First of all, welcome.

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

Give me some background on PatientKeeper and its products.

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

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

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

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

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

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

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

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

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

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

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

What makes PatientKeeper different from other physician workflow solutions?

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

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

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

How does PatientKeeper tie all the disparate systems together?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

How much of your focus is on integration and connectivity?

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

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

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

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

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

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

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

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

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

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

How has growth impacted your existing clients?

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

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

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

About how many clients do you have currently?

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

What benefits do customers see?

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

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

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

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

Tell me what’s coming up with PatientKeeper.

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

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

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

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

Fast Facts

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

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

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

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

Give me an overview of HTP.

Prior to the acquisition, HTP was a 12-year-old company focused on healthcare connectivity. We had been an Inc. 500 company for a couple of years and growing rapidly. In Ohio, we’re certainly viewed as a technology company success story.

We offer RevRunner®, a solution set under a SaaS (software as a service) platform for hospitals and physicians. Customers have experienced tremendous ROI from using RevRunner. It is the flagship that fuels our growth.

Our second product line is for RHIOs. We run the health information network for the entire state of Utah. It’s one of the first, maybe the first, successful RHIO in this country that has financial sustainability. It’s more of an administrative-based RHIO instead of a clinical one.

A third capability of HTP is our payor software, Transaction Manager. We have around 25 payors using it to help them comply with HIPAA through our edits.

How did the acquisition come about? Were you surprised or were you getting feelers?

We were not actively looking to sell the company or to merge with anybody. However, over the past year or so, there was interest from the investment community and strategic partners wanting to acquire us. We were partnering with people and, within three or four months, they wanted to talk about potentially acquiring us. It was very common because the space is so hot and we’re fortunate to have strong technology.

When we thought about potential partners, RelayHealth was unquestionably at the top of the list of companies that could unlock the value in HTP’s technology. When they expressed an interest and began to pursue us, we certainly listened because we felt good about that. The ethics and the feeling about the management team and folks we were interacting with was outstanding. We allowed the conversations to get to different level with them than we had with anyone else. The rest is history.

What attracted their interest?

RelayHealth really understands that the front end of the revenue cycle is where healthcare needs to focus to maintain financial health. That’s right where HTP, with our RevRunner solution, is positioned.

It’s a very good fit with the large business that RelayHealth has. They have a comprehensive view of both financial clearance and financial settlement connectivity that providers need with patients, payors, and financial institutions. We just snapped into their existing portfolio. I think they were really impressed with our suite and the added value it brings to healthcare providers.

We do four things to help providers pre-service. We find and verify insurance coverage for those patients who have it. We optimize collection from those patients who can pay. We identify assistance for those who cannot pay. We empower our customers with the tools and information to know the difference between these three scenarios.

What does that mean to them? They collect cash – now. I think that was pretty powerful when you look at how healthcare has evolved. There are very few industries where you are considered best in class and you might get paid 60 days after you’ve provided a service.

What our service does for providers is empower them with the means to tell a patient, for example, “You’re scheduled to come in a week from Tuesday to get a CT scan. We’ve talked to Aetna and verified your insurance coverage. We’ve also analyzed the pricing contracts between Aetna and that particular hospital. You’re going to owe $850 out of pocket when you show up for the procedure.”

That’s a transformational event that supports consumer-driven healthcare where patients have more choice. It’s also in line with HFMA’s Patient Friendly Billing™ project. What typically happens today is that a patient gets a bill 45 days after they visited the hospital. They are unhappy because the bill was larger than they expected because, without their direct knowledge, their employer had raised their deductible. Now they have a $5,000 deductible instead of $ 500 deductible.

So now you’ve got an angry patient who says, “I can’t believe I owe $850,” and you’ve got a hospital trying to get the bill paid and waiting to collect the money. A lot of times, patients won’t pay either at all or on a timely basis. They’re healthy again and don’t feel they have to pay. Interestingly, people understand paying their veterinarian bills … and do pay these long before taking care of their own healthcare bills.

With our service, a provider can now educate the patient in a friendly way so they know upfront, “I’m going to owe $850.” The hospital can work with them to determine the optimal payment scenario for that patient.

The first step is really conducting a thorough analysis of their health plan coverage and validating that. We don’t just stop at checking the insurance the patient thinks they have. More times than people realize, patients often say they have no insurance when they actually do; or, they “remember” the wrong insurance.

Then, if our analysis indicates a high proportion of the financial obligation will need to be funded by the patient, we next evaluate their ability to pay. If they can’t afford it, maybe they’re eligible for the hospital’s charity program, Medicaid, or some financial assistance. Or, maybe they can pay for it but will need a payment plan.

All that can now be worked out upfront so everyone is educated. Our ability to connect to payor databases and financial institutions means we are presenting the most current and available information possible to help that patient accurately to understand their role and accountability in paying for their care service.

How do customers like the results?

Providers are very satisfied because they are able to move the patient cash collections to the point of service, which increases their cash flow and reduces their post-service effort required to collect. That’s a huge goal for every hospital in the country. Also, with the trend toward consumer-driven healthcare, you have more educated consumers who now don’t feel surprised or shocked when they get their bill. They know upfront what that procedure is going to cost. They can make informed and better choices.

Will that kind of pre-service activity pick up as financial responsibility shifts more to patients themselves?

Absolutely. The trend is going to continue. A couple of years ago, $5,000 deductible plans were considered to be fairly high. Now they’re commonplace. You even see $10,000 deductible plans. As the patient payment responsibility continues to increase, it increases the need for providers to be able to do patient-friendly financial counseling where they’re educating the patient on what their out-of-pocket is going to be in terms the patient can understand. Consumers get this every day in making every other purchasing decision – and now they will receive this informational service with healthcare as well.

Some services, like the Propensity-to-Pay assessment, may not interest hospitals that don’t collect aggressively. Do you find that customers are using more of your tools as reimbursement gets tighter?

They definitely are. I think if you go back just a couple of years, people really frowned on those types of processes, but it helps the hospital determine upfront the optimal payment pathway based on the patient’s propensity to pay.

They can often write it off or send it to collections on Day 1 instead of spending time and money trying to get a bill paid when they’re never going to pay. From a hospital’s perspective, you can spend $1.50 collecting $1.00 and it’s not worth it. If you can spend 15 cents upfront to collect $1.00, that’s obviously worth it.

