I literally cannot imagine any circumstances where the replacement of VistA was not troublesome. VistA was custom designed for the…
John Kass is vice president of healthcare strategy and business development for Bottomline Technologies of Portsmouth, NH.
Tell me about yourself and the company.
Our go-to-market strategy is twofold, both on the direct front and as well working through Tier 1 ECM vendors. As healthcare changes and there’s a lot of consolidation in the market, we’re seeing a movement toward procurement being something that they want to simplify in that supply chain.
I spent four and a half years at Hyland Software prior to coming to Bottomline. We were taking many people from paper to electronic and linking that information into the electronic medical record. But one of the things that really stood out is that paper has been holding back the power of ECM for quite some time.
Logical Ink was an e-capture, mobile capture, e-data solution. There was a lot more you could get out of paper and changing the process was key. We signed a private label partnership with Hyland Software. Really being able to go back to customers that I’ve worked with for quite some time and improve the value in technology they’ve already purchased.
Describe what Logical Ink does and how you incorporated that acquisition into the product line.
We acquired that technology several years back. It was called Logical Progression. Chris Joyce, who is our director of product development here today, is the developer of the solution.
When Chris invented Logical Progression, the market looked very different. The biggest change is that we’re seeing much more connected healthcare brought on by Meaningful Use. We’re seeing EMR adoption growing. The goal is, how do we create a longitudinal view into the patient?
What’s really changed is, when I came on board, taking the focus around the strategy of… this is something that ECM became a very natural marriage. The product is a much more connected solution today. It’s an enterprise, what we call a standardized one capture platform, any downstream system. In addition to moving and capturing the form, we have the ability to capture discrete data elements in the form and map that downstream. You can have one encounter, capture that information, send it to a Hyland Software OnBase, link that to an electronic medical record, and simultaneously send discrete elements of data down to a population health system or another system discretely.
The other change is that four years ago, solutions like the iPad did not exist. They’ve revolutionized the way we interact with technology in a way that I can hand my 70-year-old mother an iPad and she immediately gets it. We’ve got a native iPad application. We’re also on Windows. The ability to have devices that are much affordable and usability being much higher has changed the game in the last several years.
Can you explain what Hyland OnBase does and how you tie into it?
It stands for “one database.” OnBase is an enterprise content management system. In the patient-related world, there are things inside of that electronic medical record that you’re capturing as discrete data elements, but there are all kinds of things that generate from paper or other people’s systems that have no meaning to it. It’s called unstructured content.
Hyland can quickly bring that content in, capture it, and then put meta-data or key words around that content. Once they add meaning to that content, they have some very slick opportunities to link that contextually into an electronic medical record, or even on the ERP side in the non-healthcare world.
One of the things that we saw was having the ability to not have to scan physical paper into a physical device. There are too many documents going down to HIM to batch scan, so the burden on HIM is still very, very heavy. The goal is, how do we decentralize the capture in a seamless way and how do we optimize the ability to ultimately know what that form type is, because we’re starting electronic in a way that’s very meaningful with the patient?
We can simplify all of that, the scan queues and hiring people to work and help index that content. We can immediately send that to OnBase through an API and they can immediately place those hyperlinks contextually within the electronic medical record. When you look at it from a workflow and a patient engagement perspective, it’s a game-changer in how you interact with that content.
HIM does batch scanning, indexing, and QA to link the scanning of paper. Is electronic mobile capture a better way, and will that process eventually go away?
You’re seeing quite a few trends in the industry. I’ll categorize it in a couple of ways.
There’s always going to be that external content. A patient walks in with pieces of paper that originated in another facility. I call that third-party content. We’re seeing that as an area that you still typically have to scan. If you’re a large IDN, you’re seeing a lot of the banks starting to offer the ability to scan that for you and create an index file as a value-added service. That’s number one.
We’re seeing more things captured discretely as a result of Meaningful Use, tying EMR adoption to reimbursement. But more importantly, certain stages of Meaningful Use are required. In other words, the government said these EMRs need to be certified and they have to do certain things. That’s certainly gotten rid of some of the paper.
There’s that remaining paper. There’s that remaining interaction. Those are things that start inside your own facility. It’s the consents. It’s the patient history. It’s the ABNs. It’s sometimes taking a photo and being able to embed that photo and have the patient or clinicians fill out information about that photo. Prior to Logical Ink, you would have to literally plug a camera into a USB, go out and find that photo, and attach it and attach meaning. With Logical Ink on an iPad, a clinician can take a photo with the embedded camera, embed that photo instantaneously in a form, and fill out information or have the patient fill out information. When we hit submit, it can automatically be linked into the downstream system.
Do you think that the increased use of electronic medical records has expanded rather than contracted the content management market?
Certainly it has. There is absolutely no doubt about it that. There was a mandate, there was reimbursement tied to it, and there was a timeline. These were all very compelling events to moving people forward. It’s an impetus to a range of people adopting technology at different times. We’ve seen an industry movement across the board through this mandate that’s been very big.
