HIStalk Interviews Terry Edwards, CEO, PerfectServe

Terrell “Terry” Edwards is president and CEO of PerfectServe of Knoxville, TN.

Tell me about yourself and the company.

I started PerfectServe in the late 1990s. Prior to that, I was with a company called Voicetel, which was one of the early pioneers in the interactive voice messaging space. While I was there, I identified needs to improve communications in the healthcare industry, starting with the physician practice. All of our early development was working with physicians and independent practices, group practices around the country. We began to grow the company. 

In 2005, the practice opportunity led into the hospital in the acute care space. We entered that market in 2005 and that’s been driving PerfectServe’s growth ever since. In terms of where we are today, we have 80 hospitals under contract. We’re serving doctors in about 12,000 practices in the country. There are more than 30,000 physicians on the platform today. We’ve had good growth.

In the old days, hospital people would  have a list of pager numbers for doctors or would call their answering service. How has that changed?

There’s more variability today than there was. We’ve got not only pagers, we’ve got secure messaging apps, we’ve got websites where we can go to get messages to people. We still have a plethora of answering services, call centers, and hospital switchboards. It’s all this variability that results in the inefficiency in communications overall, between clinicians especially.

You mobile app does just about everything—doctor-to-doctor calls, calls to patients that mask the originating number, and secure messaging. How are doctors using all those options?

The mobile app for us is just one interface into the platform. It’s designed for the doctors to do a number of different tasks, some of which you mentioned. 

The real core value that PerfectServe provides is enabling more accurate and reliable processes. We’re taking out a lot of the variability, some like we described earlier, and as it relates to different contact methods or different contact modalities. There are also process rules that tend to be based around clinical work groups, whether it be three cardiologists over here or maybe it’s a STEMI team or a stroke team or a group of internal medicine doctors. 

For every one of these little groups of practicing clinicians, there are a host of if-then type rules to determine just whom to get a communication to.  For example, if we need to contact a hospitalist, we may need to know whether this is about a new admission or an established inpatient because the clinician who receives that communication is likely to be different. If it’s an inpatient, it’s which hospitalist is caring for this patient right now at this moment in time. It’s those things that add another layer of complexity. 

PerfectServe’s strength is in building those routing algorithms into software so that we eliminate the need for the initiator to know who to contact. We’ll route the communication automatically to the appropriate provider. That’s how clinicians are using PerfectServe. It’s about connecting with the right person. 

If I’m a doctor, it’s about making sure that I’m getting the calls and messages I’m supposed to receive when I’m supposed to receive them. That mobile app that you see enables me to do some things like change my call schedule, change my contact modality, follow up with a patient, access messages securely, and access colleagues.

You’re saving time and improving efficiency, but what’s the patient benefit or the satisfaction benefit to the clinician?

We’re taking waste out of the communication cycle time. This is important because in every hospital, every day, hundreds — or if it’s a large hospital, thousands — of times a day, nurses and other hospital staff or other clinicians are reaching out to doctors in the course of providing care. Some of them are in the hospital. Many of them are not. Sometimes it’s not just a doctor, it’s another member of the care team, such as a nurse practitioner. 

We’ve done a number of studies — time motion studies, process flows — and PerfectServe has proven to reduce the subsequent or repeat call attempts by 81 percent and cut the nurse-to-physician communication cycle time by more than two-thirds. In fact, we did one study at the Orange Coast Memorial Medical Center in Orange County, California where we took the average nurse-to-physician contact time from 45 minutes down to 14. 

What that means is that clinicians are able to intervene more quickly because these are all care-related communications. They will range everywhere in urgency to “I need you right now, a patient could be coding” to “this is something that’s important, you probably need to know about it by tomorrow morning so you can take action when you come in to round.” These things have an impact on patient care risks in terms of reducing sentinel events and can have an impact on throughput. We’ve had clients measure improvements in ED throughput, impact on length of stay, reduction in code blue events, and many, many areas of hospital operations.

Does your system help close that loop where you page someone, you never get a call back, and the ball gets dropped?

It depends. Oftentimes there may need to be multiple contact methods deployed. Just due to the increased concern around HIPAA, we’ve had a higher adoption of secure messaging as a primary means of contact when a message is involved versus a live phone call. But secure messaging is reliant on our mobile app, which means we’re dependent on the wireless networks, whether it be Wi-Fi or the cellular. While we’ve got much better cellular coverage and Wi-Fi coverage than we had five or 10 years ago, we still have areas where the coverage might be somewhat spotty. 

