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Rolling Over Mountains – An Interview with Niko Skievaski, President of Redox

Posted on October 16, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Over the past year I have been following the success of Redox and I have read many articles about the entrepreneurial journey of their President and Co-Founder, Niko Skievaski. I recently had the chance to sit down with him at the MGMA18 conference in Boston.

Rather than revisit the same questions that have been covered in dozens of other articles, I wanted to go in a different direction. I wanted to learn more about Skievaski- the-person rather than Skievaski-the-entrepreneur and I wanted to hear Skievaski’s opinion on the state of the healthcare as an ecosystem.

The latter is something that we have been investigating here at Healthcare Scene. For more details, see John Lynn’s recent post about MEDITECH’s app development environment (Greenfield) and my article exploring whether EHR companies are difficult to work with.

Skievaski and I had a wide-ranging conversation. I hope you enjoy it.

You and I met briefly at the Redox party at HIMSS18 earlier this year. I just want to thank you for your hospitality.

You’re welcome. We love our taco parties at Redox. I’m glad you enjoyed the fiesta.

I understand that you recently moved from Madison, WI to Boulder, Colorado. Why the move?

I lived in Madison for 10 years. I was working for EPIC during that time so it made sense to be there. But I recently decided that I needed a few more mountains in my life so I moved to Boulder.

All through college I raced mountain bikes and I wanted to get back to that. Madison does have a few rolling hills which are fun to ride down, but there’s no comparison to biking down a mountain. So I moved to Boulder for the mountain biking.

You’re from Canada right? [Yes] I was up in British Columbia for two months in the summer last year just mountain biking the trails up there. That was my first real experience being in Canada for an extended period of time. It was fun. You guys are really chill up there in Vancouver.

There are many players in the data integration space. Some have been in the business for decades. Why has Redox succeed in capturing the buzz while others haven’t?

We do things fundamentally differently than existing vendors in the integration space.

In the status quo, you implement an EHR and you need upwards of 400 interfaces to connect it to various other systems in your hospital. So you go out and hire 5-20 interface analysts to sit around all day and code the interfaces you need. You do that a few times, like we did at Epic, and you realize that you are building the same interface over and over again for different health systems. It is literally is the same interface.

Redox is based on the premise that you only should have to build the interface once for all healthcare systems. Once it’s built, others can leverage that work too. For example, we connect Brigham and Women’s ADT feed to Redox. We mapped it. We know where all the fields are. And we’ve done the same with hundreds of other health systems. So if there is any reason that Brigham wants to share their info with any of those other health systems we can facilitate it very easily.

Legacy players didn’t grow up in the cloud so they don’t think like we do. They come from a world of on-premise integration and at a time when healthcare organizations wanted to do all the interface work themselves. It’s a different world now.

I guess you can say that we’re getting the attention because we are solving the problem so differently than everyone else.

One of the interesting things about Redox is that you don’t sell to healthcare organizations. Instead you focus exclusively on HealthIT vendors. Why is that?

We started by working with HealthIT startups that knew how to build in the cloud but didn’t know anything about HL7 and didn’t want to. Yet these companies needed to connect to their customers’ EHR systems.

Without that integration, healthcare organizations wouldn’t buy these amazing cloud apps because of the lack of easy connectivity to their existing systems. In that equation, the incentive lies with the HealthIT company. They are the ones that want to solve the issue of connectivity more than the healthcare organization does. So we target companies that need this help and we go to their customers, get connected to the data and make It easy for the new company to focus on what they do best – which isn’t data integration.

The first project we do with a health system is very much like a standard integration project. The second project is where things get excited because we use that exact same interface we built the first time. There’s really no work to be done by the organization. That’s how we scale.

Is there an ideal type of HealthIT company that Redox likes to work with?

With certain vendors who have the right multi-tenant architecture, like PointClickCare, we can just connect with them once and they can then provision to their customers with a flip of a switch. Any PointClickCare location that wants integration, they can just click and make it happen. Together we make it very easy for a PointClickCare customer to connect with HIEs and the healthcare organizations that they work with.

Basically any HealthIT vendor that is truly cloud-based and that has embraced the concept of having a single platform for everyone is an ideal fit for Redox. Of course, we’re willing to talk to anyone to try and find a solution, but if you are cloud-based HealthIT vendor we should really be talking.

Can you give me an example of an advantage Redox enjoys because you are cloud-based?

