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HIStalk Interviews Frank Naeymi-Rad, Chairman and CEO, Intelligent Medical Objects

May 29, 2013 Interviews 8 Comments

Frank Naeymi-Rad, PhD is chairman and CEO of Intelligent Medical Objects of Northbrook, IL.

5-29-2013 7-22-20 PM


Tell me about yourself and the company.

I received my computer science doctorate degree from Illinois Institute of Technology. My dissertation research work was in developing medical dictionaries that support electronic medical records, decision support, and information retrieval used at the point of care.

I got introduced to medical terminology when I was teaching classes to medical students, where I was directing academic, research, and administrative information services at the Chicago Medical School. These classes included use of computers for directed history and physical documentation, informatics workup, and concepts in medical artificial intelligence as senior electives.

During the senior elective setting, I wanted students to build knowledge for different decision support applications. The major task and challenge that we had developing knowledge for the decision support was standard terminology. Each system had its own dictionary. The systems we used were MEDAS, Dxplain, QMR, Knowledge Coupler, and Iliad. The medical students had to build knowledge for pattern recognition as well as rule-based decision support and application.

The knowledge created by students for a given diagnosis was then compared to knowledge within these expert systems for the same topic. The key learning objective was that everyone learned how the computers were used to make decisions and the results could be manipulated to reflect the new discoveries.

During that process, the most important aspect that came out was when we compared students’ patterns to other expert systems. It became clear that what was missing was standard medical terminology. This became the topic of my dissertation. It was really the concept of capturing and preserving the truth, what the source of truth about a given decision was and how the decision was made by the computer.

It was then necessary to reverse engineer the patterns back to the original form to explain why it led to the need to build a dictionary that students used to codify the rule. This allowed us to compare the pattern across multiple domains using the same foundation dictionaries. This led to my dissertation topic, which was a feature dictionary for clinical systems and electronic medical records.

The ultimate test was how the students’ knowledge would perform when interfaced to real patient data. Into the late 1980s and early 1990s, there were no coded electronic records. This led to the development of a history and physical documentation program on the Apple PowerBook for medical students. This program was expanded as a tool for second-year students as part of a supplement for the introduction to the clinical medicine class.

This program allowed students to develop comprehensive documentation for the history and physical exam. While the objective was to a develop a patient electronic record that could be used to test the student decision support pattern, instead it led to the creation of an electronic medical record which was used a the Cook County ER. IMO was created to help commercialize the product that was sold to Glaxo Wellcome, which at that time was called HealthMatic.

Later on, HealthMatic was sold to a company called A4 Sytems, and then A4 Systems sold its assets to Allscripts. The EMR that we developed at the medical school, with the help from many of the same IMO team developers working with me at the medical school, helped commercialize it. The current generation is called Allscripts Professional.

You can understand how the team who is working at IMO right now are key players in the industry. This is the same team from the medical school as well as the same team that developed the early clinical documentation for HealthMatic and medical content work for Glaxo Wellcome.

 

Describe how IMO’s product and the terminology works with EHRs.

Our flagship product is interface terminology. Our primary objective is to capture and preserve the clinical intent and then map that clinical intent — the truth — to their corresponding regulatory requirement. Interface terminology manages and maps between clinicians’ terms and the required regulatory code terminology like ICD-10 and Meaningful Use codes as well as reference terminology like SNOMED CT.

The way we have succeeded is that we have removed the overhead of making a clinician to be a coder. They can say what they want to say. We manage the code and mapping and help our EHR partners to capture and preserve the truth.

 

Who is your most significant competitor?

The competitors that I see are people who do not really understand the challenge of terminology and the importance of preserving the clinical intent. Fortunately and unfortunately for us, I think the knowledge base within the marketplace is growing. We need a dynamic model to respond to these changes as soon as possible.

We are very happy that we are able to help our partners meet regulatory standards. Adaption of standards is a very daunting task for many of our vendor partners. There has been a lot of movement in our space because most of the new regulatory standards require several new coding subsets.

