HIStalk Interviews Phyllis Gotlib

Phyllis Gotlib is CEO and co-founder of iMDsoft.

Tell me about the company and your products.

iMDsoft was founded in 1996 after a few years of development. We started with an alpha site in Tel Aviv and had our beta site at Mass General and Brigham and Women’s in 1997. Once we got clearance on our products, we decided to move to Europe and also to validate our implementation methodology.

Our first product was for ICUs. We went to Europe and decided on four different languages and four different countries. We received rave reviews.

Our first commercial installation with ICUs was in Lausanne, Switzerland in 1999. We went into the Netherlands in Dutch, Norway in Norwegian, and of course to the UK in English. Since then, we grew all over Europe, came out with a new product in 2001 for the entire perioperative environment — pre-op, inter-op, and the PACUs. We had a partnership with Fukuda Denshi, second largest medical device manufacturer in Japan, in 2000. We went back to the US in 2002 and set up our headquarters in Needham, MA where I spend most of my time.

Since then, we have close to 150 hospitals world-wide with more than 9,000 beds under license. We continue to grow beyond the walls of the ICU and OR as we expand outside of critical and acute care. We have a new product called MVgeneral that goes to the general floor.

We map the entire inpatient workflow in all these departments. Every type of ICU — all adult ICUs such as neuro, CCU, med-surg, NICUs, PICUs, and the entire perioperative environment, step-down, and general wards. We have supporting products that include MVmobile for ambulances and MVcentral, a tele-intensivist product, and others. All of our products share one database and provide a true continuum of care.

Most US healthcare IT vendors have customers outside the US, but most of their business is domestic. Is it an advantage or disadvantage to have a more balanced international footprint?

I see that definitely as a hedge. We started in Europe because, at the time, the R&D was in Tel Aviv and there was a blend of a lot of languages and people that came from the European countries to Tel Aviv. That was an easier way to start the company.

You can see similarities between territories. You can see similarities between the European market and Canadian market and between the UK market and Australia.

The US is different, but when we do user groups, the US customers are really happy to mingle with the European customers and vice versa. We believe in a sharing philosophy. Our US installed base is really high-visibility and very impressive, with Johns Hopkins, Mass General, Partners, Barnes-Jewish, Henry Ford, and so on. In Europe, we also have high-end academic hospitals, community hospitals, and smaller institutions.

They all like to mingle, to exchange protocols, and to share information. For us as a company, it’s definitely a hedge and allows us to lower the risks and to be able to answer the needs of the different regulations and initiatives in different countries.

You’ve described iMDsoft as a disruptive innovator, but I don’t know that many US healthcare CIOs are familiar with the company. Who are your competitors and what are your competitive advantages?

You will hear me quite often say that it depends on the segment and the territory. I would put them in buckets. The competition can be the old medical device companies like Philips and GE. Another bucket would include the bigger guys, like McKesson, Eclipsys, maybe Cerner. The others would be smaller, software-only companies like Picis. In Europe, in every country you can find a local vendor that is really specific.

You can differentiate the competition into OR competition, perioperative competition, and the ICU competition. But of course, I would tell you that we have very little competition [laughs].

Regarding differentiation, definitely I would talk about clinical data granularity. Secondly, I would say decision support. After that, our ability to customize — the flexibility of our products.

One of our fortes is interoperability. A good example is Barnes-Jewish Hospital. We are integrating and interfacing with eight different vendors. Giving you only US examples, at Lehigh Valley Hospital and Health Network, we have a full integration with, at the time, IDX Lastword CPOE, which became the GE product.

Another key differentiator for iMDsoft has always been our ability to impact not just the quality of care and clinical decision-making for our customers, but also to contribute meaningfully to their level of operational efficiency and resource deployment, and ultimately, to make a positive impact on the financial performance of their critical care department.

When I talk about customer impact, it can come from a number of different perspectives that cut across clinical quality, operational efficiency, and cost savings.

When I talk about clinical data granularity, every data item in our system is a user-defined and controlled parameter. They are stored in a hierarchical manner in the database, which allows them to have sophisticated relationships between them. Those parameters can be time-related or non time-related and can be from any type and they will have attributes … for instance, a formula can be a parameter, a drug can be a parameter, a change in position can be a text parameter, and so on.

A good example is saline solution, where the granularity will go down into water, chloride, and sodium. Every time a user gives one cc of such a solution, every minute you can see the trace elements in our system every minute. For instance, you can check the patient’s potassium minute by minute. These things are very important in critical care, where the patients are not eating or not drinking — they get intravenous nutrition or enteral nutrition and also all the volume that they get from drugs is documented.

