TEXT/PODCAST: One-on-One-w/Meditech President & COO Howard Messing, Part II

In every industry, there are organizations so pervasive they constitute bellwethers for the entire market segment. In healthcare IT, that company is Meditech. With over 2,200 customers and almost $400 million in software revenues last year, the Westwood, Mass.-based organization’s opinions on national policy — especially the HITECH Act’s Meaningful Use NPRM — should be taken very seriously by D.C.’s policy wonks. Offering those opinions to healthsystemCIO.com editor Anthony Guerra this exclusive interview is President and COO Howard Messing. In the following discussion, Messing — who was recently promoted to CEO subject to a perfunctory confirmation vote — offers his thoughts on the aforementioned HITECH Act, meeting customer demands for the latest software and much more.

(Part I)

BOLD STATEMENTS

My own personal preference — if I was the CEO or the COO of a hospital, independent of any government regulation — is that I would consider myself to be very neglectful if I didn’t push bedside medication verification as quickly as I could.

We really don’t want to see certification become something that prevents innovation and that homogenizes software to the lowest common denominator.

… the real issue is that in 5.6 and 6.0, obviously, there’s a brand new user interface that is much more acceptable to physicians who are used to Windows-based systems than in our older software.

Podcast [audio:One-on-One-W-Howard-Messing-Chapter-2.mp3]

GUERRA: How flexible do you think the government will be in terms of reducing the requirements put in the Meaningful Use NPRM?

MESSING: I really don’t know; I’m really not privy to the internal discussions of that. I think a lot of that is going to depend on their estimation of exactly how much money they’re going to have to spend. My understanding is that despite the fact that $20 billion was allocated to this, if they come up with a plan that causes them to spend $25 billion, they’re going to have to do it, and that’s not something I think the government wants. So I think that’s really the decision they have to make — what is their estimate as to how many people are going to meet the qualifications versus the amount of money they want to spend, and I think they’ll ultimately make their decision based on that.

GUERRA: I don’t know if there were hidden costs, but I just read an article about a $34 million contract going out to Northrop Grumman to develop a database to manage the program.

MESSING: I hadn’t read that, but that doesn’t surprise me. But it surprises me it would be $34 million. That seems like a lot, but it doesn’t surprise me that it’s happening.

GUERRA: So there are probably a lot of costs around the program to manage the program?

MESSING: Right.

GUERRA: I came across a document on your site advising customers of what they’ll need to meet Meaningful Use. I noticed that a number of interfaces were listed in there, CCD, CCR, interoperability interfaces, public health reporting interfaces, immunization interfaces, claims and eligibility interfaces. These are expensive things, right?

MESSING: Interfaces, yes. No doubt about it. Interfaces really are, for any company, custom programming, and custom programming is always relatively expensive.

GUERRA: But these are just necessary to carry out what’s in the Meaningful Use regulation?

MESSING: Absolutely. The main thing is that there has to be a level playing field — all the hospitals and all the vendors have to respond basically in the same way. So there’s no way out of it. We have to provide those data. We’re as committed as anyone could be to interoperability and to a future where medical records can move around the healthcare system very easily, and certainly interfaces is the technical way that is achieved.

GUERRA: One of the things that I’ve been looking at is whether CIOs prefer to implement CPOE or bedside bar coded eMAR first. (see healthsystemCIO.com survey) and I’ve seen CIOs come down on both sides of that. Do you have a strong opinion as to which it makes sense to do first? Obviously, CPOE is the one focused on in Stage One of Meaningful Use.

MESSING: Right. My own personal preference — if I was the CEO or the COO of a hospital, independent of any government regulation — is that I would consider myself to be very neglectful if I didn’t push bedside medication verification as quickly as I could. I think it’s the single simplest and least expensive thing that one can do to improve patient safety. I think it can be demonstrated and meaningfully proved that it improves patient safety, and I wish that we could have that in all hospitals — both Meditech and non-Meditech hospitals — as quickly as possible. But that’s a personal preference. In terms of what the government is trying to achieve, I’m a little bit surprised that they didn’t recognize that but, really, I would like to see that happen.

