Podcast interview with Richard Noffsinger, CEO of SafeMed, a clinical decision support company (transcript)

This is a transcript of my recent podcast interview with Richard Noffsinger, CEO of SafeMed.

David Williams: This is David Williams, co founder of MedPharma Partners and author of the Health Business Blog.

I spoke today with Rich Noffsinger, CEO of SafeMed, a clinical decision support company based in San Diego. I first met SafeMed’s founder, Dr. Ahmed Ghouri, a couple of years ago when the company was starting a pilot at Beth Israel Deaconess Medical Center in Boston. I liked the demo I saw then and I have been following the company ever since.

In our interview today, Noffsinger brought me up to speed on SafeMed’s collaboration with Google, its progress in radiology and the impact the company hopes to have on cost, quality and patient safety.

David: Richard, it’s a pleasure to speak with you today.

Richard Noffsinger: It’s great to be with you David. I appreciate the opportunity.

David: Richard, tell me first of all, what is SafeMed and how does it work?

Rich: SafeMed is an exciting new technology in the clinical decision support arena. We’ve set a new bar in clinical decision support that personalizes and identifies and prioritizes treatment options for both doctors at the point of care, as well as patients in a PHR, or doing it on a mass population basis. It then specifies best treatment options based on that information and is specific to the patient, their conditions, issues and their demographics and profile.

: Richard, what kind of information does SafeMed rely on? It sounds like if you have more information, it will lead to better decisions.

: David, you are exactly right. The more information that SafeMed has, the deeper and more specific the recommendations or information and clinical decision support we can provide.

At the point of care, if there is an EMR we are going to have much better information, much better results, than if we just have a few pieces of information. We pull personal information: age, weight, sex, that type of thing, and also what drugs are they taking. We also take business rules into consideration: what formularies they’re on, what their insurance covers and we also analyze and compute on lab results.

We consider not just that they had a lab test but what the lab results are. The more information we have, the better we can provide the depth and context of the information in providing the safest, most effective and affordable treatment options.

One of the areas that we have done this in is radiology, where we take into consideration all the data points for imaging. When a doctor is ordering an image, we can look at the different options and point out the highest efficacy based on the profile of the patient and what they are trying to determine for that patient and what makes the most sense from an imaging test. We are doing that at Beth Israel in Boston, for example.

: Richard, you mentioned radiology and I know that has been a focus for the company. In fact, I saw that radiology model at BI a couple of years ago when it was first being tried out.

Why do you have such a focus on radiology and how does what you are doing in radiology relate to, for example, National Imaging Associates or a cost containment organization that an insurance company might hire or own?

: The imaging market is a very rapidly growing market and it is very expensive, north of $100 billion a year, and there are companies out there that are trying to contain those costs through call centers and requiring authorization and that type of thing. What we have done is automate that at the point of care, so there is not a 24, 48, 72 hour turnaround.

It provides and empowers the physician at the point of care and where appropriate to direct them to possibly a more appropriate test for the patient given that profile. We’ve automated a lot of that call center type of functionality. Because our engine is so powerful it can do it literally in subsecond time right there in the exam room, if necessary.

Now your question is why so much focus on that. It’s one of the capabilities of the engine but the search engine is so powerful that we can purpose it in different areas, whether it is drug contraindications or lab tests or whatever. We are using the same core engine and we are just extending the rules, if you will, to that engine and to that specific specialty or requirement. It is very compelling for a lot of institutions so they are not trying to maintain multiple decision support engines.

: There are a lot products out there and services that would call themselves clinical decision support. Do you have a market map of how you would position SafeMed relative to some other players that the listeners may have heard of? Or can you lay out where you stand relative to some other companies?

: Our capability, our technology, is unique in that it can truly serve multiple constituents. We can provide the clinical decision support in a very profound way at the point of care in an EMR or CPOE system. Because of its speed, there are very few systems that have the depth and breath of capabilities that we do at the point of care.

