HIStalk Interviews Helen Waters, COO, Meditech

Helen Waters is EVP/COO of Meditech.

Tell me about yourself and the company.

I’ve been with Meditech for a number of years, having come up through the ranks in a variety of different positions.

Meditech as an organization has been in the electronic health record space for what’s coming upon 55 years, having in many respects given birth to the industry through the establishment of a programming language called MUMPS, which most people are familiar with. Our founder was the co-author of that language. Obviously we have since moved far beyond that language and into new technology and platform eras and have reinvented ourselves at several turns as the industry has changed.

How would you characterize the hospital EHR market?

It’s a market that has been busily on the move for the last probably 10 years. We’ve seen a significant amount of consolidation, which changed the market landscape quite drastically.

The rural and community healthcare space has been stressed by a lot of those changes. I was just reading this morning about the significant reduction of independent physicians in rural and community classified areas of the country being down to, I think the number was 12,000 or so. That has changed the hospital landscape accordingly as well.

But it’s an industry that is robust and tenacious. There are many places and spaces across the country, relative to rural and community hospitals, that are doing well to maintain their independence, to thrive, to recognize where and how new technologies can help them advance to more efficient organizations, more modernized organizations.

Conversely, we’re working hard to make sure that we can deliver advanced technologies and capabilities that allow them to do so, keeping our eye on the fiscal sustainability of the market as a whole. Most of us would acknowledge that in the broad landscape — whether they are large systems, academic systems, et cetera — there’s been a lot of fiscal strain on our industry from COVID and post-COVID.

We’re all working to try to advance into this new era, where innovation and technology can bear some assets that don’t always require people, or where technology can lighten and lessen the load. That includes the market space that we’re in.

When we talked last time, you mentioned that the high cost of implementing Epic or Oracle Health was probably locking in some health systems. Have you seen any indication that some of those health systems might, for financial or other reasons, now be open to making a replacement decision?

We’ve heard different levels of noise in that regard. I certainly think that the market has changed since you and I last spoke. The acquisition of Cerner by Oracle has changed the landscape in an interesting way. It was a rather large, significant investment on the part of Oracle. There’s going to be an expected return on that investment, which probably means a transition for a lot of customers. That transition will not be for free, I’m going to imagine. We see that market space attractively opening up to assess other alternatives. We are well positioned with Expanse to partake there.

The Epic customer base is coming up now on probably the 15- or 20-year mark. Our experience is that this is the point where people begin to think about their future. A lot of health systems bought electronic health records on the assumption that it would generate more volume. It would make them more fiscally successful. It would allow their expansion to grow and their quality scores to increase. Many of those same systems are struggling right now to figure out how to get to or out of red margins and try to get back to some fiscal strength and sustainability. 

That becomes more important now because of the advancements and the innovations that are going on in healthcare. There are important aspects to EHRs that are critical. They’re foundational digital systems of record. They are advanced. They are where people live and work all day long, doctors and nurses and allied health workers and many others that are in the health systems caring for patients. But they’re foundational. They are technologies now that have been in place for quite some time, for lots of different reasons.

We didn’t see the cost of these technologies come down, which for us was a bit surprising. Now those same organizations that may have overspent on the foundational technologies are feeling the challenge and the pinch of trying to find the funding to spend on the future technologies. That would relate to all aspects of artificial intelligence, ambient scribes, ambient chatbots, and certainly the large language models and generative AI. 

Our customers have been well positioned, both the smallest of them to the largest — which includes HCA and other larger organizations across the country — that are feeling well positioned for the investment they made in the foundational EHR, but now the position they stand in to take that to the next level of what the future of healthcare will be, which will be many aspects beyond the electronic health record.

What drives health systems to consolidate systems, which might mean choosing systems from an incumbent such as the EHR vendor that might otherwise not have been their first choice?

The consolidation factor has really surprised us. If you look at some of the larger national organizations, there’s very little patient crossover happening in those geographies when you own 80 or 120 hospitals. Otherwise, the technologies themselves have been ripped and replaced at times for not great gain. It depends on what system they were operating on. If it was a legacy older system, perhaps it made sense to bring into a more modernized platform.

Consolidation is something that everyone assumes or presumes to be the right thing to do, but I would say, generally speaking, if it’s not made in a wise, value-based mindset, it’s also proven to be a difficult, expensive proposition. We see a lot of the larger institutions looking to expand the footprint and spread the cost by extending systems into smaller facilities, and sometimes that ends up adding a burden of fiscal distress.

We’re big proponents of interoperability. We’re big proponents of moving that needle forward so that we can both consolidate data — which I think is more likely now to happen than ever in terms of how advanced some of the language models are, how advanced some of the analytics tools are — and then also able to interoperate with data to be able to share information across records, regardless of the vendor system source.

Interoperability has not been a technology problem in a while, but the industry has forced itself to make it a technology problem. But I think we are dawning a new era where the ability to have to consolidate on a single system may not be as prevalent as it might have seemed to be. If you look at the data from the major quality reporting systems. we haven’t achieved the scale that promised better efficiency, better quality care, lower cost, and higher patient and family satisfaction. If you don’t have those factors and you have increased your operating expense spend on foundational tools, you can be in a really challenged space. 

We are obviously proponents of interoperability and of the requirement for the vendor community to share information and data so that organizations can make sound decisions, but don’t all have to be on a ubiquitous platform.

Software being “in the cloud” doesn’t necessarily mean the same thing to every major vendor. How would you summarize cloud use and how will it develop further?

Cloud maturity has exponentially grown since we last talked. It has for our company. It has across the industry.

