Electronic Health Reporter

Ever wonder what it takes to slay the dragon; to bring down the giants? What do the health IT disruptors take into consideration as they develop their strategies for conquering the worlds in which they live?

How are your peers – the ones you glance at from the corner of your eye and watch as they nip at your heels but fail to recognize in public – working to change health IT and make a play to dominate competitors that haven’t re-invented their firms?

Since I wanted to know the answers to these kinds of questions, I put out a call. I asked health It leaders to tell me their points of attack, why those attacks work, how they determined they’re playing the best plan for success and how the dragons they are slaying are reacting.

Here are the responses I received, in no particular order, area or specialty. Once you’ve read their stories, share yours. Which dragon are you slaying; which giant are you downing?

Dave Caldeira, senior vice president of product and solution marketing, Kofax
For any disrupting technology to be successful, it’s important to demonstrate actionable benefits for IT, healthcare workers and most importantly, the patient. Kofax is improving healthcare IT in four key areas:

• Increasing efficiencies — from health, patient and finance documents to accounts payable, accounting and legal
• Improve and speed the move to electronic health records to meet “meaningful use” requirements
• Enable better outcomes by sharing real-time electronic information between heath practioners and patients
• Reduce operation and healthcare costs

The six dominant players Kofax sees in this marketplace are Cerner, McKesson, Epic, Allscripts, IOD and Ricoh. We’ve found that the best way to influence the healthcare IT decision maker is to align ourselves with the dominant players they are comfortable using. For example, Kofax is tightly aligned with Cerner for medical records. Ricoh is a reselling partner that has a dedicated team that we work with. And IOD is a business process outsourcer that also uses Kofax solutions.

For Cerner and IOD to use Kofax solutions is a huge endorsement to how Kofax is making healthcare smarter with information capture mobile capabilities and advanced analytics. Would we consider ourselves a disruptor? Yes, but we do it in partnership with the dominant players.

Pavel Smirnov, project manager, Health Samurai

When purchasing an EHR from a large vendor, customers receive all the modules from this vendor, both the good modules as well as the bad ones. Choosing such a system is always a compromise as no single system can satisfy all user requirements.

Is this something that can be improved? Health Samurai believes that monolithic architectures will eventually give their place to platforms and app stores just as in other industries. Apps in the app store have to be united, communicate and understand each other. Only using of a common standard can enable these storage and data-exchange capabilities.

Health IT has a long way ahead, but the transition has already begun.

International standards organization, Health Level Seven (HL7), has drafted a new interoperability standard called FHIR (Fast Healthcare Interoperability Resources). The standard is open source and was designed using the modern successful IT practices. It leverages web technologies and is focused on implementers. It has a growing community and the potential to take interoperability to a whole new level.

Health Samurai joined the FHIR community in its early days and made a reference implementation of the FHIR server targeting hospital-scale production environments. This implementation of the HL7 FHIR server is called Fhirbase. Fhirbase is built on top of the most advanced open source database – Postgresql. In fact, Health Samurai collaborates with Postgresql’s core developers to provide production quality storage for FHIR resources.

Health Samurai is just starting its new campaign but has already created a great foundation for the future platform. The transition from monolithic architectural systems to platforms and app stores may take some time, but this inevitable transition that is already well underway globally and Health Samurai with their solutions is one of the forces that leading it.

Bill Marvin, president and CEO, InstaMed

One in every three healthcare dollars is considered to be “wasted spending” with a large portion attributed to excess administrative costs, such as billing errors. However, there are still companies in the healthcare payment industry that perpetuate the use of paper for payments, including paper checks and virtual cards. As a result, the process is filled with inefficiencies, disjointed processes, waste, fraud and errors.

Additionally, outdated processes built on legacy technology, like clearinghouses, have little value and contribute to the waste. Payers and providers are charged high fees for EDI transactions and merchant payments. This simply is not financially sustainable for the future of healthcare payments. The healthcare payments industry needs to focus on transitioning completely to electronic payments as many organizations are doing now — and ultimately, achieve interoperability on the administrative side of healthcare.

A single platform for all electronic healthcare transactions and payments is here today with InstaMed, and it does not necessarily require a significant IT investment to implement. Our patented Estimator solution is the only way to automate the end-to-end healthcare payments process. Payers join InstaMed to connect to all of their providers nationwide and integrate with other systems to achieve 100 percent electronic payments. The opportunity for payers to transition to electronic payments sooner is a significant cost savings that directly impacts their bottom line. Our business model includes EDI transactions at a tenth of the cost to payers with integrated payment transactions, which eliminates any value clearinghouses may have. InstaMed delivers solutions that enable every provider in the U.S. to receive free electronic payments from both payers and patients, and integrates with their existing systems to automate processes.

