CPOE That’s Easy to Use? Interview with Paul Brient of PatientKeeper

November 9, 2013

Paul BrientThis is the transcript of my recent podcast with PatientKeeper CEO Paul Brient.

Paul BrientThis is the transcript of my recent podcast with PatientKeeper CEO Paul Brient.

David E. Williams: This is David Williams from the Health Business Group. I’m speaking today with Paul Brient, CEO of PatientKeeper.

Paul, nice to be with you today.

Paul Brient: It’s good to be with you, David.

Williams:  Paul, I saw a new report out by KLAS that gives a PatientKeeper product a very high rating. Tell me what that’s about.

Brient: KLAS contacted us earlier this year. They have a series of reports looking at ground-breaking technology and had heard about our new CPOE product, which takes a very different approach. We deploy CPOE as an overlay on top of an existing HIS system. Previously, the only way to get a CPOE system was to purchase the CPOE system that comes with an HIS system.

KLAS investigated the product, surveyed our customer base and talked to the physicians using it to create a usability index comparing our CPOE product to the usability of the existing EMR systems. They rated our product almost a full point higher than Epic and significantly higher than everyone else in that space.

Williams: How do all these systems work together? You mentioned HIS, EMR, CPOE. For those who don’t live and breathe this stuff, can you just parse those pieces out?

Brient: Sure, HIS stands for Hospital Information System and it is the backbone of a hospital. It’s sometimes referred to as an EMR or Electronic Medical Record, which is more of the clinically facing part of an HIS –if you’re in a hospital or if a practice, it’s the clinically facing parts of your practice management infrastructure. CPOE is computerized physician order entry.

Historically, in hospitals, all the pieces you need to run a hospital had been bundled together in a Cerner or Epic or Meditech system. They include everything from the stem that produces the bills for the stay to managing the beds in a hospital, to run the pharmacy, to run labs, to run nursing, to run an ED, to doing order entry and documentation. But as most people know in the industry, the rate of adoption of order entry and documentation has been extremely low because physicians had been very frustrated with those offerings. Now Meaningful Use has mandated that physicians use CPOE in hospitals within the coming years.

Williams: Why is it so frustrating? It seems, in a way, it would be easier to enter things using a computer than it would be without. Why is there such a resistance? Are the doctors being luddites or do they have a point?

Brient: The biggest challenge is the experience today. For physicians who go electronic, unlike the rest of the world who goes electronic, they end up having to spend significantly more time doing the task they previously did on paper. If you think of Amazon.com or any other big automation activity, it generally takes less time, which is why you automate it.

The root cause actually goes back to this HIS system that I was talking about earlier. They started in the finance department of hospitals and moved to the lab and then the pharmacy. And as they get to the last part, which is the doctors, they just expose the metaphors in the way that these systems work around the hospital to the physician. They basically say, “Hey, physician, now it’s time for you to learn how orders get processed in a hospital so you can put them in properly.” But that’s not the way physicians work and they end up having to do a lot more clicks and provide more information than they do today. So it just takes longer.

We’ve been able to do it because our approach is to sit on top of those systems to insulate the physician. Think of our technologies as a layer of insulation, from a technical perspective. We allow physicians to put in orders the way they’re used to ordering and to provide care to the patient the way they’re used to doing that. They can let the computer worry about how to translate it and get it all processed and get it to the lab and the pharmacy and wherever else.

The result is a system that –instead of taking 18 hours to five days of training, which is what most CPOE systems require– just requires about 10 minutes of shoulder-to-shoulder training with the doctor. That’s because it works the way they already know how to work, but it’s just electronic and it saves them time.

Williams: You mentioned that CPOE is typically bundled within an EMR. I know that hospitals are struggling to pay millions, tens of millions and in some cases hundreds of millions of dollars for EMR systems. But when you talk about your product going on top of that, have they already paid for CPOE and then they need to pay for it again from PatientKeeper?

Brient: In some cases, from a software perspective, the answer is yes. Because when you buy software you often get all the software bundled for one price. You can’t really deconstruct it.

The nice caveat to that for us is that it takes so much time and energy to configure the system and to train the physicians. Literally when you deploy the systems, the vendors send out armies of people to be on site to help the poor doctors try to cope with these complex and hard-to-use systems. That’s very expensive and it actually turns out to be more expensive than buying our software and deploying it to the physicians.

When we do a deployment, it’s not a big event. It’s an exciting event but we don’t send armies of people. We typically send a few people out on site. We train physicians right on the floor as they show up for rounds that day and they’re fully productive during that first round. It’s really rewarding to come and meet a physician, shake his hand, put an app on his iPad, show him a few things and then see him walk down the hall and get to work electronically. The day before, he was writing orders on paper.

