Saturday, March 28 2009 | 5:24 pm

ICA’s CareAlign Suite Provides a Cutting Edge Longitudinal Patient Record, Workflow Tools, and Secure Messaging to Improve Care and Enhance Physician Alignment

NEW ICA Logo Vanderbilt Medical Center is broadly recognized for applying sophisticated biomedical informatics technology to support its physicians and care venues in delivering quality care. Informatics Corporation of America has commercialized Vanderbilt-developed technology as ICA’s CareAlign solution, which provides a longitudinal patient record, workflow tools, population management, and secure messaging in a solution that can be rapidly implemented without changing underlying information systems. Strong technology, usability-based design, and ongoing physician involvement have combined to create a system with value in interoperability, physician alignment, and disease management. We spoke with Gary Zegiestowsky, CEO of ICA.

Tell me about Informatics Corporation of America.

ICA was co-founded with Vanderbilt Medical Center to take their clinical technology solutions out to the broader healthcare market. We believe we’re unmatched in our ability to deliver a cost-effective, proven solution that leverages data across clinical settings and aids decision-making and improved patient outcomes. Furthermore, we have the ability to build a complete longitudinal patient record, taking data from many sources and disparate formats.

Our wide range of tools gives healthcare enterprises and healthcare information exchanges throughout the country the ability to break down silos of information and deliver a comprehensive longitudinal medical record viewable by all healthcare organizations within a hospital community.

How does the ICA approach for community interoperability differ from that used in typical RHIOs and HIEs and why is that beneficial?

I don’t believe a typical solution exists, which is why we deliver a complete patient record at the point of care. Some solutions are simply about exchanging data, like lab results and discharge summaries. Other solutions go deeper on selective pieces of data, like meds and allergies, but may not include a more comprehensive view of the patient.

Dr. Harry Jacobson, CEO of Vanderbilt, once said, “Complete information is the foundation for quality care.” That is what we are all about — the whole patient picture, no matter where you are and regardless of the treatment setting.

Through the capture of both structured and unstructured data, our solutions provide a foundation for quality healthcare delivery. We also provide secure messaging for a referral or consult that automatically attaches relevant information within the record. If a system is unable to capture certain information, we can create data capture utilities to fill the gap.

What ICA tools do physicians find most useful when caring for patients?

garyz First and foremost, the complete patient record. That really is our foundation and regarded as the most valuable tool because it levels the playing field for all clinicians involved. Everyone is looking at the same complete picture, which enables every caregiver to make the best healthcare decisions for each individual patient.

Beyond that, we develop disease dashboards for key chronic disease states, leveraging the foundational record and bringing even more value to clinicians. Caregivers are able to see at a glance if the patient they are currently treating is healthy, in need of preventive care, or if that individual is bringing along “baggage” that involves a long history of illness. That level of knowledge affects approaches to care and allows for more personalized options.

Lourdes Hospital was able to go live in just six months with an ICA clinical portal that provides a longitudinal patient record from several systems. What are the lessons learned for hospitals considering a similar project?

The lessons are two-fold: First, the time to value — meaning the speed of implementation — is critical. Also, by delivering results as quickly as possible, the organization could begin building and achieving value from its investment in the IT solution. With Lourdes, the momentum was never lost through implementation because of the speed with which the solution was up and running.

Second, it’s critical that the value at each stage exceeds the effort. With this approach, we create tangible value at every turn. It becomes particularly apparent to physicians, who often bounce between the clinic and the hospital. They can easily see the value of a patient record with a single point of access that fits into their workflow. They find the system easy to use.

Vanderbilt designed what is now the ICA system by applying the biomedical informatics expertise that it is widely known for. What is the tangible difference as compared to systems offered by competitors?

I believe the biggest difference in the informatics space solution and our evolution is that Vanderbilt had technologists and programmers in the treatment setting, observing workflow and designing systems in concert with the practicing physicians and nurses. It is clinically very deep in terms of its ability to truly understand how physicians and nurses deliver care in various environments.

This approach created something that is highly adaptable and very easy to use because it is truly aligned with the workflow of the physicians, versus changing physician workflow to fit the technology.

What type of outcomes do you think customers could get with a new implementation and how do you measure that?

In the initial phase of implementation, the most significant outcome was production of a complete patient record. What we found with Lourdes is that we exceeded expectations by simply delivering on time and on budget. From the business side, the fact that we said we could deliver in six months — and did — was really viewed very positively across the organization.

From a clinical standpoint, what we’ve seen initially is very strong physician and patient satisfaction simply by making it easier for clinicians to deliver care. From the patient side, we’re seeing very positive remarks because they feel their physicians are more informed. Patient satisfaction is high because the individual’s physician has his/her complete record, obviating the need to repeat their healthcare history or recreate recent treatment they may have received at an affiliated clinic.

How was ROI measured?

Lourdes didn’t have a solid ROI-type measure. What they were trying to accomplish was to more strongly align the community physicians with the hospital and make it easier for them to deliver care and improve outcomes.
Over time, I’m sure they will be looking at whether they are improving alignment with physicians by increased referrals, or if physician satisfaction is improved. The increased referrals would probably be their biggest ROI driver, given what they were trying to accomplish.

But the reality is that if you have a complete view of the patient, it makes it easier for physicians to work with you. They’re accessing a common system across treatment settings, improving efficiency, and giving clinicians more time to spend delivering care.

