Charles Tuchinda, MD, MBA is president of First Databank of South San Francisco, CA.
Tell me about yourself and the company.
I’m a physician technologist. I got a degree in biomedical engineering at Harvard, where I built prosthetics and a hovercraft. Then I went to med school at Hopkins. I ultimately got board certified and licensed in internal medicine. I got an MBA at Harvard Business School, working on venture and biotech.
I joined Eclipsys many years ago and worked there for quite a few years. Then I joined Hearst, first as their chief innovation officer for healthcare, and then ultimately had the great opportunity to lead FDB.
FDB is a company that I’m very proud of and feel very privileged to be a part of. It plays an important role in healthcare. Its roots started at UCSF around medication, but today we have immense impact. We’re touching multiple stakeholders across healthcare and have an opportunity to expand beyond that. That opportunity lives at the intersection of healthcare information and technology.
Because I feel like I’m a technologist at heart — in fact, I’m a closet programmer — I feel so fortunate to be at a company that’s passionate about making a difference, improving safety for patients but also trying to drive a bigger agenda around cost-effective care and value. The way that we do it is so interesting to me because we can leverage the electronification or digitization of healthcare, but leverage the workflows and the fact that it’s applied to technology to make it easy for patients and clinicians to do the right thing.
Physicians have often expressed their frustration at clinical decision or guidance alerts are intrusive and not necessarily relevant to the clinical situation that’s in front of them. Has that changed over the past few years?
It’s a very delicate balance to deploy very good clinical decision support. You’re aiming for providing people with information that they may not have routinely thought about on the possibility that you’d change their decision-making process for the better.
When you look back at the history of decision support, folks may have started first in a world where there wasn’t any, so the first tendency would be to add as many alerts or as many informational prompts as you possibly can. People took a very comprehensive approach to that. If you review the medical literature today, people are measuring the performance of alerting systems by positive predictive value, trying to look at when alerts actually change behavior. You’ll see many research studies.
At FDB, we’ve taken a multi-pronged approach. One of the products that we launched in the last few years was AlertSpace. It has great success today. We took an approach that first allowed for customization of those alerts, tailoring the practice with the information that’s available. But we’ve also invested heavily in trying to increase the specificity of our learning engine, having to deal with many more patient inputs.
We in fact have a whole initiative that we call Advanced Clinicals, where we’re trying to replace the older infrastructure with a revolutionary approach to alerting. A lot of times, that actually means that the guidance is not given in the form of an alert at all — that it’s a framework. Maybe a series of questions. A process. You may get that guidance at different steps in the process. We’re on the road talking about it and we have clients that deploy it. We’re pretty excited about the potential there.
A lot of the clinical decision support setup is made by people who aren’t entering orders on the front lines. Would it be safe to allow individual practitioners to determine which alerts they want to see instead of mandating the same alerts for everyone?
That’s a really great point that often comes up when we talk to clients. Institutions certainly have a view — often around the mindset of liability protection for the institution — where they want to roll out a certain set of alerts to prevent some of the most severe or tragic consequences. Clinicians, on the other hand, especially sub-specialists, deal with some very powerful medications and very tough and complicated diseases all the time, so that balance has been hard.
That’s where the customization play has worked really well. The difference is that I would say most of the vendors that we’ve spoken to generally don’t like to allow for individual personal customization, even though they technically can and have had that as an option. A lot of the institutions choose not to deploy it that way.
We’ve thought a bit about it. In the way that we’re rolling out our future solutions — especially those based on our cloud technology and our Web services technology — we’ve allowed for the possibility of us learning the behavior of that individual. Following them around the healthcare system and even seeing patterns in that data so that we can give them alerts that have been beneficial to other people like them.
Although that’s not quite deployed, we’ve laid a lot of that foundation to make that a possibility in the future. That’s like personalization around the information that individual clinicians would need to deliver even better care for patients.
Have we solved the problem of getting medications reconciled for a patient across their different providers and care settings?
No, I don’t think med rec is solved. If you look at the data of the penetration of med rec, obviously it’s now a requirement or a best practice for clinicians to med rec on every transition of care. When I talk to clinicians — including my wife — it takes an incredible amount of time and the workflow around it doesn’t make a lot of sense.
That’s where we thought there was an opportunity. In our acquisition of a company that provided the MedsTracker platform, we saw a very innovative workflow with some really smart algorithms that made extremely great use of the information that we could provide. We’ve reduce the time it takes to do med rec dramatically. Cut it in half sometimes, down to 25 percent of what it used to be.
