Tell me about InSite One.

InSite One is the leader in medical image archiving as a service in the cloud. Since 1999, we’ve provided local, on-site, on-premises storage as well as off-site cloud storage services for the active archiving of medical data, integrated with the major PACS players.

We have expanded beyond just medical imaging. We now store a wide-range of medical information conformant with the IHE standards of DICOM (Digital Imaging and Communications in Medicine) and now XDS (Cross-Enterprise Document Sharing).

What types of content do you manage?

We manage images and reports, both reports sent to us into via HL7 and medical images sent from DICOM and non-DICOM devices. The InDex archive currently contains more than 55 million DICOM exams and 3.7 billion objects in a single archive supported by cloud services.

What are the advantages of using a vendor-neutral enterprise archive management service?

The technology used to store medical data changes more rapidly than the regulatory and clinical requirements for retaining that data. Total cost of ownership to a provider must consider having to repeatedly re-store existing data on new media and painfully migrate it to new platforms within the retention period for the data.

A one-time ingestion fee when storing that data within InDex services reduces this TCO, as we manage the ongoing technology. There are never any future costs for maintaining storage or accessing that data.

This business model provides two key benefits. It provides infrastructure simplification through consolidation and virtualization for the hospitals or even an imaging center. They don’t have to manage the technology. Vendor neutrality of InDex Services provides the ability to keep pace with the ever-changing clinical applications that need access to their data in the future without any data migration required.

InDex services supports clinical transformation. Once we have information, we can allow institutions to share it, if they choose, through routing of the data along with dynamic morphing of metadata to ensure compatibility of old data with new clinical applications.

For example, numerous PACS and modalities that are no longer available on the market have stored data with us over the last 11 years that our clients continue to access demonstrating the power of our InDex services.

In the early days of PACS, providers were stuck with the vendor they chose since there was no easy mass retrieval or conversion of their images.

In the early days of adoption, whether it was PACS or a clinical application creating the data, the use of that data was department specific. Going forward, it behooved the informaticists — the CIOs, directors of IT, and clinical IT specialists — to understand that the clinical application that created the data was no longer the sole user of that information.

Having it in a standards-based format becomes a critical strategic and operational decision as evidence-based medicine becomes ever more important.

The early business model was that vendors let you store images free, but you paid each time you viewed them. What is the customer benefit of your model?

The business model has two elements. The first is that the model is pay on ingestion, which synchronizes storage payments concurrent with procedure reimbursement, instead of paying for access or retention beyond the reimbursement period.

In the didactic science of medical imaging, where you’re comparing historical studies with new studies, it’s hard to account for that cost of retrieval. When you’re paying on ingestion, you have simultaneous revenue coming in from billing for that technical and professional service.

The model is a one-time fee based on exam or collected documents instead of paying per gigabyte or per image. With the InSite One model, we can walk into your hospital and ask, “How many radiology procedures did you do last year?” You may not know how many CTs or MRs or ultrasounds, but you know that you billed about 100,000 procedures.

The simplicity of InSite One’s business model is that we could give you a price based on this procedure volume. Our census from nearly 800 sites gives us the ability to offer a bulk price based volume.

The per-gigabyte model creates future liabilities for your operational budget. What you’ve stored this month may be small, but if your operating volumes go down, you still have to pay for that storage every month.

Our model tracks with your billing volumes since you’re paying on ingestion. If your volumes go down, such as with some imaging centers that are suffering, there is no outlay of money based on presumed storage, you pay as you go.

Your model also carries no additional cost for the customer to more fully utilize the information they’ve stored.

That’s exactly right. We store our data in a patient-centric way. Key images associated with the medical imaging exam or any key object(s) associated with any of the documentation can be accessed beyond the clinical applications originating the data if that is supported.

That collective perspective of the patient, rather than a specific exam, is another value of the InDex service, especially as we move to Accountable Care Organization business models where everyone needs to be using the same information to control the costs of delivering quality patient care.

Before Meaningful Use came along, CIOs were worried about the growing volume of data and their ability to manage the required infrastructure. Is that still the case?

The amount of information that’s coming out continues to increase. The average size of data sets and the volume of documentation – digital documentation – also continues to grow.

There is no DICOM command for delete. It’s the purging of digital data versus keeping the digital data that’s now a management issue. Those paying per-gigabyte, per-month fees or managing a growing disk farm, or those moving their data on newer and more dense technologies, have a real problem.

Providers moving to electronic medical records suddenly find that they have interesting opportunities to use the digital data they’re creating. Are you seeing that?

That’s a very true observation. We have a separate SQL database against which people can run reports. We’re certainly moving into a realm where people will be looking to do analytics on that data.

We have about six percent of the US population in a single database in our InDex archive. That makes our collective platform unique in its ability to provide general market perspectives. It also supports a future vision of letting people understand how they compare to others in the InDex universe. This will be a useful tool as they optimize their operations.

Some were disappointed that imaging wasn’t a greater part of Meaningful Use. Do you think that will change as the requirements mature?

It’s hard to predict what will happen with healthcare. The medical imaging community — whether it’s radiology, cardiology, or any of the imaging sciences – were disappointed that imaging wasn’t included. It’s a service that comes along with their professional expertise and diagnostic services.

Will it become necessary? There are business models for radiology practices that might emerge for their eligibility. For the hospital some are hinting that it may in 2015. I think it’s more likely that image sharing will become a clinical requirement instead, the more we get into personal health and groups of people managing a specific pathology or symptom.

Speaking of that, your marketing piece on HIEs suggests that “HIEs of need” may form around clinical disciplines or other group collaboration that are not bound to specific provider organizations. How do you see HIEs evolving over the next five years?

Total health is a form of health information exchange. Trauma centers need access to prior studies, transplant centers require rapid data collection, and cancer centers need information to provide consultation. I think these HIEs that are based on clinical need are going to become more and more integrated with imaging.

That could also drive the development of HIEs from a business standpoint. Within the members of an HIE, you have a concentric business model that matches what may become the emerging business model for reimbursement. You want to be able to keep patients within the Accountable Care Organization to control your costs.

Interoperability is often touted on the basis of saving money by avoiding duplicate lab tests. Lab tests are cheap, but imaging isn’t. I would think that having images more available would allow faster treatment decisions and avoid expensive re-takes.

That’s important to note. I also think the appropriateness of imaging will grow as the radiologists become part of this health information exchange, especially radiology. Appropriateness criteria have always been an issue driving the perception of the overuse of medical imaging, such as, “As long as you’re in my office, I’ll just do an X-ray.”

Image sharing will probably address that perception and also reduce the number of exams. I also think that radiology’s ability to communicate more effectively around the treatment of care will increase its influence on the appropriateness of the recommended studies and the follow-up studies.

How are customers integrating the images you store into their EMRs?

Customers are integrating InDex’s zero-footprint viewer into their portals and EMRs. Most of our installed base has been integrated into patient and referring physician portals. InDex’s toolset has been validated with several EMRs.

Adoption within the hospital setting is trailing the external use of imaging. That’s because within the hospital organization, many of the EMRs have integrated specifically to the PACS of that hospital. The universal viewer will ramp up with greater adoption as hospitals want cardiology, which might be one vendor, and radiology, which is another vendor, all integrated into the EMR.

The other thing that’s hindering the adaption of EMR integration is that PACS vendors have a lot of workstations deployed throughout the hospital.

Compared to the early days, open technologies are liberating images not just from the PACS vendor, but from the provider organization itself. Images are becoming as ubiquitous as a transcribed report.

There’s no question that imaging and its associated reports will be liberated from the clinical applications that created them through the vendor-neutral capabilities that IHE as defined. That includes orthopedic images, laparoscopic surgical images… I mean, it goes well beyond radiology.

At RSNA this year, InSite One demonstrated an imaging-specific personal health record. Instead of producing CDs, there’s a personal health record for which the patient manages permissions of who can access their images.

I think that’s an important element. When we look at the way information is exchanged today, hospitals and especially academic institutions have an onslaught of CDs. A digital exchange platform can eliminate that. Soon patients will have direct access to their data.

The imaging world really changed with DICOM and IHE.

When DICOM was created, it was intended to be a modality-to-PACS interface. It was a point-to-point interface, actually a plug they had defined to the physical level.

Since the early ‘80s when it was created, it has progressed from an interface standard to an archiving standard. It’s plausible – I’m not saying it’s probable, but it’s certainly plausible – that IHE’s XDS standard may go beyond the interfacing of information systems and where the information is stored and how you get it to defining how information is managed long term.

DICOM certainly has liberated imaging from the clinical application, but other standards, guidelines, profiles, and actors in XDS will liberate the data even further.

Everybody’s talking about cloud computing. What should providers understand about it?

The term “cloud computing” is not well understood by the healthcare industry. Cloud delivery allows for dynamic scalability. Technology can be delivered at a lower cost per click or cost per gigabyte of whatever your metric is. It’s not ubiquitous, however, and not all clouds are the same.

One of the benefits of InDex is that in this cloud — it’s our own cloud, by the way — when you need the data back, you can not only access it during a disaster, but we rebuild and shuttle with a feature called rapid restore disk packs that will take the data back to your local facility. Not over the Internet, but physically send you those disks so that you can rebuild your system from local disk. Then we take those disk packs back at no extra cost as part of our service.

Many clouds have a gateway on the premises. Should that gateway go down, all the data in the cloud is in the proprietary format. The only thing that knows what’s on those disks is the clinical application that created them. With InSite One’s InDex, our entire environment can be accessed via DICOM in a secure way.

Any final thoughts?

In the ten-year history of InSite One, other ventures focused on trying to provide managed services. The challenge has always been to understand the delivery model.

It’s been the combination of our patented software technology and our ability to scale and therefore reduce the cost to our customers over time that has given us the credibility and the ability to survive entering our eleventh year. It’s been a very exciting ride to now be managing in a single archive over 3.6 billion objects and over 54 million studies.

When I walk into a hospital today and someone is concerned about InSite One and our ability to handle their million studies a year, I can tell them we’re doing a million studies a month. That economy of scale benefits even a small imaging center that needs to share information, like an outpatient surgical center or orthopedic practice that’s feeding a hospital. We’ve been able to continue evolving our footprint that provides a common infrastructure that allows sharing patient-centric information without CDs.

Fast Facts

Services
InDex OnSite, InDex Basic, InDex Web, InDex Recovery, InDex Offsite, Recovery Plus.

Company Headquarters
InSite One
135 N. Plains Industrial Road
Wallingford, CT 06492
800.441.0091
www.InSiteOne.com

In December 2010 Dell Inc, announced the acquisition of InSite One the cloud-based medical archiving leader to help healthcare organizations simplify retention of healthcare data. The Dell announcement cited how the InSite One solution helps customers reduce costs associated with long-term data storage and migration, provide off-site disaster recovery services and eliminate one of the biggest shortcomings in healthcare today—the sharing of images between medical professionals in the diagnosis and treatment of disease.

The combination of InSite One’s cloud-based, vendor-neutral archive software and storage and disaster recovery services with Dell’s Unified Clinical Archive (UCA) solution will simplify data retention and allow medical professionals access and share images regardless of the modality, Picture Archiving and Communication Systems (PACS) or end-point device.

The Bottom Line

*   InSite One is the leading healthcare service provider of medical data archiving, storage, and disaster recovery.

*   The company’s standards-based archive, storage, and recovery solutions are bulletproof, easily implemented, and infinitely scalable, protecting users from the risk of technical obsolescence and integration challenges.

*   The InDex per-study pricing model, with no upfront capital required, is affordable for virtually every healthcare facility.

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Tell me how your career evolved from being a full-time practicing physician to chief medical officer of MedAptus.

I grew up a hobbyist around computers. Even in medical school I did part-time consulting, building applications for researchers to help them manage data. I did a medical informatics fellowship at The Center for Clinical Computing and then a job at Beth Israel working under John Halamka, where I was 50% clinical and 50% IT. I was involved with PatientSite, which was one of the first patient-centered portals.

Our clinical department was losing money. I wrote a simple, Web-based application that allowed direct input of charges. We went firmly into the black that year with exactly the same volume and same number of providers because we were getting paid more. It was powerful to see the result, which was that we were able to reinstate bonuses.

The folks at MedAptus contacted me in 2004. I talked to some of their clients, who were ecstatic about the typical multi-million dollar impact. I ended up joining.

One of our differentiators at MedAptus is our revenue cycle focus. There have been a number of people who do charge capture, but it’s typically a side job for them.

Our most mature product is Professional Intelligent Charge Capture, which captures professional charges at the point of care. It then sends those charges to administrative staff, who reconcile them and perform exception-based charge management with a very sophisticated administrative module.

The second major product line is Facility charge capture. It focuses on the outpatient facility — basically, provider-based billing, otherwise known as split-billing or technical billing — for hospitals providing outpatient services. It provides the ability to capture hospital-based outpatient revenue. It’s integrated with the professional revenue cycle, but can be used free-standing as well.

The last product is our Infusion charge capture. That grew out of a co-development process with Dana-Farber Cancer Institute. They were already using our Professional product and were very happy with it, but were looking to solve the challenge in infusion charge capture. Infusion coding had gone from a handful of codes to a complete hierarchy of codes with a bunch of dependencies on how to bill things based on what else you billed previously. It had become an administrative nightmare because of the amount of training to get the nurses to understand it. Our product started with a simple premise – it will ask the nurses what they did and for how long and the coding engine translates that into compliant codes. Despite continual regulatory changes, the user interface remains constant.

