HIStalk Interviews Peter Smith, CEO, Impact Advisors

Peter Smith is co-founder and CEO of Impact Advisors of Naperville, IL.

Tell me about yourself and the company.

Impact Advisors is a full-service healthcare consulting firm. We specialize in strategy, process improvement, technology, and implementation. We work primarily for the healthcare provider segment, so all flavors of hospital systems as well as large providers and physician practices. I’ve been at it for about 10 years now. I’m looking forward to continuing our service to the industry.

What are the most pressing problems of health system CIOs?

There’s are a couple of things, and these are driving our business as well. If you look at the context of where people are, that will help understand where they’re going. Many of our clients have already implemented their core transactional systems, whether it’s EMRs or revenue cycle systems. Now they’re looking to harvest and move to the next generation of information. 

One of the biggest challenges is that now that the transactional systems are stabilized in many environments, how do you use all that information to create a valuable experience and valuable best practices for medicine and valuable interactions with your patients and community? Really turning that corner. You’re seeing things like analytics and business intelligence become very important. You’re seeing things like the patient /consumer experience and digital transformation driving the industry right now.

Are health systems really interested in interoperability and are they and their EHR vendors making progress to make it happen?

Interoperability is a huge hot topic in the industry. It’s critical for enabling the strategies of both health providers and beyond just the single providers in terms of creating an ecosystem of health across large communities and regions. Interoperability remains at the forefront. There has been tremendous progress. The major vendors are both adding capability and interest, and more importantly, energy to creating interoperability platforms.

As these ecosystems get larger and the need for organizations to trade information among partners — whether they’re payers, other healthcare providers, or the patient themselves — you’re seeing a real push for providing open and transparent information to a much larger community, such as healthcare partners, patients, and families.

Interoperability still remains at the forefront and there’s been tremendous progress. The industry and the environment will continue to demand it.

Have hospitals become more cautious about their technology spending as they wait to see how Affordable Care Act changes will affect them?

Everybody’s in a state of uncertainty as to what the new legislation might bring. Many of our clients in the provider segment of the industry are reacting in the exact way you described. They’re waiting to understand what it is, so there’s almost a little bit of a pause right now in terms of thinking about what the future might bring and waiting to see how this will unfold.

That being said, some of the fundamental things that need to be done in healthcare are still going to be here, independent of the legislation. Organizations continue to be conscious of cost and expense as their reimbursement models change. No matter what the legislation will bring specifically, you’ll continue to see this trend from volume to value. With that comes some significant implications to the organization. How do you deliver care in a more efficient, higher-quality manner? Those fundamental characteristics will remain important to our organizations.

Even though there’s a slight pause in a moment of uncertainty, people are still moving ahead fairly actively with the foundational things. Process improvement and new technology solutions will continue to be important no matter what the legislation might bring. Healthcare is obviously very dependent on legislation and policy, but it’s also dependent on the fundamental undercurrents of economics — doing the right thing at a better price point and a higher quality.

Is Epic starting to look more like Cerner as it broadens scope to offer hosting and revenue cycle services?

I don’t know if their specific strategy is to look more like Cerner. It might be more happenstance of the environmental factors that are driving them. I can’t speak for Epic, but I imagine that their clients are asking them to do more given the relationships they’ve had with them historically. Hosting was a natural evolution for them. Providing some level of business process services is also an evolution for them.

My guess is that it’s being driven by a couple of factors. Obviously there’s some gaps in the industry around that and some of those services are probably ripe for the same level of aggregation, consolidation, and high-quality services that Epic has historically brought to the table, as well as Cerner. That and the fact that there’s probably client demand, and if you look at Cerner and Epic particularly, they have both been fairly consistent at the higher end of the market, the larger, more complex organizations. If they move into the middle market, combining a package of services is probably going to be important going to that segment of the industry.

It all made logical sense to us and we wish them both well. Cerner has had a long track record of being very successful and I suspect Epic will as well.

What was your reaction when the VA announced that it was going to implement Cerner before it negotiated a contract or developed a broad project plan?

I was encouraged that the VA and the DoD went in the same direction. Granted, it’s very different patient populations. We recognize that, but having some consistency in solutions across our Armed Services support environment could eventually pay some dividends. I didn’t have a dog in the fight either way, but I appreciate the consistency of having the potential for a single platform across the entire environment.

