Company: VitalWorks (formerly Datamedic
Corp.), Waltham, Mass.
Business: Medical Information Systems
Number of Employees: 200
The computer revolution has been more like the Thirty Years War in the medical field, where the struggle to convert to electronic patient records has spanned several decades.
Finally, however, victory has been achieved in overcoming a major obstacle to the automation of patient records. VitalWorks (formerly Datamedic Corp.), a small Massachusetts company, used co-funding from NIST’s Advanced Technology program (ATP) to design software technology that makes it easy and productive for doctors to enter patient data directly into a computer. The technology promises to make a substantial impact on medical practice and administrative costs because it
“It’s changed everybody’s life,” says David Carr-Locke, director of endoscopy at Brigham and Women’s Hospital in Boston, where the software was tested and has been used in clinical practice for some 30,000 cases over five years.
The new technology meets an important need identified by the Institute of Medicine (IOM), one of the nation’s highest scientific authorities, which said: “The single greatest challenge in implementing the [computerized patient record] is to develop a technology that is sufficiently powerful and appropriate to the needs and preferences of healthcare professionals so they can—and will—enter medical and other healthcare data directly into the computer.”
Thousands of healthcare professionals are indeed using the software to input data into the computer. According to VitalWorks, the technology is installed at more than 250 endoscopy sites and 100 primary care and emergency medicine sites involving an estimated 5,000 physicians. And the number of products incorporating the module is growing.
Nothing so grand was widely envisioned when the project was first proposed to the ATP. The proposing company (Datamedic) had only 18 employees and was interested in a then-obscure aspect of electronic medical records. Company officials believed that 60 percent of the clinical data in a patient record was contained in the clinical notes made by physicians, a minority view at a time when most records researchers were developing computerized lists of drugs, allergies, and other factors important to medical care. The ATP helped validate VitalWorks' idea through its technical peer reviews, part of the normal project selection process. “It did wonders for us in terms of saying, hey, maybe these guys really do have a good idea and in opening the door to business relationships,” says Richard Johannes, a physician who is vice president of clinical development for VitalWorks and the ATP project manager.
In the three-year ATP project, which ended in 1998, VitalWorks adapted an existing note writing technology to capture clinical data automatically through a pleasing user interface. Using a combination of medical expertise and computational linguistics, the team wrote software algorithms to define a hierarchy of related objects, attributes, and values used to codify the patient data. A specialized knowledge base was developed to support data collection and text generation. Thus, a physician can select just a couple of terms and the system produces a grammatical sentence; it also integrates the substance of the clinical note into a sophisticated database.
The company originally focused on gastrointestinal endoscopy applications, using a Minimum Standard Terminology generated jointly by U.S. and European groups. It also has developed knowledge bases for emergency medicine, internal medicine and family practice, outpatient ophthalmology, renal dialysis, oncology, and rehabilitative medicine. The underlying technology could have applications in law, business, and other fields if appropriate knowledge bases were developed.
The completed system overcomes an important weakness of traditional clinical notes. The IOM found errors of omission in 30 percent to 60 percent of clinical notes. A University of Iowa study of VitalWorks' gastrointestinal endoscopy system found that it reduced errors of omission from an average of 22.8 percent to an average of 8 percent of notes, and as few as 1 percent of notes in certain types of cases, Johannes says.
The ATP project was successful enough to encourage the purchase of the company by the much larger InfoCure Corp., which subsequently spun off Datamedic as part of VitalWorks. VitalWorks joined the ranks of organizations integrating the new technology into their own systems, according to Johannes. Other users include the Veterans Administration (VA) and Olympus America Inc., the leading endoscope manufacturer and a supplier of medical technology.
The VitalWorks module, which was commercialized with non-ATP funds, was selected for testing by several VA healthcare networks because it can be embedded into other software applications, is sufficiently structured to generate defensible billing codes, and can support multiple medical specialties, according to Clayton Curtis, of the VA’s New England region, one of several regions involved. The VA could save as much as several million dollars annually in each region through the avoidance of both transcription costs and the need to hire certified staff for billing coding, according to Chuck Brown, chief information officer for the Atlanta medical center.
Olympus incorporated the technology into a product that supports gastrointestinal endoscopy. This product is used at several hundred hospitals and ambulatory care centers, and sales are increasing by about 25 percent to 50 percent annually, according to Marc Shapiro, senior product manager. The Datamedic module increases the efficiency of report writing, he says, in the same way that an electronic address book improves on a rolodex.
Carr-Locke, who helped VitalWorks write the clinical component of the technology, said patients benefit because a report is generated so quickly that they can get a copy while in the recovery room. The medical profession benefits because the system supports both reporting and research while remaining simple to use—the latter being a critical feature for doctors. “If we make a system too complicated, they’ll never use it,” he says.
In addition to using the system to produce case notes, Carr-Locke has used it to generate overall clinical practice data for several professional papers because it provides a unique capability to search for specific symptoms, such as the number of patients who present with gastrointestinal bleeding per month.
Johannes expects that the system can enhance managed care by producing information on organizational performance and helping to evaluate various medical protocols on the basis of outcomes and cost. With all the VitalWorks modules on the market, there is the possibility of linking them together to produce (anonymous) data on large populations of patients. VitalWorks also is working on a second ATP project aimed at developing technology for a decision support system that will reduce variations in clinical practice.
May 2000
Revised