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Power Shift

February 1, 1998
by Polly Schneider
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Jim Bradley has a mission to bring electronic commerce to the physician, a great need he saw as CIO at United HealthCare in Minneapolis. From his vantage point in one of the country’s most progressive cities for managed care, Bradley witnessed the onset of healthcare reform and the explosion of change in healthcare financing. At the same time, the Internet and Internet technologies emerged with much fanfare, and with them, the potential--in his view--to dramatically alter the way physicians practice medicine.

He had a challenging job with a rapidly growing managed care giant, an outstanding IS team, an industry he loved--yet he realized that providing powerful electronic tools to physicians was out of his reach working on the managed care side of the fence. So in 1995, he left United HealthCare to search for the answer, and one year ago, formed his own company, A believer in Internet and object-oriented technologies as the foundation for point-of-care, clinical information and connectivity, Bradley’s goal is to render a means for physicians to work from any location. He talks with Healthcare Informaticsabout the tidal wave of change enabling an overhaul of the way physicians work.

What made you leave a secure position and enter the risky world of software development?
What took me from United into the entrepreneurial world was really a fundamental shift that I saw happening with United’s efforts, particularly in the company’s merger with Metra Health. I felt that we weren’t going to be able to pay attention to what I saw was a growing need to address physicians at the point that decisions are being made in healthcare delivery. We felt that physicians ought to have automated tools to keep track of patient information so they could order the use of resources, if there was an intervention or alert that should occur at the point of the ordering process as opposed to after the fact. We believe we’re creating the tool set that allows a physician to automate this workflow process. The net result is he or she will practice smarter, more consistent medicine.

What is the potential for start-ups of physician automation?
We’re at the vortex of two revolutions. Physicians are under pressure like they never have been before, and are being recognized as key influencers. At the same time along comes all this new technology that solves so many issues that have been burdening practitioners. The time from the market and technology point of view is right. The question then becomes, is it crowded space out there?

We hear that five percent of physicians use an electronic medical record--we actually think it’s less than that. It represents a broad opportunity.

How is technology changing the way physicians work?
Physicians are feeling the need to make more informed clinical decisions, and to become more efficient. With more risk being shared with physician organizations, these better- informed decisions add up to better financial success. For payors as well, collaborating at the point of care provides a foundation for far superior medical management. It also moves medical management from a retrospective policing to a prospective collaboration.

How much of an impact will the Internet have on the business of healthcare?
Internet technology is founded on certain technical protocols for electronic communications. Those protocols today dominate most corporate and governmental networks, and they’re here to stay. The platform that we’re developing on is very tried and true. Now, how quickly will we, for example, make patient records available to a physician over the pure public Internet connection--I think we can debate that. Part of that will be how quickly people are comfortable with the tools that secure such information, how quickly we can manage the performance of that connection… there are any number of questions that still remain. It is inevitable that physicians are going to use these technologies to get the information they will need to make decisions. I think the world never goes back to the way it was.

One of the primary changes will be a shift in power. Today the payor, through contracts and retrospective tools, tends to try and manage reimbursement--to a certain extent, not well. This year most of the large payors have had major earnings surprises or disappointments. I think what you’ll see is risk-sharing with physicians. This technology enables a shift of power to those organizations that know physicians, or in some cases have physicians working for them, that are focused on the process of care delivery. When the thing settles down, the power will have shifted back to the physician.

Are performance, reliability, security and privacy true barriers to using the Internet?
Some of the concerns with the Internet today are justified. That’s not to say you can’t manage around them. Let’s take, for example, performance. If the typical experience of logging onto an ISP is you get a busy signal, and once you do get through you get a poor quality line and your modem is not even 28.8, and then you ask for a download of an MRI--I think I’ve just given you a recipe for absolute disaster. So I think you do have to use some common sense.

We have to pay attention to performance at the point of care. We’ve got to be getting near a second to display information. The only exception we can see to that is a physician on call, at home, it’s two o’clock in the morning and he wants to look at a scan, and he’s willing to wait 120 seconds to look at it rather than driving to the hospital.