Today's EHR vendors were not built to solve medicine's modern problems

Interoperability and value-based care are some of healthcare's biggest issues today. No one questions whether or not these issues will come to fruition. Polarization only begins when healthcare stakeholders begin to discuss how interoperability and value-based models of payment will be achieved.

Joshua Newman, MD, CMO and GM Healthcare and Life Sciences of cloud computing company Salesforce, discusses where hospitals and health systems are on the road to succeeding in a world of value as king, how health IT vendors fit in and how interoperability will be solved by fresh faces, rather than legacy companies.

Note: Interview has been lightly edited for length and clarity.

Question: Reimbursement models are already moving away from fee-for-service to a more value-based formula. Do you expect this trend to continue in 2016?

Dr. Joshua Newman: I have exposure to this trend in a couple of different areas. A lot of healthcare stakeholders are making the investment in the chronic disease space because this takes up so much of the spend. The second area is in a more acute domain, including things like orthopedic surgery, cancer and transplants. The job here isn't to take care of large populations with aggregate benefits, but to benefit individual patients with costly cases. There are champions in both of these areas.

In my space, I see uncertainty of how to get scalable value out of chronic disease. On the other side, there is a lot of excitement from those who want to make quality improvements in the acute care space. I see both of these areas growing. The second, the acute care space, is smaller in total volume, but it will grow faster because there are more dollars.

Q: Are hospitals and health systems prepared for this change?

JN: I have tremendous respect for the difficult job hospitals and health systems do, but when we look at the requirements to really embrace value-based care, the understanding, technology and workforce just aren't there yet. We have a conservative culture in medicine. We have yet to fully change to a modern industry. There aren't the mature technologies available on the enterprise scale with the necessary adaptability, yet.

Q: What are vendors doing to handle this transition?

JN: At Salesforce, we offer our Health Cloud. We distinguish ourselves from other vendors because we have enterprise scale, but we also have the flexibility of a startup. Compared to our competitors that aggregate a number of different technologies, we have it all on one platform.

Legacy EHR vendors have a ton of clinical data, a big advantage. But, they have very old on-premise code bases. It can take years to add new functionalities. Smaller vendors can tackle one disease state, and they do that very well, but it is hard for them to expand beyond that. They are not of sufficient size or sophistication to solve enterprise-wide problems.

The answer goes beyond just us. We will hopefully see a new generation of platforms from other vendors that can handle value-based care.

Q: What role does interoperability play in this issue?

JN: The old days of doing it by yourself are gone. Fortunately, EHRs have digitized medicine. We are grateful for the work done by Epic and other major vendors, but they were built to solve fee-for-service medicine problems. They took arcane paper-based systems and created digital organization. The problem is they are less equipped to take on modern problems.

Instead, there are a proliferation of startups and other companies figuring out the interoperability problem. I see a handful of startups that are really credible and strong; they are just building momentum. When we start seeing key customers have success, there will be an incredible increase in enabling technology from these companies.

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