By being in the cloud we essentially become the cloud interface for health systems to connect to cloud apps. Vendors come to us because we make it easy for them to get the data they need. Healthcare organizations push cloud vendors they want to work with to us because they won’t have to do any work to connect that new app if that vendor signs on with Redox.

Where things get really interesting, and exciting for Redox, is when we can use our cloud platform to facilitate conversations between vendors and their common customers without the need to go all the way back to that customer’s EHR as the focal point of integration.

For example, say there is a cloud-based scheduling app that allows patients to see and book appointments online. Let’s say they are a Redox customer. Now let’s say there is a telemedicine app that allows healthcare organizations to offer telehealth visits and it reads/writes appointment data directly into the organization’s EHR. Say this telemedicine company is a Redox customer too. So if the healthcare org wants to offer Telemedicine appointments through that scheduling app, the two companies can just integrate through Redox rather than use the EHR as the point of integration because we have all the necessary information running through our platform. This would speed up the transaction and make the patient experience more seamless.

This level of integration is just not possible without being in the cloud.

One of the topics we have explored recently at Healthcare Scene is how difficult it is (or isn’t) to work with EHR companies like Epic, Cerner and Allscripts. What are your thoughts on this? Are EHR companies hard to work with?

I would say, in general, EHR companies get a bad rap. I worked at Epic and I have to say that being inside Epic you don’t realize that people outside think you are difficult to work with. We worked hard to give our customers good service. Epic supports their customers, which are health systems. If a system wants to integrate with an application, then Epic people are more than happy to make it happen. They will put together a project team to support that initiative.

I think that as long as the health system is driving the conversation, EHR companies can be easy to work with.

The challenging part is when there is no customer in between. Say you are a HealthIT vendor and you want to go strike up a deal with an EHR company, like Epic. You have to realize that it’s nearly impossible for that EHR company to assess you as HealthIT vendor. They can’t tell if you are a good vendor or a bad one. If you are an established player or someone with an idea on the back of a napkin. The only way they can tell is if they go ask their customers – the health systems. Because of this, their traditional response has been: “Yes, happy to work with you, but we need to have one of our customers on board to prove this will work.” This can be perceived as being difficult to work with.

When we started Redox we didn’t go immediately knocking on Epic’s door and asking our friends to partner with us. Instead we went out and found a mutual customer to work with so that we would have a proof point when we did approach them.

I actually think it is easier to work with large EHR companies versus smaller ones. The larger companies have more invested in each of their customers and are more apt to work on projects that their customers want to do. Smaller EHR companies are constrained by resources and often don’t have the infrastructure to support integration projects in a timely manner. The good news is that things are changing. We’re seeing a lot more of the small EHR companies come out with developer programs, APIs and partner exchanges. I think they understand the need for their systems to be open.

Is the lack of interoperability a technological issue or is it simply an unwillingness to collaborate?

Neither. It’s a business model problem.

There is no business model that drives healthcare organizations to share their data. No one bats an eye about the lack of interoperability in the consumer world. Walmart doesn’t share their customer data with Target even though there are many people buy from both retailers. If they did share data, they would just be stealing each other’s customers. Healthcare organizations are in competition with each other so they aren’t really incentivized to share data with each other, but give them a useful app in between and all of a sudden they will open up their data.

Interoperability is the right thing to do, but it’s a hard thing to do.

What do you wish you could do with an EHR company that you cannot do today?

The user interface (UI) of EHRs are locked down. I wish EHR companies were more open to change workflow or add buttons to their UIs to make things a more seamless.

I totally understand why they don’t allow it. The workflow in an EHR has an impact on patient safety as well as on outcomes, so you wouldn’t want just any vendor to be able to make UI changes on a whim. But it would be great if there was a way to do something with the UI to make it easier for the end user.

For example, if you are doing something in the workflow, it would be fantastic if you could add a button to the UI that launched a 3rd party app from within the EHR. Say a clinician is doing a chart review and they want to be able to see the latest data from a remote patient monitoring tool. Imagine if that clinician could click a button and launch the actual monitoring app rather than that app having to ship its data to the EHR and have it stored/rendered in a poor format – like a table of numbers or a rudimentary chart. Why not let the native app show the data in all it’s glory using an interface designed specifically for it?

What’s next for Redox?

We want to push the healthcare industry to a point where we don’t even think about integration anymore. We want to see an end to integration projects. Think about all the time and resources that would be saved if you don’t have to use a custom interface each time. If we can do that we can drive down the cost of healthcare for everyone. To do that we just have to keep growing the nodes on our network and be a good partner to everyone.