We expect large and innovative competitors coming into the terminology space. What they are missing is the understanding of the electronic medical record and how terminology should be used within the electronic medical record. Having the EHR knowledge expertise gives a true edge to IMO’s team as the market moves from fee-for-service to fee-for-performance.

There are many competitors within the terminology space. We have competitors who are managing the coding for reimbursement and now have to also do clinical. We have competitors who sell you tools in order for you to manage the complex mapping for the coding within the clinical setting.

Terminology management is hard and tedious work. We have a unique group of knowledge workers and physicians because they are good at it and love doing it. Adding to that our technology team, with the understanding of the electronic medical record and how terminology is used within the electronic medical record, creates a major barrier for others to match the quality of our service delivery.

 

What parts of HITECH have caused both vendors and providers to seek you out as a company?

It’s compliance to the Meaningful Use requirement and making sure that they are able to manage the changes associated with Meaningful Use requirements. When you look at our portfolio of clients, they initially used us to enhance clinical searching and finding codes for reimbursement. I believe Meaningful Use is creating a unique challenge for them because it is moving the market from fee-for-service to fee-for-performance and that aspect of care creates a unique attribute and need of understanding the use of terminology within the state of care. Our interface terminology service is to make sure that the truth about clinical data is stored as expressed by the clinical team.

For example, when you’re on the same term within the assessment, it may have a different ICD-9 code versus that same term in the history section. Being able to have a concept-based architecture that manages this complexity allows for correct mapping to ICD-9 as well as to ICD-10 complex billing post-coordination, but also maps to SNOMED CT and other required Meaningful Use terminology subsets.

We take that complexity out. We manage that complexity within our tool set and then we deliver those to our client base, allowing their clinical user community intent to be preserved so we can also code for care.

 

A recent study found that IMO’s interface terminology can identify population health issues when paired with EHR data. What are the implications of what that study found?

The early studies that I did historically looked at finding the clinical truth. You really want to make sure that what clinicians are saying is preserved in their words and that the data being collected is following guidance dictated by the clinical team. The data collection service needs to provide terms that reflect the clinician intent in its original form.

We as a company have been very fortunate to be trusted by and permitted to serve one important population of our society, and that’s the clinician. We believe clinicians are under massive pressure to do their job through primitive electronic documentation services that do not speak their language.

I worked at the medical school for 12 years and I observed students going through all of the different stages of medical training. I understand and appreciate the difficulties physicians have to go through in their medical training. The knowledge base learned as part of their training is their most important tool to make them master problem solvers. Capturing and preserving their clinical intent is always the best card we have in understanding exactly what is wrong with the patient and even when a physician is making a wrong assumption.

Our interface terminology allows the truth to be preserved and not distorted by coding optimization templates or services. Preserving the physician intent is responsible for the success of this study, identifying 99 percent plus patients correctly in this publication. By empowering the clinical team and using IMO interface terminology, we are going to have a near perfect understanding of our patients at risk.

 

What’s your perception of the state of readiness for ICD-10 transition and what impact this is going to have on providers?

The impact for our vendor partners is going to be nominal because we knew going from 14,000 ICD-9 codes to 90,000 ICD-10 codes will be a massive transformation for many EHR vendors. But for our clients, it’s different because we started distributing ICD-10 mapping last year and we have been working with them to deliver their point of service solution.

As part of our support for ICD-10 CM, PCS, and MU 2, we are expanding our terminology foundations by 3,000-plus concepts and as many as 30,000 interface terms per month. What that really means is that our clients are able to manage all these lexical variants long before the regulatory deadlines for ICD-10 and MU2.

 

ICD-10 is just a different mapping for you and you allow customers to create or maintain their own in addition to what you supply, correct?

