HIMSS 2012 – Acuitec, Lionel Tehini

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Dr. Howard Rollins, EHRtv AIMS specialist and medical consultant, interviews Lionel Tehini, President & CEO of Acuitec.

Category: HIMSS12, Tradeshows
Date: April 16, 2012
Views:25,101 views

Dr. Howard Rollins: This is Dr. Howard Rollins with EHRtv. Today, I’m at Las Vegas HIMSS 2012. And I am with Lionel Tehini, the CEO and President of Acuitec. Lionel, thank you very much for being with us.

Lionel Tehini: Thank you, Howard. Thank you for having me.

Dr. Howard Rollins: So we’re going to talk about your AIMS system and beyond your AIMS system, what Acuitec really has to offer. As an anesthesiologist, I deal with a lot of people in that–– in the–– in the field and when you talk about AIMS, people think that that’s the all encompassing solution. But I don’t think that’s true, that really goes much further than that, doesn’t it?

Lionel Tehini: It certainly does. There is a misconception of what an AIMS really is, most people categorize an AIMS as to what majority of anesthesia involves and that’s intra-operative charting.

Dr. Howard Rollins: [Right], yeah.

Lionel Tehini: AIMS is a lot more than that.

Dr. Howard Rollins: Uhum.

Lionel Tehini: AIMS should be anything that involves anesthesia care whether it be pre-operative assessment, post-operative rounds, intervention during an ED environment, helping someone to administer a block somewhere in the hospital, all the documentation that anesthesiologist does encompasses an AIMS. Over and above that is the scheduling of resources, is the management of resources, is the assignment of your resources to do these types of tests, you got tracking, managing of people. And then you got the day of surgery management.

Dr. Howard Rollins: Right.

Lionel Tehini: Day of surgery management, most people don’t understand that most hospitals rely on the anesthesiologist in charged to help the charge nurse schedule and move cases around to help get the load done. And if that’s done in a grease board without taking into consideration technology, it’s–– it’s a waste of time because they’re working on information that’s not really real-time.

Dr. Howard Rollins: That’s really what’s happening right now in probably upwards of 85% of––

Lionel Tehini: Oh, easily 85% of hospitals. I mean you’re going to a hospital operating room today and you just see grease boards everywhere. So information systems that–– anesthesia in the operating room is the true, the most sophisticated healthcare as far as I’m concerned, of anything in the hospital. If you look at the technology involved in anesthesia, it’s the most technically advanced delivery of healthcare than anybody else has got, but yet they’re the most updated as far as EHR is concerned because they’re still using paper.

Dr. Howard Rollins: Right.

Lionel Tehini: So you look at all the anesthesia machines, they’re high tech. You look at the monitors, they’re high tech. You look at the base monitors, they’re significantly high tech; the prompts are high tech. Everything that they use is pretty much high tech and it’s the most advanced in healthcare. But when you come down to the electronic medical record and these people are capturing these things on paper and if they want to know the status in the room, they got to call inside the room. If an anesthesiologist is overseeing the case and he’s got a CRNA at the bedside, he’s going to physically walk into the room. He doesn’t get notifications of events that are occurring. So technology has come a significant long way and yet AIMS seems to trail.

Dr. Howard Rollins: Penetration is low. To what do you assign that responsibility?

Lionel Tehini: I think there are a number of reasons that that’s the reason. One is I think electronic–– the whole EMR system in the U.S. lacks implementation.

Dr. Howard Rollins: Right.

Lionel Tehini: And that’s because of failed implementation. And I think the failed implementations come generally across healthcare because of lack of education. Clinicians need to be better educated. We’re making assumption in the EMR market that we are dealing with computer literate individuals. Unfortunately, most of these clinicians have never touched the computer during the training. So when we tell them to use a mouse or click on something or navigate something, they don’t have that capability.

Dr. Howard Rollins: But you know, it’s funny. Anesthesiologists, if there was one specialty that I could pick that I could say they really are ahead of the curve or really into technology, it’s anesthesiologist. But yet, we, and I include myself in that have resisted getting–– getting away from the paper record and I think part of it is the fear of artifact.

