David Williams: This is David E. Williams, co-founder of MedPharma Partners and author of the Health Business Blog. I’m speaking today with Dr. Scott Weingarten. He is President and CEO of Zynx Health. Dr. Weingarten, thanks for your time today.
Dr. Scott Weingarten: Thank you very much David.
Williams: What is Zynx Health?
Weingarten: Zynx Health is a clinical decision support company that was founded almost 14 years ago. The mission is to measurably improve the quality, safety and efficiency of health care. Clinical decision products that are provided by Zynx Health include: evidence based order sets, plans of care, alerts, reminders, check lists, as well as reference information supporting the clinical information that is integrated into the work flow.
Zynx Health has a client base of more than 1700 hospitals in the United States that care for more than one out of two patients who are hospitalized in any given year. Zynx Health also has a significant physician client base who use clinical decision support in the ambulatory setting and Zynx has a global client base in a number of countries outside of the United States.
Williams: There’s a lot of discussion recently about meaningful use, both coming out of the stimulus package and then with the release of the definition. Can you tell me your perspective on meaningful use? What is it and what’s the difference in meaningful use between physicians and hospitals?
Weingarten: The intent of meaningful use as I understand it is the federal government does not want to provide reimbursement just for installing software. What the federal government is hoping to achieve rather than just the installation of software is quality, safety and cost results that benefit all Americans or could potentially benefit all Americans. Studies show that in order for electronic health records to bring about improvements in health care, clinical decision support is required. Therefore there are a number of criteria that have been released that provide a definition of meaningful use, which include the requirement for clinical decision support as a strategy for improving health care.
There are a number of differences related to the definition of meaningful use for hospital clients and physician office clients. The number of differences are quite extensive and probably beyond my ability to go through them during this podcast, but one example would be that the requirements for entering orders in an electronic health record are more aggressive for physicians in their office to demonstrate meaningful use than it would be if entered by physicians in the hospital.
Williams: What role does Zynx play or will you play in helping customers achieve meaningful use? Are your customers already achieving meaningful use just by using Zynx?
Weingarten: Zynx provides the clinical decision support that can be used at the point of care to help demonstrate meaningful use. There are a variety of different expressions of the clinical decisions that are specifically defined in meaningful use. For example, evidence based order sets are defined as a care goal for the demonstration of meaningful use and Zynx provides evidence based order sets both in the ambulatory setting and the hospital setting. Zynx has a number of different products that address clinical decision support at the point of care, including care plans that are used by interdisciplinary care teams. So that’s one further way that hospitals can demonstrate meaningful use.
There is also a stage one requirement for five clinical decision support rules. Zynx has a large number of clinical decision support rules in our library to help clients select the rules that they believe will be the most helpful for patients that they care for. And there are other parts of Zynx clinical decision support that are directly relevant to demonstrating meaningful use.
One example would be that the requirement for medication safety in the elderly. All of the order sets within Zynx products have been checked against the Dr. Mark Beers criteria that were specifically cited in the draft definition of meaningful use from July 16th, 2009. They’ve all been checked against the Beers criteria to make sure that safe medications are being prescribed for elderly patients, at least when order sets are selected.
Williams: Since the most recent version of the definition came out, I’ve heard some complaining by providers that meaningful use is not going to be achievable or that it will be too bureaucratic to document it. I can’t tell whether that’s just people writing stories in order to have something to talk about or if that’s for real. Do you have a perspective on that?
Weingarten: I do. I think what people are talking about and concerned about is that the bar has been set high. Many, many organizations will be challenged in order to demonstrate meaningful use. It’s going to require significant effort as it relates to clinical decision support and other areas that are specifically cited in the meaningful use definition. It’s going to be hard for hospitals and physicians to demonstrate meaningful use and I understand their concerns.
The flip side of it is that many health systems, hospitals, and physician organizations are well on their way to demonstrating meaningful use and they will demonstrate meaningful use. Many organizations will clear the bar and receive the HITECH reimbursement. At the same time looking at the definition of meaningful use, I believe based on what’s included, it will lead to better health care, safer, more efficient, better quality health care.
So in the end –albeit difficult to achieve by many– I think the end result will be better health care for the American people.
Williams: It’s been almost a year since ARRA was passed and I’m wondering whether that has had any direct impact in terms of your product road map.
Weingarten: Well it has. It turns out we were very fortunate that a number of criteria that were in the recent draft definition have been part of our road map for –in some cases– more than ten years. One example: in the draft definition, they required approaches to reducing unnecessary hospitalizations, readmissions and emergency department visits. We’ve had clinical strategies that have been defined based on the peer review literature to accomplish those goals since the late 1990’s. So we were very fortunate that we had a lot of the content already developed and already in our products that was consistent with the demonstration of meaningful use.
For example, we’ve been working on evidence based order sets since 2001. So I would say we’re certainly looking at any areas related to clinical decision support that are in the definition of meaningful use that we don’t already have, but at the same time we’re very fortunate that many of the areas had already been covered by our products for a number of years.
