Imperial College spin-off launches Internet-based EMR

When com.Medica CEO Mark Simon talks about "global access" to EMRs, he doesn't mean just enterprise distribution. He means, quite literally, "worldwide."

Founded in June 1999 as a commercial spin-off of London University's Imperial College of Science, Technology, and Medicine, com.Medica is working to make the PiRiLiS patient information environment available in Europe, the U.S., Asia, the Middle East-anywhere a need for integrated enterprise applications exists. The long-term goal is to take PiRiLiS into hospitals, medical centers, and integrated delivery networks that have genuine telemedicine or electronic medical record challenges, according to Simon.

"We are looking for well-funded innovators who have vision and resources," he said. "What PiRiLiS brings is a new technology base-delivered on a PDA, laptop, or whatever-throughout the enterprise."

Like many large-scale patient-oriented information systems, PiRiLiS was born of institutional necessity and grew to meet the needs of the organization over time. Development began in the early 1990s, and the idea from the get-go was to make access to the system universal, a unique concept at the time.

As a result, PiRiLiS is a modular, scalable, Web-driven EMR system that can be adapted to an individual's or hospital's needs. Patient data of any type (text, image, etc.) is stored in an integrated, encrypted form on a dedicated SQL server provided by com.Medica. The server holds the patient data and automatically tracks and keeps a full permanent audit of the information, registering who looked at what record and when.

"PiRiLiS will allow someone to deliver the patient record in its entirety, be it text or image based, over the Internet and at the point of delivery without prescribing what technology must be used," Simon said. "It is even less than a thin client because it requires nothing more than a suitable monitor and browser."

The cost of PiRiLiS includes an installation fee of $100,000 to $800,000, plus an annual licensing and maintenance fee (about 15% of the installation cost). com.Medica provides the software, the server, and all associated storage.

"What we sell is the PiRiLiS server and the infrastructure that is plugged into the whole system," Simon said. "We demand that the people installing our product dedicate a server to it because the material they are capturing is so important to their business they need to protect it and dedicate resources to it. We add value by integrating with existing systems, and in time they become redundant."

The decision by developers to make the technology free at the point of delivery and available via commercial browsers such as Netscape or Microsoft Explorer sets PiRiLiS apart from competing EMR products. Users can access the password-protected records via a LAN, VPN, or the Internet anytime, from anywhere.

The developers also opted to write PiRiLiS in C and C++ rather than Java, which Simon believes adds another layer of reliability and functionality to the program, especially for users in less-developed countries.

"Our IP-based approach really has been one of the most important design decisions in this product," he said. "We think Java has its role, but we are still concerned about the migration and universal application of Java in programming. Every browser in the world needs to be able to see and access our system, and Java can complicate that."

Much of the development work over the last eight years was done in conjunction with the radiology department at the University of Southern California, under the direction of Dr. Jim Halls. In addition to Imperial College and USC, the company claims two installations in Asia, one in Australia, and another in the U.K.

"For the last 18 to 20 months (at USC), we have been implementing and now operating connections to all radiology modalities, providing service to surgical departments, and trying to determine how to make this universal across the hospital system," Simon said. "We started in radiology, but we have now expanded into other departments."

com.Medica is seeking to develop relationships with other vendors who will function as integration partners, licensees, or resellers of the PiRiLiS technology. The company is already in talks with Lanier, among others, and is also working to initiate clinical trials with large healthcare organizations already involved in international telemedicine.