At Datica, we have helped pull healthcare data out of EHRs and onto the cloud for over five years, with hundreds of live integrations serviced and millions of mission-critical patient messages flowing through our platform daily. The pace at which EHRs are being unbundled has accelerated over that time period, but noticeably more so over the past 12-18 months. We have directly observed through our work with customers the uptick in EHR integration today compared to a few years ago, and how much more aggressively clinical data is desired for both data-driven analytics and powering new workflows. The growth is fueled by the concept of adding “patient context” to digital products.
There is a dichotomy in the market between approaches to adding patient context, based on our observations.
On one side, there are companies that have developed technology only for healthcare users. These companies have healthcare as “a part of their DNA,” including the makeup of their teams. Many of these companies have grown, or at least survived, in the market without relying on EHR integration for adoption. A simple way to scope this segment is to look at digital health companies founded “pre-public-cloud” circa 2005-2012 who are still in business. They got to their zenith by delivering value to the system, and probably finding a way to catch the Meaningful Use wave. Many of them did not integrate with EHRs at all, period, but instead found workarounds. But as of 2018, they are now all looking to add real-time EHR integration to increase their value, boost their stickiness, add new features, or improve user engagement metrics.
On the other side, there are companies that have developed general purpose technologies that are now trying to sell those technologies into healthcare. The largest example of this category from a few years ago was Salesforce or Redhat. Today, you can add Google, Microsoft, Tableau, AWS, Splunk, VMware, and a host of others. If you were at HIMSS last week, you could appreciate the gravity of this shift by the booth sizes of these technology companies. The solutions fall into categories like cloud platforms, productivity, CRMs, analytics / BI, and communications. As it relates to the point about adding patient context, all these new entrants have understood from the get-go that clinical data improves their product value, product stickiness, and ROI.
For many of the healthcare-only companies we work with, they have spent years building relationships and gaining traction in healthcare. They have done this without EHR integration. But, as health systems start to accept the fact that their EHR vendor is not going to be able to offer solutions across all these product categories, and as more EHR data has started to flow out of the EHR, new opportunities are opening up for general technologies to scale into healthcare-now.
The core difference in the five-year period between 2019 and 2014, or even more recently between 2019 and 2017, is that EHR integration is simply becoming table stakes for digital health. This is a sea change that cannot be overstated. Only a few years ago when EHRs held the monopoly on strategic decision making at the CIO level, creatively designing a product that delivered value while avoiding the blocker of EHR integration was a key to success. Now, with EHR integration as table stakes, the key to success is leveraging EHR integration into an asset or differentiation. EHR integration and patient context opens the door for healthcare-specific features to be added to almost any technology.
This new world has leveled the playing field between healthcare-only digital health vendors and healthcare-now enterprise solutions. Healthcare-only companies have the advantage of existing relationships while healthcare-now companies bring scale that is not possible with healthcare-only. It will be interesting to see how this works out. Some of the largest companies in the world have the healthcare industry in their sights. Both categories will likely battle each other, and we think the winner will probably be the ones that are better at interoperating with clinical data in the EHR.