MED3OOO’s June 2007 acquisition of InteGreat brought together the Pittsburgh-based performance-oriented management and technology company and Scottsdale, AZ-based InteGreat, which offers what it calls healthcare’s easiest to use EHR. The acquisition gives MED3OOO the advantage of being able to offer a state-of-the-art EHR package managed under its own development and implementation agenda. That’s another way the company can help its customers gain competitive advantage and improve their performance. We spoke to Steve Ura, chief technology officer and senior vice president of MED3OOO.

MED3OOO had traditionally focused on providing services such as data hosting and management and billing services before its acquisition of InteGreat. What was the attraction of owning a technology company?

We looked at the products that we used — like Allscripts, Misys, and GE — as tools for providing the management services that we offer to our fully managed groups. These companies, despite their brand recognition, do not offer a browser-based product. Many of our physician clients want that because of its low cost and ease of deployment.

We have always provided an array of system offerings to our clients, knowing that no single tool is right for all of them. These potential clients appreciate a selection of products. The InteGreat EHR investment rounds out our product line. It also gives us control over functionality that we need internally.

You were actively involved in MED3OOO’s decision to purchase InteGreat. What was it about InteGreat that you found attractive?

The technology it was built on was designed for a software-as-a-service model or ASP-type of deployment. All the other systems that we deploy require that we use some additional technology, like Citrix or thin client.

The InteGreat product is 100% browser-based. We can deploy it without having to use additional technology. All we do is give clients a secure Internet connection.

The InteGreat EHR is functionally very strong. It’s well positioned to compete with the various other products out there.

Before you joined MED3OOO, you led development for Allscripts and A4. How have those experiences shaped feature development of the InteGreat EHR?

We are focusing on using the InteGreat EHR as a tool.

In my previous life with a couple of software vendors, we were more focused on what it takes to make the sale — how you sell a license and how you get your product in the door.

MED3OOO doesn’t operate that way. The mindset is actually to work to our detriment. If we do something just to get something in the door, we have to live with it.

We use the product and so do the customers for whom we’re providing managed services. That really changes our focus. I’m working with the development team to lay out a strategy and direction that focuses more on using the product as a tool and a service instead of just a way to pull in license fees.

What are the greatest technology opportunities to improve patient care and financial viability in physician practices right now?

We don’t like to use the word “patient”, because you and I might be feeling fine, but we still need healthcare services. We like to call them “healthcare consumers” or “subscribers,” depending on the model.

We think there will be demand across the board for more consumer control over healthcare services. Companies are moving toward high-deductible health plans. Internet tools facilitate the evaluation of physicians. We think consumers will want more control over what is done.

One of the key pieces of a consumer driven health environment is the personal health record, whether that’s Google Health or Microsoft HealthVault or something more along the lines of what the physicians themselves could offer. Who knows? But our position right now is that we think healthcare consumers are going to trust personal health records and patient portals that are branded by their physicians, as opposed to being branded by the "big man" – Google or Microsoft, for example.

Because of that, we’re building strategy and products that will allow physicians to offer personal health record technology to their patients directly. MED3OOO will provide the technical services and the computer systems, but the patient will have a better feeling of trust because it’s been accepted and branded by physicians themselves. We think that’s a big push in the world of healthcare and will help as consumers try to manage their own healthcare.

Getting back to the original question, we think technology will improve physicians’ access to information, particularly to see what other providers are doing if the consumer is being treated by multiple providers.
The key technologies, then, are a personal health record in conjunction with an electronic health record within the physician office. We’re excited about the CCHIT push to have interoperable records.

How does the InteGreat EHR’s use of MEDCIN differentiate it in the EHR marketplace?

It’s key for an EHR to use standardized vocabulary that is accepted across at least some of the healthcare industry. In particular, if you look at what CCHIT is pushing in terms of standardized codes, like LOINC in 2008 and whatever else in 2009, we think that having that standardized vocabulary gives us a leg up.

There are a wide variety of terms that are out there, but we’re using MEDCIN because a lot of other vendors are also using it, which makes us confident there will be a set of translation codes available even if MEDCIN does not become the ultimate standard.

Just like today, there are existing translation codes from LOINC to MEDCIN and from MEDCIN to SNOMED. We think that our use of MEDCIN is an advantage when it comes to interoperable records and the ability to move coded data at a detailed level.

You mentioned CCHIT. What separates the EMR companies that are doing well from those that are struggling, even though they all may have earned CCHIT certification?

CCHIT levels the playing field by requiring core features for all certified vendors. How vendors implement those features determines whether they will do better than others. Does the product match the workflow of the practice? Can the workflow be adapted to match that practice?

Also, how easy is it for a physician to discover and use the features of the product without spending hours and hours in training? That’s where I think the InteGreat EHR product stands out very well.

I don’t want to use the word intuitive, but it is easy to use. Some of our physicians use it in their practices after only a 30-minute introduction.

What matters when choosing an EHR is ease of use and the company behind the product. In today’s economy, buyers don’t want to buy from a company that may not be in business in a few years. It also comes down to how the software provider looks at the product and uses it within their company. It goes back to deploying it more as a tool, as opposed to just a way to sell licenses. I think our customers appreciate that.

How does your Process Study differ from what competitors are doing, and what kind of results does is bring to customers?

Unlike a software vendor who simply installs the product and then goes on to the next customer and does that over and over again, we’re actually in there living with the processes that we develop. When we teach processes to our customers, our approach is more focused on making effective use of the product within the established workflow. We are using workflow adjustments to improve the revenue model, which could mean increasing revenue or decreasing costs.