Williams: What does it look like from a patient perspective? Is there a difference for a patient who’s in a hospital that’s implemented CPOE well versus one that has difficult-to-use system or no system at all?

Brient:  The difference is along two dimensions. One is, these days, people expect things to be on computers. And to have a physician walk in to your room with a big fat chart of paper and start scribbling stuff in hieroglyphics on a piece of paper doesn’t provide a great feeling of security even though there are great systems to make sure that is a safe process. It’s not really reassuring.

So, you think the computer would be better. But if the physician is struggling with the computer and spending a whole bunch of time on a computer and not taking care of you — or even the fact that they have to go find a computer to go do it, which may or may not be in your room depending on what or how vintage is your hospital — it takes away from your care. You may not know that but it is.

But it’s a much better experience when a physician walks in with an iPad, puts the iPad down and talks to you, and then answers your question about a lab result by showing you a trend graph of your results. If you’re complaining about pain and he just types in a prescription right there in front of you and says, “It will be up in just a second,” that’s a much better patient experience. And frankly, it’s an experience that we’re all used to seeing throughout our life. I mean, you go to a Red Sox game and someone comes to your seat and takes your order for food and brings it back to you, electronically. It’s expected. And to see that in a hospital and to enable physicians to actually spend time with the patients — because that’s what it’s all about, not typing stuff on their computer — that’s a much, much better patient experience.

Williams: Talk about the KLAS process and how they went through that. You mentioned that you scored almost a point higher than others. But put that in context. What’s the scale and how significant of a difference is that?

Brient: We don’t have much of a role in the KLAS process because KLAS is very focused on providing an independent view of the world. So, they contacted us, asked us if it was okay. (I don’t know if we said no, what they would have done.) And then, they’re off to the races, do their research, and compile the report. We get the reports just like everyone does.

The particular metric that they looked at was usability and ease of use. On a 9-point scale, we scored 8.4. The next one was Epic at 7.5 and then everyone else is pretty much around 6.

The important thing though to know is that our scale is based on physicians rating of CPOE, which as we’ve been talking about has historically been the kind of third rail application for this EMR vendors. The EMR usability ratings, at least right now, are based on all users of the EMR –not just physicians—and across all components of the EMR.

So, one might imagine that the ratings would be different from the EMR vendors had they just asked physicians and asked just about CPOE. And maybe KLAS will do that at some point. But we were very, very pleased. And I think KLAS frankly was a little surprised at the fact that physicians actually really like to use our CPOE product.

They really do like to use it. There are also great quotes in the report about improving the workflow and saving time and really making it a joy to use. That’s what all software is supposed to be. When you get your iPad, you’re not intimidated by it and run around saying, I don’t want to use it. You can hand it to your three-year-old and he can use it because it’s so intuitive. We’ve created a CPOE product that you couldn’t give to your three-year-old, but you can give to a well-trained physician and they can use it and put in orders.

Williams: Let me change the topic. This may be an unfair question, but since you are a long-time health information technology expert, I’m going to go ahead and ask it. There’s a lot of news these days about the federal health insurance exchange and the trouble that’s going on there, the vendors being called in to Capitol Hill to testify, and so on. What’s your perspective on what’s going on and do you think they’ll get it fixed in time?

Brient: It certainly is a loaded question. My general feeling is one of disappointment. As a technology project, frankly the health exchange is not radically complex when you think about all the states that developed exchanges. Massachusetts has one. It works.

I think it shows the challenges of government procurement, and raises the question of whether the procurement process has produced the best and brightest contractors. I know it’s a real challenge just from personal experience to deal with the government and go through that process. They ended up with far more contractors than I would suggest to build the website certainly. I’m sure there are all sorts of reasons that I can only imagine in the political process. And they spent about $500 million doing something that probably should cost about $10 or 15 million.

And of course now this is a political thing as opposed to technology problem.

They certainly can fix it. It’s not wildly complex. It is certainly much less complex than anything you see on Google.

I’m confident they’ll get it fixed. I wish it didn’t cost so much for governments to act on things like this. It’s a shame it’s become a political football as opposed to a technology problem, which it definitely is.

Williams:  I’ve been speaking today with Brient, CEO of PatientKeeper. We’ve been talking about CPOE in hospitals and how the PatientKeeper product has been rated very highly by KLAS.

Paul, thanks for your time today.

Brient: Thanks, David. I really appreciate it. It’s great talking to you.

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