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Health 2.0 EMR API report 2018

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The 2018 AMR API study from Health 2.0. A survey of the experience of the small health tech application companies working with the large EMR vendors. This is an update and expansion of a similar 2016 study. Both studies supported by the California Health Care Foundation.

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Health 2.0 EMR API report 2018

  1. 1. 2018 Data, including updates from the 2016 survey EMR-API Survey Results Report Generated by:
  2. 2. Generated Report for: Q1: How vital is it for your product/service to integrate with an EMR? 79% 19% 2% Vital Nice to have Optional Unncessary Total Respondents: 103 2 Small health tech companies really care about integrating with EMRs
  3. 3. Generated Report for: Total Respondents: 46 Q2: How significant do you think the change in sentiment from mainstream EMR vendors has been around allowing easier API-access and other forms of data access for third party tool integration over the last 2 years? Total Responses: 103 3% 11% 63% 23% The big EMR vendors are getting better…. 3 Significant Improvement Modest Improvement No Change Situation Got Worse
  4. 4. Generated Report for: Total Respondents: 46 Q3: How significant do you think the change in sentiment from health care providers has been around allowing easier API-access and other forms of data access for third party tool integration over the last 2 years? Total Responses: 103 1% 22% 54% 23% ….Providers need to catch up 4 Significant Improvement Modest Improvement No Change Situation Got Worse
  5. 5. Generated Report for: Total Respondents: 46 Q4: Are you investigating blockchain technologies as another method for data storage, integration, or anything else? Total Responses: 103 7% 50% 38% 5% Blockchain—Getting beyond a buzzword? 5 Yes, we’re actively using them Yes, we’re investigating No, not yet N/A
  6. 6. Generated Report for: Total Respondents: 46 Q5: What have your interactions been with the Carin Alliance? Total Responses: 103 80% 5% 11% 4% Aneesh/Ryan? Get to work guys! 6 Actively working with Carin Alliance Investigating working with Carin Alliance Decided not to work with Carin Alliance What is the Carin Alliance?
  7. 7. Generated Report for: Do you have any general comments on the progress towards data access? 7 Most respondents feel data access still needs improvement… “There still are multiple barriers. No progress towards writing data back into EHRs via API. Large upfront fee or revenue share requirements by EHR vendors.” “Frankly it's a mess. Epic is the only company we need access to and their support to external companies is a joke. They rarely respond to requests for information/help and when they do they tell us that as a startup we don't have the rights and size to integrate with their platform. It's a dreadful state of affairs. I suspect they do this to steal the ideas of startups so they can integrate the ideas into their products. Thus, resulting in zero need for products from startups.” “Surveillance capitalism and regulatory capture still rule the day. Patient data is worth a lot of money and virtually no one is wanting to have real transparency on how it's used to manipulate prices or "create" intellectual property.” “Yes - most vendors are unresponsive and do not see the value in integrating with third parties, which stymies our growth. “ “Still a lot of talk, obvious value to be had but limited actual progress.”
  8. 8. Generated Report for: 8 …but some feel like data access is getting better despite the barriers Do you have any general comments on the progress towards data access? “Both Cerner and Epic have been very accommodating. Their pricing strategies are not set in stone and they seem to be trailing different options.” “It's an exciting time to be involved in data access and interoperability.” “I have seen a change, I feel like my clients do not have to beg as much to get a chance to talk about why they need the EMR to work with us. But the barriers still exist.” “Technical progress on standards like FHIR and SMART have been great. Business progress has been slow (e.g. app store business models).” “It is moving in a better direction, however, the cost involved is too much in some cases which make it tough to integrate.”
  9. 9. Generated Report for: Q6: Has your company attempted an integration with an EMR vendor? 85% 15% No. We haven’t. Yes! We’ve integrated. Total Respondents: 103 Yes: 88 No: 15 9 Most respondents know of what they speak
  10. 10. 10 No. We haven’t.