How do you use secure messaging in the system?

chart Secure messaging takes conversations, phone calls, and paper messages between physicians, nurses, and patients and makes them electronic, thus expediting the message and response.

What we have seen with our Bassett Healthcare implementation is that 99 percent of patient inquiries are now responded to within 24 hours. Secure messaging also eliminates misinterpretation, and users can respond quickly to the electronic communications, which helps move information more efficiently than the older, traditional modes of communication. It is used for everything from referrals and consults to answering patient questions and filling prescriptions.

The biggest advantage is that nothing is lost. Reminders, audit trails, and reporting within the system ensure that every message is received and responded to appropriately.

What type of involvement is required from the hospital IT department to put your system in?

Since we are building onto existing systems, the IT department needs, very simply, a way to retrieve the information from each system in order to build out a complete record. The initial effort is in working with them to extract this data. As we progress towards deployment, we test on the QA side and release the different modules into production, at which point we may need assistance if they are handling that responsibility.

How does your product leverage existing technology investments in hospitals?

That’s really part of our core approach with the solution. It builds on everything that already exists within the hospital system. It’s how we deliver our solution and why we are able to provide the solution in such an economical way. We optimize the existing value of these systems with both information and functionality and preserve the investment made in these legacy systems.

Do you see more health systems moving toward a single vendor solution, and if so, what effect might that eventually have on your business?

There are a lot of trends out there in the market today and we definitely recognize a contingent moving towards a single vendor solution. We also recognize that a healthcare community will always have niche systems based on specialty and clinical setting that are not encompassed into these enterprise-wide implementations. We can still add value by helping bridge the gaps to unite those systems.

If an enterprise is trying to connect to the community in an HIE, there is a role for us. If the system has a solution that is fully deployed but requires connection to an HIE, we can do that, too.

Dr. William Stead is a company advisor for you. How does your solution fit into the recommendations of the IOM committee he chaired that advocated patient-and physician-centered systems and decision support?

Many of the fundamental concepts highlighted in that report are consistent with our solutions and the approach that we’re taking to the market.

In the study, one of the biggest fundamental gaps found in the places they visited involved effective use of information to make better decisions at the point of care. Our strongest value is that our solutions span the whole spectrum of care. At the end of the day, we’re leveraging the information to make better decisions and deliver better care, whether that’s the foundational record or the disease dashboard or a secure message.

You were recently awarded the Healthcare IT Summit Award for the solution with greatest market potential. What do you see is the potential for your market over the next one to three years?

With the recently passed economic stimulus package, we see ICA aligned well to meet the goals the government is trying to achieve. We see five core points throughout the bill: preventing medical mistakes, providing better care to patients, cost-saving efficiencies, preventive care, and the evaluation of the most effective healthcare treatments.

Providing a comprehensive, longitudinal medical record with disease and preventive care dashboards, secure clinical messaging, and other workflow tools will assist healthcare entities in achieving the objectives of the package. We are excited about our role in accomplishing these objectives.

Where in the market are you finding the most interest in your solution?

One comes from organizations trying to provide a more complete view of information for their physicians to deliver better care, whether that is within a hospital or a community or between a hospital and an affiliate. More broadly, the focus is on trying to really align with affiliate physicians as a care team. That is one of our core solutions from a physician standpoint.

Expanding on this, if we look at community-based care involving HIEs and the RHIOs, it’s just a continued expansion based on, again, making sure that every caregiver is on the same page so they can make the right healthcare choices for the patient.

With community-based care, it’s more about providing complete patient information to better utilize emergency departments, as well as direct information to a primary care home. It’s also about being able to proactively manage key disease states, which really hits the spectrum of hospitals trying to connect with affiliates, as well as communities across the state. Chronic disease is a big cost driver across the country.

Anything else you’d like to add?

Although we are a new company, one thing we can show for ourselves is strong, proven results. We have the ability to go live in a short time across various spectrums.

In the HIE space, we are one of the few out there that has a very strong track record of success. In fact, we now have the Memphis RHIO, which we migrated from Vanderbilt to our commercial solution in November. That has been operational for two years. We went live with the HIE Montana in December. We also signed recently with the city of St. Louis to implement a similar project.

In the hospital market, we’ve had Bassett Healthcare in Cooperstown, NY live for almost two years, constantly expanding clinical functionality. We brought Lourdes Hospital in Paducah, Kentucky live within six months.

So, I believe we’re already getting traction out there as a HIT solution with potential for both hospitals and communities. As we continue to innovate and build on what we’re taking to market, we can jump to the next generation with a very well established, comprehensive solution within the healthcare market.

Fast Facts

CareAlign Suite

Informatics Corporation of America
1801 West End Avenue, Suite 1000
Nashville, TN 37201

Notable Customers
Vanderbilt Medical Center, Bassett Healthcare, Lourdes Hospital, MidSouth eHealth Alliance, Health Information Exchange Montana.

The Bottom Line

*   ICA’s CareAlign Suite offers a unique blend of portal, EMR, communication, and disease management capabilities.

*   The ICA solution takes a biomedical informatics approach rather than a traditional IT “data processing” approach, developed using Vanderbilt Medical Center’s deep expertise.

*   CareAlign leverages existing systems to provide new clinical value, timing benefit with expense for a quick return on investment.

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