Celebrate February as 100 Automated CDI Queries Month!

We are celebrating February as the month where HITEKS along with our clients will achieve 100 Query Types in our ConcurDI For NoteReader CDI Library!  While we have long-ago surpassed all competition who have less than 25 Query Types, reaching 100 is a monumental achievement which reduces manual burden on health systems to cover the entire chart and improves physician compliance with our queries since they arrive within seconds of their note writing.
As a result of this milestone, we are offering new clients the first year usage of our system for no charge and with no strings attached.  In fact, we will offer credits to each new client who uses our system to generate additional CDI Query Types beyond the 96 currently in our system.  Here is the current list (note: some have multiple variations which are in parentheses), contact us for a demo today. 

Here is our current CDI library, contact us for a demo today for 100% guaranteed significant increase in total queries, query compliance and queries completed by subsequent documentation:

 HITEKS CDI Query Library

Abdominal Pain
Acute Heart Failure (3)
Acute Hypercapnic Respiratory Failure
Acute Hypoxic Respiratory Failure
Acute Myocardial Infarction
Acute Neuro
Acute on Chronic Diastolic Heart Failure
Acute on Chronic Systolic Heart Failure
Acute Renal Failure
Acute Respiratory Failure (2)
Acute Tubular Necrosis
Adrenal crisis
Asthma (2)
Atrial Fibrillation (2)

Bowel Obstruction
Brain Hemorrhage
Cerebral Infarction
Cerebral Edema
Chronic Heart Failure (2)
Chronic Kidney Disease (2)
Complex Pneumonia
Cor Pulmonale
Diabete Mellitus/Hyperglycemia
Diabetes Mellitus
Diabetic Hyperosmolarity
Diabetic Ketoacidosis
Drug Overdose
Encephalopathy (2)
End-Stage Renal Disease

GI Bleeding
Hepatic Encephalopathy
Hepatic Failure
Hypercalcemia (2)
Hyperkalemia (2)
Hypernatremia (2)
Hypertensive Encephalopathy
Hypocalcemia (2)
Hypokalemia (2)
Hypomagnesemia (2)
Hyponatremia (2)
Hypoxic Ischemic Encephalopathy
Immobility Status
Malignant Hypertension
Malnutrition (2)
Metabolic Encephalopathy
Mild/Moderate Malnutrition
Morbid Obesity

NICU Respiratory
Pediatric Asthma
Pressure Wound
Pulmonary Embolism
Respiratory Failure
Septic Encephalopathy
Severe Malnutrition
Simple Pneumonia (2)
Toxic Encephalopathy
Uncontrolled diabetes

FAQ: Frequently Asked Questions About HITEKS’ Automated CDI Query and Physician Notification System integrated into Epic’s NoteReader CDI Workflows

Questions and Answers from our recent ACDIS virtual educational conference exhibit booth visitors:

Q1: Does the provider see the 3 responses (Respond/reject/ask me later) before seeing the query itself? I’m confused why an organization would allow a provider the chance to just bypass the query details before actually seeing them?

A: Yes, all evidence is presented in the query along with the responses. See our demo webinar where we outline the content of each query, starting from the Evidence we find in the patient’s chart, to the suggested responses to the physician, and the Infobutton content to speed understanding of the evidence.


Q2: What happens if the doctor deactivates or rejects the query? We are not supposed to query multiple times for the same, so does this mean it just disappears into cyberspace? Are these queries part of the medical records?

There is an audit function within Epic that allows for auditing all query activity, so if the doctor rejects the query, it is stored in Epic and a report is available to view the rejected queries. The queries also become part of the medical record.


Q3: If they reject or ask me later do they have to give a reason why so it can be tracked in case a clinician uses this option a lot?

A: No there is no reason required, but there are KPIs (Epic and HITEKS reports) that track over-usage of reject and ask-me-later.


Q:4 Not sure that I would like all the physicians getting the queries, how does this work in practice?

A: The queries are presented in the To Do bar and Items to Address dialogue within the note itself. Any provider can respond to the query but are not required to do so. Once there is a response the query no longer appears to the provider.


Q5: That is an interesting option – that if the documentation is signed – then the entire care team can see/answer the query. Is it hard to keep track of responses that way?

A: No, it’s easy to keep track of responses because once a provider responds to a query it is deactivated for all providers.


Q6: If the entire care team providers are sent the query, if one responds does it deactivate for the others? I’m concerned that could result in conflicting responses if not.

