Interview: MedcomSoft's C.E.O., Dr. Sami Aita

Interview: MedcomSoft's C.E.O., Dr. Sami Aita, discusses "industry challenges related to clinical automation and proper data collection".

By Robert Gleeman, Medical Journalist for EMR Update, robert@emrupdate.com

Dr. Sami Aita, who prefers to be called "Sami" by his employees

In our telephone interview, I started out by mentioning to MedcomSoft's C.E.O., Sami Aita, MD, that I noticed that everyone I encountered at MedcomSoft calls him "Sami".

"Yes," he laughed, "that's my real name!"

"But don't most doctors insist on being called ‘Doctor This' or ‘Doctor That'?" I asked.

"Yes," he answered, "but to me, a title, whether it's ‘Doctor', or ‘Chairman', is only a title and it has no importance."

But you are a medical doctor?

"I'm a M.D., yes," he confirmed, "I'm an emergency doctor."

A great accomplishment for anyone, yet you went on to start an EMR software company.

"Yes," Sami continued, "and I'll give you a bit of the story about how it happened. Before moving to Canada, I was one of the founders in Paris, France, of the Emergency and Homecare Center, S.O.S. Medcins 92, which was highlighted in the recent feature film by Michael Moore, "Sicko". I went on to create similar systems in Canada, and I tried to computerize the medical records of these emergency medical systems. We didn't find any software at the time that would help us do the emergency ‘triage' for patients, so I decided to put together a team to build the software for the emergency center. From there, we went on to create a practice management system for Canada. Then in 1994, we decided to put all our energy into creating a new generation of electronic medical records."

MedcomSoft is a publicly-traded company, isn't it?

"It is," he answered, "we went public in 1998 and we are traded on the Toronto Stock Exchange."

How's your "burn rate"?

Sami explained, "We have no issue there at all. Our sales growth has been phenomenal in the past two years as you might have read in our latest press releases, and we have always had access to funding when we have needed it, which is one of the advantages of being a public company. Without ‘cutting corners' or limiting our focus on customer satisfaction, we can carry forth our mission and lead the company to profitability in our current fiscal year, which started July 1^st."

Your EMR is known for MEDCIN, the codified medical language designed as a standardization tool. Let's talk about MEDCIN.

"I think there are a lot of misconceptions still in the EMR marketplace regarding MEDCIN," he said. "Many people see MEDCIN as just a codification system, but it is more than that. If you wish to capture medical data to the sixth level of granularity, there is no other system other than MEDCIN that will allow it. Six levels are considered the maximum in granularity, or detail, of a medical state. MEDCIN will allow you to codify everything numerically. What MedcomSoft has done is bring that MEDCIN vocabulary to a second level by doing the cross-codification of all lab results coming from U.S. Labcorp or Quest Labs-bringing lab results to the standard vocabulary of MEDCIN. Also, we have cross-codified all drug brand names to the MEDCIN standard, a project we have done with Medicomp (publishers of MEDCIN) and GSM, publishers of the drug database that we use."

"Now, by doing that," Sami continued, "we have created the first fully homogeneously codified electronic medical record, which opens the door to full interoperability with different EMR brands and systems. Since MEDCIN is ‘cross-codified' to the other medical vocabularies such as LOINC, SNOMED, CPT, ICD, etc., the data we capture with our software is fully compatible with all standards and vocabularies at the same time."

However, the importance is not only codification, because codifying the data is great for the purpose of aggregation and analysis, but the future of health care is really in pulling out specific data in relation to a condition or disease. To do that you need to have the clinical IT links between the data elements and conditions or disease."

IT links?

"Yes", he continued. "So let me explain to you what is a clinical link. If you take fever, for example, as a clinical concept. Fever exists in x number of medical conditions. So each one of these conditions has a link to ‘fever', or ‘fever' has a link to each one of these conditions, and I think there are in excess of a thousand conditions that have ‘fever' as an element that comprises these conditions."