Certainly with the enterprise content management piece being a component … I always tell people, your goal isn’t to buy an enterprise content management system and an EMR. Your goal is a longitudinal record of the patient where you can see every action and encounter through one viewer. So Epic becomes that viewer, for example, or Cerner. But what’s great about ECM with the embedded nature of it, when you’re viewing some of that content through the core EMR, many times folks don’t even realize that the ECM portion of that is not just an extension of the actual core system.
Thinking about gaps in functionality or gaps in usage that electronic medical record systems have, what can automated or online forms add?
HIMSS came out recently and talked about with so many EMR vendors moving so quickly to try and fill the mandates of the different stages of Meaningful Use, while they focused on the functionality, usability’s probably something that has not taken a front seat given the time.
The other thing we’re hearing is that early productivity reports are showing that with clinicians having to do so much charting in front of the patient, productivity is going down. As you can imagine, part of diagnosing a patient is observing that patient. One of the things that we have been focusing on is the ability to have the patients fill out on an iPad, for example, all of these required forms. That’s unvalidated data at that point.
Now imagine as you walk into your doctor, having the doctor on an iPad asking you questions and updating and editing that information to validate that. Then capturing in that one encounter, moving the form into an ECM solution, but moving the data elements and mapping them discretely into the electronic medical record. We see that that is absolutely key.
The other thing is that while the EMR encompasses probably 80 percent of the overall enterprise technology around clinical and financial applications, there’s all kinds of “ologies” and patient disease management systems. People talk about data silos in healthcare. I would argue that what we really have is vendor silos. We’ve become that unified front end despite where the information is going with a simplified front end that they’re used to, applications like a Windows tablet or an iPad. We’ve focused on those areas to help augment and improve the usability and the optimized workflow.
What are some ways that customers are using your technology to improve their core hospital systems?
We’ve got a facility in California that is capturing various forms, but also simultaneously feeding discrete data from Logical Ink right into their disease management system, their population health system. They saw an application that we believe is a differentiator. We’re not just capturing signatures on forms — we’re having a very interactive process with that data. We came up with a concept of you have one encounter, so you capture once with the ability to push to any downstream system.
This is a paradigm shift for them. Before, they were scanning that piece of paper and somebody was entering the discrete information manually into a system. The ability to automate that process in a way that happens very natural with the interaction was a real game-changer from both a workflow time to get information in and certainly from a cost perspective, removing the manual process of having to hire people to manually do that.
Do you have some ideas about best practices for improving the satisfaction of patients with the intake process?
There are areas that you’ll go into, a very static patient access area, where there are stations of people working. You literally are going to go in there, check in, and sign all your forms. The fact that our solution can be a desktop solution, can be a web solution or can be a tablet solution means that we offer a very, very compelling licensing model where we don’t differentiate. A device is a device. It gives you the opportunity to use many different platforms for many different uses.
Where things become very compelling is healthcare – unlike, for example, an accounting job, where you log in and you may not move all day long — many healthcare workers are roaming throughout the facility for different encounters and what have you. The ability to take what used to be maybe a computer on wheels with a scanner on a cart, wheeling that around, physically having to take a packet of 10 forms and physically putting 10 forms through a physical device called a scanner, is a lot of work. Sometimes that gets in between you and the patient.
If you’re out there wheeling that cart around and your role is to wheel that around all day, changing that from walking with an iPad, scanning a patient’s wrist band, having the ability to pull that patient, pack it up because we’ve got all the integration on the back end with the ECM and all of the different document types and the levels of those document types already being pre-set to the EMR, your ability to walk in very pervasively and have that ability to capture things in a pervasive or untethered way is something that again is a paradigm shift. It allows people to be much more natural and upright and a tablet doesn’t get in the way between you and the patient.
Most people didn’t see the potential for enterprise use of tablets when the iPad came out, but now everybody wants to use them. WiFi connections are decent and tablets are cheap. Will more opportunities come up?
I think so. Like you said, we’ve got bandwidth today. We’ve got devices. I look at an iPad as a productivity tool, more an appliance than a computer. That’s where you can draw a line in the sand. It really does simplify the way in which you interact with technology, for example.
Four years ago, you look at where bandwidth was. We had no Meaningful Use. You were talking about a tablet that might cost $1,500 and it really wasn’t enabled for the touch experience. The market wasn’t there to take advantage of the applications.
Fast forward to today, looking at being linked to those Tier 1 vendors, looking at really tying and anchoring into investments that have been made there, and putting the engine behind the ECM in a way that paper has held ECM down for years. If you look at all of those factors, we’re at a time where the market’s there.
People are using these tablets in their personal lives. There’s a very consistent, constant look and feel. People don’t want to use a device at work that’s more of a barrier than the one they use at home to look up an article on the Web. We believe that we’ve bridged that gap in a way that the same simple tools they use in their personal life, they can absolutely start to use in their professional life.
What are the company’s plans for healthcare over the next few years?
The timing is right. The market is right. We’ve got the right platform. We think we’ve got the right strategy. We want to be heads-down focused. The company is always looking for potential acquisitions, so that’s something that I would say is ongoing. But we’re looking to do the right thing for the right time and the right reasons. I’ve been on board a year.
I’ve gotten very, very comfortable in my role and I’m at a point where I feel like we’re optimizing some of the things that we’ve done over the last year. For the time being, we want to keep focused on the opportunity we have right in front of us.