Why are digital therapeutic companies not connecting to the traditional healthcare system by integrating with an EMR.

Currently, the world of the traditional EMR system and the world of digital therapeutic companies (DTx) do not integrate, and the reason is that there are significant barriers preventing integration. There are four main barriers today that prevent further integration. A new approach is needed.

When looking at EMR integration, there are two worlds. On one side there is the traditional hospital health system with EMR vendors having installations of their EMR systems, with a general focus on the healthcare professional (HCP) in the hospital setting. On the other side there are patient centric digital health solution providers and digital therapeutic companies (DTx) that focus on providing digital services for patients to track and manage their health and conditions. Given the large presence of EMR systems in hospitals and large number of EMR vendors and on the other hand the vast amounts of patient data, generated through devices and apps provided by DTx companies, it is very surprising to find that these worlds are not really integrated.

Look a bit more closely and one would see that there is a low level of EMR integration with digital health solutions, only implemented on a small scale/case-to-case basis or in the pilot stage. Why is it that from the thousands of digital health solutions available today, only a few are integrating with EMR systems, and will this change in the future? The answer to these questions may lie in the integration barriers that currently exist, and that prevent integration and the merging between the old and the new.

EMR integration definition:

EMR integration spans various dimensions but here it is defined as “the integration of patient generated device data with the patients’ electronic medical records in the hospital information system”. For example, blood glucose data gathered through patients’ continuous blood glucose monitor (CGM) gets updated in the medical record of the patient and can be accessed by the managing clinician from within the hospital EMR system.

There are 4 main barriers to EMR integration.

Fragmented EMR vendor landscape and interoperability barriers

The EMR vendor landscape is fragmented, especially in Europe where there are many small regional players. In the US, the landscape is more consolidated, with a few large vendors (e.g., Cerner and Epic), dominating the market. Because of the fragmented vendor landscape, many different data standards are in use, as well as a variety of connection standards for data transfer and sharing. Additionally, old legacy EMR systems are less agile and adaptable to the modern digital landscape, posing additional challenges.

Same vendor, different local installations

It is not a “one size fits all” scenario and differences in local installations of a particular EMR vendor system often exist, and it is not surprising to find these differences even between hospitals belonging to the same organization or hospital group. This means that a case-by case integration is almost always necessary, a process that can be slow and costly for both integration parties.

Disruption of clinical workflow

Clinicians are busy people and if EMR integration means that there is disruption to their workflow such as learning a new piece of software or logging into a DTx web portal and spending time generating and downloading patient reports, the chances are high that clinicians will be very skeptical and show reluctance towards EMR integration adoption. Without the clinicians on board, any integration project would be particularly challenging.

Competition due to DTX companies providing their own dashboards and HCP portals

With user centric digital therapeutic companies (DTx) building their own dashboards and HCP portals for patients to share their data directly with clinicians, it may be easier for doctors to use these platforms rather than fully integrating the data generated by these DTx provider platforms directly into the hospital EMR system. This may lead to competition between traditional EMR vendors and DTx companies, especially, when these DTx portals are more user friendly and easier to navigate.

It is not expected that the two worlds will merge in the near future and at a large scale. Companies that are willing to prepare well and put in extra effort will have a competitive edge in the modern digital landscape. Companies that want to link their DTx or other digital health services to the traditional health IT world represented by an EMR should carefully plan their integration activities otherwise they will get drawn into costly, never ending IT projects without reasonable ROI.

  1. Understand the business potential of an EMR integration: EMR integration will impact the business of every DTx company. Before getting drawn into large API and integration projects companies should investigate what are the business potentials and costs. There is a substantial market potential for a EMR integration offer but the value proposition is new to the market (has to be defined) and it comes at a price.
  2. Understand EMR integration options: There are a few EMR integration options a DTx company can choose from. This includes the “build your own” or “buy” option (working with integrators might be a good option), the data format option for the data exchange (HL7 and/or FHIR), the frequency of data transfer (on request or monthly might be more than enough), the “read or write” option.
  3. Understand roll out options: Building an API for faster EMR connections might look like an attractive implementation option, but it must be aligned with the country regulatory environment and/or diversity of EMR implementations within the target groups. Choosing a step-by-step market entry approach or making it a differentiating element of the DTx value proposition will also determine the implementation plan.

What is evident is that EMR integration is currently not the norm. Major barriers prevent integration, and these are not easily overcome. If DTx companies decide to integrate with EMR systems, they should follow a clear step plan to maximize integration success and a positive ROI.

If you are interested in learning more about EMR integration and the barriers and opportunities in the constantly changing digital health space, we invite you to read the case story on “Competitor analysis of EMR integration strategies to support digital chronic care service provider.” Happy to connect and discuss it further with you.