Podcast interview with Andy Hurd, Chairman and CEO of Carefx Corporation (transcript)

Way back in December I interviewed Andy Hurd, Chairman and CEO of Carefx Corporation. My transcription service (Casting Words) took forever to produce the transcript. In any case, here it is.

David Williams: This is David Williams, co-founder of Medpharma Partners and author of the Health Business Blog. I am speaking today with Andy Hurd. He is the Chairman and CEO of Carefx Corporation. Andy, thanks for your time today.

Andy Hurd: Thanks for having me, David.

David: Andy, what is Carefx?

Andy: We provide a workflow platform that allows disparate applications to interoperate in an intuitive way, simplifying access to information for caregivers, and providing the information that they need to make informed decisions.

David: Would this typically be in a hospital setting?

Andy: Yes, typically in a hospital setting. We are currently installed in about 400 hospitals around the country. We also have a couple of HIE/RHIO initiatives that expand us into ambulatory settings as well.

David: What is the typical situation a clinician faces at the hospital if they are trying to get information? You mentioned disparate systems. How many systems are there and do they just not interoperate now?

Andy: There are literally thousands of systems that are in place. In this effort to digitize the chart, move to electronic medical records, there has literally been an explosion of thousands of applications that have been deployed and all of them terrific in their own right but none of them unfortunately work together.And so healthcare has this challenge, very difficult challenge in managing transitions. So managing the transition if you present yourself in the emergency room as an example, information will be taken on the ED Department application.

As you move from the ED, say you are admitted into a unit ward on the floor of the ICU or the surgery, each of those departments has its own applications and most of the time they don’t talk with one another.

So it’s those transitions that create this incredible challenge. In those transitions, data is lost, quality is compromised, costs are incurred and so by providing a platform that allows for an integrated view for those applications to work together, we give robust views of data to clinicians who are providing care.

And so that challenge that exists with all of the applications is one that is very real and I don’t see going away any time soon.

The reality is that healthcare is really a perfect environment for disruptive innovation so as new technologies come to the floor, as new and different discoveries and ways of diagnosing and treating illness, there is going to be commensurate new applications to help facilitate and support those workflows.

As DNA markers are used as a tool to diagnose disease, as an example, new ways to capture that data are going to present themselves. And so I see this problem only getting worse. And so having a platform like the Fusion Platform from Carefx that allows those technologies to work together and give the doctor a unified view, I think it’s great.

David: I suppose people aren’t really starting up too many new hospitals at least in the US.But if someone were setting up a hospital from the ground up, would they put systems in place that would actually obviate the need for Carefx or if they were using the best of breed across different departments and different applications, is there still a need even in that environment for the sort of offering that you have?

Andy: Even if you were to have the brand new hospital or magic wand scenario with Cerner, Epic or Siemens, even their most comprehensive suite deployed, would probably only capture 50 or 60% of what is necessary to be able to provide the applications and data.

Even at its very best there are some terrific cardiology applications, OB applications, specialty applications with some of the big vendors don’t have the application strength in that particular specialty that a niche provider may have.

So there will always be a need for a platform like Carefx, because I think there will always be advancing applications and technologies that frankly it’s just not realistic to think that one single provider will be able to provide.

David: Can you tell me how some of these new trends, for example, provider report cards and pay-for-performance affecting the need for your service? Does it make much of a difference or do you actually see some sort of a change as a result?

Andy: It sure does and it creates a terrific opportunity for us. We talked about this ability to help manage transitions, to help bridge the gaps that exist between applications or departments and their widely disparate applications provided by many different vendors. But because having that ability to give that longitudinal view to be able to capture that data and sometimes in those gaps to be able to capture or enter data in places where opportunities to enter that data hadn’t existed before.

Because you have these new and powerful views of data, they can be used in many different ways as you speak to relative report cards or core or quality measure tools of applications that we have built on top of our platform.

Med reconciliation, as an example, where you may have a core health information technology provider or clinical information system provider that is also working with a competitive OB system or a competitive ambulatory system.