A: Yes, once a provider responds to a query it is deactivated for all providers.


Q7: Very interesting concept to build the query in with the Medical Record. Any push back from the physicians??

A: No, we have only had positive feedback regarding the ease of accessibility and early notification of the query.


Q8: Are your automated queries customizable?

A: Query customization is a simple process and can be accomplished in minutes. Types of customization include evidence targets of labs, meds, diagnoses, symptoms, note sections (i.e. Past Medical History – PMH), patient age, inpatient or ambulatory or both, and other demographics


Q9: Is the demo of the product integrated with Epic NoteReader CDI part of the recorded 60 minute Webinar?

A: yes, please use this link to view our recorded presentation


Q10: Hi there! does your product also integrate with Epic for use in the ambulatory setting?

A: Yes, HITEKS For NoteReader CDI in Epic is available in both ambulatory and inpatient environments; another interesting fact is that through our automation, 100% of all the patients and their charts are reviewed by our program. You can activate us in Epic’s App Orchard (ConcurDI For NoteReader CDI in Epic)


Q11: Where do you find the biggest advantage of using your system?

A: If you look at our KPIs where we show the 3x increase in CDI query case counts, you’ll realize that we help a CDI team handle the query types that are automatable, and open up time for the complex queries that require CDI Specialist review, leading to a more efficient CDI resource function. Our clients are also measuring their Case Mix and RAF Score improvement, which is significant.


Q12: Tell me more about your query library, how often are they updated for compliance via the AHIMA practice brief?

A: the query library is unique and we update regularly for compliance; our clients drive the update process and we currently have quarterly updates where we propose changes and get modification requests according to local needs and national guidelines such as AHIMA. Currently we have a fully automated CDI query library of 70 queries and growing, here is the list:


Q13: what if the PMHx inadvertently gets picked up as a diagnosis or symptom trigger and direct mode sends out an inappropriate query to a physician?

A: HITEKS recognizes PMHx sections in the note and extracts anything out of that section as PMHx, not a current diagnosis as we would if it were in the HPI or Assessment sections of the note.


Q14: Why do you say that the HITEKS solution is the only one approved and available for both silent and direct modes, aren’t there other vendors supporting Epic’s NoteReader CDI workflows?

A: The reason that HITEKS is the only approved vendor is that we have gone through the process to become validated and supported by Epic as part of the App Orchard program.  HITEKS pays Epic to be included in their App Orchard which comes with a variety of benefits for their customers.  Regarding Silent and Direct modes, HITEKS is the only vendor with proven ability in speed and accuracy to deliver direct mode queries to documenting physicians, with extreme configurability to change queries in silent mode and direct mode, whenever needed.  This reduces the risk to a health system at notifying physicians directly.  Just ask our clients!


MUE in EHR Workflows

Pharmacy & Therapeutics Committees are now able to leverage EHR workflows and real-world data on their health system’s population for policy creation and monitoring. HITEKS works has been developing applications integrated within EHRs since 2011.  Our latest app is listed on Epic’s App Orchard for MUE in Heart Failure.

Medication Use Evaluations (MUE, or Drug Utilization Review) for your pharmacy workflows can now benefit from these

1) Hyperlipidemia and Heart Failure

2) Inflammatory Bowel Disease: Ulcerative Colitis and Crohn’s

3) Community & Academic Oncology: NSCLC, AML, Breast

4) Devices: Cardiovascular, CNS, GI, Oncology

The areas of functionality for our platform where we enhance EHR workflows and data are as follows:

a) Guidelines-based Evidence Research for Pharmacy & Therapeutics Committees combining Real World Data on a health/hospital system’s own population with published evidence

b) Prospectively monitoring and enforcing pharmacy policy and formulary placement through EHR-workflow decision-support for physicians, pharmacists and quality improvement

c) Supporting automated workflow for clinicians in Prior Authorizations and other Payor requirements to increase medication compliance



Digital Health Solutions

For Evidence Assurance

August  2020



1.Real World Evidence & Digital Health Approach

2.Unique EHR-integrated Platform & Company Background

3.Insight Platform & CarePaths Solution Walkthrough


Provider engagement with Electronic Health Records provides  significant opportunities to apply Evidence-based Medicine

HITEKS’ Insight Platform allows EHR-Integrated workflow advice



Simplifying Paperwork and Increasing Patient Access to Oncology Compassionate Use Therapeutics

Hiteks, a trusted partner of physicians and FDA processes[1], announces its support of access to investigational products for patients with cancer by providing comprehensive services to oncology healthcare professionals in completing expanded access requests.

