Tag Archives: Real World Data

Signify Premium Insight: Veradigm’s Shift as it Seeks to Capture New RWD Opportunities

In mid-February, healthcare tech and analytics company Veradigm and HealthVerity, a leading real world data (RWD) marketplace, announced they would be teaming up to ‘advance research and improve patient care for cardiovascular disease and diabetes patients’.  

Veradigm says the collaboration will see full interoperability between Veradigm’s Cardiovascular and Metabolic Registries data and de-identified patient data on HealthVerity’s IPGE platform.  

The Signify View 

The tie-up reinforces Veradigm’s strategic focus on RWD and life sciences (the company was the RWD and life sciences arm of EHR vendor Allscripts until the end of 2022, when Allscripts rebranded as Veradigm). It is also Veradigm’s first partnership free of the Allscripts name. 

The company’s journey to RWD began in earnest in March 2022 when Allscripts (of which Veradigm was a small but growing unit at the time) was split in two after struggling for several years to grow revenues and inpatient/health system market share. The bulk of pre-split incarnation of Allscripts’ EHR portfolio – inpatient solutions Sunrise, Paragon and Opal, TouchWorks ambulatory EHR for large practices and its population health management tools – was sold to IT monolith Harris Computer Corporation for $526M. This business now operates under the Harris umbrella as Altera Health, and accounted for $927.6M of Allscripts’ total revenues in 2021). 

The split left Allscripts with two EHR products for small practices: Allscripts Professional, and Practice Fusion (a suite of originally free EHR products that Allscripts acquired in early 2018), as well as Veradigm. Combined, these businesses generated $552.2M in revenue in 2021. Veradigm was established with the aim of using Practice Fusion’s EHR data to provide research tools for payers, providers and life science companies for research, drug discovery, clinical trials and RWD-type applications. On 1 January 2023, the remaining Allscripts business were rebranded as Veradigm. 

Veradigm’s decision to gradually distance itself from pure-play EHR is a positive step. Its RWD business (particularly that to payers/lifescience) is growing faster (15% for payer/lifescience in 1-3Q22). While its provider revenues, largely driven by Allscripts Professional and Practice Fusion EHRs, while still the bulk of the business, are growing at a much slower rate (4% 1-3Q22). 

 

By selling much of its EHR portfolio to Harris, Veradigm is now free from Allscripts’ shackles and, should it choose, can team up with other EHR vendors who offer greater value (as well as develop partnerships with RWD vendors like HealthVerity). As Veradigm focuses on growing its RWD and life sciences focus for the business. 

Growth Goals  

On the face of it, the collaboration brings together two heavyweights which, in theory, should accelerate Veradigm’s RWD and life sciences business growth. HealthVerity is one of the largest platform RWD marketplaces, offering as a repository of healthcare and consumer data, and through the partnership it will act as a conduit for Veradigm to sell its ‘regulatory quality’ cardiology and metabolic registry data to pharmaceutical firms and other researchers.  

Veradigm’s Cardiology Registry is the largest US outpatient cardiovascular quality improvement registry, with more than 102M records and 13,000 providers. Its Metabolic Registry has 79M records and 11,100 providers. Veradigm’s EHR data of more than 176M patients from the past five years is also incorporated in both registries, as well as data from 300M medical claims made over two years. This ancillary claims and registry data is much more structured and usable than healthcare data (see diagram below). Based on population health data, it is already growing quickly and should continue to do so. 

Beyond the HealthVerity tie-up, Veradigm will also be keen to capitalise on a concept known as ‘data gravity’, a kind of snowball effect where the more data a company has, the more data it attracts (essentially because it is regarded as a good host in which to commercialise it). However, if it wishes to take advantage of this concept, Veradigm will need to partner with, or have access to, larger volumes of clinical data. Clinical RWD (cRWD) comprises just a small percentage of RWD projects today, but is growing quickly, particularly multi-modality projects which combine types of cRWD and cRWD/RWD. 

cRWD is also the hardest type of data from which to profit, because curating data is hard – for example, in the anonymisation of unstructured data, as well as GDPR and HIPAA compliance. There are hundreds of ways to de-identify data, but the process of de-identification ironically risks losing some original value in that data.  

