HIStalk Practice Interviews Wyche T. Green, III, President and CEO, Greenway Medical Technologies

Wyche T. Green, III (“Tee”) is president and CEO of Greenway Medical Technologies of Carrollton, GA.

Tell me about yourself and the company.

Greenway is passionate about creating a smarter healthcare system; a system that embraces the electronification that is taking place today in which the provider and the consumer can thrive and that eventually leads to improving population health. The current healthcare system is closed and not very innovative. I believe it’s changing and I think about the day when data captured on each one of us in a smarter system will actually assist in improving the care we receive and the care that the next generation will receive.

We’re building platforms that enable providers to embrace electronification, embrace the consumer, and begin this quest of improving population health.

I have never considered our company as strictly an electronic health record company. It just happens to be a component of what we do. We provide ambulatory solutions that connect to enterprises and hospital systems. You will see very soon that components we offer such as PrimeEXCHANGE around interoperability, the communication portal PrimePATIENT and the data intelligence within PrimeDATACLOUD alone can service communities of health in their own right to solve community issues that may or may not utilize the core of our PrimeSUITE EHR. If you think about the struggles of the establishment of HIEs, PrimeEXCHANGE currently supports more than 5,000 connections allowing widespread provider access to ride a platform that can exchange with systems like Epic, Cerner, and Relay Health, and more than 600 hospitals, labs, HIEs, and registries.

The collective power of these platforms and solutions enable physicians, leaders and patients – in communities large and small – to create a smarter healthcare system where everyone benefits. As healthcare rapidly evolves, our culture is committed to providing these powerful tools to successfully navigate change. As the healthcare system realizes our common goal of unlocking, assessing, sharing and applying decision-making information, population health will certainly improve. That’s what we stand for.

We started the company in 1998 in Carrollton, Georgia where we remain headquartered today. We have grown from a closely-held investor base to trading as a public company listed on the NYSE. A lot has changed over the last decade but our mission and passion to create a smarter healthcare system endures.

Who are your most direct competitors and what factors are causing them to increase or decrease in influence?

For me, for Greenway, it’s changed. I think it is shortsighted to consider that your competitors come from within your direct market. We’re pushing for significant and meaningful change in how we manage healthcare, but sometimes there are forces that impede or slow that change. Today, the industry is faced with an economic issue with how we pay for healthcare services.

We are moving from production medicine to value or outcomes-based medicine. Innovation is playing a major role in that transformation. Greenway is driving innovation to enable that transformation. But today, the majority of the system is still built around fee for service. How long will that take to change? Those are the biggest competitors in the industry today.

Everybody talks about product usability and ONC seems interested in transparency in that area. What efforts does the company make in terms of usability and how do you see market demand affecting that?

For Greenway, it’s focusing on solving customer issues and creating value for them. That is the key. We are working on usability innovations that may not make it into the mainstream for years to come, but customers have real issues today and we are crafting powerful solutions for them. They will face new issues tomorrow. We will continue to create and deliver more innovation to answer this unending call. That’s something we are acutely focused on.

So usability translates into customers issues. If providers can’t use your technology at the point of care, how will we get to a clinically-driven revenue cycle? Greenway has invested a tremendous amount of energy with subject matter experts across the more than 30 different specialties we currently serve and provide templates to optimize the workflow at the point of care. This way aspects like clinical decision support and payer-based care plans that are ultimately going to be important to the consumer, are done inside these provider workflows. Again, focusing on customer issues and creating real value for them is the priority, and usability will advance our providers ability to successfully adapt to this changing landscape.

How has life changed since becoming a publicly traded company?

Primarily it has given Greenway a debut on a much larger stage to tell our story. We are now able to tell our story from the New York Stock Exchange, the center of capitalism. That is a big arena to communicate our message of positive change around the creation of a smarter healthcare system.

Greenways awareness continues to accelerate and add momentum to our purpose. Larger organizations are having conversations with us about how we can solve their issues in innovative ways. How we can solve community issues through PrimeEXCHANGE, through PrimePATIENT, through PrimeDATACLOUD. We are having these discussions.