Key Features of Hiteks’ Expanded Access Program:

  1. Eases physician workflow related to the FDA application requirements for expanded access to investigational medical products.
  2. Supports thesystematic collection of data (i.e. FDA Form 3926)and streamlines data sharing with appropriate stakeholders (i.e. FDA, BioPharma Sponsor, and IRB).
  3. Reduces paperwork and bureaucracy by electronically storing and filing relevant data to support healthcare professionals in completing expanded access requests and downstream reporting:
    • a. Seek and obtain LOA (Letter of Authorization) and product from BioPharma sponsor to ensure compliance with Expanded Access program
    • b. Submit package to FDA: FDA 3926, CV,& LOA
    • c. Submit annual reports on patient status to FDA
    • d. Withdrawal IND, if appropriate



  • Because Hiteks occupies a central place in the EHR workflow for providers, it is able to efficiently present options to providers who wish to complete the submission of a request for a Compassionate Use therapeutic.
  • Hiteks retains a HIPAA-compliant database of information that can be used for downstream outcomes analysis and reporting.


Workflow supported by Hiteks’ CarePaths:
Expanded Access Decision Support

Form FDA 3926


Access to Hiteks’ CarePaths: Expanded Access for Epic 2019 Customers

6-weeks of elapsed time

  1.  Clinical and Compliance Departments decide to use Hiteks for Expanded Access service
  2. Communication to Hiteks and Epic to begin implementation of solution integrated with Epic
  3. Hiteks coordinates with provider organization’s compliance and IT functions to configure solution within provider workflow according to workflow triggers specified in Epic’s External Decision Support framework via FHIR-based resources and Dynamic BPAs
  4. Provider IT downloads App Orchard credentials, Hiteks assigns provider ID and password, and Epic Test Server connects to Hiteks
  5. Provider validates the Expanded Access workflow functionality
  6. Physician and administrator training conducted
  7. Provider IT function copies the Epic Test configuration into Production& provider network team implements Epic Production rules for FHIR access
  8. System Go-Live

Gerry Petratos, MD, MS, CEO, Hiteks Solutions Inc.

Gerry has worked previously as Global Head of Healthcare Data Analytics at Roche and Genentech Pharmaceuticals before co-founding Hiteks in 2011. He trained as an NIH Fellow in Medical Informatics at the University of Utah and Intermountain Healthcare. He currently leads Hiteks’ decision support integration for CDI, oncology, cardiology, and infectious disease providers within EHR workflows.

About Hiteks:

  • • Hiteks Solutions is privately held, physician-owned and managed organization
  • • Founded in 2011 with corporate offices in New York City
  • • Currently over 100 hospital and medical practice clients in 16 different States
  • • Integrated with Epic since 2014

[1] Hiteks currently supports the Epic-integrated CarePaths: Point-of-Care Decision Support tool, available at https://apporchard.epic.com/Gallery?id=2724, and has previous experience working with the FDA under previous CRADA agreements, including for reporting and analysis of Adverse Events using Hiteks’ software.

Hiteks’ Automated CDI Queries for Epic Improves CDS Productivity& Physician Compliance

New York, NY, December 17, 2019 – Hiteks Solutions announced that it has completed implementation of its industry-leading clinical documentation improvement application, ConcurDI For NoteReader CDITM for Epic 2019 in both Direct and Silent Modes at a leading healthcare delivery system in Southeast United States.  This installation marks the first time where the volume of automated query types exceeds 30 and has 14 direct-to-physician automated queries.

The importance of this implementation is the measurement of important metrics in both direct and silent modes showing savings of hundreds of hours per week of resource time and improved physician responsiveness to previously annoying and disruptive queries.  For this latest implementation, here is the list of initial automated query areas in each mode, expected to increase in number quarterly:

Silent Mode:

Acute Heart Failure, Acute Respiratory Failure, Acute Tubular Necrosis, Anemia, Asthma, Chronic Heart Failure, Chronic Kidney Disease, Cor Pulmonale, DVT, Diabetes Mellitus Hyperglycemia, Diabetes Mellitus Ketoacidosis, Encephalopathy, End-Stage Renal Disease, Hypertension, Pulmonary Embolism, Sepsis, Shock, Pneumonia, and Uncontrolled DM.