When I think about the future and the importance of med rec, it’s a really important decision-making process that’s going on when you’re choosing the drugs and how the patient should take those drugs. It’s an area where FDB will be able to bring more to bear in the future.
The traditional FDB work clinical process is around ordering and around dispensing the drug. Med rec is doing that in bulk, when you’re thinking about the disease and then going to go communicate that to the patient. For us to be able to leverage some really sophisticated CDS and then create the documents and artifacts that gives the patient the best education, the best understanding of what they should take — that’s the right thing to focus on.
Do you see the company’s role or product line changing as healthcare moves from management of episodes to management of care?
Yes, I do. I hinted at a few things. Maybe I’ll make them explicit.
One is when I looked at FDB and first started thinking about the strategy, I thought FDB would need to able to touch patient data. Getting into the clinical workflow with this MedsTracker platform and being very comfortable — and frankly, HIPAA-compliant — I thought was going to be an asset for the company in the long run. I thought that the future of applying information would require personalization to the patient situation.
Then when I think forward about FDB’s agenda, we have a great heritage of providing solutions that improve the safety of medications, but I thought that the potential would be greater than that, to the extent that we would have access and the trust of patients and clinicians to look at their data and give them personalized guidance. I thought that there would be a big opportunity there.
We looked into clinical workflows, which is why obviously we had an interest in med rec. The future will allow FDB to demonstrate our ability to deliver more than just safety, that we would help people achieve the outcomes that they want and look at a wide range of inputs. Hopefully we continue to earn that right.
What challenges do you see for IBM’s Watson and genomics informatics companies that are trying to take theoretical knowledge from one system and insert it into the workflow of physicians using another system?
I love that people are investing in innovating in healthcare because I think it really pushes the envelope and gets people to think beyond what they normally might.
When I look at technologies like Watson, they inspire us to think about how we could leverage that type of approach to what we do. When I look at where it could be made helpful to patients and to our vendor clients, we focus around making it simple and embeddable. When you look at our MedsTracker platform, we’ve made it very simple to put in med rec. When we look at our Cloud Connector, why I’m so interested and excited about that is because we can deliver technologies like natural language processing, really complex risk algorithms, all through a Web service interface that would be very easy for a developer to pick up.
When you think about genomics, there’s a massive database behind that. Millions of mutations and millions of mutations of variants tied to drugs, drug-gene pairs, and those disease processes. That knowledge in the old scheme is really not feasible to deploy, because in the old scheme, you would ship the information out and hope that the EMR would build that algorithm and process it. You really need technologies like Cloud Connector, like a platform that makes it so easy for developers and consumers to use it.
When I look at these companies and these trends, I like it because I feel like it’s educating the market on what people should need to improve healthcare. Then I think FDB’s prospects are great because we’re very much dedicated to simplifying it and aggregating that information and making it easy to use and then focusing it right to a very specific workflow so people can benefit from it.
FDB doesn’t just produce clinical content, but also performs the subtle activity of integrating the information into standardized databases and working with EHR vendors to present it seamlessly to their users. Will IBM or other companies look to FDB as the company that can make their jobs easier by providing existing hooks into vendor software and databases?
Yes, absolutely. We have had conversations with IBM. We’ve had conversations with other large technology companies. In many cases, they’ve licensed our content to do precisely what you’re saying, meaning bridge the expertise gap that might be at their general purpose tech company with how it might be applied appropriately in healthcare, in the workflows. Genomics companies have also licensed and collaborated with us as well. In fact, we’re very excited about some of the things that we’re planning to show at HIMSS.
People would traditionally think of FDB as a medication information company. If you’re a technologist looking at FDB, you would realize that we’re a data aggregation and normalization company that brings complex information, simplifies it, and makes it very usable for technologists to consume and deploy. That’s why we have great channel relationships with all the major EMRs. It’s something that we continue to build on.
One thing that I tell my friends about my work that I really enjoy is the type of relationship that we have with many of our clients. We’ll walk into a meeting and we’ll have an opportunity to teach them about something. We’ll say, "Hey, guess what, here is the latest approach to drug interactions," or, "Here is the latest approach to genomics. You could offer it as a feature in your software product and you’re going to have great impact where everyone’s going to benefit from it."
We teach them technically how to pull it off. We give them the information that would drive that functionality. That’s the type of impact that we hope for and the fun that we have deploying the technology to make a difference.
