Dr. Howard Rollins, EHRtv AIMS specialist and medical consultant, interviews Steven Tolle of Merge Healthcare.
Dr. Howard Rollins: This is Dr. Howard Rollins. I’m at Las Vegas 2012 HIMSS conference, and I have the pleasure of speaking to Steve Tolle. Steve is the Senior VP of Solutions Management for Merge Healthcare. So here we are at HIMSS, tell me why you’re here and what’s exciting with Merge.
Steven Tolle: So we’re at HIMSS essentially promoting our brand and promoting this message about enterprise image, and interoperability, and enterprise imaging strategies for hospitals. So if you think about images and medicine – we believe that they’re the truth in medicine, so if you’re going to see an orthopedic surgeon, a cardiologist, an oncologist, an ophthalmologist, a dermatologist; they’re looking at an image, and that image, and what they see can have a significant impact on your life and your care. So we are working with hospitals now, focusing on – you got enterprise strategies for CPOE, you got enterprise strategies for Supply Chain Management, but you don’t think about enterprise strategy for image management. And when you think about a typical hospital, they have multiple PAC systems; each department has their own PAC system, they don’t talk to each other in one delivery system. They might actually be sending CDs across the street because they can’t talk to each other effectively. There’s significant opportunity to improve efficiency, and so we’re here talking to hospitals about that.
Dr. Howard Rollins: And interfacing is kind of the buzzword now; it’s everything, isn’t it? We’re in interoperability.
Steven Tolle: Interoperability really is the key. When you think about two things; a third of imaging done in a country is considered to be unnecessary. So if you take a classic example; if some gets hurt, they go to the ER, they get a scan. That ER might not be affiliated to the place where they’re going to get their ultimate treatment. So when they go in and have to see the orthopedic surgeon for example, they’re going to get another scan. Was that scan really necessary? And did the patient really need to be exposed to additional radiation?
Dr. Howard Rollins: Right.
Steven Tolle: So it really comes down to unnecessary images and unnecessary radiation exposure, and how do we improve patient care ultimately and manage cost out of the system?
Dr. Howard Rollins: Now, Merge has been involved in image imaging for quite a while haven’t they?
Steven Tolle: Yeah, so Merge actually helped found the standards that all imaging use; which is called DICOM. And so, we’re a global company. We have headquartered in Chicago, we have offices in Toronto, we have offices in France, and in China. We have worldwide distribution relationships with very large manufacturers who embed a lot of our technology in the equipment they sell. So we’re well known in the DICOM-world as being a setter of standards.
Dr. Howard Rollins: And you have some rather prestigious clients, don’t you?
Steven Tolle: We do. Yeah, we have fifteen-hundred hospitals. We all have most of the top-twenty hospitals in the country as our clients. We have six-thousand ambulatory clients as well; so about a third of the diagnostic imaging centers in the country, and about half the orthopedic surgeons in the country. So we got a very diverse client base – a lot of specialty care.
Dr. Howard Rollins: And my understanding is you have many products that are vendor neutral – you are able to interface with other people’s products, is that correct?
Steven Tolle: Yeah, so that’s the reality in most hospitals and most communities is that they don’t have a single vendor solution. You know, they’ve purchased over time from different players whether it’s – you know, GE PACs or Fuji PACs or Merge PACs, and so we have to be able to talk to multiple systems. So we have a vendor neutral archive, we have a vendor neutral viewer which we call our I-Connect Access Viewer. And that’s about how do you get your referring physicians in the community to be able to interact with the radiologist to not only see the report but see the image, and show the image to the patient so they actually understand – why do I need to have this procedure on my heart? – for example. So we have to deploy this product to iPads; it’s a web-based product so you can watch it on a browser but we have to read images from any PAC system that’s in the community.
Dr. Howard Rollins: Now, when you are interfacing with other vendors’ products, is security an issue? Or have you solved that issue?
Steven Tolle: So we have solved that challenge. When you think about the cloud as an example you know, the cloud is getting pretty crowded because when you’re at HIMSS this year; everyone is talking about the cloud.
Dr. Howard Rollins: Right.
Steven Tolle: But it poses certain challenges that you didn’t typically have when you’re deploying a system on premise at a hospital. Typically, physical security for a hospital managing their PACs and their archive was sufficient. You can lock the door and you don’t have to worry about who’s getting into the building. When you’re in the cloud, you don’t have that ability to control things, so we have to work – focus on things like encryption. We encrypt the data at rest. And so we’ve done a lot of RND investment around how do make sure you got the right level of security with the right level of performance, and then how do you also manage things like – you got a standard called DICOM that’s not always exactly the same. So when you got an image coming from a GE PACs or an image coming from a Fuji PACs; all using the same standard, they don’t always actually have the same exact format. And so we have to be able to change those formats; switch things around so that we actually can be in the neutral.