  11. 11. Generated Report for: Q7: Please select one of the following that best describes the extent of your integration attempt(s). Total Respondents: 2018: 87/ 2016: 73 11% 36% 30% 23% Yes!We’veintegratedNo.Wehaven’t 11 Read and write Extracting data from the EMR and inserting data back into the EMR (i.e. read and write) Read Extracting data from the EMR for a proprietary application (i.e. read) Read, write and change Extract data, insert data back into the EMR, and make a change within the vendor system (i.e. read, write, and change) Manipulate Bring in your own external data & combine it with data generated by vendor system, manipulate/analyze it and make a change 8% 33% 27% 32% 2018 2016 Most integration remains read & write with some slight changes Note: This question was based on a suggestion from Lyle Berkowitz MD
  12. 12. Generated Report for: Do you have any comments about your ability to write to an EHR and the consistency of that experience across various EHR integrations (e.g. have you resorted to a PDF as the lowest common denominator)? 12 “We have worked with Athenahealth in writing our data back to the EMR. Since we leverage their API platform we have only resorted to sending PDFs for consents and missing API writes. The experience has been good and bad. We have access to write to a lot of data in the EMR but we often find many of the API endpoints are not tested completely so the development partner bears the cost of testing the interface” “Resorted to PDF as lowest common denominator, and that is even a challenge in some scenarios.” “Unable. Epic doesn't even allow access to the data we want to access, let alone being able to write data.” “Very difficult. Athenahealth is the only one that makes it easy to write into the EHR” “Most EMRs are not very open, so we use Redox except for AthenaHealth where we have direct integration. We do use PDF as a lowest common denominator.” Ability to write to an EHR differs by vendor, with Athenahealth getting the most praise
  13. 13. Generated Report for: Q8: How many integrations has your company attempted? Total Respondents: 87 48% 17% 7% 3% 25% 20+ Yes!We’veintegratedNo.Wehaven’t 13 1-5 5-10 10-15 15-20 63% 18% 1% 3% 15% 2018 2016 Most companies have done more integrations since 2016
  14. 14. Generated Report for: Q10: Were the majority of these integrations started before the end of 2015 or after January 2016? 14 Total Respondents: 87 16% Before December 2015 84% After January 2016 Yes!We’veintegratedNo.Wehaven’t The pace has definitely picked up in the last 2 years
  15. 15. Generated Report for: Q9: Which EMR vendors have you integrated with? Total Respondents: 85 Yes!We’veintegratedNo.Wehaven’t Note that respondents were able to select more than one vendor. The mean number of integrations per respondent is 4, while the median number of integrations is 3. 64% Respondents: 54 19% Respondents: 16 45% Respondents: 38 53% Respondents: 45 54% Respondents: 46 27% Respondents: 23 20% Respondents: 17 29% Respondents: 25 29% Respondents: 25 15 Integrations reflect Epic’s dominant position
  16. 16. Generated Report for: Q11: How did you access the data? Total Respondents: 51 Yes!We’veintegratedNo.Wehaven’t 40% 39% 72% 31% 7% 24% 25% 83% 19% 29% 21% 14% 25% 43% 12% 4% 19% 26% 25% 14% 38% 36% 53% 50% 10% 50% 6% 14% 6% 14% 12% 4% 13% 25% 16 Used Direct or Other Protocol Used Batch or Non-API Data Exchange Used 3rd Party Integration Engine Accessed Vendor API Data access? Athenahealth & Allscripts’ APIs lead the pack
  17. 17. Generated Report for: Most growth for Cerner & Epic has been in using 3rd party integrators. Well done, Redox! 17 Yes!We’veintegratedNo.Wehaven’t 72% 72% 83% 75% 39% 31% 40% 42% 14% 4% 4% 4% 21% 19% 19% 14% 16% 10% 17% 25% 25% 26% 19% 8% 4% 14% 25% 19% 29% 4% 6% 2018 2018 2018 20182016 2016 2016 2016 Used Direct or Other Protocol Used Batch or Non-API Data Exchange Used 3rd Party Integration Engine Accessed Vendor API Data access method, the big 4 compared 2018-2016
  18. 18. Generated Report for: But in reality, it’s not simple... 18 “For many vendors, it is a combination of ways to get all the workflows we need (other than Allscripts and Athenahealth). Epic still requires a mix of API, HL7, direct message and batches. Others are HL7 and direct.”
