The healthcare IT world is vast, with a tremendous range not only of sizes of vendor companies, but also niches and types of vendors. For every mega-vendor, there are literally dozens of smaller players that often make up for what they lack in size with outsized impact based on unusual technology or a unique vision or combination of characteristics.
In addition to our profiles of the very large vendor firms our readers consider the most interesting, this year we once again offer glimpses of companies that are making their mark both in terms of success and with regard to unique footprints or approaches in the industry. Below, please find nine capsule profiles of “up and comer” vendors whose trajectories you'll want to watch going forward.
dbMotion: Approaching semantic interoperability
Bill Fera, M.D., is very much a physician on the move. As vice president of medical technologies and medical director of interoperability at the vast 20-hospital University of Pittsburgh Medical Center (UPMC) health system, Fera is constantly shuttling around working out clinical informatics issues with his clinician, IT, and executive colleagues. He certainly doesn't have time to waste on navel-gazing or on any technology that doesn't take him and his colleagues where they want to go. But Fera considers his work over the past three years on semantic interoperability-the technological foundation to allow for unified, integrated views of patient information across multiple platforms-to be some of the most important of his career. And that work has all come about through UPMC's partnership with dbMotion, Pittsburgh, Pa., which continues to occupy a virtually unique place in the clinical IT galaxy as a facilitator of IT that really makes a difference in busy physicians' work-lives.
“I think they're obviously way ahead of the curve in terms of talking about semantic interoperability,” says the 39-year-old Fera of the founders and leaders of dbMotion. “A lot of people are still thinking that interoperability is connecting an EMR and a lab; or aggregation. But the dbMotion people are about not only gathering information, but presenting it in a cohesive framework, so that you as a clinician can actually benefit from it.” In fact, the U.S. launch of semantic interoperability emerged out of intensive work that Fera did with clinical informaticists from dbMotion during late 2007 and into 2008, and which has continued to evolve forward since then. The result? Physicians at any UPMC facility can bring up patient imaging exams, labs, and medications from any UPMC-affiliated facility, via a single-screen view, anywhere across the system, improving patient safety, clinician workflow, and efficiency, all at once. The hard work that birthed this innovation involved Fera's sitting down over several weeks with dbMotion informaticists to stitch together the underlying semantic, or vocabulary, connectivity from across numerous clinical systems.
The vision for all of this came out of the mind of Ziv Ofek, the founder and CTO of dbMotion. Ofek, a modest technology whiz with a love of healthcare and clinicians, says, “For so many years, we only focused on how to put data into machines-EMR, CPOE, etc.-to try to define processes, mechanisms, and approaches. Around five or six years ago, people started to realize that just putting the data into machines wasn't the entire solution; I can put data into machines, but I can't take it out or use it efficiently. And people started talking about putting the patient into the center, but it was really just rhetoric. Because if the patient is in the center, we need to focus on the people who are treating the patient, and their processes.” As a result, a journey that began with Ofek's part-time project to help a physician in Israel optimize her access to data became a decade-long, ongoing quest to create a better clinician experience when it comes to accessing and using patient information at the point of care.
dbMotion is still a relatively small company, with five current hospital and health system customers in the U.S. (including the UPMC health system, which has a minority ownership stake in the vendor), plus the Canadian province of Manitoba, as well as a hospital network in Brussels, Belgium, and a 14-hospital system and two other hospital organizations in Israel. But Ofek and his colleagues have no doubt that the company will continue to gain traction, as more and more hospital and health system leaders here in the U.S., as well as globally, come to understand the critical role that semantic interoperability will play in creating true interoperability of systems, and in optimizing clinician workflow.
CPM Resource Center: evidence-based care in allied health
The Grand Rapids, Mich.-based CPM Resource Center (CPMRC), an Elsevier company, has been quietly making waves in the industry by helping hospital organizations drill down to the level of allied health professional clinical documentation and care plans. Indeed, says Michelle Troseth, R.N., CPMRC's executive vice president and chief professional practice officer, the firm has grown 400 percent in the past few years, with nearly 300 hospitals in its collaborative consortium (essentially the company's nationwide user group). CPMRC customer organizations have busily been drilling down several levels, using clinical IT tools to support non-physician care. For example, clinician leaders at Abington (Pa.) Memorial Hospital, last year implemented CPMRC's core software program, which has brought evidence-based guidelines and clinical decision support to nursing and to the respiratory care, physical therapy, and dietary areas of that hospital.
Bringing clinical IT support to non-physician pieces of the hospital care puzzle is something that comes naturally to CPMRC executives, most of whom have R.N. or other allied health backgrounds. But there's more to the story, of course. Asked what makes CPMRC different, Troseth says, “I know it sounds cliché, but we're mission-driven. Our mission is to co-create the best places to give and receive acute care, and everything we do is with intention. And that's what makes us different, and it's why our clients value what we do with them.”
