Hospitals serve three important customers: patients, physicians, and payers. As they formulate strategy to increase the efficiency and quality of their interactions with those customers, technology is invariably a key component. RelayHealth is an industry leader whose intelligent network improves clinical communication, increases transactional efficiency, and helps build successful relationships among patients, physicians, and payers. We spoke with Ken Tarkoff, Vice President and General Manager of RelayHealth, who oversees the company’s growing roster of consumer offerings.

Let’s start with an overview of the RelayHealth and your job there.

McKesson acquired RelayHealth in June 2006. It created a larger connectivity business by combining its assets with connectivity assets from Per-Se, which included NDCHealth’s, large pharmacy switch; the claims, remits, eligibility and statement businesses from both McKesson and Per-Se; an online patient-friendly billing service; and medical management solutions , which included a patient education reference service and a nurse call center application.

You recently launched the Results Distribution Service. Where does that fit in the offerings?

We have three main modules for physician-to-patient and physician-to-physician connectivity. Through our first physician-to-patient connectivity module, we can handle appointment requests, billing questions, or having the office communicate online with the patient to replace phone calls. We do clinical communication, such as lab tests results, and prescription renewals.

We also have webVisit® consultations, which provide for a secure, online interview between physician and patient. About 14 health plans across the country offer coverage or reimbursement for that service, meaning a patient pays a co-pay rather than an out-of-pocket fee. Aetna and Cigna just announced taking the programs nationally to all their participating physicians.

The second module, physician-to-physician connectivity, does referral communication, health record exchange, and all types of communication required for care collaboration.
The third module is e-prescribing, a standalone module that has both renewals and point-of-care prescribing as a part of our RXHub and SureScripts connectivity.

We launched the newest connectivity service about nine months ago, the Results Distribution Service. As we were selling our connectivity and messaging service to hospital systems, we had a number of hospital customers come to us and say, “There would be a lot of value in putting the results we need to deliver to physicians in your messaging platform, where they would be connected and actionable.”

They wanted to push them out in an easy way so that physicians can do something with them, communicate the information to the patient, populate it in a PHR, and so forth. The new Results Distribution Service created a great opportunity for hospitals to take advantage of the connectivity service available to their physicians and patients.

What’s the benefit to hospitals and how does that approach differ from that of RHIOs?

It’s very different from a RHIO in execution strategy, but there are overlaps at a high level. A RHIO focuses on creating a central data repository that reconciles patient information, creates governance and privacy around access to that information, and offers a place where people can view that information.

We actually are starting to look at working with RHIOs in different regions. Once you’ve centralized that data, we can make it actionable and connected. Once you’re on a RHIO, you need to be able to push that information to the physician or the clinician, connect it out to that patient, and then let the patient share their information with other providers. That’s not something that RHIOs tend to focus on.

We solve a different pain point — connecting those different constituents together in what we call the Virtual Information Exchange. It can plug into a RHIO, a hospital, a physician’s EMR, a pharmacy, and so forth, the different places that will have information.

We pull that information in and push it out to the provider, hospital organization, or someone else who needs access to that information for communicating or sharing information about a patient’s care.

Is the PHR a key part of your offering?

Yes. A personal health record is a core component of the Virtual Information Exchange. When you’re sending a result to a physician, you’re adding to or editing the health record that’s been set up on behalf of that patient for that physician. Those physicians can exchange that information and can share it with patients through messaging.

The health record is really the backbone of the communication continuum. It includes administrative, clinical, and financial information. Not only do you have information around results, meds, allergies, and conditions from your EMR, PHR, or other data sources, it can pull financial information and administrative and demographic information from the practice management system. This health record is a core component of the ability to have good exchange of information across the exchange.

A really important difference between our approach and a RHIO is that we’re not trying to get 100% of the data on every patient in a central place. The value for a hospital is the ability for them to make incremental progress on building these exchanges of information and getting the different constituents connected; building and growing the health records on those patients and providing services on that exchange will provide more value to each of the constituents.

For example, on the Virtual Information Exchange today, a number of hospital organizations will be launching pre-registration on the service, offering access not only to the hospital, but to the patient, on the same platform where physicians are actually communicating with that patient as well.

Say you’ve got a result back from your physician saying that you need to go to the hospital. When you pre-register at the hospital, you can see, view, and edit that information in the same place. That makes it connected and more valuable to you as a consumer. Otherwise, when you’re doing pre-registration from a hospital, it’s completely removed from anything you’ve done with your physician, even if they’re employed by the hospital.

What are the big building blocks of a hospital’s project to build connectivity with the Virtual Information Exchange?

Most of them set up the connectivity around results distribution, where the hospital information goes out through connections to a number of physicians. They will target their employed doctors and several hundred strategic physicians to connect for results delivery and, in many cases if they’re not on an EMR, e-prescribing connectivity. They also get the physician-to-physician and the physician-to-patient messaging set up.

