HIMSS 2015: Medicomp’s Dave Lareau

Michelle Noteboom: Give me a bit of background on Medicomp and what Medicomp does.

Dave Lareau:Medicomp was founded by Peter Goltra in 1978 and the main mission since its founding was to present relevant clinical information to the physician at the point-of-care so they can document and treat the patient. That’s really the core of what we do. We work with 15 to 20 physicians, most of them board certified in internal medicine, as well their specialty. We have a fairly expansive knowledge editing system, where the physicians work with our knowledge engineers.

So, if you’re thinking about asthma, what are the relevant symptoms, history, physical exam, test, diagnosis, and therapies? If somebody presents with left upper quadrant abdominal pain and nausea and vomiting, what would you be thinking of, and what would you want to document, what kind of test do you want order, what’s your presumptive diagnosis? At the point-of-care we can present the relevant information for documentation given the clinician’s thought process so that we don’t slow them down, we don’t get in their way, let them see more patients. They get all their documentation done and it’s all coded to all the standards. The ICD-9 or 10, as well as LOINC, RxNorm, etc. is in the background, but they’re dealing with something that is fast and familiar. That’s what we do.

As you can imagine, over 30 years, the technology has evolved.  It started on an IBM Series/1 mainframe, then we went to UNIX systems, we went in the ‘90s to the client/server stuff, and since about 2003, we’ve been doing strictly very modern, JavaScript, HTML, XLM, browser-based state-of-the-art stuff. Our main goal over the last five years has been to make it easier for existing systems to integrate these point-of-care documentation tools. That’s been our focus. Some people think of us as a middleware vendor, some think of us a component vendor. We are focused at HIMSS this year on our ambulatory physician documentation tool that had just been integrated with Allscripts Sunrise at Phoenix Children’s Hospital with great success. They’ll be in our booth talking about that. We think it’s a real breakthrough.

I would say we were not completely surprised, but we were very gratified by the fact that Phoenix Children’s built it and it’s up and running. They’re reporting that they see more patients using this than they did before – maybe a 20% to 30% increase in patient output in their ambulatory clinics for every doc, which is an astonishing result when you consider it.

So, we’re much more focused over the last couple of years on making this tool available regardless of the existing EHR platform because those systems are not going away.

People have made too much of an investment in them. It’s a nightmare to replace them. We have over the last four or five years re-architected our stuff to integrate with almost any system. That’s the median-long answer to what we do.

MN: What other EHRs are you integrating with?

DL: Our MEDCIN ENGINE is the thing that presents all the data, but it’s not the UI layer of Quippe. It is in about 10 different ambulatory EHRs. That’s our technology from about 1998 to 2004. It’s in Greenway’s Vitera product, GE’s Intergy, Pulse’s system, Allscripts Touchworks, the DOD’s AHLTA EHR, athena.  There are probably three or four others.

The issue for us is the moment that somebody announces that they’re integrating Quippe or MEDCIN into their product for a future release, it kills their sales funnel for the current release because people say, “Well, we’re going to wait until that is ready and then we’ll take another look at it.” So we sign fairly strict non-disclosures when somebody starts our evaluation period that we will allow them to break the news as to when their new capabilities will be available, and when they want to announce it. There are two more in the wings that are as significant or even more significant than Allscripts, but we will leave it to them to make the announcement.

MN: So going back to Phoenix Children’s Hospital, give me an idea of the scope of it in terms of how many physicians you’re working with and how the whole relationship came about.

DL: Phoenix Children’s is a very happy Allscripts Sunrise customer. They picked it years ago and then they did a reevaluation probably three or four years ago and said, “Wait a minute, these guys open .net”. They use the Microsoft tools. They’re going to allow us to integrate other things. We’re going to stay with them.” At the same time, they were acquiring, merging, and bringing on ambulatory clinics.

About two and half years ago they brought their providers together, and said, “Let’s see what we want for clinical documentation.” So they did. For four to six months they had focus groups, they met with the docs. They pretty much decided this is the kind of tool we want. They didn’t want six templates. They wanted a dynamic tool but they wanted it to meet all their requirements. It had to be Meaningful Use and ICD-10 ready, had to allow them to treat a patient with multiple problems. They basically designed a clinical documentation tool.  Then we were at HIMSS in 2013 and one of their project leaders, a woman named Kelly Basfield, came and played Quipstar.

In Quipstar, we actually do a demo and then we train people how to use it in 20 minutes. As far as I know, we’re the only vendor that gives 40 people our software on the show floor and say, “Here, bang on it.” She then came up to me really excited. I mean really excited and said, “This is unbelievable. We asked our doctors to design their perfect documentation tool and this is it, this is actually what they designed. Tell me it’s real, please, please, please”.