What's going to happen for CPMRC (a division of the Amsterdam, Netherlands-based Elsevier, which acquired CPMRC from Eclipsys in December 2007 for $25 million) in the next few years? “I think we're going to be discovered,” she says, “Because we can't waste money or time anymore in healthcare; and I think we'll be looked at as a national model to learn from, because our professional practice framework is embedded in the electronic health record.”
A-Life Medical: Prepared for ICD-10
For A-Life Medical, a provider of computer-assisted coding products and services for the healthcare industry, the transition to ICD-10 could turn out to be quite a game-changer.
Things are already busy; the San Diego-based company processes more than five million transactions monthly and provides coding services to more than 40,000 physicians nationwide. “If you think about it, there are 1.2 billion patient visits per year, and each visit requires medical codes for reimbursement,” says president and CEO Jaye Connolly, who has been with the company since 2005. The reimbursement process, she says, is manual, time-consuming and error-prone. “And to add more insult to injury, we've got ICD-10 coming, which is going to expand the coding from 20,000 codes to 155,000 codes.” As a result, A-Life is going to become “a need to have. We were a nice to have,” she says.
The company's ultimate goal, Connolly says, is to improve the accuracy, efficiency and speed of the medical coding process. Using its patented Natural Language Processing technology, LifeCode, A-Life interprets electronic transcribed patient encounters through its online data center, which are then coded for reimbursement purposes. “That's our core technology,” she notes. “We take medical transcription and other types of documentation and push it through our LifeCode engine, and it can go through and decipher what is written and apply it to coding.”
And while the company is currently focused on coding and ICD-10, another area on its radar is data mining, what Connolly believes is “the next big thing.” A-Life acts as a data repository, using its tools to transform all of the data within a health organization into knowledge for meaningful use, such as core measures and clinical pathways. This can improve efficiency and productivity, reduce overtime and cut down on use of external auditors, she adds. “When I talk to CFOs and others in the health information management department, they say, ‘we have to start working smarter, not harder.’ And that's what our technology does. Right now, they have all these queries and reports, and what they really want is for someone to give them their core measures.”
And while A-Life has been in existence since 1996, the company seems to have a renewed vigor when it comes to the health IT market. A-Life Hospital, its subsidiary, recently inked a deal to provide facility outpatient-based, computer-assisted coding services at five of OhioHealth's facilities, with a possibility for future expansion.
“We're very excited,” says Connolly. “We're finally getting the interest we always knew needed to be there.”
PatientKeeper : Workflow first
For PatientKeeper, improving workflow has always been a top priority. The Boston-based company's suite of applications works to bring together data from systems across the hospital and community to provide a single, actionable view of the patient. “Our focus as a company is to help physicians in terms of improving workflow and saving them time by providing applications that work for them,” says CEO Paul Brient.
And what physicians and hospitals need now more than ever, particularly with the passing of ARRA-HITECH, is reliable, easy-to-use CPOE and physician documentation solutions. “With these two applications being pushed to the forefront, the stakes for automating physician workflow have been raised pretty significantly,” he says. As a result, PatientKeeper has “dramatically accelerated” its computerized physician order entry (CPOE) solution. The initial roll-out at Mercy Medical Center in Cedar Rapids, Iowa, is scheduled to go live by the end of 2010.
Unlike many CPOE systems on the market, PatientKeeper's product is targeted toward community hospitals, according to Brient. “Most of them were built in academic institutions. Our focus is on the independent, solo physicians who spend part of their time at a hospital.” The goal is to enable physicians to interact with orders the way they're used to, while also providing the decision support they might get from a large vendor.
Everything, he says, comes back to improving workflow - putting data at the physicians' fingertips and making it as easy as possible to provide quality patient care. “Our strategy has really been around connecting the community; giving physicians all the information about the patient that they need to make the right decisions,” he says. With its line of products, PatientKeeper is able to connect all of the physician practices, hospitals, reference labs and imaging centers in the community, creating what he calls a true “information exchange.”
As the industry surges ahead and ARRA-HITECH takes shape, Brient says PatientKeeper's top priorities will be to attract more physicians, and to expand the footprint of its CPOE solution. All the while, the company aims to keep an eye on the most important constituents in healthcare reform - those on the front lines. “Sometimes we lose sight of the fact that physicians ultimately control 95 to 100 percent of the healthcare costs in the country. That's where we need to be focused.”
