Data and Destiny: A Conversation with Commissure CEO Michael Mardini

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The mantra for practice management in the post-DRA era is data management, and everyone knows how much data a radiology practice can produce. From the multitude of bills (service points) to the vast number of customers—not to mention the deluge of clinical data—radiology practices need tools. Commissure offers tools that assist in three domains: reporting and communications, decision support and utilization management, and data analysis tools. For the purpose of this interview with Commissure CEO Michael Mardini, focused primarily on the utilization management tools and the leverage they provide the radiology practice in the post-DRA environment. Mardini founded voice recognition and reporting company Talk Technology in 1994, which was acquired by Agfa Healthcare in 2001. He founded Commissure in 2004. As the business side of radiology evolves, where do practices need to be in their ability to manage their data? What are the flash points?

MARDINI: Right now, outside of the most business savvy clients, they really are not prepared. I didn’t know this coming in. The thing that has amazed me more than anything is the limited access clients have to their own data. They have to buy special tools, and they are hiring programmers to write the reports, so only the savviest of sites can really use their own data. With P4P looming, there is no way, absolutely zero chance, that any of the items or any of the changes focused on utilization management are going to be dealt with unless there are some major changes in the ability of clients to access their own data and to manipulate it. There’s a lot to be done. RadCube goes a long way, but it really starts with accessibility and consumability of the data, opening these closed architecture databases that exist now so that people can actually use their data. Commissure supports IHE-compliant methods of accessing this data that virtually every vendor conforms with. Wikipedia defines commissure as the place where two things are joined. In aggregating tools for reporting, decision support, and practice management, what do you intend to bring to radiology?
MARDINI: We look at the round trip. We as radiology professionals, whether you are a radiologist, a technologist, or an administrator, provide a service to the outside world, and the service we provide, at least internally, takes into account a lot of things: what kind of systems we are using in modalities, PACS and RIS, etc, and how we manage all of this. Internally, this is all very important, but the outside world generally cares about two things: how do I get my patient in for the right test in an efficient manner, and when are you going to communicate the results? From a service perspective and for the people we provide service to, those are the two things that matter most and the two things that we are ultimately being measured on.

Commissure wants to affect appropriate ordering by providing support and knowledge on the front end at the time of ordering. Next, we want to provide tools for reporting that provide a consistent, concise method of reporting results in an accurate and efficient manner, and tools for communicating those results in an audited, confirmed, and traceable manner. Finally, we aim to provide some means of looking at this data, both for internal use, as well as external use, whether for communications, utilization management, practice management, or clinical research.

These are the areas we feel we can ultimately help radiology improve on. Transcending all of this, there is the whole concept of orchestrating workflow in a heterogeneous environment. We don’t necessarily care that we are the worklist, nor do we think there is even a need to provide worklist and workflow functionality in a hospital that has a single PACS and a single RIS to work from. These systems all have worklists. The problem is they are provincial and only know their own work, they only know what is in their own system. So, in a scenario where there are multiple RIS or multiple PACS or multiple visualization tools, Commissure can fill the role of providing a common worklist, common workflow in an environment where, because you have all of those other systems, you would not otherwise be able to do.

That is the connection, that’s the “commissure” in Commisure. Our solutions add value to existing IT infrastructure in the department. A department may turn off some feature or functionality in