What will be the industry fallout following Nuance’s cybsersecurity-related cloud services outage?

It’s unfortunate for Nuance that they are in the news. Any vendor, particularly those providing ASP cloud services, is ripe for breaches and security issues. It’s just so prevalent right now. Our expectation is that threats will increase and get more serious, more complex, and more sophisticated. Obviously this has been a bad week for Nuance, but this could happen to almost any vendor given the scale and magnitude of what’s going on.

The event will will raise awareness and visibility. Nuance will obviously react appropriately. It’s going to hurt, but they’ll be able to survive that and learn from it and provide better, more secure solutions moving forward. The industry is going to learn from it. These high marquee visible threats and breaches will make everybody stronger. Its unfortunate that Nuance will have some significant issues as a result of this, but it will ultimately make the industry stronger.

I don’t think anybody — whether you’re a vendor or you’re a client or a provider — will be impervious to this. It’s something we have to deal with on a day-to-day basis. We work with our clients to prepare themselves, but the message is to understand that it’s not a matter of if, but rather when you get hit, unfortunately.

What are the characteristics of startups that are finding success working with health systems?

You’re going to continue to see innovation, and I hope we do. It’s an important part of the industry and an important part of the growth of the industry. Innovation around the periphery will extend and grow. 

You’ve obviously seen a lot of innovation in the BI and analytics space and a lot of vendors moved into that space. Not all of them will survive, but the good ones will. You’re seeing who can bring a better product to the market that has the opportunity to aggregate, as an example in this case. Those products will come in in a focused way and then expand based on their ability to deliver in the marketplace. It’s similar on the patient / consumer experience side.

How will the agenda of vendors and customers change in a post-Meaningful Use environment?

The vendor marketplace is seeing a stratification of vendors. A couple of vendors continue to gain market share and continue to sell. Then there’s a tier of vendors that are probably a little less dynamic, more static in terms of their market share. My guess is that their primary strategy is to preserve their existing client base and then add around the margins to that space. The strategy of the vendors that have been dominant over the last couple of years is to develop new, interesting products and extend their continuum of product and services.

There’s another factor here, too. Everyone has assumed that the EMR market has diminished. It has. It has not grown as substantially as it did in the Meaningful Use era, but there’s still a lot of work out there deploying EMRs. One of things that is driving that is all the mergers and acquisitions. You’re seeing a tremendous amount of aggregation in healthcare, both locally and regionally, and that is fueling the replacement of a number of EMRs as you move to the hosts or the acquiring provider’s platform. There’s still a lot of work out there to be done.

What trends are you and your competitors seeing that will drive the consulting business?

From a consulting standpoint, the most important thing is to continue to innovate your services as to what the market needs. Per the previous question, we’re incubating and delivering services now around things we think will be important to our clients in a year or two. We’re actively working on digital transformation, patient / consumer experience, BI, and analytics.

We still do a lot of work in EMR replacement. There won’t be as many huge implementations as there were in the Meaningful Use era. They’re more likely to be smaller or medium-sized implementations and in smaller providers, smaller community hospitals who are a little late to the game in terms of transitioning. We re-architect our services to be nimble, quick, and efficient for that market.

What trends will be the most important to follow in the next five years of healthcare IT?

The infusion of information into the healthcare delivery process is of tremendous importance. That infusion of information will come in many ways. We’re seeing the tip of the iceberg of what information can do to healthcare. You are going to see standards and best practices around treatments and delivery of care. That clinical and economic information will make a tangible difference in how you diagnose and treat patients as it works its way to the point of care. Not retrospective information, but point-of-care information based on best practices, based on very customized, personalized medicine and genomics.

Another trend is that we will see tremendous digital relationships that organizations will have with both patients and their families. We’re on the cusp of that. Not just portals and things like that, but a real relationship with the patient, and probably more importantly, their families to deliver care. Not only the information exchange, but wearables and discrete technologies that we’re going to be using. All those components of healthcare will revolutionize how we deliver care.

Those are the things I’m excited about, that we’re shaping our services around, as they will drive demand for the next couple of years.