High Performance Clinical Information Systems Empowering Health Professionals for Quality Patient Care [Interview][Transcript]

Malcolm_Pradhan_Alcidion_HealthcareComputerSoftwareGuest: Malcolm Pradhan
Presenter: Wayne Bucklar
Guest Bio: With over 20 years of experience in Medical Informatics, Malcolm Pradhan is one of the world’s leading minds in Clinical Decision Support. Prior to co-founding Alcidion in 2000, Malcolm was the Associate Dean of IT and Director of Medical Informatics, University of Adelaide. During his time at the University of Adelaide, Malcolm provided thought leadership and conducted research into applications of clinical decision support, and into optimum uses of a variety of statistical and probabilistic methods for applying clinical decision support. He also was active in the Australian health informatics community, as a founding fellow of the Australasian College of Health Informatics (ACHI). Malcolm’s broad knowledge and vision of the path to a high performance healthcare system are complimented by formal qualifications of an MBBS from University of Adelaide, and a PhD in Medical Informatics from Stanford University.

Segment overview: In today’s Health Supplier Segment, Chief Medical Officer Malcolm Pradhan from Alcidion Corporation joins us today to talk about the various services they provide for the health industry. In his time at Alcidion, Malcolm has overseen and driven the development and design of Alcidion’s products and has been responsible for transforming Alcidion’s technology platform, which was initially used only for Emergency Medicine, into a powerful health informatics platform which can be applied to a broad set of clinical scenarios. Throughout his career, Malcolm has contributed to the Health Informatics community, and has specialised in research into patient safety, evidence based medicine, operational analysis and optimisation, data analysis and probabilistic simulation modelling, and Bayesian analysis and modelling.


Health Professional Radio

Wayne Bucklar: You’re listening to Health Professional Radio, my name is Wayne Bucklar and joining me today is Malcolm Pradhan. Malcolm is the chief medical officer at Alcidion Corporation and joins us from South Australia. Malcolm welcome to Health Professional Radio.

Malcolm Pradhan: Thanks Wayne, good to be with you.

W: Now Malcolm tell us first of all what it is that Alcidion does and what’s the geographical footprint you service?

M: Alcidion aims to create a health informatics platform called “Miya,” which is used in hospitals to track data for various systems, try to understand what that information means and then push information back to the clinicians, both doctors and nurses and allied health staff. So they’re aware of what’s going on with their patients and within their organization. So in contrast to existing eHealth systems which more like passive data stores, the Miya platform’s designed around trying to play more active role in healthcare and understand what’s going on to assist clinical staff. And we do that through systems in the ED, through patient flow systems and in outpatient clinic systems. At the moment we’re in about 11 large hospitals around Australia in Victoria, Melbourne territory and Tasmania.

W: Now Malcolm how is that platform spelled? Miya is it m y?

M: M I Y A .

W: M I Y A.

M: Yup.

W: Now new eHealth platforms are fairly rare these days, I mean there’s the discerners of the world have a kind of iron grip on big enterprise systems. How has Alcidion and Miya gone in the phase of that sort of opposition?

M: Well I think there are a couple of types of customers out there, one that at the moment would urge to buy one big system and really try to put a base in with one of those systems. As you pointed out, they say that it can do almost anything but those are very expensive systems and they’re very high risk. And also what we’ve found particularly in Australia and outside, certain key centers in the US that it’s very hard for health organizations to successfully implement the features that really start to provide value back to or return on investment back to the health core organization. So decision support, analytics and so forth are really, there’s not much money left over for those after the initial installation and the change management. But also the other thing is that a lot of those systems are design to originally around more administrative sort of purposes so they actually reduce the productivity often. And that was found for example in some studies out of New South Wales that was published last year, that after one large center implementation the productivity in the emergency department went down and haven’t really recovered. They’re not really designed for target key clinical workflows and improve productivity for clinicians – so that’s our angle. So we’re looking at customers who don’t want to spend the bazillion dollars in buying a large system and all the high risk implementation, the stakes that go along with that. We know from a lot of work in implementation studies in healthcare that these are very high risk projects. And also those who have purchased systems but now want to actually improve productivity and start to implement some of the features on the EMRAM or the EMR adoption model that got to get return on investment from IT expense.

W: Yes, certainly the implementation of the some of the big enterprise systems has involved blowouts of in the tens of millions of dollars and timeframes that have doubled or tripled what was originally forecast. Now I take it you rolled out your systems on a hospital by hospital basis?

M: Yes, that’s right. And our approach has been I guess Miya has always been that biggest barrier to getting the systems in, it is really productivity of a workflow. And there’s a few that doctors and nurses don’t like technology and they’re resistant to it, but really they just don’t want stuff that slows them down.

W: Yes.

M: And that doesn’t actually help them with their work. So a lot of those systems that we talk about, as you say large blow outs, they’re still really mimicking paper and they’re storing documents and free text in the way when in which we’ve done with paper. And what we’re trying to say is well actually let’s target key workflows and get people productive on that. We do that by as I mentioned pushing more information that risk away to the clinical staff, so that they know what’s important. The second of all we’ve got some great mobile devices as well which integrate into the platform and we do that 10 years now, we’re doing things like RFID log ins, so people can just walk up to a computer and wave their ID badge and get logged in with a number of seconds. So if you don’t get those barriers out of the way, then you can’t get to the next conversation which is about “Well how do you want to improve the quality of care?” and “How do you want to automate your task?” Because you’ve lost people from the first step. So the work flow is really important, so we do that on a hospital by hospital basis. And we try to work, implement in a way that gets people a benefit upfront so they’re not having to bend ages learning something that isn’t really going to be useful to their everyday of work.