Voalté : Alert and on call
When Rob Campbell, a veteran of the IT industry, first launched Voalté, a software solutions provider based in Sarasota, Fla., he adopted a unique approach. The CEO asked a nurse what she felt the company needed to do become a great vendor in her eyes, and she said, “Just don't give me anything else to do.” Campbell took those words to heart, and made it a key focus in all of Voalté's planning to try to improve the product without adding to nurses' already long list of tasks.
Voalté, which opened its doors in December 2009, provides point-of-care solutions that let users to send and receive text messages, make voice calls, and receive critical care alarms on smartphone devices. Its products are designed specifically for nurse teams to help streamline communication and improve patient outcomes.
“We think we have an opportunity to redefine communications at the point of care,” says Campbell. Voalté One, which combines voice, alarms, and text messaging on a single platform, was first made available for the Apple iPhone. Soon after Voalté One infrastructure was installed on the Blackberry, and plans are in place for an iPad application.
The Voalté One application was first piloted at Sarasota Memorial Hospital in the summer of 2009. The company was able to fine-tune the product based on feedback from nurses and other staff, who gave the product high marks.
That was important, says Campbell. “Although we sell to hospitals, our user is the nurse on the floor who's working a 12-hour shift. So rather than starting with IT, we start with the nurse.”
A strong focus on the needs of the nursing community is just one aspect that he says gives Voalté an edge over its more seasoned competition. “We're not dragging around 20 years of old thinking, and we're not dragging a 10-year-old legacy system that we're highly invested in,” says Campbell. “We have the latitude to be a lot more disruptive - and it involves our product, the user experience, our pricing and service models, and everything else. We love being in the position we're in.”
Phreesia
In 2005, Chaim Indig and Evan Roberts started Phreesia in a 400-square-foot apartment in New York City with the goal of simplifying one of healthcare's most essential functions - gathering patient information when a patient checks in to the physician office. Their vision? To revolutionize the traditional patient check-in process by eliminating the paper clipboard and automating patient intake right in the waiting room using an electronic tablet. That tablet, they envisioned, would gather not only patient demographic and financial information but clinical history. This information would be used to enhance the patient-doctor conversation, which would soon follow in the exam room.
“Evan and I want to improve healthcare, and the first step in achieving that goal is improving the information collected from patients,” says Indig. “If providers are collecting poor data, it's garbage in, garbage out.”
The company has grown exponentially since those early days in Chaim's apartment. Currently headquartered in New York City with operational support across the U.S. and Ontario, Phreesia has grown to 90 employees. The tablet itself, called a PhreesiaPad, was redesigned from its early days to a friendly, orange touchscreen. Specifically designed and tested to be non-intimidating to even the most technophobic patient, the tablet allows patients to tap a screen rather than fill out paper forms on a clipboard. Once that's done, Phreesia automatically verifies insurance eligibility and benefits.
With the provider's bottom line in mind, the PhreesiaPad also automatically tells the patient if there are any outstanding payments or co-pays, and accepts payments using a card swipe even before the visit. By handing out the PhreesiaPad, physicians get legible documentation, automatic eligibility and benefits verification and payments.
In addition, electronic signatures are collected on all practice policies and HIPAA contracts. Returning patients verify rather than re-enter their information - something that makes user adoption high. “Patients love this,” says Indig. “They know their information is secure and private, and Phreesia saves them time when they return to the doctor's office, and office staff love us because they don't have to sort through illegible forms.” The collected data can be viewed anywhere via secure logins provided to designated employees.
Phreesia continues to grow - and continues to innovate. In 2008 Phreesia launched its Spanish version to better serve a larger population. Phreesia's most recent innovation is the ability to collect patient payments at the front-end. “People prefer to control their own payments,” says Indig. “We give patients the convenience of self-service, while ensuring that practices collect the money they are owed.”
Aspen Advisors: Optimizing value
Aspen Advisors, a consulting company based in Minneapolis, took great care in choosing its name. Dan Coate, the firm's principal, elaborates on the symbolism behind the unusual choice of name for an HIT company. “We chose the name Aspen because we wanted to model our organization after a stunning grove of aspen trees living in harmony with its surroundings.”
It's the characteristics of those trees that form the vision behind Aspen Advisors, Coate says. Aspens are tough and resilient, the trees propagate by roots and one seedling can grow into an interconnected colony, and each tree in the colony will then exhibit synchronous behavior such as coming into leaf at the same time.
Interesting - but how does that relate to healthcare? The vision of that aspen grove is the vision behind all its HIT engagements, and according to Dan Herman, managing principal, Aspen Advisors' mission is simple: “To optimize the value of our clients' healthcare information technology investments.”
Established in 2006, the firm has grown significantly year over year, and currently has 45 associates working in major healthcare systems like The Cleveland Clinic, UPMC Health System and Virtua Health, Inc., to name a few.