Because those don’t work together, a platform like ours can tie together that information and give you persistent medication reconciliation from ambulatory all the way through to discharge.

Capture data for quality and core measures from ambulatory all the way through to discharge, not portions of it, but all of it, which I think is the key.

So, we’re seeing a considerable amount of activity in that area which we think is a very strategic area. Now it goes beyond just technology to where it’s really solving a very challenging business problem for the hospital.

David: One of the things that we see is hospitals trying to have tighter connections with their affiliated physicians in the community to improve referrals, and also, the stream of information. Do you extend outside of the four walls of the hospital to the broader more distributed enterprise?

Andy: Yes, we sure do and we’ve got great examples of that to specifically talk about, including the Louisiana rural health coalition. A large HIE established to pull together ambulatory and rural hospitals and link them together with the last remaining level one trauma center in the state of Louisiana, which is LSU Shreveport and be able to do it with the main goal being to tie together these small rural hospitals where they’re 170 miles away from Shreveport.

They may not have a cardiologist or a neurologist on staff, but when one of those citizens in Louisiana needs that care, being able to provide access and link together LSU with a small hospital in Bunkie or some of these small places without asking that patient to have to drive the 170 miles.

So we established at the core of that initiative is the Carefx Fusion portal, which ties together not only ambulatory systems but also rural health, small rural health systems  in one unified view that the physician can get access to through the browser.

So we think it’s really important to be able to solve the problem within the four walls of the hospital, but that’s the tip of the iceberg. S

David: It’s interesting you mentioned the RHIO/HIE movement because there’ve been a lot of these organizations that have been setup, often funded by grants and then they have some difficulty with their business model. Do you have a perspective on this whole HIE movement? I’m thinking of some of the ones that aren’t maybe the rural ones that you’re describing, but some of those that are in the more populated areas.

Andy: Absolutely, and I think it’s very easy to take shots at RHIO’s or HIE’s that may not have made it, that are maybe wrestling in early stages with a business model and self-sustainability.The fact is that it’s an incredibly important and ambitious target that frankly, of course we have to do.

This whole concept of being able to view patient data rather between facilities so that – god forbid, one of us ends up unconscious and shows up at an emergency room where we have not previously been seen – it would be great for that data to be available, to have data, medications, previous histories available for the attending physician.

So it’s an ambitious goal. It’s something we have to do. I think it’s very easy to take shots at something that has failed. And I think that what we’ve seen is  the problems with the ones that have not made it.

But I think some of the problem is that people have not been willing to look at this challenge in new ways, and have essentially approached it with building very heavy lifting duplicate CDR type of solutions that have complicated data schemes for a limited number of applications.

There are a number of reasons that doesn’t work and it’s not really sustainable. Chief among those is the politics of data. You can imagine when you’ve got an ambulatory practice, a facility, a hospital, maybe a competing hospital across town, a competing IDM in another state…

The whole question of who owns that data, who’s going to care for that data, who has access to that data, and even more importantly: how reliable and up-to-date is the data when you’re creating a duplicate database?

So if you constantly have to synchronize with applications or databases to bring into a centralized duplicated database, as the physician, how do I know that the data that I’m looking at is two minutes old, two hours old, two weeks old? How do I know that?

That model is flawed. So that duplicating and creating the heavy lifting central data repository, where we’ve had an enormous amount of success is that in deploying a very agile solution.

Now, when a doctor needs information at the point of care in an intuitive and robust way, we are very focused on that end game and not so much on complicated data schemes and the other components. That has served us incredibly well.

So, to apply technology at the business problem rather than throwing technology at it and trying to pigeon hole it into a business model.

David: It’s interesting: when you talked about the politics of data.I’m wondering if you could comment on a different approach that’s being used, such as HealthVault or a Google Health. For example, I’m living in Boston. Beth Israel Deaconess Medical Center is where I get my care. My health plan is Blue Cross Blue Shield of Mass. Both of those institutions have teamed up with Google Health so that I can load my PatientSite record into Google Health and Blue Cross.

