HIStalk Interviews John Loyack, Thomson Reuters

John Loyack is director of product management for the healthcare division of Thomson Reuters.

Tell me about Thomson Reuters Healthcare and what you do there.

Thomson Reuters Healthcare is the healthcare and science business of Thomson Reuters. Within that business, we have a variety of business units. The three on the healthcare side are our payer business, management decision support, and clinical decision support.

The clinical decision support business is what you might be most familiar with. It’s a number of different offerings that you loop through to a number of acquisitions through the years, but the Micromedex business is probably the largest portion. Another important element of that business was MercuryMD, which was acquired in 2006 and now referred to as Clinical Xpert Navigator.

I’m the director of product management. I oversee the Clinical Xpert Navigator suite of products.

You mentioned the MercuryMD acquisition. What motivated the company to make that acquisition and what’s been done with the products since then?

I think the motivation there was to embed the evidence that Micromedex had available even further into a clinician’s workflow. Pharmacists, nurses, and physicians were very familiar with using Micromedex products. It is a very well-known brand and has been available for years, but it was one of the things that were obviously separate from clinical workflow.

I think the acquisition of MercuryMD provided a pretty strong answer for that, or at least answers the question of how we further embed the clinical evidence that we know clinical staff are using into their workflow. It’s one of our most recent releases. Pharmacy Xpert is our first introduction on what we refer to internally as our Intelligent Evidence suite of offerings. It’s all based on the Clinical Xpert Navigator platform.

There weren’t many CPOE users in 2006 when the acquisition went through. Now that clinicians are interacting directly with systems, it must be easier to present that decision support and clinical evidence.

It’s true, but providing real-time access and patient data for a variety of clinical staff is just an amazingly important driver for this. It’s something that we hear from users even today — that being able to give their clinical staff access to the right information at the right time remains a critical, critical element that helps them avoid drug events and helps them improve performance in a number of different ways.

I remember MercuryMD being the highest-ranked product in KLAS for years, going back nine or10 years ago. How would you characterize the competitive landscape in which it plays and why the scores have always been so high for what is now the Clinical Xpert product?

Mobile patient data systems were MercuryMD’s sweet spot. Providing a variety of clinicians with access to mobile patient data, making it very intuitive and easy to use, and also, very importantly, something that was a predictable and replicable implementation process — something that we could do over and over again regardless of what type of infrastructure the hospital had.

Even though we see lots of standardization today, one of the reasons we’ve been able to maintain this position is the fact that every hospital we deal with has a very different infrastructure. They’re using different vendors. Even within the hospital’s walls, they may be using one vendor for the ADT system and using a different vendor for the pharmacy. Or maybe there’s been an acquisition and Hospital A has acquired Hospital B and one’s using Meditech and one’s using Siemens.

Being able to provide a bridge over top of that, which also addresses one of the major pain points of physicians, is something that MercuryMD and our Clinical Xpert specialize in. That offering alone and our ability to do that constantly over and over again, and being able to go in and say that we can implement the solution in 8-10 weeks and actually delivering on that, is what led to those KLAS results. That hasn’t changed for us, so even now we see hospitals coming to us to say that they’ve decided to move or standardize with this HIS vendor or that one, and we’re very happy to continue to work with them.

I like to think that we have a pretty good relationship with the HIS vendors. We’re providing something that, from the competitive perspective, not all of them offer. Its technology has increased in a number of different ways, whether we’re talking about the speeds of networks or the computing power of devices, but it is something that I think we, along with just a handful of other vendors, are able to offer today. We’ve been able to maintain that position with KLAS by coming through time and time again in terms of the implementation process.

If I remember right, in the old days, the product ran on synched Palms. I would imagine that the iPhone and the iPad have made mobile application strategy completely different than what it was then. How do you think that’s going to play out as far as how your development efforts will be focused with those new tools for clinicians to use?

You’re taking me for a stroll down memory lane. Our first offering did not have a desktop element at all. In 2000, when we first came out with the MData Enterprise System — which was the MercuryMD product offering — that was something that ran on the Palm OS only. It wasn’t until 2002 that we introduced what at the time it was Pocket PC, but then Windows Mobile.

