- The recent flurry of interest in public application programming interfaces (APIs) as a way to connect disparate health data has prompted electronic health record vendors to open the floodgates to third-party developers with bright ideas about how to improve health IT.
Many of the major names in the health IT industry, including Allscripts, Epic Systems, and Cerner Corporation, have created development sandboxes that allow curious app engineers to whip up innovative tools to improve interoperability, streamline workflows, deliver clinical decision support, and analyze big data, and coordinate care.
Some have even gone a step further with app marketplaces, which allow those innovators to offer their wares directly to a built-in customer base eager to take advantage of tools that can enhance their health IT infrastructure.
Epic Systems, for example, announced its highly anticipated App Orchard in February of 2017, boasting approximately 300 signups in the first two weeks of operations, and the Allscripts app store offers around a hundred different add-on options addressing everything from patient engagement needs and perinatal data management to support for wireless scales.
But the veteran expert is athenahealth, which is aiming to expand its existing Marketplace offerings and its More Disruption Please program even further to solve a variety of healthcare’s biggest problems – including the challenges of the convoluted and poorly organized patient-facing mHealth application sector.
athenahealth bet big on the now-ubiquitous marketplace approach in 2011, just a few short years after Apple brought downloadable software purchases to the mainstream consumer consciousness.
“Now, in 2017, everyone is working to develop a platform-based approach. But the idea of an app store was fairly advanced thinking back in 2011, especially for healthcare,” said Jonathan Porter, Senior Vice President of Network Services at athenahealth.
“Healthcare has been behind every other industry from the IT perspective for years, but as we enter a very rapid pace of change to try to catch up, most of the big developers are looking for ways to leverage the entrepreneurship and innovation that’s out there in the ecosystem. There is a lot of money going into app development, and that is starting to produce a tailwind for providers.”
The application-based approach to health IT is benefiting from a perfect storm of regulatory changes, financial pressures, user frustrations, and emerging data standards.
As value-based care prompts a heavier reliance on health IT for population health management and patient engagement, clinical users fed up with limited EHR functionality are urging their vendors to equip them with the capabilities they need to make good on risk-based contracts.
Combined with the swift rise of FHIR and the healthcare interoperability zeitgeist spurred on by MACRA, meaningful use, and the 21st Century Cures Act, the time is right for developers to start offering plug-and-play, mix-and-match infrastructure components that can be tailored to an endless variety of specific clinical and administrative needs.
Fortunately for providers, electronic health records are starting to morph into “operating systems” that can support a more modular take on customizable development that still relies on industry-wide standards. Vendors are trying to be as agile as possible while responding to the increasingly mobile, patient-centered, and data-driven healthcare landscape.
A greater reliance on application programming interfaces and third-party developer programs, along with a more open approach to architecture that will promote interoperability, are becoming vital strategies for the success of the vendor industry as their customers demand more functionality from their product packages.
“The marketplace is going to be so critical for our future because the days of selling software licenses to individual customers is coming to an end,” explained Porter. “Healthcare is becoming too interconnected for that. Basic EHR interoperability, CCDs, and HL7 aren’t going to get us to the level of expectation consumers have for these new interactions.”
“So if we can embrace what’s happening in other industries and move to an app store mentality – a platform-based mentality that has lots of parts extending out into the ecosystem – then we’ll be able to better meet the consumeristic demands of our patients, and we’ll be able to help our customers succeed in that new world.”
While thousands of developers have signed up to explore athenahealth’s public APIs, the company is taking a fairly stringent approach to deciding which applications ultimately become available in the marketplace.
Only 150 partners have completed the entire application review process so far, but Porter believes that an extensive curation process is the key to ensuring that providers see meaningful results.
“Because we’re in healthcare, we have to make sure that these offerings adhere to certain industry privacy standards and such, so we do make our partners jump through those hoops to safeguard patient data and meet HIPAA requirements,” said Porter.
“And before any developer can receive approval as a certified partner, they have to demonstrate that their applications produce a measurable benefit. So if you’re a developer offering a scheduling optimization app, you have to prove that the product can raise the volume of available appointments every day or improve the flow of patients in the way you say it will.”
Developers must put their products into operation with a small subset of pilot clients during the approval process, Porter continued, and athenahealth uses its cloud-based network to monitor the performance metrics of those organizations.
“That’s probably unique among the app marketplaces out there right now,” he said. “Because we have insight into our users, we can watch their performance and see what’s working and what’s creating problems. And because we get paid based on how well our customers perform, it’s very important for us to be as innovative as possible on behalf of our users and be certain that what we’re offering them actually helps them succeed.”
The strategy helps interested clients overcome one of the major sticking points of the health IT application ecosystem: knowing whether or not the investment is worthwhile before committing to a purchase.
Patient-facing mHealth apps in particular have suffered extensively from a lack of oversight and trusted reviews, and providers are often hesitant to recommend these tools due to lackluster functionality, poorly designed interfaces, questionable security, or bugs and glitches.
Patients may be able to delete an app off their smartphone relatively quickly and write off the 99 cent purchase price as a minor poor decision, but providers tend to face steeper costs and a much more lengthy integration process for apps that support patient care.
A problematic application connected to the EHR can lead to long-lasting data integrity errors, exposure of personal health information, patient safety risks, or inappropriate decision-making, leaving organizations in much more serious trouble than their typical consumer counterparts.
A strong review and approvals process on the part of the app marketplace can prevent many of these problems, said Porter.
“Our clients can trust that those 150 certified developers have all proven that they generate positive results based on their value proposition,” he said.
“You know that when you sign up with one of these partners, you’re going to get something out of it. Not everyone is going to see exactly the same results, of course, but there is a certain level of trust that the application has been tested in a real-world situation and that it has gotten good marks on its performance.”
athenahealth has such confidence in the marketplace model that the company is looking to expand its application shopping options even further.
“Now that we have seen success for our core customer base, we’re exploring how we can lift healthcare overall,” said Porter. “This year, we’re really working hard on that.”
“So if you’re using Epocrates, which is a free medical reference tool used by the majority of doctors in the country, there’s going to be a marketplace for that, too. It will launch towards the end of this year or early next year, ideally. The offerings will be interoperable so that anyone can use the apps that connect through us.”
A patient-facing mHealth application marketplace is next on the agenda, he added, and will complement the company’s EHR patient portal refresh.
“Our users care for 15 percent of the country’s population every year, so that is a great opportunity to create a trusted landing place for patients,” said Porter.
“We hope it will offer applications that will help patients with their day-to-day healthcare needs: care coordination, communication with their providers, chronic disease management – whether you’re a patient or a provider, you will be able to explore those types of tools.”
Both new marketplaces will require third-party vendors to undergo a privacy, security, and functionality vetting process that is similar to athenahealth’s current protocols, although Porter acknowledged that patients tend to have different criteria for success than their care providers.
“We know that success for providers is tied up in finances and quality measurement, but what does success mean for a patient and how can we measure it? Is it the number of times they use the app, or is it something more complex like maintaining lower average blood glucose levels over time? We will have to work through those questions so that we’re sure that the products we’re putting out there will impact the patient experience in a truly positive way.”