Earlier this month our company reached a remarkable milestone. We welcomed our 1,000th nephrology provider into the Acumen family. As we celebrate this achievement it is an appropriate time to reflect on the past and to look to the future. I have worked full time for our company for the past three years. Prior to that I held a part-time and consultative roll dating to the fall of 2007. However, my exposure to our EHR began many years before.
Acumen Founders Innovate Early
I remember meeting Drs. Dugan and Frank Maddux in 1995 when I was considering making a change from my nephrology practice in South Carolina. Dugan and Frank moved to Southside Virginia several years prior and when they arrived, they discovered the city of Danville did not have an Internet service provider, so they started one in their basement. I still recall Frank providing a tour of their basement during a recruiting visit my wife and I made to the area. There was substantially more cable down there than one typically finds in a basement and the hardware not only required a backup generator but a substantial cooling effort to keep the machines happy. One of the collateral benefits of this project was that the Maddux household was one of the earliest (if not the first) rural Virginia home with terminated fiber!
Frank had done some early work with computer programming, creating one of the first pieces of software to trend and integrate dialysis lab results. Where the man found the time remains a mystery to me, but in the late 1990’s while practicing nephrology full time and fulfilling his duties as President of our 15-physician practice, he began writing the foundational components of the Acumen nEHR in use today.
Centrally Located Servers Change the Game
One of the many visionary decisions Frank made over 15 years ago was to create an application accessible through the Internet, known today as “software as a service” or SaaS. The practice’s patient data would be stored on a group of centrally located servers (i.e., in their basement). In contrast to the existing client-server model where every practice had a server in their office, this approach offered our users several advantages that still exist today:
1) Anytime, anywhere access to patient data provided via the Internet
2) Data integrity and security managed on a large scale by our company
3) Substantial cost savings created by economies of scale
In hindsight this was a remarkable path to take given the uncertain future surrounding the Internet. Not to mention the fact that in the mid-90’s HIPAA was just an annoying acronym with little clarity regarding its future impact on Health IT.
Taking the EHR to Market
Our practice, a dual specialty practice composed of nephrologists and urologists, served as the guinea pig for Frank’s after-hours endeavor. Following a proof-of-concept period, a company was formed to commercialize the EHR. The application in the early days was called the Gamewood Healthcare Network. The early years were challenging from a sales-and-marketing perspective, in large part related to timing and the “readiness” of the nephrology provider community to adopt technology. But through perseverance and a substantial amount of hard work the company arrived in 2006 at the confluence of several important events.
First, the OIG created a safe harbor for EHRs under the anti-kickback statute, which in 2007 enabled Fresenius Medical Care to select our application and provide financial support for affiliated nephrologists interested in acquiring Acumen. Concurrently, our company underwent a transformation, as a seasoned and nationally experienced management team was assembled with the opening of our corporate office in Nashville, Tennessee. Led since 2007 by our CEO, Dana Hensley, the company continues to acquire the talent that fosters the vision Frank established. As a result we have grown very rapidly over the past few years.
In 2009, two additional factors positively influenced our growth. The American Recovery and Reinvestment Act of 2009 (ARRA) was signed by the President in February, effectively igniting the frenzy that now surrounds meaningful use. Later that fall, our company was acquired by Fresenius, which opened up new opportunities as we began operating as a wholly owned subsidiary of FMC-NA.
Certified for Meaningful Use
Over the past few years, we have taken the Acumen nEHR application through two separate CCHIT certifications (2007 and 2010) and subsequently Stage 1 Meaningful Use certification (2010). Three years ago we created and continue to operate one of the largest CMS qualified PQRS Registries in the country while focusing exclusively on nephrology measures. We have developed and deployed a mobile solution which expands feature functionality well beyond the scope of the typical EHR. Indeed the application looks substantially different today than it did when I joined Dugan and Frank in practice 15 years ago.
A Future Ripe with Opportunity
So, what will the next 15 years bring? Of course, it’s impossible to say. The world of Health Information Technology is evolving rapidly. Even making forecasts measured in months is tenuous at best. But I think there are tremendous opportunities ahead as we continue to follow Frank’s vision to bring the right information for the right patient to the nephrologist at the right time. Here are just a few of the opportunities I see:
1) Regulatory forces within the government move closer each day to establishing clear standards to facilitate data exchange between disparate information systems.
2) Led by Apple and a fast-charging Google, the world of mobile computing is growing exponentially and Health IT has a seat at this table.
3) Patient-centered care is driving a number of initiatives including ACOs and PHRs.
As we look forward we recognize our existing application is not perfect. Each day we work to iron out the subtle inconveniences our growing customer base brings to our attention. Usability, human factors engineering and “click neutrality” are not concepts we ignored in the past, but today they sit much closer to the front of the bus, reflecting the maturity of our company.
As we celebrate this important milestone and consider where we are going, it’s important to remember where we have been. The future may be difficult to predict, but I am certain the next 1,000 will arrive much faster than the first.