Pharma Builds Bridges with Advocacy Groups

Healthcare reform underscores the need to engage patients before launching clinical trials.

• Alex Philippidis

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It seems the key to achieving this aim is patient engagement. Health IT expert Leonard Kish coined patient engagement the “blockbuster drug of the century” needed to fix the ailing healthcare system for its ability to improve the quality of care and lower costs.

What is patient engagement? Broadly, it is defined as patients taking ownership of their health care. A 2012 Institute of Medicine report defines it as “engaged, empowered patients” as part of a system “anchored on patient needs and perspectives” and promoting “patients, families and other caregivers as vital members of the continuously learning team.” The best part about the patient engagement blockbuster drug is that it not only applies to patients in a clinic or hospital, but with advancements in mobile health and telemedicine, it applies to every patient, everywhere.

Half the population suffers from a chronic disease – diabetes, heart disease, asthma, depression – a condition that can be treated but not cured, and these 148 million Americans account for three of every four dollars spent on healthcare. But numerous studies have shown that it costs less to keep these patients well than to have them returning repeatedly for treatment. Health Affairs summarized this research stating, “A growing body of evidence demonstrates that patients who are more actively involved in their health care have better outcomes and incur lower medical costs. This finding is motivating health care organizations to better inform patients about their conditions and care choices, so they can be more fully involved in maintaining their health and making decisions about their care.”

The fiscal motivation to engage patients is also being incentivized by the government. Hospitals attesting to Meaning Use are given federal grants for demonstrating a minimum level of patient engagement, for example, access to test results from an EHR. The government also started the Hospital Value-Based Purchasing Program – reducing Medicare payments to hospitals by 1%, then calculating a score based on the quality of its care to determine how much money each hospital deserves to get back. While part of the score is determined by adherence to clinical standards of care, such as administering medications to control blood pressure or blood sugar, 30% of the score is determined by former patients rating the hospitals on experience of care, using the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, which focuses on the communication skills of doctors and nurses and the cleanliness and quietness of the environment.

Third parties are also starting to rank hospitals based on patient ratings and how deeply each hospital’s patient communities are engaged in their care. The Patient Engagement Index, the first third-party index of its kind, ranks 74 major Florida hospitals based on three criteria that research shows can lower costs and improve outcomes: personal health resources (read-only internet access to health information, mobile applications, interactive tools for managing health), social engagement (hospital ratings on social media and consumer ratings sites) and patient satisfaction (CAHPS results).

In a world where people are always “plugged in” and accustomed to using the internet to go about everyday business, it makes sense to use technology to engage them about their health. People use online banking to view their entire financial history, yet almost 50% of patients report that information necessary to their care was not available when needed. Before booking a hotel or hiring a plumber, people use the internet to compare prices and reviews of performance, but 85% of patients say they have not been informed by comparative quality information about their health care. Less than half of patients feel they receive clear information on the benefits and trade-offs of treatments for their conditions. Almost half of patients are not satisfied with their level of control in medical decision making. Hospitals and care givers are making the push to engage patients in these ways as other industries do, by treating them like consumers.

Vanderbilt University Medical Center, for example, created its Patient and Family Advisory Councils with a mission of optimizing the patient experience. They revamped the patient education process, initiated 24-hour visiting hours (even in the ICU), redesigned the online patient portal, introduced a secret shopper program, redesigned the surgical experience and rewrote the surgical informed consent form, among other efforts. An increasing number of hospitals are forming committees and councils like Vanderbilt’s aimed at making small changes to put the patient first.

One of the easiest changes a hospital can make is updating their website. An attractive, patient-friendly site that is easy to navigate and has information about the hospitals/clinics services, health insurance coverage, pharmacies and drug costs. Make it available as a mobile site and in Spanish and other languages. Some take it further and include patient portals in which patients can schedule appointments, get test results, pay medical bills, refill prescriptions, search covered medicines and view claims. Others include wellness planning to help patients make better lifestyle choices around diet, exercise, smoking and alcohol use, and to help with medication compliance. Symptom checkers and virtual doctors, nurses and coaches are becoming increasingly popular, as well.