Then she went and got David Higginson, their CIO, and Vinay Vaidya, their chief medical information officer. They came over and they played and banged on it. They said, “This is a little hard to believe. Would you be willing to let us evaluate this?”  We saw a real opportunity here because this was two years ago, at the time when all the big vendors were saying, “Look, we’re not doing much innovation, we’re not doing anything, it’s all about Meaningful Use and ICD-10. Everything else is going to have to wait.”  No one was really looking to do anything new in clinical documentation.

There were a lot of vendors looking at us that said, “Dave, you know, we can’t just do it now. If our users asked for it, we’ll consider but right now, it’s ICD-10 and Meaningful Use, 24/7, 365.” Phoenix saw it and said, “Well, we need to do something for clinical documentation. We’re not going to wait for the vendors to do it. If this is real and if it actually works with our system, if you guys are the architect to do that, we’d like to evaluate it and give it a try.”

So, we signed an evaluation license with them because we wanted that feedback too. We wanted to know that we had made the right decisions over the last five years for what doctors wanted and what the technical teams needed to integrate these things. You do what you think is right, but you don’t know until somebody does it. Until then, it’s all theory.

They were willing to do it. We met with their team a couple of times. They came for training and in November of 2013, about seven to eight months after HIMSS, they came to what we call MEDCIN-U where we do a three or four-day dive into Quippe and MEDCIN, and then we follow that with a three-day integration workshop that they sent some developers to. Bryan Bannon actually had it integrated with their SCM by the time they left on Friday. They started a high priority process at that point in time and decided that they were going to take their first clinics live.

The following September they did just that. Now they are rolling up their second set of clinics. We were so blessed to work with such a talented team. They blew us away. The integration worked seamlessly. They worked with their docs, they designed all their protocols. They’ve been an incredible partner and now Allscripts has been there three or four times to look at it. We’re talking to them about what they want to do moving forward to make it available to more of their customers.

The degree of success of it all caught me a little bit by surprise.  I’m not supposed to say that, you know what I mean? I asked them if they would come and tell people about it at HIMSS and I really didn’t know what they would say. I asked if we could come and do a video and here are the questions we’re going to ask you, just answer him honestly whatever you want to say.  When we got the raw video back, I was stunned. I couldn’t believe it. One of the top healthcare IT departments in the country was saying, “This allow us to see more patients. The integration was seamless, and our doctors love it.”  I mean who says that about clinical documentation? It usually takes more time and slows you down.

MN: Is physician documentation going to be your primary focus at HIMSS this year?

DL: The primary focus is presenting the physician documentation capabilities and we are having representatives from Phoenix Children’s and one other company in our booth showing their implementation of it.

We’ll be talking about our physician documentation tool, which is browser-based and modern technology. It can be integrated with just about anything. We don’t have to do it. It’s pretty easy to do it yourself. Doctors will see 20% to 30% more patients. They’re going love their documentation. It’s going to meet all your requirements for Meaningful Use, ICD-10, and any other quality measures you want. What more could they want out of clinical documentation?

MN: Perfect!

DL: They get all those, all the coded data so they can do all their population analysis. The reason we’re focusing on that issue rather than anything else is we have a really compelling story that can be told by somebody who’s done it.

MN: Last question, I know you usually have lots of prominent health IT folks playing Quipstar. Who’s lined up to play this year?

DL: I know Jacob Reider, the former deputy ONC Chair is playing. Also Gregory Moore of Geisinger Health System; Mike Miliard, the editor of Healthcare IT News, Dr. Lyle Berkowitz of Northwestern Memorial Healthcare and a couple more.

I hate doing it the same thing year after year. This will be our fourth year, but I really haven’t been able to figure out a better way to show that this software is real, that you can learn to use it 20 minutes. This year, one of the things I’m going to say is, “I want you to get 30 to 40 of your best friends. I want you to go any to any other booth and I want you to say, “Train us how to use your software in 15 minutes and let us sit here and play with it.”  It won’t happen.

So it’s a lot of time and energy and effort, but it really helps break through the clutter when people go, “Oh my God, they’re actually letting all these people use their software without supervision while they stand around.” It makes it real because what you see on the show floor is in the next release.

MN: Anything else you’d like to add?

DL: No, just that we wouldn’t have the success story at Phoenix Children’s if it wasn’t for Allscripts’ willingness to let them do it, to have the open architecture that allowed them to do it, and the incredible talent and dedication of the Phoenix staff. And, all the work that our people at Medicomp have done over the last four to five years make our technology so modern and easy. It was really a nice confluence of four or five things coming together all at once. I’m so thrilled that the folks at Phoenix are going to be at HIMSS to actually talk to people about what they did and how they did it.

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