Direct Mode:

Bowel Obstruction, Coma, Diabetic Hyperosmolarity, Hypercalcemia, Hyperkalemia, Hypernatremia, Hypocalcemia, Hypokalemia, Hypomagnesemia, Hyponatremia, Malnutrition, Morbid Obesity, Obesity, and Urosepsis.

ConcurDI For NoteReader CDI is the only CDI solution available in Epic’s App Orchard. Unlike solutions that were designed for different purposes like voice dictation data entry and back-end ICD-10 coding, Hiteks’ solution is designed as a clinician-facing application directly in the EHR workflow.  ConcurDI For NoteReader CDI providesclinicians (documenting physicians and CDI Specialists) with easily configurable CDI logic.  This design enables cloud-based updating, user-configurable queries and automated queries at the point of care in real-time.  In addition, because of the large clinical experience and user validation, ConcurDI For NoteReader CDI already provides the client with a rich library of queries at time of implementation.

ConcurDI For NoteReader CDI is powered by Hiteks’ Insight Real-time IntelligenceTM platform which combines proprietary artificial intelligence (AI) with sub-second Natural Language Processing (NLP) technology. The app works in the background, analyzing notes and structured data and is always in-sync with the EHR data.  Its AI engine springs into action when its logic indicates that it can offer the physician or CDI Specialist a real-time query in the context of a recently written note that might help achieve more complete and accurate documentation.  According to Martin Coyne, MD, Hiteks’ Chief Medical Officer, “the rapid acceptance of ConcurDI For NoteReader CDI in the marketplace results from the fact that physicians find that it speeds up their documentation review and sign-off.  Until now, the EHR had a reputation for impeding workflow.  Finally, we are able to help the physicians focus more on the patient while simultaneously improving the speed and accuracy of the documentation.”

The Hiteks team is comprised of physicians with many years of clinical experience and engineers with many years of enterprise software development expertise. Dr. Petratos, Hiteks’ CEO, stated that “with the rollout of ConcurDI For NoteReader CDI within user workflows in Epic, we are beginning to see how powerful and usable external decision support can be.  Our engineering is powered by expertise in real-time clinical analytics which enables us to leverage all the data in the patient chart. Other companies can only work with a limited data set and work retrospectively which fails to meet the needs of sophisticated health systems.”

About Hiteks

Hiteks is a leading provider of hosted EHR integrated clinician productivity, A.I. and NLP software solutions to enhance clinical decision making.  Its suite of tools includes Sepsis Surveillance, Heart Failure Medication Optimization, and other decision support by enabling real-time feedback to clinicians at the point of care. Hiteks’ Affiliated Clients Program enables thousands of clinicians nationally using its cloud software to benefit from each other and participate in innovative offerings, including sponsored programs for reduced or no fees. For more information, please visitwww.hiteks.com, or https://apporchard.epic.com/Gallery?id=648.

Contact Information: Sales Department, Hiteks Solutions Inc., (212) 920-0929, info@hiteks.com

How Hiteks Compares with Competition


HITEKS’ Complete CDI System Surpasses Competition:


1. Type of Queries/Advice:

Patient-Specific, Non-Generic




2. Workflow Enabled: 

Front-End, Once the Note is Finished





3. Configurable Logic: 

Validated by Nurses, Doctors & Coders



4. EHR Embedded: 

Epic App Orchard Approved & Supported




Competitive Vendor Matrix for CDI Solution Capabilities


Vendor Capability A.I. Vendor Coding 360 Vendors

Chart Prioritization for Query Opportunities


EHR Workflow Integration for CDIS

Limited, No Infobutton

Direct-to-Physician EHR Notification to Increase Compliance

Limited, Delayed

Automated Query Library to Reduce CDIS Workload

<20 >88

Ambulatory CDI Query Module

Patient-Specific & Non-Generic, including Pediatrics & Gender-based CDI



CDI Feature Matrix

System Feature Other Vendors
Usability Limited compliance; Slow speed High compliance; Fast speed
Accuracy 70-85% >95%
Query Creation & Maintenance Time consuming (weeks), complicated Quick (minutes) & Configurable
Evidence Presentation Limited EHR & Infobutton