Healthcare systems are also reaching out in the form of social media. 26% of hospitals in the U.S. participate in some form of social media – Facebook, Twitter, YouTube or a blog – circulating information about wellness programs, support groups, healthcare in the news and ways to get involved, and 60% of doctors say social media improves the quality of care delivered to patients. More than 80% of individuals ages 18-24 say they were likely to share health information through social media and nearly 90% say they would trust the information found there. For that tech-savvy demographic, a social media presence is key.

While using technology, mobile applications and social media engages a large portion of the population, there are still others that need other forms of outreach to take ownership of their health. Montefiore Medical Center in the Bronx started a program called Goal to Reduce Re-admissions at Montefiore (GRRAM) to target the elderly and low-income patients and improve their hospital aftercare. Dr. Ricardo Bello, head of the GRRAM program, said that many people living in the Bronx do not have a regular primary care physician (PCP) to call and therefore tend to use the emergency room when they had a medical problem after discharge, many times resulting in re-admission to the hospital. For this demographic, without access to a PCP or interactive technology health tools, they needed a different tactic to enlist patient engagement. Montefiore started a clinic that sees patients 7 days after discharge to go over medications, post-op activities and care and answer questions.  Also, patients were given a wristband similar to the LiveStrong band with Montefiore’s 24/7 hotline number and told to call with any questions.  A team mans the hotline number and makes sure patients get the information needed or are referred to a physician as soon as possible. While still early on in the program, Montefiore has already seen a significant reduction in number of re-admissions.

Regardless of the method of outreach, healthcare systems across the U.S. are making changes big and small to engage their patients and encourage them to be more active in maintaining their health. This sharing of health ownership, along with a push by government rules and regulations and internet-fueled information sharing today, will revolutionize the healthcare system and make receiving treatment a truly collaborative experience between the patient and his healthcare team.

By: Alexina Fredman, Senior Consultant

The post “The Blockbuster Drug of the Century” – Patient Engagement appeared first on Falcon Consulting Group.

Improvements in the ability of medical devices and health IT systems to communicate and exchange data could lead to more than $30 billion a year in savings, according to a new report from the West Health Institute.

In recent testimony before the House Energy and Commerce Subcommittee on Health, Joseph M. Smith, MD, chief medical and science officer of San Diego-based WHI, revealed these findings to the committee as it weighs policy changes aimed at mobile technology and medical devices.

In hospitals today, patients are treated with as many as a dozen medical devices in a typical intensive care unit, according to WHI, including defibrillators, electrocardiographs, vital sign monitors, ventilators and infusion pumps. These devices are often from different manufacturers and not connected, requiring a costly and complex IT infrastructure – and introducing the potential for miscommunication that could lead to adverse events.

“We see an enormous opportunity to use information technology and device innovation to bring about the much needed transformation in healthcare delivery,” said Smith. “Today’s hospitals are filled with medical devices that are unable to share critical data, creating potential dangers to patients, as well as inefficiencies that put a tremendous financial burden on our healthcare system.”

While there has been progress made on interoperability standards, the healthcare industry continues to fall short on adoption of those standards.

WHI’s report, “The Value of Medical Device Interoperability: Improving patient care with more than $30 billion in annual health care savings,” is based on interviews with industry stakeholders uses existing published research to estimate the financial impact on the U.S. healthcare system.

The study shows potential that lowered costs and increased quality could be derived from improvements in several key areas:

• Adverse events avoidable with medical device interoperability;
• Redundant testing resulting from inaccessible information;
• Clinician time spent manually entering information;
• Increased length of stay from delays in information transfer;
• Device testing and development costs; and
• Provider costs to integrate devices with electronic health records.