Lionel Tehini: Correct.

Dr. Howard Rollins: The fear of being out of control of our little space.

Lionel Tehini: Now, on the contrary to what I was just saying, you’re a hundred percent correct, anesthesiologist on the other hand, are tech geeks.

Dr. Howard Rollins: Right.

Lionel Tehini: They have to be because they work with technology all the time. So they know the problems of what technology can do. They know that technology can create issues as well as solve issues. So their concern is anything ending up on the charts, that they have not vetted, validated, and made sure it’s correct. So artifacts are a big, big issue.

Dr. Howard Rollins: Right.

Lionel Tehini: Majority of the systems in the market, to my knowledge, all the AIMS systems in the market, the exception of GasChart, which is our product, does not allow you to review your–– the data before it ends up on the chart. We allow charting in three different mechanisms. One is manual, so they can enter the chart manually, just like they do on paper today. The other is automated which is taking the data as it comes out of the machine in whatever frequency that they wanted and just putting that data as the machine says it is on the chart. The third and the most preferred mechanism that we have all our customers use especially when they’re first implemented, is what we call semi-automated. What semi-automated does, it presents the data as captured, captured bin data that comes off a machine to the clinician, the clinician can vet that data before they chart it.

So we talk about captured data versus charted data. Captured data is what comes off a machine; charted data is what the anesthesia team vets before they put on their chart. That is one of the big keys of our success is the fact that we are able to do that. They are able to edit that data and know how to explain all these artifacts away such as when a surgeon’s leaning on a cuff so there’s an incorrect reading because the proximity came loose or whatever it is. So they have many, many ways to do this kind of things and so that’s what–– that’s one of the biggest strengths of our system actually. And I’d love to claim the success of it but it wasn’t my doing. It was a requirement that is part of the original development of this. That system would never have gone live at Vanderbilt if we were not able to have done that for the Vanderbilt clinicians because they did not want to sit to explain away artifacts and spend most of the case having to do that.

Dr. Howard Rollins: I was going to bring that up, in fact, that your system was in fact developed by anesthesiologists that are leading––

Lionel Tehini: Absolutely.

Dr. Howard Rollins: –– University–– Vanderbilt University Medical Center and I think that that speaks volumes to the input that you had in developing this system.

Lionel Tehini: Absolutely. I mean Vanderbilts are phenomenal about that. Extremely bright individuals as I’m sure you understand.

Dr. Howard Rollins: Yes.

Lionel Tehini: Not that–– not that anesthesiologist in general, I mean I’ve learned a lot about anesthesiologist. They have the greatest sense of humor.

Dr. Howard Rollins: (Laughs)

Lionel Tehini: They are tech geeks and they really, really are easy to work with because they are–– they do understand and they are very, very intelligent. And the thing I like about anesthesiologist, if I had to be a clinician, I’d be an anesthesiologist because you don’t go home with the patient. When you leave at the end of day, you don’t have any patients. It’s a great––

Dr. Howard Rollins: I’m really starting to enjoy this interview. This is great.

Lionel Tehini: (Laughs) So yes, Vanderbilt plays a huge–– they played a key role in our development and they still play a huge role in our development in making sure that clinically said, we don’t do anything dumb, that our workflow doesn’t inhibit their performance and the ability for anesthesiologist to administer their work and be able to do their job. So they all–– they are very great partner but they are very, very difficult as well in validating things. At the slightest little thing, the number of clicks, the ability to get to information instantly, they don’t want to have to scroll, click anything. Everything must fit on the screen.

So that’s another thing you find about our system, it’s very ted-based and it’s very obvious and it’s very driven around what we call “forcing functions” to help the clinicians make decision and see what they need to finish the chart with. So it’s very intuitive when you look at the screen. And as I said, I’d love to create–– I’d love to take all the credit for this but that comes because of the clinicians we work with. Vanderbilts are great people.

Dr. Howard Rollins: They are very part–– very particular.

