Information Technology & Services
Update: Wednesday, 19 September 2012
Matthew Sappern is CEO of PeriGen of Princeton, NJ
Tell me about yourself and the company.
I joined PeriGen in January of this year. I came over from Allscripts and Eclipsys, where I had been for about eight years in various capacities. I headed up a big chunk of our development organization at one time, ran our remote hosting business, ran our services business for a while, and then after the merger, ran all of our client sales for a year-plus. I joined PeriGen in January, and now I am getting my arms around labor and delivery.
What is the size and scope of the company?
We are about 100 folks. We have offices in Tel Aviv, Princeton, and Montreal. We are the combination of two firms that merged in 2009. We have more than 150 customers right now, including Banner, MedStar, Maimonides, and Albert Einstein. It is a good cross-section of teaching hospitals as well as community hospitals. Our solution flexes pretty well across the entire gamut of hospitals.
How have fetal surveillance systems changed the way that obstetricians had practiced over the years?
The interesting part about fetal surveillance systems is that they really have not changed much at all for a number of years. That is what attracted me to PeriGen. It was the first time that I saw that any vendor was applying some new technology and starting to innovate.
Surveillance systems, archiving, and annotation on the strip have been around a long time. Everybody does it, right? Philips, OBIX, GE, WatchChild, and PeriGen… we all do it pretty well, to be honest with you. PeriGen takes a different approach in applying evidence-based medicine to detect when there is risk in labor. I am hoping that we are ushering in a whole new age of applying systems to healthcare. That is really what drove me here.
That must be a different driver than at Allscripts, where you had to convince doctors to use CPOE or EMRs because someone else wanted them to even though the benefit might not necessarily accrue to them personally. I assume obstetricians want or demand PeriGen’s products?
When I was at Allscripts, Meaningful Use happened and hospitals were getting behind EMRs. It is a great feeling when we show our product. Clinicians’ eyes really light up, because it is just a bit different from everything else that is out there.
It does everything that what I term “commodity systems” need to do, but our ability to apply technology to what has been a subjective part of labor and delivery is important. Probably 80% of medical malpractice comes back to bad interpretation of the fetal monitoring strip. We have figured out a way to apply technology to help interpret that strip.
Doctors and nurses … their eyes tend to light up when they see this stuff. I think as with every new disruptive technology, it takes a little bit of time for people to understand why it is so much better than what is out there, particularly as budgets are tight.
What malpractice benefits have obstetricians seen from using the product?
There is a bunch. Banner Health Systems has seen a precipitous drop, on the order of millions, in their malpractice expense.
Not only are we a great hedge on the downside of malpractice, but it is my contention that we actually can help hospitals categorize when there are complications with labor, and potentially get greater reimbursement for that work. Even Medicaid provides higher reimbursement for vaginal delivery with complications as opposed to vaginal delivery without, but a lot of times that goes unchecked because there is no simple system to categorically and systematically define or determine whether there have been complications in labor.
Most of the physician documentation begins with the moment of birth. Our ability to show that there were complications in the labor portion, we think, is going to allow hospitals to correctly charge and code their DRGs and establish some top-line revenue growth as well.
As unfortunate as it is when there is any kind of patient harm that could have been avoided, everybody is very sensitive to anything involving newborns or peds. When you look at those malpractice-driven events, are they usually because of lack of following procedures or failure to detect complications?
Those go hand in hand sometimes. A lot of times there is a subjective interpretation around whether the fetal monitoring strip is showing complications or not. What we have tried to do is firmly establish a tool that helps us determine that case. In fact, the NIH has licensed our tool to go back and take a retrospective view of thousands of strips from problematic births to determine if there is any way to change the protocol.
Many companies are trying to develop software to analyze incoming data streams from patient monitoring systems. What have you learned as an early adopter in applying evidence to physiologic monitoring data?
You are only as good as the evidence. We have put an awful lot of research into the 19 patents that we have. We have about 6,500 OB-specific protocols that we use. We are continuously vetting that.
We have got some great clients. They work very closely with us in helping to shape our product as we go forward. Sometimes they say, “This protocol might be a little bit outdated”, or “We had a case in here that your system really doesn’t contend with, and here’s how we think the workflow ought to go”, and they help write new protocols. I think vigilance is part of that.
You are applying accepted knowledge, but it sounds as though you are also using the information you collect to develop what may become the next standard?
Yes. Standards evolve. Part of evidence-based medicine is when you get the evidence of something evolving; you got to take advantage of it. We are constantly working with our clients to evolve our solution set. It has really worked out well for us and for them.
Everybody is spending a lot of their time and money working to implement electronic medical records, but the solutions market seems solid for high-acuity specialty areas like surgery, labor and delivery, and the ICU. Is it hard to earn a place at the table when those hospitals have made their big investments, and you are offering them a system they may not have thought about?