CDI Pre and Post HITEKS

Current State of CDI Post-HITEKS Automation
Query sent hours after admission note, progress note or discharge summary Real-time trigger of query at point of provider documentation
Recipient = Attending only Recipient = All Providers on Case
Manual Query Development Standardized Query Templates by Topic
Missed opportunity for non-CDI reviewed cases (40% Gap) 100% of inpatient admissions and clinic visits run through algorithms (systematic review of all documentation)
CDI team sending high rate of repeat queries CDI team able to review higher rate of complex cases with prioritization


Pre and Post-HITEKS Case Activation




Using Digital Health Innovation to Improve Clinician Productivity and Quality Care

Martin Coyne, MD, MS CMO Hiteks
Gerry Petratos, MD, CEO Hiteks

How are Clinicians like doctors, nurses, pharmacists, and others directly involved in patient care doing?  From many reports, neither Clinicians nor their supporting administrative staff have fared well in the past decade—but don’t blame the Electronic Health Record (EHR) or downward wage pressure.

When you evaluate different segments of Clinicians, the ones who practice in a technologically rich environment for workflow simplification, compared to those lacking productivity tools, treat their patients more effectively with less frustration. Clinicians who have access through fewer steps to timely educational information and treatment reminders in context to their patient can provide better evidence-based medicine (EBM).  EBM such as new guidelines from medical societies, applied efficiently during care, translate to improved provider utilization of the EHR, clinical decision-making, and patient engagement.

The question of how to best apply technology to reach high-productivity amongst Clinicians makes the difference.  Most medical practices and hospital systems in the United States are mandated to use the EHR along with additional decision support capability, with other countries following suit.  While the EHR provides the digital foundation and framework into which workflow-based information services can be integrated and delivered to the Clinician, early experiences using the EHR have been dismal.   Clinician resistance is attributed to the lack of intuitive screens requiring many steps to accomplish what was previously done with the swipe of a pen and paper.


1st Stage of the Digital Health Revolution


The first stage of the digital revolution in US healthcare, which comprises 16% of the economy, was defined by the universal implementation of the EHR.  This digital tool was viewed by Clinicians as impeding their workflow and by patients as interfering with the physician-patient interaction.  In addition, addressing quality of care metrics and increased medical costs has been limited even with continued medical science advancement of disease treatments.

Heart disease is a good window into the future of global healthcare. According to the CDC, heart disease is responsible for 1 in 4 deaths in the US every year.  6 million Americans have heart failure, with a projected rise to 46% by 2030, driven by obesity and increasing diabetes.  Heart failure is the consequence of arteriosclerotic heart disease.

In the last 30 years, the use of statin inhibitors has markedly reduced heart disease. Despite this intervention, heart disease is still the leading cost driver for US healthcare.  The reason is that heart disease is now understood to be multi-factorial.  Not only elevated LDL but elevated PCSK9, high TMAO, interleukins, and myocardial enzymatic abnormalities are causative.  Specific treatments for each of these conditions are now becoming available to physicians and patients.  Costs for these new treatments/year range from $15,000 for PCSK9 inhibitors to $250,000 for Tafamidis for cardiomyopathy.

In advanced heart failure, similar advanced and costly treatment options are now offered.  These range from Sacubitril, a drug that improves cardio perfusion, to digital monitors of physical signs of heart failure like oxygen and blood pressure monitoring to miniaturized implantable pumps.  The key prerequisite for the decision to advance to these next steps is strict implementation of American Heart Association recommendations for generic heart failure medications.  This last step requires traditional close attention to patient symptoms, reviewing standard lab values and monitoring drug compliance.

Heart disease is emblematic of the opportunity and challenge for US healthcare.  The opportunity is that medical science is rapidly providing insight into the disease and building more powerful treatment options.  The challenge is failing to apply or inappropriately applying these advances at the point of care, leading to patient dissatisfaction, increased morbidity and enormous cost overruns.


2nd Stage of the Digital Health Revolution


The second stage of the digital revolution will enable healthcare providers to meet this challenge and fulfill their professional obligations to their patients.  This stage leverages the information available in the EHR by presenting it to the clinician in a timely and user-friendly format.  The promise of decision support to enhance patient-specific advice in fewer steps, clicks, and screens required to perform the job is now possible through software technology like natural language processing and artificial intelligence.