In 2006, we moved over to BlackBerry.  We’ve got a number of sites that are very happily standardizing on the Research In Motion infrastructure and devices today, but we’re also happy to recently announce that we’ve moved on to iPhone as well. Android is clearly part of our roadmap. It’s something that we are working on now and we’ll keep everyone up to speed on our progress with that.

I think by moving in that direction and by keeping up with what the market is asking for, that’s one of the things that allow us to maintain the position that we’re in and continue to show continued value by keeping up with all this. It’s not easy. You could imagine just on those different operating systems that I just mentioned. I haven’t even given any consideration to all the tablets that have been introduced, or the different web browsers that might be used, but those are the other things that we keep up on as well.

Speaking of the iOS in general, we’re very pleased to put our solution over there. I think the results are going to show for themselves. Our clients are thrilled that we’re able to introduce something that runs on the iPhone, the iPod Touch, as well as the iPad. It’s not just one device that we’re moving to. We’re actually able to, as we move from one operating system to the next, keep up with a number of different devices.

When you look at both the increase in demand because of the iPhone, iPad and iPod Touch applications, and also what people are trying to do with Meaningful Use to be prepared, how do you see those playing together and affecting your business?

I think we’re seeing a very positive affect. Thomson Reuters just issued a statement recently on how we support Meaningful Use in general.

This actually might be a good segue into one of the other things that we’ve done with the legacy MercuryMD product line, but the Clinical Xpert Navigator product suite as well.  We’ve taken a look at a number of the specific Meaningful Use objectives and we’re moving down a path to certify a number of our offerings. I think the most important from my perspective is the CareFocus offering, which is a part of the Clinical Xpert Navigator suite.

Our plan is to certify to support core objectives to implement the clinical decision support rules related to a high-priority hospital condition, as well as giving hospitals the ability to track compliance with that rule. It is something that I think from a mobile perspective, the core offering is still one that’s resonating within the market, but we’ve also moved significantly beyond that by introducing our CareFocus offering.

These two offerings, Clinical Xpert Navigator and CareFocus, are providing us with a foundation for the future of the Thomson Reuters clinical decision support business by giving us our foundation that will allow us to introduce what we’re referring to as our Intelligent Evidence product line as well.

I noticed that in hospital reports about use of the CareFocus system, which I would characterize as a patient surveillance system, some of your users have claimed that they had reduced patient mortality by identifying high-risk patients and then suggesting or offering interventions to clinicians in real time. How important is the real-time aspect of that, and have traditional clinical systems vendors developed something similar?

I certainly hope I don’t come across as dramatic, but it is a question of life and death. When you’re giving someone access to important, constantly-changing information about a patient, giving them access to something that is as close to real time as you possibly can is critical. That’s the kind of thing that our sites, our clients, have seen that has led to the success stories that they’re seeing.

In the past, perhaps you had a critical care response team or a critical assessment team that was ultimately looking at a patient and going through information manually and trying to judge it. A lot of times, we were hearing from some of our clients that it was coming down to a judgment call. Folks were going in, and based on their experience, making a judgment on a patient. Certainly, it’s not something that allows you to predict 100% of the time the true situation with the patient, but if you’re doing that in combination with real-time access to patients, I think that’s a really powerful combination.

By giving users the ability to essentially pull the needles out of a haystack, they can say, “I’m a part of a critical assessment team and these are the five that I need to be aware of right now. These are the five that may potentially crash. One of them recently saw a temperature spike, so I need to go give them the attention they need.”

I think the other element that’s important here is not only is it the surveillance, not only is it the real-time element, but we’re giving them something that’s accessible on a mobile device. We’re giving them something that they can access on their BlackBerry and on their iPhone, so now they’re able to go to the point of care and review those results, or they’re checking out for the day and there was something about that one patient that I wasn’t quite sure about. Now a lab result just called in and I can call back to my partner and ask them to take a look at that patient because something’s just changed and I want to make them aware of it. Without a mobile aspect, without a real-time element there, you wouldn’t be able to react in the time that really is required.