  19. 19. Generated Report for: Q13: Was a large provider client necessary to engage a vendor in a conversation about accessing data? Respondents: 35 | No: 6 // Yes: 29 Respondents: 13 | No: 8 // Yes: 5 Respondents: 29 | No: 9 // Yes: 20 Respondents: 31 | No: 24 // Yes: 7 Respondents: 28 | No: 22 // Yes: 6 Respondents: 16 | No: 8 // Yes: 8 Respondents: 14 | No: 6 // Yes: 8 Respondents: 18 | No: 10 // Yes: 8 Respondents: 16| No: 7 // Yes: 9 83% 17% 69% 31% 21% 79% 50% 50% 57% 43% 44% 56% 38% 62% 23% 77% 56% 44% NoYes Yes!We’veintegratedNo.Wehaven’t 19 Want to integrate with Epic? Get a client. Others getting more accessible.
  20. 20. Generated Report for: Q14: Were there any terms in the contracting with the client or vendor that you found troubling, e.g. that inhibited your ability to keep your intellectual property? 20 Yes!We’veintegratedNo.Wehaven’t 39% 61% Total Respondents: 54 Yes: 21 No: 33 A big minority have trouble with EMR contract terms…
  21. 21. Generated Report for: And the finger is pointed at the usual suspects! 21 “High upfront cost in order to partner with EHR and get access to APIs” “Epic asks for first born child and then some to participate. I hope they get a FTC lawsuit in the future.” “The Epic App Orchard, which we still haven't been able to sign, has some brutal terms that give our IP to Epic. Still trying to work through that.” “Epic was tough about giving us access to CCD documents. Not super helpful during integration implementation and wouldn't commit to any enhancement requests.” “Epic wants to know the details of our technology. It is high proprietary information and I know what Epic is up to, they want to take it for themselves.” “Epic - App Orchard terms are very broad and unfriendly to "partner" vendors, and they were not open to any negotiation of terms” “Cerner has a lot of byzantine IP policies and refuses to publish API endpoints. Epic is much better.” “Allscripts has a clause that many believe allows them to take anything running on a client's station.” “Some third-party marketplace programs have very strict restrictions on non-compete. This makes it very difficult to build a product without fear of being ejected from the App Store.”
  22. 22. Generated Report for: Experiences and initial contacts vary 22 “Athena, Allscripts and now Epic have an application process and a workflow you go through to get developed, tested, deployed. NextGen did a partner agreement so we co-designed the integration to what they could handle. The rest we had to figure it out on our own.” “First contracted with the health system, got them on board, and then signed Redox as an integration partner. Then, the health system contacted Epic.” “We have several of these, typically the client is the initial contact, they then contact the EMR vendor, then we then work through a series of meetings to get the systems integrated” “Mutual customer contacted us and set up meeting with integration team from other vendor or hospital. Often multiple meetings to map out and work through challenges.” Please provide a general overview of the integration process. (i.e. who was your initial contact, what sort of meetings were required, how did you ultimately reach an agreement etc.).
  23. 23. Generated Report for: If you’ve integrated across multiple EMRs, does the process begin to get easier and where? Is the process easier because you know what you’re doing or are economies of scale gained in regards to technical lift? 23 “The process only gets modestly easier. The elements that are defined by SMART on FHIR get easier. But the variables of whether each vendor provides a decent test sandbox, how to write back to the EHR, who does what during implementation -- These are the items that are really difficult with the first integration with each EHR vendor. Then your second Cerner, second Epic, second Sunrise, second Paragon implementations are indeed easier. And it's easier because we know what we're doing, not writing the implementation guide for the first time!” “It is easier with experience, but for most EMRs a large customer is required to get any movement on the EMR side. For this reason we use Redox for much easier access, albeit at the cost of a deeper integration into the EMR workflow.” “Not necessarily because the problem is a business problem and not a technology problem” “Yes, it gets easier and you start to see patterns. Also our own infrastructure is significantly more sophisticated than it was two years ago.” Most respondents say the process gets easier, some disagree
  24. 24. Generated Report for: Q15: Would you say vendors were generally supportive of your integration efforts? Respondents: 36 | Yes: 16 // No: 20 Respondents: 12 | Yes: 7 // No: 5 Respondents: 28 | Yes: 17 // No: 11 Respondents: 29 | Yes: 28 // No: 1 Respondents: 27 | Yes: 24 // No: 3 Respondents: 16 | Yes: 6 // No: 10 Respondents: 14 | Yes: 5 // No: 9 Respondents: 17 | Yes: 8 // No: 9 Respondents: 14 | Yes: 7 // No: 7 44% 56% 61% 39% 38% 62% 36% 64% 47% 53% 58% 42% 50% 50% YesNo Yes!We’veintegratedNo.Wehaven’t 24 89% 11% 97% 3% Some EMRs support the little guys, others not so much.