GUERRA: Let’s talk about the certification process, both the certification NPRM and the IFR. The IFR was really for organizations like CCHIT and the NPRM was on the process which would be of most interest to organizations like yours. What are your thoughts on what was put out? We know they want to go with a two-part program that has a temporary and permanent phase.

MESSING: Certainly, we understand the reasons why certification is necessary and, in general, are supportive of that. We’re also a little bit afraid about what certification means. We really don’t want to see certification become something that prevents innovation and that homogenizes software to the lowest common denominator. I’m a little worried that might happen, particularly if this goes on at the same time that perhaps the FDA gets involved in this kind of thing. We know in Canada now there’s some regulation going on that effects this kind of certification — the concept of having an external body at least take a look at what you’re doing.

The issue of whether there’s one certifier or multiple certifiers, that’s something we’re also very concerned about. We’re hoping it doesn’t get to a point where customers say who they want you certified by, because it really can be quite an effort to get yourself certified. But we don’t have any problems or any worry about whether we will meet certification or not — we’re not at all concerned with that. The question is how long will the process take, and what else it takes away from, and what we need to do to get there.

GUERRA: I had one vendor CEO tell me he had to spend a good chunk of R&D on what Washington wants. Does that cause disintermediation between you and your customers, because now you have the government stepping in and saying, “Your software has to do this.”

MESSING: First of all, I agree with whoever said that. That’s part of what I was implying when I said I worry about it effecting innovation. Maybe the way you expressed it is a better way to say what I’m concerned about. If it was up to me — both in terms of certification and, frankly, in terms of Meaningful Use — I would have been very clear to express the operating procedures in terms of results, not in terms of specific methods to get the results and, to some extent, that’s happened but, to some extent, that is not what’s happening. As soon as you dictate actual results, you fall into the trap of things not necessarily being customer driven but driven by the government. Over the long haul, that may mean there are features in there that are not necessarily useful to customers, and that it takes longer to get some of the features that are not required, but are useful, into the software.

GUERRA: Some say the FDA process for approvals is too onerous, and that it would cause vendors to skip minor upgrades so they wouldn’t have to go through it. What are your thoughts?

MESSING: Well, we are familiar with the FDA, at least in respect to our blood bank software which has been certified and regulated by them for many, many years, and we know what it takes to make that happen. Certainly there are some aspects of it that are onerous, so I won’t say I welcome FDA approval. On the other hand, I don’t think I’m as opposed to it as some other members of our industry.

My single biggest worry for Meditech moving forward, the only thing that keeps me up at night, is patient safety. Our software is getting deeper and deeper into the clinical process, people are spending more time using it and relying on it, and we’ve been very fortunate to not have had any major serious incidents. We try to do everything we possibly can, but I do worry about patient safety — ultimately, that’s what the FDA is about. So I may quibble with the particular way they go about it, and I may, in my day-to-day activities, complain about it but, overall, I think if it puts an emphasis on patient safety and makes the software safer it’s actually a good thing. I never thought I would say that about the government, but that’s what I’ve come to believe.

GUERRA: So you have a robust process of feedback from customers to find out if a safety incident occurs?

MESSING: Yes, we have internal classification on anything that comes back, things that are bugs, things just like patient safety, things that we feel we must get on the phone immediately and call all customers who have that software about, it doesn’t come very often, but we have those processes in place. And then also — in terms of the FDA — we work on making sure that the quality control procedures are in place so those things are minimized in the first place. That’s what’s being regulated right now up in Canada. They’ve decided in Canada that our software, our industry software, is a medical device, and that we have to meet all of the quality-control demands for a medical device that are appropriate up there. It’s not too different than what we have to do with the FDA but, of course, it has its own set of requirements.

I would anticipate that’s going to happen here at some point. If not right now, at some point over the next three, four, five years, I’m sure the FDA — if they get the funding from Congress to do it — will get involved in this area.

GUERRA: Let’s talk a bit about software versions. You’ll probably have to correct me somewhere along here, but I know your newest is 6.0, there are versions in the 5s that are out there, could just give me an idea of what versions the majority of your user base is on, and what versions you’re going to have certified?