"Now when you look at the link in reverse, asking for all the data elements that link to a condition, you can use these links to pull automatically all the information related to a disease from any patient chart. So when you use a software such as ours that has on one side extreme granular codification and on the other side an engine with 73 million clinical links inside, you are able to automatically extract from the data any element captured in the patient's chart over time, related to a disease, in a sub second, and display it in a spreadsheet format that will show you immediately the progress of that disease over time, even though the data elements were not tagged specifically for that condition when they were recorded."

That will be fascinating to our readers

Sami beamed, "This is really the biggest thing that our software offers, that unfortunately the rest of the market did not grasp until now, because the market stopped at the concept of codification, and there are now multiple proprietary codifications of zero value. The value of MEDCIN is not in the codification, but rather in its 35 years of research producing 73 million intelligent clinical links between the clinical concepts."

Some have called MEDCIN the last, best hope for interoperability.

"It is true to a certain extent, although full interoperability depends more on finely-granulated codification than on the intelligent links that I mentioned previously. We've been working with the MEDCIN vocabulary for about nine years and demonstrated on many occasions how it facilitates interoperability at the highest level."

MedcomSoft has experience here. Sami explains, "As an example we have recently ported a practice of twelve pediatricians that was using another MEDCIN-based system from another major vendor. We were able to take the entire database, capture it, and map it back to our system. In one day the clinic was able to move to our system with all data, scans, and patient files intact."

If two doctors have your system, can they trade medical records?

"Absolutely. A simple matter," he said.

Because, you know, if two doctors across the street are using the same EMR, they still can't trade records.

Sami elaborated, "Because the EMRs of today are built generally with the wrong concept. They concentrate on "neat" functions but produce text as an end product which is not understood by computers. The fundamental building blocks of any patient chart are simply codified cells consisting of codes and values that link automatically to a patient, physician, facility, etc. Any doctor could create these data cells which could be easily understood by another system, could be aggregated in a repository, and could reconstruct for you the medical record. All you need is the engine. This is the technology of MedcomSoft."

"Anybody who has today a system that keeps medical records in text is keeping dead data which will never be able to achieve interoperability or real time clinical decision support nor any extraction of relevant data on demand at the time of care."

"In the near future our system will support ‘intelligent compliance' which would bring up real time recommendations based on best practice or academic guidelines for treatment while taking the entire patient record into account. Things like co-morbidity, risk factors, family history, lab results and current medications which all make the recommended treatment different for each patient."

We talk a lot in EMR Update about granularity. What else should we be discussing?

Sami was emphatic. "What we need in this market today is education, before anything else. The last step, that of clinical links, is one where the industry is still in the dark. If you want to accomplish real disease management at the point of care you need a system that carries these clinical links."

Tell me about the pricing of your product. You're packaging in a lot more technology than most systems. Is it as expensive as it sounds?

"Absolutely not," he proudly stated.  "As a matter of fact our complete EMR system including PM sells for $11,500 for the first physician and $6,500 for any additional physician on the same database. It is a full enterprise, secure and stable system that is easily scalable from 1 to several hundred users."

Any parting words for your fellow members of the EMR Update Forum?

Our newest sponsor was generous. "Anytime you want to do any follow-up in any areas which are educational and not commercial in nature, I would love to contribute to the Forum, especially to emphasize the importance of data quality before functionality. I will become more active in an educational role without getting too commercial."

"On the clinical documentation engine you see the MEDCIN vocabulary on the left side that goes down to the sixth granularity of data elements,  and on the right side the narrative that is generated upon selecting any data element in any random way. The same documentation engine works with pre-set protocols, templates, pre-filled protocols, previous encounters data, free text, dictation, transcription and embedded picture annotations."

"The flowsheet gives a view on the entire chart and can be filtered by specific section of the chart such as physical findings, symptoms, tests, therapies etc. or can be filtered by disease, by specific data elements on a template or protocol and by dozens of other criteria. Hovering on each cell will show a full description of the cell and value, hovering on a column (that usually corresponds to an encounter) will automatically display the narrative of that encounter. Very hard to describe these unique, flexible and very powerful tool, however I will be more than happy to give you a quick demo if you want to see it in action at the speed of light."