So while ancillary RWD is an easy, low value path to growth for Veradigm, the real potential riches lie in also accessing cRWD. 

The cRWD Challenge 

We discuss the challenges of exploiting cRWD in this recent Insight. cRWD remains firmly in its formative stages, and is difficult to work with, limiting mass utilisation. While the potential of cRWD is undoubtedly vast (and Veradigm already has an advantage over other cRWD vendors like GE and Philips given that it has more immediate, and broader, access to EHR data and social determinants of health), data curation is time- and labour-intensive. Despite the upside potential, companies like Veradigm would be advised to tread carefully, and avoid betting too heavily on the potential of curated data until NLP technology enables the curation process to become more automised. A more logical approach will be to grow its registry and claims RWD businesses (which are already the bigger part of the company) and, instead of participating directly in cRWD, it may choose to circumvent the issue of clinical data curation and partner out with more vendors like HealthVerity instead. 

A more immediate problem for Veradigm as it tries to accelerate growth in its clinical RWD business is that it lost many resources in the portfolio sale to Harris. Notably, Allscripts’ dbMotion data integration solution. This would have been a valuable weapon for Veradigm in harmonising Oncology Information System (OIS), Laboratory Information System (LIS) and clinical data across its PHM portfolio, but it is now in Altera’s hands. Veradigm also lost some Allscripts inpatient information in the company break-up. 

That said, dbMotion was quite an old technology. An aggregation engine is truly useful only if it can curate data and make it automatically usable. Maybe there is an opportunity here, therefore, for Veradigm to develop a new data aggregation solution which will better serve its own strategic ambitions. 

Race Against Time 

As a public company, Veradigm does not necessarily have the luxury of time to achieve growth. It will need to satisfy its shareholders that its decision to shift focus to RWD is the right one. 

In a 2023 Financial Guidance report, the company says it expects revenues of between $640M and $660M in 2023 (from $552.2M in 2021), and to achieve this it will need to maintain some growth via cash cows (its EHR product lines). In a 2020 Life Sciences Briefing, Veradigm highlighted life sciences and payer solutions as high growth areas for the business, and it really needs to start performing.  

Clinical RWD promises much, but with the challenges of curating data it will take time to unlock the obvious potential. In any case Veradigm will also be up against other EHR vendors which are predicted to continue to dominate the clinical RWD market for the foreseeable future. Wider partnerships between Clinical RWD vendors and generalist RWD providers will be increasingly required as requests for combined clinical and non-clinical datasets increase. Again, this may be a strategic direction option for Veradigm, a company with plenty going for it as it moves into new territory. 

Signify Premium Insight: Epic Pilot Takes Off in the Face of RWD Headwinds

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Epic claims its Best Care point-of-care tool, being piloted in the US and drawing on the real world data (RWD) from its Cosmos database, will ‘empower’ clinicians to make better decisions. 

But Clinical RWD is in its formative stages, with limited decision-making value at present. Expectations for Best Care and other decision-support tools reliant on nascent RWD must, therefore, be tempered at present. Clinical RWD, which refers to clinically-housed information as opposed to the many other types of RWD (some well established), offers vast potential, however, and work to unlock this potential is underway, but with many barriers and challenges to overcome. 

The Signify View 

In principle, any tool enabling clinicians to make better point-of-care decisions is welcome. Epic sees its Cosmos database, with data on 160 million patients in the US equating to billions of clinical data points, as holding a significant store of value. 

Clinical RWD certainly has the potential to drive personalised medicine initiatives forward, and have a transformative impact on patient care. Cosmos, which is effectively a data aggregator, contributes to this potential, although the greatest clinical value lies in interpreting that data to provide recommendations. Data curation is central to this, using artificial intelligence/algorithms. This transformation is now happening, but as we wrote last year in this Insight, data curation is labour-intensive and time consuming. 