Correct. We don’t allow them to manage their own mapping outside of our mapping because we really believe in this crowd-based or wiki-based model. It creates transparency that our clients have the correct standard mapping. Our mapping obviously grows and changes faster because of this transparent model and medical knowledge changes. We have developed sophisticated tools and workflow to manage all the mapping ourselves. 

Normally when people go to IMO we move them to what we call a migration process to make sure that everybody standardizes their local dictionaries to the same datasets. If there is an error in our mapping or if there is an inconsistency, we can always correct it quickly in the next release. But if we allow local mapping, it really can violate some of the principles that we have. We don’t prevent them from having local variation and mapping. They can have their own lexicons if they want to, but we don’t take responsibility for those maps and will not distribute to other sites.

 

If they have like a certain phrase that they use locally, they can build it into the equivalent of a dictionary so that even if it’s not commonly used they can still understand?

They could still understand, but they should normally be asking to send it to us. If it matches our editorial policies, we distribute to everybody else. Everybody else would use that as well.

But I think it is important for them to be cognizant of the bigger picture because we really believe that this is the grand opportunity to really make standards like SNOMED and ICD-10 to truly work, because if we map correctly to them, at least these standard coding systems and these regulatory coding systems become more valuable for our future. Obviously they will be changing as well. If people start mapping their own local terms, there’s no way to be able to validate or review that and then challenge it.

 

That would be unusual, right?

That’s unfortunately not true. There is always going to be new concepts requested. We have term request workflow to incorporate new valid terms in our next release within six weeks and to have everything made available to our community. There are going to be some domains that most likely our clients would need to have their own local terminology, but terminology as it relates to clinicians’ decisions, like the problem list, the past medical history, assessment, and plan, which are foundations for clinical team decision making and requires billing codes that need to be codified correctly.

 

Has ICD-10 changed your business substantially so that people are seeking you out for a painless solution?

I don’t believe that ICD-10 alone is the issue. The reason our product has been sought out is EHR adoption and usability by clinicians. I really do believe that clinicians are commanders-in-chief when it comes down to fighting diseases and planning treatments. Clinicians are the key stakeholders as we transform from fee-for-service to fee-for-performance. They must be in control.

What our vendors do is use IMO as a source of truth for tracking clinician commands and orders, preserving the patient problem list and differential diagnosis using their dictation into the electronic medical record. ICD-10 is just a byproduct that the EHR vendors needed to comply to. You could say the usability is how the value of IMO is realized when complying with ICD-10, SNOMED CT, and within a few years ICD-11 are byproducts.

 

What research and development is the company working on?

We have been done with ICD-10 for quite a while. Our biggest research and development is invested in tools to manage our growth that we are facing right now. We are becoming the foundation technology innovation platform for many of our EHR partners. What that really means is that we have worked very, very hard to make sure to marry technology with terminology.

We have a cloud-based solution we call our portal service that allows the physicians to search the way they want to search. We can then rank order the search results in context of the domain that they’re searching for. This new technology allows us to do what we call just-in-time vocabulary releases. We have 60 releases a year total and for diagnostic and procedures 10 releases each. Using the portal eliminates many of the overheads associated with local dictionary normalization.

But these 60 releases a year historically without our technology would be impossible to adopt with import/export technologies. In most cases it takes maybe some times two or three months for people to deploy updates or in many cases people only deploy the regulatory requirements rather than updating on a monthly basis. By having this portal technology available, allowing the marriage of technology and terminology, we are able to make these datasets available at the point of service for our clients almost instantaneously after delivery of our service.

This has really increased our product usage. We have over 350,000 physician users and over 2,500 hospitals using our product. Many of our vendors are moving to our portal as their terminology innovation platform. One comment that we get from our clients is that they know when IMO is not there. That’s by far the biggest compliment that we could get.

 

What does the physician see differently if they’re using a system that uses IMO versus one that doesn’t?

They can find what they’re looking for and the description that they want to assign to the patient’s problem in the right lexical context and within the top three to five term list results.

 

Is that time-saving for them?

