Todd Cozzens – Picis

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Eric Fishman, MD speaks with Todd Cozzens, CEO and Vice-President of Picis.  Today, they discuss the past, present and future of Picis.

Category: Uncategorized
Date: July 22, 2010
Views:14,963 views

Dr. Eric Fishman: Hello, I'm Dr. Eric Fishman with EHRtv and today I have the distinct pleasure of speaking with Todd Cozzens, CEO and Vice-Chairman of Picis. Todd is a co-founder of Picis and it was to a large extent his vision and genius that drove the company to success. Todd is widely seen as a thought leader in the industry and today, I'll bet that we will learn not only about Picis itself but also where the healthcare information industry is headed. So Todd, I thank you very much for coming and joining us today. If we can start back in 1994 let's say and then you'll bring us all the way I'll bet to the future that would be very helpful. So here it is back in 1994 and Picis is being formed. Can you tell us about that?

Todd Cozzens: I was in the medical equipment business working for Marquette Electronics.

Dr. Eric Fishman: Now GE.

Todd Cozzens: Now GE. And we were really focused, as you know being an orthopedic surgeon, on patient monitoring and cardiology equipment. And from those patient monitors as we added more functionality and EKG analysis and pulse oximetry, etc., we started to get tremendous amount of data out of those monitors. And then we had early docs that were building their own little spreadsheets to get that data out and understand more what you could do with that data and we came up with the concept of driving that into an electronic flow sheet. So not only were we one of the early pioneers of an electronic flow sheet in the high acuity areas, we had already had that device connectivity and developed that technology early on. So coming out of Marquette, which we sold to GE around that time, it was really a question of now what to do with all this data and I hooked up with a couple of docs who had developed this technology.

Dr. Eric Fishman: And this was both in the operating room and the ICU from the beginning?

Todd Cozzens: It started in the operating room, the anesthesiologist.

Dr. Eric Fishman: You figured out that had spent a lot of time in the operating room.

Todd Cozzens: Exactly, exactly and he was really understanding how to build the anesthesia record. But we realized that you're getting all this tremendous amount of data from these devices around the patient it's pretty much the same problem in the ICU where you have those devices as well - - a little bit longer time intervals -- but the same idea of capturing the data. Also the concept early on that we had that it's really important to transfer that data from the operating room to the PACU or recovery room to the ICU, that continuous flow of data because as you know, when the Institute of Medicine report came out about the 100,000 lives being lost, it's all in those transition areas. You know how dangerous it is for a patient to arrive in the ICU out of surgery and not know how hydrated they are and what complications that can lead to.

Dr. Eric Fishman: Now when I look over the drapes, I see the anesthesiologist writing carats up and down for the blood pressure. Is that archaic now? Is that information being taken automatically from the blood pressure cuff populating a data base and being seen in real time and all of that information is now available to the nurses, physicians and any other caretakers in the recovery room in the ICU?

Todd Cozzens: Absolutely and that was an initial step that we had to overcome early on and it wasn't just about one or two of the devices. As these new devices came out like the BIS EEG monitor and all those other new innovations that came out, you had to have 100 percent of those devices connected to the electronic record because without that if they had to spend any time on paper for one single piece of data, you lost them as a user. So get that adoption. The first thing you do is automate the record, have that device connectivity. It's amazing today how few anesthesia work stations, even with a number of competitive systems on the market, actually handle that basic issue of collecting that data automatically.

Dr. Eric Fishman: It seems so fundamental now. Does Picis make the physical machines because when I'm thinking about blood pressure cuffs and items of that nature, I think of Welch Allyn for instance as a company that makes the physical vital signs machines that are capable of putting the data into an electronic format. Does Picis make the machines as well?