Technological advances using advanced clinical analytics and cloud computing over the past couple of years have now enabled constant monitoring of patient data to bubble up to Clinicians attention as the most pressing cases requiring action.  These innovations can monitor 15-20 data points in the EHR, necessary for modern management of complex conditions such as Sepsis monitoring, as well as Heart Failure, and then present it seamlessly to the physician for evidence-based treatment intervention. This workflow prioritization using the computer to identify the EBM options as next steps in Clinician management optimizes productivity.

The systematic approach of integrating decision support into the EHR workflows focuses Clinicians’ attention on improving population management of disease areas such as Sepsis, Heart Failure, Oncology Biomarker Testing, Back Pain, and others. The response to the initial Clinician backlash against the EHR is not to stop using the EHR, rather to enhance the EHR’s presentation of meaningful patient-specific information to speed decision-making.

The second stage of the digital revolution using advanced software technology to extract and interpret data in the EHR will bring the healthcare industry into the 21st century.  In the 20th century, physician productivity was described in a simplistic fashion, using outdated concepts of a worker producing widgets.  In this idiom, productivity tools helped a worker produce more widgets/hour, i.e., see more patients/hour.   But healthcare globally requires a more modern concept of provider productivity.  In this concept, productivity is defined as a tool that enables a physician to gather, review, interpret dynamic, multiple data points in a timely way and apply this to implementation of evidence-based, cost-effective treatment protocols.

This is what the patient wants.  This is what the physician wants and must do.  This is what society requires.  This is what digital productivity software tools like Hiteks provide in the context of individual patient encounters to enhance the EHR workflow experience.


Dr. Martin Coyne
A long experience as a clinical gastroenterologist combined with many years as CEO of large medical groups gave Dr. Coyne the perspective that the physician in real-time at the point of care is central to the multi-trillion dollar healthcare industry. It is this perspective that has informed the development of the Hiteks product portfolio. Experienced Medical Group Administrator (100+ physicians, $100+ million budget) Extensive Clinical Research Experience Published more than 40 Scientific Articles M.D., Boston University M.S. in Medical Informatics from Northwestern B.A. in History from Brandeis.

Dr. Gerasimos Petratos
Gerry Petratos, MD, MS, is CEO of Hiteks Solutions and began his career as an NIH-trained Medical Informatics physician with experience in EHR-integrated decision support systems from Intermountain and the University of Utah.  Dr. Petratos has 9 years of experience as the former Global Head of Healthcare Data Analytics at Roche and Genentech.



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Point of Care Decision Support

Ronald M. Razmi, MD, CEO, Kinders
Gerry Petratos, MD, CEO, Hiteks


For years, Big Pharma has marketed its drugs to healthcare providers using a tried-and-true model: running clinical trials, publishing the results in journals, and presenting them at conferences. To drive awareness, brands leverage the evidence in marketing campaigns and physician detailing. Ubiquitous as it’s become, however, this approach has shown mixed effectiveness in commercializing drugs. Its overall return-on-investment is inconsistent, and its effectiveness in new product launches is declining. In many cases, brands underperform because physicians continue to use older and cheaper alternatives, even when a brand offers significant advantages in certain patient populations.

In other cases, several drugs are indicated to treat a single illness, and physicians do not remember the nuances of each alternative at the point of care. Increasingly important are the workflow distractions of the practicing physician; most of their time is now spent in the digital environment reviewing or entering patient data.

Ubiquitous as it’s become, however, this approach has shown mixed effectiveness in commercializing drugs. Its overall return-on-investment is inconsistent, and its effectiveness in new product launches is declining. In many cases, brands underperform because physicians continue to use older and cheaper alternatives, even when a brand offers significant advantages in certain patient populations.


So, how do you overcome this issue? By spending even more on physician education to cover every possible clinical scenario and which treatment to use in it? Perhaps. Improving physician education is always a worthy goal. But brands reach a point of diminishing returns when it comes to information retention: physicians simply won’t remember each detail, in each scenario, at the point of care. eDetailing, in which interactive digital content is made available for clinicians to review on their own time, has drawn a positive response, but information about ROI is still limited. Some of the developments of the last decade offer a new path forward. In recent years, the adoption of Electronic Health Records (EHR) has significantly increased. The newest EHRs have improved functionalities, making relevant clinical information like radiology, pathology, and labs more easily available within the system. Given that clinical workflows are already increasingly digital, there is a natural opportunity to educate physicians about possible treatment options at the point of care, rather than before or after it.