Absolutely. We are seeing up to three minutes for complex visits and as much as 30 seconds per common visit. The most valuable is a more granular problem list and orders in their clinical speak. We have not measured the IMO factor in follow-up time saving. We hope to work with our partners and perform independent research on the effects of having IMO in time and quality.

 

Where do you see the company going in the next five years?

Where we are going is to empower our vendor partners to deliver the best EHR solutions in the marketplace. We believe that our technology and removing this complexity associated with its managing terminology makes our partners stronger. They can do more innovations for clinician documentation. That is the most important thing to us.

We believe we want to participate in the success of the care delivery organizations in our country. I believe that as clinicians become empowered in the clinical setting and take over the responsibility of delivery of care using IMO-enabled EHRs, they and care delivery organizations will see a reward based on the quality of care they’re delivering. We would be a key part of this transformation for our vendor partners, their clients, and users.

As we allow our vendor partners to innovate, many of IMO’s portfolio terminology-enabled assets that we have been developing in the last 20 years will become more valuable at the front line and will allow our partners to build a positive distance between their offerings and others not using IMO. We hope to grow with our vendor partners to eventually make the US destination healthcare through new innovations in medical terminology-enabled technology. This is the way it should be.

 

Do you have any final thoughts?

Thank you for your time and opportunity to present IMO to your audience. We are honored with the finding of the independent study result showing that when using IMO interface terminology, nearly perfect agreement is achieved with greater than 99 percent in a peer-reviewed CDC publication. This article was truly energizing for me and the IMO team working in this space of dictionaries and terminology innovation to capture clinicians’ intent. It seems that finally after all these years we can actually see the fruit of our work, and that is really a good feeling.

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Currently there are "8 comments" on this Article:

  1. I work at IMO, and this interview provides a great overview of what we do. One thing worth adding is that I am often asked whether we see ourselves as a “replacement” for standardized terminologies, e.g. SNOMED. The emphatic answer is no. We see ourselves as a bridge between the clinician and standardized terminologies, By offering clinician-friendly terms mapped “under the hood” to SNOMED, LOINC, ICD-9-CM, ICD-10-CM, CPT-4, and more, we facilitate capture of structured clinical information at the point of care so that the standard terminologies can be better leveraged (for clinical decision support, reporting, population management, billing, etc.). “Capture once, use many times in many contexts”, so to speak.

  2. I have known Dr Naeymi -rad for over 17 years. His vision has not changed in all that time. When most EMR’s saw nothing wrong with forcing Doctors to use Plain ICD – 9 and CPT descriptors, he kept pressing for letting the MD use the clinical terms and let his vocabulary tool map to the billing and snomed terminology. This simple but powerful concept has made all the EMR’s that use IMO much more physician friendly and is much more accurate in capturing clinical intent.

    My Hospital was an early adopter to Enteprise EMR’s. We had the “cadillac” of the EMR’s which is as much as I will say about its identity . It used basic ICD-9 for problem list look up. I recall many a time, I would have a complex patient in the ICU that i had spent 45 minutes with and then I would write a detailed note. Sometimes at the end of all that time spent, I would be asked by the program to put in a diagnostic code. I would try a few terms that were relevant and would get nothing that fit or things like “Aortic insufficiency associated with syphilis”. Frustrated by this, and not willing to spend any more time with it getting nowhere, I elected to always put in “Acne” as the reason they were in the ICU. This “rage against the machine” was a statement that I was not going to waste my time trying to find out how someone else would describe the illnesses that I learned in years of training and experiences. One of my favorite diagnoses I could find if I was looking for hyperchosterolemia was “pure hypercholesterolemia” a term that I never quite understood.

    After IMO was implemented, I could find everything i needed in one try, and I never had to put someone with ACNE in the ICU again!