People are beginning to understand that Greenway creates powerful ambulatory platforms and solutions, not just an electronic health records. Which is what we’ve been all along. Now stakeholders better understand the value of what our platform is capable of.

Everybody’s talking about Big Data and analytics. What do you offer and what will you need to offer as business models and requirements change?

The key is again our cloud-based portal PrimePATIENT that includes the HealthVault PHR, Blue Button functionality and other scalable integrations. Platforms that allow communities to solve issues in their area as it relates to how patients interact with each other and with providers. Issues with how I exchange information across my community from systems that might not be Greenway.

PrimeEXCHANGE also gives us this capability. Our PrimeDATACLOUD platform allows us to share clinical, financial and administrative data across multiple settings and allows different analytic engines to pull data to run different types of analysis. One thing is for sure, no community is alike. We believe one size fits one, not one size fits all. We have to define in each community what the value–based system is going to be and what data and analysis is essential.

In some areas of the country, we have a tremendous variation on how you keep score. That can be very confusing for providers. To be able to create the flexibilities of different types of analytics that can be run based on what that community has defined as what’s important to them and their stakeholders. That flexibility is critical in healthcare.

I heard somebody describe it in a way that we’re playing in a soccer game with 12 people, but there are 50 referees. That’s so true. So creating innovative platforms that allow the communities to drive what they deem is valuable, what they deem as outcomes, we’re able to do that with these portal, interoperability, and data intelligence platforms.

You offer PrimeRESEARCH that connects life sciences companies with physician practices. Is that a significant demand, and do you see that as a competitive differentiator?

Yes, it’s a major differentiator. It’s very much about creating a smarter system. Where is most of the care in this country delivered? It’s delivered in ambulatory environments and communities. Why wouldn’t we want life sciences and research connected, or research and providers connected at this intersection?

There is an abundance of useful and relevant information in our systems that need to be unlocked and used properly. When leaders, providers, and communities can leverage the exacting information they need to improve their efforts, we are making big steps in creating a smarter healthcare system. This is something that has not been done in this country on any type of scale. We’re doing it for the first time.

We’re in 43 different clinical trials today for providers who haven’t really participated in any type of research since medical school. Now they’re offering solutions, offering information, they’re being educated in ways that they haven’t been in many, many years. I believe as more and more of the consumer mindset emerges in healthcare, we’re going to demand access to this type of information. It’s going to be done in that patient-to-provider relationship.

Right now we can query our network of customers to securely identify relevant patients that match a given study. We support the practices to enroll patients, collect study data, and provide remote monitoring that becomes another source of provider revenue. I see that early Stage 3 proposals include a core measure seeking the ability of EHRs to query enrollment systems so providers can seek out available studies. We’ve already eclipsed that task but I’m glad that policy is catching up to the importance of ambulatory platforms and clinical studies.

Some are calling for EHRs that are open and that allow the use of third-party apps to add or change functionality. How would you summarize the state of openness of the EHR market and Greenway’s interest in incorporating that capability?

We offer the most open platform in the market today. Our advanced application programming interface has allowed innovation to explode in this industry. We have more than 100 different relationships in various stages of development or currently operational on behalf of our customers and their communities.

We launched our Greenway Marketplace API a year ago during HIMSS12, so the doors are open for others to collaborate and innovate with us. This year in January we announced more innovations around web services to accommodate all partner platforms along with encryption and connection advancements.

If you look at the range of cloud-based and integrated solutions coming together they reach across clinical, financial and administrative needs. Isabel Healthcare, for example, is a Michigan-based company that has developed a comprehensive diagnosis decision support solution. Krames Staywell out of Illinois specializes in patient education materials. codeHERO brings charge capture to a wide variety of remote technologies, and another company we work with, DMEhub, coordinates the electronic prescribing of medical equipment and devices. You can see the unlimited potential here.

We understood and our partners have come to understand that the annual or relegated software releases are too slow and we needed to unlock the velocity of innovation. It’s not about where the data comes from, it’s about data liquidity. That’s a term we have used for a decade. Unlocking useful and relevant data so it flows to the right people at the right time in the right places, securely and safely. I believe others are seeing why this is important in what historically has been a closed, isolated market locked within four walls, but the rules of the road are changing.