Jon A. Di Gesu, vice president of marketing, Harmony Healthcare International

Most of the existing healthcare software is clerical in nature – primarily focused on billing, accounting and document management. But when looking at the clinical areas: ADL coding is less than half electronic; medication and physician orders are less than 40 percent electronic; nursing notes are about 25 percent electronic. Clinical software adoption is lagging far behind. Most SNF clinical record keeping is still largely on paper.

The “last mile” of healthcare IT is at the bedside. Traditional healthcare systems suffer from garbage-in-garbage-out syndrome – the caregiver interface to the system is too hard to use in that demanding environment. This is the main reason detailed clinical data is not being captured, and facilities are not realizing the true potential of automation.

Braveleaf LLC turns the crisis in healthcare software into an opportunity. We build easy to use software that fits the caregiver’s workflow. Now the computer system becomes a productivity tool, and accurate information is captured at the bedside. By overcoming this challenge, we are able to fulfill the larger expectations for health IT – improved efficiency and strategic decision support based on actual bedside data.

Braveleaf LLC has developed its solutions by:

• Developing empirically: Working directly with caregivers in facilities to develop solutions that fit their workflow
• Clarity: Careful visual design, clear typography, correct text size and colors and labels geared towards creating ease of use and ease of understanding
• Opinionated Software: Software built by teams that combine software expertise with deep clinical and operational understanding . Includes a robust set of assessments, care planning tools and workflows that support skilled care documentation.
• Checklists: Software that aggregates disparate tracking, prompting, and signoff for scheduled care into comprehensive checklists.

Better software equals better care. By closing the usability gap, Braveleaf software delivers: Nurses spend less time on paperwork and more time caring for people. Better communication between nurses, therapists, aids, MDS coordinators, and pharmacists drives better care, more compliant documentation and more accurate reimbursement. Administrators access timely, comprehensive data about their business and can generate insights and demonstrate value.

Brian Baum, founder and CEO vitaTrackr, Inc.

“All healthcare is local” – four words that form the barrier to health industry efficiency. Four words that are no longer even accurate. Healthcare has become “anywhere”. The local legacy serves to perpetuate inefficiency.

The losers, the health consumer and those that pay for care.

The result, entities in healthcare compete on their perceived assets, a portion of which are their data repositories. Hence data is silo’d and information technology companies rally to support the unique needs of their customers. In the process, systems do not interoperate because a.) their customers really don’t want to share data and b.) by creating disparate IT systems the potential exists to lock customers into a given platform or system. A win/win; and a massive lose.

Fortunately or unfortunately, depending on perspective this “false market” is not sustainable. While no one may want to blink, the reality is that continuing on the current path will bankrupt our nation at which point competition based on who holds the greater data reserves will be irrelevant.

The Amazon-moment in healthcare will exist when the benefit of being “connected,” moving and sharing data becomes the norm and competition is defined by the value an organization adds to data to provide a better product/service/consumer experience. At that inflection point, the scramble will be on to “get connected.” Data islands will become relegated to the dustbin of health industry history.

This inflection will not occur through mandate, positive or negative financial incentive or compliance with standards. It will occur when organizations recognize they are falling behind their competitors. At

vitaTrackr we are creating a nationwide independent/agnostic health data marketplace. We connect any source of health data with any authorized user of data. We also intermediate consumer consent to pass data. We enable digital health. The impact — moving data becomes a utility function; enhancing the value of data becomes the competitive differentiator. As the competitive balance shifts to how an organization adds value to data, the network effect takes hold and the new strategic imperative becomes “connecting and sharing.” Early movers will gain competitive advantage; ultimately, connectivity will become the base standard for entrance to the game.

Don Cook, co-founder and CMO, iCare.com

We believe that the EHR gold rush is over for legacy EHR vendors. iCare.com is a startup enterprise SaaS EHR for hospitals. We compete against the likes of Epic, Cerner, McKesson, etc.

Our software will get hospitals out of the data center business and put their focus back on patient care where it should be. As you could imagine, our approach appeals to the CTO, CFO and CEO.

The problem began with hospitals rushing to install expensive, on-premise EHR systems to take advantage of financial incentives from the US government while, at the same time, healthcare payers were pressing hospitals to reduce costs and improve outcomes. Now they’re stuck.

Current EHR solutions on the market do not meet the needs of today’s complex, fast-paced, safety focused hospitals and health systems. Healthcare organizations today are required to navigate ever-evolving regulatory changes with a constant focus on patient care and business sustainability. They have a constantly growing and evolving network of partners, suppliers, vendors, consultants and external systems. Temporary project teams, contingent workers and multiple lines of authority are common place. Hospitals are demanding flexibility – and legacy systems were not architected for today’s challenges.