Many factors determine whether physicians willingly use information systems: usability, functionality, and workflow integration are often the most important. Hospitals are buying systems whose benefits depend on active physician usage, but results have been unimpressive, with utilization barely reaching into double-digit percentages of doctors. PatientKeeper’s applications help physicians work more efficiently and practice better medicine, but they also unlock the value of existing hospital systems whose physician usage is less than optimal. We spoke to Paul Brient, president and CEO of PatientKeeper.

First of all, welcome.

Thank you. I’m excited to be here. This is our first appearance on HIStalk. I’ve become an avid reader and am quite impressed with the growth of HIStalk.

Give me some background on PatientKeeper and its products.

PatientKeeper was founded 10 years ago, based on the reasonably simple observation that physicians weren’t adopting technology. We’ve spent the past 10 years trying to solve this problem by creating a platform for connectivity and writing software applications for physicians to automate their day. Today, we integrate into all the systems that physicians use – HIS, PACS, EMR, scheduling, and departmental systems - to help physicians practice better medicine, save time, and increase their revenue.

We don’t believe that the problem with physician adoption of technology rests with the physicians. We believe the problem is with the technology.

Our approach is to start with the doctor and work backwards into the core hospital and physician practice systems. We are experts at connecting disparate hospital systems and pulling out the data that doctors need to automate their workflow. We bring it together in a way that’s useful for them. We give them the flexibility to work with that information anywhere on any device - from a smartphone to a tablet, laptop, or desktop.

The result is a solution to the proverbial “last mile” problem hospital that CIOs have been trying to solve, getting physicians to use the HIS and clinical systems. Many of our client hospitals find that when they deploy PatientKeeper software, they go from having 10 to 20% of their physicians using technology to 70 to 90%.

Do you think the market still views PatientKeeper as a PDA software vendor?

It’s certainly not an accurate assessment. Mobility is an important part of automating a physician’s workday because physicians are rarely in one location through the course of a day. They work 24/7 and need to access clinical information from a variety of locations. However, this is only a part of the solution we offer.

We’ve had the goal of automating physician workflow from the beginning. Our first application was charge capture. Our second was mobile clinical results. We have been a recognized leader in these segments, which drives the perception that we are a PDA or mobility company.

We now offer 14 physician-centric applications with three more on the way this year that run in our Physician Portal and on a variety of mobile devices, including smartphones. Our integration platform is so well engineered that we are winning RHIO and HIE customers as well.

PatientKeeper has recently announced a number of new clients. What do you think is driving the demand?

Our business is growing very fast and has been for the past three or four years. A couple of things have been going on in healthcare IT over the past 20 or 30 years that set the stage for this growth. Most organizations, hospitals in particular, have automated their core processes in laboratory, pharmacy, and nursing. More recently, hospitals have begun deploying barcode medication administration and electronic vitals and I&Os. PACS is now achieving high penetration.

As hospitals get to the end of this investment, they often realize that they’ve made millions of dollars of investments in technology, yet their core constituency of physicians is still not engaged in using it. We’ve been able to provide solutions for that missing link, helping physicians engage with, and actually use, the technology that’s already in place. Hospitals are able to finally leverage their HIS investments for physicians. When organizations see our solution, they say, “Wow, that’s what’s been missing.”

What makes PatientKeeper different from other physician workflow solutions?

Most companies have just one or two applications for physicians. They do not have the breadth of our integration capability to deliver a complete picture of patient information.

If you look at physician workflow, physicians do a bunch of different things: review clinical results, bill, write prescriptions, document treatment, sign transcribed documents, sign out to caregivers, and contact other members of the care teams. It’s a very complicated workflow. We see the problem as, “How do we give the doctor a complete program for what they do, everywhere they work?”

That’s pretty unique in the market. Ten years ago, we started building powerful integration technology to support much more than our first application of charge capture. That’s paying off as we go to market today.

How does PatientKeeper tie all the disparate systems together?

The primary core competency of our organization is to pull data from, and where relevant, push data back into all these different systems. We have a robust integration platform and the bulk of our engineering staff is focused on system integration. We have deep knowledge about the core HISs out there and most of the ancillary systems. When we go into a hospital or a physician practice, odds are we are familiar with their systems and have a variety of options for integrating them.

The company recently announced partnerships with Sage and GE Healthcare over the past year. Will we see more?

Yes. Partnerships are an important big part of our growth strategy. Both Sage and GE allow us to sell in a market segment that we otherwise wouldn’t be able to touch, in particular, the smaller physician practices.

We have other partnerships to provide turnkey integration and new functionality to existing customer segments. As part of the GE relationship, we offer some high-value integration technology that we market together to academic medical centers and large group practices. Other upcoming partnerships will provide opportunity in different segments of the market.