The analysis, which stems from WHI’s work with the Medical Device Interoperability Coordination Council, also includes several case studies that show how interoperability can improve patient care.

One example, according to the report, shows how functional interoperability could prevent adverse events due to drug errors. If a cancer patient’s pain medication is distributed by an infusion pump that receives direct information from that patient’s vital sign monitor, it could ensure the patient isn’t over-medicated by mistake; these systems are typically independent and require multiple manual settings, all of which increase the potential for error and raise costs.

“Medical devices need to share data, based on standards, so that they can better inform clinicians and help patients,” said Peter Pronovost, MD, medical director for the Center for Innovation in Quality Patient Care at John Hopkins University. “By doing so, we can both improve quality and reduce costs.”

Mike Miliard “Medical device interoperability could save $30B a year, says WHI.” Healthcare IT News March 21, 2013

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The House Committee on Energy and Commerce, Subcommittee on Communications and Technology, will launch a three-day series of hearings today to investigate issues involving mobile health – particularly how to keep innovation flowing without over-regulating.

Slated as a witness in Tuesday’s hearing, Jonathan Spalter, chairman of Mobile Future, an organization that represents innovators across the wireless ecosystem, including nonprofits writes in his testimony that his group is united in its commitment to advance a policy environment that encourages mobile investment and innovation.

“Nowhere is that promise of future innovation and opportunity greater than mobile health,” he writes. “Our message today is that the innovation and vision exist now in both the medical and technology communities working together collaboratively. This progress will proceed, in many respects, as rapidly as government allows.”

Kerry McDermott, the former director of healthcare for the Federal Communications Commission (FCC) and now senior director of health care technology policy for West Health Institute, a non-profit organization focused on lowering healthcare costs, spoke earlier with Healthcare IT News. She says there is “a lot of consternation in the market.”

Vendors, she said, “can innovate faster than the regulatory environment can keep up with.” She added that the FDA “is trying to set up guidance in the mobile app space. They are really trying to take a light-touch approach. There are so many apps that can do good; they want to let them flourish. Policy is a very blunt instrument and you’re asking the agency to snap a chalk on that curve. In today’s world that doesn’t cut it anymore. We need something to be more tailored.”

Because of that, the FDA is leaning more heavily on guidance and less on regulations. So far, it is limiting its regulation to apps that can turn a phone into a medical device, McDermott explains.

Robert Jarrin, senior director of government affairs at Qualcomm Incorporated, in his prepared testimony, would like to see FDA promptly finalize the Mobile Medical Applications (MMA) draft guidance document, issued in July 2011. “The final MMA guidance should offer specific examples of low-risk regulated mobile medical devices that FDA, through enforcement discretion, would not regulate.”

FDA “should continue its commitment to consistency, predictability and transparency by coordinating internal and external efforts through a single dedicated office of mobile health within FDA,” Jarrin advises.

George S. Ford, chief economist for the Phoenix Center for Advanced Legal & Economic Public Policy,  writes in his testimony that “low barriers to entry, quick time to market, inexpensive retail prices and rapid upgrade cycles have made the mobile application economy an American economic success story.”

“Anyone with a good idea and computer coding ability can get into the business and distribute their innovation around the world,” Ford adds. “And thanks to the proliferation of subsidized smartphones and the popularity of ‘app stores,’ mobile apps are projected to be a $25 billion industry this year and are estimated to have already produced 500,000 jobs.”

Health-related applications are a growing segment of this market. Five percent of smartphone owners have downloaded an app to track or manage their health, according to a September 2012 Pew study. Under the Federal Food, Drug, and Cosmetic Act (FFDCA), the Food and Drug Administration could potentially classify these applications – as well as the smartphones and tablets that run them – as medical devices, subjecting them to a lengthy clearance or approval process. Further, this classification could subject these products to the 2.3 percent medical device tax under the Affordable Care Act.

“Overbroad application of this classification could stall the innovation, investment, and job creation that wireless smartphones and apps are bringing to healthcare, as well as ultimately impact the larger wireless ecosystem,” Ford warns.