 

This may sound like a tall order, but maybe not for someone who rolls over mountains on a bike for fun.

[Update: Niko Skievaski’s title which was incorrectly reported as CEO. Skievaski is Redox’s President and Co-Founder]

Are EHR Companies Difficult to Work With?

Posted on September 10, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

There is an entrenched myth that EHR companies are difficult to partner with – more interested in up-front partner fees and revenue sharing than actually collaborating with 3rd party companies. Two companies are working hard to be different.

Early in the spring, I had a lengthy conversation with a group of vendors at HIMSS18 about partnering with EHR companies. I had stopped at a booth and somehow we got onto the topic of collaborating with EHR companies as a way to accelerate product development and sales. The person I was speaking with was very frustrated at the lack of response from three of the larger EHR companies. I’m paraphrasing, but her statement was essentially this: “All they want is to charge me their 5K partnership fee and then take 10% of everything I sell to their customer base. It’s ridiculous.”

At that point, several representatives from surrounding booths joined in our conversation. All of them had similar frustrations and shared similar stories of being shunted to the partnership team – which in their opinion was just a sales team in disguise – where they were told about all the wonderful benefits they would receive in return for an upfront partnership fee. I’m sure many Healthcare Scene readers can identify with these vendors.

This conversation stuck with me and over the spring and summer, I decided to dive deeper into the world of EHR partnerships. I wanted to know if the myths were true and I wanted to see if there were any companies that were operating differently. Over the past several months at every conference I have attended, I have made it a point to find out as much as I could about the various partnership programs and spoke with dozens of vendors who were proudly displaying partnership badges on their booths.

The good news is that there are at least two companies working hard to build a thriving partner ecosystem. The bad news is that many EHR companies do not have a well-defined partnership strategy and many vendors do not feel they are getting full value for their participation in EHR ecosystems.

One of the key things I learned is that there is a distinct difference between working with an EHR company on interoperability vs being part of their partner ecosystem. There have been many articles over the past few years about the difficulty of extracting data from EHRs in order to share it with other organizations involved in the care for patients. Headlines like “How disparate EHR systems, lack of interoperability contribute to physician stress, burnout” are common.

Many of the EHR companies I spoke with separate their interoperability efforts from their partnership programs. The ability to share data with others, they said, was not related to how well/not well they worked with 3rd party companies. So while it may be true that EHR companies have a lot of work to do on interoperability, partnership for some is something a few companies are doing well.

One company is Allscripts.

After HIMSS18, I had the opportunity to drop in on the fourth annual Allscripts Developer Summit in Chicago. I honestly did not know what to expect and I was pleasantly surprised at how intimate the event was. The rooms were smaller and had people sitting at round tables listening to presenters and asking lots of questions. The level of interaction between the speakers and the developers at the tables was refreshing to see.

Most of the attendees at the Summit were developers and product managers from companies that were Allscripts partners. Most of the discussions in the sessions and in the hallways centered around the latest APIs and FHIR initiatives.

The Summit is part of Allscript’s Developer Program (ADP). Allscripts recently announced that its ADP partners have together processed more than 4 Billion API data exchange transactions since the company started tracking it in 2013. In the announcement Tina Joros, VP and General Manager, Open Business Unit at Allscripts had this to say:

“We are trying to create a new mentality of innovation for our clients so that they view innovation as a path to improve overall workflows and connect with patients. We have made our API platform easily accessible and cost-effective for developers to use so that they can develop and test their solutions. This includes the ability for developers to use our FHIR APIs to meet regulatory requirements for our shared clients at no cost.”

I had the chance to sit down with Joros during the Summit and she shared with me that Allscripts does more than just provide access to their APIs. “We help companies with sales and marketing as well,” said Joros. “We coach partners that are new to the space how to ‘talk healthcare’. We help them craft and tell their stories to their target buyers. We spend a lot of time on the phone and in the field with our ADP partners. Our goal is to reduce the risk for clients to adopt new technology.”

With more than 8,000 registered developers in ADP, I asked Joros why so many companies had joined. “One of the key differentiators is the ADP Integrator tier of our program; most competitors have programs that make it easier to sign up for the FHIR APIs but they also have a vetting process in place to review companies for partnership,” said Joros. “In our ADP Integrator tier, however, companies can sign up immediately to access all our FHIR and proprietary API functionality – there is no wait or vetting by Allscripts and no fee to get started. The pricing model is designed so that companies only pay Allscripts when they are ready to go to market via a testing fee and usage-based fee. The ease of signing up and no fee to get started are unique in the industry.”

