With HITECH making physician acceptance of CPOE more important than ever, getting the user interface right is paramount. Unfortunately, most HIS vendors have spent the last few decades optimizing their products to capture transaction and store data. Thus, physicians are often left wanting when trying to navigate green screens using function keys. To address this need, those same HIS vendors have gone back to the drawing board in an effort to make the docs happy. But third-party vendors have also been working to fill the breech, including PatientKeeper. To learn more about how this vendor is making core HIS offerings palatable for physicians, Healthcare Informatics Editor-in-Chief Anthony Guerra recently caught up with CEO Paul Brient.
GUERRA: From my vantage point, PatientKeeper seems to occupy a unique position. I don’t quickly come up with three to four companies that do what you do. Obviously, you compete with the core HIS vendors because you’re supplementing what seems to be a deficiency in those systems. Would you describe it that way? Tell me a little bit about the hole you’re filling in the market.
BRIENT: That’s really a good question, and I think your observation is exactly correct. We actually have a (PowerPoint) slide that we use when talking about the competitive landscape for us, we look at each of our applications and there are a variety of point-solution vendors for each one. My observation’s always, “Well, we compete with all of them, but they don’t compete with each other.” We really look at the world a little bit differently than just about anyone has, and our shtick is very much around how you automate a physician, how do you get a physician technology that they will adopt, embrace, love, use, and that’ll make a difference for them.
There are people in the core HIS vendors who look at us as a competitor. They say, “We have a hospital information system, and we have a place for physicians to go look at the stuff that’s in it. If PatientKeeper provides a way for physicians to look at information, they must be competing with us.”
We take a different view. Our view is that looking at the results from one hospital information system is only a very small piece of what physicians do. We all know the challenges that the HIS systems have had with physician adoption, and people always say, “Well, gee, the user interface isn’t good,” or this isn’t good or that isn’t good. The concept that you can automate a physician at the same time you’re automating the individual hospital — which might be just one of the hospitals or physician practices where they do business — is just flawed. If you want to automate a physician, let’s automate what that person does. If I want to find you a technology to automate your day and I said, “Well, I’m going to take on 15 percent of it because that’s what I do,” how is that going to produce a great result for you?
GUERRA: Right. So you automate the doctors’ workflow. You make life easier for them, but the doctors aren’t typically buying your solution. It’s the hospitals that want to strengthen that relationship with their physicians. Is that accurate?
BRIENT: Yes. About 70 percent of our customers — the people that buy — are hospitals, 30 percent are physicians themselves. So some physicians do buy our solution. But in many cases, in most cases, when hospitals buy our software, they buy it because they want to make their physicians happy with technology. No one goes out and buys a hospital information system to make the doctors happy, but they buy our system to make the doctors happy.
GUERRA: Having a nicer CPOE interface can give competitive advantage to one hospital over another.
BRIENT: Correct. And there’s a whole bunch of workflow that physicians have, like signing out coverage and even knowing the phone numbers of the people they need to call. I mean, silly stuff in some ways, plus real deep stuff like charge entry and accessing results from their EMR, if they have one. Those things are really outside anything that a HIS would want to tackle.
GUERRA: The 30 percent of your customers that are docs — are these very, very large practices or do you scale down to the smallest of the small?
BRIENT: We do both. The ones that buy direct are generally large practices. That’s the way our company is setup, but we partner with both GE and Sage and they resell our products to small practices. So we actually have some solo physicians using our technology. From a business model perspective, that’s not something we could do directly, just because of cost issues, but our software scales nicely. We run it out of a hosting center and have turnkey integration to both GE’s Centricity Physician Office as well as the Sage Intergy product.
GUERRA: You’re obviously partnering with some ambulatory vendors there, where does your product end and the electronic medical record begin? What’s the difference?
BRIENT: Well, in some ways an ambulatory EMR is very similar to the HIS discussion we just had. So for some physicians, take a dermatologist for example, they only go to their office, they should just buy an EMR and they don’t really need us, right? All their workflow is there because they go to their office every day, and that’s where they work. You get physicians, surgeons, cardiologists, or orthopedics, all the physicians that go to hospitals and also their practice, well now going into an EMR makes matters even more complex, because I’ve got an EMR and let’s say I practice in two different hospitals. So now, I’ve got two HIS systems that are different. I’ve got my EMR, I’ve got probably three or four different kinds of PACS systems I need to deal with, maybe an ED system or two. So I’ve got all the different systems that have some of my patient data in them. There’s no place that I can consolidate a patient list.