Promise vs Reality 

Best Care is a one-year hypertension-focused pilot, launched last October. Leveraging data from more than 160 million US patients on Epic’s Cosmos database, it provides clinicians with information on similar hypertension cases, treatment histories and outcomes. While Epic claims this information will ‘empower’ the clinician in the decision-making process, in reality the onus remains on the clinician to extrapolate information they feel will support their decisions. At this nascent stage, Best Care is not ready for mainstream adoption despite the capabilities it brings to clinicians etc. Long-term, Epic intends for Best Care to embed the information directly in the clinician workflow, and when it does, users will derive more value from analysis outputs rather than trawling through many ‘similar’ cases. 

Too Much, Too Soon? 

The Best Care pilot launch was followed by Epic’s introduction last November of Lookalike, a telehealth ‘kerbside consultation’ tool. Physicians faced with unfamiliar diseases or symptoms use Lookalike to connect with a provider that has experience with similar diseases or symptoms. The physician can then enquire about treatments and outcomes with the provider. But, like Best Care, Lookalike has limited advantages at present, although in this case the disadvantages are not data-related. Simply facilitating connections between providers increases workloads. Furthermore, there are currently no ‘provider-to-provider’ reimbursement structures in place to make Lookalike attractive at this point. 

The launch of Best Care does, however, offer a window into the wider development of Clinical RWD, how data can be monetised and the challenges of curating and managing data. The research industry is hungry for the mountains of different RWD being generated (see table below), and this is a massive market driver. 

Types and associated benefits/limitations of Real World Data  

Highlighting the lack of data commercialisation, Epic currently does not address the real commercial payers for clinical RWD, pharmaceutical, biotech or medtech companies (and, to a lesser extent, regulators), who have deeper pockets than academics. Several things will need to happen to achieve this.

Kill or Curate 

Cosmos is essentially an aggregator of structured research data, which has little value in supporting clinical decision making. Curating data so it can extrapolate nuanced information in clinician notes, which is then used as the basis for a point-of-care diagnosis for tools like Best Care, is the goal here.  

AI and automation hold the key to unlocking the potential of this ‘unstructured’ data, ultimately offering a clear clinical direction. Natural language processing technologies are also being developed to support this. But, based on current evidence, vendors like Epic are far from unlocking this potential as of now (even if, across healthcare, point projects are making some progress). 

Competition Heats Up 

The RWD market is immature – it is no doubt a greenfield opportunity – but activity is gathering pace. Eighty percent of the value of the RWD market is currently provider and payer. But the remaining 20% (secondary users) has the greatest upside potential for data monetisation over the medium term.  

An intensely competitive space has fast emerged in RWD. Disruptive start-ups are flooding in (and have the potential to do well against, for example, the EHR vendors in cost-conscious environments), developing platforms that automate clinician workflows and facilitate continual data access which are then sold as a loss leader to providers. The focus here on dynamic platforms, rather than static databases, enables more organic growth. 

New partnerships are being forged which promise to accelerate tech-driven data curation. Epic has alluded to the fact it would be open to allowing third-party developers to make incremental improvements or add-ons to Cosmos, a significant departure from its traditional organic approach. Elsewhere, EHR vendor Cerner acquired RWD company Kantar Health in 2021, and Oracle Cerner’s HealtheIntent PHM platform is now feeding Kantar’s database.  

But despite the flurry of activity, it is too early to determine whether any companies have, as yet, developed good analytics tools on the back of their datasets.  

In our recently-published Strategic Analysis of Real World Data (purchase the report here), we state that EHR vendors are predicted to continue to dominate the RWD market. Several new entrants are expected over the next few years, however, and there is potential in specialist partnerships. Wider partnerships between Clinical RWD vendors and generalist RWD providers will be required increasingly as requests for combined clinical and non-clinical datasets increase. 