In addition, our content partnerships deliver clinical content and decision support to physicians. More of those are in the works. This is all part of assembling the right total solution for physicians.

Are you typically selling to the hospital systems or directly to the physicians?

In many communities, we’ll sell to the hospitals first because that’s an easy way to reach many physicians. Those physicians can then purchase additional modules such as charge capture or e-prescribing for their practice. In some communities, physician groups will buy the PatientKeeper solution and ask the hospitals to implement it on their behalf. The key is to reach physicians based on dynamics of a particular geography.

You recently announced PatientKeeper’s capability to run on BlackBerry smartphones. What is your overall smartphone strategy?

We’re excited about our smartphone strategy and smartphones in general. We announced support for several new platforms at HIMSS. One is a partnership with RIM for supporting BlackBerry smartphones. We also demonstrated upcoming support for the iPhone and the Nokia Simbian operating system.

Our goal is to make sure that when a physician shows up with the latest, shiniest, coolest smartphone, it can run our software. It’s a big challenge and a big R&D effort. But given the rate of change out there and what physicians are adopting, I think it’s pretty important.

What is your focus with regard to customer satisfaction and how does this relate to your KLAS scores?

Customer satisfaction is our primary focus. We tie our internal company goals and bonuses to yearly improvements in our KLAS scores.

Two big things affected scores last year. First, we made a major change to the architecture of our software for about a third of our customer base. We moved from having direct integration with an HIS to a more beneficial configuration with an intermediate repository. This delivers a downtime solution, better performance, and easier integration to other systems both inside and outside the four walls of any healthcare facility. However, it was a somewhat painful upgrade.

The second issue involved smartphones. A year and half ago, smartphones were not as stable as they are today. The Treo 600 and 650 were both very cool, but did things like freezing or resetting while you were trying to make a phone call. The device manufacturers are past those issues now, but it was a rocky time for us and for our customers. The new Treos and BlackBerry smartphones are great and the new Windows Mobile 6 devices are really slick.

We’ve also made significant investments in account management and online customer support. We have a customer support portal. All of our major customers have an assigned account manager as a single point of contact outside of services and the normal support channels to make sure that, at a macro level, we’re partnering correctly with our customers.
We have a large and growing customer base today and we’re making sure we continue to deliver the same high-quality customer service that got us to where we are today.

The market wants applications that require minimal training. What are you doing to make your products easy to use?

You hit on a particularly important success criterion for any physician-focused application. Our software is pretty intuitive, so you don’t need a lot of training. We achieve this using physician focus groups and doing extensive usability testing with physicians before we release our applications.

We believe it should take no more than 10 minutes to train a physician on our software. Then, we visit the physician again a week or two later and spend another five or six minutes with them. In the follow-up optimization period, we show the physician two or three things that make them ecstatic. We say, “Instead of clicking four places, you can click here once,” or, “If you configure the screen this way, you see everything you want on one screen.”

Where does PatientKeeper fit with regard to the Stark exemption laws?

We’re very excited about the concept and are cheering it on. The ideal implementation for us is providing physicians with access to both hospital data and practice data. If a practice has an EMR, we can provide so much more to the physician by pulling demographics, scheduling, and clinical information from the practice.

From a business perspective, Stark doesn’t change our economic relationships with hospitals because the laws have always allowed them to provide access to hospital data using our software. Our more practice-focused products, such as charge capture, still don’t qualify for the exemption.

How much of your focus is on integration and connectivity?

We didn’t set out to be a connectivity company or an integration company. We set out to be a company that builds software that physicians can use.

What we learned on Day Two of that endeavor is that connectivity and integration are essential components of our product. Therefore, we have built robust technology to do integration across systems. Not because we want to sell integration technology, but because integration is a prerequisite for our applications to work.

That said, some people building RHIOs and HIEs are using our technology for data integration. We think they’re missing the full value without taking advantage of the physician applications, but we’re happy either way.

We just announced our contract with the Healthy Ocala RHIO in Florida to provide them with their technology infrastructure. Interestingly, they are one of few self-sustaining RHIOs out there. The combination of our integration platform and our physician applications is core to its self-sustaining business model.

So you actually have organizations that are using PatientKeeper just to share data?

Very much so. We have RHIOs and HIEs as clients, including Healthy Ocala. Our technology allows physicians to get data from multiple hospitals, ancillary systems, outpatient settings, and practices to see a consolidated view of patients.

HCA and CHI contracted with PatientKeeper in the last year. What are they using?