What, then, is keeping point-of-care education and decision support from being widely used today? The answer is that although many things are possible in theory within EHRs, the reality is a long way from this theory. One of the key barriers is the difficulty of interfacing with EHRs. There are many reasons for this. EHR companies create obstacles to prevent access to their proprietary databases. Medical centers, meanwhile, have a high number of competing projects. Finally, nearly 80% of the data in EHRs is unstructured, meaning it must either be ignored or—often manually—converted before it’s accessible and available for analysis.

These barriers would give pause to any Life Sciences company. Indeed, they are some of the
primary reasons that the ROI for such projects to date has been unfavorable.

However, they are not insurmountable, as we discovered when we began to devise a business process and technology solution that could anticipate and overcome them. In fact, our experience building Kinders and Hiteks—two companies that leverage new technologies and enhance healthcare business models—suggests that with the right tools, Life Science companies can build point-of-care solutions that are highly effective marketing vehicles.


Here’s what companies should look for as they evaluate potential partners and systems:

– EHR integration: It’s no secret that the EHR landscape is complex and cluttered. But your installation costs will skyrocket if your point-of-care solution doesn’t easily integrate with the EHRs that are being used at the majority of medical centers. For Hiteks, we first built software that would integrate easily into of most major commercially available EHRs, especially Epic. Then, we fully integrated this into the Epic main engine to become an application for their customers. Because Epic has the largest base of users, this allows us to achieve the wide-scale adoption of new decision support solutions without additional local installation—and create a turnkey solution on the technical side.

– Effective methodology: False positives and irrelevant suggestions are a big problem in POC support. To minimize override rates, make sure your decision support solutions providers can work with you to create decision support that results in highly relevant advice. Our approach includes studying the clinical guidelines and drug labels for the brand, understanding current clinical decision making around the specific illness, mapping current workflows within the EHRs and listing the data used by clinicians to arrive at a management plan, clearly defining the pivotal points in decision process, and building logic to generate reminders at the right time.

– ROI measurement tools: You won’t be able to improve your POC support tools—or make the case for extending them to other brands—unless you keep rigorous track of your results. By combining software that’s fully integrated into the EHR and a robust clinical logic creation methodology, our software can launch point of care decision support reminders quickly and consistently. We then closely monitor engagement with our reminders, using EHR logs to track clinicians’ acceptance of the advice—and any resulting behavioral changes.


Our experience shows that point-of-care support solutions can be highly effective. One pharma brand we worked with had a novel treatment in sepsis. Yet while clinical evidence showed significant advantages for their treatment in certain patients—reducing progression from Sepsis and Severe Sepsis to Septic Shock by 25% and shortening the length of stay by half a day—72% of physicians continued to rely on commonly used antibiotics that have been the mainstay of sepsis treatment for decades.

After careful study of the clinical workflows and clinician decision-making process, we identified all of the key data elements that clinicians use in choosing a sepsis therapy. We then mapped where each one of these data elements resides in the EHR. Using the most up-to-date clinical guidelines and the drug label, we created the logic to generate a reminder in the EHR for the clinicians at the appropriate moment during the management process. This guidelines-based reminder showed the novel therapy as one of the options. It also summarized the reason physicians might select it and the potential associated benefits. Within 3 months, this solution led to 12% increase in the usage of the therapy as the first line of treatment.

Summary: Digital workflows now allow for the ongoing support of clinicians at the point of
care, using a combination of well-designed technical solutions and clinical logic that’s based
on patient data and the application of guidelines and drug labels.

Dr. Ronald Razmi

Ronald M. Razmi, MD, MBA began his career as a Cardiologist and as a McKinsey consultant worked with the world’s top life sciences companies in strategy, digital health, and product roadmap. He was CEO of Acupera, a digital health company focused on using analytics and digital workflows in improving chronic care management. He advises healthcare companies in a range of areas including commercial strategy, digital health, and Artificial Intelligence.



Dr. Gerasimos Petratos

Gerry Petratos, MD, MS, is CEO of Hiteks Solutions and began his career as an NIH-trained Medical Informatics physician with experience in EHR-integrated decision support systems from Intermountain and the University of Utah.  Dr. Petratos has 9 years of experience as the former Global Head of Healthcare Data Analytics at Roche and Genentech.