GUERRA: How much can these physicians handle financially? I wonder if there is frustration that getting an EMR doesn’t mean they are going to function smoothly. You’re saying they may also need a product like yours.
BRIENT: Well, at some level you probably have to look at the world before and after ARRA. Before ARRA, most doctors were not purchasing EMRs, really small physicians were not. In the ARRA world, you get your EMR mostly for free, so that’s helpful; physicians like that price point a lot. We haven’t experienced a lot of frustration there. It’s more of a ‘thank God.’ The EMRs, people understand why they’re buying them for the most part. Our product, they buy for two reasons: one is it saves them time — doctors love to save time — and it makes them more money, specifically our charge capture application, because they’re losing charges on the inpatient side almost universally. So it’s really more about the benefits.
GUERRA: I would imagine you need a tremendous amount of physician engagement. Do you have focus groups and panels and plenty of doctors that work for you? How do you make sure you’re continually refining that interface for what physicians need?
BRIENT: We do all of the above. One of the things that’s neat about the physicians that work for us is they almost all still practice medicine. We put a lot of stock in what they have to say, but the people that we care about the most — in terms of feedback — are the physicians that are taking care of patients and using our software. And so, before we build any product, we work with at least two sites for co-development. We have formal physician usability panels and we go through an iterative agile methodology from a software-development perspective. We work very closely with the physicians in mock workflows, take those observations and walk them through the system to get that real physician feedback. We do that because, even if you’re a doctor, if you come work for software company, you get stale and you don’t really appreciate what’s going in direct patient care. So I probably spend half of my week every week out in the hospitals running around the country talking to as many doctors that are using our software, or want to use our software, as possible. We’ve got product managers and formal product advisory boards comprised of physicians that provide us feedback, because it is so critical. The whole thing falls apart if the software’s too hard to use or it’s not solving the problems of the doctors. Since the use of our system is always voluntary, people would stop using it very fast.
GUERRA: They would just cut you out and go back to their HIS?
BRIENT: Yes. I mean, this is supposed to be better. If it isn’t, they won’t use it. So the fact that we have 15,000 physicians using the system every day and, in about four months, that’ll be about 30,000, is a testament to the fact that we’re solving a problem that isn’t currently solved.
GUERRA: You do a lot of physician engagement. What is your advice to CIOs on how they can better engage physicians?
BRIENT: Well, let me give you my opinion since you asked. If you look at physicians today, you have to put yourself in their shoes, right? They feel they are being asked to do more and more and more, get paid less and less and less. They are also blamed for a lot of things that aren’t right in the healthcare equation. And then you enter things like CPOE for example, and the first thing they do is ask all doctors to change the way they practice medicine. That’s a pretty difficult pill to swallow. Physicians believe that they practice medicine well today, rightly or wrongly, that’s their belief, and a lot of the changes that we ask physicians to make, as part of CPOE projects, are fairly arbitrary things about the way they practice, not evidence-based things, because most of the things they do aren’t driven directly by evidence but relatively arbitrary physician reference things. So why take so long to get them to agree with everything? Probably not the right way to engage a doctor, right?
A better way to engage a doctor is, “I am here to make your life better. I’m not here to turn you into a clerk. I am here to help you take care of more patients, better, faster.” It benefits everybody, and therefore you’ve got to be very, very careful about what you ask them to change, and how you ask them to change. And so if you just think about any change management exercise — and adopting technology is change management, even if it changed for the better, it’s still change management — this is a tough one. You’re essentially saying, “Come to this three-day training session, change the way you practice medicine, do this thing that is going to slow you down.” You should be saying, “Let’s tailor the system to the way you practice. Let’s focus on a few key change management issues that we’ve all bought into, let’s provide you extra assistance or support.” If you do that, I think you’ll have a lot more success.