I mentioned the announcement of Pharmacy Xpert, the clinical intelligence dashboard for pharmacists. I know you have some folks that are already using it. Tell me how they’re using it and what the results have been.

I don’t think we’re quite at the point where we’re seeing the results pour in, but we do have a number of sites that are using it.  Shall I give you a description of the product overall?

Sure.

The elements that we’ve been talking about so far — Clinical Xpert Navigator and that platform — that ability to integrate into the hospital’s information system and pull data for disparate systems, that’s the core platform combined with the real-time surveillance solution provided by CareFocus. Those two elements, those two components provide the platform for that.

Built on top of that for the very first time, we have integrated Micromedex content, so things like the DrugDex database, DiseaseDex, Drug, and IV Index. We have some profiles that have been built as a part of CareFocus by our editorial staff — our Knowledge Development Team in our Denver office – who have created pharmacy-specific profiles that are an important element of that as well.

Then we introduced a number of pharmacy applications on top of that where the design actually supports pharmacy decision support. It links into the hospital information system. It provides access to the Micromedex content that pharmacists are used to using. To take things a step further, we’ve introduced a number of calculators that are a part of that. Features and benefits that improve the overall pharmacy workflow and provide the total solution combining all those things together.

It sounds like the focus is going to be real-time information and then either mobile access or push-type information. Where do you take the product line from here?

We have a Patient Xpert offering that is something that’s essentially providing access to patient education from any HIS we’re working with. Offerings like our CareNotes offering — that’s another part of the Micromedex suite. We have a pediatric offering that’s under development.

We have a number of things going on in 2011 that will take advantage of that single, consolidation platform that is complimentary to all the EMR/EHR platforms, but something that addresses a variety of different clinical decision support needs. We can do that through a combination of workflow solutions, mobile solutions, and real-time surveillance combined with the evidence that Micromedex has been well known for.

The mHealth market is pretty big, but if you look at just the part of it that affects physicians practicing in hospitals in the United States, what’s your big-picture view of where you see that whole segment going?

I can promise you it is going to be a lot more mobile. We’re reaching a point where some of the research estimates I’ve seen show that we’re going to be in the 90th percentile in terms of physicians using smart phones or mobile devices or a combination of mobile device and mobile health applications just over the next few years.

In the early days of this business, we were very excitedly seeing numbers — and this goes back to 2001-2002 — that said by 2006 we would see 50-some-percent of penetration of mobile devices being used by clinicians, predominantly physicians. It’s just becoming a more and more mobile world. I think that is something that we are very happily looking forward to and beyond that.

I saw a press release from another vendor recently that talked about the iPad’s impact on healthcare and how healthcare alone was I think, the third-ranked industry that was embracing the iPad and using it in very specific ways today. That’s something that I see — healthcare and mobility are two areas that have gone hand in hand for years and will continue to do so.

Final thoughts?

I think being able to provide one patient platform is something that will allow us to reach many, many users. When I think about the base of users that use our solutions, it’s certainly not just physicians – it’s also nurses and pharmacists. Pharmacists tend to be some of our power users. Certainly physicians, of course, but even beyond that, case managers, care managers, and a number of different folks throughout the hospitals that all have access to this type of solution and tell us what an impact it’s having.

As a part of one of our recent releases of CareFocus last year, we introduced the ability to provide alerting functionality. Or, if one of your CareFocus profiles returned new results, users would have the ability to be alerted by e-mail or text notification. That anyone subscribing to a particular list would be told that a targeted patient had been identified.

We continue to take things that step further. That’s something that has introduced us to even newer audiences. We have folks even within the IT department who were supporting all this and rolling this out to folks who are now some of our user base as well.

It’s been a very interesting ride. I can certainly say that it’s an industry that has been a pleasure to watch grow over the last 10 years or so. There’s still room to grow, which makes it exciting. There are a lot of good things going on.