The further you go along the revenue cycle, the higher the cost to collect. In the healthcare vernacular, we’re triaging patients to determine their optimal payment pathway. For example, if a patient doesn’t have insurance, the Propensity-to-Pay analysis may lead us to say, “We see you may be eligible for Medicaid. Meet with our financial counselor and let’s see.” Or maybe they are eligible for charity care. One scenario often happening is, “We see that you have insurance, but it’s fairly light, so we’re going to have to work out a payment plan for you personally.”

How much does the average hospital leave on the table?

We do a simple upfront analysis free of charge for hospitals. We’ll run a hospital’s self pay and bad debt. Over the last three years, we’ve found that four to 15% of patients tagged by the hospital as self-pay actually have some kind of Medicaid or commercial coverage.

A fairly large system found over $9 million in 2007 by using our technologies, where people walked into the hospital and said they were self pay, but actually had either valid commercial or Medicaid coverage. That happens because of the complexity of life. You have divorced parents where a child may be covered under the other parent’s insurance or maybe they changed jobs and didn’t know about it. People often have insurance and don’t know it, the complexities are endless and hard to track in the absence of current technology.

Healthcare, historically, uses paper, phone calls and people going to websites trying to figure all this complexity out. We use technology to automate the connections to the payor and analyze data to find coverage and money when antiquated processes don’t.

People say they want healthcare to work like other businesses, where patients have a choice before incurring expenses and where they know what they owe immediately. Is that consumerism important to your business?

Absolutely. Pricing transparency was the first wave. We like to say, “You have an estimate – now what?” The estimate was great, but how can the hospital collect the money? Our solution for financial clearance not only provides that pricing transparency, but also provides an optimal payment pathway for both hospital and patient to work things out so that particular service gets paid.

It seems like after many years of focusing on clinical systems, the trend is moving back toward fundamental business systems. Do you see that happening?

Yes. As hospitals say, “No margin, no mission.” Unless you’ve figured out your revenue management processes and automated them and are operating efficiently, it’s hard for any hospital to stay in business. Healthcare is complex and the payor rules for reimbursement are constantly changing. In a manual world, it is very hard for providers to stay current.

You deliver your offerings by software as a service (SaaS).

That’s correct. We’re typically up and running and integrated with the hospital’s information systems within 30 days, particularly for the insurance verification services. That’s because there’s no footprint at all in the IT shop of the hospital or physician office. It’s all Web-based. There is no software to install, maintain and update on hundreds of users’ desktop computers. Training is simpler and faster.

Someone might take a quick look and say HTP looks like a clearinghouse.

We like to say, “We’re not your father’s clearinghouse.” We have clearinghouse capabilities, which are in fact best in class for eligibility and insurance verification, but the way we present the data and make it usable is what really distinguishes us.

For example, when providers now perform insurance verification, even with a standard HIPAA format, they see a different formatted and coded eligibility response from each payor. That’s because every payor response is different and providers use many main payors, it’s hard for staff to sort through clearinghouse eligibility data and find important data points like co-pay, co-insurance, and deductible year-to-date.

Instead of that approach, we present payor information in a normalized fashion that allows the hospital staff to quickly get to the data point about that particular consumer of healthcare that they’re looking for. This makes training much easier too.

There’s a feature called My View that allows them to sort those responses and see those data points. If they’re sitting in the emergency area, they can see their ER co-pay at the top of the list every time. That’s not how all the other clearinghouses work for eligibility.

We have proprietary technology that provides more comprehensive data from a payor than you can typically get in traditional HIPAA eligibility inquiries. We’re able to get very key elements, like deductible year-to-date met, coinsurance, and a lot of other data points that you typically won’t get through a clearinghouse. We’ve invested heavily over the last three years to build out this network of advanced payor connectivity. That’s a big differentiator.

Our mantra is to make the data usable. We do some other things with our workflow and work lists. We sort through the data to find the needles in the haystack for those actionable events that the revenue cycle staff person is looking for.

What causes a hospital to recognize they need to improve their practices and come to you for a solution?

A number of providers now realize that automating the connection with payors and financial institutions rather than relying on paper and endless phone calls is the right and only way to go. Certainly the move toward consumer-directed healthcare is forcing hospitals to be smarter about how they go about getting paid upfront. If they don’t do that, they’re at risk of going out of business.

We have a very solid process for how we go about proving our ROI before the customer signs a contract. For example, we can run an analysis to find out how much money they could go bill tomorrow if they were using our technology. That’s pretty compelling to most systems, even if they don’t have a budget for it.

What we’ve seen in the last 12 to 18 months is a tremendous interest in this more advanced connectivity during the revenue cycle. With our direct sales team and with our solution now part of the RelayHealth connectivity business under its nationwide reach and huge penetration into healthcare, we’re really excited about the opportunities.

You have a wide enough customer base that integration shouldn’t be a challenge.

Correct. We’ve already integrated our service with most of the leading hospital information system platforms. We have very good references and our KLAS ratings are strong.

Your newest service is Charity Care Compliance Manager. What does that product do?

There’s a growing storm in the industry. The IRS is changing its guidelines for how hospitals maintain their non-profit status.

The IRS Form 990, Schedule H change makes it more difficult for hospitals to receive the same level of credit that they used to receive for charity care. Those changes have a lot to do with using actual charges instead of billed charges. I’ll spare you the details, but that’s a growing concern as the non-profit status of hospitals around the country is being challenged.

It’s voluntary to fill out the new Schedule H in 2008, but it will be required in 2009. You have to be able to document that you’re tracking and managing your charity care appropriately. Charity Care Compliance Manager helps hospitals do a much better job of effectively classifying bad debt vs. charity. We think this will be a huge event that providers are just starting to realize this impact of 990H.

What benefits will customers of RelayHealth and HTP see with the acquisition?

RelayHealth has industry leading connectivity services through its intelligent network. When you combine RelayHealth’s huge presence and large installed base for claims management services, patient statements and online account management services, and then you put HTP customers on the front end of that with financial clearance services, you have a very complete offering for helping hospitals and physicians optimize their revenue cycle.

What changes do you expect over the next 3-5 years?