W: You’re listening to Health Professional Radio with Wayne Buckler. My guest today is Malcolm Pradhan who’s the chief medical officer with Alcidion Corporation and we’ve been talking about their product in the electronic healthcare records space, I guess the electronic management space. Malcolm does your offering in the market include algorithms to assist in decision making?

M: Yes. So my background is from clinical decision support and so after doing medicine I did my PhD in clinical decision theory at Stanford in the medical informatics unit there. So it’s a key area of mine, so we have a quite a few algorithms that can be applied to decision making. But what we’ve found is that it’s often easier to implement a hospital space practice rather than come up with a generic … necessarily because each hospital has gone through lots of committee meetings and government’s processes to get through a set of guidelines or so forth. So we’ve spent a lot of effort in speeding up that process so we have technology called “smart forms” which we’re able to take people’s existing forms which were often how they’ve implemented their base practice. Capture the data in a structured way, so rather than just free text, we translate that into snomed ICD 10 in the background and then we can run decision support across that to automate tasks and to make sure that the data or the management is consistent and recommend next steps for example. So the biggest barrier I found is because we’ve had this fairly advanced decision support technology around for a couple of decades now and the barrier isn’t the algorithms, it’s really integrating with the work flow and fitting into the user’s mental model.

W: Yes.

M: So that’s been some years ago we still realize that’s actually yeah we’re not after the one single algorithm that’s gonna solved this stuff. It’s actually getting people to integrate it and use it. So to do that we’ve packaged up our decision support offering in a way that fits into work flows and can be extended and increasingly become more sophisticated as users want. As I said at the moment the understanding and the confidence in decision support is still a growth area and that’s what we’re really excited about in terms to grow … because we’re very well placed in terms of our background and platform to just take advantage of that.

W: Now Malcolm my favorite question in every interview, in every industry there are misconceptions. What’s the biggest misconceptions amongst your customers, clients and patients that drives you nuts and keeps you awake at night?

M: Yeah. From a customer point of view, I think the biggest misconception is that going out and buying one of these expensive systems is going to solve your healthcare problems and improve productivity and improve safety, and that’s not the case. You know that expression “buying a new phone doesn’t guarantee you better conversation”…

W: Uh huh.

M: And I think that’s the big problem. And so sometimes because this area is complex, both health and IT are complex and health informatics being the combination is complex. So a lot of the time people will just think “Okay it’s a little too hard, we’re just gonna buy this one system.” And really the healthcare IT vendors of course some of that problem by not interoperating and that’s the other big misconception out there, that people think that health IT industry is the same as say other industries that have started to interoperate and allow data to move between them. Whereas it’s really data, hoarding data and not sharing it and not interoperating is a strategic play, it’s not technical state, it’s not technical barriers to sharing information – it’s purely strategic. And so that’s the other big problem I find is that when people buy big systems or any system, they don’t say you must be interoperable and communicate with these other systems, ideally two way and therefore they can’t innovate. So you can’t get the system and so actually if we add this and this, we can come up with this new solution that solves our problems – and that’s really scary because with the increase in the aging population increasing demand on healthcare, we can’t bend three times more on healthcare so we only have innovation left and people aren’t buying systems with the view of operational innovation and how are they gonna use the technology investment to actually cope with new models of care and support innovations in health systems, that’s what’s frustrating to me because it is very doable, it’s purely a political play.

W: Well we hope as providers like yourselves share the medical professions what can be done and how it can be done, the resistance to doing it will fall away. Certainly that idea of that data interoperability went away in personal computing back in about 1980, when the idea of locking through making your data inaccessible just became unacceptable in the market place and in other industries it’s flowed through. So we live in hope that that will flow through and maybe today we’ve done a little to dispel some of those misconceptions you spoke of. Malcolm how can people get in touch with you, what’s the best way?

M: I think the best way is through our website www.alcidion.com and there’s some links on there and tells you a bit more about our product. Happy to get any messages, probably that’s the most reliable way to get through there.

W: Yeah, because I’m always in trouble for not giving people enough warning when I mention websites and phone numbers, fair warning listeners pencil ready that was alcidion.com.au, www dot A L C I D I O N dot com dot au.

M: Great.

W: Thank you for your time this morning. It’s been a pleasure having you with me, I look forward to having a much longer conversation with you about the joys of electronic health records at some point in time.

M: Thank you very much Wayne, good to speak to you.

W: If you’ve just joined us on Health Professional Radio this morning, you just missed my conversation with Malcolm Pradhan, the chief medical officer of Alcidion Corporation. But the good news is we have a transcript of this story on our website at www.hpr.fm. You can also listen to the full interview in our audio archive both on YouTube and SoundCloud. You can access those also through our website. This is Wayne Buckler for Health Professional Radio.