  25. 25. Generated Report for: 25 In general, the big guys are becoming more supportive, especially Cerner 44% 56% 61% 39% 89% 11% 97% 3% 2018 2018 2018 2018 37% 63% 31% 69% 77% 23% 75% 25% 2016 2016 2016 2016 Were vendors supportive? The big 4 compared 2018-2016
  26. 26. Generated Report for: Q16: Was there a fee associated with accessing an EMR vendor API or other non-API interfaces? Respondents: 35 | No: 13 // Yes: 22 Respondents: 10 | No: 4 // Yes: 6 Respondents: 25 | No: 7 // Yes: 18 Respondents: 26 | No: 9 // Yes: 17 Respondents: 27 | No: 17 // Yes: 10 Respondents: 12 | No: 3 // Yes: 9 Respondents: 11 | No: 3 // Yes: 8 Respondents: 14 | No: 8 // Yes: 6 Respondents: 13 | No: 3 // Yes: 10 63% 37% 72% 28% 63% 37% 75% 25% 73% 27% 43% 57% 60% 40% 65% 35% 77% 23% Free$ Yes!We’veintegratedNo.Wehaven’t 26 Majority of vendors still charge a fee, most of the time
  27. 27. Generated Report for: Q17: If you were charged a fee, did it most resemble: 27 Yes!We’veintegratedNo.Wehaven’t 36% 47% 15% 20% 40% 44% 33% 27% 50% 32% 40% 40% 20% 11% 77% 45% 14% 10% 40% 30% 20% 22% 33% 9% 18% 10% 10% 20% 22% 14% 9%5% 33% Annual License Fee Percent Revenue Share or Other Trans- actional Fee Other But the charge is moving to % of revenue
  28. 28. Generated Report for: Q18: If there were fees associated with accessing a vendor API, how much do you estimate they totaled? 28 Yes!We’veintegratedNo.Wehaven’t 53% 24% 24% $25,000- $50,000 > $50,000< $25,000 67% 33% 60% 10% 30% 60% 20% 20% 50% 17% 33% 67% 33% 50% 50% 73% 27% 63% 12% 25% Most fees remain relatively modest
  29. 29. Generated Report for: Q19: Overall, would you say EMR vendors helped or hindered the integration process? Respondents: 32 | Helped: 12 // Hindered: 20 Respondents: 11 | Helped: 6 // Hindered: 5 Respondents: 25 | Helped: 13 // Hindered: 12 Respondents: 27 | Helped: 24 // Hindered: 3 Respondents: 27 | Helped: 21 // Hindered: 6 Respondents: 17 | Helped: 6 // Hindered: 11 Respondents: 17 | Helped: 4 // Hindered: 13 Respondents: 14 | Helped: 6 // Hindered: 8 Respondents: 15 | Helped: 6 // Hindered: 9 38% 62% 52% 48% 78% 22% 35% 65% 24% 76% 43% 57% 55% 45% 40% 60% HelpedHindered Yes!We’veintegratedNo.Wehaven’t 29 89% 11% In general, the same two vendors remained helpful outliers…
  30. 30. Generated Report for: …and some have gotten worse 30 2018 2016 2018 2018 2018 2016 2016 2016 24% 76% 52% 48% 38% 62% 55% 45% HelpedHindered Yes!We’veintegratedNo.Wehaven’t 48% 52% 71% 29%60% 40% 47% 53% Are EMR vendors helpful? Comparison 2018-2016
  31. 31. Generated Report for: Program exists; easy to understand Program exists; enrolling somewhat complicated Non-existent programs; difficult to enroll Partner programs: Still a huge gap! Yes!We’veintegratedNo.Wehaven’t 17% 60% 23% Respondents: 35 Respondents: 14 Respondents: 9 Respondents: 26 Respondents: 11 Respondents: 32 Respondents: 30 Respondents: 9 Respondents: 13 21% 79% 11% 33%56% 38% 38% 23% 18% 82% 72% 25% 3% 63% 27% 10% 44% 56% 22 100%
  32. 32. Generated Report for: Partner Programs: your experience may vary! 32 “Cerner and Allscripts are a dream to work with. eCW, GE & NextGen are good, but since they have no official program, the business relationship and terms are custom. Epic App Orchard contract is unreasonable and Epic’s test sandbox is not properly supported.”