What are some of the challenges that you see providers facing in terms of capturing charges?

First and foremost, we are providers of healthcare. A sick patient always takes precedence. Administrative things naturally end up being a second-tier focus and it’s easy to miss or forget charges.

On the outpatient side, you have a list of appointments. With good administrative help, they will make sure there’s a charge in for every one of them. You have a mechanism to do reconciliation. It’s very manual and labor-intensive, but it can be done.

The inpatient side of the world is troublesome because you don’t know the true denominators. You have a lot of events that you can’t predict, such as curbside consults. I see a colleague in the hallway and I ask him to see my patient. There’s no record of that anywhere to reconcile against. That provider might put in a line or do a procedure bedside and there’s no record for the administrators to know that something happened. Despite having hardworking and talented staff, they can’t know what they don’t know. On the inpatient side, there’s no safety net, so you end up losing a significant number of charges.

Another challenge with paper-based systems is providers’ tendency to put off documenting charges because it’s an annoyance. They let it build up and then try to go back and do charges for a period of time. Then providers cannot accurately remember what they did. They forget to put in procedures and defensively down-code and end up not getting paid for all the services rendered.

Paper systems create a challenge with timely payment. Not only does it take a lot longer to receive payments for services rendered, but you risk running into filing deadlines. Add in multiple payers, each with their own shifting rules, and it’s challenging to know how to properly charge.

For the most part, docs just don’t even pay attention to that. They trust the coders to do it. The coders tend to know that stuff cold, but the problem is by the time they get the charges, it’s a week or two after care was rendered, making it harder to find out exactly what happened at the point-of-care.

Do hospitalists and anesthesiologists have similar issues?

Yes. There’s tremendous benefit for both to move to an intelligent charge capture solution because on the inpatient side, it’s a dynamic environment, hard to reconcile.

The second someone stops doing a charge with the intent to go back and do it later, a good percentage of the time, the charge will never be put in. For inpatient providers, it’s fundamental to provide them an easy, intuitive mechanism to capture the charge as quickly as they can after a service is rendered.

Most EMR products today include charge capture functionality. Do products like MedAptus run the risk of becoming obsolete as more facilities add EMR tools into the workflow?

No, I actually think it’s improving our opportunity. We’re now in Version 10 of the product and are integrated with many EMRs.

EMRs are like motherhood and apple pie. They’re very good for patients and society. But speaking firsthand as a physician who has gone from paper to an EMR, they are not quicker than paper. They take more time. EMRs are focusing their efforts on trying to improve the time factor in order to improve adoption.

The revenue cycle stuff is very much its own domain. The solutions the EMRs come up with are basic. They can capture charges, but with the revenue cycle, you can’t settle for adequate in terms of your charge capture capability.

With EMRs, we’ve got the carrot now and the stick is coming. Now more than ever the need to get accurately paid for the work you’re doing is paramount to survival. This is no longer a “nice to have.”

With healthcare reform, we’ll soon to have 30 million additional covered lives coming into the system. There’s not much more in terms of additional dollars forecast to be paid. They’re trying to pay for it based on efficiencies generated from the EMRs. Payments, at best, are going to be static and are probably going to drop.

These factors make it imperative to have a well-honed system that makes charge capture intuitive and results in getting paid for all services rendered. A couple of percentage points could be the difference between making a thin profit and not surviving.

What type of financial gains and productivity gains can your clients expect when implementing products from MedAptus?

This has been very well studied throughout the years by independent resources. The numbers vary between $15-25,000 per doctor, per year. That’s top-line cash collected, year-on-year contract value and volume-adjusted. The net of it is our docs get paid $15-25,000 more a year for the same amount of work they were doing previously.

We also provide significant cash acceleration effects from the capture of charges, typically on the date of service, and rapid submission. The time from service to receipt of payment drops significantly. That lag day decrease will typically drive another $8-10,000 per doctor in terms of a one-time cash improvement.

It ends up working out nicely because that cash influx per doc is a multiple of the entire cost of the system. People can essentially be cash-neutral, actually throwing off cash within months of going live, which makes it a powerful mechanism for funding EMRs and other IT initiatives.

The administrative cost is the last piece. We’ve found that healthcare is always hungry for bodies. Even though we end up decreasing the need for people around the revenue cycle, they end up being re-tasked to other purposes that drive additional revenue.

Billing rules continue to be more and more complex, and soon the industry will move to ICD-10. What’s involved with researching and maintaining the various charging rules?

To say it’s not trivial is a large understatement. Everyone in the company is steeped in the revenue cycle, which has allowed us to not only survive, but thrive and help our customers manage these challenges.

Regarding ICD-10, we view it as an opportunity. Clearly there is a lot of work involved in migrating systems and preparing for ICD-10, but one of the real challenges with charge capture today is that the ICD-9 vocabulary is very limited. It’s several decades old and there are not enough codes to adequately describe what physicians see. There are a lot of mappings where a doc might be looking for a particular entity, and it might map to a “not otherwise specified” or “not elsewhere classified” code which is confusing.

ICD-10 provides much better specificity, so that when a doc locates a code, it will look much more like what they’re looking for. That’s definitely going to be a large benefit for providers.

When you look at driving rules and creating intelligence, more specific codes allow us to leverage our intelligence in the system to an even greater extent.

Do you have clinicians helping you figure out the codes and billing rules?

For the billing rules, we have a combination of technology that we license. What’s out there is good, but it’s not where we need it to be, so we have built additional rules that represent our intellectual property, understanding of the marketplace, as well as client experience. We continuously hone our rules based on feedback from administrative folks across the country as well as our client services staff.

My role is to help understand when and how we should reach out to doctors with this information. You have to be very careful when you reach out to a user with an exception because you risk fatiguing them if you do it too often. And if you hit them with something that they don’t understand and can’t answer, it leads to frustration and lack of adoption.

Just triggering a rule and pushing it out to the doc – that’s half of what you need. The other half is knowing when not to ask the doc the question. In other words, parsing out an administrative question versus something the doc can help with. Our goal is whenever the alert pops up for a provider is for it to be relevant and easily answered based on care. We’re not trying to make physicians coders. What we are trying to do is ask information at “the golden moment” – the point when they know everything about the encounter.

That understanding, the nuance and the art form of how and when to present information to the providers, is a big differentiator for us.

MedAptus was recently awarded a patent for technology to process and reconcile professional technical charges. What makes this technology unique?

The patent highlights our facility charge capture product and the processing of facility charge capture information based on professional information. It’s leveraging knowledge across systems to intelligently capture the facility charges.

We’re very proud of doing that, obviously. It’s recognition that what we’re doing is unique out there, and is leading the way in terms of applying technology to automate these processes.

You mentioned healthcare reform. How will it affect physician revenues and the demand for products like yours?

There are certainly a lot of models out there, everything from nuances of fee-for-service to a completely capitated model where point-of-care charge capture would largely become irrelevant.

I think that what you can safely say about healthcare reform now is that we’re paying for quantity of care and not quality. One of the chief challenges is realigning that so folks are paid for delivering quality.

It seems more likely that will occur in a step-wise fashion from how we’re charging today, because margins are so thin for providers. It would be extremely challenging to radically change things because folks are barely hanging on as it is. The system has to realign how it’s paying to drive quality.

Things like pay-for-performance are early steps. Obviously, Accountable Care Organizations are getting a lot of play and you have Medical Homes as well. If you look at the commonalities of all of those, it’s trying to get more efficient care and then rebating some of the cost-saving steps to providers, trying to align interest toward quality rather than quantity.

None of these things change the need to be able to capture your primary service, because all these additional bonuses are going to be percentage points on top of your base revenue, which is still going to drive your success or failure in the marketplace.

Every payer has its own approach, measures, definitions, and codes to append onto claims. Operationally, it becomes a nightmare and bordering on impossible without a strong use of technology to take advantage of these one to two percentage points of payment.

Let’s say a patient has CHF. The insurer is Aetna. Well, I think they have a pay-for-performance program on CHF, but what is it, and what are the choices of where the codes have to append?

The cool thing we’re doing with technology is to automate these rules in the background. They only fire if a provider is subscribed to that payer’s pay-for-performance measure and that particular patient qualifies for it. The provider gets a simple list of choices and the appropriate code gets added on to the back end. That is a real-world example of how we’re enabling people to survive this shift from payment for quantity to payment for quality.

Is there anything else that you’d like to add?

We are certainly very excited by the marketplace, especially with EMR adoption uptick and health reform. I think everyone is very interested in optimizing their revenue cycle to get everything they can.

Fast Facts

Products
Practice Plus Edition, Inpatient Edition, EMR Edition, Enterprise Edition, Facility Edition, Infusion Services Edition.

Company
MedAptus
176 Federal Street
Boston, MA 02110
617.896.4000
www.MedAptus.com

Notable Clients
Beth Israel Deaconess HealthCare, Caritas Christi Health Care, Dana-Farber Cancer Institute, Dartmouth-Hitchcock Medical Center, MD Anderson Cancer Center, University of Minnesota Physicians, University Physician Associates/UMDNJ.

The Bottom Line

·  MedAptus provides flexible, scalable, point-of-care solutions for sophisticated charge capture automation that eliminates manual processes and increases payments.

·  Improved charge collection increases the bottom line and the reduced charging workload allows adding new services that benefit patients.

·  Revenue cycle management is critical now, but will be a key to survival once healthcare reform starts making rapid and unpredictable changes that will affect the financial well-being of providers.

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QuadraMed had a limited line of clinical applications when you joined the company in 2001. How has your job and the company’s emphasis changed now that it has a highly regarded clinical suite to join its strong patient management, billing, scheduling, and health information management solutions?

Acceleration, in a single word. The vision that everyone has had in the HIS industry is similar, such as following the Gartner criteria for workflow and knowledge management and providing an effective user interface and high quality embedded analytics.

For us, that vision became reality when QuadraMed acquired the Misys CPR products. It accelerated us forward. The depth and power of our solutions grew exponentially. Our new integrated meds management product is a good example. It’s distinctly better than what we had and distinctly stronger than many other solutions on the market because it was modelled after real clinical workflow.

What is your take on the HIS industry and where you think QuadraMed fits into it?

Everyone working on both the vendor side and the provider side recognizes that no product is complete or where we want it to be. The industry as a whole is making progress and we’re doing more complicated things.

However, the HIS industry as a whole is moving at a glacial pace when compared to other industries. It’s not significantly further along than it was 15 years ago. We’re a lot more paperless. We’re more automated. There’s more decision support. But, compared to where everyone sees us going, the industry is still in its infancy.

Markets are consolidating. Ten years ago, when you bought an HIS system, you could buy tools in applications that allowed you to build up a system the way you wanted. But that meant build work usually fell on the clients. Implementations took a long time, making it frustrating and expensive to get an application, much less a system, to the point where it was strong.

QuadraMed has addressed this by developing a starter set, a core solution to get going quickly. Although other vendors have also taken this approach with varying degrees of success, QuadraMed offers functionality comparable to the biggest players, but for a significantly more competitive price. This creates an opportunity for us to compete for a much larger share of the market and that’s a great fit for us.

Economic conditions today may force some hospitals to look hard at improving patient throughput, case management, utilization management, and similar functions. If a hospital called you today and asked for help in those areas, what kind of systems or services would you recommend?

My blog recently included a headline that read “Overcrowded Hospitals – and Bottlenecks; ROI=Zero If You Improve Anything Other Than a True Bottleneck.” The whole issue with throughput is redesign to eliminate waiting.

We have a number of solutions and related services that can help do exactly that. The “Quad” in QuadraMed represents the four pillars of an end-to-end HIS: access management, care management, HIM management, and revenue cycle management. Each solution offers unique opportunities to improve patient flow and minimize wasteful waiting.

On the access side, many of our clients are challenged with MPI problems, so we have very strong clean-up services coupled with applications to maintain a clean MPI that are particularly useful in large and multi-hospital systems. MPI issues have huge implications for the registration process, getting clean bills out, and quickly and reliably providing patient information for safety and quality.

On the care side, flow can be improved through rich use of pathways. We have solutions for our clients that provide pathways for the CMS scope of work diagnoses. These can absolutely reduce the time to initiate the appropriate antibiotics or the appropriate agents for patients coming in with strokes, heart attacks, etc. We have teams of clinicians that go to hospitals and assess how to make improvements.

In HIM and Revenue Cycle Management, we’re speeding up processes, eliminating waits, and looking for risks, like RAC audits. Of course, we help with denial management to reduce throughput challenges for billing and collections.

Collectively, those four pieces are parts of an integrated inpatient throughput value chain, before, during, and after care is provided.

ICD-10 has generated much discussion. What is your thought on the role of current taxonomies and nomenclature for research and decision support purposes versus reimbursement?

Great question. As we both know, the ICD-9 terminology was really developed to classify diseases for aggregate public health reimbursement purposes. It works reasonably well for that purpose. But there are many clinical conditions that are not only inadequately represented, but also a degree of clarity that’s lost by picking a particular code.

For example, the ICD-9 code for hypomagnesemia and hypermagnesemia is the same. It is insulting to a physician to use codes that obfuscate. ICD-10 is exciting clinically because it expands the number of codes roughly tenfold. You can get much closer to describing a clinical scenario.

That said, you can go the next step and into nomenclatures like SNOMED. Those systems are exciting and useful and can do some additional things that systems like ICD can’t do. ICD-10 is necessary. The rest of the world is there. The fact that the US isn’t is more a reflection of our reimbursement system and its incentives. Payers are the ones resisting ICD-10 because they don’t receive additional value from them. That is something the policy makers should be paying attention to.