Lionel Tehini: Very particular in that and our customers that have joined the group and become users of the system have become as particular and have seen the value of it. So they don’t let us off the hook either. I mean they understand the value of what they got from Vanderbilt.

Dr. Howard Rollins: And tell me about VPIMS. So I understand exactly what that means.

Lionel Tehini: VPIMS is a–– stands for the Vigilant Perioperative Information Management System. It’s a fully comprehensive information system for the perioperative environment. We start from the time a patient goes into the surgeon for a surgical consult and we manage the entire process from a clinical perspective, patient communication, history and physical, everything we start at that point and it flows right through to the time a patient is discharged from the perioperative environment. Even to the point of post-surgical CQI with our first surgical CQI module, but everything that happens in the system is aggregated in one complete system.

Dr. Howard Rollins: Able to report to AQI and other reporting agencies?

Lionel Tehini: Absolutely. So it’s able to report not only billing information to AQI but clinical information, too. Most of the AQI dated to date is related to billing information. We are one of the first people to be able to do clinical information that we send in to AQI. And AQI has been a great organization to work with as they work out the bugs in the XML and they target their former track to accept this chart of clinical information because really the amount of data that is being captured, what happens to a patient in a 2-hour window in the operating room, doesn’t happen to a patient anywhere else in healthcare for days.

Dr. Howard Rollins: That’s right.

Lionel Tehini: The intensity of data and the magnitude of data that’s on the patient is huge and for that to be transmitted easily across to an aggregation system such as AQI is–– is a test that AQI has undertaken and they did a good job of it. But it’s not something that they can just say, “That’s a cookie-cutter. Let’s go with it.” It’s set in a standard that is completely different to anybody else, so we’re fortunate.

Dr. Howard Rollins: And today a rather large percentage of patients that are–– pass to a hospital, at some point pass through the operating room.

Lionel Tehini: Well, I would say majority of our customers, I would say probably close to 75%, the least would be 75%, sometimes it’s up to 90% of the hospital, patients that end up in the hospital comes to our system; the one exception being Vanderbilt, obviously.

Dr. Howard Rollins: Yeah.

Lionel Tehini: I mean Vanderbilt is a huge monolith of healthcare but most of our facilities outside of Vanderbilt are pretty much driven around surg– surgeries. And the interesting thing is even though the system is built at Vanderbilt which is a complex environment, the system is so simple to use and so simple to configure and install that we are able to downsize it to some of our hospitals that are full 800-bed hospitals––

Dr. Howard Rollins: Uhum.

Lionel Tehini: –– and yet they’ve got at patient surgery centers which are 14, 16-bed facility outside like patient surgery centers and they are able to use exactly the same system with exactly the same configuration in those environment. So it’s not good for just one huge complex like Vanderbilt, it‘s actually driven around the surgery centers as well.

One thing I will point about what Vanderbilt has done which is actually brilliant for our management perspective, they have created–– within our system, you can create what we call management parts. So you can mange each–– you can break your hospital up and you can break your OR up into various different what we call parts and you can manage it as if it was small surgery centers.

Dr. Howard Rollins: Uhum.

Lionel Tehini: So you can have a part of four Ors and you can manage that as its own independent team, its own metrics, its own measurement capabilities, its own performance key indicators and you can––

Dr. Howard Rollins: In a large institution, that’s fantastic.

Lionel Tehini: –– you can push through that and so what it helps them do is measure performance at a different level that nobody else is able to do because–– because our system is built by academicians, is geared around this key–– key performance indicators the ability to report this indicators out real-time unsurpasses anything else in the market. And that’s one of the biggest strengths that we have is that we can help you make real-time adjustments in your operating room environment so that you’d eliminate overtime or you move cases around so that people can get more efficient and get things done. So it’s–– it’s because the structure of the database and I would say 90% of the credits has to go to Vanderbilt for that.

Dr. Howard Rollins: And there are a few things I’d like to discuss. One, you mentioned the word workflow and to–– we anesthesiologist, workflow is key. We don’t want our workflow interrupted. If we want it enhanced or we want it left alone; number one. Number two is interfacing. Interfacing is so important because it’s easy to have all these things but will it interface with everything else I’ve got and the hospital has? And number three is implementation because I know that your company touts themselves as very, very strong in the implementation process so that you can bring this whole system to reality. So could you dress–– address those three concepts?