Todd Cozzens: No, Picis does not make the machines, we just do the interface. The commonality between all these interfaces is good on one hand that every device today has a RS 232 output, so a serial output. The problem is there's no DICOM standard for IT data coming from medical devices and there is no standard being dictated out of the current legislation either. So every device manufacturer has its own protocol for sending those. It's not only the blood, sweat and tears of understanding, getting an algorithm, having it flow seamless into the record in lightening time frame because if it's not sub second getting that data into the record you've lost the users; it's that tiresome work of getting those protocols right and understanding is it a push protocol, pull protocol. The Spacelabs monitor has a different driver for every language, the GE monitor has one driver for all versions, the HP monitor or the Phillips monitor has a different version for every new version of software and you've got to really work hard. They have to make them work 24/7 in this environment. It's a lot of pressure, its very tough work.

Dr. Eric Fishman: You bring up an interesting point which is the interconnectivity. and I think of HIEs when I'm thinking about interconnectivity. I would think that it's critical for a company such as Picis to be interoperable with essentially all of the various physical things that are in the operating room. I mentioned Welch Allyn blood pressure cuff that are less than $1,000. These are very large, very expensive machines and I would assume that there's a variety of vendors both for the operating room, for the recovery room, for the ICU and the emergency room and you cover the entire waterfront. I understand that Picis spends an extraordinary amount of its gross revenue in research and development.

Todd Cozzens: Yes.

Dr. Eric Fishman: Is a large part of that in the interoperability?

Todd Cozzens: Absolutely.

Dr. Eric Fishman: So let's delve into the HIE aspect.

Todd Cozzens: By being who we are, which is the specialist in high acuity areas where the patients are the sickest, caregivers are in the biggest shortage and that's only increasing now, we've got to be able to imbed ourselves into the EMRs of the world, the HIS systems of the world; be compatible, interoperate and in many cases, we do much more interoperability with those systems than they do with their own products. In the old days, we used to wait for data to come from those systems.

Dr. Eric Fishman: And now I guess we're pulling it out.

Todd Cozzens: And now, what we see, all of the things you hear about our high tech and how slow it is and how confusing Meaningful Use is and where the whole legislation is going, one thing is clear, one thing that really is moving very fast is the whole concept of interoperability and the whole HIE. As I said before, it's not good enough just to get the data from the monitors, the lab data, etc. You've got to have every single piece of electronic data automated through that system with the EMR, with the system you're going to discharge the patient to, etc. So interoperability is absolutely key and we've built an extensive core of competency in that.

What we're really pleased with today is that these standards have really driven a lot of change in behavior with the firms that we have coopetition with. So for example, I'll give you Exempla Healthcare System in Denver. They've got an Epic EMR. They put Picis in after they bought Epic. We've integrated to the point where the Picis emergency care data will go directly into the Epic main system in the data depository and show up in real time in the record on the floors. When that patient is discharged and goes over to Kaiser, you can see in real time in the ambulatory record in the Kaiser system, that data coming from that ER.

Dr. Eric Fishman: That's an impressive feat.

Todd Cozzens: So some of those companies that were formerly very proprietary in their approach have been forced to open up because of this.

Dr. Eric Fishman: So bringing you back to a conversation I had a number of years ago. I was speaking with Hugh Zettel of GE and I asked him very pointedly, was the lack of interoperability a technological issue or was it a business issue. This was about four years ago and he said very clearly at that point and time that it was a business issue, that the technology existed. Do you find that you have -- and I'm very happy with the Epic success -- are you still having some companies that are hesitant, to use a friendly word, to provide you access to their database, to allow the information to go in and out smoothly?

Todd Cozzens: Well, I think what this legislation has done is forced awareness about what's available. CIOs now have a lot of power and hospitals have a lot of power and they sometimes don't understand how much power they have. So it was that CIO at Exempla that went to both Epic and to Picis and said, you guys (inaudible) together. You've got to do it as well as you would do as if you were the same company and we did. We actually for the first time saw a company like Epic's engineers sort of talking and exchanging information etc. We had another situation recently where a big IDN on the west coast has a GE medicalogic physician system, a Mc Kesson inpatient system and Picis in the high acuity areas and they took us around the table and the CMIO said either you guys interoperate and I want to prove that by sending continuity of care documents CCDs to each other and I want you to do it now by this certain date or else you're all...

