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Right. I do want to ask you about, not to speculate too much about what’s really next for eClinicalWorks, but before get there, I do want to ask a more general question. Obviously the technology is really developing where now, especially with the emerging importance of population health and wearable technologies etc. With all those things are coming into play, what trends or what do you think is going to develop over the next, say, 5-10 years? How is technology going to continue to change this landscape?
I think it will change the definition of an electronic health record over the next five years. An EHR that does not do patient engagement and population health as a core competency won’t be the electronic health record of the future. That transition is going to be the fun one. That transition from moving from what I would call a meaningful use compliant EHR to a capability that does manage populations, engages patients, digitizes the entire system, allows a provider to talk to another provider, allows a lab company to distribute lab results directly to patients; that entire ecosystem connected, transparent, cloud-based; gone from selling products and services to an ongoing monthly model of use technology is where you will see the trend moving.
You will also see the status quo challenged in a big way. The priority will become the patient because they’ll be the consumer of care, and the employer that foots the bill of care, and technology that serves purposes for employers and patients will dominate more conversations than the ones that do the inpatient systems.
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Interesting. This is just an additional question I had listening to what you were just saying. Do you think that MU, although well intended has led some providers astray on what the real meaning of these products are? Do you think that that had any part or any negative impact on what we’re seeing now?
Most certainly. There was an artificial deadline with an artificial incentive to get paid. People will make decisions without the proper due diligence. That’s not just applicable to healthcare. That would apply to anything. So, yeah, I think that decision-making has happened, and I think we have seen that a worse thing of that as well as we go into it. 70% of our business now is coming from customers that are on a different EHR, so I do think that trend will continue.
I also think that you will see a far fewer number of vendors standing within five years. I also think that the government will be more involved in our industry, not less. Our company will have to figure out how to balance those two: how to keep our customer happy while meeting government mandates, which I don’t think are the easiest or the most efficient, sometimes, in their deadlines and their priorities. You’ve just got to manage it.
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Right. With that in mind, another similar question: We’re calling this at HIT Consultant the year of the patient engagement. I think by and large that’s really what’s happening. People are really waking up to the fact that patient engagement is where it’s at, because obviously provider engagement is key, and the success of these solutions are riding on that.
Also, the success as to how you engage with the patient. You talked greatly about how your company is making those strides through the wearable apps, through all those applications and whatnot. My question to you is: why do you think it has taken so long to consider the patient? That’s sort of like it was the last consideration when it came to technology, maybe not for you, but maybe the consensus out there.
There was no incentive. The incentive has only come over the last few years. We built it many years ago. Our patient portal started in 2003 if not before that, actually. In 2003, we were actually used by customers. You asked me the question, “Why are we thinking about it now?” Because now many patients are getting into high deductible health plans (HDHPs). Patients are now spending out-of-pocket money. They’re going to take a little bit more time asking the question “what is it going to cost me? What’s the value I’m going to get?”
More importantly, “If you’re going to try and draw my blood again, I might have to pay for it, so I might actually give you my lab result now, because I don’t want you to do it a second time.” Previously, what was it? You’d go to the one doctor, they’d draw your blood, you’d go to someone else, they’d do it again. You go from one dentist to another dentist, they do your x-rays. Not only do you get radiated twice, you get more radiation in your body, you pay twice. Now people say, “No, no, no. Wait, wait, wait. This is costing me money. I’m going to take my stuff with me.” So now patient engagement, in both cost quality in labs and medical information, is directly tied to economics; the day that happens, industry changes.
At the end of the day, money is not the only factor, but sometimes it’s a big factor in influencing what happens. Today consumers are going to ask the question, “Where am I going to get my service if the quality is the same?” How are they going to find lower cost standpoints? It’s going to change the industry.
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Yeah. Do you think there will be regulations of costs nationwide? Do you think we’ll see that in the future?
There won’t be a regulation of cost. It’ll be a visibility of cost, and the best cost providers will survive. That’s how it gets regulated in a capitalism economy, and that’s what’s going to happen. That’s how you and I buy cars today. That’s how you and I go decide what option that we can spend our money. We try and understand the safety, the value, the money, and then make a decision; and usually that means you better start competing in an open market. Healthcare has not been in that space. It will change next year. It will change the year after. It’s not going to turn back anymore. You know Medicare already published the data. More and more employers are asking for more and more data from their peers.
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That’s right. With all the future talk in mind, let’s talk a little bit about eClinicalWorks. I know you can’t give away any thing, but where’s the focus now for you guys in say the next five years?
I think we’ve got our vision always the same: improve healthcare by building a supply chain of consumers (which are patients) and providers (which are doctors and ancillary service providers like labs, diagnostic imaging centers, laboratories), and find a way for this to be a fully digital, cloud-based solution. I think in the next five years, the size of this cloud will increase. We’ll have more patients. I’d like to get to 100 million patients within five years using the technology. We are at about 14 million on one side and six, so I’ve got about 20 million today, so I’ve got a long way to go to get them in.
We do, on the other hand, have 200 million plus patients whose electronic health records are in eClinicalWorks’ EHR. I think we’ve got a good start to get there. That would be the focus: further improve quality of care by building technology that allows providers to understand what they should do (which will be population health) predictive modeling, and make the EHR more easy to use on iPads, so their doctors don’t have to worry about point and click. I think we’ll continue to innovate. It’s going to be a fun, fun, fun five years, but it’s going to be a roller coaster.
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Yeah. One last question about the population health: We just talked about why there was no incentive before, and now patients are really thinking about their own health, especially with high-deductible health plans. Do you think now, applied to the provider mindset, more providers are really thinking, “OK. How do we execute population health management effectively?” That the mindset has evolved within the last year or so?
Yes. The last year there has been a dramatic change. There is a definite interest. There is also a definite realization that managing a population of patients, not just for primary care, even. I was talking to a large orthopedics group, and they’re talking about how are they going to reduce the cost around hip replacement and still keep the same quality? I have Ob/Gyn’s asking the question, “How are we going to reduce the c-section rate?” because at the end of the day, that’s not going to work healthcare-wise to have un-moderated, uncontrolled, unverified c-sections. I think, yeah, absolutely. I hear it every day now.
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Is there any additional thoughts or concluding comments you want to make based on the discussion we had today?
I’d say as a company we couldn’t have asked for a better trajectory of where the company needs to go. In the last four years we started different verticals in the company that all started building momentum. Whether it’s healow with patient engagement, whether it’s CCMR with population health management, whether it’s revenue cycle management, and then our core product line with EHR, it’s going to be fun times making a change in this industry, both in terms of cost and quality, allowing our customers to succeed in that space.