We will continue to see an increase in consumerism. The burden of the cost of healthcare will continue to be pushed directly to consumers. That’s going to drive more choice. Hopefully that will have the effect that we’re all looking for, which is to bring the ever-growing healthcare costs under control.

It shouldn’t be a strange question to ask your physician or provider, “How much is that going to cost me?” Today they may look at you and say, “Why are you asking that? Don’t you want the best healthcare possible?”

I think we’ll see a change with consumerism from that being a strange question to a common question, one that providers are going to be answering. If they can’t answer it, they won’t be in business long because people will go elsewhere.

Fast Facts

Product
Financial Clearance Services

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

Notable Customers
Catholic Health Partners, Tenet Healthcare, Resurrection Healthcare, OhioHealth, Redlands Community Hospital , The Ohio State University, the Utah Health Information Network.

The Bottom Line
* RelayHealth’s front-end revenue cycle connectivity services help providers find the best way for patients to pay for services received.
* Software as a service (SaaS) means a fast implementation and quick return on investment with minimal use of internal IT resources.
* RelayHealth is perfectly positioned to deliver the financial and clinical tools needed in an increasingly consumer-centric healthcare delivery model.

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Let’s start with the elevator speech on Sentillion, please.

Sentillion offers identity and access management solutions that are focused on the healthcare industry. We provide technology that enables healthcare organizations like hospitals to create, manage, and apply electronic identities that their caregivers use to access their clinical, business, and personal productivity applications.

In today’s electronic world, we have identifiers and credentials that prove who we are. How do you assign those identifiers, particularly in a corporate or professional environment? How do you distribute them to the right people? How do ensure that those people apply their identities to access systems in a way that’s appropriate to their job and the tasks they need to perform? We offer four products that can be used separately, but also play very well together to create a larger totality of the solution.

The first product is called proVision™. It solves the aspect of identity and access management known as provisioning, which involves the tasks and policies around questions like, “How do I give somebody an electronic identity?” “How do I ensure that identity is appropriate for their role?” “How do I set up the underlying application accounts so people can do their jobs in an enterprise directory, an e-mail system, an order entry system, a PACS system, and a results reporting system?” And, most importantly, “how can I automate this so it’s not a manual undertaking?”
 
proVision also enables managing the full life cycle of these identities. If somebody’s role in the organization changes, such as when a nurse becomes a nurse practitioner or a medical student is hired as a physician, how do you change what they can do electronically? Our system allows people to manage that. Perhaps most importantly, proVision enables organizations to deal with the suspension or disabling of accounts, such as when someone leaves to work for a competitor, retires, or is a student who no longer works there. proVision enables total life cycle control of how identities are assigned and allocated.

expreSSO™ picks up on the idea that, if people already have those identities, then they need to do things like log on to their systems. The myriad of systems in healthcare were designed to be managed and maintained separately, so users get different identities and credentials even though they’re one human being. Electronically, they’re multiple personalities. Because of that, the fundamental task of signing on becomes torturous in a healthcare environment. You have a dozen or more systems with different IDs and passwords on each that you access 50 or 100 times a day. You’ve got to keep track of all those passwords. expreSSO is a single sign-on system, but optimized for use in the health care environment. For example, it enables people to sign on and off extremely quickly at workstations that are in shared areas, like at a patient’s bedside or at a nursing station.

Vergence® picks up where expreSSO leaves off by taking the idea of single sign-on and surrounding it with a whole bunch of other very important capabilities to create a complete clinical workstation environment for caregivers, whether they’re in their offices or in care areas. It adds what we call context management. Context management enables caregivers to easily access patient information across multiple applications without having to repeatedly search for a patient, encounter, or study result. Using Vergence, if a physician reviews a patient’s record in the hospital’s main information system and then needs to evaluate images from the patient’s chest CT, the simple click of an icon for a PACS system presents the exact image desired; without Vergence, the physician might have to search through several screens, enter a patient’s name or record number, or scroll through multiple studies searching for the desired result. Vergence’s patented context management solution does this work automatically, allowing caregivers to focus on the patient. For caregivers Vergence saves time; for patients Vergence prevents medical errors due to selecting the wrong patient’s record or reviewing the wrong patient information.

Vergence has a variety of other functions, such as role-based access. When you log on, you are presented with only the applications that make sense for your role. We also provide centralized auditing so we can tell organizations, from a single audit log, who has accessed what patient records, when, where, and from what application. You don’t need to do a massive forensic analysis to discover if there’s been a transgression. Or even if the patient simply says, “I’d like to know who has accessed my medical records?” which is a virtually impossible question to answer without Vergence.

Lastly, we have a product called vThere™, which solves the problem of creating productive, fully functional, but easy to deploy solutions for caregivers who are physically remote from the healthcare enterprise, at home or in their offices. Although physically outside the enterprise, these caregivers want access to applications and systems with the same performance, the same richness of functionality, and ideally, using the same set of credentials they use from within the enterprise.

vThere meets these demands using virtualization technology to enable healthcare organizations to distribute, not physically, but virtually, clinical workstations to remote end-users. They can they use these workstations offsite, but as if they were physically connected to the enterprise network, accessing the native applications in exactly the same way as if they were inside the four walls.

So, you’ve got provisioning to start the whole process with proVision for creating identities; expreSSO and Vergence for creating increasingly rich experiences when using a multitude of applications in care and non-care environments; and then vThere to break down the traditional barrier of being constrained to the richness of functionality with in the four walls and enabling rich functionality to be achieved outside the hospital.

Sentillion was just named the number one single sign-on vendor in all of healthcare for the year by KLAS. What do you think it is that makes Sentillion better than the competitors?

What’s particularly interesting is that KLAS asked specifically about single sign-on. Most of our customers use Sentillion products that do more than that. So, we’re pretty confident that they answered the question without blinders on and from the full experience they’ve had from us, which means we’re dealing with more elaborate and sophisticated problems than vendors with just single sign-on. To me, that makes the fact that we were named #1 even more impressive.

The other thing notable about the KLAS ratings is that 60% of our customers who responded said that we are their best overall IT vendor. Not best single sign-on vendor, but their best overall IT vendor. One hundred percent said that we are key to their long term plans and strategy. What it means is Sentillion is more than a vendor that just takes some kind of technology, lobs it over the wall to the customer, charges them some money, and then walks away with a nice handshake and says, “Good luck, let me know if it all works out.”

