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Showing Them the Evidence

May 26, 2011
by Mark Hagland
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Zynx Health Rides the Meaningful Use Wave
Scott Weingarten, M.D
Scott Weingarten, M.D.

It's natural that people working in healthcare would follow the trajectories of giant-sized IT vendor companies that are eating everything in their sight and making high-profile waves in the market. But what about once-small vendors whose core offerings are taking them places fast? The Los Angeles-based Zynx Health, founded in 1996 (and since 2004, a subsidiary of the Hearst Corp.), has lately seen its core product-evidence-based and consensus-based physician order sets-in demand as never before, given the forward evolution of the meaningful use process under the federal Health Information Technology for Economic and Clinical Health (HITECH) Act. For instance, a draft requirement under Stage 2 of meaningful use is for the use of evidence-based order sets (as of press time, the industry was still waiting for the final Stage 2 requirements to be issued); and the emergence of accountable care organizations under healthcare reform is adding yet another market opportunity.

IN MEDICINE, AS IN EVERY OTHER AREA, IF YOU HAVE THOUSANDS OF OPPORTUNITIES TO MAKE A MISTAKE, YOU WILL DEFINITELY MAKE A MISTAKE. -SCOTT WEINGARTEN, M.D.

In fact, as Zynx is one of two companies currently dominating the evidence-based order sets area (the other being ProVation Medical, a Minneapolis-based division of Wolters Kluwer), it is poised to capitalize tremendously on developments in the federal healthcare policy sphere. And with more than 1,700 contracts with hospitals and medical groups-a figure that is growing by the week-the shift towards evidence-based, automation-facilitated delivery of patient care is putting Zynx Health into a growth mode for the foreseeable future.

A considerable portion of the credit for Zynx's current market prospects must go to Scott Weingarten, M.D., the company's CEO and co-founder. Weingarten, an internal medicine physician by background, says the idea for the company emerged out of experiences he was having with his patients while still in clinical practice. “Like all other doctors, I went to school for a long time and thought that I was well-trained, and I cared deeply about each and every one of my patients. I certainly tried very hard, and worked very long hours,” he says. “But in medicine, as in every other area, if you have thousands of opportunities to make a mistake, you will definitely make a mistake.” Weingarten particularly recalls one situation, in which he neglected to perform a preventive care procedure that might have averted a particular problem for a patient. “Fortunately, that patient did OK,” he recalls, but it was primarily because of luck, and I said, we shouldn't have to rely on luck.”

Over time, Weingarten's concern over having made a mistake evolved forward in his mind into the idea for what became Zynx. He gathered a few colleagues together to begin to build a decision support solution based on culling evidence from the clinical literature and embedding it into electronic physician orders.

The timing of Weingarten and his colleagues turned out to be exquisite. The company's first significant go-lives, during the 2002-2003 period, coincided with an important “aha” moment in the industry, as leaders of patient care organizations who were trying to develop evidence-based order sets from scratch began to realize how incredibly time-consuming and resource-intensive the process of developing, maintaining, and updating such order sets could be. The rest, as they say, is healthcare IT history.

PHYSICIAN BUY-IN, AND MORE

Customers are very enthusiastic, as they are able to get physician buy-in for computerized physician order entry (CPOE) more easily when offering evidence-based order sets, and particularly when engaging their doctors in adapting and customizing those order sets to meet their organizations' individual concerns.

Robert Murphy, M.D., CMIO of the 11-hospital Memorial Hermann Health Care system, based in Houston, has been helping to lead his organization forward with CPOE through a rolling progression of go-lives (they are live with physician order entry in four hospitals house-wide, as well as in nine of their 11 hospitals' emergency departments, to date). As part of that process, he says, “We really make sure we prepare through clinical process and transformational work. Evidence-based care is a part of that transformation, and often requires a great deal of work with the clinical leaders and administrators. Zynx has been a critical element to help make us successful” in that ongoing effort, he says. “For us, the investment in Zynx was one involving a long-term commitment, because it's a fair amount of work to get started, to build the infrastructure to make it work with” the health system's core EHR. Based on work done so far, he reports, “We can now update our order sets in about a two- or three-week period.”

What's more, use of evidence-based order sets is a key component in clinical performance improvement, says Jeffrey Rose, M.D., vice president clinical excellence, informatics, and CMIO, at Ascension Health, the St. Louis-based health system with 79 hospitals in 20 states. “I believe that most things in both the acute-care and ambulatory settings begin with a physician's order,” Rose says. “As a result, if you influence how physicians order, you can influence how care is delivered. And if you do that based on evidence, the likelihood is that you're going to raise the bar for everyone practicing, narrowing variation in practice, and improving quality.”

With his company's customers having already generated more than 160,000 customized order sets and care plans, and the numbers increasing rapidly, Zynx's Weingarten says he's “very optimistic” going forward. In this area of healthcare IT, certainly, the sky seems to be the limit when it comes to growth opportunities in the next several years.

Healthcare Informatics 2011 June;28(6):54-55


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