An Exclusive Interview with Scott Decker, President and CEO of Healthvision

Right after New Year's, I published reader-provided speculation that security and Internet giant VeriSign would be making an investment in Irving, TX-based Healthvision. Healthvision CEO Scott Decker sent me a nice e-mail, saying that he had followed HIStalk for six months and was "glad to see you are closing in on the actual story."

He explained that VeriSign would be making a minority investment, not an outright purchase, concluding with "Your blog has forced me to start talking to clients this week before the press releases have all been approved, so this is generally market information that should be ‘official’ later this week ... If you think your readers would be interested, I would be happy to spin through one of your interviews and give you my perspective on the world of Connected Healthcare Communities."

We had to work around our respective schedules, so by chance, both the official announcement and the interview occurred today. Thanks to Scott for taking time on what I'm sure was a hectic day to spend some time with HIStalk.

Tell me about Healthvision.

The company was formed in 1999. We have about 100 employees, probably about 110 now. We’re still a private company. The business we’re in is building connected healthcare communities, which is how you connect the fragrmented healthcare system and get the right information to the right people at right time. We do it as an ASP, so we’ve built a web-based infrastructure. We have about 41,000 clinical users as subscribers who get access to clinical information through our system.

Here are two examples of what we do. Let's say I'm a primary care provider who's on Medicalogic and the guy down street uses Allscripts. We have a mechanism to keep using your system and sharing your data with the Allscripts guy and vice versa. Maybe it's the doctor in the office next to you. We're taking the pain away from moving data.

Ultimately, we're going to win when, in the Dallas-Fort Worth area, I can get on a site called scottdecker.myhealth.com or something like that and pull up a screen that looks like My Yahoo with my information, which came from a hospital, four or five physicians, and payors. All those things coming to me. In the markets we’re in, we’re pretty darned close. Where we aren’t, we’re not even close. That’s what we’re about – facilitating those kinds of things.

What is the nature of VeriSign's investment and their interest in Healthvision and the healthcare industry?

It’s been a really interesting deal for us. They spent a year talking to us, as well as quite a few other people in the healthcare industry.

From a corporate standpoint, VeriSign has two core businesses. They resolve all .com and .net DNS addresses, supporting 25 billion queries a day. Most people are familiar with their checkmark asset. They put in security infrastructures for 95% of the Fortune 500. Third, they do SMS message switching for telcoms, so if you send a text message from Cingular to Sprint, they handle it through their brokering hub, 150 million times a day.

VeriSign is looking for partners to use those technologies. They tried to find the right partner to get into healthcare. Because of our Internet network based model and our approach to the market, they saw synergies. They could apply their asset to healthcare. For us, it’s a great partner and infrastructure that tackles problems like scale, trust, and security.

What VeriSign security technologies make sense for Healthvision customers?

We can bolt their messaging to our networks easily. I should mention that they can transform that message to reformat it for Blackberry, Palm, or any device in a secured fashion. The second technology we’re excited about is their security front-end, which they call their fraud and abuse and person verification front end. 

HealthVision seems to have changed its business model a few times, from hospital web pages, then portals, and now interoperability. Are you chasing fads or responding to market opportunities?

It’s interesting to hear that perspective because we’ve always been about providing a centralized portal toolkit. From day one, we’ve helped hospitals with that infrastructure; with consumer websites, which few hospitals had in 1999 when we started; and web or portal technology to get clinical information out to end users, primarily physicians and their office staff. We started building that infrastructure in 1999. Certainly we’ve switched our marketing to match where people’s interest lies, so it may seem we’ve been switching focus, but it’s been the same platform the whole time.

When proposed the Neoforma merger with Eclipsys and Healthvision failed in 2000, Healthvision was supposedly worth $2 billion. Did the dot-com bust hit hard?

It was real hard for us, just like for everybody else who went through it. I don't know if it was $2 billion, but we were saying $1 billion. It was a bizarre time.

The good news is that we were building products and planning, even when we were playing all the same games as everyone else with free money. On the bad side, we didn't go public, so we didn’t get that cash in the door. We built a traditional technology company post-meltdown. Mindsets changed. It was a tough transition, but we made it through it and we still have 98% of the customers we had them. Certainly it’s easier to manage the business today when it’s about what works and how cash works.

General Atlantic expected synergies between Healthvision and Eclipsys. Did it get them?

No. I don’t think anyone who didn’t cash out got the synergies they were dreaming about. Everybody was trying to capitalize on anything dot-com. Eclipsys spun out their Internet assets just to get capital. Of the companies General Atlantic Partners invested in at that time, probably 50 or 60% of the dotcoms went away, but at least they got a viable company out of it. Thankfully, we’re past those days.

Who are your competitors and why do you think Healthvision’s products are better than theirs?

