HIStalk Innovator Showcase – Logical Progression 6/3/11

Company name: Logical Progression
Address: 125 Edinburgh Drive, Suite 210, Cary, NC 27511
Web address: www.logicalink.com
Telephone: 919.655.1970
Year founded: 2005
FTEs: 8

Elevator pitch
Logical Ink is a tablet-based documentation software solution that helps healthcare organizations improve their documentation and replace paper-based workflows with interactive, mobile, pen/touch-friendly electronic forms.

Business and product summary
Our core competency is providing healthcare organizations a patient and provider-friendly way to capture documentation in a mobile setting. We’ve been focused on the pains providers are having with the adoption of electronic medical records and the pains hospitals are having with eliminating paper in patient-centric settings such as registration and consents. Traditional approaches such as desktop and Web-based software have a miserable track record of success because of a number of factors. We address this with years of research, guidance from a number of physicians/providers in the industry, and a balance of technologies: our interactive forms platform, digital ink, handwriting/voice recognition, mobile tablet devices and sophisticated integration with existing clinical systems.

We provide a simple, monthly subscription pricing model that is based on the number of forms you submit through our document portal.

Who is your target customer?
Hospitals and medium to large clinics.

What customer problem do you solve?
We help hospitals fill the gaps in their EMR and more easily transition to electronic medical records with a provider- and patient-friendly solution. We eliminate paper forms while introducing eforms intelligence to validate at the point of care, capture clean documentation, feed the completed documents to the enterprise content management (no more manual scanning/indexing) and feed the captured discrete data to the clinical repository.

Who are your competitors?
Topaz SigPad solutions, Digital Pen solutions like Shareable Ink, Salar, Phreesia are all in our space (patient/clinical documentation and patient check-in) and doing good things. But paper and the status quo (traditional approaches to the EMR interface) are our biggest competitors.

Why are you better than your competitors?
In short, our technology, our approach (pen + tablet), and our people. We offer things you can’t do on paper, sig pads or digital pen: interactive forms with video playback, image capture and annotation, colored ink for emphasis, zoom in/out, in-place editing/erasing, drop-down lists, dynamically hidden form sections based on answers (e.g., mark pregnancy question as read-only/hidden if patient is male), dynamic form content (populate informed consent risks based on selected procedure), and popup instructions/tooltips.

Real-time validation at the point of care for missing dates, signatures, and values. We can lock down parts of a document based on security roles. We provide real-time integration with the EMR or clinical repository via HL7/ODBC to keep demographics, vitals, medications, allergies and orders current in the documentation. We’re active in CFR Part 11 compliance because of our work in clinical trials.

We are the only vendor focused on using tablets (Windows, iPad, Android) and pen-based input (along with traditional keyboard and voice). That means no paper and no wires so providers can remain bedside. We have over 30 years combined experience with enterprise eforms and mobile technologies. We’re experts in everything tablet.

Pitch video created specifically for this Showcase

Customer interview (the HIM manager for a large, prestigious academic medical center)

What problems have you solved using the Logical Ink technology and what has been the overall impact on the hospital?

As we were making the move to a fully electronic health record, we did an assessment of all of our documents within the record. We realized that we had several types of documents that our major systems could not support. The documents were in different care settings and completed by different role groups, but they all had a common denominator – they were documents that required a patient signature. Some of those documents were being scanned, but we knew that this was an interim step and were looking for something that could truly move us from a paper to an electronic record. 

We were additionally challenged with a highly decentralized environment where our clinicians have offices in several locations throughout the campus (or the state). When we we made changes to forms based on policy or regulatory requirements, it was very difficult to ensure that we had appropriate version control. Inevitably someone would still be using an old version of a form.

Finally, we wanted to make sure that documents were available when they were needed. Our environment meant that forms were sent via interoffice mail or faxed to the correct office after being completed. This inevitably led to delays in availability which led to bottlenecks in our workflow. 

The initial feedback has been quite positive from both the front end clinicians and the back office staff. The technology is easy to use and mimics paper. The output is crisp, clear, and the patients seem to love it. The decision support has been very helpful in ensuring that documents are completed before they are filed in our repository

If you were talking to a peer from another hospital, what would you say about your experience with Logical Progression?

The Logical Ink team has been great. From the start, they were constantly thinking about solutions to our concerns. We chose the procedure consent as our document to pilot. One of the key issues that we needed to resolve was how to provide our physicians with the flexibility and freedom to complete the document as they felt was appropriate while maintaining structure around document classification and content. Logical Ink worked with us to provide an innovative solution to the issue that made our physicians, our IT department, and HIS happy. They are still developing ways to innovate within our project parameters, the most recent example is embedding a video into a form to assist with patient education.

