Chris Gaerig

Chris Gaerig

The mission of Pittsburgh-based Four Rivers Software is to help improve the quality of health care in America while decreasing the cost. To accomplish this goal, the company continuously adds to and innovates its brand of computerized maintenance management systems (CMMS), which assist in tracking equipment, keeping maintenance schedules, and asset management. With the company’s expanding TMS product line, Four Rivers hopes to expand the capabilities of CMMS and assist clinical/biomedical engineers in new ways. 24×7 recently sat down with Pierre Harrison, the company’s vice president of sales, to discuss the CMMS industry, the importance of the systems to those in the health care technology management profession, and where the industry is headed in the near future.

24×7: Tell me about the history of Four Rivers Software.

Harrison: The company was founded in 1990. In 1995 we decided to focus exclusively on health care and have done so ever since. I think in 1995, we had somewhere around 50 health care accounts. It is now approaching 1,600.

The history of the product has been somewhat aligned with the industry in terms of a DOS-based platform and then a LAN-based platform. We are on our third generation of Web-based applications, which is primarily where we’re focused now. We offer an exclusively Web-based platform running on a customer’s Internet, and now we offer a SaaS model, which is a rapidly growing portion of our business.

24×7: Why did the company change to solely health care?

Harrison: The health care industry has very specific needs, whether you’re talking Joint Commission or preventive maintenance or applications for medical equipment. Our product is designed to address the needs of the biomed community. They have specific needs, and what we decided to do was one thing very well, rather than do an OK job with multiple industries.

24×7: Can you talk a little bit about CMMS in general?

Harrison: In the early days, a computerized maintenance management system was a database that kept a list of the equipment and work orders—either preventive maintenance or corrective maintenance work orders—at a hospital that needed to be accomplished. The demands on the system now are far more complex.

One of the trends in the industry is that biomed groups are reporting more and more to IT environments because the equipment is getting more and more IT-centric. Eleven years ago, no one wanted to keep track of an IP address. It was just something that was not needed. Now a system better be able to keep track of an IP address on an IV pump.

I think the role of these has really grown from a simple, “I need to fix this IV pump,” to a more asset-management-type system: When did we buy it? How much are we spending on it? Could we replace it with something cheaper? They are now more capital-centric systems.

24×7: So these differ from but can work in concert with RTLS?

Harrison: Yes, that is also happening. It goes to the capital and utilization. People want to know where things are with an RTLS [real-time location system]. We can find it to go work on it and reduce the cost of trying to locate the equipment.

I think one of the biggest things that will happen with RTLS systems is not only knowing where equipment is, but if it is on. If it’s attached to a patient and it’s being used, obviously we can’t go and work on it. I don’t know of anyone saying, “Here it is, and it is on,” but that is definitely where it’s going to be.

The other thing is if you look at a simple example like a specialty bed, the RTLS systems will help you reduce costs in terms of if it is in use or if we can return it. When you look at the cost of a specialty bed and maintaining that, it can have a significant impact. Utilization of equipment can have a significant impact on the capital budgets of a hospital.

24×7: What are one or two things that you have heard from biomeds that they want from the CMMS?

Pierre Harrison

Pierre Harrison

A Quick Take

24×7: What is your history in the industry?

Harrison: The quirk of my career is that I have only ever sold software to the health care industry. I started out selling physician accounts receivable systems. I’ve sold radiology management systems. And I went into the sale of the core backbone to the hospital, the large HIS systems. From there, I joined Four Rivers selling a specific health care solution to a specific target market.

Harrison: Being more mobile is definitely key. That’s why we have a robust approach to the mobile applications. And the solutions have to do a lot but simply and quickly.

24×7: Why are these systems so important to biomeds? Are there any hospitals working without a CMMS?

Harrison: It’s really a replacement market at this point. Somewhere around 99.9% of hospitals have some form of a system. We do a lot of data conversions, and what we find is that we’re doing conversions from systems that may no longer be supported. We’re doing conversions from home-grown systems in which hospitals have decided that they’re not in the software business. Then we do replacement systems where the competitors have not kept up with the complex requirements in an easy-to-use environment.

