HIStalk Interviews Helen Waters, COO, Meditech

Helen Waters is EVP/COO of Meditech of Canton, MA.

Tell me about yourself and the company.

I’ve been with Meditech for a long time in a variety of roles. I serve today as the chief operating officer of the company. I’m responsible for a number of functions.

Meditech has been in business since 1969 as an originating founder of healthcare IT, in the sense of programming language and operating systems. We have enjoyed a long and fruitful life in healthcare IT. We are excited about where we sit today in terms of the future of the industry, the innovation going on, and the Expanse platform in particular, which is our most recent introduction as a cloud-hosted web platform.

What were the key developments over the past few years that improved the company’s position in market share and product rankings?

I would say the contributing factors were the decision to write the platform to begin with, to take the step beyond the hospital walls into the ambulatory environment, which we did with Expanse, having built an integrated and comprehensive system to get to a single electronic health record. I believe that the openness of the platform has made a difference.

We have made a conscious decision to lean into the changes that are happening for the marketplace. Innovation is coming of age, and while there’s a lot of hype that goes with that, there’s clearly an opportunity for good augmentation of electronic health records. We wanted Expanse to be a platform that would be open and capable of plug and play with other tool sets that our customers would have the choice to want to acquire and use. SMART on FHIR and open APIs are a key aspect of Expanse. That has driven a lot of interest in the platform in comparison to others who believe that they should be all things to all people. Choice will be good for healthcare.

A great example of that is our work with Google. Before the announcement in November of what GPT would do to bring AI conversations around the kitchen table, we had a vision for what artificial intelligence and large language models could do for healthcare. Our work in 2022 and the delivery of a solution today to a customer embeds the native Google search into our platform. But it goes one step further in leveraging Google’s large language model called BERT, which is a predecessor to many of those that are being released today in terms of Med-PaLM and PaLM itself. Meditech is leveraging that extensively to surface conditions from historical visits in Meditech, legacy platform, or other vendor platforms so that the physician gets a really quick search and summarization of data, scanned documents, and handwritten notes, and uses extensive LLM capabilities and learnings to do that. We are excited about where innovation sits. 

The Google project was a great example of us walking the walk about the platform and the openness and making sure that we solve problems that exist in healthcare today. Certainly the density of records and the difficulty finding data is known across all the EHRs, causing physician and nurse burnout that we are intent on addressing.

How can technology be applied to address burnout?

The first swipe at that was finding the data really easily, not depending on how a vendor stored it or what category they were under. That’s why picking Google search and being able to search on words, misspelled words, medical terms, and do that fast and easy, was the first priority.

The second was to make sure that any information that would be relevant could be found with ease, so that a clinical decision could be made with confidence. That’s the embedded utilization of machine learning and in the LLM in that solution that we call Google search and summarization.

Then fast forward and we have the introduction of ambient listening capabilities for both the physician and the patient, to be able to discern from human conversation what has been said, to begin the generation of a note and to be able to summarize for a patient what happened in that office and what the exchange was like.

Our customers are already using artificial intelligence and the learnings from all of that information. The technology is very present in solutions like Suki, Nuance DAX, or Augmedix. The next stage of that is to take the benefits of generative AI, which is significant learning over large data sets, and improve the experience and the accuracy. AI for us today, beyond what we have delivered for search and summarization, will make some of the monotonous, redundant tasks that irritate physicians and nurses much easier. That’s the set of projects that we are working on today. But in terms of ambient listening and connecting to those solutions, that’s already happening, and we are optimistic. 

The irony of all of this is that having been in the industry this long, we started out fighting with the pen and pencil in terms of handwritten orders. We went to keyboards and struggled through that. Meaningful Use mandated the changing of the way physicians and nurses delivered care and documented it. We’re going full circle all the way back around to the voice being the most powerful tool. The technology is caught up in those regards and will continue to get better and stronger as time goes on.

What are your talking points when you are in competitive situations with Epic and Cerner?

The market is really interesting right now. The acquisition of Cerner by Oracle put a whole new inflection point into the industry. Cerner has historically been a combination of acquired solutions. Cerner certainly built a lot of solutions, but they bought a lot of solutions. Now Oracle has to sort that out as it is developing something brand new to replace Millennium, which is quite dated, as indicated by the name. 

The acquisition history of this industry is challenged by what we’ve seen in the past. Really, really big companies come in and then make a decision to walk away. I would count Siemens, McKesson, and others in that bucket. We are watching Oracle and Cerner and we have an idea of where we think they will head, but that puts some uncertainty in the marketplace for customers and prospects.

Epic has been the beneficiary of a very strong market consolidation trend of the larger academic medical systems that make a decision for them, and then those academic medical centers and larger systems expand and buy a lot of hospitals. We have certainly felt that, but we have been told, and actually have some validation, that our platforms are comparable. In fact, ours might be a little bit more technologically advanced in terms of the native cloud nature of it. Applications being written for the cloud, not just running in the cloud. 

We feel quite confident in our ability to compete against any other company. Integration is a hallmark of Meditech, and it’s decidedly evident when you look at Expanse. The concept of partnering with the industry to solve problems — even if we don’t solve them all, but we bring solutions to the table — will be attractive to the market.