How will the EMR industry look different in five years than today?

The industry is going to continue to evolve and we will continue to innovate. I think you’ve touched on some of those aspects in your questions around research, open development, usability, and data. Also consumers are changing their habits on how they access information to seek the best care. The makeup of our customers is changing. We have customers like Walgreens. Who thought that Greenway’s ambulatory platforms would be serving an organization like Walgreens? Walgreens is stepping in to fill a void within primary care and Greenway is a strategic partner in that.

We are also working with the Evolution Health division of Emergency Medical Services Corporation to provide house call medical services to mobile providers. We are working with physician affiliates of Hospital Corporation of America and launching a community outreach and EHR adoption program with Baylor Quality Health Care Alliance.

We are beginning to see larger and larger health systems begin that dialogue with us because they understand how innovative this platform is and they understand the value it brings to their customers. This is exciting!

But make no mistake, with the current economic landscape and the healthcare reform that’s hitting this country, coupled with a short supply of primary care physicians coming out of medical school, drastic changes in healthcare payment and delivery are ahead. With all of that change, with all of that disruption, come incredible opportunities for organizations that are innovative enough and can drive value on behalf of their customers.

News 2/19/13

The CalHIPSO Regional Extension Center launches service offerings that include Meaningful Use tracking, EHR readiness, and eligibility registration attestation.

DeKalb Health (IN) selects e-MDs Solution Series for its 19 providers.

RCM provider MediGain acquires ASC Billing Specialists, a PM and A/R management company specializing in ASCs.

Telligen Iowa HIT REC achieves 100 percent of its goal of 1,200 providers live on certified EHRs with active quality reporting and e-prescribing.

Researchers from Indiana University devise an artificial intelligence (AI) framework that may outperform physicians in making cost-effective clinical decisions that result in good outcomes. The researchers used EHR data to compare real outcomes and costs associated with 500 cases with the hypothetical models generated by computer algorithms. The results indicate that AI could improve patient outcomes by 30 to 35 percent.

gMed releases gGastro+, a gastroenterology-specific EHR with integrated endoscopy reporting, a patient portal, and practice maintenance.

Vitera says its v8.10 release includes enhancements to Intergy EHR and PM, Practice Analytics, and Practice Portal.

CMS hosts a 90-minute call February 19 at 1:30 EST to discuss avoiding the 2014 eRX and 2015 PQRS payment penalties.

Michigan lawmakers introduce legislation that calls for the creation of a single universal prior authorization form for prescription drugs.

Covisint reports that its customers have earned more than $30 million in incentives using its DocSite PQRS solution.

Patient-centered medical homes deliver slightly better care in terms of patient satisfaction and preventive care, but may not result in cost savings according to a study published in Annals of Internal Medicine.

MedCity News categorizes the three types of organizations buying EHRs in 2013 as 1) small provider organizations purchasing their first EHR; 2) practices switching EHRs as part of a merger or acquisition by another organization; and 3) providers that are disgruntled with the current EHR and looking for a replacement.

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DOCtalk by Dr. Gregg 2/17/13

Byproduct versus Focus

Byproduct was walking merrily down Fifth Avenue when he ran smack dab into Focus.

“Hey! Focus, my old friend!” Byproduct bellowed. (He had always been a rather boisterous fellow, most notably when extolling his own virtues.)

“Hiya, Byproduct,” Focus smiled. “My, don’t you look fine in your William Fioravanti bespoke tailoring and sparkling Harry Winston accoutrements!”

Byproduct beamed unabashedly. “Yes, indeed. Times have been very good, very good, Focus. Here in the States, the whole healthcare digitization issue has had me rolling, simply rolling in it!” he exclaimed.

Focus could see Byproduct’s chest swell as he crowed of his success. Always keeping his eye on the ball, Focus drove straight past the huff and fluff to wring the core of Byproduct’s message to the fore when he said, “Yes, here in the U.S. documentation has been creating more mountains of offshoot data than anyone ever imagined. Too bad, isn’t it?”