We’re focused on how the practice can use the product to make things better, as opposed to simply making a patient’s record better. That’s a fine distinction. You can make a patient’s record much more detailed and get better E&M coding with pretty much any EHR-type product, but that doesn’t necessarily save the practice any money because it can be seen as a burden.

Our process really focuses on how we can make you more efficient and how we can improve the revenue model.

MED3OOO traditionally promoted solutions available from your various business partners, like Allscripts and Misys. If you had a new prospect today looking for an EMR solution, which product would you promote?

It goes back to seeing these products as tools. We try to assess where the practice is — what their workflow is and what product would best meet that need. We’re marketing each one equally based on what we know about the strengths and weaknesses of the products.

For example, we’re working on two proposals for customers right now for the Allscripts Enterprise product, formerly TouchWorks. Allscripts is happy to be working with us on that. At the same time, we have proposals out to many customers for the InteGreat EHR product.

It really comes down to which we think is going to be a better fit. It also comes down to customers that may say, “Hey, we really like TouchWorks. We want to use it, but we don’t want to have to put up with the ordeal of making it work on our own hardware. We want an ASP model.” In that regard, we don’t try to convince them it’s the wrong product for them. We go through the process and make TouchWorks work for them.

Most of InteGreat’s past clients are larger clinics with 25 or more physicians. As the higher end of that market becomes more penetrated, do you anticipate offering the InteGreat EHR to smaller offices?

Yes. In fact, we already have, because we have many MED3OOO customers already using our practice services, practice management, and billing.

Several practices have told us they would really like to have an EHR. Many of them are smaller practices, including 10 physicians and below. We feel those guys are a perfect fit for a Software-as-a-Service deployment, as opposed to an in-house deployment. We have practices now that are 10 doctors or less using the InteGreat EHR with the ASP model.

Do you see the market becoming more price-sensitive?

Absolutely. We would like to see the market get to the point where a product like the InteGreat EHR would be so attractive to a physician, both in functionality and price, that they could simply put the appropriation information into an Internet site and be up and running within a day at an acceptable monthly charge. Whether we get there next year or five years from now, I don’t know, but I really think it will get to that point.

And does the InteGreat EHR lend itself to that model?

Yes, very well, because it’s pure browser-based. You don’t have to load anything onto your machine. It’s very easy to use.

MED3OOO has been involved in revenue cycle management for over 10 years. What trends are you seeing in that arena?

History always repeats itself. Five to 10 years ago, hospitals were trying to buy out physician practices, but realized that wasn’t a good revenue model for them because they were losing money. So, they divested themselves of those practices.

Now it appears that hospitals are trying to get back into that market, but we’re seeing them being a bit more cautious and a little bit smarter about it. They are now looking at companies like MED3OOO for the management of those practices.

I think it will probably swing more towards hospitals getting involved in trying to manage physician practices, buying them out, and consolidating them in a community. But, they’ll also look to outside companies like MED3OOO to help them manage that process and make sure it is profitable, as opposed to what they did last time.

Your executive team has deep domain expertise in healthcare. How is that an advantage over your competitors?

Everybody on the executive team has been living and breathing healthcare for many, many years. Pat Hampson and I have been in healthcare for 30 years and others for 20 years.

What that really means is that we bring a lot of practical experience to the table, with folks who have been there, done that. Not just from the, “I want to sell you something” side, but also from the folks who were buyers who were users of these systems.

For example, my background comes from having worked in hospitals for probably 15-17 years before joining the vendor side. Many of our folks are just like that. We know the impact of the services, or lack thereof, that are provided by companies like ours. That makes a world of difference to how we go about doing our jobs every day.

How does being part of MED3OOO provide value to InteGreat customers?

It’s a bigger company with more financial backing than InteGreat had in the beginning. We have the ability to put more resources into the product and make sure we keep it up to date and perhaps even surpass some of the other products that are out on the market. We provide more financial stability and more investment.

In addition, we are in practices managing them. We’ve seen the EHR’s impact on practices. We know the good, the bad, and the ugly of most of the other commercial EHRs out there. That really drives what we pay attention to in the InteGreat EHR, both on the development side and on the implementation side. That will make the InteGreat EHR a more cost-effective solution as we move forward.

Anything else that you’d like to add?

MED3OOO really is a strategic partner with customers. I hate to use those words, because everybody does. But I think, in MED3OOO’s case, it really is true.

Because we use recurring revenue models, we make money when a physician practice makes money. In other words, we are making a percent of the profits instead of a straight fee.

When we implement a system, whether it be our own or someone else’s, we always look at how it impacts, not only the practice’s bottom line, but our own bottom line. If we implement a practice in a way that loses the practice money, then we don’t get paid. This is the key piece of what drives our implementation process and everything else that we do. We make sure the way we do things isn’t disruptive and really does help the bottom-line.

Fast Facts

Products
InteGreat Electronic Health Record, IC-Script, IC-Imaging, IC-Encounters, IC-MyHealthRecord Patient Portal, IC-Orders

Company
MED3OOO, Inc.
680 Anderson Drive
Foster Plaza 10
Pittsburgh, PA 15220
888.811.2411
www.igreat.com

Notable Customers
Carle Clinic, Christie Clinic.

The Bottom Line

* InteGreat’s EHR is easy to learn and easy to implement requiring only a browser and an Internet connection.

* InteGreat and parent company MED3OOO focus on increasing physician practice revenue and efficiency, not just selling software licenses.

* MED3OOO provides peace of mind to its physician practices with a 20+ year track record, financial strength, and a wide variety of operations and technical services.

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