HCA is deploying PatientKeeper applications to their hospitals. For example, there was a recent article you referenced about Oak Hill, an HCA hospital in Florida that recently went live with PatientKeeper. We’re working closely with HCA to support them as they deploy. CHI is taking a different tact by deploying a few hospitals initially.

Both organizations had made major investments in healthcare information technology and have pretty much fully automated their hospitals. They wanted a single point of access for their physicians to be able to access clinical information. That’s what they bought from us.

It’s very exciting for us because it affirms that the marketplace is embracing our vision. This success with major MEDITECH clients has also allowed us to refine and improve our MEDITECH offering. Smaller community hospitals with MEDITECH can therefore reap the benefits of our refined offering for improved physician workflow and satisfaction.

How has growth impacted your existing clients?

As we have grown up as a company over the past four years, we have invested ahead of growth in terms of R&D, customer support, and QA. About two-thirds of our employees are in those functional areas. We have automated portals for tracking customer issues and an account management group in place.

There are certainly challenges with growth as well. Four years ago, I had direct relationships with every one of our customers. Today, despite spending lots of time on airplanes, it’s hard for me to do that. So, we’ve invested in an account management organization that provides close oversight of our customers.

We hold a well-attended user group conference annually. Most important, we formalized a customer advisory board comprised of the leadership from 20 to 25 of our customers that meets every six months. We’ll spend a weekend talking about product strategy, what’s on their minds, and what we’re doing. We never release or start a product without validation from our customer advisory board. It has really helped keep us in alignment with our customers as we grow.

About how many clients do you have currently?

We have contracted with roughly 10% of the hospitals in the United States. We also have about 200 physician practice customers.

What benefits do customers see?

You really have to look at it from two perspectives. From the end-user physician perspective, it’s about three things: saving time, practicing better and more informed medicine, and making more money.

That said, physicians aren’t always the buyers of the technology. Hospitals often buy it for their physicians. Also, our system is independent of the HIS. If the HIS is down, our system is still available with results. Many of our customers use it as a business continuity or downtime solution.

Furthermore, because our portal is a true zero-footprint web application, it allows remote access for physician practices and others needing it without investment in Citrix or Terminal Services.

We’re also connecting the community. Hospitals can connect with their practices and share data with other hospitals and ancillary service providers. That’s a big benefit our hospital customers are just beginning to realize.

Tell me what’s coming up with PatientKeeper.

We’re working on several new applications. Though we’ve automated a big part of the physician workflow, there is more to do. In particular, we are working on next-generation documentation products and working on helping physicians with the order entry process in CPOE-enabled hospitals.

We are committed to supporting the new smartphones coming out, making sure we certify, validate and test each new device.

In several geographies, including Florida, Texas and Iowa, we have contracted with more than 30% of all the hospitals. That creates opportunities for us that we’re just beginning to realize in terms of working with regional payers for disease and case management. Payers do a fair amount of disease management and have a lot of information about patients that would be very useful to the care process at the right time.

Hospitals have been silos of information, but because we have enough scale in certain areas, we may actually be able to unlock those silos in a systematic way. I’m not sure exactly where that takes us or if this makes sense yet, but that’s part of the fun of leading a growing company.

Fast Facts

Products
The Physician Information System includes a wide range of software products including PatientKeeper Physician Portal, PatientKeeper Mobile Clinical Results, PatientKeeper Charge Capture, PatientKeeper Analytics, PatientKeeper P4P, PatientKeeper Business Continuity, PatientKeeper ePrescription, PatientKeeper eSignature, PatientKeeper Forms, PatientKeeper Messaging, PatientKeeper Provider Directory, PatientKeeper Reference Library, PatientKeeper Sign-Out, PatientKeeper Ambulatory Order Entry

Company
PatientKeeper, Inc.
275 Washington Street
Newton, MA 02458
617.987.0300
www.patientkeeper.com

Notable Customers
Berkshire Medical Center, Catholic Health Initiatives, CHRISTUS Health System, Community Hospitalists, Healthcare Corporation of America, Healthy Ocala RHIO, Massachusetts General Hospital, Mercy Medical Center (Cedar Rapids, IA), SUNY Stony Brook, Iowa Health System, University of California San Diego Medical Center, Virginia Commonwealth University

The Bottom Line
* PatientKeeper delivers quick, high-satisfaction physician utilization of existing IT systems.
* PatientKeeper is more than PDA software vendor – its systems support physician workflow, tie disparate systems together, provide anywhere-anytime access to clinical information—from a portal or mobile device, and give the IT department options for downtime procedures and data integration for health information exchanges.
* PatientKeeper’s customers represent 10% of US hospitals and include renowned medical centers and large integrated delivery networks.

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