Dr. Eric Fishman: All gone.

Todd Cozzens: ... going to be off the table. And sure enough we all did it. We were exchanging and that's working and live now among those three disparate vendors that three years ago wouldn't even pick up the phone and talk to each other.

Dr. Eric Fishman: Funny how a few tens of billions of dollars of federal money will change things.

Todd Cozzens: It's changing fast. The business drivers are there, the technology is there and for everyone to survive in this business - look, no one's going to be able to do it all. Not Epic, not GE, not the biggest company in the world. There are 250, 300 vertical applications in a hospital and no one's going to ever dominate and make every single one of those. So just by the very definition of how hospitals are automated, you're going to have to have the interoperability factor across the board.

Dr. Eric Fishman: Now let's expand the scope for just a moment, and very well stated, from how things work in a local environment, a hospital, an IDN, to a regional even, you know a statewide HIE.

Todd Cozzens: Well, first of all it's a lot about the governance and about how hospitals are organized and a lot of the health systems in 90s, even though they were newly formed IDN's, they'd still have their little silo systems. A number of our sites, our IDNs around the country were actually taking those siloed servers and centralizing them and doing it right, the way they should have done it originally. We see that with things like supply chain with the Lawson systems etc. all kind of siloed different. So you've got to get the IDN on a vision to have everything in a uniform manner. A lot of our business in the last couple years has been IDNs doing that and getting their act together. Then it's how those systems interoperate with each other and then as you know, the HHS vision, the ONC vision of interoperability. The hospital is a tiny microcosm. It's what they call the medical home where that hospital EMR has got to connect through the physician's office, to that outpatient lab...

Dr. Eric Fishman: To the physician himself.

Todd Cozzens: ... to all the community centers for IT. That's where the real exchange and that’s where the real benefit from all this automation is going to happen when you can carry your information electronically from caregiver to caregiver because invariably, you're not going to get all your care in a hospital, you're not going to get all your care in a physician office. You're going to be going to mini clinics and it's just getting more fragmented than more unified. So that interoperability in all those different types of environments is going to be even more important.

Dr. Eric Fishman: I completely agree. I see the IPad and we'll talk about that in a few minutes but how long do you think it will be until this is no longer an issue? When is it that the HIEs will have been proven to be successful and we won't need to be sitting here discussing will people play nicely in the sandbox, will the technology work properly?

Todd Cozzens: Well, you see so much focus and you see a lot of investment going into the HIE companies and they're a pretty hot commodity right now. You see great little companies like dpMotion, Audicity etc., innovative players and by the way, it's not pretty what they're doing underneath the covers there. They are coddling systems together and they're using whatever standards are available like we all have over the years. As the standards get more proliferated, so will their job and eventually who knows what their role will actually be. My guess is they're going to turn into more data repository and if they're smart, they're going to put that investment into what do you with all that data instead of how you interconnect because I do believe that interconnectivity will become much more of natural built-in capability of these systems. We already see there's been more change in the last couple years than we've seen in 10 years and some of the examples I just talked about couldn't have happened even five years ago.

Dr. Eric Fishman: Sure. I can see that. Now, you've talked about what do you do with the data and I know understand that Picis in particular has, as you've mentioned, since 1994 aggregated phenomenal amounts of data and to be truthful, this is all for the benefit of the patient and I understand that Picis has managed to put together a rather large repertoire of situations where the data that you've collected has managed to improve the care, if not of the patients from whom it was collected, for the care in general. And if you could you give us a couple of examples of that?

Todd Cozzens: Well, sure. The amount of data we collected is very granular. We're collecting all the vital sign data in these high acuity patients. You know in a NICU, fetal heart rate is three beats per second. So you have to have a significant example at that level and be able to collect all that data. Now that we've automated all these work stations people know that little old Picis is a little bit bigger than it used to be. We're in 1800 hospitals.

Dr. Eric Fishman: Quite a number of them VA hospitals.