Once they launch that connectivity and deploy the application out to the different physicians, they are connected with the Virtual Information Exchange. Then, they do a variety of things. They work with us to use our interoperability with different EMRs. Sometimes they want point-to-point interfaces for results into their EMR. They also often want messaging interfaces into the EMR.

A lot of physicians aren’t using EMRs today, so they’re looking at other modules and capabilities that we bring. We’re going to be bringing patient education content to physicians who are not on an EMR so they can use it to communicate with patients. As they’re building that exchange, they can start offering new services from the hospitals and promote them out to the patient population by offering pre-registration and other capabilities.

What benefits do hospitals expect to see?

Number one is around results distribution. There is a direct ROI in delivering results more effectively to physicians. It makes it easier for them to do business with the hospital. It makes it a more convenient experience for the physician and, indirectly, for the patient. As they’re delivering the results in an actionable way to the doctors, those doctors communicate those results to patients. They make the patient experience much more valuable.

Many competitive marketplaces are looking at how can they make it easier for physicians to do business. This is a way for them to offer technology in a model that deploys very quickly to get a quick win and immediate value to the physician practice to make them feel closer aligned with a hospital.

Many hospitals haven’t had much success in trying to align their interests with those of their physicians.

A couple of things are important to them. Obviously, saving costs, increasing revenue, and physician alignment. Physicians are a main source of revenue to hospitals. If the hospitals can be easier to do business with, they provide a lot of value to those physicians. There’s a lot of momentum around hospitals looking at ways to provide better relationships.

This is a technology that you can deploy very quickly. There are some other options available to them that don’t quite go at the same speed to be able to get technology out there. This is a way to get out there quickly, get things hooked up, and really begin to leverage that in ways that, from a strategy platform, get yourself connected to your physician community very quickly and begin to do things faster than your competitors.

RHIOs don’t offer competitive advantage since competitors use the same platform.

I think RHIOs are good for the marketplace. It would be great if we had more of them, because I think the value to the patient and the physician would be significant. I just think the cost model and the economic model isn’t worked out yet. Hopefully, our healthcare system will fix that.

Our service is a little different. Hospitals invest in our technology to get a market lead with it, but they fully expect other competitive hospitals to come onto our network. In fact, that’s happening in a number of places. We’re getting the second or third hospital systems coming onto the exchange.

What they’re looking for, as the first mover, is to able to get some brand loyalty and leverage the exchange by offering more and more services, with the understanding that eventually, if they’re communicating with those physicians, they’re going to have to use a platform that physician can use with other hospital systems in the area. But there’s a lot of value in doing it in a way that gets you to be the market’s first mover.

As a second mover, if someone’s already set up that platform, there is value in leveraging something that the physician has already adopted and invested time in for use in their practice. So, depending on the types of movers, there are different reasons on whether you’re first, second, or third, depending on where you are around the country.

Here in the Bay Area, we’ve had a number of first movers. We’re now seeing a lot of hospitals moving to get in on the exchange because the adoption has been successful enough to make it an opportunity to leverage into a connected platform that already covers a large geography, whereas some of the new geographies where we have folks, like St. Luke’s in Kansas City, the driver was from a major hospital system in that marketplace along with Blue Cross in Kansas City that has a reimbursement program.

Now they’re just starting to get other hospitals and other systems interested in plugging in. They see it as an advantage for other hospitals to come in because they’ve had some good traction in getting the physicians connected so far. They get that market mover advantage and then can provide more value if they can encourage other hospitals to leverage the same platform.

Can you upsize an exchange to a RHIO?

I don’t think so. There’s fundamental difference between the two. Our plans aren’t to build a RHIO model. We don’t really want to be in the business of creating centralized databases and reconciling information. We want to be focused on providing that connectivity and information exchange.

We’d like to see RHIOs develop in markets that can provide additional information so it’s a more compelling experience. Right now, there aren’t great resources to get information about a patient. We have to find a number of places to be able to pull that information from.

I don’t foresee these overlapping anytime in the near future. I also think that the market needs both solutions. I think that we fully expect, as RHIOs gain traction, we’ll be working with more and more RHIOs to provide that complete connectivity across the community.

So your model is pushing information out vs. brokering data queries.

Yes, information is pushed. There’s a results push from the hospital. The physician pushes a message to the patient. The patient pushes the message to the physician. The physician pushes the prescription to the retail pharmacy.

We don’t really get in the middle of trying to take data and create a centralized data repository that reconciles enterprise master patient index information and rules privacy and access based on a consolidated set that everybody sends their data to.

Do privacy issues differ between a RHIO and the Virtual Information Exchange?

There are definitely differences. The way privacy is set up is that everybody is set up with connections. As a patient, for example, when you’re set up with your connectivity to your physicians, you can have multiple relationships with physicians that you manage independently. Each connection needs to be approved by each party to be able to share that information.

