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Apparently, Hospital EHR Use Still Has A Long Way To Go

Posted on August 20, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

It’s fairly easy to look back at the progress hospitals have made with EHR use and be impressed. In less than 10 years, most hospitals have gone from largely paper-based processes to relying on EHRs to support a wide range of clinical processes. Even given that hospitals got meaningful use incentives for EHR adoption it’s still a big deal.

That being said, we’ve still got a long way to go before hospitals exploit EHRs fully, according to a new research study. The study, which appears in the Journal of Medical Internet Research, concludes that it will take until 2035 for the majority of hospitals to put a fully mature EHR infrastructure in place.

To conduct the study, researchers relied on the HIMSS Electronic Medical Record Adoption Model (EMRAM) dataset, which ranks a hospital’s adoption of varied EHR functions considered important to hospital care quality and efficiency. The researchers sifted through EMRAM data for 2006 to 2014 and then leveraged them to predict future adoption levels through the year 2035.

After analyzing the data, the research team found that the majority of US hospitals were in EMRAM Stages 0, 1 and 2 in 2006 and that by 2014, most hospitals had achieved Stages 3, 4 and 5. Having analyzed this data, researchers predicted that Stage 5 use should peak by 2019 and Stage 6 levels of use by 2026.

Where things really start to get interesting is the path from Stages 5, 6 or 7 EMRAM. The study concluded that while most hospitals would reach these stages by 2020, a “considerable” share of hospitals won’t achieve Stage 7 by 2035.

It’s no surprise to read that as the level of sophistication needed grows, the number of hospitals that have achieved it tails off, with just a few likely to hit the prized Stage 7 in the near future. Developing a mature infrastructure calls for an infusion of time, talent and funding, and even resource-rich health systems might not have all three at the same time.

Also, given that one of the key requirements of Stage 7 is having interoperability functionalities in place, it’s easy to see why many hospitals won’t get there anytime soon. Heck, there’s good reason to wonder whether the bulk of hospitals will ever achieve interoperability, at least as it’s currently defined.

But do we need to measure everything by EMRAM standards? I don’t know, but it does seem that the question worth asking after defaulting to these measures for many years.

Don’t get me wrong – I’m not an EMRAM critic. It certainly seems to have done a good job of tracking hospital EHR progress for quite some time and it can be used by leaders to create a common goal for a healthcare organization. On the other hand, if it predicts that it will take more than a decade for hospitals to develop a mature EHR ecosystem, despite their pouring endless resources into the game, maybe it’s worth reevaluating this model. Just a thought.

Is It Worth The Trouble To Drop Fax Use?

Posted on August 17, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Not long ago, ONC held its 2nd Interoperability Forum in Washington, DC. One of the big ideas being kicked around at the event was killing the use of fax machines to share health data.

During her keynote address, CMS leader Seema Verma went so far as to say that she’d like to see all provider organizations go fax-free by 2020. Apparently, Verma wants providers to switch to other means of digital information sharing.

Sounds good, right?  Well, maybe not. Despite its flaws, faxing does have the advantage of being easy to use, available in virtually every provider office and fairly reliable. I’m not sure we can say that about most other forms of digital health data exchange. In fact, dropping faxing may leave doctors with bigger problems than they had before.

After all, before we stop faxing, we’ll have to find a digital document format that plays nicely with other systems and makes patient information easy to access. That, not surprisingly, may be tougher than it sounds.

I particularly like the way Jay Anders, MD, broke these issues down in a recent email message. Anders, chief medical officer of Medicomp Systems, makes the following observations:

  • E-paper may not be interoperable: In fact, it may create new barriers to data sharing, he suggests: “Electronic paper is not effective. It [can] create a data tsunami in healthcare – a flood of clinical data that physicians cannot access at the right time with the right patient.”
  • Free text is a burden: While e-documents may be easy to pass back and forth, making use of the data within can be really tough, he says. “When the EHRs receive these PDFs with mountains of free text, how do they interpret that data? How do they present that data to physicians? How do they make that data into actionable information?

His bottom line here is that while providers can use e-documents to share data, there’s no point in trying unless they can offer useful information at the point of care.

After taking in Anders’ questions, I have another one of my own. If providers will still need to go through contortions to extract data from e-documents, how is that better than using faxes? After all, if you run faxed documents through a sophisticated OCR process, you can capture and even format health data information.

In other words, given the issues inherent in using digital documents, putting faxing to bed may not be worth the trouble. I have to agree with Anders’ conclusion: “So, how does sending electronic communication of scanned PDFs rather than faxes enable interoperability? The answer is that it doesn’t.”

