Here’s what happens in a healthcare utopia: You, the patient, have a health record documenting every allergy, vaccine, and family history of illness since birth. Instead of filling out new patient intake forms every time you see a specialist or change primary care physicians, your doctor can access your health record, complete it, and send it to the necessary healthcare professionals in your life.
Building such a platform is not a particularly difficult technological task. Yet most people don’t have access to their childhood immunization records. Data from Crunchbase shows funding for health record startups stands at $367 million, the highest since 2021, and 2022 isn’t over yet.
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But despite rapid innovation in the space, electronic health records continue to be a thorn in the side of doctors, increasing the rate of physician burnoutwhich slows down their adoption and prevents us from reaching this utopia of health.
The problem, it seems, is not one that startups can solve, at least not without mass cooperation among the many doctors, labs, clinics, and other healthcare startups that technology attaches.
“When you hear clinicians constantly complaining about increasing administrative burden and complexity; it became cumbersome and complex because the technology allowed it,” said Paul Chung, a Permanent Kaiser doctor and UCLA professor of health policy.
The history of the electronic health record is a perfect example of why the adoption of technology in healthcare is lagging behind all other industries. These files are often trapped in a tangled web of siled and disparate organizations that don’t work well together, leaving innovation behind.
Untangling this tangled web of EHRs
The quality of care movement in American medicine began in the 1960s to improve patient outcomes in the healthcare systemand revived in the 80s and 90s with the advent of data storage computers.
Hospitals adopted complex business-driven platforms to cope with a large influx of patients, and doctors’ offices began adopting similar technology in 2009 after the HITECH Act. HITECH was an Obama-era push to move patient data to the computer as part of a goal to connect the healthcare facilities a patient needs to navigate. But the switch to computers quickly proved difficult for healthcare workers.
“If you talk to most clinicians, I think that took away a lot of the joy of clinical practice from them,” Chung said. “But there’s also a general recognition that there’s a need for surveillance that you can probably only do with technology.”
The problem of interoperability
Individual physicians and groups adopted expensive EHR systems that came with steep learning curves. But neither of them spoke to each other. HITECH promised a simple and cost-effective future, but doctors still needed to fax patient information or enter it into multiple systems to update patient records.
“The first wave of health tech said, ‘Well, if the doctor just put more data in this record, we’d get so much more'” said Jacob Effronlead investor at Redpoint Ventures which focuses on investments in health care. “But doctors are so busy. It’s not realistic.
Others blamed the design of the EHR systems. Epic Systems, one of the oldest and best-known systems for hospitals, was ostensibly accused in Congress of having been deliberately closed. Receiving a digital medical record from companies like Epic came with steep fees. Epic fired back by pointing out that medical institutions using its technology have high interoperability. It didn’t help.
“It’s like the 800-pound gorilla problem,” said Kevin Zhanghealthcare-focused partner in Initial companies. “The incumbent EHR vendors are pretty nefarious with the way they’ve foreclosed the market. It’s basically created IT systems that [makes] hospitals extremely difficult to integrate.
Additionally, hospitals themselves are encouraged to maintain independent EHR systems. Epic customizes specific features for different hospital systems to create exactly what they need. This means that one healthcare organization’s platform is radically different from another. If you were a hospital paying Epic to do this, you might want to make it easier for patients to return to you instead of taking your records and visiting another one.
A little bit closer
The pandemic has brought another wave of innovation to space. As health centers began to adopt telehealth and virtual visits, it suddenly became important to put everything that happens in the doctor’s office (scheduling appointments, filling out admission forms, billing) online. . Physicians turned to their EHRs.
Funding for EHR tech startups grew from $98 million in 2020 to $751 million the following year, a 666% increase, according to data from Crunchbase. Meanwhile, a second wave of companies is looking to better integrate with existing electronic health records through the adoption of FHIR standards in 2020. FHIR, or Fast Healthcare Interoperability Resources, is a set of standards intended to facilitate the data sharing by companies. .
One of them, ORP, has raised $95 million since its launch in 2014, according to Crunchbase. The platform connects providers to a host of different billing platforms, remote patient monitoring systems, and telehealth startups to create a bespoke administrative solution for physicians. Another one, Gorilla Healthraised $50 million in March to improve the flow of patient information between providers and payers.
While many of these new ventures are promising and intuitive, they aren’t so useful to the nation’s largest hospital systems without buy-in from the big EHR players.
“Even if you obtained the adhesion of the [hospital] CFO or business manager, this hospital onboarding job is a nightmare and quite tailor-made every time. That’s why it’s so tricky,” Zhang said. “And they have low margins to start with, so they can’t take on giant projects all the time.”
It is, ultimately, the crux of all healthcare investments: healthcare markets revolve around patients, providers or insurance. Without buy-in from these markets, no matter how good the technology, startups are doomed.
“It’s the fun of investing in health care,” Effron said. “What can make it so complex is that it has to work for a lot of different people in the system.”
Illustration: Dom Guzman
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