Physicians can’t just come onto the exchange and get access to your information. They have to request or suggest the connection and you have to accept it, or vice versa. So, we have controls around who has access to the information. We also have the ability to track who’s looking at whose information and how you manage all those different connections.

Because we’re connecting parties together and pushing information across, we’re setting up an exchange where everyone is managing their own connections. In a RHIO environment, anyone can come in and get access to any data that’s in the system. That’s a very different business problem for a RHIO than for us.

Many companies are trying to push the personal health record concept without having the data touch points, meaning that the PHR ends up looking like a piece a software for the patient to type into. RelayHealth should have an advantage since the PHR could just be a view into the data you already have.

I would agree with that statement. I would make couple of comments to that. One is that we absolutely believe that a standalone PHR that’s not connected is of very little value to a consumer. It’s the equivalent of doing online banking, but where your paper statement gets mailed to you every month and you have to go away and key in your own information. You would never do it. The only way you would do it is if you could download some or all of your information and be able to edit from that point forward.

A PHR will only be valuable to a consumer if its truly connected, meaning in getting data; and actionable, so you can do something with the data that’s relevant in communicating with your doctor, getting your results, or in some kind of action with the healthcare system.

RelayHealth is not a consumer brand. We’re not trying to compete with a traditional PHR company like WebMD or Google. In fact, RelayHealth does not market itself directly to consumers on purpose. We use the brand that the consumer is most comfortable with or is the most relevant. In most cases, a hospital system or a physician organization promotes it. We’re the technology inside that provides that capability.

As more consumers go to the hospital or physician Web sites or go to consumer sites like WebMD and Google, we view ourselves as, once you’re there, we can connect you to your health care providers. Our future plans are that if you have a health record on Google or WebMD, you would be able to exchange that information with connectivity to your physician or hospital through RelayHealth.

We see the market evolving in that direction. That’s why we think many of the PHR solutions that are out there, as they drive more traffic, will be interested in working with us since we’re focused on the connectivity and not around being a consumer destination site.

An un-networked PHR is worthless if the doctor’s not willing to look at it and is given a convenient way to do so.

I agree. I think most people in the market are coming around to that. A lot of the consumer focused technology companies are trying to drive more consumerism to get the consumers to be more engaged and that trend will encourage provider adoption of connectivity. That’s the right trend for the market.

The speed of adoption is going quickly, but it won’t go exponentially fast without some push from the consumers, when they start demanding to be connected. I think that’s why you’re getting entries from folks like Google and others who are really viewing this as an opportunity to mobilize the consumer who want that connectivity.

Companies talk about Healthcare 2.0, but it sounds like RelayHealth is already doing a lot of that.

We’re not one of the social networking sites, but we’re a Software as a Service model, meaning one hosted site. Everyone has access to that site. We upgrade our site on a Software as a Service platform. From that perspective, we absolutely believe in that model.

A lot of times, when I think of Web 2.0 technology on the consumer side, there are a lot of things around social networking and that connection. That’s not something we currently do. We’re looking for ways to plug in our technologies into the companies that have been successful in that regard. We want to provide connectivity to the consumer wherever they are going be, whether it’s at a social networking site, at a search site, at a hospital portal, or at a physician’s portal.

Consumers will not tolerate being completely disconnected depending on what physician or what hospital they go to. Over time, there will be a movement to get everybody connected. Web 2.0 technology is the key enabler of that. So, we use a lot of that technology in our Software as a Service model.

Any final thoughts?

We have a list of customers that are currently announcing their relationship in launching this technology. We’ve seen a lot of momentum around it. We’re very excited about this space. We see a lot of opportunity.

We’re also excited about the momentum around consumerism in general. We’re seeing folks like Google, Microsoft, and others make big plays in this space. It’s really going to help the market see the power of the consumer. It’s a great opportunity to get awareness. The consumer is quickly going realize the need to be connected. Obviously, that plays into what we’re doing, so we’re excited about how the market is growing.

Fast Facts

Products
Results Distribution Service

Company
RelayHealth
1564 Northeast Expressway
Atlanta, GA 30329-2010
800.778.6711
www.relayhealth.com

Notable Customers
Saint Luke’s Health System, Kansas City, MO
Atlantic Health, Morristown, NJ
John Muir Health, CA
Hill Physicians, San Ramon, CA
OhioHealth, Columbus, OH

The Bottom Line

• RelayHealth offers products for patient-provider communication, hospital revenue management, pharmacy network services, health plan member satisfaction, and employer member benefits.
• Hospitals are realizing that technology and data exchange are vital tools in aligning with their community-based physicians for mutual success.
• RelayHealth’s Virtual Information Exchange can provide competitive and consumer benefits quickly and cost-effectively.