Making Sense of Things 

Curating data brings challenges. For example, the anonymisation of unstructured data, as well as GDPR and HIPAA compliance. In the case of Cosmos, potentially valuable data in a sensitive database of more than 160 million patients in the US must be de-identified. There are hundreds of ways to de-identify data, but the process of de-identification ironically risks losing some original value in that data. 

Also, RWD is made up of many different types of data (as mentioned previously), and so another challenge is to unify and curate these disparate data forms. Several vendors have launched products in this regard, to ultimately provide access to RWD through ‘data unification’ platforms. This draws upon the existing relationships vendors have with healthcare providers, and provides hungry users access to an ever-growing pool of connected longitudinal patient data 

Baby Steps 

Against this early-phase RWD backdrop, Epic is wise in taking a measured approach to Best Care. It will want to establish a proof of concept before widening its ambitions. A pilot buys time for RWD to evolve, and for the many forces now at play in this market to bed in. As of now, Best Care cannot be considered a decision support tool. But the fact that Epic’s ambition is to ultimately embed the tool in the provider workflow suggests it is acknowledges the current shortcomings, and is focused on addressing these in time for full commercialisation. 

Signify Premium Insight: Evidence of Opportunity for OneMedNet

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OneMedNet, a company best known for its image exchange solutions, has announced that it is set to become publicly traded via a SPAC acquisition by Data Knights Acquisition Corp, with the deal set to close in the second half of 2022.

The move will give OneMedNet a pro forma enterprise valuation of $317m, and the money generated is hoped to help the vendor grow as it increasingly focuses on the provision and commercialisation of imaging data for real-world evidence (RWE).  According to the vendor this focus will help it target the clinical trial and clinical research industries and use imaging data to assist in bringing diagnostics and therapeutics to market quicker.

The Signify View

As a vendor progresses it must be ready to adapt. If it is to grow beyond an embryonic stage, it must be prepared to react to changes in the market and pivot to capitalise on opportunities as they arise.

OneMedNet’s IPO announcement highlights a vendor that is willing to make such a change. It is a company that has grown to its present size, primarily by leveraging its technical nous to develop capable medical imaging software, with a particular focus on image exchange and data management. However, regardless of its capability, and specialisation, this is a competitive space with comparatively low growth prospects. Instead of toiling away for single-digit percentage improvements in annual revenue, OneMedNet has chosen to turn its attention to a market that has the potential to be altogether more lucrative.

For pharmaceutical and AI firms, the potential reward for the successful development of, for example, a new drug, is enormous. But the process for such development is arduous and expensive, with many once-promising innovations resulting in little more than a costly dead-end. These companies are therefore looking for tools that can help them undertake these processes more effectively, and have the financial clout to be able to pay handsomely for them.

Getting Data to Deliver

Real-world imaging data is one such tool that meets this need, giving OneMedNet impetus to increasingly focus on that area. Using its technical imaging know-how, the firm intends to act as an intermediary between providers and customers. Creating a platform that can curate anonymised patient data for hospitals, cleaning and organising it to allow hospitals to license the de-identified data to pharmaceuticals and AI vendors. OneMedNet is far from the first vendor to see the value in this provider data, however its approach is novel for imaging IT vendors. At present, AI development typically relies on publicly available datasets, although other approaches, such as provider partnerships are also used. There are several downsides to these models. It can, for example, be relatively inefficient and provide data that are poorly organised, inaccurately labelled or very homogenous, potentially limiting the utility and universality of any tools developed using them. Other vendors are also focused on a platform approach, but this is more commonly utilised for broader patient clinical data, rather than imaging-specific data. As such, OneMedNet is not following a well-trodden path, it is not an aspirant data-broker, instead its goal is to become a technology enabler, facilitating the increased use of RWE.

Other vendors will also seek to capitalise on this opportunity. Large healthcare IT vendors which already have strong access to a large number of hospitals through their installed bases, as well as nimbler pure-play specialists, could bring together significant amounts of data in agnostic data management platforms. In many cases, however, these vendors will offer generalist solutions, broader and more versatile but lacking the imaging data specialism that OneMedNet can offer.

