Tell us a little bit about yourself and Medicomp.
I’ve worked in the EHR industry for almost 20 years in various roles, from product to marketing, commercialization, innovation, business development and corporate strategy. The industry looks a lot different now than it did in the late 90s and early 2000s when I was getting started. However, I’ve always seen Medicomp Systems as a knowledge and technology leader in the industry.
Medicomp pushes the healthcare industry towards better data and tools to help clinicians at the point of care, and to help the system work better as a whole through enabling interoperability and better structured data. Medicomp is a middleware vendor that provides a clinical engine designed to help clinicians find the data they need when they need it and ease documentation without getting in the way of patient care. I discovered them in 1997 when I was working part-time for an EHR vendor who thereafter licensed their first software development kit (SDK), MEDCIN. It was very impressive even then, and as you can imagine the engine, Medicomp’s tools and the technology have come an enormous way since then.
What’s the number one thing healthcare organizations can do to improve usability in their organization?
I strongly believe that tools that enable structured data to be better used, found and just “work” properly inside EHR systems, will drive better outcomes, clinician satisfaction and ultimately make the system work better. I think for far too long systems focused only on the revenue side of things, and overlooked clinician usability and the architecture that’s needed to for a good system overall.
Having good, clean structured data is part of it, but you also need an engine and clinical knowledgebase that ties everything together and enables coding, compliance, and diagnostic views so you’re not jumping all over a patient chart trying to find information. How is a doc supposed to find the last three A1c values for a patient who is walking in that may have visited other facilities? How does that correlate to other indicators related to their diagnosis? That question in the paper or even current EHR world could lead a clinician down a road for quite a while trying to find information. However, a clinical engine can serve that data to them in real time, while also allowing them to document the visit, report quality measures and input information for billing. But many systems haven’t invested in that type of technology yet, because they have focused historically on payment and fighting the certification and compliance battle.
If you had a magic wand and could fix any big problem in healthcare, what would it be? Why isn’t it getting fixed already?
Personally, I have always been partial to the interoperability problem. It’s not been fixed yet because there are issues with the coding standards or lack thereof, issues with standardization of messaging and APIs, issues with incentives like “who’s going to pay for interoperability and how does everyone get a piece of the pie”, but also bigger issues like “what are you going to do with the data once you get it and are responsible for it”. These, for the most part are big issues that still haven’t been resolved.
I have unrealistic thoughts about other coding standards that could have been utilized to make interoperability easier, but given where we are at today, I think that the biggest driver to get us to an interoperable world is to “pay for it”. If you want the faucets to open, you need to create financial models that enable that. Models where clearinghouses can make money, data warehousers can make money, and all other relevant parties. We also have to make sure the costs of inevitable issues with data sharing are not prohibitive.
Right now, there’s really no incentive for organizations of any size to share the data besides the “stick” of data blocking litigation. You really need to add a large carrot to the mix. All that being said, there’s a gigantic open question of “what do you do with the tsunami of data when you get it”? How do you make sense of it and how do you find what you need, especially if you’re responsible for receiving it. That’s where organizations will have to find technology partners to make sense of that data.
Why do doctors largely hate EHR software?
It largely has to do with the genesis of EHR companies. Most of them came from the revenue cycle management world, and the driver of purchasing has always been, “how can we ensure we get the money”. That drove vendors to make very efficient billing software, but there was no upside to building usable EHR products.
For a long time, it was totally acceptable to have a scheduling system and a beefed-up word processor and call that an EHR. Add an e-prescription module to that and you really had a full-suite. (I’m exaggerating a bit here, but really it wasn’t far off from that.) We have come quite a ways from there, but I do think that a lot of the vendors haven’t spent the time, effort and investment required to follow the way clinicians think and work. We need to give clinicians the information they need and get out of their way, but make all the compliance stuff just “work” in the background. That’s what they want and need.
What’s holding back healthcare from gleaning value from all the health data out there?
The first barrier is the “getting-the-data-in” problem. And, that’s because if you have garbage in, you’re going to get garbage out. Doctors are or were taught to take minimal notes (often illegible) and that was perfectly fine. How do you translate that to the digital world? You can’t. So instead we have a mix of typed, dictated, scribed, point-and-click, template-based approaches, which give you mostly unstructured text. That’s not very helpful if you want to do stuff with data on the other side whether it’s billing, compliance reporting, analytics, interoperability or just about anything.
The thing is, that’s not going to go away. Clinicians are not going to stop dictating, so the first issue becomes what is the best combination of technologies and approaches to get the highest amount of clean, structured data into your system, as reliably as possible. Once you do that, you can use clinical intelligence engines, analytics tools and other technology to get what you want out of it.
Where are you seeing some hope when it comes to healthcare interoperability?
Having the government finally take a hard line on data blocking is a good first step. After that, the payment systems really need to be the next big move. How do you incentivize interoperability all across the healthcare ecosystem, and how can you create opportunities for great business models?
There are certainly pockets of data sharing starting to happen, but it’s sort of like where the EMR world was back in the early 2000s before the government poured billions of dollars into the market to gain adoption. You have seen companies like CareSync emerge, but they weren’t able to hold onto their business model. Telehealth becoming a sustainable business and COVID in general have highlighted the need for interoperability, so I do think that it will help to continue the push for interoperability, but ultimately there will need to be an injection of incentive to make it viable long term and to fuel the innovation needed to solve the problem. If they figured it out in payment systems and pharmacy world – where all the money is, we can figure it out in the rest of health data as well.
What can the health IT community do to help you and Medicomp?
Up until this point, clinician usability, good clinical data, and the engines and tools needed to drive that in EHRs wasn’t a huge focal point for healthcare systems. The last few years seem to have changed that with the move towards value-based payment and the usability and burnout crisis facing clinicians today. I would strongly encourage anyone in those organizations to take a look at technologies like what Medicomp provides to enable better usability in EHR products, to help clinicians find what they need when they need it, follow their train of thought, document without getting in their way, and have all the compliance, interoperability and billing stuff “just work in the background” so they can focus on the patient.
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