For example, with our single sign-on product, we are approaching 350,000 live caregivers. There’s nobody even close to that. With our provisioning product, we’re approaching 150,000 managed identities. Those numbers keep growing. When we work with our customers, our objective is to get them live and keep them live, which also points to our single sign-on product, where we track intensely our uptime. We run five-nines or better uptime for all of our customers in terms of single sign-on. That means less than 45 seconds a month of outage. It’s the total service and commitment that we bring that I think has been the underlying key to the KLAS ratings that we were able to achieve.

A security magazine had a great article on Delano Regional Medical Center, a small, rural hospital that realized it was losing business because community-based physicians didn’t like dealing with multiple sign-ons when working remotely. What can other hospitals learn from them?

We pioneered, at best I can tell, a process that we call an Executive Alignment, or an EA. When a customer has signed on, we don’t just kick off our project and tell the technical team to create a project plan. We get the executive team and all of the project stakeholders together, bringing everybody together for an initial meeting to say, “OK, you went through a sales process, selected Sentillion, and bought the product. Now let’s step back and ask — why did you buy the product?”

It sounds like a strange question to ask a customer, but what we find is that, when you bring everybody together, the perspectives on the business drivers for solving issues around identity and access management are fascinating to hear. They provide a rallying point and executive alignment, a business glue that holds everybody together as to why we’re doing the project, why it’s important, and what outcome they can expect. 

When we talked last, you said, “Vendors think users are afraid of technology, but in fact, users will avoid technology that gets in their way’. Do you think that vendors are hearing that message?

No. It’s a tough message to hear. Maybe your initial idea was solving a workflow problem, but you get distracted. You are at risk of losing sight of the problems you wanted to solve in the first place.

One of our competitors has made a big deal about something called “logical and physical security convergence,” the idea that you physically get into buildings and then to your computer systems. They want to solve all those problems. We looked at that in 2005, but the required assumptions don’t hold for hosiptals. For example, that each person physically enters the premises one at a time. I don’t know about you, but I’ve never seen doctors lining up at a door and swiping their cards to enter into a hospital one at a time. Without knowing who’s in the building, how could you possibly use that in any productive way to control computer access? At the end of the day, the guiding light is that the only reason caregivers will use our technology is that it makes their jobs easier.

Sentillion recently introduced expreSSO, which is a more focused and cost-effective single sign-on application. What’s the market reception been to that product? Are customers finding it easy to choose between expreSSO and Vergence?

We’ve been thrilled with the reaction, not only from the market, but also from industry analysts that cover this space. We had a pair of them a few weeks ago who obviously thought they had seen it all and weren’t expecting to be impressed. When we showed them expreSSO, in particular the tooling that the IT person sees, the only way to describe the look on their face was blown away. It was, “Just when I thought nobody could come up with any better way to solve these problems, you guys just came up with a way.”

There are customers who believe that they only need to solve the single sign-on problem. As I mentioned earlier, Vergence solves a much broader set of problems that includes single sign-on, but can go well beyond that. For those customers who are convinced that they just need stereo rather than surround sound, we now have a stereo system that we sell, too. If you someday discover that you really want surround sound, we’re there to provide that as well.

The single sign-on functionality from the end-user perspective for expreSSO and Vergence are virtually identical. We leapfrogged ourselves, and everyone else, in the tooling, how the IT organization creates the connectors. We used a metaphor like you would see in movie-making software, making it very easy to step through the series of tasks in generating a connector without writing any code. It’s very visual. It allows you to create a series of snapshots — you might think of them as frames in a movie — and arrange these frames to create a complete sequence of events. Those underlying events correspond to how you want to automate the sign-on process; how you want to automate the password reset process; how you want to automate handling events. Also, how you handle the sign-off process.

We’ve been able to take the tooling to a whole new level. That’s what’s caught the eye of our customers and the analysts. Later this year, that tooling will find its way into Vergence as well, but using the platform of a new product to pioneer and push and challenge ourselves to create a whole new generation of tooling and not only leapfrog ourselves, but also leapfrog anybody who’s in the single sign-on space in terms of how you go about generating connectors. That’s what’s got everybody excited.

You’ve got that as a new product and vThere is also relatively new. What are your priorities going forward?

The reason there’s a Sentillion is that we listen carefully to what our customers are struggling with. They don’t necessarily say to us, “Solve our problems in the following way,” but rather, “We have these problems. Is there something that you can do about it?’

proVision came about from a discussion I had with a CIO customer of Vergence in 2004. People said, “We want a product that focuses specifically on single sign-on and that makes it really easy to generate and maintain connectors” and that gave birth to expreSSO. Others told us, “We’ve got tremendous challenges with remote access. We’re paying a fortune for Citrix. Portals are powerful, but the Web-based metaphor is really difficult for transactional activities like order entry and we need something else.” That led to vThere.

On the list is the idea of taking the kind of problems we’re already solving in the enterprise and helping our customers solve the same set of problems for people who are outside of the enterprise, like physicians or patients in the community. Hospitals are establishing applications for patients to use, often put up by different organizations within the healthcare system, so patients end up with different IDs and passwords. Does that sound like a familiar problem? They have separate IDs and passwords for personal health records, to schedule an exam, to make an appointment with a doctor, and to deal with insurance. Groups are throwing applications up as fast and furiously as they can, and not thinking about the totality of the end-user’s experience. So you will see us taking what we’re doing and, over time, broadening the audience for whom our identity and access management solutions are benefiting.

The company is ten years old this year. What are the best parts about the first ten and what do you hope for the next ten?

I’ve been reflecting on this. Certainly one of the things that I’m struck by is we have accomplished more than I ever imagined when we started the company. We were so ambitious. We thought we had a crystal ball that was as big as anybody’s. When I look back, I realize we have so far exceeded and gone beyond anything we could have conceived of and it’s liberating. As I look ahead to the next ten years, I try to convince or coach people at Sentillion to not be afraid to think big because you can’t think big enough. Whatever we will be in the next ten years, we can’t conceive of that today. We will look back ten years from now and think, “My goodness, were we small-minded ten years ago in what we thought we could do versus what we could accomplished.”