Once it’s online I will be able to integrate the information myself. I don’t have to negotiate any data use agreement with these different parties. Any view on what kind of role that plays, either as a complement to what you’re doing or as an alternative to it?

Andy: I think it’s always good news when Google, Microsoft, and others are coming into the space, and I don’t think they do it for fun. I think they do it because there’s a good business there. There’s a meaningful problem to solve. I think those are steps in the right direction.I think there are challenges that are created there. I’ll give a little shameless plug here on Carefx in terms of what our platform allows and we’ve done at sites such as Trillium up in Toronto and some other facilities. This is a very logical extension if you have access to and are providing data from all relevant applications to a clinician who’s providing care.

This is role based, so that a clinician in one department is going to have a different view of different applications than one in another, or a nurse has different access rights than others. The same thing would apply to the patient.

That patient, also in a role-based way, has a filtered view for appropriate viewing of specific data, but the same data and dynamic data. Not end state data, but dynamic data that they can see presented to them. Then two things occur. One, any physician that you go to see with a self-populated PHR, a Patient Health Record, they’re going to immediately dismiss that.

If you self populate your records, I think there’s very little credibility for a physician to say, “OK. You entered all this information. It’s all from you. All right. Let’s run these tests. Let’s look at these different areas. Let me go to my system and see what we have.”

So that’s a big problem. Self-population of a PHR I don’t think is sustainable for several reasons, but most important is the credibility with the clinician.

I think the second part is that anytime you are storing data, you’re typically storing it in an end state or treating it as if it’s end state data.

With dynamic data, things that change, a lab result or a glucose reading that has a relevance of changing from the time that it was taken two weeks ago went into a data repository, was put into a PDF, and was transferred in. So you push it into your PHR.

If it’s end state data for things that need dynamic view, you create a whole other set of problems. So why not be able to have access whether it’s with ambulatory, also the hospital, and the Blues to be able to have the same access to applications and the information, real time dynamic data, but just presented in a slightly different and more user-friendly view to the patient?

So now everyone is aligned. We’re not looking at a vault or something that you did that you entered. But you’re looking at the data as the caregiver entered it and how it exists in your actual health record.

David: It does sound very exciting and optimistic. I’m wondering what your view is of what’s going to happen under the Obama Administration with health care, and specifically how it will relate to your business.He’s going to be coming into office in just a month from now. There are big plans for spending and potentially upending the health care system. Any sense of how it might shake out for you or what you’re looking out for?

Andy: When you contemplate the macroeconomic environment, not eight years ago but 16 years ago, the Clinton Administration comes in 1992, makes a lot of campaign promises and a lot of talk about health care and other things. But the budget issues and the economic issues were bad, but they were not so bad that they couldn’t be fixed. That means cutting. That means reducing spending and cost containment. The ironic twist that has occurred in the current macroeconomic situation is that the problem is so bad, that it’s viewed as unfixable.

The reality of the problem that the Obama Administration has, if you want to call it a problem, is people are begging them to spend money. They cannot spend enough money, basically, to continue to grease this economy.

They have consistently talked and consistently cited what they call medical IT as a target for that funding, with some of that funding an effort to get overall costs and inefficiencies in line.

It’s incredibly encouraging that there’s been a consistent view from the Obama Administration that medical IT can help solve that problem. I think we’d all benefit from health care becoming more efficient and increasing the quality and the delivery of care. I think that’s a very positive thing if you want to find a silver lining in a very ugly economic time.

David: You’re right. It went from being a problem that things are so expensive to being good. Just for context, we had the Big Dig here in Boston that was the biggest public works project in the world at one time. It was 15 billion. So you’re not going to be able to spend $600 billion on roads and bridges and 50 billion for health care IT, which is one of the numbers that’s been thrown around. It sounds like a lot of money. On the other hand, it’s only about a third of what AIG sucked down without that much to show for it. I think that it will be interesting times.

I’ve been speaking today with Andy Hurd. He’s Chairman and CEO of Carefx Corporation. Andy, thanks very much.

Andy: Thank you. I enjoyed it

April 16, 2009

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