For another view on Seema’s comments and the fax machine in healthcare, check out John Lynn’s post on the real problem when it comes to replacing fax machines in healthcare.

Hospitals That Share Patients Don’t Share Patient Data

Posted on August 7, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

If anyone in healthcare needs to catch up on your records, it’s another provider who is treating mutual patients. In this day and age, there’s no good reason why clinicians at one hospital should be guessing what the other would get (or not get as the case is far too often).

Over the last few years, we’ve certainly seen signs of data sharing progress. For example, in early August the marriage between health data sharing networks CommonWell and Carequality was consummated, with providers using Cerner and Greenway Health going live with their connections.

Still, health data exchange is far more difficult than it should be. Despite many years of trying, hospitals still don’t share data with each other routinely, even when they’re treating the same patient.

To learn more about this issue, researchers surveyed pairs of hospitals likely to share patients across the United States. The teams chose pairs which referred the largest volume of patients to each other in a given hospital referral region.

After reaching out to many facilities, the researchers ended up with 63 pairs of hospitals. Researchers then asked them how likely they were to share patient health information with nearby institutions with whom they share patients.

The results, which appeared in the Journal of the American Medical Informatics Association, suggest that while virtually all of the hospitals they studied could be classified as routinely sharing data by federal definitions, that didn’t tell the whole story.

For one thing, while 97% of respondents met the federal guidelines, only 63% shared data routinely with hospitals with the highest shared patient (HSP) volume.

In fact, 23% of respondents reported that information sharing with their HSP hospital was worse than with other hospitals, and 48% said there was no difference. Just 17% said they enjoyed better sharing of patient health data with their HSP volume hospital.

It’s not clear how to fix the problem highlighted in the JAMIA study. While HIEs have been lumbering along for well more than a decade, only a few regional players seem to have developed a trusted relationship with the providers in their area.

The techniques HIEs use to foster such loyalty, which include high-touch methods such as personal check-ins with end users, don’t seem to work as well for some HIE they do for others. Not only that, HIE funding models still vary, which can have a meaningful impact on how successful they’ll be overall.

Regardless, it would be churlish to gloss over the fact that almost two-thirds of hospitals are getting the right data to their peers. I don’t know about you, but this seems like a hopeful development.

Hospitals Struggle To Get Users On Board With Mobile Policies

Posted on August 6, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A new survey has found that hospitals are having a hard time managing and tracking user compliance with mobile communications policies.

The survey, which was conducted in early 2018 by communications vendor Spok, collected information on mobile device communications strategies from approximately 300 healthcare professionals. Forty-four percent of respondents were clinicians, 10% were IT and telecom staff, 6% were executive leaders, and another 40% had a wide variety of healthcare roles.

Spok found that hospitals who do have a mobile strategy in place have had one for a long time, with 42% having had such a strategy for either 3 to 5 years or more than five years. Another 46% have had a formal mobile strategy for one to three years. Only 12% have had a strategy in place for one year or less.

Reasons they cited for creating mobile device strategies included the launch of a communication initiative (46%); a clinical initiative (25%); or a technology initiative (24%). Five percent of responses were “other.” Top areas of focus for these strategies included mobile management and security (56%), mobile device selection (52%) and integration with the EHR (48%).

Other reasons for mobile initiatives included clinical workflow evaluation (43%), device ownership strategy/BYOD (34%), mobile apps strategy (29%), mobile app catalog (16%), mobile strategy governance (14%) and business intelligence and reporting strategy (12%).

However, there’s little agreement as to which hospital department should monitor compliance. Forty-three percent of respondents said the security team was monitoring policies for the hospital or system, 43% rely on a telecommunications team, 43% said a clinical informatics team played that role, and 26% had monitoring done by a mobile team. Twenty-one percent said individual departments enforce mobile policies and 9% said they don’t have an enforcement method in place. Another 9% of responses fell into the “other” category.

Given the degree to which monitoring varies between institutions, it’s little wonder to learn that policies aren’t enforced effectively in many cases. On the one hand, 39% respondents said the policies were enforced extremely well most of the time, and one-third said they were enforced well most the time. However, 4% said the policies were being enforced poorly and inconsistently, and 44% said they are not sure about how well the policies are being enforced.

Hospitals are aware of this problem, though, and many are taking steps to ensure that users understand and comply with mobile policies. According to the survey, 48% offer educational programs on the subject, 42% use technology or data gathered from devices to measure and track compliance, 37% leverage direct feedback from users and 23% use surveys.

Still, 21% said they don’t have a way to validate compliance — which suggests that hospitals have a lot more work to do.