What do you think the best hope is for turning research into clinical practice?

Translational Medicine is a relatively new term for “How do we bring science into clinical care delivery as rapidly as possible?” I address this in my blog, “Science 2.0,” in some depth.

It takes 17 years for a medical fact to reach routine general practice. That’s too long. It means we’re treating people with things we know are ineffective. The translation/dissemination of knowledge problem is pretty significant. 

The similarities between Translational Medicine and Web 2.0 are really striking, which is why I wrote the Science 2.0 post. The way science is communicated today is through publications. Publications have summaries of the studies’ conclusions, but there’s not enough information published in most of them for the results to be reproduced by a separate team. There’s a fundamental problem with our publication system that is linked to the way our reimbursement and intellectual property systems work. If people fully disclose their secret sauce, they no longer have intellectual property protection.

Web 2.0 introduces new business models. It also recognizes that society must be able to interact in order to build databases and use them during routine care going forward. Two-way mediums are absolutely critical.

The same is true for Science 2.0. Consumers and care providers are starting to share observational data more immediately. This ties into broader initiatives, both personal, like medical health record banking, and larger, like communities of interest (e.g. PatientsLikeMe). People will be able to have their own health records examined for what new science might have to bear on them, along with the ability to see the validity of sources providing these opinions.

There are a variety of ways this will come together, as we are seeing with Microsoft and Google taking a position with health record banking. It’s very exciting because this is really ground zero for the collaboration and improvement of translational science with direct consumer access to knowledge.

What additional big challenges do you believe hospitals clinical departments are facing today?

Many! Clearly the costs and the value of the delivery equation are being scrutinized more closely than ever before. There are many options in terms of how to manage departments. Do IT departments outsource or develop internally?

There’s the social challenge to what we’re doing. We are trying to automate the delivery of high quality care while assuring the financial health of provider organizations as a whole. That ends up meaning we’re changing the way physicians take care of patients, how physicians are related to their hospitals and health systems, and how physicians are reimbursed. The same thing is certainly true for the healthcare provider organizations, how they compete within markets, and how that’s related to the payer-insurers.

With the new administration, we’re seeing more speculation as well as consideration of new models. Everyone is interested in health information technology. We see hospitals closing because the economics of the care delivery process are often fundamentally unsustainable. Our ERs are overcrowded.

Those are the kinds of things we need to discuss openly so we can collectively build the kind of healthcare system we want. In my blog, I’ve elaborated on the publicly available objective data concerning each of these topics. The feedback has been encouraging.

How do you see the correlation between closed loop clinical quality and financial health?

As a framing comment, about 10 years ago, people started to realize that you couldn’t really have a standalone pharmacy system any more. The interoperation with nursing and physicians required deep integration.

We’re now seeing the same thing with most other aspects of health information systems as well. For example, when a lab system determines that a patient has a new panic level for a low potassium level, the response needs to be coordinated, collaborative, and contextually appropriate. You risk creating patient safety problems unless you create a closed loop system that can reason over different rules and evaluate the true situation, and then package a single, coherent alert to the correct person. This is probably more than just a nice idea; it’s a necessity.

We need to close the loop on communication and messaging. Closing the loop with RIS and PACS is another example, where, for example IHE identified the problem and an explicit solution.

In QuadraMed’s case specifically, we have been delivering closed looped solutions for several years. Closed loop clinical documentation is an area we’re very excited about. The idea here is that when a clinician sees a patient, the clinician needs to record findings in the most practical, efficient way possible. That may be dictation or direct entry to a PC, an iPhone, or a BlackBerry. Each device must be able to capture the documentation and preserve patient flow and throughput.

The most effective way to get documentation in some office settings is dictation. To do that and close the loop in the process, you must do it real time, which requires voice recognition and natural language processing to convert words into codes.

The closed loop process ensures that whatever happens on the care side creates the proper documentation, informs an appropriate order set based on the appropriate evidence based medicine, and provides the correct data the coding and revenue cycle people need in order to assure appropriate reimbursement. Closing the loop on that process is something that QuadraMed is extremely well positioned to address. We have industry-leading solutions in place for different users: the care users, the HIM users, and the revenue cycle users.

What have you learned about HIT from writing your blog?

As you might expect, I’ve learned the most from topics that are personal, such as the issue of self-management. Maintaining attention and focus are increasingly hard to do for all of us in modern life.

I’ve been told by dozens of readers that the vast majority of talented, busy HCIT professionals have something that many call attention deficit traits, similar to ADHD. They are having more and more trouble focusing, staying focused, and dealing with fragmentation in their lives. This is one of the main reasons why a surprising number of highly talented executives in all industries underperform.

I’ve learned that hitting the brakes requires discipline — the discipline to not check your e-mail for an hour or two, to get enough rest, to get exercise. Without a personal system, you can effectively end up with ADHD.

The blog has also given me a new perspective concerning legal challenges and provided me with valuable feedback on my evidence-based medicine and clinical decision support posts.

Anything else?

The concept of the high reliability organization (HRO) is something I feel very strongly about. Other industries that have had highly error-prone, tightly coupled processes have made themselves very safe and we can, too. The way others have done it is by focusing on anticipating failures in order to prevent them and by investing in the containment of those errors they can’t prevent. The opportunity to translate that into better HIS systems is phenomenal.

HRO thinking in HCIT translates into doing a better job of getting flow sheets as check lists. The challenges? Build work can be labor intensive, development is always iterative, and these “reports” can create an unacceptable impact on performance in many existing HIS systems. A lot of companies are creating wrap-around products in order to create higher reliability organizations because existing IT infrastructure can’t support them. It’s a messy and unsustainable approach.

One of the things really interesting about QuadraMed is that we’re based on Caché, which is a very high performance database engine. The Caché system is better suited to the kinds of information manipulations that are required in healthcare. This gives the CIO and CMIO folks an opportunity to move toward creating a highly reliable organization that includes anticipation and containment underpinnings.

High reliability needs to be part of the strategy when rolling out new systems. If you wait until after the initial go-live, you’re less likely to invest in the knowledge management required to get it done. “Get ‘er done” can be more costly than “Get ‘er done right” the first time.

Today, most of us don’t have a high level of confidence that HCIT will make “the right thing to do” the easiest thing to do. You only get there by making systems, and thereby the organizations that use them, highly reliable. And of course, those systems, to the greatest degree possible, need to know what the right course of action is for common, well described care needs. We’ve got a long way to go!

A final word?

Urgency. Something worth mentioning is the need for executives to bring a sense of appropriate urgency to their organizations. When you consider the emerging genomics data as it relates to common diseases like breast and prostate cancer or dosing common drugs like Coumadin, there’s a rapidly rising demand for stronger HCIT.

That genomic information is absolutely fundamental to getting to the right treatment. Today, there aren’t any enterprise-class clinical systems that handle such information well. We need to drive HCIT so we can facilitate care, deliver correct information, and do it better, faster and cheaper. Terabytes of genomic data per patient are just around the corner.

Fast Facts

Product
Care-Based Revenue Cycle Solutions

Company
QuadraMed
12110 Sunset Hills Road
Suite 600
Reston, VA 20190
800.393.0278
www.quadramed.com

The Bottom Line

*   QuadraMed CPR has high physician utilization, robust clinical decision support tools, and integrated Six Rights medication management, all at a highly competitive price.

*   The Care-Based Revenue Cycle optimizes the healthcare process by linking clinical and documentation elements with the revenue cycle: patient identification, access, care management, health information management, and revenue management.

*   QuadraMed is an industry-leading healthcare IT vendor with 2,000 clients in several countries, well positioned to assist its clients demonstrate “meaningful use” of electronic health records systems that meets the requirements of the American Recovery and Reinvestment Act of 2009.

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Tell me about the Paragon product and who is using it.

Around the time McKesson acquired HBOC in 1999, it became clear that an integrated hospital information system (HIS) built with industry-standard Microsoft technology could change the industry. So, the Paragon vision developed.

We focused on delivering an affordable, contemporary, single database, Microsoft-based hospital information system to meet the clinical and financial needs of community hospitals. The market demanded a comprehensive solution, but it also had to be an easy-to-use and intuitive solution that takes advantage of the Microsoft Windows interface. The Paragon HIS also serves as a foundation for a complete community hospital solution, surrounded by other McKesson and non-McKesson solutions.

This is the core of our vision and we remain true to it, even as we add new functionality and applications that meet the expanding needs of our customers.

We really don’t have a typical hospital. Paragon’s primary market is standalone hospitals, which understand that integration and an industry-standard Microsoft platform are key to their growth strategy. Most of our customers are community hospitals that are not part of a major delivery network or enterprise, though we do have multi-entities with more than one facility.

Those that understand the vision and benefits ultimately chose Paragon. The solution works well for the critical access hospital with 25 beds all the way up to a 500+ bed hospital, such as the one we recently signed in Puerto Rico, the largest hospital in the Caribbean. More than a quarter of our hospitals are over $100 million in operating expense and we have a few that are over $200 million.

We’re in a market where low cost of ownership is very important. Paragon has a far lower cost of ownership than the traditional big systems in the industry. Our integration and technology provides other advantages against mid-range vendors and best-of -breed solutions.

What clinical functionality do community hospitals typically want?

Most community hospitals are now looking to provide automation for all of their clinicians, whether physicians, nurses, or other caregivers, such as therapists. The main drivers are improved quality of care, patient safety, and reduced costs. As a result, we believe that integration is central to meeting these goals.

McKesson systems touch virtually every department in the hospital. Paragon offers a full clinical suite of products, totally integrated with our Paragon financial and ERP product set. Community hospitals typically want to integrate all of those functions and are ultimately driving toward an integrated, single electronic medical record.

What type of technologies do they seek?

The key is an integrated solution. They don’t want to deal with deal with multiple interfaces supported by a host of different vendors. They don’t want to deal with multiple and diverse technologies. It’s not a specific technology, but more about technology being delivered in an integrated, coherent, and non-complex environment. The more successful vendors offer truly integrated solutions.

In terms of our customers, the buyers want contemporary technology and all the things that Microsoft can deliver: database auditing, high availability, scalability, and open access. For example, we publish our entire data model as part of our documentation. Every column and every table is described and illustrated to the customer. This allows customers to use standard reporting tools to pull data and create reports.

The technology must also deliver a contemporary relational data model that is optimized for long-term data retention. We created an architecture that enables us to store data indefinitely. In fact, no Paragon customer has ever purged any data out of their live and active database. With Paragon’s technology, you can run the whole solution on as few six servers. It’s just simpler and easier than most of our competitors.

The third area is Web access to data, either for the traditional physician, caregiver or via a consumer portal, which we’re seeing more and more. Long term, we expect to see our customers providing more access to patient data in terms of a personal health record.

Describe a typical Paragon implementation and the kind of services your customers want and need.

This is an area where we believe we separate ourselves from most of our competitors. One hundred percent of our implementations are done with McKesson implementation consultants on site at the hospital. Some of our competitors offer classes where hospital staff has to fly to them, attend general classes, and then they are pretty much on their own.

We go in and evaluate the current processes and workflow. Jointly with our customers, we set objectives we expect to meet post-implementation, mutually develop the implementation schedule, and track it until completion. We’ll even supply complete project management for the customer if they can’t provide it. Our implementation team has an average of 18 years’ experience.

Another unique offering is detailed conversions of accounts receivable and any other application system that can be electronically converted.

What in-house IT resources do Paragon installations require?

It’s minimal. Because we’re Microsoft-based, we recommend the customer have a Microsoft-certified database management person.

Staffing is relative to the size of the facility, but in very small facilities, you can have as few as three or four people on the IT staff. In large facilities, you seldom see more than 20.

One of the things we stress in implementing Paragon – or any other automated system in the hospital, for that matter – is that the project is not just an IT function. The department heads have to take ownership of the system. If they abdicate that responsibility and let IT manage and perform all the implementation, those departments will not run as effectively and typically will not optimize the value. We strongly recommend that our customers provide full-time project management during the implementation.

A few years ago, Paragon seemed to be on the decline, only to come back as a number one rated product. How did the company move past those early bumps in the road?

We made a renewed commitment to the development and future of the Paragon solution. McKesson stood up and did the right thing. We met with every customer to understand their pain points and their situation. We listened and gave them options, right down to a refund if they preferred to walk away or move to another vendor. We not only said we would treat them fairly financially, but we would help support their transition to a new vendor.

Once we moved past that with every customer, we committed to a set of deliverables with very specific due dates. We made our target for every one of those deliverables, helping build confidence with our customers. I believe this created a solid foundation for a happy customer base. Some of the happiest customers I’ve been associated with throughout my career are customers who were once very dissatisfied and then turned around by quality services and responsiveness. It’s an interesting phenomenon.

Paragon has been top rated in KLAS for the last three years. To what do you attribute that high client satisfaction rating?

I think it’s two things. First, we have defined a vision for Paragon. Customers who ultimately decide to purchase Paragon buy into that vision. As long as we deliver that vision, we have extremely happy customers.

We also have a phenomenal track record of product delivery. The HIS industry historically has a mixed track record for quality products and timely delivery. Prospects call our existing customer references and ask, “Tell me about Paragon and McKesson. What do you like most about them?” Almost always, our customers say, “They tell us what they are going to do, they do what they tell us, and they do it on time.” That is a real anomaly in this industry. We’re open and transparent, sometimes more than what customers expect. They find it refreshing.

How do you think that federal stimulus plan will impact small hospital IT?