MESSING: I like that you call them “versions in the 5s.” The first answer to that is yes, we are getting what we call our 5.6 software certified, so there is not any need to upgrade to our latest software in order to meet the requirements of the government. Upgrading to our 6.0 software generally requires a hardware refresh, and so it’s not something that all customers want to undertake. Even though I opened this conversation by saying there’s a lot of customers that want to upgrade the system, there’s just as many who financially want to spend the minimum they can in order to qualify (for the stimulus funds) if staying with their existing software gets them there. So some of them already run our 5.6 software, and some of them will upgrade to our 5.6 software, and then some of them are going to upgrade to our newest 6.0 software. So we do have plans in place for all of our customers to qualify, if they so choose.

We have no short-term plans to migrate all of our customers to our latest software. Certainly, 6.0 is our latest. That’s the thing we’re most excited about. It’s got some technology in it that, for the future, enables us to do things that perhaps can’t necessarily be done, or at least not done as well, in some of the older software. On the other hand, we see it as being a five- to 10-year process before the bulk of our customers would ever get to that 6.0 software. It’s going very well, but we have a lot of customers, and we want to make sure that it’s done in a controlled fashion. Controlled, meaning not only on our side but controlled in terms of finances and needs on our customers’ side.

So today, we have approximately 15 customers live with our 6.0 software. I know there are 30 or 40, maybe 50 underway and another 50 to 75 contracts to move people up. So the vast bulk of our customers — remember we have well over 2,000 hospitals — are still running our older versions of software and will be doing so for some time to come. We still have a full complement of development staff working on the older products, we will still be introducing new features in there and, while that might not be (the case) 10 years from now, we certainly see that for the indefinite future, because we have a very large customer base that needs to be supported.

GUERRA: What percentage of your current customers will have to upgrade? What percentage are on a version that’s old enough they must upgrade to be on a certified product.

MESSING: I don’t know the answer to that, to be perfectly honest. We ask all of our customers to upgrade to the latest version of their product, be it the new software or the old software. Certainly, the vast bulk of those are either on 5.5 or something earlier with a plan to upgrade to 5.6, or they’re on track to go to 6.0.

GUERRA: This may be a silly question — but is there something between 5.6 and 6.0 (laughing)?

MESSING: No. There’s no 5.7. I don’t know what the future will bring, but there is no 5.7,

GUERRA: Might you go back and fill in that gap (laughing)?

MESSING: You know, actually, if I had to do it all over, we probably would have called 5.6, 6.0 and 6.0, 7.0. I don’t want to confuse anyone. It turns out that our 5.6 release was a very, very large release. There’s a lot of stuff in it, and it’s much more complex than the numbering would tend to indicate. But that kind of numbering is what the industry expects, it’s what we do, it’s just a way of labeling software.

GUERRA: Regarding your software, some people have said they want to get on a more recent version — maybe 6.0, maybe 5.6 — because those versions have the CPOE sophistication necessary to get doctors to embrace it. Have you heard that, and what are your thoughts around the versions you have out there and the degree of functionality around CPOE that those versions offer?

MESSING: I don’t think it’s about functionality. First of all, there’s a lot of truth to that statement, but the real issue is that in 5.6 and 6.0, obviously, there’s a brand new user interface that is much more acceptable to physicians who are used to Windows-based systems than in our older software. The older versions do have a robust user interface, but it’s not quite the same, so that’s the big reason for getting acceptance in 5.6. If there are doctors who really want something that looks a lot more like what they’re used to, then 5.6 or 6.0 is the way to go for that. So that’s probably the source of the comments you’re hearing.

Part III

Related posts:

1. TEXT/PODCAST: One-on-One-w/Meditech President & COO Howard Messing, Part I
2. TEXT/PODCAST: One-on-One w/Former ONC Senior Adviser John Glaser, Part III
3. Podcast: One-on-One w/Meditech Maven John Haffty
4. TEXT/PODCAST: One-on-One w/Former ONC Senior Adviser John Glaser, Part I
5. TEXT/PODCAST: One-on-One w/Former ONC Senior Adviser John Glaser, Part II