  33. 33. Generated Report for: Big 4 are becoming much better partners 33 63% 27% 10% 2018 2018 72% 25% 3% Program exists; easy to understand Program exists; enrolling somewhat complicated Non-existent programs; difficult to enroll 38% 38% 23% 2018 17% 60% 23% 2018 15% 33% 52% 2016 43% 46% 11% 2016 43% 48% 9% 2016 13% 40% 47% 2016
  34. 34. Generated Report for: API quality? Still Athenahealth & the rest Yes!We’veintegratedNo.Wehaven’t 23 High technical quality, relatively easy to work with Not great, but workable Poorly designed APIs 34% 48% 17% Respondents: 29 Respondents: 6 Respondents: 4 Respondents: 21 Respondents: 6 Respondents: 27 Respondents: 24 Respondents: 5 Respondents: 4 67% 33% 25% 50% 25% 24% 67% 9% 17% 17% 66% 85% 11% 4% 46% 42% 12% 80% 20% 50%50%
  35. 35. Generated Report for: In general, the big 4’s APIs are getting better 35 2018 2018 2018 2018 2016 2016 2016 2016 High technical quality, relatively easy to work with Not great, but workable Poorly designed APIs Yes!We’veintegratedNo.Wehaven’t 85% 11% 4% 60% 32% 8% 34% 48% 17% 24% 67% 9% 46% 42% 12% 28% 48% 24% 27% 45% 27% 25% 67% 8%
  36. 36. Generated Report for: Rest of the vendors’ APIs are getting better but some, like Meditech, are getting worse 36 2018 2018 2018 2018 2016 2016 2016 2016 High technical quality, relatively easy to work with Not great, but workable Poorly designed APIs Yes!We’veintegratedNo.Wehaven’t 50%50% 80% 20% 67% 33% 18% 45% 36% 10% 40% 50% 23% 38% 38% 17% 17% 66% 25% 50% 25% 2018 17% 50% 33% 14% 71% 14% 2016
  37. 37. Generated Report for: App Stores are getting real Total Respondents: 54 Yes!We’veintegratedNo.Wehaven’t 33% Respondents: 18 50% 33% 19%39% 17% 24 Respondents: 21 Respondents: 9 Respondents: 10 Respondents: 27 Respondents: 18 None Q22: Have you taken part in a vendor’s app store program?
  38. 38. Generated Report for: Are the App stores worth it? 38 “Many of them are starting to roll out programs but most are very early. Love the App Store concept for ease of use. Fees can be hefty.” “Had to back out of Epic Orchard - agreement was too risky for the business. TBD on Cerner and Athena - cost is high.” “Epic: $5000/$15000/$30000 to join app orchard plus transaction costs. Very expensive.” “The Athena and Allscripts App stores are great but they do not help in promoting us or with acquiring clients” “Athenahealth does offer the MDP program, but they do not adequately support it. The company is resistant to working with us to market to their existing customers, and their large account team actively worked against us giving customers inaccurate information.” “As an earlier stage start up, having to pay 20% revenue share for a client clicking through to us from a marketplace with virtually no sales support is high but necessary evil.”
  39. 39. Generated Report for: Q23: Several of the major vendors, including Epic, Cerner, and Allscripts, have opened their FHIR standards, but so far only about 20-30 providers have made them available. Do you: 39 13% 22% 33% 32% Total Respondents: 54 Have provider clients / prospects who have already made data available via FHIR Have provider clients / prospects who are telling you they will take part Find little interest in this from your provider clients / prospect Not have any experience with this Yes!We’veintegratedNo.Wehaven’t Providers may be the biggest hurdle.