We believe the economic stimulus plan is going to have a positive effect on hospitals’ purchasing of IT solutions for EHRs and further automating clinical areas in general. We’ve seen some Stark law exceptions in recent years that have accelerated that process. The stimulus plan has the potential to increase IT deployment and adoption even further. I think it will also get hospitals’ board of directors more energized to get off the bench and support IT purchases. We see no downside for vendors that are well positioned and who can respond to the legislation.

McKesson offers multiple hospital applications. How do you determine which of your products is the best fit for a particular hospital?

One of the interesting things about being a part of McKesson is that we don’t just sell Paragon — we sell a McKesson community solution. This means that Paragon is the foundation and we surround it with other McKesson assets. Increasingly, hospitals are looking for solutions that include PACS, HIM and document management, physician solutions, automation, and ambulatory for owned and affiliated physician offices.

As a healthcare company, McKesson strives to focus on partnering with hospitals long term. In the technology division, we have the advantage of having the Horizon suite of products, the Paragon suite, and the rest of McKesson’s assets. The driver for which set of McKesson products we offer is what’s best for the customer. We look at their overall requirements, whether they have a best-of-breed strategy or a fully integrated HIS strategy. No other competitor in our market has the full array of offerings and suite of products that we do. That’s very attractive to our customers.

What are the good and the bad parts of being a small division of a large entity like McKesson?

There’s no real bad. There’s a level of bureaucracy and administrative work that you have in a large corporation that is required, but that’s not necessarily a negative — it’s just a reality.

I don’t think there’s a ‘bad’ because in our company, the business unit leaders have a lot of autonomy. The corporation seldom mandates or dictates our strategy or our vision as long as it is aligned with our overall corporate strategy and goals.

McKesson is a very ethical and moral company, with a long history of success — 175 years. The traditional things that people might complain about in big companies don’t really exist here and the benefits are many. For example, we have tremendous financial resources. McKesson is the 18th or 19th largest company in America. Over $100 billion in revenues, strong cash position, strong balance sheet. We have incredible assets. And it’s a true healthcare company, as our only business is healthcare.

Unlike traditional IT vendors, we have all kinds of assets. We have large payor relationships, not just provider relationships. We’re actively engaged in the commercial side of the business. We have full suites of pharmacy-related products and services. We deliver total solutions. Our RelayHealth division is doing things that are transformational because of the breadth and scope and size of our company. These are all benefits.

We can also rely on the wide range of McKesson’s expertise. McKesson has built virtually every form of IT product once, twice, three or four times over its history. As a small business unit, we have access to all of that expertise and all of those people.

We also have a huge sales channel. In addition to the traditional hospital channel, we have sales forces for imaging, automation, and physician practices. All of them are educated and cross-trained on Paragon. We’d never be able to afford that kind of support if we were a small company.

Being part of this major corporation gives us the ability to leverage McKesson products and its intellectual capital. We have people who can give us good advice on product development. So when we go to market with a product, our initial release is equivalent to a second or third release from our competitors because we are able to leverage the lessons learned within the larger McKesson organization.

Is there anything additional you’d like to add?

One of the things that make us unique in this industry is that the vast majority of the hospital information systems that are operational today are running technology that’s 20-plus years old. Paragon is the only system I’m aware of that is a fully integrated hospital information system using truly contemporary technology at its core that covers the breadth and needs of a community hospital and the associated ambulatory setting.

It runs on what I consider the world’s best and most contemporary technology – it’s a pure Microsoft-based product. We haven’t modified or changed one thing that Microsoft offers. We use it purely as it was built off the shelf. It provides us with a tremendous competitive advantage over virtually every older product out there that’s later in its life cycle. It’s one of the big reasons why Paragon has been Best in KLAS for the past three years and one of the big reasons why we have a tremendously high win rate against our major competitors. It really is different. It really is contemporary.

Fast Facts

Product
McKesson Paragon Community HIS

Company
McKesson Technology Solutions
5995 Windward Parkway
Alpharetta, GA 30005
www.mckesson.com/paragon

Notable Customers
Texoma HealthCare System, Ridgeview Medical Center, New London Hospital Association.

The Bottom Line
* Paragon is the top-rated solution for community hospitals, which make up the great majority of the hospitals in the United States.
*  McKesson offers a single vendor, affordable electronic medical records system by combining the award-winning Paragon integrated suite of applications with McKesson’s document and diagnostic imaging systems.
*  McKesson solutions offer a single vendor to manage the all-important revenue cycle and financial management processes, giving its customers a single contact that avoids the headache of coordinating multi-vendor solutions that fall short in functionality and integration.

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Providing clinicians with advanced clinical decision support at the point of care has emerged as a priority for healthcare organizations. What is driving this and how is Wolters Kluwer Health Clinical Solutions meeting the decision support needs of its clients?

Clinical decision support improves quality of care and patient safety. Hospitals and EMR vendors both recognize that providing clinicians with current, accurate clinical information at the point of care reduces errors and adverse events and improves outcomes. That, in turn, translates into a cost savings of millions of dollars per year for hospitals.

Equally important is the fact that many hospitals now have the technology infrastructure in place to support point-of-care delivery of clinical decision support tools, such as computerized alerts and reminders, clinical guidelines, order sets, diagnostic support, and advanced clinical workflow tools.

To address our clients’ needs, Wolters Kluwer Health Clinical Solutions leverages its 200-plus years of medical publishing experience, unmatched breadth and quality of content from more than 4,000 publications, and clinical and technological expertise to deliver end-to-end software solutions and content encompassing the full continuum of care.

For example, UpToDate is our evidence-based, peer-reviewed information resource covering more than 7,700 topics and addressing questions that arise in clinical practice across medical specialties. In addition to comprehensive presentation of the evidence, each topic offers practical, detailed recommendations that clinicians can use at the point of care. A study conducted with Solucient — now a subsidiary of Thomson Healthcare and a well-recognized leader in measuring hospital performance — showed that hospitals with access to UpToDate performed significantly better on risk-adjusted measures of patient safety and complications, and had significantly shorter length of stay than hospitals without access. These benefits correlated with how often UpToDate was used at each hospital.

ProVation Order Sets, powered by UpToDate Decision Support, is our actionable, evidenced-based order set authoring and management solution that allows hospitals to put evidence-based healthcare into practice by establishing and maintaining standards of care. It provides clinicians with actionable direction, and also contains editable orders, narratives and live links to supporting evidence-based guidelines for rapid, contextual reference. In addition, it allows hospitals to define a review process for individual order sets, create reusable order set templates, and archive comments, changes and activities throughout the life of an order set.

Medi-Span is our electronic clinical drug information solution that supports CPOE, e-prescribing, and pharmacy dispensing functions. It provides clinical drug information that is embedded within the workflow to support and automate many essential clinical decision support functions, including interaction screening, allergy checking, dose screening, etc. Content is managed in tandem with our Facts & Comparisons drug information reference.

Another aspect of clinical decision support that we are hearing more about is standardized order sets that link to evidence-based medicine. How do hospitals benefit from order set tools?

Standardized order sets have been around a long time, in part to simply avoid the need for physicians to write them over and over. Doctors write numerous orders when they admit someone. For the last 20 or 30 years, physicians have found it more convenient to write an order set once, copy it, and then just check off the required items.

Today, order sets have become fundamental in shaping patient care. They improve clinical performance and regulatory compliance by establishing standards of care and advancing the practice of evidence-based medicine.

In the last five to 10 years, hospitals have been trying to build order sets and make sure they are consistent across caregivers. That’s where the problem comes in. You may have up to 1,000 physicians at a facility who need to agree on the best order set. They also want to see the literature and evidence supporting particular orders.

This is where ProVation Order Sets, powered by UpToDate Decision Support, comes into play. It overcomes these challenges and delivers process improvements, enhanced regulatory compliance, and improved patient safety more rapidly than paper-based order sets.

How would a hospital implement ProVation Order Sets and what are the benefits?

ProVation Order Sets, powered by UpToDate Decision Support, greatly streamlines the authoring, review, and maintenance process so physicians can reach consensus more efficiently. We give them a starter order set with evidence-based content. With one click, they can jump to the original evidence to see why we have structured the order set in a particular way. They can assign ownership to an order set and develop the process they want to use to build consensus.

Our application automatically sends e-mails to the reviewers. They can quickly review the order set via a web browser, add comments, and let the owners know when they are done. All the comments are tracked and can be audited. Our order sets content is very granular, so when they edit an order within our application, it is automatically mapped to our order catalog.

Once everyone involved in a facility’s order set process is done editing, they can simply release that order set and pull it directly into their CPOE system. It also gives the organization a way to audit and maintain order sets. They can see what was changed, when it was changed, even what the order set looked like two years ago. They have all of these tools they never had before that streamline workflow, take out costs, improve quality of care, and improve their financial situation.

In all the discussion about the benefits of EMRs, is clinical content getting the proper amount of attention?

EMRs have evolved in stages, along with hospitals. Everyone started with the main systems and put a lot of time and effort into getting them right. Now they are evolving, and other things are becoming more important, including clinical documentation and content.

Vendors are trying to understand how they can best provide content to the physicians using their systems. Some try to build it themselves. Some ask customers to build it and then share it with other customers. Many are finding that clinical documentation content is very difficult to maintain.

One of the reasons we’ve focused on creating content for EMRs is so that vendors don’t have to worry about that part. We provide the quality content for physicians to document their cases. It is much more effective for the EMR vendor to leverage medical content and decision support created by the experts than for each to try to create their own.

How can your products add value to common existing systems from Cerner, Eclipsys, Epic, and other vendors?

Most of our products integrate with or provide content for EMRs and they add a great deal of value to vendor offerings.

ProVation Order Sets, powered by UpToDate Decision Support, is particularly beneficial for organizations using CPOE and can be used one of two ways. For vendors working with hospitals that use both EMR and CPOE systems, ProVation Order Sets can automatically import a new order set directly into the CPOE system. There is no need to recreate and rebuild that order set. We also have created mappings between our order catalog and the vendor’s catalog, and have tools to allow efficient mapping of our order catalog to the hospital’s order catalog.

Other Wolters Kluwer Health products, such as Medi-Span, are deeply integrated into EMRs or pharmacy billing systems. Medi-Span provides a complete line of drug information databases and tools that power EMRs. It identifies what medication is selected for the patient, recommends appropriate dosing, and then considers the patient’s allergies, age, and medical conditions in conjunction with the selected drug to return alerts and warnings to the clinician based on all the information. Medi-Span can greatly improve patient safety, the quality of care, and outcomes. Facts & Comparisons is another drug information system with EMR compatibility.

ProVation MD, which replaces physician dictation and transcription for procedures, has interfaces with all of the major EMR vendors. Physicians use ProVation MD to quickly generate the procedure note and associated billing codes, which can then be immediately integrated into the patient’s record within the EMR.

UpToDate provides clinical decision support for clinicians at the point of care and can also be accessed directly from the EMR. An UpToDate search box is integrated into the EMR, which allows clinicians to access current and accurate clinical information quickly and easily. UpToDate has more than 340,000 users globally who rely on this content every day. The results of the study I mentioned earlier, where hospitals using UpToDate performed better on patient safety and complications, and had significantly shorter length of stay, potentially translate into better health outcomes and millions of dollars saved per year for an average hospital. This is a huge value for EMR vendors to provide their hospital clients.

Finally, we have an entire Custom Content solution specifically designed for EMRs. We work directly with EMR vendors to build and supply the evidence-based clinical and physician structured documentation content they need and we constantly review it to keep it current. The content is exported to the vendor and resides in their own native functionality.

What that means is that when I sit down in front of a particular EMR, I’m using that vendor’s user interface and functionality, but the content is from Wolters Kluwer Health. The EMR vendor can just pull our content into their application.

Who is the hospital decision-maker for Wolters Kluwer Health Clinical Solutions products and what are they looking for?

Because our products are designed to advance clinical decision support and clinical documentation at the point of care, as well as to improve coding compliance for increased revenues, there are actually a variety of decision makers. But it always starts with someone who has seen our products and immediately understands the value.

We typically start with a physician champion who is willing to answer the clinical questions and say, “This is something we would use and it would improve our patient care and our workflow.” Beyond that, the CIO is involved because they are responsible for understanding the software and technology platforms.

The CFO is interested because our software increases revenue, streamlines workflow, and provides a really strong return on investment. The CMO or CMIO is interested in how the software helps track and document quality measures; how it improves physician documentation and patient care; and how it can help with Joint Commission reporting.

The coding staff is interested in how our software works and how it will affect their workflow. Then, of course, there is the CEO, who coordinates all these things. We talk to all these people and they are all involved in the final decision making process.

Physician usage at the point-of-care implies strong product usability and design. How do you approach that?

One of the things we pride ourselves on is the development of user interfaces that physicians not only use, but really like to use. ProVation MD has a user interface that can provide complete documentation in two minutes. We use that same interface design within our order sets solution, and apply the same technological excellence across all product lines.

All of the end-users of our products are involved in the initial design and development. Pharmacists have driven the design and use of Facts & Comparisons and Medi-Span. Physicians, nurses, coders, and pharmacists have all been involved in the design of the ProVation and UpToDate products. Clinicians know what clinicians need and what their workflow and technological preferences are. Their investment and involvement in the design process is the key to our high satisfaction and utilization rates.

ProVation MD takes a different approach toward clinical procedure documentation than dictation and transcription. How does it work and what are the benefits?

