Podcast interview with Prem Urali, CEO of HealthUnity (transcript)

This is a transcript of my recent podcast interview with Prem Urali, CEO of HealthUnity.David Williams: This is David E. Williams, co-founder of MedPharma Partners and author of the Health Business Blog.  I'm speaking today to Prem Urali, who is CEO and co-founder of HealthUnity.  Prem, thanks for being with me today.Prem Urali: Thank you David for having me.Williams: What is HealthUnity?Urali: HealthUnity is a five-year-old, successful health information technology company.  We are solely focused on the health information exchange market.  We offer what we believe to be the most comprehensive standards based product for building health information exchanges. We target pretty much all the various segments of the HIE market namely: hospital outreach by exchanges, IDNs looking for solutions within the IDN or reaching out to the community.  We also do local and regional exchanges leading up to statewide exchanges.  Also we help companies plug into the nationwide health information standards.Williams: In order to be able to do that, what are the main services or products that you offer?Urali: The approach we took to the solution to this fairly wide set of problems is what we believe to be a fully integrated product.  To be able to do a fully integrated product that offers an HIE solution for the various market segments, we believe that there are three major technical components that are needed.  The first is infrastructure services.  These are things like: how do you manage the exchange, how to you manage the various nodes on the exchange, how do you manage the users, the master patient index certificate of authority and how you get data into the exchange; what people commonly refer to as adaptive services.  All of this falls under the bracket of what we call infrastructure.Second are the real services that people care about, which we call clinical services. These are things like results delivery, record location, clinical summary access, providing access for the patients to their own data, providing lab results that need to be reported to aid the local, state, or federal public health to the authorities.  So these sorts of clinical services are the second bracket of services.Then the third one is what we call gateway services.  These are pre-established or already existing services out on the Internet that need to be connected.  An example of that would be somebody who can connect to the Surecripts network or the RxHub medication history services. These sorts of things fall under the category of gateway services.  So in some ways there are basically three types of things that we do.  The first one being infrastructure services, the second one the clinical use cases and the services needed to do that and the third one being the gateway services.  We offer solutions across the three of them enabling our customers to realize the visions of HIE's.Williams: A lot of what I hear out in the market is about how there isn't a lot of interconnection and how there aren't a lot of standards and everybody exists in a silo.  The way you're describing it sounds like you're offering the capability to bridge all of those gaps.  Where are we in the lifecycle here?  Is it very uncommon that people have the sort of services that you're describing or is it in fact more widespread than is generally recognized?Urali: The cycle that we are seeing in the industry, it is still evolving.  We believe there is a lot of positive movement towards standardization at various levels and it's a very complex problem we've been working on for the last five years and we continually invest in it.  So we think they are converging. We believe with the establishment of meaningful use in the next few weeks that potentially by the early part of next year it's going to be become much more clear as to what will be expected, in what time frame and how to go about doing it in terms of standards and in terms of really achieving profitability. Hence we believe that companies that are strongly focused on R&D and can deliver a good solution at a reasonable price in the time frame that it needs to be done will be successful in serving the market need that comes about.Williams: At first you were talking about three different segments that you're serving, between the hospitals doing outreach, between the IDN's, and the third one the local and regional and eventually the statewide networks.  Those are probably more of the RHIOs that people used to talk about. But you don't hear that term very much now.  In fact a whole bunch of them have fallen by the wayside.  Do you have a perspective on that market and how it will tie into the stimulus act and the health reform that may or may not come?Urali: Simply speaking about RHIOs and local exchanges, regional and statewide exchanges, we believe that there is much more momentum behind them especially because of the stimulus bill.  One of the provisions in there requires state designated entities.  We think that's going to give a much-needed impetus to those types of exchanges and be more prevalent.  We also think if done right that could actually save money for entities.Let me put it in a different way.  If providers are looking to meet meaningful use criteria, they need to be doing some sort of health information exchange.  That could be done in a cost effective manner by forming these local groups or statewide groups that can have better leverage and can kind of distribute the costs, the infrastructure costs, especially across them and if it is done right it could actually be saving them money and it could be a much more effective way to getting meaningful use criteria met.Williams: What about people that aren't waiting for that, but your existing client base that would be more on the hospital outreach side or the IDN side? What's the cost like for them?  I know you mentioned there are the three different types of services, so I'm not sure how you break it out, but how do they think about what the cost is and what is it based on?Urali: When we talk to customers, they are usually surprised in a pleasant sense about how much it costs to be able to do an exchange or get the initial part of the exchange going.  Since we built pretty much all of the technology needed on the exchange side of things ourselves, we can offer an initial exchange that does one or two clinical services and then potentially a model for the infrastructure at a very low cost and in a rapid time frame.  We have done initial implementations at the $50,000 range for example or in some cases even less than that.  