Q&A: MEDITECH CEO on more than 40 years of healthcare change

'Our entire industry, for the last 20 years, treated clinicians as if they were desktop workers'
By Skip Snow
10:29 AM
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Howard Messing

Founded in 1969 to develop software to assist in hospital labs, MEDITECH company has since expanded its portfolio and revenue to $514 million in 2014, and expanded its solutions across the clinical workflows and across the continuum of care.

[See also: MEDITECH joins CommonWell, among others]

According to MEDITECH, its solutions are used by more than 250,000 physicians, who keep records of more than 100 million people at 2,300 or so hospitals and thousands of ambulatory settings as well.

Howard Messing has been with the company since 1974 when he joined as a developer. CEO since  2010, he spoke recently with Healthcare IT News about the need to simplify life for his customers and help drive the industry toward a next generation of enhanced software, interoperable across care settings. Here's what he had to say.

On making software since 1969

MEDITECH has been a provider in this space for 46 years. We have seen our growth start from the very early days to today, where we find ourselves providing a comprehensive [electronic health record] and all the other associated pieces that go along with that. Over that history, we've managed to prove ourselves as a cost-effective and safe EHR for the entire healthcare continuum.

On the fact that Epic and Cerner aren't the only game in town

If you look both at our market share and our successes over the last few years, we can disprove that. I think a lot of that has to do the fact that we have not in the past been in the big university hospitals. But when you have well over a quarter of the marketplace in terms of facility, it is hard to say that you are not a player. We have a quarter of the acute care facilities and many of the associated ambulatory with that. We have about 26 percent of the U.S. market and about 40 percent of the Canadian market.

On the move toward mobile

Our entire industry, for the last 20 years, treated clinicians as if they were desktop workers. The big success of Microsoft in the '90s was the first effective introduction of the keyboard, mouse, and screen for desktop jobs. In the last 20 years, we have been (and when I say we I mean the entire industry) treating clinicians, nurses, doctors, and other clinicians as if they were desktop workers.

Over the last two or four years, I will give Apple some credit for being the ones to introduce a better interface for mobile workers. They have introduced a UI and associated concepts to be really much more amendable to being used for a mobile workforce.

We are in the process of introducing that on all of our products. We have started with ambulatory. We now have a Web mobile-based ambulatory product that we think has been designed by physicians with the workflow that physicians and clinicians expect, and we expect their productivity to be enhanced by the system. I am pretty confident we will be able to increase the productivity of clinicians. That is the reaction we get from anyone we demonstrate it to.

On interoperability as an industry imperative

Interoperability is a key to getting community health done effectively, unless you can assume that a patient gets the entirety of their care within one healthcare system. The ability to track both the patient's healthcare through your institution and other institutions, and potentially other modes of care, is important.

We certainly all think that interoperability is important, and I see that changing over the next few years and becoming finer grained. Where we started with continuity-of-care documents and non-discrete data, we are all moving towards discrete data. I think that is the key to being able to solve both the population health problem and the master EHR problem – being able to have one source of truth about a patients electronic health records. That is a key thing to moving forward, and we're hopeful that the entire industry – and by industry I don't just mean the vendors, I mean the healthcare providers as well--can be united on this. I think we still have a problem in our industry with the incentives for providers to interoperate.

One big thing we will see over the next four or five years (is) what I call the achievement of true interoperability: our ability to get things like individual lab results and trend them along with lab results developed in-system and out-system.

Longer term, I think the rise of an API mentality in our industry is important. The ability to allow applications, particularly specialty applications, but applications of all kinds to operate in a more natural manner than we do with interfaces, and things like the FHIR, and maybe Stage 3 meaningful use, depending on how the API requirements there shake out. We will also have significant change in our industry in the approach the EHR is (taking) over the next three to five years and beyond.

On the urgent need for population health management

Being able to both measure and affect the outcomes achieved (is key), particularly as we move towards an emphasis on population health. We will see more and more initiatives from both the government and the payers to move our system away from the episodic-based healthcare that we've pretty much provided in the past, to one where we not only pay for outcomes, but we pay for outcomes as applied to population as a whole. I think we have to prove we can help with that.

We always had components in our system that were applicable to population health, and we have introduced yet another product, both business and clinical analytics, which is designed to cover the population health space. It's been released to three customers so far. It is receiving good feedback, both from those customers and from other customers that we've shown it to.

On the need to link EHRs with pop health tools

I just don't see how having two separate systems is going to be effective or productive. I think there is a lot to be said about having them combined. It doesn't make any sense to me to have two record-keeping systems. It seems you would have a much more flexible approach – particularly as we evolve this whole area into having one record-keeping system and the ability to have components of that – that controls both population health and individual encounters and make sure that those are coordinated.

Although there are many inherit capabilities in the underlying separate pieces of the record, the one thing that ties them together will be our business and clinical analytics, our dashboards, our ability to flag patients by disease and a population, and follow up based on characteristics of the predictive analytics that goes along with all of that.

On the way's value-based reimbursement is changing the industry

The history of our healthcare system has been one where we change our reimbursement policies to try to get to grips on things. This is the first meaningful change, I think, in a long time that there seems to be wide agreement (that) can have an impact on both the quality and cost of care. There seems to be a lot of excitement on both our customers and ourselves about what impact this might have on the broader healthcare system. We are going gun blasters on, making sure that we can support our customers as the reimbursement models change.