Clinicians use ProVation MD to document their procedures in a wide variety of specialties. The old way clinicians would do things was to dictate, save their work, and then send a file to be transcribed. If the transcriptionist didn’t understand everything the first time, there would be some back and forth.

The note would eventually get to the chart and then be reviewed by a coder. The coder would translate the doctor’s words into a code for billing.

What we do is build deep, embedded medical content so that a physician simply has to make selections on how they accomplished that procedure. It’s very patient-specific. It’s not using a template. All of that content is tied to the proper CPT and ICD code, so if you accurately say what you did, you can be guaranteed that the correct code will be brought up. You can also be sure that the documentation supports that code.

It usually takes under two minutes for a physician to complete their notes in ProVation software. The note can also be e-signed and automatically sent to the billing system for coders to review immediately. The other benefit is that you are automatically creating other documentation while doing the notes. You create the letter to the referring physician, copy other caregivers, and provide patient education for that procedure.

Are economic conditions encouraging hospitals to take a closer look at procedure coding, documentation, and physician efficiency?

The economic climate is making everyone look at everything. Hospitals are looking at ways to enhance revenue, streamline workflow, and become more efficient. ProVation fits in with that in several ways. We consider our ROI to be more than just improving efficiency and workflow. We actually show specific revenue increases.

ProVation can help increase patient throughput, particularly if used in combination with our MultiCaregiver product, which is for peri-procedure nursing and ancillary staff documentation. You can see more patients with the same staff levels because you are not entering the same information into multiple places. ProVation helps increase patient throughput, streamline workflow, and do the same or more with less staff. And, it directly improves revenue.

Is the company well positioned to support its customers on pay-for-performance and PQRI initiatives with the Q1 data reporting system?

Our content is granular and embedded. It allows physicians to click on menu items and rapidly complete documentation. But it’s deeper than that, in that every one of those menu items is tied to a controlled medical vocabulary and a reportable database. When physicians are documenting, it’s not just free text, but granular data elements that can provide all sorts of reports. They can use the data for studies, and it lends itself well to looking at a variety of quality measures, including P4P.

Your Clinical Solutions team includes a sizeable number of clinicians. What influence do they have on product development, implementation and support?

Within Clinical Solutions, we have about 180 on-staff clinicians including pharmacists, physicians, nurses, nurse practitioners, medical informaticists and PAs. In addition, we have another 100 or more medical content specialists with medical backgrounds and technical expertise. UpToDate also works with a community of 4,000 physician authors who are not employees, but are experts in various clinical areas.

Across all our products, clinicians play a very significant role, including a primary role in product design and clinician workflow. Both our on-staff clinicians and clinician customers provide input on how the physician is going to use a product and how it can improve the life of the clinician.

One of our tag lines is, “Built by Clinicians, for Clinicians.” We believe strongly in having people involved who understand what the needs are, how to get it right, and how to improve both the workflow and the value to customers.

In terms of support, we have award-winning customer support teams. We have a great team of implementation specialists and 24/7 phone coverage of any issues. When there is an issue that relates specifically to the medical content, the evidence behind it or workflow for physicians, the clinical team is very involved to understand the customers’ needs and to continue making our products better.

Anything else you would like to add?

We have more than 500 different interfaces up and running. We do a lot of integration with EMR vendors and we also integrate across our products. Right now, we’re working to integrate UpToDate within the other Clinical Solution product lines. We also have products that are integrated across our Wolters Kluwer Health medical research platform. We have integrated Facts & Comparisons and Medi-Span into many of our products. We integrate the type of knowledge they provide into our order set application.

Because we have these state-of-the-art products that span across the point-of-care spectrum, we are able to bring value from each of them into other parts of our products. We’ve been able to integrate the best of them across the entire care delivery continuum.

Fast Facts

Products
ProVation® Order Sets, powered by UpToDate® Decision Support, Medi-Span, Facts & Comparisons, ProVation MD.

Company
Wolters Kluwer Health
Clinical Solutions
800 Washington Avenue North, Ste. 400
Minneapolis, MN 55401
www.pointofcareapplications.com

Notable Customers
Allscripts, Baylor University Medical Center, California Pacific Medical Center (CPMC), Duke University, Exempla Inc., Fox Chase Cancer Center, Massachusetts General Hospital, Orlando Health, St. Dominic-Jackson Memorial Hospital.

The Bottom Line
*   Content and information products from Wolters Kluwer Health Clinical Solutions turn EMRs into a clinical decision-making tool for healthcare professionals.
*  "Built by Clinicians, for Clinicians" ensures that actionable information is evidence-based and provided by an authoritative, internationally trusted, and respected source.
*   The company’s products drive process improvements, regulatory compliance, and patient safety improvements.

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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?

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?

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

Product
CareAlign Suite

Company
Informatics Corporation of America
1801 West End Avenue, Suite 1000
Nashville, TN 37201
615.866.1500
www.icainformatics.com

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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Tell me about RRA and how you became involved with the company.

RRA was incorporated in 2005. The owners have worked in the healthcare IT consulting industry for the last 12 years. Both Laura Noble and I worked for Phamis, the Seattle company that developed electronic medical records products and provided services for provider organizations.

After leaving Phamis, we established a consulting organization whose primary mission was to deliver implementation, technical, and support services to clients. The primary skill set that we and our employees had was experience with Phamis LastWord, also known as the IDX CareCast product.

How are your consultants helping hospitals extend the life of the former IDX product, now GE Centricity?

Some of the product areas are dated, such as the patient accounting system, but that has been to our advantage. We have some of the last remaining individuals with that type of expertise. Our employees and consultants have, on average, 15 years of experience with the GE Centricity lines, including the LastWord, CareCast, and GE Centricity product. We can help our clients extend the life of the product and work with them to optimize the system so it’s working at its highest functionality.

Other product areas are still being developed further. Our many years of experience with the core products, which is patient access, clinician order entry, and documentation, along with patient accounting, allow us to talk with the clients interested in keeping their system in place rather than moving to a new vendor. We can help them get to a place where their system is functioning at the ultimate level.

I think that’s a key differentiator for the type of services we provide that other consulting companies do not. We have more than a hundred years of experience with the product. That gives us that extra opportunity to serve our clients.

Where do your new consultants come from?

We’ve had a positive reputation with regard to employee satisfaction since we’ve been in the business. Most of our consultants are folks that we worked with previously, who may have worked with us perhaps at Phamis, IDX, or at GE, or at a client site.

Most of our employees are people with whom we have had wonderful, long-term personal and professional relationships. That really helps build our expertise since they know us and we know their level of experience and their interest level in working on one project versus another. Additionally, our clients have known our consultants for a long time and often call and ask for a particular person by name to work on their projects. It really is a nice match.

We are a company that focuses on people who have not just a GE background, but other vendor experience as well. We are pleased with our talented consultants — people who have worked in the industry for a long time and across many vendor applications. The talent of our people is what allows us to provide clients the best consultants out there.

How do you think GE’s recent layoffs will affect your business?

It’s hard to predict what may happen as a result of GE’s potentially laying off folks. Ultimately, I don’t think it changes much for us. It could bring us additional business, but that’s not something we’ve focused on from a business planning perspective.

Our focus is really trying to get the client to see where their gaps are — where they are having issues and trying to help them bridge that gap. If GE ends up laying off a large number of folks, it will be a little bit further down the road before we can see what that would look like and how that would impact the clients directly. We may have an increased ability to help clients if the layoffs include GE implementation or development people.

What HIT vendors do you think are particularly hot right now?

Certainly Epic is hot, which is why we’ve developed an Epic service line to meet the industry’s direction. We’ve been working on that for quite some time.

We’re also finalizing some of the business details around our Picis business line service. We believe that those two service lines compliment the skills and experience of consultants we have and also address some of the hot products out there. We have a lot of GE clients who use Picis, so it feels like a natural fit having this complimentary service.

We chose Epic because it seems to be one of the fastest growing healthcare IT companies right now. We want to be involved in Epic because we believe that our experience and our people are going to be able to blend nicely with that product. Since we have such a long history with IT healthcare companies, we think that our company will be an eventual leader in that service line.

With the HIT or HIS vendors, clearly Epic is out there, but we’re seeing a lot of other product companies. We do not hear of a lot of clients choosing McKesson or Cerner any more, but we are hearing Allscripts come up every now and then.

Given economic conditions, are hospitals finding it more efficient to use consulting firms instead of hiring staff?  

We haven’t seen a lot of changes with regard to hospitals requiring consultants to fill staff augmentation roles or whether their preference is to hire full-time employees. I think sometime this quarter we’ll start to see what kind of hiring or staffing trends will be happening.

Our biggest area of impact right now is the client’s list of projects that were once slated for 2009 that seem to have been reduced dramatically. This can be anything from a hospital construction project to an IT project. That does seem to be impacting the clients that we’re working with directly, so they may have fewer dollars for their IT projects.

Certainly they are more closely watching their travel expenses, which may impact our ability to be on site versus working remotely. Clients are asking us to be a little more creative with our travel, or to do more remote work than usual, to allow them to utilize their consulting dollars efficiently. But I think that it will be a few more months before we actually see some trend that indicates whether they are going to start to utilize consultants to provide temporary assistance versus hiring longer term employees.

Now that the economic stimulus package has been approved, what kind of manpower do you anticipate hospitals will require for advancing IT projects and where will that manpower come from?

We are all anticipating that the current administration is going to make additional dollars available to hospitals for EMR projects. If they are engaging in those projects, they are certainly going to need additional resources in order to move forward and meet any funding deadlines. What additional resources are needed really depends on the organization and where they are in terms of IT staffing.

Some may have a strong, well-staffed, and experienced IT department with the flexibility to engage their current staff in these potential new projects. Others may require the assistance of firms like RRA.

If some of these organizations do get the government funding, that will allow us to hire more people in 2009 than we might have projected. It’s dependent on when funding actually gets back to the hospitals as working capital and how quickly they establish project timelines for everything they want to accomplish. We may not see anything from that until 2010, but we anticipate being able to hire additional staff to react to what our clients will need to meet those requirements.

We’ve read about the economic stimulus options as much as anybody else in healthcare. We’ve discussed the type of projects that hospitals need financial assistance for to meet the requirements of an electronic medical record. We believe one of the primary areas hospitals need to address is the additional training required for their physicians and nurses to become computer literate. That’s probably going to be a key area where consulting firms, and in particular RRA, are going to be helpful to the physicians and nurses of our clients.

What type of individual is attracted to a consulting career, both in general and more specifically with RRA?

I feel people are attracted to RRA because of our reputation in the industry, as far as being a leader as a consulting company for GE services, and hopefully for other service lines in the future.

People know we respect our employees and that, as a small company, we have a tremendous benefit package that is equal to or better than some of the larger organizations. Today more than ever, people really need to have good benefits. Sometimes smaller companies can’t offer that. We spend a great deal of time and money and effort establishing a great benefit package to entice the best resources available.

We also think that our organization is set up to allow folks to be independent and demonstrate their industry and product knowledge, expertise, and professionalism. We let folks do their work. I think people know that we’re a good company for allowing employees to grow. They like the fact that we’re a smaller company, with few mandatory obligations and little overhead.

We attract consultants who want to focus more of their time with an individual client and not on excessive internal paperwork, company meetings, and corporate structure. Some of these folks might have come from an implementation background, where they spent their time across five, six, or even 10 clients. Consulting gives them the opportunity to spend their time with just one client and really focus on their needs. I think that’s what attracting them into consulting.

I noticed that RRA encourages employees to volunteer with local charities. How does this tie into your overall company culture?

That is an important piece of who we are. Our benefits, our core values, include encouraging folks to give back to their communities. We have a charity match program to encourage employees to donate to their favorite charities.

It links back to our core values. RRA is not just a company that we work for. We ask, “How can we give back, it may be through volunteering or providing funds, or raising money for some of these organizations?” This is an important part of who RRA is. It also allows our employees time to do other important things besides just coming to work and doing their job.

Our company culture really does provide our consultants opportunities to give back to their own communities while having a little time off and a lot of fun and personal satisfaction.

What is RRA’s growth strategy?

Over the last two years, we have maintained a strategy of trying to grow at a reasonable rate. We’re taking the perspective that we want our business to grow, certainly, but probably a little bit slower than some other companies.

We take the time to make sure that our employees are vetted appropriately so that our retention rate is high. Also, we want to work with our clients to make sure we are providing the best resources for their specific projects. Sometimes it takes a little bit longer to find those people and to find those right projects. So right now, our strategy is to grow between 20 and 25% per year over the next two to three years.

That may change if we see different economic drivers, whether it is what’s happening with the new administration’s stimulus plan for funding healthcare projects or, perhaps, changes in the priorities healthcare organizations have for their current IT projects. If things start to kick off differently in 2010, we may increase that growth rate, but right now, we’re going to stay where we’ve projected over the last three years.

What differentiates RRA from its competitors?

I think the thing that comes to mind first concerns our employees. Doing the right thing for and by our employees is number one in our mind.

The number of years we have in the industry is really unique with firms of our size. Also, while we have staff with tremendous GE experience, we also have people experienced in both GE and Picis or Epic and GE. We have people experienced with Allscripts and Eclipsys. We know that our folks have been invested in providing solutions for healthcare IT for a long time. It really gives us the ability to provide our clients the best consulting resource available.

I think some of the offerings that we have are unique, specifically in the GE Centricity area. We provide several technical services that our competition isn’t providing at this time; technical services, whether it’s system management or tailoring migration or just having a technical team with a solid understanding of the database and system architecture.