“How will the FDA handle small, iterative updates to apps to accommodate operating system changes?” he asks. “Does the FDA process contemplate the potentially short life span of a particular wireless device or version of an operating system? Does the FDA intend to reevaluate apps each time there’s a change anywhere in the ecosystem? Why is an app even considered a medical device under the FFDCA?”

“The lack of clarity surrounding the definition and guidelines has also exacerbated the problem by creating a cloud of uncertainty around applications and device uses that do not fit clearly into the examples the FDA provides,” Ford writes.

Bradley Merrill Thompson, general counsel of the mHealth Regulatory Coalition, also calls for FDA clarification on mobile apps. “The development and adoption of these technologies has been so swift that thousands of mobile health apps are already on the market,” he writes.

“Now we need final guidance on mobile medical apps to assure innovative products get to market so that healthcare professionals, patients and consumers all have access to needed tools to manage their health,” says Thompson. “A final guidance would provide the regulatory predictability necessary for investors to support, and manufacturers to develop, important new products.”

Diana Manos “House panel starts 3 days of hearings to explore mobile health.” Healthcare IT News March 19, 2013

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Through the module, patients can submit confidential feedback via an online questionnaire that is tailored to the needs of the provider. Results can be measured against the Department of Health’s quality care targets, officials say. This will support providers in the delivery of quality, evidence-based care, leading to a more patient-centered National Health Service (NHS).

“We saw this collaboration as a key move towards a clearer understanding of patient’s expectations and the actual quality of care,” said Christine Whitehouse, Stalis’ managing director, in a press statement. “This is represented through the patient’s ability to give honest feedback via a confidential internet survey, moving away from a paper-based questionnaire, meaning more accurate results for healthcare providers.”

The Patient Experience module brings together solutions from both companies. The IPROS CUBE Assured Compliance service allows providers to design patient surveys specific to their auditing requirements. Stalis’ CareInform solution integrates the survey results into a single patient data repository.

Instantly accessible via real-time dashboards, the cloud-based solution offers providers a view across all quality metrics.

“Integrating our Assured Compliance with Stalis’ CareInform solution provides trusts with a single point of use for monitoring and analyzing current, reliable, relevant and sufficient evidence of compliance, ensuring the NHS is more accountable to patient requirements,” said Rob Anderson, IPROS CUBE managing director, in a statement.

Jamie Thompson “New module allows patients to give feedback on care experience.” Healthcare IT News March 15, 2013

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To be honest, it’s easy to get swept up in the pageantry of the conference, especially when you snake your way through the exhibit hall and witness the vendor grandeur that fills the senses with excitement and awe at the cornucopia of solutions and strategies that exist to help keep the industry moving forward through innovation and collaboration. The conference may seem overwhelming at times, but chances are you had an agenda prior to arrival and were able to successfully seek out the education sessions, vendor booths, and social conversations that were on your checklist.

There are probably a host of takeaways from this year’s conference for some (maybe even too long of a list to fathom) and for others just a few key points that stuck. I had the pleasure of attending a few post conference meetups and while I was there, I asked some industry professionals this question: “If you could define what your one key takeaway from this conference was, what would it be?”

Here is a recap of what they told me:

