HIMSS10 – Medical Informatics Engineering

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Doug Horner, President and Founder of Medical Informatics Engineering (MIE), speaks with Dr. Eric Fishman about MIE’s history and growth in the EHR market. MIE started in 1995 to create a health information exchange in Indiana. The company has grown to now offer an entire EHR portfolio. They discuss MIE’s web-based EHR, called Webchart, which is a multispecialty product in beta release that is minimally invasive to a physician’s workflow.

Category: HIMSS10, Tradeshows
Date: March 23, 2010
Views:8,069 views
Information:

Dr. Eric Fishman: This is Dr. Eric Fishman from HIMSS10 and today, we're discussing Medical Informatics Engineering with Doug Horner, the President and Founder of MIE. Doug, thank you for taking your time out at HIMSS10 and if you could tell us a little bit about how MIE was founded. What came to you to start that process?

Doug Horner: In 1995, we started MIE to do health information exchange in northeast Indiana. Over a period of about three or four years, we were able to get about 80 to 90 percent of the physicians connected to a network and most of it was billing information that was flowing across it. We developed in 1998 web-based technology that allowed them to take their paper records scan them in and get them online. If fact, if you recall, in 1995 Netscape had just gone public. In fact, we had a CIO once tell us he thought the web was a fad and was going away. So we were a little ahead of our time using web-based technology in 1998 but we stuck with it and then began developing on top of our document management system e-prescribing, problem list management and even occupational health components and things of that nature.

Dr. Eric Fishman: You have an interesting announcement about web-based technology that you'll talk to us about in just a moment but I understand you've got about 1,200 physicians actually using MIE at this point and time.

Doug Horner: That's right. We've been around for a while mostly throughout the Midwest and have kind of marketed through word-of-mouth. We have 1,200 physicians that span about 15 different specialties.

Dr. Eric Fishman: Occupational medicine is one I understand that you do.

Doug Horner: That's right.

Dr. Eric Fishman: But you have a practice as large as 100 physicians and I assume that that's a multi-specialty group?

Doug Horner: Yes, exactly. A multi-specialty from neurology, OB/GYN and internal medicine so, yes, it runs the gambit.

Dr. Eric Fishman: Good. Tell us about WebChart EHR Now.

Doug Horner: WebChart EHR Now we're launching March 1 at the beginning of the show. It's in a beta release. It's fully online web-based enrollment. It's kind of a Google docs and spread sheets if you will for EHRs. We have this minimally invasive implementation philosophy with physicians. We try to give them EHRs but be minimally invasive to their work flow.

Dr. Eric Fishman: Now, that's going to be a big thing at HIMSS this year is minimizing the implementation time. How long does it take physicians to implement MIE in general?

Doug Horner: Well, the WebChart EHR Now product is ready to go. You can actually, within a matter of minutes, onboard yourself to our EHR and it's set up as a multi-specialty and then you can customize it.

Dr. Eric Fishman: In all due respect, it probably takes a fair bit of customization, a fair bit of time to have a physician actually going into the office, using it in, I guess I'll call it a power mode, because to use it as one of the products that is in an office may not be as effective as using it in a - not to misuse this word - in a meaningful fashion. How long do you think it takes, how many hours or how many weeks until a physician really has changed their work flow to use this new system?

Doug Horner: Typically, we have seen anywhere from three to six months. But a physician when they start using the product to after six months they are in a position where they, "I'll never go back to what I was doing before."

Dr. Eric Fishman: I've heard that before. Is that a smooth continuum so that it's not a big bang - and maybe that's why you call it minimally invasive - as you said, you sign on, you're working, you're using it and then step by step, in an incremental fashion, you're able to start implementing the various features. Is that how --

Doug Horner: Yes. In fact, Meaningful Use mandates certain things be captured digitally. For example, the problem list, e-prescribing. It doesn't mandate that you collect the chief complaint or the history of present illness in a coded manner. Our EMR works in a way that allows if a physician dictates, he can continue to dictate but he may use his nurse to enter some coded information, he may enter some coded information. If he uses paper, we have stand-in bar coded optical mark forms that are integrated in our product. So we have a lot of different ways in which a physician can get up, start using the EHR and what we really try to achieve is a chartless office.

Dr. Eric Fishman: Good.

Doug Horner: That's critical because EMRs that don't get rid of the chart end up like it’s a boat on a dock - one foot on the boat, one foot on the dock.

Dr. Eric Fishman: You need to make a decision.

Doug Horner: You've got to make a decision. You've got to leap into it.

Dr. Eric Fishman: Let's go back to the documentation. How do you find that most of physicians actually get the history, for instance, the physical exam, how do they get it into the document that could be sent out to a referral source for instance. They use handwriting, they dictate, speech recognition, pen recognition.

Doug Horner: I've found that there's no one-size-fits all solution so we have a variety of point and click. Actually, I've worked with physicians where 80 percent of their visits might be point and click and then the other 20 percent they may fall back to dictation or handwriting on a pad tablet PC or even bar coded optical mark forms and then even voice recognition. We have Dragon Naturally Speaking integrated in our solution. We have a number of physicians who will actually dictate right into the product, so it varies. It depends on the physician and his comfort.