Lionel Tehini: So let me address interfaces first because I think interface is, as we just mentioned, how complex the anesthesia environment is.

Dr. Howard Rollins: Uhum.

Lionel Tehini: A lot of the AIMS system out and a lot of the other people use third-party vendors for the integration to talk to these device monitors. We don’t. We have developed our own drivers, at our own drivers certified and we talked in over 90% of the different devices that are on the market today that are being marketed by these vendors such as Phillips, GE, Dräger, and etcetera. So we have developed our own drivers to capture that information. The reason we do that is because our customer is–– there’s nothing–– we talked about mission-critical applications, and AIMS solution is the most mission-critical application out there they have to deal with, okay. And I’ve dealt with systems since the 80s.

Dr. Howard Rollins: Uhum.

Lionel Tehini: And we’ve already used this term mission-critical applications. Well, this is mission-critical to the patient, not so much to the anesthesiologist as much as it is to the patient so information is absolutely important that it’s accurate, correct, refers to the right people. And the reason why we’ve done this is because if there’s a communication breakdown between the device and the software, the last thing we want to do is have to contact a third-party vendor and try to get the support person on the line to get online to bring that back up again because five seconds could be a matter of life and death in the operating room.

Dr. Howard Rollins: Right.

Lionel Tehini: So they know they go one–– one place to contact. They pick up the phone, as a matter of fact, they text us from the operating room, they tell us “OR 1 is down”. We immediately go in and we fix it. The other thing that we’ve done, which is unique and no one else has really done this in the industry as a whole, is we’ve developed what w call a product called Sentry. Sentry is based from the same philosophy as what healthcare is. It monitors every single aspect of our system so it monitors every interface. It monitors every communication protocol and it monitors every single system to make sure that the systems are operating.

If it’s not, it does an immediate notification. If it finds any fault in the network, any fault in communication, any fault in our connection coming lose on a device, we know about it before the actual clinician knows about it. So our support staff can be reactive and get on there immediately and starts solving these problems rather than waiting for a clinician to send a text to us or call us to say to us why aren’t we getting the data from––

Dr. Howard Rollins: That’s unique to Acuitec?

Lionel Tehini: Absolutely unique to Acuitec. So we’ve put that into our system and we monitor every single interface. We also have built into our system an integration engine, an HL7 compliant integration engine. So our communication with third-party systems for health information exchange whether it be the EMR, or whether it be any other foreign systems such as a lab system or a pharmacy system, we manage that all into through our HIE integration engine. So it’s all built in our system. Interface is very important and we–– we have a team that focuses on that to make sure it’s compliant, everything is working and we monitor those through Sentry. And that’s why we built Sentry because we know how critical this is inside the operating room.

Dr. Howard Rollins: Right.

Lionel Tehini: Implementation, the biggest failure, I think, in healthcare systems globally whether it be healthcare or any other system, as a matter of fact, is the failure of implementation. And that’s what leads to most catastrophes is implementation, they don’t focus enough time and do implementation method–– methodically. We follow a nine-step process for implementation. We do not skip as step. Every step has to be done, okay?

I was fortunate enough to be groomed by the Japanese in the 80s and 90s and they follow a very disciplined approach in manufacturing that I was able to bring into software when I did a software implementation. And we never make assumptions. Everything has to be signed off at every step and validated and vetted according to a quality control. If they have hardly in place, we vet it, we validate it. We don’t assume. That’s why we are able to do our implementations in a very rapid fashion.

Dr. Howard Rollins: How rapid?

Lionel Tehini: We can come into a facility and we can be up and live. The shortest we’ve been up and live is 60 days. The longest we’ve been up and live is a 120 days.

Dr. Howard Rollins: That is a short timeframe.

Lionel Tehini: And the–– the 120 days happened because of a delay in the delivery of server from Dell.

