Canadian software firm brings CIS expertise to U.S. market

Canadian software firm brings CIS expertise to U.S. market

Bottom-up approach challenges legacy systems

As senior physician and an associate professor of medicine at Royal Victoria Hospital in Montreal, Dr. Art Gelston spent many years being frustrated by the clinical information systems available to him and his colleagues. He felt his medical staff did not have the right informatics tools and could not take advantage of newer technologies to facilitate the management of their workload and their patients' care.

So in the early 1990s, he began building a modular DOS-based clinical information system for use at Royal Victoria. Over the years, incorporating feedback from colleagues and staff, he has made numerous adjustments to the system, slowly refining and improving its user and system interfaces and workflow capabilities.

Today, in addition to his duties at Royal Victoria, Gelston serves as president and CFO of VisualMED Clinical Systems. The Montreal-based company was founded in 1998 by Gelston and a management team with several years' combined experience in medical device and informatics firms. The company has spent the last two and half years turning Gelston's prototype into a commercial clinical software product called VisualMED. This development effort recently paid off with the first commercial sale of a VisualMED system, to Lakeshore General Hospital in Montreal, which netted the company $2 million.

VisualMED differs from other CIS packages in that it was built from the ground up by a physician with firsthand knowledge of a healthcare provider's clinical workflow and decision-support needs, according to Richard Le Hir, senior vice president and CEO. By taking a modular software-based approach, the system can be customized to meet the specific needs of each hospital department, while still facilitating the integration of this information across the enterprise.

"The underlying logic is a workflow design, but it is the medical practitioner's workflow, as opposed to the logic that could have been developed by an IT person," Le Hir said. "This is a physician order entry system that incorporates data from all sources of clinical information—labs, pharmacy, x-rays, or any other method by which doctors inform themselves of the clinical state of a patient."

VisualMED is currently an intranet-oriented Windows NT package designed to sit on top of the hospital's clinical data repository. The HL7 transaction manager links the legacy systems within each department to the repository to enable bidirectional transfer of data. Modular software, built using Delphi 5/Midas linked to Oracle 8i tables, integrates physician order entry with clinical nursing activities as well as numerical and image results reporting. In addition, the system's decision-support algorithms can be modified by the customer to adapt recommendations to local practice standards. VisualMED is in negotiations with 3M and other repository providers as potential strategic partners.

"VisualMED doesn't make decisions for the physicians; it is an expert system that helps them make decisions," Le Hir said.

For example, the drug module, which provides such information as the price of a particular drug as well as any potentially dangerous drug interactions for a specific patient, helped reduce drug expenditures at Royal Victoria Hospital 30% in one year, according to Le Hir.

The system is also DICOM-enabled and can be linked to the hospital PACS, so medical images can be accessed and displayed within the clinical context of the patient record. In fact, VisualMED has a strategic relationship with Intelerad Medical Systems, another Montreal firm, which has developed a Web-enabled Linux-based PACS that can be incorporated into the VisualMED CIS.

Ultimately, the company anticipates going to an Internet-based system that would enable referring physicians and other remote providers to access patient information in a hospital database more easily, but Le Hir says many security and confidentiality issues still must be resolved before this can happen. Security is currently handled via password or fingerprint identification. In addition, the VisualMED system develops a profile of each user, based upon the user's activity within the system, and assigns a correlating level of authorization that determines how much data the user can access.

Recognizing that the U.S. market holds much greater revenue promise than the healthcare delivery model in Canada, VisualMED has taken several steps this year to increase its U.S. presence. Although established in Canada, the company is now considered a U.S. firm, following a reverse merger with a Nevada-based public shell, Cherry Tree Capital Corporation. VisualMED also has a U.S. office in Boca Raton, FL. VisualMED shares should begin trading on Nasdaq before year's end.

While currently relying on a direct sales force to market its products, the company is also looking to form some strategic partnerships to help it break into the marketplace. Efforts are also under way to add voice recognition capabilities to the system (via a partnership with Locus Dialogue, a Montreal-based VR firm) and to incorporate Bluetooth wireless protocols to make the system functional on PDAs and other mobile devices.

"The size of the U.S. market and the existence of a huge software vendor market has prompted us to look into opportunities to go into joint ventures," Le Hir said.

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