We are not out designing CRM systems. We’re not out designing tools that will be considered fully competitive with an innovation sector that is breathing and living. We are out there to participate and co-exist in the marketplace for the benefit of healthcare and the customer. We think that we continue to deliver something that all of a sudden is being talked about more, which is a strong, value-driven, sustainable investment in electronic health records. 

This industry is under significant distress from a financial perspective, driven by the pandemic, labor cost increases, supply chain increases, and some decline in volumes. I think we demonstrate the absolute best solution in terms of the sustainability of a modernized, contemporary, yet sophisticated platform that allows our customers to make that investment to establish the foundational pieces of a digital ecosystem, but that also leaves room for them to continue to invest as well in other solutions that are being designed and implemented with great energy in the industry by new players and innovators.

Our allocation of operating expense budget or percentage of revenue is far more moderated than the Epic system. That is well documented and proven. That has probably been a contributing factor to the financial challenges that exist in the market. Technology generally should level off or go down in cost over time. We’re an important part of the health ecosystem, but we’re not the be-all, end-all of it. We want to participate, we want to co-exist, we want to modernize, and we want to continue to thrive, but we want to be a partner to this industry and to the real challenges that exist for it, which are cost containment, high quality care, and a better user experience, even if that’s in partnership with a important player like Google and Meditech delivering that.

Epic hasn’t lost many of their direct clients, but Community Connect sites have more variable satisfaction and lower switching costs. When Cerner loses clients, it is usually to Epic. Where is Meditech’s opportunity and what is the strategy to get hospitals to switch?

The prospects come from our competitor installations for sure. I’ll be honest to say that when you make a $100 million, $1 billion, or $2 billion investment in an EHR, which is somewhat the price tag that you typically find in Epic deployments, it’s not easy to replace. The replacement concept and cost is daunting. 

The Cerner market, the Allscripts market, and certainly some of the hybrid vendors that are out there is where we are drawing customers. Meditech as a Service has been incredibly attractive and well received. We have replaced all of the vendors that you just mentioned in terms of Community Connect, CommunityWorks from Cerner, CPSI, Allscripts, and the old Paragon solutions.

We go to this market with a recognition that it’s competitive. Customers are looking to make investments for the long term. But they are looking more than ever to talk about the financial implications in the long term in these investments. We see the market as open. We see, in particular the changes in landscape with Allscripts departure and with Oracle coming in, opportunity where customers will want to have conversations. We are at those tables. We are quite active in international markets and doing very well there, in terms of the Irish UK, Canada, Australia, Africa, and other parts of the world. We are expanding our customer base in just about every English-speaking market that we are in. We are pleased with all that.

The talking points are the fact that this company has played an important role in healthcare, has a widespread impact on the delivery of healthcare, and has been an incredibly stable partner to the industry in helping to solve real problems. It has been a company that sought to do well among all that in the capitalistic society, but not add to the burdens of delivering healthcare. Our sustainability and cost model has made a difference.

Ironically, when you look at organizations like HCA, they have Meditech, Cerner, and Epic. They wrote a check to Epic about 10 or 12 years ago for a key market. They have Meditech Magic and a couple of Expanse customers. They had many Cerner sites by virtue of acquisition. We were fortunate to win their confidence and trust for the future. Part of that was undoubtedly driven on partnership and confidence. It was driven on value and in the fact that they don’t chase shiny objects. They had all three platforms to comb through over a decade and make their own determination on how big the variation and difference was. Not just go off of folklore, but actually dig deep. 

I think they were attracted to our commitment to being a platform company, to be sure that they had the freedom and flexibility to work with our system as foundational and as the main tool in the delivery of care. But also the freedom to invest and innovate on their own and with other partnerships, with Expanse enabling that and not halting the concept. Other vendors’ EHRs are more in tune with wanting to be all things to all people and to control a lot more. 

That is one of the biggest testimonials. If you look at some of the truthfully bigger not-for-profit systems that have grown from three hospitals to 20, 40,  80, or 140, they are figuring out scale. HCA figured out scale and is well managed and operated. They are incredibly invested in technology and innovation as a transformative driver to care, and we are delighted to be their partner in that journey.

Due diligence doesn’t seem to be as big of a topic in the industry. There’s a lot of folklore about systems and about physician preferences. Ironically, when you get really into the weeds and talk to doctors who are using systems, the nation and the world have a problem with electronic health records. It’s not a Meditech driven problem, it’s an industry-driven problem. It would point to the evidence that no matter how much you paid or how pristine you thought you were getting a system, we’re still on the journey to solve problems. Due diligence about investigating the depths of what a vendor can offer, and not making assumptions based on which brand-name healthcare marquee organization purchases a system, is important. I hope that boards and CFOs get back to the table talking about fiscal sustainability and the reasonableness of investments in foundational tools like EHRs.

I have seen that decline in a number of times where organizations just write checks and don’t even look to see what’s out in the marketplace. People say they are buying systems to please physicians who are not the ones writing the check. We’ve found that when they are operating hospitals or surgery centers, they are quite different, making sure they do due diligence to understand systems and capacity and spending money with some caution. I hope more of that comes back to the industry, because I think it’s been lacking in the last 10 years. I feel like we are well positioned to have a conversation with any organization and talk about some of the more important issues that get a little whitewashed at times. We haven’t seen enough due diligence in the last 10 years.