Herman says that Aspen's team of associates is highly skilled in all aspects of healthcare technology and understands the complexities of healthcare operational processes, the vendor landscape, the political realities and the importance of projects that are executed successfully - the first time. “Every client is critical to us,” he says.
What makes Aspen so special, Herman adds, are its team members, many of whom left larger professional services firms like Healthia/Ingenix, First Consulting/CSC, and DeLoitte Consulting to be part of Aspen's unique culture, unobstructed by corporate bureaucracy.
“A key focus area for Aspen is building a culture that offers the best consultants in the industry an opportunity for professional growth and personal challenge,” says Herman. “Aspen's core values - client interests first, healthcare industry focus, professional integrity and continual growth - are deeply held in the organization.”
While continuing to maintain a strong base in the United States, Aspen's vision extends globally, and the company recently completed a project that included the selection, design and implementation of multiple systems at a new state-of-the-art specialty hospital located in Botswana, Africa. The fully-networked, paperless and filmless facility, which opened in January is currently serving patients in Botswana who were previously obliged to travel to South Africa or farther for quality care.
Source88: Audacious pricing structure
What would motivate one of the leading CIOs in the country to leave his position as CIO of a major healthcare system? For Lindsey Jarrell, former senior vice president and CIO of BayCare Health System in Tampa, Fla., it was the desire to share his experience and help other, often struggling hospitals begin to deal with the difficulties of an EMR implementation. That element in itself might not be too unusual-but what sets Source88 apart was its commitment to do it for the unprecedented price of $88 an hour, or about half what more established companies charge.
In 2009, Jarrell teamed up with Scot Kizer, a prominent healthcare attorney specializing in technology licensing and healthcare law. According to Jarrell, Source88 uses the latest in open source technology, web-based applications and other innovation to drive its costs down. “It's simple, really,” says Jarrell. “We're a bunch of innovative, forward-thinking folks who understand that the relationship between information, infrastructure and people is key. And we know that it must be managed, organized and understood by everyone across the entire spectrum of caring.”
Jarrell says he worked in and around healthcare consulting for 15 years and in the last four, as BayCare's CIO, he was able to sit on the other side of the table and utilize many consulting services. “My experience tells me that there is a lot of room in the market for high quality consulting firms,” says Jarrell. “The industry needs a firm that participates in honest communication, impeccable work ethic and thought leadership, all at a very reasonable rate.”
The company is off to a fast start, and is already working with three large health systems within its first four months, with two more large health systems on the horizon. “By the end of the year we anticipate being at 30 full-time employed consultants,” says Jarrell.
Source88's innovative pricing structure depends on its team members who, Jarrell says, are expertly trained to immerse themselves in complex, detailed engagements. The company's offerings include implementation of the major HIS vendors in addition to project administration, staff augmentation, building and testing, go-live support and training.
In order to consistently support and maintain those values/promises, it is important, Jarrell adds, that Source88 not be a 1099 staffing company. “Instead, what we are is a really great team of energetic professionals dedicated to re-inventing the healthcare implementation consulting business.”
Anvita Health: Insights via analytics
The fact that the San Diego-based Anvita Health was founded by physicians offers one clue to its market cachet. The company, created in 2000, offers clinical analytics that can analyze clinical data in real time to identify drug safety problems, patient safety gaps, and other pressing issues in patient care organizations. Its analytical engine provides alerts that take the clinical decision support concept to a new level, drawing out inferences that can lead to more accurate diagnoses by clinicians working at the point of care. Meanwhile, on the payer side, the company also offers health insurers the chance to identify high-risk members early on.
Using its real-time-available capabilities, the young company has created such win-wins as developing a resource-optimization program that has helped physicians in the physician organization at the Beth Israel Deaconess Medical Center (BIDMC) in Boston harness an advanced analytics solution to BIDMC's CPOE system, to decrease inappropriate diagnostic imaging ordering, while helping that organization to reach 100 percent of its pay-for-performance goals with its largest health plan payer.
“Understanding what's going on with a population, down to the specific patient, we think is the most exciting thing in healthcare,” says CEO Richard Noffsinger. “And we want to add insight, knowledge, and actionable information to the user, whether the end-user patient, the doctor, the insurer, whoever it is, who might need that information.”
As for why this young start-up is spreading its wings across multiple spheres (hospitals and health systems, health insurers, pharmacy benefit management companies), Noffsinger says that, “Because of how complex and byzantine the industry is, I don't think you can be a player if you decide to only play in one sphere. And to have an impact, you can't have 10, 20 knowledge bases, you have to look at it from a multi-view perspective. It's hard, but it's the right place to be.”
Healthcare Informatics 2010 June;27(6):58-64
