Blockchain technology may evoke crypto-currencies and overhyped Silicon Valley startups, but at its root, blockchain is a way to share information securely by also sharing the responsibility for keeping it safe. For Baker and his partners, for instance, the technology would facilitate the tracking of unused medications. Rather than having a central administrator manually verify every time a drug changes hands, participants will share that role. They’ll record and store data about donated medications on a shared electronic ledger and verify their authenticity by tracing a medication back to where it was manufactured and forward to where it’s needed. “This is an example of how blockchain can help save lives,” Baker says.
For the better part of a decade, blockchain has been hailed as a technology that will change how almost everything—information, goods, money—gets created, distributed and consumed. Experiments are taking place across the landscape of American business, and that includes hospitals and research laboratories. Indeed, plans for blockchain in health care outpace those of any other sector, according to a recent Stanford Graduate School of Business study.
The challenge will be to find the right fit, which means identifying problems that can be solved by a technology that can streamline and secure the movement of data. Electronic health records (EHRs) have been an early target. They’re now the lingua franca of health care, and patient medical data has taken root in the records of insurance companies, hospitals and the offices of physicians and other providers. But not all of these records are accessible to everyone who might need them. In the city of Boston alone, 26 EHR systems are used by more than a dozen hospitals, with patient data often dispersed across multiple platforms—making it nearly impossible to consolidate every patient’s individual encounters into an accessible, comprehensive health record.
Interoperability has been the banshee cry of ONCHIT (The Office of the National Coordinator for Health Information Technology since 2006. when a uniform standard for interoperability was mandated for electronic health records. Today a standard is in place and any EHR vendor must comply and be certified by a certification authority, or the purchaser will not qualify for federal incentive payments. Some vendors (Epic, and others) design their system to be interoperable with any user using the same software.). It is built-in, not an add on or another system to purchase. It may also be a factor in EPIC dominating the enterprise ecosystem, such as Mayo Clinic, UCLA health systems. Yet after the dust settled, the victors were fairly predictable, with Epic having a slight edge over Cerner in terms of overall market share—28% and 26%, respectively. Epic reigns supreme in the over 500-bed category with a 58% share of the market, compared to Cerner's 27%. Thanks to government contracts, including the V.A. deal, during 2018 Cerner signed the largest number of new hospitals, totaling 177 contracts, including integrated delivery networks, standalone hospitals, and customer add-ons. This is the second consecutive year the company has led market activity. However, due to customer attrition of 77 accounts, Cerner's net gains fell behind Epic, which added 122 contracts and lost one.
When factoring overall wins and losses for U.S. acute care hospitals, Epic led the pack, gaining 121 accounts, Cerner added 100, and Athenahealth won five new contracts overall. The remaining players logged overall losses with Allscripts down by 28 hospitals, MEDITECH dropping 18, CPSI losing 6, and MEDHOST down by 5. eClinicalWorks neither gained nor lost accounts in 2018, according to the report
In today's market interoperability and security are dominated by these large vendors, and any attempt to engage health care providers will be a steep uphill fight for several reasons.
1. The technology is largely misunderstood, and perhaps untrusted given the history of blockchain in financial markets and currency.
2. The market for EHR has exhausted users financially and psychologically. After ten years of planning and stress induced by major capital outlays which have already endangered several hospital systems it is doubtful how many potential clients will take another leap. Physicians and other health care professionals are complaining about how their EHR interferes with face time with a patient, and the extra clerical work requiring after hours to complete the records. And they are not reimbursed accordingly.
The reality is billions of dollars have been spent to build our current EHR bubble, and it is not going to burst soon. The return on investment has not begun to flow to users. Why buy another system if this one works good enough.
Thanks to government contracts, including the V.A. deal, during 2018 Cerner signed the largest number of new hospitals, totaling 177 contracts, including integrated delivery networks, standalone hospitals, and customer add-ons. This is the second consecutive year the company has led market activity. However, due to customer attrition of 77 accounts, Cerner's net gains fell behind Epic, which added 122 contracts and lost one.
When factoring overall wins and losses for U.S. acute care hospitals, Epic led the pack, gaining 121 accounts, Cerner added 100, and athenahealth won five new contracts overall. The remaining players logged overall losses with Allscripts down by 28 hospitals, MEDITECH dropping 18, CPSI losing 6, and MEDHOST down by 5. eClinicalWorks neither gained nor lost accounts in 2018, according to the report.
2018 MARKET SHARE BY VENDOR
Epic 28%
Cerner 26%
MEDITECH 16%
CPSI 9%
Allscripts 6%
MEDHOST 4%
athenahealth2%
None/other 9%
Interoperability Platforms 2019
Shifting Away from Traditional HIE
Authored by: Coray Tate and Colin Buckley, October 17, 2019 | Read Time: 3 minutes
Interest in HIE technology exploded nearly a decade ago, and the HIE solution market has been in flux ever since. Today, the field of vendors is narrow, and many provider organizations want technology that is more than a conduit for sharing patient records—they are looking for interoperability platforms that enable the use of aggregated data for innovative use cases. To understand where vendors are in the transition from traditional HIE to interoperability platforms, KLAS interviewed organizations identified by their vendor as their most advanced users. In-depth interviews with these organizations—as well as general performance feedback from vendors’ broader customer bases—reveal wide variation in use cases and the customer experience