We chose an unusual path to provide technology, as opposed to an application. A technology is a platform for a specific vertical, like healthcare in our case. That commitment to healthcare, the understanding we’ve gained about it, and our amazing customer base are responsible for our ongoing success. If we had come out of the gate as a horizontal company, we might have lasted two years, crushed or unable to keep up because we would have had no particular perspective or understanding about the set of problems we could guide our products and services around. The committed focus to healthcare is not only a source of pride, but is also the reason we have been able to experience such a vibrant and sustainable company.

Fast Facts

Products
Vergence, expreSSO, proVision, vThere

Company
Sentillion
40 Shattuck Road, Suite 200
Andover, MA 01810
978.689.9095
www.sentillion.com

Notable Customers

AtlantiCare, Cottage Health System, Eisenhower Medical Center, Great Ormond Street Hospital, INTEGRIS Health, NYU Medical Center, Sharp HealthCare, Sisters of Mercy Health System, Sunnybrook Health Sciences Centre, Tenet Healthcare Corporation, Texas Children’s Hospital, University of Michigan Health System, UPMC.

The Bottom Line

· Sentillion’s expreSSO single sign-on makes it easy and cost-effective to roll out convenient application access to caregivers and other users.

· Sentillion’s sharp healthcare focus has earned the company the #1 KLAS ranking in single sign-on applications.

· Users benefit from easier access to multiple applications and reduced errors in selecting patients across multiple clinical applications, but IT shops also enjoy improved security and full HIPAA auditability of electronic patient information access.

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Describe AT&T’s involvement in healthcare.

About four and a half years ago, we started down this path of developing our vertical industry practice. We worked with an outside consultant to research several industries, specifically looking at their business processes for mobile workers. We identified nine vertical industries in which to develop a go to market plan and healthcare was prioritized in this research.

We initially started with a focus on the electronic patient record and specifically e-prescribing. We knew it was early in the life cycle in terms of adoption because hospitals had to first create the patient records electronically to be able to access them on wireless devices.

Much of our early success has been in home healthcare and with the healthcare nurses who work in the field. They need to schedule their day, find their patients’ location, and then enter information, capturing in real time the patient assessment. That information is then sent back to the homecare agency or hospital and the reimbursement process begins immediately.

We have a dedicated healthcare marketing and sales team who work with healthcare customers to identify business process and workflow where wireless data can bring efficiency. Our application consultants then can best recommend the right solution for their requirements.

Hospitals use many technologies to communicate within the four walls and with their physicians. What services does the market want that AT&T can provide?

There are a several applications we think help providers begin to move to mobile applications and encourage clinician adoption. One is Enterprise Paging. If you think about historical paging applications that physicians have used, they had to carry a wireless device and a pager. What we offer is an enterprise-grade application that runs directly on a wireless device. It allows them to integrate into their back-end systems and receive alerts on their mobile device directly from the enterprise system. Clinicians have a pager and their voice solution all in one device.

We also have a product called Office Reach. It extends PDX functionality to wireless devices. When the staff dials a four-digit hospital extension, if that contact isn’t at their desk, the call automatically rolls out to their wireless device. By dialing one number the caller can reach the recipient on campus or beyond.

More specific to home healthcare is our LaptopConnect offer. AT&T provides mobile broadband to home healthcare clinicians to send and receive data from their laptop wherever they are throughout the day. Field staff can complete encounter information on their laptop and wirelessly transmit the completed forms for immediate processing.

We worked with AMR to design an EMR for their field clinicians and first responders in ambulances. While in transit and assessing the patient, the patient data can be entered into a laptop from the ambulance and transmitted to the hospital. When the ambulance arrives, the patient’s assessment information has already been transmitted and the attending physician can immediately begin treatment.

How is mobile broadband working for remote caregivers and what are the options for them?

We see a mix. Initially, we saw greater adoption of laptops with wireless cards which provided caregivers access to AT&T’s mobile broadband network to send and receive information while in the field. Wherever there is voice access, they also have data access to get on the Internet, to access applications, and to be able to transmit patient data while at the point of care.

We are seeing an increased demand for wireless PDAs for those users who don’t require a full screen and keyboard – but can select answers from a pull down menu and perform some data entry. McKesson Horizon Homecare is a good example of an application that operates on wireless devices – both PDAs and laptops. Homecare Homebase is exclusively deployed in the field on handheld devices.

AT&T’s mobile broadband network is available in over 250 major metropolitan markets - giving users the speed they need to quickly transmit information.

What’s going on with the iPhone in healthcare?

iPhone was initially made available to consumers. Just recently AT&T offered the iPhone for enterprises on their corporate contracts. Convergence is definitely a big topic with hospitals, being able to have a single device like the iPhone that has Wi-Fi and cellular support is of interest. Apple recently announced the upcoming availability of an SDK for the iPhone for developers to build applications specifically for this device.

On a related note, in the hospital setting, one challenge is that many of the physicians buy their own device through consumer channels but they want access to the enterprise system as well. With the Stark law, there’s sensitivity about what services and technologies the hospitals offer their affiliated physicians, but at the same time, there’s also this need to build a relationship with the physicians. So, we see hospitals wanting to provide the ability for those customers, their physicians, to be able to get access to a device the physician has selected as their primary device.

AT&T offers programs whereby a hospital can elect split billing for network time. The hospital is billed for data and the physician is billed separately for voice. Additionally, provider organizations can extend their corporate discount to employees – allowing them to purchase the device of their choice at the discount provided to the organization. This is a good program for hospitals, to be able to offer some differentiation of devices and services and can help IT steer the clinicians towards specific devices they are more willing to support.

Doctors were supposed to love PDAs and their manual synching of data, which flopped. Is this Version 2.0 of that, with a device with at least as much computing power, but also part of the network?

Absolutely. It is about having real-time access to patient information and decision support regardless of where they are during the day. Physicians are not only inside the hospital,, but also at clinics, their office, on-call, and roaming between care settings. They need to remain available for contact and they need the ability to have a device that provides them real time access to voice and data. There is increasing demand to get real-time access to patient information and be able to send updates back into the medical record regardless of where the physician is throughout the day.

