HIStalk Interviews Margaret Laub, CEO, Intelligent InSites

Margaret Laub is president and CEO of Intelligent InSites of Fargo, ND.

Tell me about yourself and the company.

Intelligent InSites is 10 years old. I think about us as being the operational intelligence platform that essentially leverages real-time data from both EMRs and other HIT systems as well as sensory tags. Our goal is to increase the efficiency of health systems while improving care.

I joined Intelligent InSites in August. I have a background in healthcare services and technology for the last 15 or so years. I spent some time at McKesson, where I ran the “not the distribution business” and “not the hospital technology systems”, but what I call the “all other businesses.” Everything there has a technology component to it and a services component to it.

I’ve been in technology and services in healthcare for a long time. I grew up in the accounting field. I was an accountant back in the day with Coopers & Lybrand, which is partly what really interests me in Intelligent InSites and operational intelligence.

One of the reasons I’m here is to see the value of knowing what’s going on within your hospitals. Really seeing what’s going on and being able to make immediate decisions about those activities that can provide value from the standpoint of improving satisfaction, saving money, meeting compliance regulations, or improving quality. Back in the day when I was growing up, I did things like activity-based costing, which is essentially looking up what’s going on in your business, applying inputs and outputs to those things, and being able to make decisions about how better to improve your processes.

When I saw Intelligent InSites and the fact that we were a platform that was looking to accumulate data from a number of different data sources — sensory tags and/or HIT systems — and actually apply it at the point of service as well as being able to look at data providers over a period of time, I got very excited. I said, “Wow, that’s a great thing for me to do.” I’m here and very excited about helping us create this market.

It doesn’t seem that long ago that an RFID project involved expensive door frame sensors and passive tags. You got just enough software to turn out a primitive tracking log and maybe saved some money by tracking equipment instead of renting it. What’s the current state and how did we get here?

Many things coalesced. They all came together at one time. The population and customers probably started demanding more service. I don’t want to be treated like the old days, where I had to go to an old hospital and have things done to me. I would like to know what’s going to be done. I would like to be part of that process. I would like to comment on the value of the service I got. There is the whole consumer quality driving aspect to the environment that we didn’t have 10 years ago.

New reimbursement models are coming down, both from the standpoint of the regulatory environment as well as just the fact that populations are growing and everybody needs to use their resources in a much more efficient way. There are fewer physicians. There are fewer nurses. There are fewer dollars to be spent on things. All of these things are coalescing all at the same time, which is going to cause folks to say, “Wait a second. I really, really, really have to look at how I’m operating the business.” 

More importantly, as the volumes of patients or services are being provided, every single thing has to be done for an individual. Healthcare is individual. Each one of us is going to be treated a bit differently, and yet we’re going to have to find ways to treat people consistently and in a standardized way just because we’re going to have to do it from a financial standpoint.

That’s what’s changed. People need to get insight and visibility into how to do that. It’s not just about the hard dollars any more. It’s not just about finding pieces of equipment. It’s how are we using an equipment, to whom are we applying that equipment, why are we doing it, for how long are we doing it, is there a different way to do it? All of those things need to be looked at, because all these influences are coming together at once.

Certainly accountable care has even moved that far up. Meaningful Use, accountable care, all of those things are just driving it. Hospitals and IDNs really do need to start thinking of themselves in a bit of a different way. I think it’s the larger IDNs, the ones who are leading, who have done the EMRs, and who have taken big steps in looking at the clinical side of the business. Now we’re going to start looking at, how do I take the clinical piece and how do I integrate that into my operation so it’s not only clinical delivery that’s efficient and effective and valuable and satisfactory, but it’s also how I actually deliver it?

Many times people find creative uses for a technology once the infrastructure investment has been made. Do you have some examples of some high reward type customer projects?

One of our customers has used our technology to do their workflows in a very different way. In clinics generally and in hospitals, the patient goes to where the services are. One of our clients has changed the way they deliver the service. They take the services to the patients. The workflow has changed. It gets more efficient. It gets more effective. 

What they’ve been able to do with our enterprise platform as well as one of our workflow apps that we’ve worked with them on is change the way that that service is delivered. Instead of the serial nature of it, essentially the services are going to the patient. That’s very, very different. I think they’re one of the folks that won an award or will be winning an award at HIMSS in the near future.

The other I think that’s very innovative is what we’ve done with the VA. We recently — along with our partner HP — were awarded the VA national contract. They will be doing a couple of things. They will be using our enterprise software, a platform across all of their hospitals. They will have one unique view across the 152 sites that they have, as well as have that unified view at the hospital level. It’s a very innovative use. It’s not just a point solution. It’s not just being used in one department or for one hospital. It’s being used across the whole entire enterprise.

The VA’s announcement was, in my mind, a turning point for RTLS. It suddenly was not only validated, but being deployed in a widespread implementation by an organization that’s been good at changing around their technology. What did the VA have in mind when they decided that RTLS was the way to go?