Williams: If I look at this from the patient perspective, what would be the impact on a patient who went to a hospital that was using Zynx compared to a hospital that was not? Would there be anything that the patient would see that would be different? Or would there be something behind the scenes that would be different about their care?
Weingarten: It would be behind the scenes rather than anything the patient would see.
Let’s pretend that a patient is hospitalized with community acquired pneumonia and the patient is quite sick and goes into the emergency department. The patient has a fever and is short of breath and has a bad cough and can barely talk because the patient cannot breathe well. The patient is evaluated in the emergency department. Let’s use the example of an emergency department that subscribes to Zynx and has orders that would ensure the patient gets the treatment that has been shown to lead to the best outcome.
An example might be selecting the diagnostic tests that are required that have been shown to lead to the best outcome. Some examples might be checking the oxygenation status or performing blood cultures. Then it would also include treatments that have been shown to lead to the lowest mortality rates for that individual patient. That would include rapid administration of antibiotics and also the provision of the best antibiotics that are associated with the best outcomes, meaning the lowest mortality rates.
Then let’s say this patient is quite ill. The patient is put on intravenous antibiotics, given oxygen and now needs to be hospitalized in the intensive care unit. The order set and the plan of care that the patient would receive would include orders again associated with the best outcomes based on the peer reviewed literature and the guidelines that might be relevant to the individual patient. So behind the scenes, which I do not believe the patient would recognize, the patient would be diagnosed and treated with all of the clinical decision support that would give that patient the highest probability of having the best outcomes.
That means the patient being treated quickly and having their illness resolved as quickly as possible and leaving the hospital feeling well. So that would not be apparent to the patient.
Williams: We’ve been talking today about evidence based decision support. I noticed on your website you also use the term “experience based decision support.” I’m curious about what that means.
Weingarten: What that means is there are many areas where there is evidence to suggest one treatment is better than another. So I’m going to stick with the example where the patient was hospitalized with community acquired pneumonia. There is very good evidence on which antibiotics are more effective and which antibiotics are less effective.
There are also areas that have not been studied as well in the medical literature. So it might be whether to do a complete blood count on admission on day one and day two for a patient with community acquired pneumonia or which specific blood test should be ordered or whether to do liver function tests on a patient with community acquired pneumonia. So for whatever reason, either it has not been studied or maybe there is conflicting literature –one study suggesting one approach is best, another showing a different approach is best– we have the experience of more than 90,000 client customized order sets and plans of care that reside on our server.
What that means is in the aggregate, we have an opportunity to see what hospitals are actually doing. So if we find, for example, that our client base has customized 2,000 order sets, and in areas where evidence does not exist or evidence is conflicting, the experience is that they all tend to prescribe certain blood tests, certain diagnostic tests but not others, then we use that information in the aggregate in order to inform our next generation of order sets. Many of our order sets are on their fifteenth or twentieth evolution based on the experience of how clients are actually using our order sets and plans of care in their own organization.
Williams: When I asked you before about some of the grousing about the meaningful use definition, you talked about the bar being set relatively high. I’ve also heard the notion that there is going to be an expectation that this meaningful use definition will evolve over time, presumably to become even more challenging. Do you have a sense of whether that will happen and how it will happen? Is the government just going to have to lower the bar so more people can reach it?
Weingarten: You know, I don’t know whether that will happen or how it will happen, but I think that you could see there being tension both ways. On one hand certainly you may want to lower the bar a little bit for rural hospitals or small community hospitals that may be challenged to achieve some of the criteria that are part of the meaningful use definition. I’m not sure whether you would or you would not, but it’s certainly a discussion that is likely to be had.
On the other hand, at the same time, one goal of meaningful use is to maximize the health and improve the health care of the American people. If that were your primary objective, you would be far less likely to lower the bar over time and I believe you would certainly consider keeping the bar high.
Williams: The way things are looking it seems as though health reform may be enacted about one year after the HITECH Act. What kind of incremental impact would health reform have on Zynx beyond what we’ve describes here with meaningful use?
Weingarten: I think it has a huge impact on Zynx. My understanding of health care reform is that the goal is to expand access to health care and at the same time there is a lot of discussion and debate about how to pay for providing health care to additional people who may not have had access to health care in the past.
There is also a lot of discussion about rising and unsustainable increases in health care costs. So as people think about executing whatever plan is required for delivering health care reform, I believe there will be a lot of discussion about clinical strategies to the best possible health care at the lowest cost.
As people contemplate what those strategies are, as in the case with ARRA, people are going to want strategies that have been proven to lead to excellent patient outcomes at the lowest cost, or evidence based strategies rather than opinion based.
I believe at least the demand for evidence based health care and evidence based clinical decision support will increase significantly as organizations –whether it’s the federal government, state government, hospitals, health systems, physician organizations and all health care providers– try to implement whatever comes out of health care reform and they try to increase access to care, provide high quality, safe care at an affordable cost.
Williams: I’ve been speaking with Dr. Scott Weingarten. He is co-founder, President, and CEO of Zynx Health. Dr. Weingarten, thanks very much for your time today.
Weingarten: Thank you very much David.January 12, 2010