A 2005 study I read described the use of MetaVision Event Manager to deliver alerts that are based on physiologic and order information in the ICU and the OR. What are the opportunities there?

It’s a huge opportunity. We hear that from all our customers. The Event Manager was endorsed by Harvard Medical School and by most of our hospitals. It’s a real-time decision support, a rules-based engine that provides alerts that can be clinical, administrative, or financial in nature. They can be delivered to the appropriate person and place as needed via screen, telephony, pager, and so on.

I can give you an example. First, we collect all the data. Once the granular data is in our database, you can then put rules on the data. You can write statements, like if-then statements.

One of our hospitals in the United States — I cannot say the name — conducted a study that showed that a certain generic anesthetic was as good as the brand name anesthetic for longer surgeries. The hospital gets reimbursed for the procedure at a set amount, paying for the anesthetic themselves. They did not have a reliable mechanism to remind anesthesiologists to use the generic drug in longer surgeries.

They programmed the alert to remind the anesthesiologist to consider switching to the generic if the surgery has already been more than X minutes. The statement was very easy. The alert took one day to produce, it took them a few days to test it, and in less than a week it was in production. Over a year, it saved them more than $500,000.

That’s an example of ROI using the Event Manager, but since every data item is a parameter, you can also use it to drive clinical improvements. In another hospital in the UK, they managed to reduce their drug costs per patient from $197 to $149 just by increasing generic usage, from 61% to 81% with MetaVision using the Event Manager.

I could go on and on with examples like that, but it’s actually using all the granularity, all the elements, all the parameters that we have in our very rich database and putting rules on top of them.

What about the use of reminder checklists and dashboards?

Our dashboard actually allows us to see the data in a global view, not only on the patient, but also on the unit. Along the way, we’ve also started implementing entire regions. We recently started an implementation for an entire province in Canada, another province in Australia, and also in Norway. Our dashboard provides a global view of a unit of a hospital, a region, or also something more like a network or province.

The checklist is something quite easy. It’s done all over the system. The entire system is rule-based and you can add alerts and mandatory fields. It’s really comprehensive and has all the functionality that is required to provide best practices and to give guidance.

Most of what I’ve written about iMDsoft involved the lawsuits with Cerner and Visicu over intellectual property involving remote monitoring technology. Did that turn out the way you hoped?

We are actually in the midst of our litigation. However, I can tell you that Visicu recently lost against Cerner for the same complaints and Cerner used our prior art to defend itself. So, I believe we are in very good shape.

A recent study, perhaps not very well done, concluded that remote ICU monitoring did not do much to improve outcomes or reduce costs. What was your reaction to that?

It was ambiguous. I’m never happy to see that the competition is doing a lousy job. If you look at the entire market and you see that we have only 10% penetration, we are beyond the early adopters. I need everyone to do a good job because if not, it will put up additional barriers. I know that we have ARRA, the stimulus, other regulations around the world helping us, but still, we need to do a good job.

So, there was something in my heart where I was glad to see that our competitors didn’t do a good job, but on the other hand, overall, that’s not the right thing.

It is interesting because, from our end, we have a study that shows in our tele-intensivist program, a customer was able to reduce the mortality rate by 30% by using MVCentral in their remote ICU.

You have some of the best hospitals in the US as your customers. Is the US market key to your strategy and if so, how will you get the word out?

Absolutely. I think our customers are our best advocates. We are investing in enlarging our channel distributors in the US and I hope that by the end of 2010, we will be able to have a balance between the rest of the world and the US revenues.

Do you think the stimulus incentives will affect your business here?

I think hospitals in the US will have no choice. The government, the payors, and the regulatory agencies have all begun to link clinical performance to reimbursement. It’s a first in the modern history of medicine. US government initiatives, such as PQRI, the various pay-for-performance initiatives launched by large payors, and European government initiatives have all been in the headlines.

Elected officials see these initiatives as crucial to contain health costs and improve quality of care. We at iMDsoft definitely believe the recent trend will continue and the amount of reimbursement at risk for hospitals will grow.

We see also that clinical data management and protocol enforcement now have important financial repercussions and making clinical information systems for critical care an even higher priority. There is not one CIO that doesn’t have this on his radar. They just need to prioritize it, whether it will be on the budget of this year or next year, but it’s definitely on the radar.

The start that everyone was hoping for the last 20 years is actually happening now, not so much because of the carrot, but because of the stick — the penalties and because it is impossible to manage so much data and so much information that is coming from so many different sources without having a clinical information system.

Final thoughts?

We are excited about what we are doing. We have a vision and a passion here. We are in 21 countries, supporting 18 languages, and hope to expand. We would like to continue to be a innovation leader and keep the level of quality of our products and services as we continue to grow.