Todd Cozzens: We're 140 million in revenue and about 700 employees so we've grown quite a bit but in those 1800 hospitals you've got a lot of examples. Mayo Clinic for example has now had our operating room system, our ICU system, NICU, PICU in all their 949 patient work stations. They are a big ICU so to speak. The VA for example has probably got the largest high acuity database going. We're in over 40 VA hospitals now of the 130 that are there and they have all standardized under VAs own proprietary data warehouse, data analytics product which we interconnect and operate with seamlessly at all these centers. There doing incredibly innovative studies. They're looking at things like tachycardia which you need all that granular data to be able to do and publishing lots of groundbreaking papers on that and we're very happy to participate in those kind of studies.

Dr. Eric Fishman: Can a physician in real time be querying the system to have it make recommendations for them for the care of the patient who's right in front of them as well?

Todd Cozzens: Absolutely.

Dr. Eric Fishman: Discuss that for a few minutes if you could.

Todd Cozzens: Well, decision support so we have rules engines built into all our products. You know, you have to be careful as you talk about decision making and rules as it regards to the FDA so we were very careful that we provide all the capability for those caregivers to be able to make their own rules and take them to the next level in order to get standard content available but definitely, the evolution of rules based, evidence based medicine into these systems is a big area. All of our products, we put extensive rule capability and decision support capability. Risk management is now a big part, as you know, of our emergency care system. We used the content from the Sullivan Group. So caregivers as they're taking care of a patient and when all of the other tests prove negative and all of a sudden an indication comes up with the Sullivan Group content for risk management on a pulmonary embolism, you know you rush that patient in, get the MRI and bang, you've saved a life. So big differences in how these systems can improve outcomes as well.

Dr. Eric Fishman: Do you find that the physicians adapt to that technology readily?

Todd Cozzens: Physician adoption is probably the single biggest barrier to this whole issue as you know and you've talked to many, many companies here. We've always focused our initial roots in having clinicians develop these systems; drive these systems, the workflow. So we've got 85 high acuity caregivers on staff designing, testing. As we say, eat your own dog food using it in a clinical practice. A lot of these big EMR companies have taken their general ward system and try to put it in the emergency room.

Dr. Eric Fishman: It's not one size fits all.

Todd Cozzens: It doesn't work. It's a whole different way of medicine. It's template based medicine and it's much more complex in the operating room. So you've got to have systems really designed by these caregivers for that workflow. I think one of our big successes is that all of our products have over 95 percent physician adoption and I think in any of the high acuity areas, you'll see less than 50 percent in most of the competitive products because of that intuitive nature of the workflow that we designed into the product.

Dr. Eric Fishman: And as a physician, in my humble opinion, that's one of the most critical issues and yet with the American Recovery and Reinvestment Act, the HITECH Act, we've got very substantial financial incentives for hospitals to very simply be doing the right thing getting information out.

Todd Cozzens: Yes.

Dr. Eric Fishman: Tell us where Picis fits into that system.

Todd Cozzens: Well, we spent a lot of time working on that. We spent a lot of time in Washington during the formative months of that, know a lot of the constituents there. We've got a lot of the Boston influencers there involved - John Glaser, John Halamka - all people that we've talked to extensively and have known them for years; spent a lot of time in Washington with the different senate and house members discussing this. We really tried to do a couple of things from the legislation. Number one, we wanted to make sure that it was phased in over time.

Dr. Eric Fishman: Are you happy with the current understanding of the plan?

Todd Cozzens: We are because we think our customers can meet Meaningful Use and get there pretty quickly with what they've installed for Picis today and there's some things that we're adding to round out the rules as we go forward but we're pretty much there with our products today, but it's really about those products being adapted, being able to use in these environments and we're happy with the progression of that. We wanted to make sure that there was going to be the ability to put in modular systems so the interoperability rules help us tremendously. Those barriers to interoperability, as I said before, are going down or being dropped tremendously and that's a big help to us. We also believe that the outcomes and quality reporting that's going to come in 2013 and 2015 and those demands really raise the bar on functionality of what these high acuity systems have to do. So a couple of things are going to I think positively affect our company: number one, the functionality, the bar to be able to meet Meaningful Use for high acuity - which the aging population is spending all their time in high acuity - that bar is going up. That's good for us because we're raising the bar ourselves. And then the interoperability...

