Startups, Health IT

Can Flatiron Health redeem EHRs?

EHRs don’t always get the most love from providers. But with its OncoEMR, New York City-based startup Flatiron Health is rethinking the concept of an EHR and everything it encompasses.

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EHRs have come to represent necessary evils in healthcare. Millions have been invested in EHR implementations and in some instances, they have become technologies that providers love to hate.

One company, however, is attempting to redefine (and potentially redeem) what an EHR — as created by the likes of Epic, Cerner, and athenahealth — means. They are asking that instead of an all-encompassing tool what if there were a specialty EHR that homed in on a specific need in the healthcare system?

That’s the aim behind Flatiron Health’s OncoEMR.

The New York City-based company was founded in 2012 by Nat Turner and Zach Weinberg, two young entrepreneurs who sold their ad-tech company, Invite Media, to Google in 2010. And the duo has been successful in raising millions.

In 2012, Flatiron garnered $8 million in a Series A round led by Google Ventures, First Round Capital, and LabCorp. Google Ventures led a $130 million Series B round just two years later, and Flatiron nabbed another $190 million in a Roche-led Series C round in 2016.

And unlike so many startups that bite the dust — research from Accenture shows 50 percent of digital health startups fail within two years of launch — Flatiron has survived.

In an email to MedCity, Turner chalked the startup’s success up to a skillful team and strong investors — a common refrain among those startups that survive — but also its attitude toward patients:

This approach [of having a strong investment and a talented team] has ensured not only our success, but also that we are always putting the cancer patient first in everything we do.

For Turner, that focus toward patients was engendered through a personal experience.

Turner’s seven-year-old cousin Brennan was diagnosed with leukemia and subsequently underwent drug regimens and four bone marrow transplants, as well as multiple relapses. Though Brennan has now been in remission for five years, Turner and Weinberg saw his encounter with the healthcare system as motivational.

“We wanted to ensure that all cancer patients — not just those who have the means and resources to get the best treatments available — have access to the same level of care and best clinical research,” Turner said.

And thus, Flatiron was born.


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Its model revolves largely around its OncologyCloud suite, which is made up of three components: OncoEMR, OncoBilling and OncoAnalytics. The software, according to Turner, is used at approximately 265 oncology clinics throughout the country and in Puerto Rico, including Florida Cancer Specialists and South Carolina Oncology Associates.

While it is specifically geared toward cancer clinics, OncoEMR encompasses features similar to those of other EHRs. For one, it includes the HIPAA-compliant SeeYourChart, a portal that enables providers to communicate with their patients.

Integrated with OncoEMR is OncoBilling, a system through which practices can file and manage claims. OncoAnalytics brings together the information from OncoEMR and OncoBilling to give a practice additional clinical and business insight.

Each aspect is delivered in the cloud via any web browser, Turner said.

“What they’ve built with OncoEMR is extremely powerful,” Mamta Parakh, head of data science at Quartet Health, said in a phone interview. Quartet, another New York City-based startup, strives to integrate behavioral health and primary care. Like Flatiron, one of its major investors is Google Ventures.

Parakh touted the benefits of Flatiron’s model, such as how it provides clinicians with the ability to gather structured data. Additionally, she declared that OncoEMR can give physicians strong visualizations about their patient panels. It provides “a lot of good clinical decision support at the patient level, which traditionally has been hard for EMRs,” she said.

The one downside she mentioned involves taking a broader look at the market. Many of the nation’s largest hospitals and health systems have already heavily invested in other EHR systems like Epic.

“To have a new system like OncoEMR, I’m sure there’s issues with getting to high market share when people have already spent significant resources,” Parakh said.

Still, Epic’s large market share doesn’t mean it cancels out the value of EHR systems like Flatiron’s.

“In my opinion, given the focus on oncology, it gives the OncoEMR the flexibility to design the EMR system to collect oncology-specific information in the way that makes the most sense to the oncologists,” Parakh said, compared to a general EHR like Epic, where various specialists are using it for various reasons. “It’s sort of difficult to design an elegant system when you’re trying to be everything to everybody.”

Turner agreed, saying Epic and Flatiron have contrasting systems.

“We are also much more than an EHR company,” he added, citing additional technologies and tools — like OncoAnalytics — the startup has developed.

Flatiron isn’t the only startup using technology in the oncology space. Though it also seeks to help cancer patients, New York City-based Cota Healthcare‘s model looks different than Flatiron’s.

Instead of building an EHR, Cota uses its technologies to focus on delivering precision medicine. The company “patented a Real World Data classification system — the Cota Nodal Address System — that captures, validates and structures all prognostically relevant attributes of a patient, their disease and therapy,” Cota founder Andrew Pecora told MedCity via email.

The startup’s technology, Pecora said, can integrate with EHR systems, including Epic, Cerner and Allscripts.

Similarly, Turner said OncoEMR is “absolutely” interoperable with other systems, and that the company supports data exchange with other technologies.

These connection capabilities could spur potential opportunities for Flatiron to work with larger vendors.

The type of data that Flatiron is able to collect is complimentary to what a regular EMR would be able to collect,” Parakh said.

As organizations continue to focus on specific aspects of the healthcare system — like oncology or even home health — systems like those of Flatiron will only maintain their growth.

“I would think that there would be more specialty healthcare record keeping,” she said. “Whether it’s called an EHR or not remains to be seen,” but there will likely be some type of mechanism to collect more information.

Photo: anilakkus, Getty Images