“What?! Too bad?” roared Byproduct. “My God, man, this is the heyday of all heydays. Me and the missus are getting ready to purchase our fourth far-too-large mansion. We’ve a passle of private jets and a mountain of Maseratis. We’re heading off to tour the world for the next two months. If you call that “bad,” then I’m happy things are so bad!”

With a glint in his eye, Focus went on, unfazed by Byproduct’s blustering. “Well, my old friend,” Focus said, “I wouldn’t be away too long. It seems there are changes afoot in the world of healthcare documentation that may just derail your digital data heydays.”

Just the slightest bit of air slipped from Byproduct’s swollen chest as he asked, “What do you mean? What could possibly derail this wonderfully massive data capture behemoth I’ve masterminded?”

Focus replied, “Oh, it isn’t that capturing more and more data won’t continue, my dear Byproduct. It’s just that the glory days for healthcare data capture are waning; a new day for healthcare data is dawning and it’ll be all mine.”

“Bullhockey,” said Byproduct. “From coding and billing to Meaningful Use, what could be more important than data capture? Healthcare data piles are growing exponentially; if I was a stock, I’d be bigger than Apple.”

“True, my old pal, true. But from Imhotep and Hippocrates to Pasteur and Mostashari, healthcare data collection has never been the true driver. It’s always been a byproduct – a necessary element, for sure – but nonetheless an offshoot of the true mission of healthcare. That true mission,” continued Focus, “has and always will be the care of people’s health. That’s why it’s called ‘health care.’”

Byproduct looked momentarily flummoxed, but quickly regained his bravado. “Nice try, my naïve Focus, but this train is running full throttle. Everyone knows that it’s the data collection that gets paid. Data capture is what HIT is all about. The days of pen and paper created mountains of irretrievable pulp-based records that may have held interesting content, but which were becoming impossible to utilize. Everyone knows,” he continued, “that digital data capture is the key to making that content accessible.”

“You are, as always, so correct and yet so misguided, dear Byproduct,” came the now impassioned Focus. “Data capture is imperative for the logarithmic growth of health information. Information technology can do wonderful things with all that data, wonderful things which were previously unthinkable. The problem isn’t data capture, per se; the problem is that data capture has become the sole focus of so many who are now involved with healthcare.”

“So you’re saying that data capture is important, but not central?” Byproduct asked quizzically.

“Exactly,” replied Focus with emphasis. “People’s lives aren’t sets of data points; they’re stories, stories full of nuance and subtleties. The same is true for their health. That’s why they call them ‘medical histories.’ Technology has not been invented which can truly capture those stories and yet it’s those stories which provide the core of health meaning. It’s those stories with their vagaries which provide true value. It’s those stories which people tell to their doctors and nurses and such and it’s those stories which give those healthcare providers the keys to understanding, diagnosing, and treating.”

“But EHRs are all designed to capture discrete data, Focus. They are all predetermined, point-and-click input portals. Without that, it’s just uncapturable, typed-in text. How can you possibly create predefined elements to cover every possible nuance?” questioned Byproduct.

“Ahhh, my dear colleague and cohort, there indeed is the crux,” agreed Focus. “Perhaps it’s the design of data capture that has blurred the vision for HIT. If data input were rehumanized, allowing people to tell health stories instead of inputting predefined phrases and terms, then the true meaning of the data – the story – could be preserved. Data capture can be improved and can be done more on the back end, after the story has been told.”

“Not possible,” retorted Byproduct. “Everyone knows that it’s templates and dropdowns that rule the worlds of HIT data collection. Providers will just have to figure out another way to share your so-called ‘stories.’ You can’t template that.”

“No, not using your approach you can’t. But, there are new ways to document coming, new digital tools that can capture discrete data while allowing the medical story to be told. I’m betting your heydays are numbered, my old friend,” consoled Focus. “These new methods might just bring me, Focus, back to the fore of healthcare.”

“Balderdash!” snorted Byproduct. “I’m just too big to be stopped!”

“So were TWA and Pan Am at one time,” Focus replied. ”Have you seen Quippe? Or how about CLiX?”

From the trenches…

“It is very difficult to get people to focus on the most important things when you’re in boom times.” – Jeff Bezos

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, an HIT and marketing consultant, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).