What services do you offer that CIOs may not have thought about?

We just recently released AT&T Video Share. It’s an emerging application for businesses. Users can take and send live video from their mobile device – allowing another mobile phone user to see exactly what they are seeing. A home healthcare nurse at a patient’s home can send a video of the patients wound to a physician and get a recommendation on the spot or determine whether the patient needs to come to the hospital for further evaluation or treatment. The nurse and physician can have a live conversation while viewing the video together. We’re in the early stages of seeing what other healthcare applications can benefit from Video Share. Customers can see the value and have already asked for enhancements such as transmitting the video to a PC, or to other mediums so they can share the video. We expect this application to expand with the growth of telehealth.

Companies are making huge investments in remote monitoring, alerting, and alarming. Is that the last frontier of healthcare, taking those services out to where the patients are instead of having them come to you?

That’s true. You have big companies like Philips, GE, and QualComm developing telehealth solutions. We’re having conversations with a number of vendors in this area because we see this as an emerging market with great growth potential. Healthcare provider organizations are looking for ways to decrease the cost of care and better manage patients through their discharge planning.

We have participated in disease management pilot programs and will continue to explore the applications being brought to market. With continued participation in pilot programs, we can better understand the customer requirements and pinpoint the high demand areas for these types of products. Some of these emerging applications will be offered directly to consumers, some through hospitals and some through payors.

What’s your mechanism to get at the table with those making decisions in hospitals?

HIMSS Analytics recently reported that up to 30% of healthcare IT initiatives are focused on mobility. CIOs are not expecting us to just come and talk about wireless devices. They want to sit down and talk to us about wirelessly enabling business and workflow processes to bring efficiency, patient safety and cost savings into their hospital. They are also exploring ways to encourage clinician adoption of technology.

We’ve made changes over the years in our business to support those types of conversations. First, as I mentioned earlier, we worked with an outside consultant to assess the healthcare industry and interview healthcare decision makers to identify those business processes that would benefit most from wireless enablement. This provided us with the foundation to begin a conversation around areas that we knew would benefit the hospital. Second, we hired industry specialists in marketing and sales who come from the healthcare technology industry and can really speak to the needs of provider organizations. And we’re expanding our national healthcare sales organization. Additionally, we have highly skilled and trained mobility application specialists and enterprise architects who can have a deep dive conversation on applications and technology.

We also partner very closely with the healthcare IT clinical and enterprise systems vendors as well as wireless ISVs whose applications are integrated to better deliver end to end solutions.

What are you hearing from your healthcare executive advisory committee?

They provide us insight into what’s happening in this particular industry with their thought leadership. They give us a good pulse in where mobility investments will be focused for them and other healthcare executives. Top of mind for them currently are requirements for capturing data wherever the point of care, integrating devices, disaster recovery, emergency preparedness, business continuity, and telemedicine . These are considered strategic areas of focus for these CIOs.

This advisory committee also looks to AT&T to bring together our portfolio of technologies and services in a meaningful way for their unique business needs. So topics like FMC are also top of mind for these CIOs.

I wasn’t aware that AT&T offers an enterprise recovery service. What does that involve?

We’ve put together a full suite of disaster recovery subsystems, including offsite operations centers and data centers, along with fully engineered telecommunications backup facilities to assist our customers.

So, for example, we will bring in a cell site on wheels in the case where there’s a disaster. We have back-up if there are any issues with damaged cell sites. We do that regularly. We have a whole task team that immediately is deployed and brings those infrastructures into place from a wireless perspective.

The FCC’s grant program shows that the government thinks that telehealth is important, setting aside money for regional broadband networks in rural areas.

We’ve actually just appointed a task team to see how AT&T can help our customers apply for these grants. There’s a commitment by the federal government to fund telemedicine networks throughout the country. That initial investment was supposed to be $100 million over two years, but it’s now $417 million over three years. There will be 69 awards.

How do you work with partners?

We have an ecosystem of partners that we work with in healthcare. These partners align with the prioritized business processes where wireless brings efficiency, including wireless ISVs who have developed specific applications around those business processes. PatientKeeper, MercuryMD, Epocrates, McKesson, Homecare Homebase and Emergin are key partners of ours in the healthcare segment. It’s important for us to understand these applications and assist our customers in identifying the right solution for their needs.

We have a broad data developer program where partners receive a certification for their wireless applications on our network. Our program also provides technical support for our partners as they develop mobile applications. These application providers are promoted on our website and our sales team is always updated on new certified partners in the program. We partner with ISVs and device manufactures to educate industry decision makers on wireless solutions and their benefits. These marketing programs include webinars, industry events and much more. We also jointly participate in customer meetings.

We always feature partner applications in our booth at industry events. You’ll see a number of these applications demonstrated in our booth during HIMSS.

We’ve taken some first steps at reselling some wireless applications in certain verticals. So, in the categories where it makes sense, we’ll partner in a very real way to sell, bill, and support an application through our direct sales force.

How do you summarize to a CIO what AT&T brings to the table?

AT&T has deep knowledge and experience in the healthcare industry to understand where wireless data adds value to their business processes. We can bring the resources, the assets, and the partnership to the table to orchestrate the right solution.

Fast Facts

Products and Services
Enteprise Paging, Video Share, OfficeReach, Laptop Connect, Enterprise on Demand, Commercial Connectivity Services, Wireless WAN Connectivity, NetMotion Mobility, Integrated Laptops, Wireless Email and Messaging Solutions, Push To Talk, TeleNav,TeleNav Track, Emergin

Company
AT&T
Healthcare Industry Solutions
16331 NE 72nd Way
Redmond, WA 98052
http://www.corp.att.com
Tammi DeVore, Senior Healthcare Marketing Manager
425.580.6658
tammi.devore@att.com

Notable Customers
Jupiter Medical Center (FL), VNA of Florida, American Medical Response, St. Luke’s Health System, Rush University Medical Center, Yale New Haven Health Services, Evanston Northwestern, North Carolina Healthcare Information and Communications Alliance, Baptist Health (FL), Baptist Health (AR)

The Bottom Line
* Wireless communications and a remote connectivity strategy to access information in new ways and in new places which can help organizations drive successful clinician relationships.
* Contact AT&T for a free Healthcare Wireless Workshop that will help you assess your network requirements and capabilities as you implement your HIT initiatives.
* AT&T is the voice and data networking provider chosen by the American Hospital Association after an 18-month review process.