  3. By providing easy-to-use tools to map clinician descriptions to standardized terminology, IMO provides an incredibly valuable service. The recent CDC study is a wonderful example. While there is a great deal of talk about using EHR data to characterize patients automatically (without the need for tedious and expensive manual chart reviews), it takes the type of standardized terminology mapping that IMO provides to ensure that this process is accurate across a large number of clinicians who may use slightly different language to describe the same condition. In essence, it allows standardization of patient descriptions without forcing every clinician to use exactly the same terminology – which is impractical. This capability can enable the full potential of electronic medical records to actually be achieved.

  4. Frank, I love your vision of a semantic highway, and your deep understanding of the foundational role that terminology plays in achieving our semantic interoperability objectives.

    One of my favorite books is The Phantom Tollbooth, by Norton Juster. It’s a story of Milo, a lost little boy, who one day comes home from school to find a tollbooth and little car in his room. He gets in the car, and drives through the tollbooth, entering a wondrous land where he embarks on a search for rhyme and reason. Along the way, he comes to a town, Dictionopolis, where he encounters five wizards. Whenever one of the wizards says something, the other wizards repeat it, but say it in a different way. Milo (apparently a junior informaticist, and probably one of your disciples) goes on to say: [“Well, then,” said Milo, not understanding why each one said the same thing in a slightly different way, “wouldn’t it be simpler to use just one? It certainly would make more sense.”].

    Imagine having a decision support engine, and trying to evoke rules when every piece of information that comes in is structured differently! I love Milo’s quote because it reminds me that standards are a prerequisite for functionality, and that terminology standards are at the foundation of so many of our EHR functional requirements – for quality reporting, for decision support, etc.

    I’m a big supporter of any technology that makes it easier for folks to adopt standards – and I see the work you’re doing at IMO as being a significant enabler. Thanks again Frank for helping to drive us along the semantic highway.

  5. Dr. Dolin, I have to admit this is a great analogy you used here. It is so exciting to see that together we can allow intellectually- trained clinicians communicate their art, science and experience delivering best care, and in the background through the standard we can share and compare their discoveries with their colleagues through the semantic highway.

  6. When you learn new languages, it deepens your understanding of what people mean when they talk. Words and syntax tell the story . IMO’s semantic highway accomplishes that same outcome by unifying our collective understanding of what is wrong with a patient, which is the start of the treatment decisions and communications process. It is an amazing change from communicating clinical issues in billing codes, to using a clinical language we all learned in medical school. The beauty of the IMO terminology story is: I now understand what you mean.

    IMO is a story so fundamental to clinical operations, that it should be a mandatory component in all we do through EHRs and HIEs.

  7. I am delighted with the opportunity to add to Frank’s excellent historical perspective of Intelligent Medical Objects. As a cofounder of IMO and current board member, I am continually impressed at how far Frank has taken IMO over the last decade.
    Our relationship began at the Chicago medical school in 1985. At that time, I was a Chief of Medicine at the North Chicago VA and Frank was director of the Computer Science Department at the Chicago Medical School. My informatics interest was to build a computerized patient record that could talk to medical expert systems. Our vision and indeed our dream then was to provide clinicians with real-time clinical decision support that would increase the quality of care and eventually reduce costs. Frank and I continue to share that dream and we see IMO as a critical part of that journey.
    Central to the ability of the Computerized Patient Record (CPR) to talk to medical expert systems was a consistent and coherent medical vocabulary. This was the focus of Frank’s PhD research and laid the groundwork for current IMO products. What sometimes gets lost in the discussion are the other significant contributions to the informatics medical literature that grew out of this project. Under the expert guidance of Dr. Martha Evans, Chairman of the Computer Science Department at The Illinois Institute of Technology, and Frank’s PhD advisor, the research that laid the foundation for IMO also produced over 50 peer reviewed articles in the medical literature around medical expert systems, vocabulary management, electronic health records and computers in medical education. In addition, these research endeavors produced at least 12 PhD’s. Frank has continued to place a high premium on education and has configured a relationship with the Science and Technology Departments at the University of Illinois to continue research in these important areas.







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