Visteon's Vision: Paperless, Efficient, Medical Office

By Danialle Weaver

It has taken five years, required a "start-from-scratch" strategy and cost several million dollars.

But a small software company in Central Florida is beginning to generate some serious revenue with a product that ties together two critical components of managing the modern medical office - patient data and financial records.

Visteon Corp., based in Maitland, just outside Orlando, has sold its client/ server software to several large health care providers in Florida and the Northeast and has drawn growing support from Silicon Valley venture capitalists.

Visteon's chief product, BigVision, is an integrated suite of clinical, financial and operational software for physician organizations. Initially conceived as part of a consulting project, BigVision has developed a life of its own. And it's winning praise from users, technology analysts and industry executives.

"BigVision has really become an invaluable asset for me in my practice," says Dr. Howard Pelteson, a physician with Orlando Health Care Group, the first health care provider to use it.

Nor has it hurt that Visteon designed the system to run on Microsoft's strategic business platforms, including Microsoft SQL server, Microsoft Windows NT and Microsoft BackOffice. In fact, BigVision is the first software of its kind designed expressly with Microsoft in mind.

In 1995, InfoWorld magazine named BigVision one of its top 10 client/server implementations. Both Intel and Microsoft have published case studies detailing the system's operations.

"Visteon's product has really been built in a way to support the clinical and administrative workflow itself, versus being a back-office support tool," says Nancy Davis, an analyst with Charles J. Singer & Co., a health care information technology consulting firm.

Typically, she says, practice management systems have been built to support the person in the billing or management office. The systems have not been used at the point of care. "BigVision has clearly been built from the standpoint of here's the patient flow through the clinic and here's the types of tools you need to meet those needs," Davis adds.

Further, most large medical practices now use software that runs mainly on mainframes or mid-range computers, such as the Hewlett-Packard 9000 or IBM's RS/6000. Most lack the user-friendly graphical user interface made popular by Apple and Microsoft Windows. Some are programmed in MUMPS, a proprietary medical programming language.

To be sure, Visteon isn't the only software company in the market. And it has yet to appear on some radar screens.

"We don't consider them to be a major competitor," says Tracey Moran, a spokeswoman for Burlington, Vt.-based IDX Systems. She says 70 percent of all the large physician groups in the U.S. run IDX software. The company, which has been in business for nearly three decades, launched its Windows NT-based practice management software about a year ago. The company has about a thousand customers.

That doesn't bother Visteon's executives. "We are attacking the market aggressively because we believe there is a significant opportunity for a next-generation health care information systems vendor to establish a clear leadership position in the physician organization market," says Thaddeus Seymour, Visteon's president.

And analysts say that the market is so splintered that companies well known in certain parts of the country have little visibility, or business, elsewhere.

"There are over 1,000 practice management vendors, and there are strong players - IDX being a good example," says Davis. "But then suddenly, you could walk into Minneapolis and you could have some local vendor that has the majority of the market share and IDX really is hardly ever seen."

Although Visteon has not turned a profit, the company just began marketing to physician practices in late 1994. And, while the company is private and David Greenberg, Visteon's CEO, won't reveal financials, statements made by company executives indicate revenues of approximately $1.6 million in 1995. Projections show $5 million in sales in 1996 and a tripling of sales in 1997. By the end of that year, the company hopes to double its work force to 90.

BigVision is not cheap: Many clients would invest somewhere from $500,000 to a few million, not including hardware. Visteon recently inked its first multi-million-dollar deal with Raleigh, N.C.-based Medical Asset Management, a 275-physician practice with operations in eight states.

"The Medical Asset Management contract established BigVision as a significant, nationwide enterprise player for forward-looking physician operations," says Greenberg.

BigVision benefits from continuous feedback from users at the Orlando Health Care Group, one of Florida's largest managed care providers. The group is the main provider of medical services for 185,000 central Floridians who are members of Prudential Insurance Co.'s PruCare health maintenance organization. The group has 150 doctors and 13 offices throughout Orlando.

OHCG and PruCare hired Greenberg's company, then called EMed Systems Corp. in late 1990, to help choose a computer system that would allow it to meet the challenges of a new competitive era in medicine: managed care provided by doctors operating under fixed-price contracts, rather than under traditional fee-for-service. The system the group sought would be easy and intuitive to use. It would be cost-effective and expandable, without the constraints of proprietary hardware and operating systems. And it would mimic the "flow" of patients as they move through the health care system.

After analyzing what was then available, Greenberg, an information systems professional, decided the system did not exist. So he began building it from the ground up. He codenamed it "Big." Greenberg retained the marketing rights to what he hoped would one day become a commercial product. He also decided to build the system on an unproved, yet-to-be-released platform called Microsoft Windows NT, running Windows SQL databases.

"The company bet the farm very early on that Microsoft strategic enterprise platforms would become the platform of choice," says Greenberg.