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What challenges are hospitals having with access management?

There are two: improving customer service and making the revenue cycle more efficient.When we started SCI in 1999, we expected a major change in how healthcare is paid for. Cost is shifting from employer to employee. About 25% of insurance plans are high deductible, with employees responsible for the first $1,500 to $5,000. The idea behind these plans is that consumers will be more careful about their healthcare spending if it’s their own money. That’s a real challenge for providers because there’s going to be more competition for those dollars.Consumers who had generally ignored price will now become much more focused on the cost of healthcare. They will shop around for it like they do for other services. Providers will have to compete on price, quality, and service. Pricing always becomes efficient over time and quality has always been really hard to measure. However, service is something that easily differentiates providers.

A consumer will patronize a provider that is more convenient and offers better service. The problem is that service is an area that healthcare providers have been traditionally bad at. SCI is focused on how we can make it easier for patients, physicians, and hospitals to do business together.

We’re helping our clients identify service bottlenecks and helping hospitals reach out to customers. They can’t wait for the patients and physicians to come to them as they have in the past. Self-service tools have to be available in physician offices and patient homes.

In every other service industry, you can order services and conduct financial transactions online. The hospital industry needs to begin reaching out to its customers and Web-based self-service is a good way to do it. The revenue cycle begins at the time of ordering or appointment scheduling and hospitals need to start collecting critical data at those times.

Other access initiatives include developing individualized patient preventive health marketing; dealing with the public’s pricing questions; and large scale questions such as, “Should every hospital have its own business office?” since it isn’t necessarily a core competency of each hospital. With the right input tools such as ours, outsourcing can become a successful reality. These are the challenges that we’re seeing today in the access area.

What kinds of satisfaction improvement can your systems drive?

Convenience is important to the customer, which are physicians and patients. One example is that every physician office should be able to order patient tests online from any hospital or clinic in the community. They should be able to order quickly while the information is still fresh. Hospitals shouldn’t call physicians back about lost orders because that’s disruptive and poor service. Our Order Facilitator product makes this ordering process easier.

Most people don’t like standing in the long lines that hospitals seem to specialize in. Why shouldn’t you be able to schedule an appointment, provide your registration information, and pay any co-pays or outstanding balances online? You can do it with airlines, banks, restaurants, health clubs, and almost any other service business. You should be able to register at home at 10:00 or 11:00 PM when you have a few moments.

Healthcare is not that different from other service industries. You just need smart systems that can work with the unique complexities of our industry. I’ve spent more than 20 years in this business developing scheduling products and our scheduling products incorporate these complexities. It is like having all the hospital’s experts in scheduling and registration in one computer box.

We are the only company that can give you an immediate appointment time when you request it, just like with the airlines. When you want to go to Chicago on an airline, you get a real seat immediately after you hit the “book” key. With older healthcare scheduling software, everyone has to request — and I emphasize “request” — an appointment. It usually takes 10 minutes to 24 hours before you get a verified time, and even then, you only get a single choice. That isn’t good customer service, especially when every other industry works on a real-time basis.

SCI products help build bonds between the hospitals and their physician and patient customers. Customers are starting to demand these services. Prospects tell us that physicians who have experienced our self-service tools in their competitors’ hospitals threaten to not send patients to them if they don’t get similar tools.

It’s those little things that really cement your relationship with your physicians and patients. Eliminating all the surprises and annoyances found in revenue cycle activities through better workflow management is another area for vast customer service improvement.

Broad-line vendors try to convince prospects that their obvious product weaknesses in access management are more than offset by integration. What advice would you give a prospect hearing that pitch?

Our main competitor is what I call the “single vendor mentality.” Nearly all of the scheduling systems offered by the large HIT vendors were developed in the early ‘90s for a different industry than we see today. Their effectiveness 17 or 20 years later is really doubtful, especially as we are entering a whole new age of reimbursements and customer service expectations.

When we first started computerizing the HIT industry, most hospitals went overboard with the best-of-breed approach because it was small vendors who were developing the innovative products. Integration was difficult to manage. Then, large companies started buying up the innovators and the industry flipped to the opposite extreme, a “single vendor is best” mentality.

I think a more rational model has emerged. There is realization that certain areas require innovative solutions that these large vendors don’t have. We are starting to see a thawing in that mentality. It’s OK to buy the best to meet new challenges, such as access management.

We’ve actually seen this in other industries too. For example, SalesForce.com has been very successful against its large competitors. When I hear the integration pitch from large vendors, I ask prospects, “Why should you settle for an inferior product?”

Maybe they don’t have the capital dollars, their IT departments have full schedules, or they’re worried about integration. My answer is that our technical model of delivering Software as a Service solves these challenges. It’s a very disruptive technology because, as the vendor, we take the entire risk of the operation.

The SaaS model solves a lot of problems. Predictable monthly payments versus a huge capital investment. Implementations in weeks, not years. Support finger-pointing is a thing of the past. Upgrades occur without much IT involvement.

The only thing left in the single vendor argument is the integration of data. There is a cost component when you integrate data since you have to develop interfaces. Today with HL7, it’s really plug-and-play. The interface cost is very low when considered against the much better ROI of our solution.

Many single vendor companies use “integration obfuscation” to impose what I call an artificially high cost for interfacing. These interfaces should be in the $10-$20,000 range, but vendors often quote much higher pricing to try to block sales. The programming has already been done, maybe hundreds of times. From our perspective, we can populate every field in the host system through our HL7 interfaces, so reporting on data through a single reporting tool is easy.

The single vendor mentality has started to go away in the last couple of years. We’ve begun to see a new breed of CIO who is unwilling to accept inferior products. These new CIOs realize the business importance of access management issues. They’re not afraid to try the best solution, even if it comes from a smaller company. Innovation comes from vendors who have a laser focus on particular business problems.