The complexities of the GE product really do require some technical expertise, whether it’s in the form of some additional programming or Tandem assistance. It’s complex to move the code. We really specialize in that area.

We also specialize in upgrade services and that’s one of the client focus areas with GE’s product. It’s complex, but we have been able to develop tools to assist our clients. We really think that our tools are premier and something that our competition just isn’t able to offer. That’s what we call filling in the gaps in the services RRA provides.

Fast Facts

Services
Lastword and CareCast application, technical and project management consulting; broad services for customers of Epic Systems, Picis, and Eclipsys; nursing informatics consulting.

Company
Renaissance Resource Associates
P.O. Box 64935
University Place, WA 98484
877.782.6357
www.rraconsulting.com

Notable Customers
Lehigh Valley Hospital and Health Network, Community Health Network, Park Nicollet Medical Center, Thomas Jefferson University Hospital, Montefiore Medical Center, Stanford Hospital and Clinics, Nebraska Medical Center.

The Bottom Line

*   RRA is a focused consulting organization using deeply experienced consultants to provide the best consulting resources available.
*   RRA screens new consultants for exceptional experience and capabilities, intentionally limiting company growth to avoid lowering recruiting standards.
*   The company has unique experience in preserving the value of GE Centricity Enterprise for customers and optimizing its use to achieve enterprise goals.

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Tell me about your background and what you do at RelayHealth.

I’ve been with McKesson for four years and I was fortunate to have been involved in the creation of RelayHealth a little over two years ago. I’ve directed several start-ups, almost all in healthcare IT, and I love that hard-charging, entrepreneurial, “get it done and climb the hill” culture of a start-up venture.

That’s interesting, considering you work for a large corporation.

That’s what makes RelayHealth unique. Unique in that the risk/reward tradeoff is a consideration when looking at doing a start-up within a company like McKesson versus an angel or VC-backed endeavor. The idea of incubating and sustaining an entrepreneurial culture in an organization that has achieved the scale of RelayHealth can be contagious.

McKesson embraced that. They isolated this team and our business and provided a framework of support that encourages us to drive innovation. When you’re a stand-alone start-up, you’re always looking for capital; but, here we’ve got a Fortune 18 company that supports us all the way. It’s very exciting.

RelayHealth has a broad set of offerings for a two-year-old company. How do you describe them in your elevator speech?

I’ll give you an analogy. I recently got the opportunity to sit in the middle of a live orchestra without any knowledge of what it really takes to make everything work together. I was amazed to learn how different members have distinct roles and came together to create a successful end result. The conductor plays a role, the lead chair plays a role, and the different sections play off each other to create the music. It is much more complex than I had ever imagined.

It occurred to me that in healthcare the roles aren’t always clearly defined … it’s difficult to see what others are doing in contributing to the care of the patient. That’s what we’re trying to effect — create a way for healthcare to collaborate because the individual players really can’t see what’s happening in the other parts of the process. The consumer and the physician can work together to orchestrate the process and fill the role of lead chair and the conductor.

We engage every healthcare constituent in the process — patient, provider, payer, pharmacist, financial institution, and others–to make it more efficient and more effective. We harmonize the care process by giving them access to the information they need but did not have available to them before. Our elevator pitch: RelayHealth enables a virtual exchange of patient information.

How has the economic downturn affected your business?

Our revenue model is based on Software-as-a-Service (SaaS) delivery and transactions or subscriptions, not licenses. That removes some of the barriers to actually bringing in technology for customers who are being squeezed on capital right now. You don’t have huge capital outlays upfront — you pay as you go. We’re not charging license fees, nor do we have long install cycles. Our install cycles are short and low cost. Our SaaS platform provides us with a very low support cost. Those economics really help in today’s financial climate.

Our transaction volumes fell off somewhat in October 2008 as people were getting laid off and losing insurance. But by the middle of the fourth calendar quarter, people started back scheduling doctor appointments, claim volumes rebounded, and prescription volume normalized. Moreover, we always see an uptick at the end of the calendar year as people look to spend any excess money in their FSAs.

We also think that as patients look for alternative ways to obtain medical care, they will take advantage of lower cost options such as RelayHealth’s webVisit® consultation service. A HIPAA-compliant, Web-based messaging platform is an easy and affordable way for patients to interact with their doctor to get the care they need for non-urgent conditions. Physicians need only a computer and the Internet to use the online service.

We also stress that online connectivity can promote a healthier patient population. Built-in preventive health e-reminders, for example, “It’s time to get a flu vaccine shot,” can be sent to patients with chronic care conditions and even alert the doctor’s office after a few days if the patient has neglected to open his or her message. It gives patients and their physician an easier way to work together to manage their care in between office visits.

Are you seeing more impact from consumer-driven healthcare plans and the rise in patient financial responsibility or self-pay accounts due to higher deductibles?

Absolutely. We’re seeing more emphasis on point-of-service and consumer self-service types of capabilities, especially in the physician’s office. Physicians are really getting pinched by a lot of these economic changes. They are the ones that typically have to eat the costs associated with collecting of higher deductibles and co-pays. Determining the correct source of funding for the patient’s care and collecting upfront is important. Doctors can’t afford the ongoing cost of collection efforts. Plus, the higher level of patient financial responsibility has made it imperative to develop a plan for getting paid when initial care is being delivered.

We recommend a three-prong process: Enact better screening prior to service to identify those patients who can pay, those who qualify for third party coverage or Medicaid, and those who truly need financial assistance.

What would you offer the typical two-physician office to make them more efficient?

We have great financial tools for identifying coverage that can drive more point-of-service collections. We also take costs out of the back end by moving many functions to the Internet. Consumers can pre-register and view their accounts online and make online payments. We also offer an e-prescribing platform that saves the physician, pharmacist and patient both time and money. We’ve got workflow tools to manage the entire claims process.

We have established clinical connectivity too, such as results distribution to the physician and the patient. We have messaging capabilities for helping patients with referrals, and automatic population of a personal patient health record that documents and archives all interactions. We also provide physicians with the ability to conduct webVisit online consultations, which helps doctors with throughput and drives reimbursement for non-urgent symptoms normally discussed over the phone for free or in person.

Physicians who have minimal technology may be at a crossroad where they either have to put a server in the back room to run an electronic medical record or use services like yours that require minimal upfront cost and maintenance but get them paid. Do you see physicians having to make that choice?

We advocate a modular approach. You don’t have to go all the way to an EMR immediately to realize significant value. Small physician practices are not going to go digital very easily. It’s a marathon, not a sprint, so you have to take it one step at a time.

Studies show that practices using EMRs today are not all getting the full value of their investment. We think there is a better way to gain adoption by leveraging Web technologies and lower cost SaaS platforms.

But the bottom line is keep it simple, deliver value, and integrate into their workflow. We’re seeing firsthand what it takes to help our customers manage the diversity of servicing Baby Boomers, Generation X, and Generation Y to Generation O and the Millennials.

The company describes itself as an “intelligent network.” Do you think physicians and hospitals will increasingly find their value to be driven by who they connect with and how?

Yes, I most certainly do. Although some of the RHIO and state HIE efforts are intending to solve the connectivity problem, they fall short of addressing the functionality and workflow requirements to support a community-level service. We’re also seeing hospitals aggressively executing initiatives to connect both employed and affiliated physicians into the acute setting. In our case, a complete healthcare community supporting the interconnectivity and workflow for physicians, pharmacies, patients and multiple care settings is the goal.

This community level hospital driven-connectivity initiative enables providers to extend their brand — not the RelayHealth brand. Consumers with strong ties to their providers easily recognize their group practice, hospital, or health system brand. What we provide is a unique set of B2B2C solutions that support and broaden that brand equity into the community.

The industry has been plagued by the fact that most connectivity is proprietary. We are an open network. We are driving standards for interoperability. Our goal is to build community networks and make it easy for other vendors to interconnect to all applications and users on the network. It’s a somewhat unique strategy. We’re growing local networks of collaboration among payers, hospitals, health systems, physicians, pharmacies, and even financial institutions, all of them working together to appropriately connect to each other as well as to patients.

Why should a physician’s office care about your being a neutral partner?

Let’s use the ATM analogy. Consumers can go to an ATM and complete a transaction with their bank, no matter what the location of the ATM. Thanks to the banking industry’s efforts years ago, electronic banking transactions became commonplace.

RelayHealth is not trying to be the end user application in most cases. Instead, we’re providing the connectivity and network services that deal with the interaction taking place between two entities. We interoperate with most of the EMR vendors.

Our value is not based on whose application is running in your environment. Rather, the question is, “Who can tie it in with the physicians, pharmacies or hospitals that you or your patients work with?” With our interactive services, you get more value, and most importantly, the patient gets more value.

How important is the role of insurance companies in that connectivity?

It’s very important. That was one of the first things that came out of the creation of RelayHealth. We focused early on deepening our payer connectivity. Most of the payers are no longer just insurance companies. They’re managing the health of their members and trying to support physicians and hospitals with administrative and clinical decision support services that reduce costs and improve outcomes/medical loss ratios.

With the connectivity we have to the physician, it’s natural for us to work with payers. Not just for care management, but to address the administrative costs they incur for simple things such as printing and mailing checks and EOBs to physicians. Hundreds of millions of dollars can be saved each year just by enabling simple transactions like EFTs and 835s.

Then you layer on top of that the information and other services that the payers give to their physician network to extend the value of what they are striving to accomplish. We’re seeing payers reaching out to hospitals and physicians to create a more collaborative working relationship. We provide the connectivity to more effectively enable that collaboration.

Insurance companies had an interest in becoming banks to be able to manage healthcare savings accounts. Are you seeing any impact from that?

No, not really. Everybody thought HSAs and high-deductible plans were going to catch on like wildfire similar to 401(k)s. So it made sense that the payers would position themselves to have custodial responsibility over those funds. They, too, however, are being challenged on many fronts.

As employers are applying pressure because of premium increases, insurance companies are getting more entwined in healthcare delivery. We’re working on some really interesting capabilities with some of them, leveraging their data and health expertise. I think you’ll see them continue their efforts to being more ingrained into the care process, with a big push toward disease management as well as wellness and preventative care.

Everybody thinks everybody else is making all the money in healthcare. Is administrative friction eating up all the potential?

To some degree, I think the answer is yes. The one thing we do know is that hospitals and physicians aren’t making as much money as the average consumer probably thinks they are. I worry that they’re already running on very thin margins and are likely to be squeezed even further.

The solution is not easy. It will take a truly collaborative effort to get costs under control and improve margins.

We have all heard GM and Chrysler express that healthcare costs are part of their problem. Eventually, the consumer is paying for this, whether through the cars they buy or the places they shop. Now that more costs are being shifted to the consumer, I believe they have the largest voice. If we can engage consumers in the process, which is really what we’re trying to do, I think we’ll take a big step in our country toward making improvements.

What do you expect from healthcare reform and what role do you think RelayHealth will play?

The Obama team, as we all know, has been very focused on healthcare reform and investments in healthcare IT. McKesson is a very active participant on the Healthcare Leadership Council and submitted recommendations to the transition team for HIT funding. Giving priority funding to connectivity services that have been proven to deliver immediate value is where RelayHealth can help make an impact.

What are your thoughts on privacy?

There is no question that every effort must be made to protect patient privacy. It is a key concern for us all and needs to remain in the spotlight. At the same time, we need to break through some of the issues and stigmas that may inhibit our ability to create a nationwide network to support electronic medical records.

RelayHealth won a consumer award for “best innovation stimulating consumer engagement” this past December. What capabilities were involved in winning that award and what’s the benefit to consumers?

The award recognized our ability to transform paper- and phone-based delivery of hospital lab, pathology, and radiology results as well as transcription reports into a secure and actionable electronic exchange between physicians and their patients. We’re taking data from the lab, radiology, pathology — anywhere there is a report — and presenting it to the physician, who reviews it with a couple of clicks and sends it to the patient electronically in a way they can understand. The exchange and archiving of vital patient data in their personal health record improves the quality and continuity of their care. It makes it much easier for collaboration about their care among the physician community.

RelayHealth acquired HTP in May 2008. Where are you with integration of the capabilities this brought?

We have been moving fast and furious. The demand for the capabilities that HTP provided has escalated even more than we expected because of the economy. The issue of verifying eligibility and identifying coverage is critical, so their advanced capabilities and payer connectivity were a great addition to our portfolio. Helping hospitals determine charity and Medicaid eligibility is also in huge demand. We’ve already integrated it into several McKesson and non-McKesson applications. The key thing is we’re also integrating it into the new B2B2C services, so it’s now proliferating into our entire service line.

Here’s a simple example. When a patient goes online to pre-register or to request a webVisit, the first thing we do is verify insurance coverage and process co-pays. That was a natural fit for what HTP had to offer. It has been a game-changing opportunity for physicians as well as hospitals and a platform that fits well in our portfolio.

Last summer, Microsoft issued a press release about working with RelayHealth to offer provider connectivity for HealthVault. How are you working with Microsoft?

We have pilot initiatives underway as well as a joint development project. You should see more at the upcoming HIMSS conference about our joint progress. This is an example of the kind of partnerships needed right now to make a significant impact. It takes a strong commitment by big companies to move markets.

Our strategy is to build a network of users, provide the infrastructure for collaboration, and then provide the applications that are unique to that data transfer process.

Is it like the Internet, where each new person on the network provides more value than they consume individually and you eventually have an infinite number of ways to capitalize on the footprint?

Exactly. That’s our approach. We’re not trying to keep the network as a proprietary network. We envision that we’ll be able to host other SaaS applications on this network. It will not be RelayHealth; it will not be McKesson. As we build the network, I think you’ll see that it will accelerate the capabilities that we have, many of which will not be ours.

