A profitable business technology is usually based on either or both of two principles: the “killer app” – the one sequence of industry-specific software that transcends what was previously considered impossible – and the deep niche – the ideal, untapped segment with which to marry it.

If you’re looking for the divine intersection of the most lethal killer app and the deepest of deep niches, you’re hard-pressed to find a more scenic crossroads in the world of therapy than the speech pathology program at Cincinnati Children’s Hospital Medical Center (CCHMC). An early adopter of technology in the healthcare field, the 100-employee speech pathology program at CCHMC computerized the entirety of its administrative functions as far back as 1995 under director Ann Kummer.

"We were spending too much time with documentation," says Kummer. "I would see a patient, hand-write all my notes and then have another patient waiting almost immediately."

It was a practice, she says, that forced her to designate a weekly block of time to transcribe her notes instead of working on the case immediately after observing a patient.

"If something came up, however, my dictation would wait for a week," says Kummer. "And when I did dictate the report, I couldn’t be interrupted. Then I would have to wait for it to come back, make corrections, send it back, then review it again and then send it away to be mailed. The turnaround was easily a month."

Today, says Kummer, "We can get a report done in minutes' time."

The difference-maker for the CCHMC speech pathology program was an internally developed software suite known today as Chart Links. Kummer and her team developed the program, which was based on an iteration of Lotus Notes, in collaboration with a company called The Future Now. The application was so effective that it caught the attention of computing giant IBM.

In fact, the suite won IBM International Beacon Award in 1995 for the best, industry-specific application across all Lotus Notes software developments.

Not wanting the distraction of maintaining their software, the higher-ups at CCHMC sought a buyer for their blue-ribbon baby, and were soon approached by a New Haven, Conn.-based start-up that dubbed the application Chart Links, transformed it into a Web-portal application and then assumed the same name for its own business. Unlike most document-based management applications, what made Chart Links so effective for her practice, says Kummer, was its roots in workflow processes.

"Chart Links computerizes everything from referral to case management, studies, billing progress reports [and] home programs. [Basically,] anything and everything related to the patient," says Kummer. "It offers reminders in 'if-then' formulae that make it hard to make a mistake or forget something because when you do one action, a pop-up tells you what to do next. Reference databases automatically inherit all the information, so you never have to enter it more than once."

In the world of therapy, where there are so many management issues to consider – such as inpatient and outpatient duties, patient scheduling, billing, insurance and treatment plan development – even the most diligent and meticulous of people can miss a step here and there.

Factor in an overwhelming caseload and scatter 100 employees over seven additional satellite locations and Kummer's position as an administrator becomes eminently sympathetic in short order – as does the value of a powerful management software application.

"If you’re talking about clinical care, first of all, Chart Links helps us to track our patients better," says Kummer. "It doesn't let you forget; its home programs database can be customized, printed, faxed or e-mailed and saved in an electronic medical chart. It tracks insurance information, tallies how many visits are left, and at what date the authorization expires – at which point, it will offer to contact the insurance specialist if necessary. It has helped us make sure that we have insurance coverage before we see kids. Now when I see a patient, I can get the report over to the office of another doctor before the patient arrives there. It’s a huge difference in terms of quality and efficiency."

In terms of return on investment, says Kummer, Chart Links has enabled her office to condense its support staff operations, observe therapist productivity such as hours worked versus hours billed and track progress of patients seen and billed.

Moreover, it has opened the eyes to hospital administrators to the value of focused technological innovation in the therapy environment, and opened the door for additional computerized therapy in the future.

For example, after the meteoric rise of Chart Links, CCHMC installed a CD server for dynamic storage of licensed therapy content such as CDs used for language development, rehabilitative programs and games.

"We used to have to buy a separate CD for each location," says Kummer. "Storage was a problem; CDs could get lost or broken. Now all the CDs we purchase are loaded on the server. Multiple users can access them at once, and it’s a much more efficient way to use CDs."

The speech therapy program at CCHMC no longer uses observation windows, either. Now, at every location, an in-room camera films the session for broadcast on a closed-circuit television feed that is viewable in a monitoring room. In addition to reinforcing security, the setup allows therapists to perform demonstration therapy, which parents can tape record in order to work with the child and advance his or her treatment plan in the home.

Not to be left behind in the wake of advancing progress, "We’re actually moving towards digital technology [DVDs] now," says Kummer.

So to what does Kummer ascribe the overwhelming success of her tech-minded program? A dedicated staff of co-workers.

Computerizing your workplace "is an initial investment of time and money, and that investment can be tough," says Kummer. "When I first came to CCHMC, there were only three of us. Now there are 100. The more people you have, the more [with which] you can divide the responsibilities," she says. "And I have a lot of good people working for me."

Betty Esposito, vice president of Chart Links, echoes that sentiment.

"Our product, or any product in the market, is a tool that helps administrators run their businesses," says Esposito. "And the tool brings the most value to the people who actively understand and manage their businesses. Unless there is a strong management component already in your organization, that tool is not going to help you."

"We are not trying to solve the IM problem for the entire hospital, but we are trying to solve the information management problem for the therapy department," says Chart Links’ president, Ron Miller, MD. "The healthcare system is being pressured to become more efficient, and these tools can help that. When you talk about millions of dollars being spent, clients will face tremendous pressure to demonstrate effective outcomes – and these are far easier to demonstrate in a computerized world.”

In the future, Miller says, “Improvements in therapy are going to drive reimbursement. We're providing the tools for the therapist to compare their outcome measures."

"I think you have to understand your workflow and you have to put in a lot of work to do this," says Kummer. "It’s not a matter of if; it’s a matter of when. People are not going to have a choice to stay in business if they are not computerized."


Matt Skoufalos is a New Jersey-based freelancer.