As we’re working with our clients and our physician end users, we will try to get them to adopt fail-safe processes. In a fail-safe process, we might be notifying one or multiple wireless devices, so we could be sending a push notification out via Apple’s push notification services, for example, but if the message is not retrieved within a certain time period, we might escalate to a pager, which a doctor still may need to carry based on where he or she goes in the course of practicing medicine. That still may be the most reliable device for them.

Most people would say that texting and paging aren’t HIPAA-accepted ways to communicate PHI. Do you think hospitals are worried about that?

There’s a lot of confusion in the market related to HIPAA compliance and secure texting. It stems from not a real good understanding of what the laws say. There’s nothing in HIPAA regulations that says sending a text message is a violation. What the laws say is that you as an organization, as a covered entity, need to conduct a risk assessment. Based on that risk assessment of where PHI is being transmitted and floating around in your organization, you need to establish effective policies and then implement those policies using various tools and technologies. Then monitor your performance over time. 

There’s like this spotlight that’s  being directed towards just text messaging. But when we look at clinical communications, it’s like a floodlight. What we see is that there’s PHI floating in a lot of different places via a lot of different means. That’s the part that I think the industry doesn’t fully understand right now. We’re doing our part to educate people. We’re beginning to see people understand that there’s more to that issue than just texting.

How are you finding the quality of the average hospital’s Wi-Fi?

Because we are able to work with a number of different modalities, we’re device agnostic from that standpoint. But it is interesting. We see a variety of different qualities of Wi-Fi infrastructure and we also hear a variety of different things. Wherein some organizations, the IT group might say that the Wi-Fi network in its organization is really robust, and then you talk to some of the physicians and they’ll tell you exactly the opposite. So it’s kind of spotty. I wouldn’t say universally across the board that the industry has overall a real robust infrastructure. I would still say that it’s fairly spotty and organization dependent.

One of your selling points is you don’t just work within the four walls.

That’s right. PerfectServe is really about improving clinical communication processes. That’s the heart of what we’re about doing.

I talked about getting into the acute care space. The core application that’s driven the growth there is improving the hospital-to-doctor communication process, because it’s one that’s filled with a lot of complexity. As we come into an organization, we’re about enabling the clinical leaders to enact and drive a process change across the entire medical staff. We have the technology to do that, but we also have the implementation services to make sure the technologies are implemented properly. In other words, the algorithms are built based on the workflows of the different groups and the physician preferences. We’re also able to share best practices because we’ve learned so much working with doctors around the country. 

We’ve also have the support services to help them maintain that improvement over time. Our client advisors work with our customers to then build on those improvements. That’s really key, because a lot of the problems that organizations might want to solve — whether it be say around a consult process, critical test results communication, or ED patient notification — many of these problems can’t be fixed because the underlying process infrastructure is broken. When we deploy, we’re coming in and fixing that underlying process. Once you have it fixed and you have everybody on a common platform, you can then build on it, and that’s where the client advisors come in. 

The other piece is that the applications work not only in the acute space, but they work in the pre- and the post-acute space as well. We may have, for example, a group of hospitalists and a group of referring primary care doctors. We’re able to manage communications between the two of them, between the nurses and the hospitalists, among the primary care doctors and their patients, as well as maybe the skilled nursing facilities or the long-term care facilities where those doctors are also seeing patients. It’s just one system that the doctors have to manage the communications that flow from all these different sources. That’s a real strength of the organization. We’re able to do it via platform that enables them to achieve their HIPAA compliance standards as well.

The company’s been around 16 years and you’ve been there the whole time. What are the biggest lessons you’ve learned about building a company?

Oh, gosh, there are a bunch. I think I’m going to write a book one of these days. There really are many. There are lessons from just general things of starting up any kind of business to working with venture capitalists in raising money and the challenges you go through as you take a company through its various stages of growth. Organizations change significantly when you’re going from $1 million to $5 million in revenue, and then from 5 to 10, and 10 on to 20. The fact that I’ve been able to go through all those various stages has been quite an experience. 

Just selling into hospitals is tough. It takes time to get traction. You’ve got to be persistent. You have to be patient. I love working in healthcare because I enjoy the people. Most of the people that we get to work with — the doctors, the nurses, the executives running hospitals — really want to do the right thing. That’s what we’re here to help them do. But it’s been a lot of fun at the same time.