going to come from this terrible pandemic; that the way Congress is writing legislation to address the short-term emergency is going to be a permanent change that changes the way patients see providers well into the future."
Instead of scheduling an appointment, traveling to the physician's office, waiting in the lobby and exposing themselves to other sick patients, Mr. Black sees more people wanting to schedule virtual visits with personalized treatment. They will also turn to virtual visits for triaging to avoid unnecessary ED visits, which could have devastating consequences during the coronavirus outbreak and is generally much more expensive for the health system as a whole even in times of wellness.
On building the infrastructure for telehealth. While the technology exists for telehealth and virtual visits, in most places the systems and infrastructure for mass use hasn't been scaled. The system is far more complex than just the patient video chatting with the clinician; the patient's medical record needs to be available during the visit, and the information communicated during the visit must then become part of the patient's overall record and history. There is also a registration and scheduling component to virtual visits, and at some point, physicians will begin to comb their in-clinic appointments to recommend which should be virtual instead.
"That kind of exchange and dialogue will happen if you have an interconnected system that allows you to conduct a televisit. This is different from having a point solution where you are just connecting over the phone to ascertain the best course of action based on the clinician's professional experience," said Mr. Black. "There is a lot of interest, from a systems standpoint, in the overall ability to do a televisit properly and connect it to the medical record, enabling the next caregiver to know where the information came from and what to do next."
There is also a billing component to the televisit, and potential lost revenue if the billing isn't done appropriately or the patient doesn't understand their financial responsibility. "It can be painful for the patient if they are billed for a visit that should be covered by their insurance," he said. This is all changing dramatically in the COVID-19 world, too – reimbursement, licensing restrictions, and increased awareness of the role that broadband availability has on telehealth efficiency.
On how Amazon, Apple and big tech will influence the healthcare space. Big technology companies have entered the healthcare market with services for data storage and management, pharmacy, supply chain and more. These companies are experts at elevating the consumer experience, and are serious about becoming major players in the healthcare space.
"These companies are extraordinarily well-funded and have a lot of experience with consumers and dealing with large, complex problems. They come with the knowledge of the human experience. For example, Amazon understands the buying patterns and behaviors of their customers. These companies are very serious and looking at the healthcare market as an interesting opportunity. I think they'll still be around 10 years from now, bringing their expertise in artificial intelligence, machine learning and organizing datasets to take out actionable insights from the mass amounts of data in the healthcare and the public domain to help healthcare providers make decisions. I don't think they will compete with EHR vendors, but rather add an extra layer on top of our existing transaction and clinical systems."
They won't be interested in rebuilding the technology of EHRs, Mr. Black says, but instead partnering to access the data inside the EHRs and making that information more consumable for patients. EHR vendors are already partnering with Microsoft, Amazon and Apple among others on building beneficial relationships for patients and care providers.