The VA’s ultimate objective, and they very clearly stated it, is better care for the veterans. They looked at it as yes, there is value as that relates to tracking hardware and patients and where they are, but ultimately what they’re looking at is how do we deliver better care to the veterans?. Their decision, at least from our understanding, was based across a couple of things. How can I see that across everything that I’m doing, and more importantly, how do I plan for the future when there are many things that I don’t even know that I’m going to use down the road? What kind of platform do I need that will grow with me, that I know is not going to be something that I’m going to be replacing in five years? What kind of platform can I get that can integrate with the systems that I currently have, including VistA, which they’ve talked about and we will be integrating with them. How can I use all of those things? 

They are really forward thinking in terms of not just thinking of it as RTLS software, but as  software that allows them to collect data from a number of sources, apply some contextual information to it that will come out of their VistA system, and be able to translate that into better care at the point of service.

Some of the more promising projects in the early days involved tracking employees, which got a lot of pushback. Are those projects still off the table?

I haven’t run into that in my tenure here at this point. In fact, one of those other examples that I didn’t give you before was that we have a client who is a family medical clinic. They are using badges to track translators at the clinic that supports a customer base of 25 or 26 different languages that are spoken. When someone comes into the door, rather than wasting time in searching for that person, they can use the badge to track down the appropriate translator and get that translator right to that patient and as soon as they walk in the door.

In the VA, it’s not even a question at this point to my knowledge. It’s something that they’re a bit concerned about, but I don’t think it’s something that’s causing them major issues right now. They do have unions and they’re going to be working through that, but we haven’t heard that being a major problem. The customer that I referred to before that’s using a new process in the clinic, I do think they are badging some their folks. They’re just saying, “Hey, when can I get badged?” because it actually helps them in their processes. I’m not saying that that is not an issue that is going to be dealt with, but I don’t believe that’s going to be a bigger issue as it might have been even 10 years ago.

Even some simple things where you take pieces of information out of an EMR. If a patient has an allergy and if you can give that information real time to a nurse when they are in the room and they can make sure that there is not something that they might be inadvertently doing that would cause a problem in allergy, all of a sudden what you’re doing is you’re actually helping that nurse do their job rather than worrying about, “Gee, was she in the room for a period of time?” I think most caregivers are in the business for care giving, and if we can show them both kinds of values rather than “Hey, we’re trying to figure out if you went out and had a cigarette and went to the ladies’ room or whatever you did, you didn’t punch in or punch out” or whatever it is — I think that that’s going to change the acceptance of it.

Some of that information has to come from a traditional EMR. Do you find a happy coexistence with EMR vendors?

EMRs are a great source of the contextual information that we need to leverage. Over time, they’re going to be willing to share pieces of information. Are they going to open up their whole entire databases to folks like us? No, but I do believe over time, as we say, “Hey, can we just have pieces of information? Can we get that from you?” they’re going to be willing to do that.

Probably more importantly, what we can do is give them back automatically collected information. Instead of a physician or a nurse keying in when something happened — it happened at this point in time, the person went from this process to that process — if we can, use tags and locating information to automatically update the EMR, that makes the EMR itself much more useful and valuable. Again, this is not something that’s happening right now,  but I think over time as these pressures are applied from all angles, from the client, from external sources, to maybe make some of that information available.

Who are your main competitors and how do you differentiate yourself from them?

We are purely an enterprise software and services company. We are focused exclusively in healthcare. Because we’re only focused on providing real-time operational information and we can take it from a number of sources, we’re neutral. We can take it from all the different tag providers, we can take it from databases, we can take it from anywhere. It’s really hard to say who a traditional competitor might be. I don’t know that there’s anybody that does exactly what we’re doing right now.

That being said, we do tend to be to get grouped with the other RTLS vendors even though RTLS is only a component of what we do. If they are looking for somebody, they probably find us more through the RTLS. But if we do get grouped in with the RTLS, it’s probably Stanley at this point in time from their acquisition of AeroScout. Even then I’m not sure that is a fair comparison because we have an open platform. We’re totally focused in healthcare and again, we are neutral as it relates to any not only RTLS or sensory system, but also any other kinds of databases.

Where does the company go from here?

I hope that maybe five years from now we are no different than a CRM system, than a lab system, than a scheduling system. We’re just a component of what every IDN does. We are their operational intelligence platform. We’re the folks that notify when things go not as planned. Healthcare is individual. Every person is unique. Everybody wants to be treated appropriately, yet we have to have a consistency of how we deliver.

Hopefully we’re the ones at that point in time who are giving the alerts at the point of care that something different needs to be done here. An action needs to be taken. We’re the value provider in that sense. We will continue to be in healthcare. We will not be external to healthcare. We will always be a healthcare-focused company.