You’ll see organizations that are more progressive developing cloud-native applications, which we’ve done a series of, to ensure that the electronic health record is, in architecture and not just in front end, highly modernized. Most of the vendors in different capacities are moving in that direction, to different degrees.

Some are lifting and shifting an on-prem system into a cloud, but not necessarily taking advantage of that cloud architecture. It might just be hosted there. You might not have anything natively developed for the cloud. You might not be offering a SaaS model.

We transitioned both the development of new applications to be done natively in the cloud to modernize tool sets as to how we develop those applications, and in addition to that, we are obviously operating fully in the cloud and offering a service solution. This is quite different and has proved to be a really good decision for us. We announced in 2018 and began in 2019 and 2020 to see that uptick in the market. Now we have well over 120 customers that are operating natively on our cloud services offering called Meditech as a Service.

What results have you seen from working with Google and what projects do you have planned?

The product that we announced at HIMSS22 we called Expanse Navigator, which is a search and summarization capability within our record. It’s the ability to take advanced search features within the EHR and access and synthesize and surface structure and unstructured data. You have all of those aspects of scanned docs, handwritten notes, and images that are surfaced and scanned both within the live system and then obviously from legacy systems.

One of the advantages we saw there was being able to truly know the patient for whatever term they’ve been with that health system. Oftentimes as people migrate and move EHRs, a lot of the data gets left behind. This allowed us to bridge those two worlds for our customers and for any customer coming off of a legacy platform.

This initial product was built off of the BERT language model. It wasn’t necessarily generative AI, but it was one of their first large language models. The feature in that was called Conditions Explorer, and that functionality was really a leap forward. It was intelligently organizing the patient information directly from within the chart, and as the physician was working in the chart workflow, offering both a longitudinal view of the patient’s health by specific conditions and categorizing that information in a manner that clinicians could quickly access relevant information to particular health issues, correlated information, making it more efficient in informed decision making.

We felt that was a big step forward to give physicians who are quite busy in their 10 minutes with the patient wanting to feel more confident in what they were doing, making sure they had the right information in front of them.  It’s been really successful. It’s highly valued and enjoyed by our customer base, Expanse Navigator.

Beyond that, with the Vertex AI platform and certainly multiple iterations of Gemini, we’ve walked forward to offer additional AI offerings in the category of gen AI, and that includes both a physician hospital course-of-stay narrative at the end of a patient’s time in the hospital to be discharged. We actually generate the course-of-stay, which has been usually beneficial for docs to not have to start to build that on their own.

We also do the same for nurses as they switch shifts. We give a nurse shift summary, which basically categorizes the relevant information from the previous shift and saves them quite a bit of time. We are using the Vertex AI platform to do that. And in addition to everyone else under the sun, we have obviously delivered and brought live ambient scribe capabilities with AI platforms from a multitude of vendors, which has been successful for the company as well.

The concept of Google and the partnership remains strong. The results are clear with the vision that we had for Expanse Navigator. The progress continues around the LLMs, and what we’re seeing is great promise for the future of these technologies helping with administrative burdens and tasks, but also continued informed capacities to have clinicians feel strong and confident in the decisions they’re making.  

The voice capabilities in the concept of agentic AI will clearly go far beyond ambient scribing, which is both exciting and ironic when you think about how the industry started with a pen way back when, we took them to keyboards, and then we took them to mobile devices, where they could tap and swipe with tablets and phones. Now we’re right back to voice, which I think will be pleasing provided it works efficiently and effectively for clinicians.

What benefits have clients seen from Traverse Exchange?

We launched Traverse Exchange in Q4 2024. We had actually started the year prior in Canada. It’s a data exchange between Meditech customer organizations and organizations on other vendor EHRs. The core tenet is to share patient data regardless of where the patient is receiving the care and regardless of the EHR they’re using. It allows the customer to remain on or implement the systems that work best for their organizations.

There’s burden reduction in that we’re sharing information into and accessible within the standard clinical workflow and  to move beyond cumbersome static documents, which we’ve been dealing with with CCDs and even cumbersome data exchanges like CCDA. It’s leveraging our FHIR-based requests for targeted data at the point of care and physicians being able to easily access information regardless of its origin. We talked to so many customers who will say, I don’t want to go to XYZ vendor. I don’t want to be offered a connect system. But I’m terrified of being left out and I’m terrified of not having the right amount of data for my patients. 

The sole reason we did this was to try to finally debunk in the industry the fact that everyone has to be on the same system to arrive good decision making and get quality outcomes. We are pushing this envelope significantly. We’re going to push it on our EHR competitive partners and ask this industry to come together to finally allow for the free and easy exchange of information directly into clinical workflow. We’re happy to participate, in turn, on the other side.

What will be the most important factors in the company’s next few years?

I would say the same factors that have been in the past years. Continued introspection about the things that we do really well and the aspects of our company that we need to continue to retool for the future and the market that we’re in, actually the market that is in front of us where the puck is actually headed. Continuing to deliver very effectively for customers and be sure that our customers can do the speaking on our behalf.

Leveraging the success of HCA, who is rolling out our Expanse platform. That was a calculated decision. It was a value-based purchase on their part. We intend to prove the value relative to the outcomes, the clinician satisfaction, and also the innovation factor, which we are both seeking in this partnership. By the way, not just HCA. I would say that you’ll see us continue to focus on our outcomes in other markets where we have a good foothold on potentially driving and leading the market.

The US market consolidation was outside of our control, and there were some real benefits to that for some vendors. We intend to challenge and continue to move forward passionately the way we always have, but making sure that we’re continuing to adjust for what the market is looking for.