  40. 40. Generated Report for: Who is to blame for creating a bottleneck around data access? Providers or EMR Vendors…? 40 “EMR vendors are definitely creating a bottleneck around data access, even for their own clients with sometimes obscene fees for something as simple as a flat-file report!” “I still see EMR vendors as the major bottleneck in data access. Poorly defined APIs, high cost of access, little to no support for developers. There are exceptions (Allscripts and Athena), but this is generally the rule.” “Providers very much want easier access to data. Usually have a complicated bureaucracy within the hospital system to navigate to allow that.” “It seems like Epic has the reins tight on their customers as well as startups like mine from coming in and accessing the data to for financial gain with their systems. Epic might like to give the impression of being open but in reality it's a very murky and mysteriously dark world of affairs going on at Epic. It's really disheartening.” “Yes, certain vendors are a bottleneck around data access.”
  41. 41. Generated Report for: …opinions are split. 41 “It always seems to be a chicken-egg scenario. Provider: ‘I would love it if you would integrate with our EHR vendor’ -- Vendor: ‘I would be happy to integrate, when the provider makes me do it’ and around and around we go. But things do seem to be getting better.” “There are several functions that require data exchange that are on the edge of HIPAA requirements that many EMRs and providers use as a reason they hide behind and use as reasons not to leverage innovative technologies in the market today.” “Not much has changed in this space since 2012. Some EHR vendors continue to be difficult to work with and others are starting to loosen their grip a bit. Unfortunately, local hospital IT shops continue to be afraid to allow access to data by third party vendors.” “It's both. In most cases one points to the other.” “Most of our clients have been very willing to open data access to 3rd party apps that bring demonstrable value to their health system.”
  42. 42. Generated Report for: Total Respondents: 46 Q24: How available would you say the FHIR standard is these days? Total Responses: 54 13% 45% 34% 8% And what about FHIR? Yes!We’veintegratedNo.Wehaven’t 42 Available for Read, Write, Update Available for Read Not Widely Available Not Sure
  43. 43. Generated Report for: Do you have any comments on what you’re seeing or would expect to see from government / HHS / ONC in promoting or enforcing access to data via APIs? 43 “I would like to see the government push harder for interoperability. The EHR vendors got a huge taxpayer funded windfall with Meaningful Use and they should be pushed to open up.” “I would like to see government set the example and standards for open APIs in digital health care that will allow for additional innovation and shared data." “Not only access but enforcing some process-oriented goals such as timeline to access, sandbox to try, etc” “I would expect to see the government pushing EMRs to open up their platforms for innovative companies like my own to come in and make exciting change to drive down costs and improve quality of care. Then again, who knows with this trumped up government we have right now.” Everyone hopes the government pressures EMRs to open up
  44. 44. Generated Report for: Q25: Have you integrated with Healthkit or other Apple platforms? 44 Total Respondents: 53 Yes!We’veintegratedNo.Wehaven’t 9% Yes: 5 Of those who answered “yes”, 40% indicated the data they are using via Healthkit was from a traditional EMR or other health provider data source 91% No: 48 40% 60% Apple may be the future of EHRs. But not yet!
  45. 45. Generated Report for: Total Respondents: 46 Q27: Apple Health requires that providers publish an open API that conforms to the Argonaut Project implementation guide of the FHIR API. Have you connected to any providers in a manner consistent with the method required by Apple? Total Responses: 53 4% 96% Yes No …and Apple’s EMR API? Not yet either Yes!We’veintegratedNo.Wehaven’t 45
  46. 46. 46 Yes! We’ve integrated.