How would you complete this sentence in summarizing for them: "I would recommend that you take a look at Logical Ink under these circumstances:”

I would recommend that you take a look at Logical Ink if you need a flexible solution to complete your EHR migration which is capable of capturing patient signatures, handwriting, and integrating multimedia.

An interview with Chris Joyce, founder and president of Logical Progression

Tell me how your solution is better than digital pens.

We have really embraced a paperless forms platform that’s more interactive than the forms platform that you’d get with digital pen. We do share a lot of the natural user experience with writing your notes in the margins, capturing discrete data, just the familiarity that the physicians and the patients would have immediately when they see the interface. But obviously, when we put our forms on the tablet, we’re paperless, there are no wires attached, so that’s the immediate thing you notice.

Once you’re completing a form, we provide validation at the point of care. The forms platform will highlight required fields that have to be signed or filled out. If you try to save a form and you’ve got incomplete data, it will tell you there at the point of care, “The patient forgot to sign this,” or, “They forgot to date this” and you can correct it on the spot. You’re not having to wait until you’ve docked the pen and you’re receiving an alert after the fact. We think that’s pretty important for just cleaner documentation in general. It really doesn’t disrupt the physicians because they can quickly correct that and move on.

There are some little things like drop-down lists that can be dynamically populated from the clinical repository, pop-up tool tips for help instructions, color ink annotation on diagrams that can be pulled from a static library or even the camera on the tablet. Those are some of the major differences.

I believe overall, as you just get off of paper, the better off you are when it comes to archiving as well. Our electronic form in the source document. I’s the original source and we know when we archive that that we don’t have any extra pieces of information that have to go along with that.

I’ll ask you an investor-type question. Are any parts of your offering patented?

They are not.

You said you compete mostly with paper and traditional EMR interfaces. How hard do you think it will be to get customers to spend money on your product to replace those?

We have had some pushback historically because people expect our user experience to be baked into their EMR solution. Ultimately, that’s one of the reasons why we want greater exposure. I believe that they’re correct in a lot of ways that if you’re going to provide a mobile, physician-friendly module to your EMR, you should have an experience like Logical Ink in your product. We are, however, complimentary to that investment.

In practice, even though hospitals are investing a lot of money in electronic clinical systems, there are a lot of gaps that are left over. Not all physicians are created equally, so some will have weaker areas than others, but particularly in the areas where we’re extending the EMR to the patient in their documentation in intake and registration, in questionnaires — there are big holes there — but in the physician areas of the ED and the clinical documentation and the anesthesia record, those are just areas where the conventional approach is so frustrating and weak for the physicians that it’s a non-starter.

We get calls from ED physicians a lot that are looking at our solution because they’re very concerned about their productivity loss if they were to switch to a traditional-based system. We certainly recognize that we are providing something that a lot of the larger vendors should be providing just as general sensibilities for mobility and user-friendliness.

Do you think it will be hard to convince hospitals to trust a small company to provide and support technology that in many ways could be mission-critical?

We haven’t had that big of a problem there. Historically, IT and healthcare is risk-averse. The same could be said for clinical trials and the life sciences folks. It seems like the consumer tablet market and the Meaningful Use legislation has really reached a critical mass with that sort of forcing them to take greater chances, to get meaningful progress toward electronic records.

I think that the EMR vendors have been around long enough and their traditional approaches have been tried out. It’s not due to lack of money. I’s not due to the lack of not trying. It’s just there are some fundamental problems with their approaches and I think that there are going to be some vendors and some hospitals that will take those risks to go ahead and make progress.

What is the next level for the company and what will it take to get there?

We’ve been fortunate to have an explosion of tablets in the last year and that has obviously forced us to innovate. We were initially supporting Windows tablets only. With the introduction of the iPad and the Android devices, you’re finding that the platforms are very fragmented.

The software development platform is what I’m speaking to. We will continuously support the new, emerging devices and it will force us to also re-think some of our approaches. Traditionally we’ve been looking at a pen-based interface, whereas the new tablets don’t always come with a stylus. In some cases we’ll introduce Digital Ink to those platforms and use third-party styluses or we’ll make the forms platform more flexible for additional types of input, like touch, soft keyboard, that type of thing.

As far as business, what does it take to advance?

Our goal in participating in HIStalk and in this discussion is really to raise awareness. We want to, in the short term, get more hospitals to adopt solutions like ours just to be aware that they exist and just see the benefits of them.

I think ultimately from a business standpoint, we would like to partner with a large EMR vendor that’s ambitious and wants to address the mobility and the user-friendliness of their documentation solutions and integrate Logical Ink into that experience.