Dr. Eric Fishman: For disclosure, I'm involved in marketing of Dragon Medical. Do the physicians who use Dragon like using it? Do they get good recognition with it?

Doug Horner: Oh, yes. There is a bit of learning how to use the product and coming up to speed on it. It's not like a transcriptionist but, you know, if you want fast turnaround, you don’t want to have to come back and look and review and sign the record, with a little bit of inconvenience up front, you save yourself a lot of inconvenience down the road so it depends on the physician whether or not they're comfortable doing that but the doctors who use it really love it.

Dr. Eric Fishman: Let me talk to you about MIE and possibly your new product. What do you feel is the strongest feature of it if you were to compare it with other products in general? It is a fully featured product, it has the e-prescribing et cetera, et cetera. What do you think is the strongest point?

Doug Horner: Well, we designed the software from the onset, as I mentioned, we built a REO in northeast Indiana. We developed it to be interoperable. I find it amazing that you can buy an EHR from a company and have two doctors using different systems and they can't communicate. Or, you have to spend $20,000 to do it.

Dr. Eric Fishman: Not for long but you're right, that's still huge..

Doug Horner: Yes, exactly and for the last 10 years, we've developed it to be interoperable so if two doctors are using WebChart EHR Now in completely different practices in their separate databases, they can still share patient information. It's just a simple click and there's no interfacing charges.

Dr. Eric Fishman: That's critical.

Doug Horner: Yes, and in the sharing of information, even if you're not capturing coded information, sharing information is key. Physicians deal in a fuzzy world where not everything falls into nice little buckets and we believe that getting information, moving it around and making it accessible to the physician is even more important than capturing in a coded way. But where it makes sense to be coding, for example, meds and problem lists and things of that nature, we're very vigorous in that. We've been using the standards like Snowmed. We've actually had Snowmed imbedded in our product for the last 10 years and that's something a lot of the EMRs have to catch up with. We use coded information where it's acceptable and easy to do and then we allow people to move information around easily and that's probably the biggest differentiator between our product and others.

Dr. Eric Fishman: I understand that there are a number of societies for instance that are promoting your product, the American College of Cardiology. Can you tell us about that initiative, that relationship, please?

Doug Horner: Yes, we just announced earlier this week that American College of Cardiology is endorsing WebChart EHR Now for cardiology. They have an initiative called Pinnacle which is a quality improvement and it captures measures on about a dozen cardiac problems. We were one of the only EMRs that was able to integrate with it directly so cardiologists using our product won't have to go through another collection process in order to report to the registry. It's totally integrated into our solution.

Dr. Eric Fishman: And so if you're being endorsed, if you will, by the ACC, I assume that you've got interconnectivity with various EKG machines and various stress test machinery et cetera.

Doug Horner: Yes, we like cardiology because we have integrated PACS in our solution, EKG and CTA, ultrasound, all these different modalities that have to be brought together. Cardiology is kind of a fun specialty. It's really technical and they move around from the hospital to the office.

Dr. Eric Fishman: You've got to get the work flow right for that.

Doug Horner: Exactly, that's right.

Dr. Eric Fishman: I find that products that are appropriate for one specialty frequently are appropriate for other specialties as well. Can you tell us about some of the other specialties that your product is particularly appropriate for?

Doug Horner: Sure. We excel very nicely at OB/GYN. Again, very similar kinds of work flow and we have ACOG sheets and things of that nature integrated in the product. Neurology is another one that we have a lot of physicians using our product as well. We have nice templates for neurology.

Dr. Eric Fishman: OB/GYN I understand the federal government considers them primary care providers. They're part of the 240,000 priority primary care providers that the regional extension centers are being asked to address. Are you getting involved in that in any way, shape or from?

Doug Horner: Yes. In fact, actually three of the technology extension programs that were funded we already have a relationship with and the WebChart EHR Now is perfect. It's web-based so those physicians can onboard themselves very quickly and the templates are already built there for OB/GYN. So, yes, it's very important to us these extension programs.

Dr. Eric Fishman: The funding is for two purposes, both helping physicians and also getting the health information exchanges together and you've got both of those covered.

Doug Horner: That's right. In Indiana, we have three functional HIOs that have been there for years. In northeast Indiana where we're at, we're one of the three and it's kind of exciting to see all this health information exchange actually get moving in the rest of the country.

Dr. Eric Fishman: Great. You're showing a number of things here today at HIMSS10. Can you tell us what they are each of them?

Doug Horner: Yes. We're in the interoperability showcase so we're showing our system interoperating with personal health records. We have a partnership with Google and Microsoft and NoMoreClipboard so patients can interact.

Dr. Eric Fishman: Doug, I thank you very much.

Doug Horner: Thank you.

Dr. Eric Fishman: It's been a pleasure and I wish you the best here at HIMSS10. This is Dr. Eric Fishman for EHRtv and we've been speaking with Doug Horner, President and Founder of Medical Informatics Engineering. Thank you.

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