I think the rush towards Meaningful Use and deploying EMRs in as fast a manner as possible definitely eats up resources on the hospital side that they would otherwise deploy against programs like ours. But I think you are absolutely right that there are specific areas in the hospital and labor and delivery, where perinatal is probably the highest-risk service line in most hospitals. There is just so much nuance that I do not think any of the larger EMRs can develop. I would like to think that most of the clinicians understand the need for a specialty solution like ours.
You mentioned that your competitors do a good job. How do you differentiate PeriGen from them?
We are the only ones who have gone well beyond that commodity solution set of surveillance, annotation, and archiving. To us, that is great, but it is an old application of technology. We are truly the only ones who are certainly doing that, but also applying our systems to deliver clinical decision support, to essentially say, “Hey, doc or hey, nurse — you’ve got a problem here. You need to look at this” and allow that clinician to intervene.
None of the other systems do that. In a way, I do not feel like we have any competition because no other systems are doing that. Everybody is doing the commodity stuff. Nobody is doing what we do.
Where do you take it from here? Companies usually branch out into something unrelated or add functionality to what they have.
There are a number of different directions. If you look at the number of obstetricians that are going through school, you see a downward trend in terms of available obstetrical talent. Careers are running a little bit shorter. It is hard work being an OB, getting up in the middle of the night all the time.
Our solution set lends itself to a service line around the remote OB hospitalist, an intriguing direction that we’re looking at. There is a number of areas that our technology is well suited for because it is so visual and it’s doing a lot of the heavy lifting for the clinician. I think we are far more suited for that kind of a solution set than anyone else in the space.
At the heart of it though, we also have an engine that can be abstracted away from labor and delivery content and populated with content from other departments as well. The concept of applying clinical decision support engines at the bedside in real or near-real time is one that can grow pretty significantly into other service lines.
I had not heard of remote OB hospitalists. How is your product used remotely compared to products like AirStrip?
We are published via Citrix. There are a number of physicians using mobile applications now without using AirStrip. The last time I was at Banner, I was speaking to a doctor, and he was sitting there on his iPad looking at tracings and actually entering some orders. Mobility is something that we feel pretty confident that there is a solution set around for us and that a lot of our clients are already employing our solution in a mobile fashion.
The remote OB is a different concept. If you are in a hospital somewhere where you are having trouble getting access to OBs, like any number of community hospitals around the country, perhaps there is a service that provides a consulting physician or that uses our system as an alerting system, like an ADP in home security.
None of these are productized now, but your question was where our application goes. Our application allows immediate visual recognition of a problem, so therefore lends itself to a number of services that do not exist today.
In a small town, obstetricians spend a lot of time waiting on labor to progress. Is it easier for hospitals to attract and use those obstetricians efficiently when they have a tool like yours?
Yes. There is no doubt that both nurses and doctors have a more efficient workflow when they are using our tools. Nurses can come in, check on patterns, and see it right away over a two-hour trend line whether there are problematic decelerations or not in the labor. It is a lot more relevant clinical information and a lot quicker than having to stare at the strip or unroll the strip out on the bed and see what’s going on.
How do you think obstetric services and obstetricians will fare under the Affordable Care Act?
I am more worried about the number of obstetricians, frankly. I think they are going to be fine. As you look at where hospitals are going with accountable care organizations, I think tools like ours are going to become more and more important.
If there is a baby that is born with a birth defect – heaven forbid, but we all know it happens — that child is in that system for, in many cases, the perpetuity of its life. Any tool like ours that employs systems to manage risk is going to be quite important in accountable care organizations going forward.
Ultimately, I think that the practice of obstetrics is changing. We are going to continue to see a higher demand, as there are less OBs delivering babies. Systems like ours can help make those OBs and the nurses on staff a bit more productive, which is what we see a lot of excitement around.
From your time at Allscripts, what lessons did you learn that you will and will not apply at PeriGen?
There are a lot of things that we can do, being a much smaller organization than Allscripts and having a much tighter focus. We have got the freedom, agility, and speed to do things that they maybe cannot do quite as well. There are organizational tenets that I am taking a slightly different approach than we ever did at Allscripts relative to how I am organizing our development and product teams. Stuff that the size and scope of Allscripts just wouldn’t allow.
Any concluding thoughts?
When I saw this application at work, I had been up for the job and I was not sure if I was going to take it. I wanted to go see the application at work in one of our client hospitals. There was a woman having some complications and decelerations in labor, which are bad. I am not a doctor, so that is about as medical as I am going to get.
Our system helped detect what was going on. They were able to do an emergency C-section. Everything came out great. At that point, I saw more than ever in my career how technology can change the course of healthcare on a patient-by-patient basis.
I feel like we are bringing innovation where there has been little to date. We are applying technology to one of the most problematic and subjective areas, which is interpreting the fetal monitoring strip. It is a great proving ground for clinical decision support overall.