Phishing Attack On Hospital Could Impact 1.4 Million Patients

Posted on August 3, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A hospital in West Des Moines, Iowa has entered its third month of public disclosure after experiencing a data breach which could impact 1.4 million patients.

On May 31st, UnityPoint Health discovered that a phishing attack on its business email system had created a breach. Its investigation found that the company got a series of fraudulent emails pretending to have come from an executive within UnityPoint. After contacting law enforcement and beginning to research the situation, UnityPoint disclosed the existence of the breach to the public.

The patient information exposed includes names, addresses, dates of birth, medical record numbers and insurance information. Cyber attackers may also have gotten access to patient Social Security numbers and/or drivers’ license numbers. In a limited number of cases, attackers might even have been able to access patients’ payment card or bank account numbers.

Since then, UnityPoint has continued to keep its patients aware of any news on the situation, a painful yet necessary process which can help it rebuild its credibility. After all, it’s likely that the news of UnityPoint’s breach will get consumers very upset.

In fact, a new survey by SCOUT in partnership with The Harris Poll found that 49% of America adults are extremely or very concerned about the security of their personal health information. Given the fact that they’ve been hit with news of such breaches very regularly in recent years, it’s little wonder.

It’s worth noting that many consumers aren’t using online healthcare tools very often. For example, while 39% of those aged 18 to 34 used online portals to access their health information, all told only 36% of Americans overall use this technology.

As their health information knowledge increases, though, most patients become more concerned with what providers do to protect the privacy and security of their healthcare data. They learn how valuable this data is to potential buyers, and how there’s a ready market for their data in clandestine, impossible-to-track sites on the Dark Web.

Also, as the tenor of news coverage shifts from technical terms like “data breach” to tales of what happened to specific consumers, it’s likely that consumers will develop a more realistic view of what’s at stake here. If they’re freaked out at that point, they’ve probably figured out how a breach could impact their lives.

Switch From Epic To Cerner Comes With Patient Safety Questions

Posted on July 25, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Here’s a story in which no health system hopes to take a lead role — the tale of a Cerner installation that didn’t go well and the blowback the system faced afterward.

On October 1 of last year, Phoenix, Az.-based Banner Health switched its Tucson hospitals from Epic to a Cerner system, a move which reportedly cost the health system $45 million.

No doubt, the hospitals’ staff and physicians were trained up and prepared for a few bumps in the road, particularly given that the rest of its peers had already gone to the process. The Phoenix-based not-for-profit, which owns, leases or manages 28 acute-care hospitals in six states, had already put the Cerner system in place elsewhere, apparently without experiencing any major problems.

But this time it wasn’t so lucky, according to an article in the Arizona Daily Star. According to the news item, there were “numerous” reports of medical errors filed with the Arizona Department of Health Services after Tucson-area hospitals in the Banner chain were cut over to Cerner.

The complaints included claims that errors were creating patient safety and patient harm risks, according to one filing. “Many of the staff are in tears and frustrated because of the lack of support and empathy [for] the consequences [to] patient care,” one stated.

Not only did the conversion lead to patient safety accusations, it also seems to have lowered physician productivity and shrunk revenue as doctors learned to use the Cerner interface. While predictable, this has to have added insult to injury.

Meanwhile, according to the paper, the state seems to come down on the side of the complainants. While hospital leaders denied there were any incidents resulting in a negative outcome for patients, “the hospital’s occurrence log for October 2017 showed numerous incidents of medical errors reported to be a result of the conversion,” state investigators reportedly concluded.

While the state didn’t fine Banner or issue a citation, it did substantiate two allegations about the conversion, the Star reported. The allegations were related to computer/printer glitches impacting patient care and an inability to reliably deliver medications and order tests as part of care for critically ill patients.

The article says that Banner responded by pointing out that it has made more than 100 improvements to the Cerner system, resulting in better workflows and greater information access for physicians and staff. But the damage to its reputation seems to have been done.

No, perhaps Banner didn’t do anything particularly wrong when it installed the Cerner platform. However, if its leaders did, in fact, lie to the state about problems it actually had, it was not a smart move. On the other hand, one of the biggest problems you can have during an EHR implementation is users who don’t want to cooperate and make it a success. It’s not hard to see users who were happy with Epic dragging their feet as they shifted to Cerner. Either way, this is an important lesson as hospitals continue to consolidate and they consider switching the EHR of the acquired hospitals.

Clinicians Say They Need Specialized IT To Improve Patient Safety

Posted on July 24, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Hospitals are loaded down with the latest in health IT and have the bills to prove it. But according to a new survey, they need to invest in specialized technologies to meet patient safety goals, as well as providing more resources and greater organizational focus.