Your cloud-based product could collect a lot of information about what’s going on in the customer’s setting, not just in the form of alerts that were presented, but also as a snapshot of patient information and situations. Could that information be useful to drug manufacturers or for safety purposes?
Absolutely. That’s partly why we started the investment and deployed our cloud product.
I’ll give you two examples. First, on AlertSpace. Over the years, we’ve built up a lot of feature functionality. From a features and solution suite, we have the industry’s best alert management platform. It’s extremely easy to use.
On top of that, we’ve added community and crowdsourcing capabilities. You can see what other healthcare institutions like you have set and their decision-making process around it. There’s a lot of additional content to bear that not only comes from us, but comes from the community.
When you look at our Cloud Connector platform, I’ve talked about giving folks access to massive online databases and sophisticated computational algorithms, but we have this hope that we need to validate, this belief that we would could probably offer a zero-install analytics and surveillance system. Something where because we’re running all the clinical screening CDS, folks can benefit from additional analytics and reporting about their high-cost drugs, about the disease processes that they’re managing, about which physician is seeing which patient. That’s something that we hope to introduce in the future.
When you look at our MedsTracker platform, it is a platform that has a lot of patient data in it. We’ve deployed a solution, such as clinical quality measures, which is quite innovative. It’s in the ordering process. The clinician is prompted to walk through whether they’ve fulfilled the clinical quality measure. The nice thing about that approach is that it’s proactive. If you forgot to give an aspirin, it will ask you, "Did you give the aspirin for this diagnosis, which qualifies for getting aspirin in the first 24 hours?" Then you can just order it alongside while checking off that you completed it.
That actually makes a difference. Most clinical quality and analytics systems are retroactive, so they’re just looking backward and seeing what people actually did. The approach that we’ve taken is on the front end. We think that has a bigger impact.
The other big area for us is around cost of therapy. When we look at cost of therapy and the analytics potential there, not only is it trying to understand the price, but understanding the outcome and the alternatives that you could potentially use to get the same outcome. That’s an area that we’re going to continue to investigate.
How do you see FDB’s role in looking at drug cost and how to evaluate which drugs are cost effective?
We continue to monitor pricing. We don’t publish AWP and we continue the decision not to publish AWP, but that doesn’t mean that we’re standing still. We’ve worked with various states and groups to develop a “better than AWP” benchmark. Although that hasn’t materialized, that’s something that we’re actively continuing to consider and push for on a variety of fronts.
That mostly then leaves us in the area of therapeutic alternatives. In the UK, we’ve deployed a wonderful product called OptimiseRX, which helps folks select the best drug. The best drug there is maybe more easily defined because of their NICE guidelines and their British National Formulary, but essentially it will offer appropriate drug alternatives that are less costly. There they’ve been able to show significant savings in the populations that they’ve impacted.
We think that here in the US, that’s possibly another option — offering therapeutic alternatives. When you look at the data about where the savings are coming from, it’s coming from a lot of interesting places, like dosage form changes. It may not just be an active ingredient change. We’re keeping track of where those savings opportunities might be and then trying to serve them up at the right time and make it simple.
How do you see First Databank and Hearst Corporation being involved in healthcare changes over the next five years?
Hearst is still very interested in healthcare. We continue to invest through the Hearst Health group in companies across healthcare. We’ve assembled a great family of companies that span the entire continuum of care. We continue to be focused on delivering care guidance. As an example, FDB obviously delivers medication guidance across the continuum, but you’ll also see our sister companies delivering appropriateness criteria, risk stratification, and other tools to help people manage and understand how care could be delivered better.
In the future, we’ll continue to expand and we’ll be hopefully an even bigger part of everyone’s life by focusing on integration, focusing on patients, and giving value to patients and the providers that take care of them.
Do you have any final thoughts?
FDB is in a unique position. We’re a company that’s extremely well trusted by the industry. It’s because we’re unbiased and we really try to do the right thing. We’ve done that for many years.
What’s so great about FDB is that we have the scale and the passion to invest, and I think that we in fact do out-invest in innovation compared to many of our competitors. Over the next few years, you’ll see FDB getting into new areas. Not only will be continue to upgrade and revolutionize our technology approach, we’ll be in areas beyond medications.
We recently launched initiative around medical devices. We’re exploring a few other areas that we think start adjacent to medication, so we’ll have the permission and the power to deliver value.
My hope is that FDB will be the go-to company for folks to use and deploy whenever they think about making a difference in healthcare.
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