It can be done in a 30 to 60 day time frame. I'm talking purely about the technical part of the implementation.  There are always several things that need to happen before that; who are the entities and what are they going to exchange, who are the clinical services and what is the government and the legal agreement under which such an exchange could happen?  Once that's in place, the technical part can move really quickly.Williams: Tell me a little bit about places that you've deployed.  What does the system look like there and what is the experience like for physicians and patients in that kind of a set up?Urali: So I can address that by probably giving you a couple of examples, one of which is an exchange that we jointly built and are currently operating with a large health care system in Baltimore, Maryland.  It's a group by the name of LifeBridge Health.  They run two hospitals.  They wanted to incorporate and exchange data with a neighboring health system.  We built an exchange that has several use cases that are operating in that exchange environment, but basically would like to exchange that with a service we call clinical summary exchange.These two systems use two different health IT, EHR environments.  One of them uses McKesson, the other one uses Meditech EHR, and between these two we have completely automated clinical summary, so as patients that are commonly shared between these two go from one facility to the other.  There is a clinical summary that gets automatically exchanged and that summary is available within the EHR environment.  We are seeing about 40 to 50 patients benefit by the summary exchange every day.Another example of more of the regional effort is our customer in Long Island, New York where we have a network that was initiated by the New York Stony Brook Hospital system.  Four hospitals got together and several other physicians that are affiliated with these four hospitals.  Together they have formed an exchange and in that particular instance, we have several use cases that we are deploying.  We have already deployed one of them and we are in the process of deploying several others including patient access as an example.Williams: So why was it in the Long Island example that they decided that they needed this?  Can you tell me a little bit more about the use cases that they have in mind?Urali: Sure.  The use cases that they have in mind are pretty much what we are also hearing from many of our other customers as well as potential customers.  These are things like clinical summary exchange, core location servers, patient access, lab results delivery, and so on and so forth.  So these are being rolled out over a period of time and across different entities.  They decided on these use cases because they are something that had an inherent need.  Now with the meaningful use definition calling for many of these same use cases, it's become much more imperative and also there is a time element to it.  They have certain deadlines that they would like to meet in order to be compliant with the meaningful use requirements coming down the pike.Williams: What are the other companies or approaches that you compete with?  So if I'm a hospital and I'm looking to deploy the sort of services that you have, what are the other sort of things that I might look at?Urali: We like to think of ourselves as being in a unique situation and I'm sure when customers go out there and look for a solution there are probably anywhere from four and maybe up to ten choices that they may look at.  The approach that we have taken is much more of an integrated approach.  We were founded around the premise of building the HIE solution in the market.  Right from day one that was our charter and it's been nearly five years that we've been at this particular problem and we believe we have a very integrated solution.  That we believe reduces cost as it does coverage limitation.  The other fact is that only companies that can invest in R&D on a fairly consistent basis would be able to help customers meet the meaningful use requirements in the time and manner that they will be expecting to meet those.  So I know that there are other choices as well, but probably not as integrated. When they look at the total cost ownership as well as when they look at the time to market, they will probably find us as a more attractive solution.Williams: You mentioned your ability to invest in R&D.  Can you tell me a little bit about how the company is funded and why you're able to make those investments?Urali: Sure.  We have bought private investors and professional investors and the way we started the company and the way we organically grew the company, we really didn't need a lot of external capital coming in, but at the same time the option for us arose to raise some capital so we can grow faster and things like that.  We have actually done that on and off on a continual basis.  We are a profitable, successful company.  In the future we don't exclude bringing in additional investors so we can actually grow faster and potentially play a significant role as the market grows in the next several months.Williams: As the spending steps up with this federal money coming, in particular, do you expect that it will make sense to be a standalone HIE company or will it make sense to bundle what you're doing with a broader array of products or services if you're to look maybe three or four years out?Urali: As it is we partner with several companies, some of whom are significant players in the health IT market.  We believe that customers look for an integrated solution.  There is not one company that's going to provide the entire suite of solutions. So we do those kinds of partnerships. For example we are close partners with Microsoft on various solutions that they are bringing to market.  We are also partners with other EHR vendors to help them bridge the gap between what they provide and what meaningful use is calling for.  Essentially meaningful use requires a lot of HIE functionality and so they find it much more attractive to work with us because they can bridge the gap that their customers are looking to do in a much more rapid manner.  So we do believe that the partnership model is the way to go.  That will benefit our customers in the time and manner in which they would like to see the benefits accrue.Williams: Great.  Well Prem, those are the main questions that I have.  Are there other topics that you would like to discuss today?Urali: No, I think we covered all of the important topics on health information exchanges.  I really appreciate the opportunity to be able to talk to you and we look forward to staying in touch.Williams: Great.  So thank you very much.