Dr. Eric Fishman: Is making it easier.

Todd Cozzens: Is making it easier to interact and be a modular system. There is modular certification available and so we're pretty pleased where the final rules are going to likely end up.

Dr. Eric Fishman: Do you have a large number of your 700 employees working towards the 2013, 2015 rules or are they mostly focused on today's function?

Todd Cozzens: We've got a lot of that capability already. A lot of it is around the quality reporting and the capabilities; all of these health intelligence tools that we've built, our dashboards, our business intelligence tools built around a business objects core, those are in their third, fourth generation already when some of our competitors don't even have any capability in that area. So we see a lot of future. Once you automate all those work stations it's what do you with the data and that's the Holy Grail here and that's what's going to make our healthcare system much more efficient.

Dr. Eric Fishman: Talking about data, portability is a critical issue and I see you've brought an IPad and I thank you for doing so.

Todd Cozzens: Yes. I'm not giving it to you.

Dr. Eric Fishman: That's okay. We have Apple so thank you. Do many of your physicians find that they're using IPads in the high acuity areas?

Todd Cozzens: Well, it's so new and I think hospitals are reluctant to go out and buy a bunch of IPads and see them flitter away.

Dr. Eric Fishman: Walk away.

Todd Cozzens: So I think that remains to be seen but first and foremost the IPad is a web browser.

Dr. Eric Fishman: Right.

Todd Cozzens: So if you have products that are compatible with a web browser, they're compatible with the IPad so it is a nice form factor and this ability of being able to have data much more portable.

Dr. Eric Fishman: So let's talk more broadly about portability in general. Essentially every physician has a Smart phone and while physicians frequently are at the bedside in the ICU, they're not always. And so how much access do physicians have to data that's held within a Picis system, and I want you to go through a few of them if you would, while they're away from a patient's bedside?

Todd Cozzens: Well since the inception of our company, it's always been critical that our caregivers have access to data outside of where they take care of the patients because especially in these critical care areas, they're going to want to see the patients from their home, from their office etc. because they need to monitor them on a regular basis. On top of that, the caregiver shortages in these areas has gotten worse and it's not going to get any better anytime soon because these are the most skilled caregivers in the hospital and they are in extremely short supply. The average age of an ICU nurse is over 51 I think it is. The average age of an operating room nurse is 56. These are pretty stunning figures.

Dr. Eric Fishman: And some of it may not be quite as technologically savvy.

Todd Cozzens: So having data that is available and portable, you've seen some models where there's a shortage of (inaudible) around the country. There's a place for 12,000 and we've only got 5,000 or something. I've seen those stats thrown around. And so you see some of these remote ICU type systems where you've got docs sitting in a bunker and they're monitoring patients etc., and you see all kinds of new interesting models of remote monitoring and telemedicine. Our philosophy is we're agnostic as to how it's deployed. Whether they want to sit in a bunker with a group of them with all kinds of other data sources around them or they've got another system where they want to see it remotely, my personal opinion is the young caregivers you're going to attract into the field today are going to want to be mobile. They'll want to be at home, they'll want to be wherever they can be. They don't want to be tied to any physical location but they do want to have the data right there. So what we've done is made our capability so that you can actually see every single piece of patient data in real time, remotely.

Dr. Eric Fishman: On an IPhone, on a Blackberry?

Todd Cozzens: On an IPhone, on any kind of device. We’ve got web browser capability, we've got a very powerful little application that Mayo Clinic has been running for years - 15,000 instances of that running in secure laptops in the Mayo system. They've done this kind of remote care anywhere concept for years. The VA is adopting that right now because they have the same issue about the shortage of caregivers and so you've got to make it compatible, it is a requirement of technology. Once again, you've got a tremendous amount of data that you've got to get out to these caregivers in real time. So there are some big technological challenges that we've overcome just because of our years of experience in the field.