One company that has been very successful at working with Allscripts is Relaymed – a company that makes connectivity software that sends point-of-care test results directly into EHRs. RelayMed has been part of ADP for four years and had nothing but good things to say about the program.

“Many EHR companies have rigid cultures that actually bias them against partnerships – the ‘not invented here’ syndrome,” commented Neil Farish, CEO of Relaymed who spoke with me over the phone. “Allscripts isn’t like that. They had a vision of an open and vibrant ecosystem. That vision is ingrained into their culture and there is support right from the top. It’s become part of their DNA. If anything, senior management at Allscripts has been paying even more attention to partners this year. They are present. They interact with us. Help from their marketing & sales teams has been easy to get and really welcomed.”

The team at Relaymed has been working with the Allscripts team to tighten and improve the level of integration between their two systems. As well, the companies together are looking at ways to expand the breadth of devices that connect to Allscripts through Relaymed.

Another company that has invested in their partnership program is Cerner.

Cerner takes a different approach when working with partners. Although they have a centralized team that helps on-board partners (legal, contracting, etc), the ongoing relationship with partners is handled directly by the team/department that works most closely with that partner. Sometimes that is the Cerner sales team. Often times it is the product team. It just depends on where most of the interactions will occur.

“No partnership looks the same,” John Gresham, Senior Vice President, DeviceWorks & Interoperability at Cerner told Healthcare Scene. “So we have to ask the key question – How does that partnership bring differentiated value to the customer? We will work with partners the way that works best for our customers. That may mean embedding someone else’s solution within our solutions, co-market their solution as part of a bundle or we may simply go-to-market together.”

It was surprising to learn that a company as large as Cerner did not have a cookie-cutter approach to partnering with 3rd parties. It would have been easy for them to put in a rigid framework but instead they adapt themselves to best suit the partnership. DellEMC, Kofax and Nuance were cited by Gresham as examples of Cerner partnerships that were flourishing.

“Customers want something seamless and not just in terms of Cerner being a systems integrator for them,” continued Gresham. “They want everything to be smooth and simple – buying it, contracting it, deploying it, integrating it and supporting it. Cerner is willing to do all those things, something that isn’t common in the EHR space.”

During our conversation, Gresham repeatedly referenced Cerner’s laser focus on delivering better patient care and better outcomes – and how that focus guided their partnership decisions. In fact, that is key to attracting the attention of an internal champion at Cerner: a clear line from the product or service being offered to customer or patient benefit.

That is exactly what happened with Goliath Technologies, a provider of IT operations software that enables IT Teams to anticipate, troubleshoot and prevent infrastructure performance issues. The team at Goliath had successfully implemented their solution at a Cerner customer. That customer spoke about their experience at a Cerner event and Jay Savaiano, Senior Director of Business Development at Cerner took notice.

“It was because of Jay and his vision that Goliath got into the program,” explained Thomas Charlton, Chairman and CEO at Goliath Technologies. “He was the first person we had a conversation with and from there everything went smoothly. He was with us every step of the way and we’re still working with Jay today. But it all started because we were able to demonstrate a clear positive impact on a Cerner customer.”

“Once Cerner decided that Goliath would benefit their customers, the process of formalizing the relationship was very straightforward and smooth,” continued Charlton. “They moved really fast. They have a fantastic team of people, very competent and focused. Everyone from contracting to legal to sales was great to work with.”

Because of the success, they have enjoyed with Cerner, Goliath has begun to put a lot of focus on their partnership with Cerner. They have begun working with Cerner developers to refine and tune their combined solutions and Goliath recently hired a new VP of Corporate Development who had left Cerner a few years ago, to help strengthen the relationship [side note the VP was referred to Charlton by people at Cerner]

“Cerner brings healthcare knowledge to Goliath,” said Charlton. “They know patient care and healthcare systems management. That deep understanding of healthcare has helped us with product development. Cerner has really helped to reshape our thinking on healthcare, patient care and Healthcare IT Operations management.”

*****

It is interesting to note that neither Relaymed or Goliath were put forward by Allscripts or Cerner respectively as example partners to speak with. Both Relaymed and Goliath were referred to me by different people who are not affiliated with either EHR company.