24×7: Can you talk a little bit about the TMS Family of products?

Harrison: The flagship product is TMS OnSite, which is the third generation of our Web-based application. The key is its flexibility. The majority of systems in the marketplace are what we term static products: What you see on the screen is what you get—if you like it, you buy it—with some ability to tailor the product, but very limited. The first two products, iTMS and TMS Enterprise, would fall into that category.

With TMS OnSite, we have introduced this concept of personalization where each facility—and even within each facility—has the ability to tailor the information that is presented on the screen. So if you want to do a preventive maintenance work order on an IV pump, you might require certain information. If you’re involved in a life safety inspection, you might need different information. Rather than trying to have one user presentation to try and fit both of those requirements, they can now tailor those to their specific needs.

It’s the same concept with one of the products within it: the Dashboard. The Dashboard presents information graphically on one screen, but the information that the technician may want is very different than what the director of biomed for the entire health system may want to be presented with. So it’s the personalization of the product that is one of the key distinguishing features of TMS OnSite.

Then we have the SaaS model, which takes TMS OnSite and puts it in data centers so that hospitals can simply use it, cutting down the overhead in terms of hardware requirements and keeping up to date with the latest versions. It takes IT out of the management of this particular application. It also changes the purchasing structure from a capital purchase to a more operational expense.

24×7: You also have mobile applications for the TMS line of products, correct?

Harrison: That’s correct. Possibly one of the fastest-growing areas, both from a demand standpoint and a development standpoint, is mobile applications. Way back, we had a Palm OS device that was very simplistic and did not do a lot. The market was not really accepting of mobile applications. Now, we have sites purchasing 100 different mobile applications to equip their people with because what we can do on a mobile device is so much more.

Really, we can get to the stage where, as the technician walks into the building, the work orders that are assigned to him would download via a wireless application, he would go about doing his work, complete his work on the fly, and then go home.

You’re starting to see more and more biomed groups responsible for multiple locations, so our devices have gone from working in a connected state to working in a disconnected state—or both—so that the guy can grab his mobile device, travel across town, service some equipment, and still be tied to the system.

24×7: Is that one of the reasons that you’ve moved to a primarily Web-based system?

Harrison: That is definitely one of the reasons. With a Web-based application, you have much simpler implementation. Anyone can access it from Internet Explorer. You don’t have to put a client on individual machines, and you don’t have to determine who should use the application. It’s available to everybody. It’s an ease of use. It’s an ease of implementation. And I would say that it’s a cost factor as well.

24×7: Is your client base national?

Harrison: We are primarily US-based, but we do have sites in Canada as well.

24×7: Is there any installation for the Web-based service, or can it be set up remotely?

Harrison: I think one of the things that has made Four Rivers successful is that we have an application for the 14-bed hospital. We have an application for larger sites controlling multiple hospitals from one database. Depending on the complexity of what people want to do with this product, we can either simply turn it on and give them a login to get them up and running, or we will go in, do workflow analysis, data services, verify all of the equipment that they have and tag it, get it into the database, and design their workflow for efficiency.

24×7: Once the system is installed, how much contact do you have with the biomeds?

Harrison: It depends on the complexity. It doesn’t take a lot to run the application. But mergers and acquisitions are very prevalent in the health care business, so we would add to the database from the hospitals that have acquired other hospitals. We would merge the data and do what we call standardization so the entire health system is running under one standard protocol.

Our customer sales group is constantly adding to the functionality of the software and providing additional services.

24×7: What are some things that the company has planned for the future?

Harrison: We are expanding our offering. We have a computer-aided facility management application, which will not only take care of the equipment, but now we will manage the building, so to speak. We are starting to manage the relationship between the CAD drawings and the equipment. Somebody can quickly look at a drawing and see the equipment, and create a work order from looking at the drawing. That is one of the big pushes for 2012, and we’re starting to see some success.

Where it’s going is this concept of an integrated workplace management system where you have one piece of software to track the biomed equipment, the IT equipment, the facilities equipment, the property management, as well as capital projects. It’s taking all of the assets within the hospital and putting it under one system.

Chris Gaerig is the associate editor of 24×7. Contact him at .