So, every time I hear large vendors making statements like you asked about, what I really hear is a vendor who doesn’t believe access is important. A vendor who believes the hospital should sacrifice competitiveness by not providing better service to physicians and patients. That it’s OK if physician satisfaction scores go down and OK to have less cash and longer days in AR. And that it’s OK to have a higher risk of invested capital. I just don’t think that people are buying this any more. The smart CIO realizes that these types of decisions are really seven- to 10-year decisions that will make all the difference in the success of their hospital in this new era.

Do you think that new breed of CIO is receptive to Software as a Service?

Yes. I think SaaS is a very important trend in software. It’s much easier as a vendor to deliver a quality product through this type of technology. It solves a lot of problems you had with traditional software delivery.SaaS is growing faster than on-premise software. Large medical centers that, six or seven years ago, would have been reluctant to sign up for SaaS are willing to consider it. Concerns about security and reliability have been addressed by the industry. The current focus is integration with on-premise applications. SCI connects to virtually every financial system in the market.Goldman Sachs put out a report about a month ago saying that SaaS is growing 23% year over year, which is very good. Sixty percent of the interviewed CIOs said that they use SaaS in some form and 10% said they were using it for more than 25% of their applications and everyone said that that within the next five years they would be using a SaaS solution. SaaS is gaining acceptance. What I see today is Microsoft, Oracle, IBM, and other large players getting into the market and that validates it further.

In your interview with Mr. HIStalk a couple of years ago, you said that Wall Street values recurring revenue streams. athenahealth’s IPO proved you right. Any thoughts of how this might change the industry?

For a given amount of revenue, a SaaS company is going to be three times more valuable than a traditional company because of its long, predictable revenue stream. It’s not the traditional feast or famine. Because of this predictability, we’re going to see more investments in the SaaS business model. Microsoft, Oracle, and SAP are investing in SaaS companies and that means more merger and acquisition activities.

What’s the future for hospital revenue cycle management and how will SCI’s products fit in? I talked earlier about all the reasons why the revenue cycle is so important. Every business runs on cash and hospitals are no different. Cash has always been tight for hospitals. Cash flow management starts early, often in the physician’s office or patient’s home, as soon as an appointment is scheduled.

Hospitals can’t continue business as usual with poor revenue cycle processes. To really be innovative and decisive in the revenue cycle, workflow technology is an absolute must-have. That’s why I see centralization in the business office functions, either through a corporate business office or outsourcing.

The larger for-profit corporations are moving toward a centralized business office model, managing multiple hospitals. They can schedule, pre-register, and do all the AR with a workflow system much better than an individual hospital. I think healthcare can make huge improvements in the way business offices are running with consolidation and outsourcing.

The problem in the healthcare revenue cycle is that it starts too late in the care process. Information is not checked with the outside databases for validity and reliability. If you centralize the business systems but don’t have a good front end that starts the process early at scheduling or ordering, then you’re just going to perpetuate the denial mess on the back end. The back office needs some way to guarantee that the data coming into the billing system is accurate so that the bill gets paid the first time it is submitted.

That’s really what cash flow improvement is all about. It’s about work flow management. It’s impossible to improve revenue cycle and cash flow without having a good front end to this process.

Your Order Facilitator product just won an innovation award. How are customers using it?

The Order Facilitator product solves the problem of getting completed orders from the physician’s office to the hospital. Rather than the physician’s office handing the patient a piece of paper that might be illegible or incomplete or which the patient fails to bring it to the hospital, the physician office goes online and enters the order. The hospital then schedules an appointment and begins the revenue cycle process.We currently have over 200 hospitals in the country on the system, tied into more than 12,000 physicians in 64 communities. Here’s where it’s pretty unique: Order Facilitator is a physician-centric system. The physicians don’t need to log into one system for this hospital and another system for that hospital. Instead, there’s one system from which they can direct an order to any hospital in the community or physician to physician referral. Hospital competitors share the same system.

I don’t know of another product that really has a true community-based focus like this. For the MDs, it means their office has better productivity and fewer disruptions. It also shows these community physicians that competing hospitals can work together to make the physician’s job a little easier.

Are you seeing more hospitals and IDNs going to centralized scheduling?

If they’re not doing centralized scheduling already, then they are way behind the curve. I think today’s access efforts are going way beyond that. Hospitals have to begin to provide the self-service tools that make it easier to self-schedule and self-register. You have to automate appointment reminders for patients to show up for services and automate re-booking if they no-show.Financial processes have to start early, either at the home or in the MD’s office. Check-in and financial collection must be self-service. So, really, if you haven’t done centralized scheduling, you have to do it right away and think beyond that quickly.

Your KLAS scores continue to climb. How did you accomplish that?

We’re a small company and we’re very focused on one particular area with a laser-like intensity. Our people are experienced and we really care about our customers.

The SaaS model has helped us a lot because it helps me plan. A predictable financial stream helps us make business decisions that are thoughtful and deliberate. With SaaS, we don’t have the support surprises that the traditional vendor would, so we put a lot more into R&D. We’ve been able to develop a much better product.

We are always trying to improve our customer processes and I think that rubs off on the client. We are at risk for everything in this model. We are directly tied to our customers’ success. We pay a lot of attention to them and try to make sure that they are successful.

What are some of your predictions for the industry and for the company over the next three years?

Consumer-driven healthcare is going to continue to grow and people are going to be smarter about their own health and its costs. There is a real problem with the uninsured population in this country that has to be addressed. This problem will continue to stress the financial management of providers, so revenue cycle improvements will be very important. The leading institutions are seeing that their old technology isn’t keeping up with today’s problems and they will have to find new solutions. I see a whole new generation of buying modern revenue cycle solutions.

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, University of Virginia Health System, Bon Secours Richmond Health System, National Institutes of Health, Integris Health.

The Bottom Line

• SCI offers affordable, subscription-based, Web-delivered systems that offer unparalleled speed to value in the critical areas of access management and revenue cycle improvement.
• Access management is too important to rely on inferior technologies, even though single solution vendors try to convince prospects otherwise.
• Doctors and patients have a choice and will favor a hospital that makes it easy to do business with them.

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

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

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

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

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

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

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

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

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

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

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

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

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

Is the PHR a key part of your offering?

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

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

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

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

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

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

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

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

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

What benefits do hospitals expect to see?

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

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

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

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

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

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

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

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

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

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

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

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

Can you upsize an exchange to a RHIO?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Any final thoughts?

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

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