So if you are a software provider that is looking to partner with an EHR company what can you do to attract their attention? All four individuals I spoke with offered sage advice.

Neil Farish (Relaymed): “Avoid the transactional models of partnership where it is just an exchange of $$$. Look to the value that you as a partner are getting, the value the EHR company is getting and the value you can provide together to their end-customers. If there is value all around then the fees should be dwarfed by the value. If not, then you seriously have to rethink that potential partnership.”

Thomas Charlton (Goliath): “Have a very clear understanding of how your product or service helps deliver better care to patients. Can you show a direct line to customer or patient benefit? If you can’t then you need to figure that out before approaching an EHR company looking for a partnership. Also, joint customers are important. The more joint customers you have the more momentum you will get behind the initiative.”

John Gresham (Cerner): “The key to making partnerships work is mutual respect. That’s the starting point. Next comes a key question – do you have a ‘what’s best for customers’ mindset. If you have that then we have a foundation for conversation. I would strongly encourage companies to build solutions for the highest possible reliability, scalability and security.  Cerner customers expect that. Oh, and you have to have proof points to back that up.”

Tina Joros (Allscripts): “Be persistent. Come talk to us at conferences. Connect with us online. I would encourage any company signed up for the program and does not feel like it is providing value, to speak with a member of our team and let us know.  In some cases, we can find a tier that is a better fit for the company or make introductions to other associates at Allscripts, so additional areas of the business can evaluate their solution.”

Myth busted.

EHR Partner Programs

Posted on May 22, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Amazing Charts just announced a new EHR partner program. This isn’t something that’s particularly new for EHR vendors. They all have lots of partners. Some have formalized them into a program like athenahealth has done with their More Disruption Please (MDP) program. Others are much more quiet about the partners they work with and how they work with them.

What’s clear to me in the EHR industry is that an EHR vendor won’t be able to do everything. There are some that like to try (See Epic), but even the largest EHR vendor isn’t going to be able to provide all the services that are needed by a healthcare organization. This is true for ambulatory and hospitals.

Since an EHR vendor won’t be able to do everything, it makes a lot of sense for an EHR vendor to have some sort of partners program. The challenge for an EHR vendor is that a partner program comes with two major expectations. First, the partner has a high quality integration with the EHR software. Second, that the partner is something that the EHR vendor has vetted.

The first challenge is mostly a challenge because most EHR vendors aren’t great at integrating with outside companies. This is a major culture shift for many EHR vendors and it will take time for them to get up to speed on these types of integrations. Plus, these integrations do take some time and investment on the part of the EHR vendor. When there’s time and investment involved, the EHR vendor starts to be much more selective about which companies they want to be working with long term. They don’t want to spend their time and money integrating with a company which none of its users will actually use.

The second challenge is that EHR users assume that an EHR partner is one that’s been vetted by the EHR vendor. Even if the EHR vendor puts all sorts of disclaimers on their partner page, the EHR vendor is still associated with their partners. The written disclaimers might help you avoid legal issues, but working with shady partners can do a lot of damage to your reputation and credibility in the marketplace. I actually think this is probably the biggest reason that EHR vendors have been reluctant to implement partner programs.

I think over time we’ll see the first problem solved as EHR vendors work to standardize their APIs for partner companies. As those APIs become more mature, we’ll see much deeper EHR integrations and the costs to an EHR vendor will drop dramatically when it comes to new partner integrations.

The second problem is much harder to solve. My best suggestion for EHR vendors is to create a platform which allows your users to help you vet potential partners. Not only can they participate in the vetting process, but it can also help you know which partners would be useful to your users. Is there anything more valuable than user driven partnerships? It also puts you in a good position with potential partners if you already have users interested in the integration.

However, an EHR vendor shouldn’t just leave potential partnership requests to their users. Many of their users don’t know of all the potential partner companies. Users are so busy dealing with their day jobs that they often don’t know of all the potential companies that could benefit their practice or hospital. Certainly you should accept user input on potential partnerships, but an EHR vendor should also seed the potential partner feedback platform with a list of potential partners as well. The mix of an EHR vendor created list together with user generated partner lists is much more powerful than one or the other.

We’re just at the beginning of companies partnering and integrating with EHR vendors. I expect that over the next 5 years an EHR vendor will be defined as much by the organizations it chooses to partner with as the features and functions it chooses to develop itself.