1. Mel Smith Jones (@MelSmithJones) – “There is something magical when you bring like minds together. It’s like landing on a planet and finding yourself. (HIMMS 2013) made me smarter, stronger and more informed of the key issues. It elevates my own ideas in a way I couldn’t have done on my own. This is how innovation happens.”
2. Mark Bradley (@amramp) – “My key takeaway from this year’s conference was to actually be able to see and experience interoperability and interfacing between devices. We are jumping from a life of concept to a life of reality. The younger generation are in a position to take advantage of technologies we (older generation) only dreamed of and move it forward in a direction never thought of. My only worry is that technology doesn’t overrun the human factor and ruin the quality of life. I also see less competition, and more collaboration between vendors.”
3. Jennifer Dennard (@SmyrnaGirl) – “My key takeaway was patient engagement, which everyone seems to be trying to figure out. Employers are increasingly seeking new ways to establish employee accountability for their own healthcare and the industry seems to constantly crave new tools to keep patients engaged in their own care.”
4. Don Seamonds (@donseamons) – “One point that stuck in my head was that you can have the best healthcare model in town, but if you can’t get patients on board, it won’t work. In addition, from a vendor perspective, the key to HIMSS is getting their message out in front of the right people. At times, it’s like stepping in front of a speeding bullet to get in front of those people, but it’s essential to reap success from the conference.”
5. Janice McCallum (@janicemccallum) – “With all the talk of patient centered care, this is the first time we see signs of it. Giving patients equal access to data benefits everyone.”
6. John Lynn (@ehrandhit) – “During HIMSS, I heard Ed Marx, CIO of Texas Health Resources say that “Social Media is the currency of healthcare.”  A very interesting way to look at social media.  Plus, there are a lot in healthcare who are pretty poor when it comes to use of social media.”
7. Dr. Joseph Kim (@DrJosephKim) – “My biggest takeaway from this year’s HIMSS conference was the emphasis on mobile healthcare. Mobile health is advancing rapidly to promote patient engagement as well as to improve clinical workflow efficiency. (The need of) mobility for doctors and nurses spurs innovative tools on many different levels. A lot of these tools may not last but the emphasis on mobility and its definition is evolving every year. The lines between mhealth mobility and telehealth are getting more and more blurred.”
8. Ken Congdon (@KenOnHIT) – “This year’s conference has taught me that I need to structure more of my editorial content on how healthcare can better manage risk. It’s all about providing real world examples of how health facilities are managing their own risk. One other impression I get is that people don’t want to hear as much about meaningful use as much as they do on how to manage the risks associated with compliance, etc.”
9. Don Fluckinger (@DonFluckinger) – “What I found interesting that the CIOs that I talked to out on the floor and some of the health data standards people I speak with are seeing the CommonWell Health Alliance as similar to the Betamax vs. VHS format argument.”
10. Dr. Wen Dombrowski (@healthcareWen) – “The three things that I think are my most important takeaways are number one that more people are focused on usability, demonstrated by my discussions with some vendors and health IT leadership that are passionate about it and at least trying to make their products more user friendly and intuitive. Number two, I think anyone who is a stakeholder in health IT or healthcare should look at current competitors, current products, and best practices and start with that as the baseline for solution development. Number three, even though HIMSS is largely focused on technology, it’s important for me to meet and connect with colleagues and stakeholders in my field and have the opportunity to get other people’s opinions on new trends, challenges, and solutions.”

John Trader “Key Takeaways from Industry Professionals at HIMSS13.” Healthcare IT News March 11, 2013

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The debate started out light – amiable even. Rove, former deputy chief of staff for President George W. Bush, began by telling the audience of healthcare IT professionals his favorite restaurant in the Crescent City (Dooky Chase, for those inquiring minds). Political consultant James Carville began by thanking the audience for selecting New Orleans as conference destination. “You’re The Super Bowl of conventions,” he said.

After arguing topics of party politics and sequestration, by the time Carville and Rove started on the subject of healthcare, the conversation proved considerably more heated – although never absent of humor, offensive as it may have been. Carville, on several occasions, rolled his eyes or pretended he was falling asleep. After a few incidences, Rove responded by feigning a deep slumber himself when Carville spoke.

When asked about healthcare, Rove called President Obama’s Affordable Care Act a “gigantic disaster, financially,” saying the nation needed to find alternatives – and quickly. The best place to go looking for those alternatives, he added, is Bill Clinton’s Medicare reform commission to “steal the idea championed there by Democrat Senator John Breaux of Louisiana,” Rove added, referring to Breaux’s premium support proposal.

