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Requirements of Meaningful Use compliance will drive consolidation in EHR industry


ADP AdvancedMD’s Steven ZoBell discusses how mobile technology is transforming medicine and the impact of coming phases of the Meaningful Use incentives and penalties.

Steven ZoBell, ADP AdvancedMDEditor’s note: Steven ZoBell, vice president of product development for ADP AdvancedMD, recently spoke with Medical Economics about the present and future of health information technology. Here is the full interview. Excerpts of this interview were published in the October 25, 2013 issue as part of the publication’s ranking of the top 100 EHR companies. 


Medical Economics:  In what ways is technology transforming medicine?

ZoBell:  Essentially, if you think about it, physician/patient encounters really have not changed a lot in the last 300 years in the sense that it’s a physician interacting with a patient one-on-one, eyeball-to-eyeball. I think technology is transforming medicine in two ways. It helps the physician get to a diagnosis in faster and more reliable ways, whether that’s through use of better instrumentation or diagnostic advances. It’s also a tool physicians can use to better understand what’s going on with their patient panels.

It gives them new ways to better understand longitudinally what’s happening with individuals, populations, or even lifetime trends. It’s really about data. Advances in technology are also improving access to it.

I think the future power of medicine is all about the physician and the patient. Technology is allowing that patient to really be an active participant in the conversation.

Medical Economics: If you could think about the delivery of medicine in the next 5 years, how will it change? How important will technology be in helping to guide this evolution?

 ZoBell:  Healthcare is going to be consumer-driven much more so in the future. There is no other business in the world like the healthcare businesses today. I, as a consumer, can walk in to see you as my doctor. I have no real expectations, and I am going to pay hardly any money for the visit. I have no idea what it’s going to cost, what you are doing today. Maybe in 30, 60, 90, or 120 days, I will pay you after a third-party entity pays a big chunk of it.

We don’t even do that with pizza. I think it’s going to change health plans, and it is moving in a way where consumers are going to care more about the cost. With technology-either apps, software or solutions-they are going to take more of an active role in ensuring their wellness or their healing. I think there are going to be many more interactions with the physician. I think there is going to be a lot more interaction with smart technological solutions integrated within their electronic health records.

I think we are going to see a physician going back to a time where they are truly guiding care, and the patient is going to be really a big part of it with their personal devices at home. We fundamentally believe private practice is really a way of allowing the physician and the patient to connect.

Medical Economics: Let’s talk a little about Meaningful Use and the government incentives. Government will ultimately provide incentives but then ultimately penalize for not adopting EHR systems. Why do you think it has taken such a massive effort by the government for physicians to adopt?

ZoBell:  I think for one piece of it, physicians did not really see the benefit of it. They have their paper slips; they are doing their documentation that way, and frankly a lot of solutions made it so cumbersome, and the solutions weren’t there.

 Second is the fact that physicians like doing it the way they have been trained and very few schools are really showing that here is the technological way to do it. So it just took some time for them to shift. They were spending the majority of their time to refine their craft and saying, ‘Hey I want to learn more about the latest procedures, so I can apply the best healthcare,’ and they didn’t really see clinical records as the way to get better outcomes for their patients.

Now I think they are starting to see it as they are evaluating population health. I think they are able to see the value, but they still are not really a fan of the fact that it’s a carrot versus stick.


Medical Economics: Interoperability is another topic on my list. Do you think physicians are ready for Meaningful Use 2?

ZoBell: I always chuckle when I am tracking Meaningful Use because I think we have a lot of solutions that aren’t certified for Meaningful Use and are not designed to be used in a meaningful way. Meaning there is a set of checkboxes that have to happen to accomplish meaningful use and certain things have to happen, certain data is acquired, certain percentages happen, and bingo, they now have a meaningful use certified software. But there was no way to say yes, this is the software that actually is in a good workflow, and the doctor can be using this in a meaningful way.

Medical Economics: What do you think the Meaningful Use 2 and Meaningful Use 3 requirements will do to your competition, the other EHR companies; will it drive consolidation?

ZoBell: I think it will on a few fronts. One, it’s cost-prohibitive to keep up. We spend a fair amount of time on regulatory compliance, meaningful use, ICD-10, and it all consumes a fair amount of resources.