Dr. Eric Fishman: And I think in part because Picis has been so successful. Do you find that most of the pull for your product is coming from the physicians who have heard about it, their colleagues are using it? Is it from the CEO, CIOs, CMIOs or some combination? And I guess most importantly as a physician, do you find that physicians have heard about the product and say their colleague in another hospital has a much easier time using your software and that's where the business is coming from?

Todd Cozzens: Well, I think Meaningful Use has really changed the whole view of how to look at IT systems from a hospital point of view. I think before it was good enough just to put in a system and buy this big mega system and the pitch from the salesman used to be, "Sir, Mr. CIO, Mr. Hospital CEO, buy $30 million of our product and by the time you need an ED system, an OR system --

Dr. Eric Fishman: We'll have one.

Todd Cozzens: - - we'll have one ready and it'll be darn good, it'll be good enough. And I think those days are gone because now to meet Meaningful Use when you're looking at these systems, you've got to meet these criteria. For the first time you're being judged by an outside body as to whether you're actually meeting the ability to meaningfully use these systems. It's an incredible change. So therefore there's scrutiny on getting systems that actually works. So we're seeing a lot of our pipeline buildup right now from hospitals that formerly were going to do that full mega approach thing. It all goes back to a president of a hospital of I met in a big academic center in the Midwest when we first started to really expand in the high acuity area. He said, "I've got to fix my ED, my OR and my ICU, that's my main hospital problem." So I think that we're back to that because they want systems that work and they just don’t want that promise anymore of it's going to come, you know, I'm going to put in your tracking and triage system but I'm not going to have all the risk management. You're not going to meet Meaningful Use with these substandard systems.

Dr. Eric Fishman: In the ambulatory arena I think of Meaningful Use as it's coming one of these days, it's $44,000 but it's not really here and it's not a phenomenal amount of money. I understand that in the inpatient arena, it's sooner, it's more and how big of an impact is that having?

Todd Cozzens: You know, I always talk about Meaningful Use or HITECH as kind of the scorecard or the scorekeeper of healthcare reform and that's really how it's designed. So if you look at the broader aspect of healthcare reform, the legislation, all the capability, all the money being poured into that, how CMS regulations are going to change etc., the margins are going to get squeezed. So to be competitive you've got to have the data. The new government's model is the CIO and sometimes the CMIO reporting directly to the CEO is so critical. You know, you look at all the successful businesses that really improve performance. Look at the Wal-mart example. Why is Wal-mart successful is because they know instantly you buy that Snickers bar in the local store here back there in Fayetteville, Arkansas they've got that on their P & L. And so it's that type of access to data that has eluded healthcare for all these years. So this is a great excuse to get there and you're going to have to have this kind of data to be able to compete.

Dr. Eric Fishman: And it probably helps a hospital with an audit, the RAC audits and has Picis been involved in situations of that nature and would you care to tell about how the data is helpful to a hospital in a situation of that nature?

Todd Cozzens: I don't think most people are aware that the RAC audit is just a harbinger of things to come. So now we see RAC audits, now we see all kinds of alphabet soup of audits coming from payers. The CMS coffs and the payer market has a code right, and that's happening here with the audits. So you're seeing all kinds of those audits develop now and right now 85% of those RAC audits are around the short patient admissions from the ED into the hospital.

Dr. Eric Fishman: I read a statistic that there's a phenomenal expense associated with admitting somebody who didn't need to for instance.

Todd Cozzens: Exactly. You're losing lots of revenue and you've just taken a bed for a patient that could be reimbursed for so from a business decision it's really care of the patient so you've got to have a system. We've just launched a new system called Care Bridge which addresses that, which helps automate that decision about what the right documentation is at the point of admission. So those things are coming but the whole Meaningful Use as well is being paid for through CMS reimbursements. So you can envision they're going to have a tough time getting certification launched but they want the money spent, right. So you're going to see self attestation just like you have with some of the other rules; the inpatient rules, the outpatient rules from CMS and so you're going to see a lot of audits around did you comply with Meaningful Use. You claimed the money, you took the money and do you comply. So the whole issue of audits to kind of go after the outliers in the system is going to expand going forward. So products that will help justify the documentation given -- not excessively, not over documenting or under documenting -- the proper documentation for what was done.