“I don’t want to say it too loud,” Carville said, but, “the last three years have been the best three years in terms of healthcare costs,” he whispered to the audience, eliciting laughter and applause from the audience. “If that trend were to continue, that would be about the best thing we could have.” Carville pointed out that Medicare delivers healthcare cheaper than any other system. “If we have one problem that could kill us is our percent of GDP we spend on healthcare costs.”

He candidly admitted that the ACA may not be perfect, but said it’s the best step forward to address the millions of Americans who don’t have health insurance. You find out what part of it works, he added, and keep going with it, and find out what doesn’t, and tweak it.

“Let’s not give credit to a bill that we’re raising taxes and robbing money out of Medicare for, but have yet to begin operating,” Rove retorted. And although, Carville pointed out the Medicare delivers healthcare cheaper, Rove mentioned that Medicare pays the average healthcare provider roughly 80 percent of what the private insurance company pays. “There’s a lot of cost shifting going on here,” he added, and those costs are being covered by non-Medicare patients.

“I never said that Obama didn’t have anything to do. I merely said these last three years have been the best three years we’ve hard,” Carville blurted out. “This ain’t Fox News, you can’t just make stuff up.”

A yelling match then ensued, with Rove interjecting again that Medicare has a lower reimbursement rate. Carville interrupted, “If the hospital’s charging $18 for an advil, you don’t pay ‘em.”

After several back and forths, interruptions and accusations, moderator Mark Romig, CEO of New Orleans Tourism Marketing Corporation attempted to move the conversation onto the topic of immigration. “Now moving on to something a little less controversial,” he said.

Erin McCann “Carville, Rove duke it out at HIMSS13.” Healthcare IT News March 8, 2013

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Former President Bill Clinton’s talk Wednesday at the 2013 HIMSS Annual Conference & Exhibition encompassed politics, economics, history, climate change, childhood obesity, health information technology, of course, and even the art of the deal.

Over the course of the keynote, he enumerated many problems with the healthcare system, but he concluded on an optimistic note. “There’s nothing wrong we can’t fix,” he said. “But we have all these horse-and-buggy systems, and you can change all that,” he told the high-tech audience, calling on them to create an improved system that would be there for everybody – “so we don’t have unexamined lives and unexamined healthcare systems.”

“You all know information technology and how we manage it is critical,” Clinton said at the start, adding that IT could play a vital role in improving access and providing leverage for the American people.

The political, social and healthcare impacts of the Affordable Care Act have yet to be determined, he told the audience. “It depends on how it’s implemented,” he said, and also on the decisions we all make outside of the ACA.

Meanwhile the national debt is rising with healthcare as a major culprit, he said, and he forecasted that healthcare would grow at three times the rate of inflation, spurred by aging baby boomers who are expected to live longer than previous generations. “The real people being affected,” he added, are being asked to move from a public system (Medicare) to private one, which costs more. “In this maelstrom, IT will become very important,” Clinton said. As he put it, information technology can help improve the quality and cost of healthcare delivery, and it can also provide access for people who have been left out of the system. “We need to do both things,” he said.

Clinton, who heads the Clinton Global Initiative, also called on the audience to consider the need for better healthcare around the world, in countries where “half of the people are still living on $2 or $2.50 a day. In those places people need systems that we take for granted.”

While he championed the need for such systems, he warned:  ”At some point in the life of every nation, almost every system gets long in the tooth.”

Clinton transitioned into talk of Congressional gridlock, the fiscal cliff, the rising national debt and Steven Spielberg’s movie “Lincoln.”

“You’ve got to show up to work and make a deal,” he said, invoking Lincoln – the movie, which showed what Clinton called “the gritty touch world of politics.”

Clinton, who made reference to his own vegan diet earlier in the talk, tied childhood obesity to added healthcare costs. “It may not sound like high-tech,” he said, but if the country were to stop feeding the healthcare system so many sick people, “You improve quality and reduce costs.”