News 2/14/13

From Orpheu: “Re: HIMSS picks. Have you picked out any HIMSS sessions that be might better-suited for someone working in the ambulatory world?”  I’ve have just started wading through the HIMSS schedule and with over 300 session options it is a bit overwhelming. My must-see list so far is not ambulatory-focused: Bill Clinton, Farzad Mostashari, and James Carville and Karl Rove. HIMSS has dozens of options to appeal to physicians and practice administrators, including sessions on patient engagement, ACO participation, mobility, telehealth, and of course Meaningful Use. I am actually curious what sessions intrigue readers so drop me a note if you have suggestions.

CMS offers guidelines for individual eligible providers and group practices to avoid the 1.5 percent PQRS payment adjustment in 2015.

NYC Mayor Michael Bloomberg announces that the use of eClincialWorks EHR by 3,200 NYC primary care physicians has led to better outcomes in terms of high blood pressure management, diabetes, and tobacco control. EMR use also spurred a 290 percent increase in preventive care services between 2008 and 2011.

Southeastern Health (NC), which uses eClinicalWorks EHR across 30 locations, adds ecW’s Care Coordination Medical Record to advance its ACO-related objectives, coordinate care, and evaluate population health.

Greenway CEO T. Green reports that the company added 750 providers in its second quarter, up 30 percent from a year ago. Green also noted that over 300 customers are now using Greenway’s new RCM platform. Greenway’s Q2 results: revenues up 12 percent, EPS $0.00.

CVS leads Wal-Mart in the retail medical clinic race. CVS operates about 630 Minute Clinics and is opening an average of  three new facilities every week. Wal-Mart has less than 130 clinics and 26 fewer than a year ago. Both Walgreens and Target, which operate a combined 400 clinics, plan to open additional facilities this year.

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News 2/12/13

Capario realizes double-digit revenue growth from its provider base in 2012 and says it significantly increased adoption of its portal application. Capario also notes that 100 percent of its clients participating in KLAS’s annual satisfaction survey believe the company keeps it promises and say they would buy from Capario again.

Vitera Healthcare Solutions hires Kermit Randa (Surgical Information Systems) as EVP of sales and marketing.

Athenahealth earns the #8 spot on Fast Company’s list of the World’s Top 10 Most Innovative Companies in Healthcare. Forbes says athenahealth “stands out” among other EMR companies because theirs is “a system that doctors actually like to use.” Teledoc, a provider of phone and video medical consultations, came in at #9.

Practices should set expectations early for the distribution of MU payments, suggest industry consultants. The decision should ideally be made prior to attestation so providers know whether they are allowed to keep incentive funds or if they are expected to return monies to the practice.

TransforMED, the AAFP subsidiary that supports practices transitioning to PCMHs, announces the retirement of president and CEO Terry McGeeney, MD.

SimplifyMD launches simpleStart, a program that allows medical practices to  go from a demo of the simplfyMD EHR to live clinical use in the same day.

An AHRQ study finds that projects funded under the “Enabling Patient-Centered Care Through Health IT” initiative have shown that healthcare outcomes are positively impacted when HIT is used to create or enhance patient-centered care.

The Huron Valley Physicians Association selects e-MDs as a preferred partner to provide EMR solutions for its 500 physician members.

Don’t miss the interview we did this weekend with SRSsoft CEO Evan Steele, who discusses a range of topics, including Thoma Bravo’s recent investment in the company, “usable” EMRs,  and MU. Steele has been an outspoken critic of the MU program and shared a few of his concerns:

• The government’s Meaningful Use program has sapped innovation out of the EHR marketplace, and it will continue to do so for the foreseeable future if CMS continues churning out overly complex rules.
• The government has set the development roadmap for all EHR companies with its Meaningful Use certification requirements and the compressed timeframe for development and implementation.
• As Meaningful Use has piled on requirement after requirement, physicians are drowning in program-related minutiae.
• Not understanding the complex requirements has kept many from even attempting to participate, and many who are managing to muddle through are suffering tremendous losses in productivity.
• Dissatisfaction is even greater among specialists. They were included as an afterthought in what is basically a primary care program, and many resent reporting on requirements that are irrelevant to their practices.

E-mail Inga.