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For 20 years, information technology was a hole where physicians shoveled their money, only to be disappointed with the results. That’s the backdrop Steve Clark must work against.

Clark is CEO of Informed Medical Networks, which has spent five years developing an electronic medical records system around the needs of physicians. Clark worked closely with the Memphis Medical Society to get frequent input from physicians, both on how the system works and what it costs. Doctors wanted to store records in a way that makes them easy to retrieve and secure to share when there’s a referral. They also asked that at the end of the day the costs be predictable, so they could be worked into a budget.

The result is the first EMR system endorsed by the Medical Society. And since it’s a private network, rather than one on the Web, it’s also highly secure. Clark believes he has a concept that can go nationwide.

“Older technology uses practice management systems, housed at each medical practice,” he said. “With ours, we host all the technology, the servers. At the clinic, they can have tablets and PCs and access the system.”

The immediate advantage is that PCs are highly reliable and function as plug-and-play, replacing the open-ended service calls that can bleed a business. The premium service, which includes records, imaging and practice management is $1,200-$1,500 per provider; larger groups that can hang all providers on the same branch get a lower price.

“It includes all training, backup, repairs, inventory and wireless network management,” Clark said. “They will not spend another dime on IT for the rest of the year.”

As a private network, it’s also much easier to share huge graphic files, such as MRI reports and PACS X-rays. The Internet is a bigger pipe overall, but millions of people are shoving billions of bits through it constantly. Practices can also access the Internet through Informed and its beefy firewalls, controlling the Web sites that employees can view at work.

“People sometimes go to sites that they shouldn’t,” Clark pointed out.

Several years ago, the Medical Society tried to form a technology committee to get over the past hurdles of IT, said Michael Cates, executive vice president. Discussions with the Memphis & Shelby County Health Department and several practices didn’t get far because nobody was satisfied with the technology at hand.

“My thought was that we needed some sort of community-based EMR system where we could share things like file servers and bring down the cost,” Cates said. “Steve and his people had to ponder long and hard, but they stepped up with a proposal.”

Since maintaining medical records is a function of primary care doctors, the Medical Society also pressed for a flat fee.

“In a primary care setting, you’re running on small margins and it’s expensive,” Cates said. “That’s why we came up with a per-physician monthly fee, just like rent. You’re not putting out thousands of dollars up front.”

The network began taking shape four years ago when Informed began servicing walk-in clinics in four states operated by NextCare Urgent Care, based in Mesa, Ariz. The new client was attracted to Informed’s status as the first national re-seller of NextGen software.

That contract allowed Informed to open a second server ranch in Arizona. Today the 10,000-square-foot facility in Memphis and the sister facility in Arizona provide redundant backup of all records. It means a disaster in Memphis won’t destroy more than 300,000 medical records that have already been gathered.

All the major carriers- — Networx, BellSouth, Sprint — are tied into the Memphis facility. Sprint and Time-Warner provide redundancy in Arizona.

After being burned by expensive technology that promised much but failed to deliver, the next step was to find primary care doctors willing to put their practices on the line to test and refine the system. Practice management consultant Bill Appling persuaded his primary care pediatric clients to give Informed a chance. It was ideal; Appling operates several Independent Practice Associations representing 75 percent of the area’s primary care pediatricians.

Even they were reluctant, but Appling had a persuasive argument: “Electronic records were going to be imposed on us anyway, so we might as well have a hand in our own future.”

Pediatricians typically have the thickest records, and several practices were already partly electronic. Clark also had a relationship with the Health Department and picked up quite a few more children through the department’s Health Loop primary care clinics.

The attitude was that mastering pediatrics would make the rest of medicine look easy.

Appling noticed a definite generational divide in acceptance of technology; generally, older doctors were more resistant. To help change attitudes three physician champions were identified--physicians who were respected enough that they could urge their peers to give the system a chance. Those three were Lelon Edwards Jr., at Pediatrics East, plus Ken Robertson and Robert Riikola, both of Memphis Children’s Clinic. Robertson has since moved to become medical director of Utilization Management at Le Bonheur Children’s Medical Center.

“Sometimes everything falls together even better than you can hope for,” Appling said. “With Dr. Robertson now at Le Bonheur, we have one of our physician champions in the hospital, talking to the specialists.”

Informed’s proprietary software also integrates with other practice management systems, lab software and both the Cerner system used by Methodist Le Bonheur Healthcare, Inc., and McKesson, used by Baptist Memorial Health Care Corp. In fact, Clark accepts the fact that competitors will likely copy his hardware configuration, pasting servers together and claiming to be an equal.

“Anybody can buy a stack of servers,” he said. “But nobody can recreate our software.”



August 2007

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