He gave a shout out to the Blue Button, a simple way patients can access their medical information, and he called for more transparency in healthcare pricing, asserting, “There’s no correspondence between what people pay and the quality of healthcare they get.”

Clinton sprinkled his talk with anecdotes and turns of phrases that elicited applause and often laughter from the audience.

But, it was the very last question that HIMSS President and CEO H. Stephen Lieber posed after Clinton’s talk that elicited the most response from the audience. Without mentioning Hillary Clinton’s name, Lieber asked Clinton if he was aware of any good candidates to be the next president, in essence asking, “Will Hillary run?” The answer: “I honestly don’t have a clue.”

Bernie Monegain “Clinton urges IT pros to healp healthcare.” Healthcare IT News March 6, 2013

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Ragon, who keeps a low profile, declined to be interviewed. In 2009, he surfaced in the press when he and his wife Susan, an executive at InterSystems, donated $100 million over 10 years to establish the Ragon Institute of MGH, MIT and Harvard. It is pursuing the development of an HIV vaccine.

Over the past five years, InterSystems’ revenues grew at a compounded annual rate of 14%, with a spike in 2010 following the HITECH Act, which boosted sales of Epic and other electronic health records because of government purchasing subsidies to doctors and hospitals. “We never run a business [thinking] that we need to grow 20% to 30% to be successful,” says Paul Grabscheid, a long time InterSystems employee in charge of strategic planning. He says the company is profitable, and has no debt.

InterSystems’ trajectory has been closely tied to the fortunes of Epic, a leading electronic health records vendor, which generated $1.5 billion in revenues last year. Epic is InterSystems’ single biggest customer. “When we met Epic, all the people from Epic and InterSystems could fit around a conference table. We’ve grown up together,” says Grabscheid.

In several ways, the two companies followed similar paths. Both are rooted in an older programming language called MUMPS, developed at Mass General Hospital in the 1960s. Their founders coded the first products, and turned down outside investors, preferring to maintain control.

An MIT physics graduate, Ragon formed InterSystems in 1978, with some of the proceeds he earned from selling his shares in a medical billing company he co-founded. (It ultimately became IDX Systems, now part of General Electric). He saw an opportunity with MUMPS (Massachusetts General Hospital Utility Multi-Programming System) which was gaining a reputation in health care as a language that could handle doctors’ notes, in addition to numerical information. InterSystems became the dominant seller of MUMPS databases, hawking a standardized version that attracted more software developers. Epic became a customer.

But with the advent of new database technology, InterSystems could no longer rely on MUMPS to stay in business. “We were becoming kings of a small market that wasn’t growing, and didn’t offer much future,” says Grabscheid. In 1997, the company introduced Caché (hidden in French), a competitor to Oracle’s database management tools. Developers could still write in MUMPS, but also in more popular programming languages, including Web applications. It is now InterSystems’ biggest selling product, attracting customers in health care such as Siemens and Sunquest, but also Credit Suisse for its trading platform, and the European Space Agency to map the Milky Way. “When Cerner attacks Epic [on using old technology], it does it based on an out-of-date historical view of the technology that is not accurate,” says Grabscheid.

The company says it’s not resting on its laurels with Caché, and points to a wide base of 30,000 customers that include the Department of Veterans Affairs, Partners HealthCare, and Cleveland Clinic. Over the past ten years, it has released two products that are increasingly in demand because of the push to connect disparate platforms to merge patient information. Revenues from one of its products, called HealthShare, have doubled to $20 million last year, over 2011. HealthShare, for example, provides the backbone for much of New York’s health information exchanges that bridge hospital systems.

You probably won’t hear Terry Ragon extol the benefits of interoperability. “He’s a private sort of guy. You’ll never confuse him with an outgoing sales person,” says Grabscheid.

Zina Moukheiber “Behind Epic Systems, A Low-Key Health IT Company Called InterSystems.” Forbes March 4, 2013

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