Allscripts CEO Paul Black on interoperability, APIs and the one EMR perception he'd change overnight

Paul Black, Allscripts CEO, discusses the health IT vendor's efforts to improve EMR interoperability and what software vendors need most from ONC's proposed rule.

The Chicago-based health IT vendor offers EHR, financial and population health management platforms to hospitals, health systems, physician practices and healthcare facilities globally. Adding to its list of services in June, Allscripts purchased prescription drug monitoring startup ZappRx, a move that will jumpstart Allscripts' efforts in the specialty pharmacy marketplace, Mr. Black said.

Prior to joining Allscripts in 2012, Mr. Black served in various executive positions at Cerner before ending his stint with the health IT vendor in 2007 as COO. He began his career with IBM, where he spent 12 years in various leadership roles in sales, product marketing and professional services, and he also served 16 years as chairman of Truman Medical Center, a 400-bed safety net academic hospital in Kansas City, Mo.

Mr. Black is a current board member of Netsmart, the Advancement Board University of Kansas Health System and the Harry S. Truman Presidential Library.

Here, Mr. Black shares his thoughts on ONC's proposed interoperability rule, how Allscripts is promoting data sharing between organizations and the EMR perceptions he wishes he can change.

Editor's Note: Responses have been lightly edited for clarity and length.

Question: What are your thoughts on ONC’s proposed interoperability rule?

Paul Black: There are some pros and some cons to it. On the pro side, it's clear they put a good deal of thought into the categories for information blocking exceptions. They did a nice job of defining what it isn't, which is helpful. Also, the focus on application programming interfaces, which we've been banging on that drum for 12 years now, is a great idea. We have supported it not only for EMR to EMR interoperability, but for EMR to registry interoperability and for patients to get easier access to their health information. The calls for transparency are also very important because of the difficulties around getting one EMR to talk to another.

We would like to see more work done on these expansive definitions as well as cost recovery on the interoperable properties. The cost recovery piece is pretty interesting because of the way they put it out; it's almost like they have put caps on it and/or are doing pricing for [the vendors], which is certainly something that has not been done for us for a very long period of time. There's also a great deal of ambiguity in the rule with different phrases such as "soon as possible" and "reasonably," which are interesting words involved in this world of black and white. When it comes to software especially, we [as vendors] need specificity and our clients need it as well. 

Q: What do you think about the proposed timeline for the rule?

PB: The timeline is almost bordering unreasonable because of the scope of the ideas in addition to the other regulatory compliance work that we're already doing. Our plate is already, I wouldn't say full, but we're pretty busy doing other regulatory work and being complaint with those rules as they're coming out as well as those regulations that have been out there for a while since the beginning of Meaningful Use one, Meaningful Use two and the Medicare Access and CHIP Reauthorization Act, etc. We're plugging away, and this is not an inconsequential amount of work for us to become compliant in the time frame ONC is suggesting.

Q: How is Allscripts making its EMR interoperable with organizations that use other systems?

PB: We've been advocates of having an open platform since 2007. We have a large group of people in the company whose only role is to help people understand how our APIs work and to help them write and understand how to make calls into our databases at a relatively low-level basis so they can get real information out and put real information back in. This is what we call our Allscripts Developer Program, which today has more than 4,000 different developers who are licensed and certified to log into our platform.

The other thing we've been working on for a long time is our dbMotion platform, which is an interoperability platform we built in Pittsburgh at UPMC to allow Cerner and Epic to talk together so that those two systems can have a single patient view of an individual's health record. We've been mastering and improving upon that platform for the last seven years we've owned it, and now, in 2019, there's more than 51 different EMR systems that are plugged into the dbMotion in the greater Pittsburgh area.

Q: If you could change one perception of EMRs overnight, what would it be?

PB: The perception that the EMRs have not reached their full potential is a bit misleading. We could go back to the report that came out in 1999 called "To err is human," which talked about the broader landscape of healthcare information technology and the way that hospitals operate. At the time, hospitals were predominantly paper-based, and anytime an industry that big operates on paper the efficiencies that you have with supply chain and efficiencies you have with duplication of ordering drugs, duplication of ordering tests, etc., were in place not on purpose but due to the fact that there wasn't a check and balance system or even a way to figure out whether or not that feature or medication had already been ordered. There's a whole efficiency component that the EMRs are not getting credit for, circa 2019.

Additionally, I think the EMRs are a lot more interoperable than people are giving them credit for. You can get data out of other organizations and move the data around. It's not easy work, but it can be done.

Q: What is your strategy and vision behind the ZappRx acquisition?

PB: The specialty pharmacy marketplace is very large, and it's been growing quite rapidly over the course of the past 10 or 15 years. I think the statistics around that are that medications account for about 2 percent to 3 percent of all prescriptions, yet they represent nearly half of the total prescription costs in the United States. ZappRx, which is a digital health company that offers a prescription and prior authorization platform, leans on increasing efficiency and medication fulfillment. If you're a physician and it's hard to order a medication, you might not order that exact drug just because of the difficulty of getting the prior authorization for it. ZappRx helps reduce the amount of time it takes and also helps with the efficacy of being able to adhere to that specialty protocol that was prescribed by a specialist for this better and more targeted treatment of that particular patient's condition.

Q: What is your top priority for Allscripts for the rest of the year?

PB: We have a lot of U.S.-based clients that are working on and doing upgrades for their certification process purposes, so we are performing a lot of upgrades throughout the end of the year and through the beginning of next year. We're also continuing to innovate around a number of different platforms we have to try and take out some of the physician fatigue as well as other usage issues of these EMRs.

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