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Hiteks Supports Local NYC Artists to Strengthen Pediatrics Focus

Hiteks is proud to support the directors of a NYC-produced documentary film called The Candidates, which was shown in November at the DOCNYC film festival and at last week’s Big Sky Film Festival in Montana:


This high school in Queens serves as an example of how youth activities, including political ones, can be presented in an educational way and create engagement and knowledge generation amongst students. The film has already received distinction by entertaining offers from studios that will soon make the film available to audiences via streaming. If you are interested in screening this film at a local high school please let us know so that we can connect you with the directors.

The need for pediatrics-based education and focus is also paramount to health care, where knowledge can be shared of how to properly identify and manage children’s illnesses such as cancer, lung disease, infections, and many others. For instance, when these illnesses worsen they become the primary drivers of patients suffering from Sepsis and Status Asthmaticus and deterioration of outcomes seen when patients enter the hospital.

By sponsoring the directors of The Candidates, Hiteks is both fostering community awareness of political issues, as well as the co-morbid conditions which need to be captured for CDI (Clinical Documentation Improvement) and CDS (Clinical Decision Support) to improve care.  Hiteks’ approach of optimizing the EHR for clinical decision-making can be best seen through our Pediatrics CDIVigilantQA Sepsis Surveillance and CarePaths For Heart Failure programs. We are able to reduce false positive Epic BPA alerts for Sepsis and optimize advice for CDI from evidence-based guidelines through our engineering which accommodates patient age and demographics, along with client-specific logic.

We will be using the funds from our investment in this film for the continued research and development of pediatrics programs in CDI and CDS for sepsis surveillance programs.  If you are interested in how your local hospital or health system can better monitor for these conditions to improve CDI, patient safety and outcomes, please contact us.

Hiteks Releases Upgrade for Early Sepsis Identification, Management and Abstraction with Fewer False Positives in Epic

New York, NY, October 24, 2018 – Hiteks Solutions Inc. announced today that they have upgraded their Sepsis detection, monitoring and management solution currently in operation at over 28 U.S. hospitals nationally, with the ability to reduce the false positive alerts within Epic. While the solution, VigilantQA – Sepsis Surveillance, has been running since 2016 by obtaining EHR data through real-time interfaces with MEDITECH and Epic, the upgrade now allows BPA alerts within Epic to be fully automated to accurately reflect Early Sepsis, Sepsis, Severe Sepsis and Septic Shock conditions according to the latest CMS, MEWS and Surviving Sepsis Campaign criteria.

VigilantQA – Sepsis Surveillance improves the positive predictive value of alerts by reducing false positives through identification of comorbidity, infection source and organ system dysfunction confounders which are known to cause alert fatigue.As a result, higher usability and confidence in the alerts also increases the timely identification of sepsis and infection sources within the 3 and 6-hour windows. Alerts can be directed to performance improvement specialists, charge nurses, other nursing staff, hospitalists and/or other clinicians. VigilantQA – Sepsis Surveillance also includes a real-time abstraction for reporting module to reduce the time and resources required in the CMS reporting processes.

EHR workflow benefits by integrating the Sepsis alerts with the Patient List Screen of care providers as a separate column, and optionally sending positive cases along with the “Evidence” and “Next Steps in Management” to specific users.Also, the triggers of the alerting can take place at various points in the clinical workflow such as Signing Orders and Opening Patient Charts, amongst others.The alerting algorithm can be configured differently based on adult and pediatric patient type and hospital setting such as ICU, NICU, PICU, Emergency Department, Post-Op, or the floor based on Hiteks’ A.I. which monitors hundreds of data points to determine the most likely causes of false positives and false negatives.

Hiteks’ current and prospective clients are eligible to receive this upgrade with Epic version 2018 through Epic’s App Orchard: https://apporchard.epic.com/Gallery?id=271 or through Hiteks’ website: www.hiteks.com/VigilantQA.Due to the high demand for this application and the new upgrade, Hiteks is able to offer significantly reduced pricing for new clients and multi-year contracts.Hiteks also offers a no-risk free trial for 6 months with no commitment to buy.

About Hiteks

Hiteks is a leading provider of hosted and EHR-integrated Decision Support software solutions to enhance physician time and knowledge by enabling real-time feedback to clinicians at the point of care with tens of thousands of clinicians nationally using its cloud software.Hiteks’ software reviews all the relevant discrete and Note data to automatically provide feedback to the clinician in the EHR in less than one second. For more information, please visitwww.hiteks.com, or https://apporchard.epic.com.

Contact Information: Dave Thomas, Hiteks Solutions, Inc., (212) 920-0929,dave@hiteks.com



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