We have built a methodology or business model where we’re an engine, and in that instance we want to integrate into the existing work flow. But that same engine can then be used as a clinical decision support in a PHR for a consumer. So as Google and other PHRs become available to the general population, we can help take that functionality to a whole new level by empowering the patient with actionable information.

It becomes much more than just a filing cabinet. It is specific to their situation, the prescription drugs that they are on or the drugs that they are on and their profiled information. It becomes very empowering to the patient. That is on an individual consumer basis.

So Google Health announced that they are in a pilot and going to be launching a PHR soon. We have been working with them for over a year to help deliver drug contraindications in their health portal, their PHR. It is very powerful to the consumer.

We leverage the same engine for the payer market. There are many players out there that are engaged in analyzing the claims data. While we do this very well also, that is not the only place we do it, as we just talked about.

So we give you one engine, purposing that in three different environments. At the point of care, for the consumer in a PHR, and analyzing a population, or a payer base of patients from a payer’s prospective.

: Richard, you mentioned payers as one of the constituencies, and I know that, for example, Aetna acquired ActiveHealth a while back and WellPoint just announced the purchase of Resolution Health. Do you fit at all in that space or have you had enquires from payers? Do you see that becoming a possibility further down the line?

: We do fit in that space and we do have a good deal of interest from payers because we not only provide the analysis, but we provide direction on where they can provide better care. Our engine not only can analyze, but can provide input on more economical directions and also on the safest direction to help a payer’s population.

We are working with other payers and disease management companies in looking at how to leverage our engine. We think that the Resolution Health acquisition by WellPoint validates and increases the interest in this market and validates the value of what we are doing and what other companies are doing in this marketplace.

: You mentioned earlier on that you were doing some radiology physician support at Beth Israel in Boston and I said I had seen it there. Can you tell me a little bit about how that relationship has evolved? I noticed that John Halamka who is the CIO there at BID and also of Harvard Medical School has joined the SafeMed board.

: We are absolutely thrilled to have John on the board. His expertise, his intellect, his knowledge and his experience in the health care IT market is really exceptional. We are exceedingly fortunate to have somebody as smart and experienced as John on our board.

Our relationship with Beth Israel is very strong. We have been working with them for a couple of years and we continue to expand the capabilities in working with them. This includes an IRB test with what we are doing in radiology and imaging and expanding the capabilities of the product. They have been a wonderful business partner through this process.

: Explain for me your vision of where clinical decision support can have an impact on cost, quality, and patient safety. How broad can SafeMed’s impact be? Is SafeMed the silver bullet for health care cost and quality?

: Well, as much as I would love to say that SafeMed is the silver bullet, I am not sure that there is one silver bullet. I can say that we think that we have developed something pretty special and that we feel that there is a strong place for SafeMed’s technology in the health care ecosystem.

There is so much information out there and there is so much new information coming all the time that a doctor can’t possibly be expected, given the pressure to see more patients in the same amount of time or less time, the new information that is coming to the forefront all the time, the regulations and guidelines. It is just virtually impossible for someone to keep it all straight.

We think a tool like SafeMed is incredibly empowering and helpful, both in the quality of care that is ultimately delivered, but also in the cost of care. There is a lot of defensive medicine going on out there. We think that we have the most powerful engine out there. We think it is foundational and transformative to health care as a whole.

We think it can have a profound effect on what is going on in health care today. Health care is just too complex, too big, too many options, too many things to consider to expect one person to keep it all straight in their mind. We think a tool like SafeMed is profound in what it can do.

: Richard, what you mentioned there about defensive medicine reminded me of a piece that my fellow blogger Kevin Pho, who writes as Kevin M.D., had published in the USA Today. He talked about wasted medical spending, and about unneeded CT and MRI scanning in particular. It sounds like SafeMed may actually be able to address this.

: David that is an excellent example. That is right in the sweet spot of where we are going and where we see incredible opportunity.

: I have been speaking today with Richard Noffsinger, Chief Executive Officer of SafeMed, a clinical physician support company located in San Diego, California.

Richard thanks very much for your time today.

: Thank you very much. I appreciated the opportunity David.

May 9, 2008

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