*This piece was cross posted on the Biotech in Wisconsin blog.*
In 2002, a nephrologist in Green Bay, Wisconsin founded Visonex with the goal of creating a software package that would capture the true clinical workflow dealt with in his everyday practice. The result is Clarity, an electronic medical record for dialysis clinics, which was launched in 2004. John Hartman’s company now employs over 50 people, primarily with development, analysis or IT infrastructure skills.
Mercom Capital Group recorded $1.2 billion in healthcare IT investment in 2012. One of the largest deals was a $40 million Series A by Kinnser Software, which provides a web based software for home health care. In an era when health technology is hot, Visonex has had significant growth despite a relatively modest $3.4 million in equity investment to date, raised predominantly through angel investors in Wisconsin.
Clarity is an electronic medical record specifically designed to work with the clinical workflow found in dialysis clinics. Hartman, who practiced for 6 years before starting Visonex, is passionate that “all billing events start with a clinical event.” So, rather than focusing on tracking information for billing or legal reasons, Visonex instead focused on providing the right information at the specific places within clinical workflow that would positively impact dialysis practices.
To date, the EMR has been rolled out in over 250 dialysis clinics across the country. Since the solution is web based, there is less IT investment and recurring overhead, which would make Clarity particularly appealing to small clinics. Hartman states that the solution is completely scalable, noting that while their smallest customer has 12 dialysis patients their largest customer treats about 2,000 patients. When comparing Clarity to competitive dialysis EMR products, Hartman is focused on customer satisfaction and assisting their customers with regulatory compliance. In ten years, Visonex hasn’t lost a customer (other than clinics purchased by larger chains), despite a lack of exit barriers such as large upfront fees and long term contracts. Customers can opt out of the service with just 90 days’ notice and pay as they use the service.
Returning to the idea of clinical workflow, Visonex was awarded a Small Business Innovative Research (SBIR) grant that enabled Visonex to better integrate Clinical Practice Guidelines (CPGs) into their EMR at the point of care in an intuitive fashion. A novel aspect is that the CPGs are not hardcoded, but can be adapted as guidelines are updated or changed. CPGs associated with decreasing cardiovascular risk and mortality were entered into the software and tested using de-identified retrospective data. After extensive testing, these changes were rolled out into study clinics. Hartman believes that presenting CPG recommendations directly into the workflow at point of care will ultimately have a positive impact on patient outcomes.
The company has also built a data exchange to allow their customers to minimize their customers from having duplicate data entry and reporting efforts. Centers for Medicare and Medicaid Services (CMS) is moving to a requirement that all facilities that participate in Medicare and Medicaid submit their data to satisfy Conditions for Coverage (CfC) for End Stage Renal Disease (ESRD). CMS has developed CfC requirements for a variety of healthcare providers including ambulatory surgical centers, hospitals, and rural health clinics. Visonex is able to share the information with CMS the via the National Renal Administrators Association (NRAA) Health Information Exchange (HIE). In addition to submitting required data to CMS, Visonex also helps clients prepare data for the quality network established by CMS, the End-Stage Renal Disease (ESRD) Network Program. There are 18 ESRD Networks across the US with the mission of improving patient care by collecting data to evaluate and oversee quality.
Although the dialysis market continues to grow, Visonex is eyeing expansion into nephrology clinics. While patient care overlaps in dialysis and nephrology clinics, Visonex will have to build out additional workflows in Clarity to handle the unique aspects of nephrology care. According to Hartman, “In the nephrology clinic has a large diagnostic tilt and has a large patient centric portion. However, once diagnosis is completed, there is a maintenance part that is similar to the workflows that are used in a dialysis.”
In bringing Visonex from concept to reality, Hartman is a great example of the impact that healthcare providers can have when they are engaged in building tools for patient care.