Dr. Howard Rollins: Is implementation – has it gone well? I would imagine there’s a lot of a challenge there.
Steven Tolle: There are always challenges in implementation. You know, the good news is we’ve done it enough so we have the playbook; so we know what the nuances are around – if we’re working with a GE system or Fuji system or an Agfa system – we’ve done it enough where we know what the challenges are going to be when we do this. But – you know when you’re moving petabytes of data from one system to another; this is complicated work.
Dr. Howard Rollins: Merge doe have the capability of going into a facility that has nothing yet and completely outfitting that facility, is that right?
Steven Tolle: We do; that’s a rare occurrence. Most of our business – replacement, natural life cycle, evolution – I’ve got a hardware refreshed.
Dr. Howard Rollins: It would be a great occurrence.
Steven Tolle: It would be a great occurrence. In some specialty like ophthalmology for example in the outpatient world, we’re very unusual in that we can actually outfit an entire ophthalmologist’s office. So we can actually sell them the attachments to their cameras, sell them the cameras. We can sell them the PAC system to manage the image. We can sell them the software they use to see their patients’ electronic record and the billing system. So we actually do that in both orthopedics and ophthalmology where it’s a – I call it windowing solution, and very few people actually do that.
Dr. Howard Rollins: Can you tell me a little about iConnect access?
Steven Tolle: So iConnect access is our zero footprint web viewer. It’s part of our iConnect stack which include a vendor neutral archive and a share functionality. So it allows in a community…
Dr. Howard Rollins: That’s – excuse me, that’s for sharing imaging?
Steven Tolle: That’s for sharing images between physicians.
Dr. Howard Rollins: Okay.
Steven Tolle: So it allows in a community the ability for a referring physician to receive an image from the radiologist zero footprint on their desktop, so they’re just using a web browser. They’re seeing the same image the radiologist is seeing.
Dr. Howard Rollins: Right.
Steven Tolle: They don’t necessarily need the same measurement tools, diagnostic tools. But typically a radiologist will look at a series of images and pick the images – the key images that they want the referring physician to see, and that’s what they’re going to look at.
Dr. Howard Rollins: And the physician can see that on their mobile device?
Steven Tolle: They can see it on their iPad, they can see it on any browser that they have access to.
Dr. Howard Rollins: I’m rather familiar with your AIMS product. And how does AIMS fit in to your whole plan?
Steven Tolle: So as a business, we’re very focused on how do you deliver services and products to hospital in addition to our large ambulatory base. So when you think about the AIMS product – it’s a forward for us, an additional extension into the hospital. You’ll see us doing more in the hospitals later this year I would guess.
Dr. Howard Rollins: I know that AIMS really doesn’t have great market penetration yet, but I see a big change coming. In fact, I was mentioning this the other day to the chief of my anesthesia group who took over for me and a rather brilliant man and he never heard the word AIMS before, and he’s in a community setting. It’s amazing, isn’t it?
Steven Tolle: Well, I think of it as– where the EMR industry was five years ago.
Dr. Howard Rollins: Right.
Steven Tolle: Right? So we didn’t – we all dreamt for years that you’d have this massive push to adopt technology – now we’re seeing that. In the specialized departments like anesthesia, the large hospital systems – some of them have solutions. But when you’re talking to someone who needs a very specialized work flow, AIMS is an incredible product that not only manages the workflow, manages supplies; which is a big part of that job. It’s a very important thing to make sure they have the right workflow when they need it.
Dr. Howard Rollins: So to sum up our conversation, let’s say that I’m a physician who the hospital has asked to help them find the right solution for their facility. And I come to you, and I say “Steve, sell me, why Merge?”
Steven Tolle: So I would say that we’re the leader in imaging nationwide; it’s a very complicated thing to do. So when you look at health information exchanges, electronic health records, and you think about how important the image is in medicine around getting the right treatment, the right diagnosis, the right treatment for a patient – you can’t practice at this. You have to be an expert. And so we want to image enable electronic health records, hospital systems, health information exchanges, and we don’t want to have to have people learn on the job. We know what we’re doing, we’ve been around – we helped define the standard. And so we’re expert at this and we hope to help others who don’t need to become the experts in this market.
Dr. Howard Rollins: Thank you. Steve, thank you very much.
Steven Tolle: Thank you.
Dr. Howard Rollins: Really a pleasure talking to you. Steve Tolle, Merge Healthcare, thank you.