All told, Orlando Health Care Group and PruCare have spent $1 million on software development, but they expect to save $7 million in direct costs over a five years.

BigVision currently has three software modules that make information available to doctors and other users through a few mouse clicks: Clinical Manager, Billing Manager, and Patient Manager. Clinical Manager is an electronic medical record that contains the same information as a paper medical chart, including allergies and sensitivities, patient histories, past appointments, laboratory results, radiology reports and immunization records.

Billing Manager integrates appointment specific data, such as the type of doctor seen, the length and type of visit, with insurance eligibility data such as prepaid benefits and copayments. Billing Manager also automatically prints patient receipts that show reminders of future appointments.

Patient Manager streamlines the patient registration process and allows receptionists or triage nurses to check patients in quickly, schedule appointments with other doctors' offices or check on patient appointments without looking through each doctor's appointment book. It also allows schedulers to balance doctors' workloads more evenly.

"I'm looking forward to the next iteration-when I won't have to leave the room to look up patient information on my PC, but can use a handheld, pocket-sized device," says Pelteson.

Visteon and Motorola's Lexicus Division in Palo Alto, Calif., have announced a joint neural network-based product, BigVision Prescription pad. It's a pen-based electronic prescription pad and software program able to decipher physician handwriting; it allows a doctor to write notes directly into a patient's record as searchable, reportable data.

In mid-September, Visteon and Softwatch Inc., Tel Aviv, introduced a prototype Internet product called PregnancyWatch Diary, an electronic diary and records manager for a home PC. It allows physicians to remotely monitor the progress of pregnant patients.

So far, Visteon has attracted $4.1 million from two Silicon Valley venture firms. The lead firm is InterWest Partners, based in Menlo Park, Calif. InterWest is a $600-million venture fund that has invested in more than 160 companies, including Silicon Graphics and Cyrix Corp. The other firm is Rowayton, Conn.-based Canaan Partners, which also has an office in Menlo Park. It has more than $400 million in capital and interests in more than 75 companies.

So far, Canaan has invested $2 million in Visteon, and InterWest has invested $1.98 million. The money will be used for building and expanding an outside sales force, increased software development and expanded services and support.

"Aggressive growth requires capital, and we are prepared to infuse the necessary capital into this business to make it a market winner," says Seymour.

He does not anticipate the need for an additional round of financing before an initial public offering, which will not occur until at least 1998. However, he adds, "We are confident we have access to deep sources of capital to grow the company."

Alan Crites, an InterWest general partner, likes Greenberg's technical vision and thinks highly of Seymour's management skills. He met Visteon's chairman, Jeff Goodman, when both worked at General Electric for the legendary Jack Welch. Crites and Goodman have remained close friends ever since. Goodman, a turnaround expert, is credited with turning Longwood's Baxter Healthcare Systems around in preparation for a joint venture with IBM.

Robert Migliorino, a Canaan general partner, also knew Goodman from his days at GE. It was Goodman's involvement that ultimately provided the comfort level the firms needed to invest in a company so far from Silicon Valley.

Greenberg, a Seattle native, left Boeing Aerospace in 1986 so his wife could take a teaching position at Rollins College in Winter Park. Yudit Kornberg Greenberg, who holds a Ph.D. in philosophy from the Graduate Theological Union in Berkeley, Calif., now chairs the Rollins philosophy and religion department. "I felt I was more portable than she was," he says, simply.

Described by one employee as the "chief enthusiastic officer," Greenberg drives a green Volkswagen camper van with "Visteon" license plates. It is his sixth VW van. Outside his office door is a purple and white plastic dart board with "IDX" written in the bull's eye. An adjacent "Enemy Wall," holds competitors' contract award announcements. "We should have had this one" was scrawled on a July 23 release from one competitor, Raleigh-based Medic Computer Systems, announcing a contract with Seattle's Medalia HealthCare, the largest network of primary care clinics in Washington state.

Friends and business associates liken Greenberg's technical vision to Microsoft's Bill Gates. A Gates aficionado, Greenberg, 43, modeled parts of Visteon after Microsoft and strove for "the right combination of hippies and nerds" required to make the company a success. Recently, Greenberg was elected chairman of the Microsoft Healthcare User's Group, which Gates personally launched at a 1995 conference. The group provides Microsoft with advice on developing the company's health care computing solutions. Several years ago, Microsoft made a small equity investment in Greenberg's company.

"David's vision of how technology can and will be used in health care - the last frontier for information technology - is incredibly parallel to what I saw in Bill Gates during my four-and-a-half years with Microsoft," says Lilian Myers, Visteon's marketing director. Myers joined Visteon from Microsoft, where she was responsible for moving Florida software development companies from older technology platforms to Microsoft NT.

Adds InterWest's Crites: "David is extremely important to the chemistry of a company like this. He has made the transition from this being his project to being part of a team very smoothly and effectively, and he gets high marks and a lot of credibility from me by doing so."