Dr. Eric Fishman: So to a large extent one could consider that Picis products are a risk management tool for hospitals?

Todd Cozzens: Well, because of the way our system runs, the way our system is paid for by events and let's be optimistic and say those events that we're paying for now are going to become bundled episodes of care but they're still going to be paid for on an individual basis per episode of care over time. That means that you really have to have systems so it all goes back to what was documented. And what was documentated, if you don't have electronically because as you know the financial system of our healthcare system has a whole different set of rules. Pulmonary failure has got a different standard for CMS reimbursement than it does from you as a clinician. But you as a clinician, I've heard this phase, I want to take care of patients, not hospitals; my job is not to take care of hospitals. So if you can take the revenue data, the financial data, the data from medical necessity for facility level charges directly out of the automated EHR then you can really do a great service for those clinicians and provide revenue to the hospitals. So that's the ah-ha moment we had three years ago when we acquired Lynx.

Dr. Eric Fishman: To actually align the interest.

Todd Cozzens: Automating these carriers is great, improving outcomes is fantastic but no mission, no margin is more prevalent today than ever especially with the economic crisis that the CFOs just went through. So we've really focused on, in addition to outcomes, in addition to these health intelligence tools, these revenue products that will help you get reimbursed for the care that you're owed really and hospitals are just leaking millions of dollars out the door through inappropriate documentation of the care that they give.

Dr. Eric Fishman: I think we would all agree with that and would understand that technology can solve that problem to at least a signicant extent. Picis is one company. You've mentioned Lynx that was acquired a few years ago. If you could briefly go over the product line, some of the major product names and what their uses are in the various locations.

Todd Cozzens: Our CareSuite product is our all encompassing product name for our high acuity suite of products that's broken down into the ICU. We've got the Critical Care Manager which completely automates all the workflow and care in the ICU. In the operating room, a little different issue. You've got a lot of business things going on so we were the first to take the scheduling and make that not just regular scheduling, it's smart scheduling and block utilization. As you know as a surgeon you're trying to get your blocks but yet having the operating room being efficient is a big challenge. Supply chain integration. As you know the operating room is a hospital within a hospital so getting all those systems to work together and integrated into one unified system was an innovation that we brought to market with our OR Manager. We call that Total Perioperative Automation. We've got OR Manager to handle all the business and administrative functions of scheduling - physician office scheduling, supply chain. We've got Anesthesia Manager to do the electronic anesthesia record and most of our customers have a completely electronic anesthesia record including digital signature. PACU etc., and a continuum of data in-between. Then on top of those carrier products in the operating room and in the ICU and in the PACU, we've got our business intelligence tools. So we have Extelligence which is a data warehouse that's built on a separate database. We've got our dashboards that work on the production database. There are a lot of query tools built into the system, a lot of rules built into the system, so a lot of levels of intelligence.

Dr. Eric Fishman: You haven't mentioned the emergency room yet.

Todd Cozzens: The emergency room is a whole area that is really been a great growth area for us because of a couple of things. Emergency rooms are getting more crowded and health care reform is only going to exacerbate that. We see in Massachusetts where I'm from seven percent increase in the ED visits just because of the universal healthcare that we've put in place. Lack of primary care physicians: in my family, most families, we're getting a lot of our primary care in those ERs these days and that's only going to get exacerbated because we only had ten percent uninsured in Massachusetts.

Dr. Eric Fishman: Substantially more nationwide.

Todd Cozzens: So the ER is a big growth but also the area of revenue leakage. There's no more area of the hospital that leaks revenue because the clinicians don't have time. Three hundred fifty charge tickets a day, invariably they're going to get lost, they're going to be illegible or they're just not even going to bother in some cases because they've got to take care of the patient. So if you can, as I said before, extract that raw data automatically from the care record that they're normally doing, their normal care process you've done them a great favor both from a workflow perspective and a financial perspective.

