The digital health landscape has two categories of players: business to consumer (B2C) ventures and business to business (B2B) applications. The former, like 23andme and Fitbit, have standalone flagship products that can exist completely outside of health systems. The latter, like Tissue Analytics, Protenus and Juxly, mainly target enterprise clients. Working with enterprise often involves dealing with EMR integration.
As any health IT entrepreneur will tell you, EMR integration is arduous, culminating a graveyard of failed health IT startups.
The challenge is that healthcare is a highly regulated and slow-paced industry. As any health IT entrepreneur will tell you, EMR integration is arduous, culminating a graveyard of failed health IT startups. Sales cycles are 12–18 months, coupled with integration cycles that can exceed 12 months. This creates barriers to scaling leading to a market that represents an antithesis of “hot” venture investing.
Despite healthcare’s bad rap among venture capitalists, there is consensus on the power of big data. Nowhere is this more certain than the data treasure trove of EMRs. However, capturing this data has its challenges. Clinicians are currently spending almost half of their day performing rote documentation tasks. This has resulted in high stress and dissatisfaction with current EMR system.
App Markets to the Rescue
Companies like Tissue Analytics are changing existing processes through streamlined workflows and efficient charting. These solutions are turning the EMR into a robust operating system and are facilitated by new programs that promise scalable EMR integrations. A few such programs include:
These programs aim to deliver untapped value within the healthcare industry in tandem with the development of SMART on FHIR. FHIR is a health information exchange standard developed by Health Level Seven International. Meanwhile, SMART formalizes the process for interacting with FHIR interfaces. The goal of SMART on FHIR is to enable the creation and rapid deployment of EMR-agnostic healthcare applications. The result is an increase in interoperability and an expanding dataset.
These huge records are organized and synthesized by ‘EMR-native’ apps to extract value. However, none of the apps have integrated with all the EMRs, despite marketing claims. The emphasis on value-based care has been to manage rising healthcare costs although for now, the task of comprehensive integration is impossible.
But as SMART on FHIR gains more adoption, digital health IT companies must position themselves to leverage interoperability features.
These include broad distribution, API access and opportunities to collaborate with experienced developers.
The problem is that only B2B applications have a critical business need for interoperability. This is because successful B2C companies have no urgent need to integrate with hospital EMRs. B2C companies are currently better served innovating and commercializing proprietary products. Therefore, the onus is on the rest of the industry to provide an incentive to collaborate.
The Curation Model
Naval Ravikant of Angellist recently posted a thread on twitter. He asserted that universities, incubators and capital firms are curation businesses. They build a brand, attract and filter applicants, tout the winners — which in turn validates the brand-, rinse and repeat.
A good example of app curation is Salesforce which used this strategy with its AppExchange to become a CRM behemoth. Epic’s App Orchard, Cerner’s code and the Redox gallery will most likely mirror this model as they aim to drive value from a curated app list.
The takeaway becomes that as a digital health IT company, integration is paramount.
As more high quality apps populate the app marketplaces, there will be incentives for B2C companies to join the party. This means more data and more possibilities.
Enter the New World
There is growing potential for technology to be the basis of a whole new healthcare system. One that is able to deliver personalized and demonstrably better data-based interventions. We see this phenomenon in the valuation of the biggest technology companies i.e Amazon, Apple, Facebook, Google.
At Tissue Analytics, we are integrating with many EMRs. By doing so, we take advantage of the opportunity to drive the development of our partners’ capabilities. This is the next phase of digital health IT and securing our positions now will serve best in the long-run. We urge other healthcare IT companies to do the same because together we will create more value for patients and the ecosystem at large.