Ann Fishman, with EHRtv, interviews David Caldwell, Executive Vice President of Certify Data Systems.
Ann Fishman: Hi, I am Ann Fishman at HIMSS 2012 with Dave Caldwell at Certify Data. Hi Dave. Executive Vice President. Dave, explain what Certify is doing in the HIE space?
David Caldwell:Sure. Well Certify is, we are founded in 2004. We spent four years developing a product for this private, what’s known as the Private or Enterprise Health Information Exchange market and that’s really largely focused on integrated delivery networks or multihospital systems and their affiliated physicians so that you can have free flowing exchange of clinical information to take care of the patient within that community, within that community where the patient lives.
Ann Fishman: Explain what the federal government is doing to mandate or encourage HIE?
David Caldwell: Sure. Well the money that were set aside in the HITECH provisions of the ARRA clearly have brought attention to this and have started to fund statewide HIEs and regional HIEs and even local city Health Information Exchanges. That’s been wonderful for all of us in this Healthcare realm because it’s bringing attention to the fact that we really need to start sharing clinical information to improve care. The coordination of that care, duplicate testing and the classes associated with that as well as improve satisfaction for patients and providers. So all of that money is very good. Most of it is going towards these public health information exchanges and they serve a different purpose than what an integrated healthcare system needs to do for their own community.
Ann Fishman: Your CEO was quoted in Health IT News as referring to the U.K. situation as an example of why the government funding in this space is not good. Will you talk about that?
David Caldwell: Sure and what he was referring to is that they took a centralized approach in a one size fits all and asked all of the physicians within the U.K. to participate in that program. Well what they found out is that it comes down to politics and all physicians aren’t going to participate in something that they are forced to be conformed to. They have a commitment to their patients and they need to manage the workflow of their business as well as how they provide care the way they best see fit for their patients and the same thing goes in the U.S. and if you look at the history of these centralized models, typically in the public space, public HIE statewide, they don’t get a 100% participation because to be able to effectively share information, the physician is asked to put their clinical information for their patients in a third party database in the center, a centralized model and it’s had some limited success but we think long term that is not the way for organizations to be sharing information. There is too many politics involved and people won’t all participate. Governance gets to be very difficult. Everybody has different interests. So it becomes a very complex politically driven model for deploying health information exchange.
Ann Fishman: One of the goals set forth in HITECH is the ubiquitous adoption of the EHRs I think by 2014?
David Caldwell: Right.
Ann Fishman: How central is HIE to that goal being reached?
David Caldwell: It’s critical. If you cannot have Health Information Exchange if all participants, i.e. providers or physicians are not on electronic medical records. So the faster we as a nation can get that adoption of putting patient records or digitizing it and making it available, then we can start talking about serious health information exchange which obviously other countries are further along in their physicians adopting electronic medical records.
Ann Fishman: There is a lot of debate in our country about whether we have come a long way which I believe is the position of the ONC director or whether we are really not moving fast enough. What do you think?
David Caldwell: Well I think we are moving at a speed which where we currently are today. I think people in policy have recognized that a lot of the suppliers and manufacturers of technology have been so busy on other priorities, it’s been difficult for them to reach some of the goals. So I think we have a very aggressive stance from a policy standpoint. We all would certainly like to move faster. We want to get to the end game which is free flowing of clinical information so that we can better take care of the patient, but I think we have certain blocks, certain hurdles in the way that are preventing us from getting there and one of them is really the adoption of standards. So that’s key that we as an industry need to focus on and a lot of folks both in Washington and throughout the country at the State level are struggling with what are the appropriate standards for us to be following.
Ann Fishman: How do you see that being solved?
David Caldwell: Well I think it’s really the suppliers, it’s industry really coming to the table and committing to adopting the standards that have been promulgated throughout not only the U.S. but also throughout the world.
Ann Fishman: Yes.
David Caldwell: And in particular I am thinking of integrating the healthcare enterprise IHE standards.
Ann Fishman: Do you see consolidation in the marketplace as a pretty certain thing?
David Caldwell: Absolutely. I mean today we have well over 300 ambulatory EMRs that are certified for meaningful use and I think as the health system looks out at their community it’s going to be very difficult for them to be interoperable with 300 different EMRs. I mean I think you are going to continue to see a consolidation on the ambulatory side. I think we have already seen that for the most part on the inpatient side.
Ann Fishman: The adoption has been solved to some extent because doctors are not all happy to be using the EHRs? What do you think, is that a funding issue that can be solved with the incentives or is it just a workflow issue?
David Caldwell: Yeah I think it’s a variety of reasons. I think we certainly have a lot of physicians who are at the end of their career. This is a big commitment in changing their practice from a paper-based practice to an electronic. They don’t necessarily see the return on that investment. So they are not going to adopt it. They are going to retire and they are going to move on and then you have a younger generation that clearly has started out their careers with electronic. So they are comfortable with it and then you have others that for whatever payment mechanisms, they can’t necessarily afford to bring electronic health record into their practice and that’s hopefully this funding that’s been done through meaningful use will help those who are unable to do that – find a financial way to do that.
Ann Fishman: How fast is Certify growing?
David Caldwell: Well we are very pleased. We believe we are the fastest growing provider in this marketplace. We launched our product after four years of development in 2009 and in the last three years, we now have over 71 health systems, 258 hospitals and growing everyday. That have chosen Certify as a solution for enterprise HIE.
Ann Fishman: What are you doing right?
David Caldwell: What are we doing right? I think what we did right from the get go back in late 2003 or 2004 when we are founded, we went out and spent time in physician’s offices and I think what other people have missed is deploying technology in a small practice where we really want those small practices to adopt technology. They don’t have the resources to develop or adopt heavy handed technology. So we really went and spent 4 years with physicians, about 200 plus physicians learning how to best deploy technology in their environment because if they don’t adopt it, and they don’t participate you are not going to have health information exchange because the vast majority of health information for any of us resides in the ambulatory setting so we need to be able to access that ambulatory information. So we did that right out of the get go and our technology platform has taken off in recent years as these integrated healthcare systems have struggled with adoption of other technologies in deploying them out into the community.
Ann Fishman: What would you say the theme is for HIMSS 2012?
David Caldwell: Yeah that’s a great question. I think it’s obviously from a overall patient perspective I think everyone at HIMSS is concerned about how do we better – how do we take care of the patient and more focused on what is the whole payment systems in the future under example an ACO, how is that going to impact how we care for them and how do we start focusing on wellness, how do we start to predict what’s going to happen in somebody’s life in terms of their health and start to address that sooner rather than spend all of our money at the end of the disease versus avoiding that disease to begin with. And I think the mood here is interoperability is going to be – HIE is the infrastructure for getting to an accountable care organization and accountable the word is there and that’s what I think people are focused on is being accountable to take care of the patient in the most efficient and effective manner.
Ann Fishman: Dave, Thank you very much.
David Caldwell: Thank you.
Ann Fishman: This has been really great.
David Caldwell: I enjoyed it.
Ann Fishman: Ann Fishman with the Executive Vice President of Certify Data, Dave Caldwell, HIMSS 2012.