The Scale of the Problem

With this new funding, OneMedNet has the power to extend its reach, granting it the ability to invest in its commercial operations, and giving the vendor the tools it needs to scale and increase its customer base. There are several ways this can be achieved, including direct sales, white labelling its products for incorporation into broader packages from other larger vendors, and partnerships.

The last of these was realised recently, with the vendor announcing a partnership with generalist data aggregator Flywheel. This tie-in, according to the announcement, enables customers to combine “OneMedNet’s de-identified clinical images and associated patient data, and Flywheel’s comprehensive research data management solutions”. Effectively, OneMedNet will be responsible for the imaging data element of a much broader RWE package. For Flywheel, it is hoped that the added capability offered by OneMedNet will enable it to make more deals of a higher value, while OneMedNet intends to grow through its exposure to Flywheel’s larger customer base.

However it is achieved, this scaling up is essential. There are numerous companies circling the space, such as established imaging IT vendors and some, like OneMedNet that are also well endowed with cash from IPOs or VC rounds. To be successful, OneMedNet needs to grow quickly and establish itself as the leading imaging data specialist. In matters of data, trust is essential, so quickly building its reputation is necessary.

Faith Healing     

Trust could become a thorn in OneMedNet’s side in another crucial way if providers are unwilling to allow the imaging data specialist access to their imaging data. The solution to this problem is, as yet, uncertain. While there are some very lucrative deals to be made for providers willing to share their data, there is still some reluctance. Many providers are uncomfortable with the idea that big pharma is profiting off their precious data, particularly if they aren’t adequately recompensed. This sentiment could be compounded if hospitals don’t see clear returns for their participation. Payment aside, providers could feel that their data would be better used by themselves or trusted partners to develop tools that would bring direct returns to the hospital. They may, in essence, feel their data are simply too valuable to sit as a tiny fraction of an enormous dataset.  Either way, if OneMedNet is to scale quickly and succeed, it will need a vast amount of data, so provider reticence could present a huge stumbling block.

Even without this active impedance, providers may simply lack the capacity to undertake the commercialisation of their data. Instead of mulling over the strategic opportunities presented by their vast archives of imaging data, many providers will have their hands full with more routine issues, not to mention the challenges presented by the post-Covid backlog of patients, for example.

The Mercy of the Markets

Despite these challenges, OneMedNet’s new focus on RWE and its decision to list are sound. The shift gives the vendor the opportunity to target a market in which it has better prospects for significant growth, rather than working away for safer, but slimmer returns.

The timing of the listing will be challenging. While it makes sense in terms of the vendor’s own chronology, OneMedNet will still be battered by the broader headwinds that have hindered other disruptive health tech vendors (Butterfly Network, Hyperfine and HeartFlow, for example). The vendor may also regret its decision to list via a SPAC acquisition given recent caution surrounding these blank cheque companies. Not only are many investors becoming increasingly wary of the deals, but institutions are also starting to formalise their objections. The SEC recently proposed updated rules to regulate SPAC deals, and Goldman Sachs, one of the more enthusiastic proponents of the acquisitions, announced it is withdrawing from the space.

These difficulties aside, OneMedNet has positioned itself well. The market for RWE is very nascent, access to data is limited, many use cases are still being formally established, and numerous competitors are entering, or could enter the space in the coming years. Despite this, the opportunity is profound given that the importance of data will only increase. If OneMedNet can ride out the turbulence of the market, and convince providers of its vision, this listing could be the start of a successful journey.

About Signify Premium Insights

This Insight is part of your subscription to Signify Premium Insights – Medical Imaging. This content is only available to individuals with an active account for this paid-for service and is the copyright of Signify Research. Content cannot be shared or distributed to non-subscribers or other third parties without express written consent from Signify ResearchTo view other recent Premium Insights that are part of the service please click here