Schafer: Medical records create a new software niche

LogicStream Health Inc. is about six years old, has only about three dozen employees and may not have $10 million in revenue. Yet it's a good example of a firm in a technology niche with lots of opportunity that seems to be a great fit with the health care know-how that our region has in abundance.

LogicStream sells software to big health care providers to help make their electronic health record systems a lot more useful in improving patient care and taking out costs.

That might not seem like much of an opportunity, but in the recent past health care systems have invested billions of dollars in their electronic health record systems. If you have been to the doctor lately and noticed a lot of typing into a computer system, what's probably happening is that your electronic health record (EHR) is being updated.

A patient-friendly feature like being able to look up your child's immunization record online and then print it out is just a small part of what's possible with an EHR.

A lot of health care organizations in our region use EHR technology produced by Epic Systems. The transition to Epic was such a big deal for the Mayo Clinic that back in May when the switch was thrown in Rochester to go live, the Rochester Post-Bulletin reported the exact time: 3:54 a.m. on a Saturday.

Epic, based outside of Madison, Wis., had fewer than 400 employees in 2000. As an example of how health IT has boomed, Epic now has nearly 10,000, mostly at its sprawling corporate campus.

But Epic and its competitors consider themselves software companies with health care customers, said LogicStream co-founder and CEO Patrick Yoder, who once worked as a pharmacist. It's up to the doctors, nurses and pharmacists to figure out how to best use their EHR systems.

It's a little like what businesses go through when implementing systems such as a customer relationship management system. Such a software tool won't be all that useful without first figuring out a process for which customer information goes into the system and how employees can best use what's there to increase sales.

"Basically what we started with was a system that allowed organizations like Fairview Health to better manage all the content they put into their EHR to make it work," Yoder said. "All of the orders, and order sets, and documentation tools, and all the things that clinicians interact with. It's a lot of work before you go live. It's a lot of work forever."

The company quickly moved on from just helping health care providers manage the content of the EHR systems by helping them implement and monitor what the customer has decided is the best or current standard of medical care.

"We were finding that it was difficult to manage that well," said Dr. Genevieve Melton-Meaux, chief data and health informatics officer for Minneapolis-based Fairview Health Services, LogicStream's first customer.

Using a tool like LogicStream's helps design a workflow for complex cases such as a surgery and also the simplest ones, like popping up an alert on the screen that the patient seated right there hasn't had a recent colon cancer screening and should get one.

If physicians or others across a health care organization are bypassing a care recommendation, it's probably because the preferred protocol was presented poorly in the EHR system and needs to be tweaked. The sooner the chief medical officer or quality control staff learns that, the better.

A lot of what LogicStream's customers care about is what happens once a patient has been admitted to the hospital, because that's when care dramatically jumps in cost and leads to lots of opportunity to both waste money and depart from practices that the system had decided were best.

One example comes from a customer who saved some money by dropping a form of blood test that had been routinely ordered when clinicians suspected a heart attack. A newer and better test has been largely adopted, but unless someone changed the EHR system an emergency-room physician could order both tests.

"If health systems are trying to do this work, they can and do utilize their internal reporting teams" without using technology like LogicStream's, said Dr. Brita Hansen, the company's chief medical officer. "The problem is that they don't have enough resources to pull reports on all this stuff, and it's very much not self-service."

Another EHR problem that this little company addresses is looming drug shortages, a surprisingly painful problem for health care providers. This is not a shortage of common pharmaceuticals sold at the corner drugstore but usually injectable drugs used after surgery or in other hospital settings.

An EHR system optimized for best practices actually makes a drug shortage worse. By aggregating data from its customer base, LogicStream might be able to spot a potential shortage before it develops and suggest some workarounds.

And LogicStream is not the only firm here the Twin Cities working on the problem of making EHR work better. Sansoro Health, for example, is a young Minneapolis firm that sells software to integrate other digital health applications with an EHR system. With its $8 million Series B financing round this summer, Sansoro has now raised $14.5 million in capital.

What this points to is how flawed an EHR system is, despite the promise of improving care. Clinicians sure seem to regard them as a pain in the neck. Half of a typical physician's day is spent entering data into an EHR and other clerical work, according to one survey earlier this year, while another survey listed EHR as the top factor leading to physician stress and burnout.

"Health information technology, as a whole, I don't think the medical system was prepared for," said Melton-Meaux, of Fairview Health Services.

That's why as an industry health information technology has such a big opportunity.

Nobody would let a physician without hundreds of cases of experience and the best training do even a simple surgery, Melton-Meaux said, yet complex technology gets rolled out in a health care system with an apparent expectation that the clinicians will figure it out.

"It's like going into the car dealer to be shown a car," Melton-Meaux said. "That doesn't teach you to drive or how to use it well."

lee.schafer@startribune.com 612-673-4302