I can see it from the many articles saying within the next 2-3 years, physicians are going to switch from 80% of the EHRs that are being used today. So meaningful use 2 and 3 with their interoperability requirements are should facilitate that, so people don’t feel like their data is held hostage on those different systems.

The other piece which I think is going to push some of the consolidation is many of the EHRs out there are built on financial models which are great through the private equity and venture capital world, but they don’t have a longevity solution aside from an exit or an initial public offering. You can only lose money for so long and then you won’t really be viable anymore. I think there is going to be a lot of merger and acquisition activity because the long-term strategies are more about what’s right for the business rather than what’s right for the practice.


Medical Economics: Okay, so what happens when the EHR incentives run out, will it exacerbate the consolidation?

ZoBell: I don’t think so. When the incentives run out and when the stick starts coming, I don’t think we are going to see much more change. I think that we kind of hit a mindshare point where physicians realize I want it, I need it; and once we get interoperability to the point where it actually is going to work really well. It’s going to be like that point when Aunt Martha realized she had to get e-mail because everyone else in the family had it and nobody was communicating anymore except via e-mail. I see that can have a much stronger impact than actually the incentives.


Medical Economics: Could you talk a little about mobile? I know you have some mobile solutions. How important is that to the future of medical delivery and how important is it to your system?

ZoBell: I think mobile is extremely viable on two fronts. One is to the patient. Mobility lets the patient be an active participant more than they ever had been. Two, I think it is for the physician because the mobile solution allows that physician to truly be untethered from their desk. Physicians complain a lot about work-life balance, they have lot of time spent in documentation or other things. Whether it’s a mobile solution that allows them to be at little Johnny’s soccer game, while they are actually answering messages from their patient, but at least they are there while Johnny is kicking the ball.

I think we are going to get to a day where every clinic in every practice is run on a tablet, like an iPad. There is always going to be a spot where they are getting to pull up some scan on a 24-inch screen to see the details of really what’s happening from the radiologist’s perspective, but there certainly is a strong place for mobility.

Medical Economics:So in your view, what are some the most exciting technological developments for physicians and why do you feel that way?

ZoBell: I think that there are so many wonderful devices and technologies that are allowing the patient to be mobile, that can hook into mobile solutions, that allow that doctor to truly get the glimpse of what’s going on. If you are treating an illness, you get to reproduce the symptoms, the issues, understand truly what you are doing.

A lot of these devices and technology allow them to monitor and see what’s happening at the moment something happens. But I also think if a lot of it is really going to be around what’s in the data. I think with the data and what can happen with searching the data and using the data. We can be using this so much deeper for physicians and patients.

The final piece of this that I see is really how we can use technology in a way to close the loop where the physician is certain that the patient is following the diagnosed plan. I go in to see you as a doctor and the system then automatically knows if I picked up my prescriptions for the sore throat you gave me and then sends me a reminder. Then in 3 days it automatically sends a message saying you have been on your Z-PAK for the entire length of it, do you feel better, yes or no, and I am able to respond. All of this is happening technologically with the physician not having to worry about it.

Medical Economics: What do you think HIT vendors will be talking about in 5 years as it relates to technology?

ZoBell: I hope that they are talking about and truly improving outcomes. What is the best technology and the best solutions out there of how we are helping them to have the absolute best outcomes for their patients? Not talking about getting paid, not worrying about the different regulations and how to be in compliance with those regulations, not talking about usability and if the system can actually slow them down, but talking about outcomes and how it’s really making a meaningful difference in healthcare of actually making patient better and letting physicians have work-life balance.

I would so love to be there. Right now we are talking about hey, we will help you get paid, we will help you be untethered, and we will help you try to deal with this compliance type stuff. That’s just noise, and we are trying to help the poor physician who spent over a decade of training so they can care for patients, and all this is just in way of that.

Medical Economics:Thank you so much.

ZoBell is vice president of product development for ADP AdvancedMD. He has more than 18 years of product development, software engineering, and business management experience. Prior to joining AdvancedMD, he was executive vice president and chief technology officer for inContact, Inc., a leading SaaS-based contact center software company. During the course of his career, ZoBell has been involved in the development of more than 25 critically acclaimed, award-winning, commercial software products.

Click here for more interviews with EHR company leaders about the future of technology.

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