What does the future hold for RelayHealth in the next five years?

I believe we’re in the right place at the right time. I mentioned earlier that I’ve done several start-ups. A lot of them were successful, but none were home runs in that they transformed markets. This is a home run.

We’ve got a great team. The market is right. The political climate is right. We have the backing of McKesson. So, the stars are aligned. As long as we don’t develop a huge ego, which we won’t while I’m involved, we’ll be very successful because our goal is to work with others, not to compete with everyone. “Co-opetition” is a good thing.

We’re creating a new market segment. The pace at which we’re innovating is the key driver, launching two or three services each quarter. Looking ahead four or five years, this will be a tremendous success story. RelayHealth will forever change the healthcare IT landscape.

Fast Facts

Product
Consumer, Provider and Pharmacy Connectivity Services

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

Notable Customers
Montefiore Medical Center, ColumbiaDoctors, Saint Luke’s Health System, Catholic Health Partners, Tenet Healthcare, Resurrection Healthcare, OhioHealth, Redlands Community Hospital , The Ohio State University Medical Center, John Muir Medical Center, Eisenhower Medical Center, Hill Physicians Medical Group, Bristol Park Medical Group, Northwestern Memorial Physicians Group, Atlanta ID Group, Medical Network One,  Greater Newport Physicians, Atlantic Health, Scottsdale Healthcare, INTEGRIS Health, the Utah Health Information Network, St. Elizabeth Medical Center, Memorial University Medical Center, Rosalind Franklin University Health System, New York University Medical Center, Virginia Mason Medical Center.

The Bottom Line

*  Software-as-a-Service offerings provide customers with quick and easy implementation, rapid ROI, minimal IT effort, and no capital outlay.

*  RelayHealth’s revenue cycle transaction tools help both hospitals and doctors collect the money owed to them. Its award-winning tools also provide patients with online connectivity to their doctors and transparency and payment assistance, both critical in the shift to consumer-driven healthcare.

*  RelayHealth is a neutral partner in an open network, improving care and information access, financial health, and interoperability across all organizations and information systems.

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Hospitals usually aren’t staffed for the surge of experts needed to bring a big project live. They also aren’t very good at winding down resources as projects are completed. That’s at odds with what it takes for CIO job security: amassing exceptional and experienced talent, assembling a push of resources to get projects over the hump so they can start generating the expected ROI, and transitioning knowledge to staff for ongoing maintenance and enhancement. The ideal consulting firm offers experienced consultants who are well cared for by their employer; good value to fit the budget of the average non-profit hospital trying to beef up internal IT resources, and executives who care about clients after the contract is signed. We spoke to Bruce Cerullo, CEO of Vitalize Consulting Solutions, Inc.

Give me a brief history of the company and how you became involved with it.

Vitalize Consulting Solutions, or VCS, was founded in 2002 by Mary Pat Fralick and Danny Arnold. Both Mary Pat and Danny are healthcare industry veterans. They are still with the company today in key leadership roles and partners in the firm.

They had a concept of a people-centered healthcare IT consulting firm. Their previous work experiences in healthcare IT were often impersonal. People had the technology aspects down well, but they didn’t have the people aspect down well. Hence our slogan, which is “Strengthen Your Team with Ours.” I’ve been in leadership for the last 20-something years and had never come across a company that actually lived by its mantra. Vitalize is a people- and team-centric organization.

We provide a variety of clinical and business IT solutions. Vitalize is arranged around product vendors, including the major players: Cerner, Epic, Eclipsys, Siemens, MEDITECH, McKesson, etc. We have nine practices, including a really well organized project management office. Mary Pat and Danny, who were joined by John Smaling in 2004, grew Vitalize from a start-up with one practice into the firm it is today.

I’ve had the pleasure of serving as the CEO and chairman of VCS for about a year. About a year and a half ago I had a little start-up a company called Lucida. I came from the world of healthcare staffing services, placing nurses, physicians, and allied health professionals. I had some success in that world and I decided to back some of my former employees in this start-up company. We decided we were going to provide IT staffing and consultant services.

I’d knock on the door of IT executives and this darned company called VCS had already been there and their clients were happy with their consultants and felt loved by them. So I thought, “Son of a gun. Who are these people?”

To make a long story short, I met Mary Pat, Danny and John, who were the principal owners of VCS at that time. We decided to bring my little company and their larger firm together under the VCS umbrella.

The critical business lesson learned is that if you do a good job with the people in healthcare services, clients are delighted, your team members are happy, and the bottom line grows. If you look at VCS’s profit and loss statements, we absolutely nail that concept by how we treat our people.

My observation of the healthcare information technology sector is that, great technology — and there’s a lot of it out there — is ultimately and completely dependent upon the touch of humans. Millions, and dare I say billions, of dollars have been wasted in IT system selection and implementation because the human part of that equation didn’t get adequate attention and resources.

VCS’s ideology is about how we treat our non–billable employees who support our consultants and about how our consultants introduce methodology, project management plans, project expertise, and training for our clients. It is all around the people first. It’s just the reality of who we are.

Vitalize was recently named one of the fastest growing privately held companies in the Philadelphia region and also to the Inc. 5000 in 2007 and 2008. What’s behind the growth?

It’s a thing that a guy in my chair loves: our growth has been largely a product of word-of-mouth or by customer referrals.

In this business, you need two things to make your business grow. You need clients who trust you enough to bring you on to strengthen their team and, you need experienced consultants who will ultimately deliver the Vitalize services to the client.

About 70-80% of our business comes from satisfied client referrals. I would dare say that north of 70% of our new consultants come to us via referral, as well from existing VCS consultants, or people who have heard about our results.

This may sound silly, but when a consultant joins us, they get a welcome basket. They get a call or e-mail from me. They get called from three or four people in our organization. They are recognized on their birthday and anniversary.

Once a year, we fly everybody in our firm to a nice location for three days of “work.” It’s usually a beach location or resort destination and it’s all about bonding and making our people realize that our words are not just words. The money we spend bringing our team together to network and get some education pays off in spades for our clients.

I think I want to work for you.

You’d be working with us, not for us. Honestly, that trip costs us hundreds of thousands of dollars a year, but to me, it’s a great employee benefit. As a leader, it’s the only time in the year that I get to look our employees in the eye and they get to look me in the eye and instill trust. We call it the “Extravaganza.”

Maybe I should come cover it on behalf of HIStalk. What’s the destination this year?

It’s right outside of Fort Lauderdale at the Hyatt Regency Bonaventure.

It’s a rough market and we expect to have a tough year in ’09 because of the general economy. With any other firm, a trip like this would be the first thing they would cut. But it’s the last thing we would cut.

Our glue is our people and the relationships we build. We have a couple of hundred consultants. All of them get up on a Monday morning — and some of them, God love them, on a Sunday night — and fly to a client location. They stay in a hotel for three or four nights and then they fly home. They never get to see each other. They leave from all over the country and then they go to homes all over the country. The Extravaganza is really important to all of us.

Vitalize provides consulting services for all the major HIT players. Are you seeing higher demand for any particular applications?

There are always ebbs and flows – who’s hot and who’s not. Right now, I would say Epic is very hot and Eclipsys is strong.

In terms of new implementation, MEDITECH has a huge market share and has flown under the radar for a long time because they tend to serve smaller hospitals, not the mega-chains, although they are at HCA. Cerner and McKesson continue to do optimization, integration and upgrade work.

This could be the year that Siemens Soarian finally gets traction. Until then, our Invision business is solid.

2008 was a strong year for Vitalize and the healthcare IT services industry in general. 2009 had every indication that it would be equally strong until the “little” upset in the last quarter of 2008. So, who knows?

You mentioned Epic. What’s involved in becoming certified? What kind of work are you doing for Epic customers?

We are a certified partner with Epic Systems Corporation. Our Epic consultants have a series of certifications that they must achieve in order to be allowed to work on an Epic system. It took us over a year, working with Epic, to become a certified partner. We had to have a certain number of consultants Epic-certified and working in Epic customers and approved by Epic.

Each time an Epic customer wants to use any third party, they have to submit their resume and get it approved by Epic. It’s very interesting and a unique dynamic from any other vendor I’m familiar with.

How are economic conditions affecting overall consulting demand? Do you see changes in hospitals wanting to hire contract employees versus hiring internally?

I think it’s going to have a double effect and you’ve hit on one of them.

First, there’s a general feeling of caution right now, but it’s not panic. There’s caution and an assessment of how clients are deploying their capital dollars in general, and how the dollars trickle down to IT.

The good news is that there are a lot of major projects in the first, second, and third years of rollout. The money has been budgeted, deployment is well underway, and the budgeted money will continue to be spent.

I think if there is a hit anywhere, it will be at the front end of the selection process, with hospitals that were ready to invest with a high level, expensive strategy firm. Those hospital executives will say, “You know what, let’s wait a year.”

I think the strategy projects will get deferred. The mission critical implementation system upgrade projects will continue to roll out.

I believe longer term, looking into 2010 and beyond, President Obama’s commitment to healthcare IT improvement could be a real boom for our industry, as well as lead us down a path of better, more available healthcare.

In terms of hiring internally versus contract employees, are you seeing any effects or anticipating any?

We are still hiring internal people. We are hiring consultants and we are deploying at a very healthy growth rate.

On the healthcare IT consulting continuum, VCS’s services are priced on the low end, typically $118-$145 hourly bill rates. We’re pretty lean and simple in terms of overhead and we invest our money in our consultants. Generally, we won’t be a target when a client is looking to cut high-priced consultants. We occupy that mid-tier, quality-value space.

Do you think hospitals and vendors are finding it more efficient to use consulting firms than hiring full-time staff?

Yes. The reality is that a lot of the work we do is capitalizable, and in the near term, a lot of the pressure is going to be on operating budgets. There will be some pressure on capital budgets, but there’s definitely more on operating budgets.

I believe that smart hospitals and organizations will use this inflection point to prune and trim high cost, fixed-term, full-time equivalent overheads. And they will leverage the smart use of consultants to fill in on those skill sets that they don’t have in-house.

Are the market conditions changing the types of people interested in permanent versus short term consulting work or working as an independent contractor?

We see a lot of top-notch independent contractors coming to us now, saying they would like the safety and security of a firm like ours. That’s wonderful news for us because we’re only as good as the quality of our consultants. Having really good people wanting to come under our umbrella is a win for them, a win for us, and a resulting win for our clients. I also think there will be a lot less job-hopping in general over the next 12 months. I believe we will see more stability among the consultant firms.

Vitalize participated in a PC donation program to a hospital in New Guinea. How does that tie in with the company’s culture?

I’m going to risk sounding like a Hallmark commercial, but that is an integral part of our culture. Our mission is about value to our clients, service to our consultants, and making a difference in the world. The ability to refurbish and send PCs to a global cause or to lend a hand to the opportunities in each consultant’s back yard are part of VCS.

We are a CHIME foundation member, which gives us direct access to CIOs, but also the opportunity to sponsor events. Many foundation members sponsor dinners and break foods, drinks, and giveaways. We chose to sponsor a trip to a local food bank. Anyone who was at CHIME could join us bagging groceries for homeless children and their families.

We had a cool, diverse group of people join us in Vegas last fall. They too want to make a difference. In every major city where events like CHIME are held, we like to leave behind more than just a large carbon footprint. For us, it was a chance to prove we’re in this to make a difference.

What would you say to those considering a career in consulting? Would you recommend working with a company like Vitalize?

Here’s my view on the strengths of the consulting career choice. You can build an incredible resume quickly working as a consultant. If you are in a single-hospital environment, you may get pigeonholed or typecast. You may be really good at something and, of course, the hospital will want you to keep doing it forever because you are really good at it. So at some point, the win-win goes away.

Our best consultants are those that have climbed the ladder and have learned everything they can in their current environment. Often, for very good reasons, they aren’t allowed to learn other aspects of HIT, yet they want to build their career.

In two years, a consulting lifestyle can involve working in some of the best healthcare institutions in America. You can work on some really interesting and diverse projects and you can generally make a lot more money consulting than you would in a hospital environment. In part, that offsets the downside of being away from your family three nights a week. Of course, I would recommend working for VCS — what a question!

How does Vitalize differentiate itself in the hospital marketplace?

I would say it is a combination of quality and value. The consultant game is often about billing as much as you can and paying people as little as possible. We don’t operate that way.

Our bill rate, compared to the major consulting firms, is significantly lower on an hourly basis. Our cash compensation to our consultants is somewhat higher. So by definition, our operating margins are going to be lower and that’s OK with us.

We also have what we call an AQA program, which stands for Assignment Quality Assessment. Each of our clients assesses our quality. On a five-point scale, we are consistently ranked in the 4.5 to 4.7 range, meaning our clients rate us very highly.

So when you’re asking for a differentiator, we lead with our track record, we lead with our quality scores, and follow through with the resumes of all of the consultants who would actually be working on the project that has been offered to us or potentially offered to us. Some firms lead with the suits and their smiley faces and a sample of resumes of really great people who will never actually engage in that project. We’re in that middle tier of companies who are big enough to do stuff with credibility, but small enough that we don’t have the enormous overhead of the big expensive firms. We intend to dominate the middle market.

Where do you see the company in five years?

We will continue to be what we are today, which is a people-focused enterprise. We will continue to strengthen our client teams with our team. We will likely be somewhat larger and even more diversified than we are today.