  47. 47. Generated Report for: Please describe why you haven’t integrated with an EMR. Yes!We’veintegratedNo.Wehaven’t Total Respondents: 11 0% 55% 36% 9% 47 Application does not need integration to add value Have attempted to integrate, but process was too difficult Other integration engine means direct integration is not necessary Too Costly Most who haven’t integrated are finding a way around it
  48. 48. Generated Report for: Yes!We’veintegratedNo.Wehaven’t Total Respondents: 11 48 41% 0% 7% 55% 21% 36% 48% 9% Compared to 2016, integration engines are giving vendors what they need Application does not need integration to add value Have attempted to integrate, but process was too difficult Other integration engine means direct integration is not necessary Too Costly 2016 2016 2016 2016
  49. 49. Generated Report for: Is there other medical data stored in an EMR that could enrich this application or improve the user experience? Respondents: 11 | Yes: 5 // No: 6 45% 55% Yes No 49 Yes!We’veintegratedNo.Wehaven’t Other data requested was: • “Orders and scheduled procedures, filing documents to visit ID so that all documentation can be associated with each encounter/appointment” • “Images and genomes” • “Lab data” • “Provider Notes, Radiology Reports, Microbiology Results” • “exact diagnostics (e.g. molecular tumor profiling)” Some still want more data types…
  50. 50. Generated Report for: Would the patient benefit from his/her professional care team receiving data from this application via (or in combination with) the EMR? Respondents: 11 | Yes: 11 // No: 0 100% Yes No 50 Yes!We’veintegratedNo.Wehaven’t But everyone thinks data will benefit their application
  51. 51. Generated Report for: Are there other crucial functionalities that could be added via an EMR integration (i.e. scheduling, notifications, messaging)? Respondents: 11 | Yes: 9 // No: 2 82% 18% Yes No 51 Yes!We’veintegratedNo.Wehaven’t And would like to be able to exchange data with them.
  52. 52. Generated Report for: Please include any other thoughts or comments you'd like to share on issues around or the general process of integrating third party applications into EMR systems. 52 “Overall it's expensive. The most expensive part is troubleshooting the API. We've found that more often than not, the API endpoints have issues. Finding those issues and troubleshooting them is a very expensive task.” “As a startup with limited capital I don't have the umph or clout I need with Epic to get them motivated to help my company integrate with the Epic EMR. I sincerely hope all the other companies with my same plight fill out this survey. Hopefully it can effect some change in the industry. We need it.” “We are very much at the mercy of the EHRs and lack of integration with EHRs is really limiting our ability to get people to use our products” “Nightmare, continues to worsen. Expensive. Big blocks to real innovation” “Athena aside (and maybe Allscripts), the other EMR vendors are not 'open' despite the activity they project with their involvement in projects like Argonaut and FHIR.” In general, small tech companies are still not happy
  53. 53. Appendix
  54. 54. Generated Report for: 54 Details on survey methodology We ran this survey from Feb 26, 2018 to July 24, 2018. However all but 10 respondents took the survey between late February and mid May. We continually advertised the survey and sent out initiations to take it both via our own resources and with several partners. Given that hundreds of small tech companies are now working with EMRs and we also had trouble getting responses in 2016 we can safely say that it’s hard to get them to respond to this type of survey. The sample size of this survey was 103 verified respondents. We excluded 6 respondents from an original 109. The excluded respondents were from Redox, Datica, Sansoro and Allscripts because they are in the business of providing access to APIs. However, we have often used their comments. 103 verified respondents began the survey, but not all 103 completed the survey in its entirety. There was significant drop off following question 10, which was the last question before respondents moved on to the long set of questions involving specific vendors. Where possible, we've presented the largest sample size of data for any given question, though we also compared the larger sample size to the group of 64 respondents that completed the survey in full. Overall, the smaller sample of respondents that completed the survey reflected a similar distribution when compared to the corresponding larger sample sizes.
  55. 55. Generated Report for: Q12: What specific resources or types of data were you able to access? 55 Yes!We’veintegratedNo.Wehaven’t FHIR CDA ADT Proprietary APIs Other Files & Formats Epic Total respondents: 34 14 10 18 9 16 Cerner Total respondents: 26 10 7 14 8 12 Allscripts Total respondents: 28 8 9 11 17 11 eClinicalWorks Total respondents: 16 3 4 7 2 10 Meditech Total respondents: 13 0 1 8 2 10 GE Centricity Total respondents: 17 2 6 8 4 11 McKesson Total respondents: 12 2 2 5 0 8 Athenahealth Total respondents: 28 4 6 7 20 7 NextGen Total respondents: 14 1 1 6 1 12

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