Dr. Howard Rollins: Are you there when you go live?

Lionel Tehini: Absolutely! We–– there’s no–– that is part of our contract. We will be on-site when they go live and we will be on-site for a minimum of two weeks when they go live because you can then, for 95% of the things––

Dr. Howard Rollins: Uhum.

Lionel Tehini: As the 5%, it comes with––

Dr. Howard Rollins: It’s the details, right.

Lionel Tehini: And you can do, they can simulate 95% of the cases; that is the 5% of the cases that they forgot about.

Dr. Howard Rollins: Right.

Lionel Tehini: Or the scenario that comes up and they’re like, “How do we document this?”

Dr. Howard Rollins: Uhum.

Lionel Tehini: And where do we document this and how do we capture this and what should I attempt to put for this, etcetera. So going live is a very, very critical time in our office. We have standby people 24 hours to make sure that they–– standby purely for their customer because not only is it critical from an application standpoint, but it is critical from the technology standpoint because that’s when you’re going to find that the switch doesn’t work properly or they haven’t configured a certain environment correctly. That’s when the proof is in the party. Going live is when the proof is in the party.

Dr. Howard Rollins: Right. Now––

Lionel Tehini: And you can’t afford a failure because it impacts the delivery of care to the patient.

Dr. Howard Rollins: And finally, I don’t think we hit on workflow. But briefly, allay my fears if I have any that my workflow is going to be interrupted or changed in any way for the worst when you come into my facility.

Lionel Tehini: Absolutely not. I mean our system is designed, as I mentioned to you, it is designed by anesthesia team. It’s designed around your workflow. So one of the things we do, as a matter of fact, in our demonstration, when we go through an evaluation with the customer and they come in and we come to our facility or go to their facility to do a demo, we’ll take them through a quick 15-minute navigation to show them how the system works, what the various indicators on the screen mean, what the forcing functions are showing them as far as errors or missed–– mischarted information is. And then we hand over the keyboard and the mouse to the anesthesia team in the room and we let, we help them open up a case and then we say, “Go ahead and chart the case.”

Dr. Howard Rollins: Uhum.

Lionel Tehini: And 99% of the time, they can chart the case. As a matter of fact, we had one of the guys come back to us and use a quote from Geico saying “This is so simple, even a caveman can do it.”

Dr. Howard Rollins: Uhum.

Lionel Tehini: And it is not because of what my company has done, it is because of what we learned form Vanderbilt and what we learned from our users. They are very, very harsh as I mentioned earlier on what we do. So it’s–– your workflow does not change; it actually supplements perfectly into your workflow and it makes it an awful lot easier. Our biggest concern with AIMS is as–– as the–– as the clients get used to it and get more comfortable with it, we’re scared that they’re going to switch over and start Googling. So you know, because they’re going to assume the system will take care of everything.

Dr. Howard Rollins: Right.

Lionel Tehini: But that’s why the–– the semi-automated, not only it is good for making sure no artifacts get on the chart but it’s also good for drawing attention to the clinician at the bedside to look at the artifact values and make sure they make decisions. On top of that, we have Vigilance. Vigilance is our remote patient monitoring system which delivers real-time information to the anesthesiologist or any clinician that subscribes to it anywhere. So they can get electronic notifications, they can look at the data remotely, they can see exactly what’s going on, so there’s no chance of anybody saying, “I didn’t know that was happening.” The only reason why they can say the didn’t know that what was happening is because they’re basically switched off, and went to the coffee shop and they were out of contact. As long as they are on the network, they have access to the information and while where they’re on, they can take care of their patients.

Dr. Howard Rollins: Thank you very much. Lionel, you’re enthusiasm shows. You know your product inside and out. It’s an impressive product. I really appreciate you spending the time with us.

Lionel Tehini: Oh, we–– we appreciate your time and thank you very much for having us.

Dr. Howard Rollins: Thank you very much.

Lionel Tehini: Thank you.

Dr. Howard Rollins: This is again Dr. Howard Rollins with EHRtv and I’ve been with Lionel Tehini with Acuitec. Thank you.

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