So our products are ED Pulsecheck, which is the comprehensive EDIS and I want to say comprehensive because the large majority of ED information systems out there just do tracking and triage and a few other things. Really the key in the ED is to get the physician and nurse as 95 percent plus adopters and that's a workflow issue. Template based medicine, you know, quick, quick, quick, understanding the workflow, risk management built in, all that capability. Decision support capability right now to help them guide their decisions and help them make the best decisions for the patient so ED Pulsecheck is the umbrella product for our comprehensive EDIS. We believe we have the most comprehensive product on the market with a lot of capability built into it. HIE capability we just added in our new 5.0 release. And then integrated with that are the Lynx tools and the Lynx tools are very focused on the optimization of coding and charging. The OPS outpatient perspective payer rules that came out in the early 2000s directed hospitals a set of guidelines on how to code their patients but the rules weren’t very specific. So Lynx came up with some great algorithms on how to relate presenting problem to the eventual code and that was the secret sauce that built Lynx. We acquired Lynx in 2007. We've tripled the run rate of that SAS based product and we've doubled the customer base. So we've got 700 customers now, 18 percent of ED visits are running through that algorithm and it's all the same algorithm across the board so it's really become the gold standard. We've worked with CMS, we've defended our customers in audits and never had an adverse event. So that's really become a great gold standard product helping hospitals recover. And some hospitals are staggering. We have one in Texas that's $28 million dollars net revenue per year. We just had a talk at our user meeting from them about that.

Dr. Eric Fishman: You've got a very happy CIO, CEO there.

Todd Cozzens: Absolutely. It helps fund a lot of their ongoing IT budget.

Dr. Eric Fishman: So what do you see for Picis for the next year or two? Where is it going? You've already put together a very substantial infrastructure, what's new on the horizon?

Todd Cozzens: Well, I'd say all our products are really number one in their area right now, individually and then high acuity in general. Hospitals don't normally buy their entire high acuity system at once. They'll buy whatever department they need to get really focused on from a business perspective. So right now though it seems that all of these areas are kind of hitting on all cylinders. So the VA has been a very prominent area for us in critical care. Large ED contracts from big IDMs both from the clinical side and the Lynx side, our operating system because of it's comprehensiveness is so far ahead of what anybody else is doing from a business perspective is being deployed more than ever. So we've always been good at focus and since we are hitting on all cylinders, we want to make sure that all of our customers comply with Meaningful Use, we want to make sure that the quality of our products increases all the time; new releases, service packs etc. so we're really putting a lot of research into that. Then as I said before it's all the data around those areas. So we can grow in high acuity with the products we have 20 percent a year for the next five years and be perfectly happy and continue to invest our profits back into the R&D as we have in the past. But there are other care areas, high acuity care areas where the patients are very sick or have a critical situation and the care givers are stressed so you're liable to get high risk. Labor and delivery is an area that has huge liability from a financial point of view so there's a financial driver, there's a care automation driver there as well. So we'll stay very close to what we do. If we do an acquisiton it'll be an additive to what we have and one plus one will equal more than two as we've done in the past. You won't see us running out to be a physician office system or a back office accounting system. High acuity is our speciality area where caregivers are busy, where the data crunching is an enormous issue and where the challenges in deriving that data and determining what to do that day in the future are going to be big issues.

Dr. Eric Fishman: Todd, it's worked for you so far and I have a feeling it's going to continue to work and I thank you very much.

Todd Cozzens: Thank you very much. Good to be here. Take care.

Dr. Eric Fishman: Thank you. This is Dr. Eric Fishman. We’ve been speaking with Todd Cozzens, CEO and Vice-Chairman of Picis. Until next time, thank you.

One Response

  • jack Hopkins says:

    Is anything being done to replace preop manager with an option that integrates easily with the other PICIS products such as Anesthesia, OR, and PACU manager? Also, is there any work on an interface device for entering anesthesia preop information without relying on keyboard entry (i.e. iPad, digital pens, etc.)

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