It’s changed over the years. For 2007, MedSeek, Medicity, Axolotl, and Wellogic on one side of the equation. We’re also competing against IBM and CSC and other large integrators.

What differentiates us is that we truly are an ASP company and that’s how we operate. Some folks sell a toolkit and it’s up to you to figure out how to use it. We offer a managed service. We're not saying it's the only way, but it gives a good option for potential clients to look at.

The other thing that’s different is experience, especially running domains of healthcare communities. We're in 20 markets with 100 to 150 hospitals, so from an experience standpoint, there aren’t many people working a network-based RHIO connected community with that experience. We have eight years of experience in developing and improving our infrastructure.

To what extent will RHIOs succeed?

They’re gaining traction. It’s exciting because there are so many. Even three years ago, there were only a couple of dozen. Now there are 250. It’s an experiment. Some will work, some won't. They're doing OK. They're probably moving as fast as anything can move in healthcare, especially for something that’s as dramatic of a paradigm shift.

Are Healthvision's fortunes tied to theirs?

I wouldn’t say Healthvision is wed to RHIOs, but to disparate groups sharing information. RHIOs brought it back up to the attention of boards and providers. We see all kinds of hybrids – health systems, IPAs, payors. There are a lot of RHIO-like models that aren’t the Washington, DC model, and that's good for us and good for healthcare. Our pipeline of opportunity is ten times what it was 24 months ago.

What do you think of the work being done on a national health information network and the companies that are doing it?

We’re involved in one of those, with IBM's bid because of our work with Taconic. NHIN is interesting because they've proven some interoperability, but the reality is that we have lots and lots of work to do at the community level to get the infrastructure in place before we connect communities together.

I’d rather see the energy put into local projects without worrying about national ones. I don’t see much there that will help our clients. I like the state of New York model instead of NHIN, where they’ve taken a few hundred million dollars and allocated it to communities that have a business plan and matching dollars and can get problems solved locally.

There’s a theoretical view of RHIOs with HIMSS and all that, then there's the practical people building the networks at the ground level. There's not a lot of cross-pollination. There are things Healthvision can do at the national level and will pursue with VeriSign.

The biggest pain point is still the cost of integrating legacy systems, especially for outpatients. Right now, that still involves building a point-to-point pipe, and even if you can get hub technology, it won’t work economically. The SureScript model is a good model. We can get some consolidation of integration done. Maybe all Allscripts users can connect into a hub and other vendors get a single point of contact so we don’t have to do point-to-point interfaces. I think that’s where you might see some cross-pollination of concepts.

So is the cost of moving from RHIOs to NHIN worth it?

I don’t see it as a transformation. Over time, hopefully we’ll have overlay technologies that will allow connecting regional exchanges together. I think the cost is overestimated.

How would you assess the personal health records market?

It’s neat. It’s where it has to go over time for us to push forward, but it's nascent, like Quicken 1985. If you want to do your checkbook online and track it with your spreadsheet and not your checkbook, that’s what a PHR is now. Until they’re connected to your bank and broker and other things, you won’t see them take off. The question is when we’ll connect them to clinical data. Like financial records, you want to share some of it with financial partners, and I can see PHRs going the same path.

Does anyone have any new PHR ideas?

Everybody I talk to agrees it’s not a hard application, just a different front end. It’s not all that sophisticated. It’s just the back-end connectivity that's hard. I've heard rumblings that Google and Microsoft are getting into it shortly, so the game could change quickly. There’s been no money put into development so far. If someone makes a business case or sells ad views, do the math. With 150 million American using it, even at a small annual fee, it’s big dollars.

What are you looking forward to at HIMSS?

Just having a lot of conversations with more of the vendor side of the world to see how far we’re getting along in sharing information seamlessly. We’ve worked with vendors on EMR interoperability for the past year, to be able to share information regardless of whose EMR it is. It’s a cultural and mind shift. It will be a good benchmark to go to HIMSS and see where we are, and also to see the response we get from the VeriSign announcement.

Who do you admire in the industry?

I admire the folks who are trying to do something different. Next year will be my 20th anniversary in the HIT world. If I step back, it can be frustrating compared to how the technology has changed around it. Pat Cline at NextGen and Glenn Tullman at Allscripts, who stuck with the technology. Like other guys coming up with new models of computing, athenahealth and eClinical Works. They're trying to get us to a network-based system and the economies of scale for our industry are huge.

You’ve got to admire the people who work in the industry and deal with all this fragmentation and messed up incentives. Once you get into it and gain a passion for it, you won't get out of it, for better or for worse, so there’s probably a mutual appreciation society as we work through it together.

Do you read HIStalk?

I sure do. Several of my clients, probably a year ago, started saying, "You gotta look at this thing." It's pretty entertaining. It's hard as a CEO to see unfiltered data and HIStalk really does a great job of getting that unfiltered dialog going. It's rough around the edges at times, but for the value it brings, it's really pretty cool.