This is an important point here. We aren’t in this for growth alone. We’re in this for quality. We know that with quality consultants, growth will follow. We have no aspirations to go public. We want to continue to be what Danny and Mary Pat envisioned when they launched Vitalize, which is an innovative, fun, diversified, quality information technology consulting and staff augmentation firm.

Will you be at the HIMSS conference?

I’m glad you asked because we will be at booth # 3055. There’s a surprise in store if you come by our booth. Plus you can meet our wonderfully talented management team.

Fast Facts

Services
System implementation, optimization, custom reporting, project management, technology and integration, education and knowledge transfer for Cerner, Eclipsys, Epic, McKesson, MEDITECH, and Siemens.

Company
Vitalize Consulting Solutions, Inc.
Corporate Headquarters
248 Main Street, Suite 101
Reading, MA 01867
877.582.4321

Operating Headquarters
500 North Walnut Road
Kennett Square, PA 19348
610.644.1233
www.getvitalized.com

Notable Customers
Henry Mayo Newhall Memorial Hospital, Albert Einstein Healthcare, University of Illinois Medical Center Chicago, Siemens, Johns Hopkins Hospital and Health System, Stanford Hospital and Clinics, Eclipsys, Danbury Health System, The Hospital for Sick Children Toronto, Children’s Hospital of Philadelphia.

The Bottom Line

*  Vitalize’s high-value tactical and strategic IT services consistently create impressive customer satisfaction and loyalty.

*  The company’s vision statement includes being recognized as the premier employer for healthcare IT professionals, providing meaningful work in a supportive environment with a caring culture.

*  Vitalize offers a variety of work arrangements: standard employee, fixed term employee, and subcontractor, all of which contribute to its reputation as a highly employee-friendly consulting firm.

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A year ago, you predicted an increase in the number of uninsured. Did that trend come about as quickly as you expected and how is it affecting healthcare IT?

The trend has absolutely accelerated. Credit markets are frozen. We’re in a severe economic recession. Somewhere between 45 and 50 million people are uninsured. We have close to 60% of commercially insured folks on high-deductible plans. That adoption will accelerate.

It’s a bad market for hospitals. Medicaid reimbursement has declined in most states and managed care rates are flat at best. Who knows what’s going to happen to Medicare?

High-deductible plans should really be renamed “catastrophic insurance.” People won’t get services because the deductible is so high and they’ll have to pay out of their pockets, so hospital utilization will go down as patients choose to put off elective procedures.

We’re already seeing self-pay bad debt rising with our customers. People don’t understand how expensive some of these procedures are. They’ll go and have them, but if hospitals don’t collect the money up front, there’s only about a 40% chance of collecting it after the procedure is done.

There will be more and more shifting to self pay because of these high deductibles. We are going to see a real challenge there for hospitals.

How are those conditions changing the mix of IT systems that hospitals are buying?

Hospitals have to develop a strategy for their marketplace. Are they going to acquire facilities or are they going to be acquired? They have to evaluate their physician network strategy. Do they want to have owned physicians or affiliated physicians or some combination? How will they establish physician loyalty?

They also have to manage their balance sheet, finding new sources of funding and spending their money wisely.

A lot of that has to do with capital budgeting. We’re starting to see hospital customers taking a really hard look at significantly reducing their capital budgets.

They have to look at operating performance and how to maximize utilization and revenue. Utilization is going down, so which programs do you cut and which do you strengthen?

Hospitals should focus on improving their relationships with their physicians. That could involve things like online outpatient orders, procedure scheduling and results reporting. Anything that avoids disruption at the office or that makes physicians more productive will be a real plus during these times.

Hospitals need systems that help them with the revenue cycle. If utilization decreases, they need to catch every dollar, which requires revenue cycle tools on the front end to identify a patient’s insurance quickly and make sure the authorizations are obtained.

Physician ordering needs to start in the physician’s office, paying attention to authorizations and medical necessity checking up-front before the patient gets to the hospital. By the time service is being rendered, you know whether you’re going to get paid or not.

If you’re not going to get paid, you can make arrangements for the self-pay portion, getting people signed up for plans or sending it to charity care.

It’s important to help hospitals with capital outlays, so the Software-as-a-Service industry with its all-inclusive subscription model will be popular. You pay a monthly subscription rate and get everything without a large investment from the IT department and without paying hardware or license fees. You get return on investment immediately.

Your business was good before the downturn. How has that changed?

All of our prospective clients are concerned about capital dollars. Hospitals are freezing capital budgets and laying people off. We haven’t seen a decline because the subscription-based model means you don’t have to commit to a long-term payment plan or contract.

It’s a different kind of financial decision to go with SCI than one of the more traditional models. You don’t have to invest upfront fees to get live on systems. We’re dealing directly with the revenue cycle and attracting physicians. There are huge benefits associated with that.

People are getting quantifiable benefit right out of the box. We offer Software-as-a-Service, so less installation time is needed and people see a real return for only a few thousand dollars a month. For that reason, traditional models will be challenged.

What will the industry look like if traditional vendors try to change to go after capital-poor customers by switching to subscription pricing?

I’ve run companies with both models. I don’t think the traditional software company can just flip a switch to become Software-as-a-Service. It’s a really different model with regard to the types of people you hire and how you deliver services.

Traditional companies will have a harder time making the transition. I expect we will see another wave of consolidation. Smaller companies will struggle.

Three years ago, you said that 80% of software would be purchased using a hosted model within 10-15 years. That was a pretty brave prediction back then. Were you right?

Yes. We’ve seen a huge uptake in Software-as-a-Service. Almost every hospital has something being delivered that way. They have gotten more comfortable with it.

The success inside the healthcare industry and in Fortune 100 companies proves SaaS is a viable model for even the largest institutions. CIOs can allocate their own resources to other projects.

Hospitals are focusing on throughput and revenue cycle issues, with consultants moving to those areas to help. What are you seeing?

Throughput and revenue cycle are the keys. Hospitals have to look at their programs and services to determine which are making money and which are bringing in business.

Hospitals will focus on scheduling. Much of the revenue cycle is back-end driven, but hospitals need to improve the front end – catching the errors, making sure everything is in order, and focusing on those self-pays.

The key now is to get patients in, make it easy for the patients to do business, get patients into the hospital and, for the physician, get the bills through without getting denials because of revenue cycle mishaps.

How do your products fit in as the patient goes through the individual steps?

Let’s say my wife comes home from a trip and gets a reminder from an SCI hospital that her screening mammogram is due because it’s been more than year. She logs into the hospital’s SCI Consumer Portal on a computer and schedules the appointment in real time.

SCI is the only company that offers the ability for patients to schedule at 11 o’clock at night. This isn’t just sending a request to a scheduler. It is essentially the scheduling “brains in the box”, similar to the airlines where you get back a choice of flights based on your preference. You get a choice of times and maybe a choice of locations. She can book that at 11 o’clock at night.

She fills in the pre-registration component so it will bring up everything the hospital knows about her if she has been there before. She can make any changes to her demographic information, for instance her insurance carrier. If any co-pays are due, she’ll be notified and can pay those. She will be able to go straight to the department at her appointment time because everything else is done.

Once she’s scheduled, the system is smart enough to ask her a series of questions and adjust the time it’s going to take to do the procedure. A patient with implants will take an extra half hour, so it will add that to avoid bumping other cases and creating an overbooking situation.

It can also shift demand. If the radiology department is booked but the hospital has an ancillary clinic that does screening mammograms, it can divert her there to make better use of their resources.

With her online pre-registration, the system has already checked her eligibility for these procedures. It finds that she’s eligible, but the hospital needs to collect a $20 co-pay. If she had needed an authorization, the system would have fired off that request and tracked it while scheduling to make sure the hospital is not over-scheduling beyond the number of times that procedure has been authorized for.

In the background, the SCI Revenue Accelerator product, which is a workflow system, would have brought up the case to a clerk and compared the old and new data, asking, “Do you want to accept the new data?”

The system works all the steps of the revenue cycle. If she didn’t have insurance after all and needed financial planning, it would go to the financial planner. They would use SCI tools to make sure they had made the arrangements for self-pays.

When she arrives, she will be checked in and a registration message will go off to the registration system. That will generate an account number.

We’re providing self-service tools for patients and doctors so that everything goes much smoother .There aren’t a lot of telephone calls or dropped data. Customer service is better and the revenue cycle is started earlier with the right data.

What do you tell hospital executives about being an SCI customer?

We talk to the CEO about physicians and the network — connecting their physicians to the institution. That’s a primary strategic driver.

We talk to the CFO about the revenue cycle and how we can streamline the whole process.

We answer any CIO questions about our technology. All they have to do is arrange for us to hook up to their interface engine to pass over registration data and either accept or pass schedule data. We want them to understand how deeply we can integrate our product so they will have the same data that they would with a larger vendor, plus even more easily accessible data that is very valuable.

You can’t do the self-service scheduling with all the larger vendors. They just don’t do it. There’s no intelligence in the box. We’ve saved over 40% of the labor costs with that self-service scheduling component.
They can’t get a jump on the revenue cycle with those systems. They don’t automate eligibility verification. We don’t need humans involved. Other systems don’t start the medical necessity process in the physician’s office.

SCI’s systems are good for patient convenience, physician relations, collections, and efficiency, but they don’t really affect patient outcomes. Is that true?

I believe they do affect outcome. Physician loyalty is so important. Without physician loyalty, you won’t have a hospital. We also make sure no errors occur in scheduling, that all the medical rules are covered and that procedures are scheduled exactly at the right time.

Patient satisfaction is a huge component of patient outcomes. It’s a lot nicer to do business with one of our hospitals. They provide really good customer service instead of making people stand in line; getting hassled about their bill. Having debt agencies calling patients because they haven’t made arrangements for the self-pay is part of the patient experience and we positively affect that.

Are customers seeing a measurable improvement in patient satisfaction?

Yes. One of the educational Webinars we offer is called “The Ritz-Carlton Approach to Healthcare” and it talks about one of our facilities that employed that approach. They really couldn’t have done it without the system support we provide. You don’t have to pass calls between departments when a patient is trying to schedule multiple procedures.

We’ve had hospitals that have established concierge services, where they send patient representatives to the individual doctors’ offices and sign up patients there. Our software lets them do it from that location with the office people right there to ask questions.

We have a lot of documentation on improving revenue and hard dollar benefits, but also improved satisfaction from patients.

SCI just won an award for its access management magazine. What topics does it address and how did people get it?

Our Innovations in Access Management magazine (IAM) is considered the Thought Leadership publication for Access Management professionals. At SCI we are very active with NAHAM, the National Association of Healthcare Access Managers. They are the primary group involved in healthcare scheduling, pre-registration, and ordering processes. All the articles are available for download on our corporate website: www.scisolutions.com.
We’re conducting educational Webinars with NAHAM around general interest topics — not our products specifically. We sponsor Webinars probably twice a month. I gave one a couple of weeks ago that had nearly 300 people on it. They really have that level of interest.

We are trying to facilitate and discuss how to improve access to the hospitals through the doctors and the patients. We think there are a lot of good ideas that can be adapted from other industries. We discuss what people have tried and what has been successful, facilitating and passing the good ideas on to other places.

What symptoms might tell a hospital that they’re having problems that your solutions can address?

Every one of them will have problems if they don’t have our product. They might have a problem with lost or illegible orders, a simple thing that’s hard to fix. I’ve seen medical practices decide to work with another hospital because the ordering process is so difficult. So, I would look at orders first.

I would see whether they would like to reduce their labor expenses or maximize their resources. We have improved utilization close to 15% in every facility that we’ve gone to, which directly affects patient satisfaction.

The CFO will know how they are addressing Medicare and the medical necessity component. Are they getting their ABNs signed before the procedure starts? Are industries in the area turning to high-deductible plans that will cause self-pay bad debt problems? How is financial planning set up? Do they have a workflow process that keeps people from taking shortcuts and making mistakes?

You’ve been in the industry for a long time. What are your top couple of predictions looking out 3-4 years?

I think we have a much better chance of universal healthcare now. That will have ramifications on the industry, on healthcare IT, and on hospitals.

We’re probably going to get some kind of help to get EMRs and clinical systems established. A lot of change is going to come from the outside.

PHRs are being developed by Microsoft and Google and others. It’s the way information will be stored and sent because no one really cares about your medical history except you.

Large employers will place changes on the industry. They could do more themselves or take stronger initiatives.

There will be more international competition than people realize. Hospitals here will try to compete on price with international hospitals that are run by doctors trained in the US. A lot of them are new facilities and are much cheaper than US hospitals. We’ll have more pricing transparency for the high-deductible plans, but also more pricing transparency and competition for hospitals going after specific groups of workers within a specific company.

Fast Facts

Products
Order Facilitator®
Schedule Maximizer®
Revenue Accelerator®

Company
SCI Solutions
180 Knowles Drive Suite 180
Los Gatos, CA 95032
408.378.0262
www.scisolutions.com

Notable Customers

HCA, McLeod Health, Radiology Associates of Sacramento, National Institutes of Health, Roswell Park Cancer Institute, Alamance Regional Medical Center, Torrance Memorial Medical Center.

The Bottom Line

*  SCI’s affordable solutions help hospitals build patient and physician loyalty while improving the bottom line.

*  While broad-line vendors treat “access management” as nothing more than the patient registration systems of yesteryear, SCI offers domain expertise that is essential in a world where consumers and physicians have choices.

*  Software-as-a-Service technologies like SCI’s, offered under a subscription model, match system costs with benefits without tying up precious capital dollars

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