Health Catalyst recently conducted a national survey of physicians, nurses and health executives to gather their thoughts on patient safety issues. Among its main findings was that almost 90% of respondents said that their organizations were seeing success in improving patient safety. However, about the same percentage said there was room for improving patient safety in their organization.

The top obstacle they cited as holding them back from the patient safety goals was having effective information technology, as identified by 30% of respondents. The same number named a lack of technologies offering real-time warnings of possible patient harm.

These were followed by lack of staffing and budget resources (27%), organizational structure, culture priorities (19%), a lack of reimbursement for safety initiatives (10%) and changes in patient population practice setting (9%).

Part of the reason clinicians aren’t getting as much as they’d like from health IT is that many healthcare organizations rely largely on manual methods to track and report safety events.

The top sources of data for patient safety initiatives respondents used for safety initiatives voluntary reporting (82%). Hospital-acquired infection surveys (67%), manual audits (58%) and retrospective coding (29%). Such reporting is typically based on data sets which are at least 30 days old, and what’s more, collecting and analyzing the data can be time and resource-consuming.

Not surprisingly, Health Catalyst is launching new technology designed to address these problems. Its Patient Safety Monitor™ Suite: Surveillance Module uses protective and text analytics, along with concurrent critical reviews of data, to find and prevent patient safety threats before they result in harm.

The announcement also falls in line with the organization’s larger strategic plans, as Health Catalyst has applied to the AHRQ to be certified as a Patient Safety Organization.

The company said that he had spent more than $50 million to create the Surveillance module, whose technology includes the use of predictive analytics models and AI. It expects to add new AI and machine learning capabilities to its technology in the future which will be used to propose strategies to eliminate patient safety risks.

And more is on the way. Health Catalyst is working with its clients to add new features to the Suite including risk prediction, improvement tracking and decision support.

I’m not sure if it’s typical for PSOs to bringing their own specialized software to the job, but either way, it should give Health Catalyst a leg up. I have little doubt that doing better predictive analytics and offering process recommendations would be useful.

Despite Risks, Hospitals Connecting A Growing Number Of Medical Devices

Posted on July 20, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Over the past few years, hospitals have gotten closer and closer to connecting all of their medical devices to the Internet — and more importantly, connecting them to each other and to critical health IT systems.

According to a new study by research firm Frost & Sullivan, most hospitals are working to foster interoperability between medical devices and EHRs. By doing so, they can gather, analyze and present data important to care in a more sophisticated way.

“Hospitals are developing connectivity strategies based on early warning scores, automated electronic charting, emergency alert and response, virtual intensive care units, medical device asset management and real-time location solutions,” Frost analysts said in a prepared statement.

Connecting medical devices to other hospital infrastructure has become so important to the future of healthcare that the FDA has taken notice. The agency recently issued guidance on how healthcare organizations can foster interoperability between the devices and other information systems.

Of course, while hospitals would like to see medical devices chat with their EHRs and other health IT systems, it’s just one of many important goals hospitals have for data collection and analysis. Health IT executives are up to the eyebrows supporting big data transformation, predictive analytics and ongoing EHR management, not to mention trying out soon-to-be standard technologies such as blockchain.

More importantly, few medical devices are as secure as they should be. While the average hospital room contains 15 to 20 connected devices, many of them are frighteningly vulnerable. Some of them are still running on obsolete operating systems, many of which haven’t been patched in years, or roughly 1,000 years in IT time. Other systems have embedded passwords in their code, which is one heck of a problem.

While the press plays up the possibility of a hacker stopping someone’s connected pacemaker, the reality is that an EHR hack using a hacked medical device is far more likely. When these devices are vulnerable to outside attacks, attackers are far more likely to tunnel into EHRs and steal patient health data. After all, while playing with a pacemaker might be satisfying to really mean people, thieves can get really good money for patient records on the dark web.

All this being said, connected medical devices are likely to become a key part of hospital IT infrastructure in hospitals over time as the industry solves these problems, Frost predicts that the global market for such devices will climb from $233 million to almost $1 billion by 2022.

It looks like hospital IT executives will have some hard choices to make here. Ignoring the benefits of connecting all medical devices with other data sources just won’t work, but creating thousands of security vulnerabilities isn’t wise either. Ultimately, hospital leaders must find a way to secure these devices ASAP without cratering their budget, and it won’t be easy.

Revenue Cycle Trends To Watch This Year

Posted on July 13, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Revenue cycle management is something of a moving target. Every time you think you’ve got your processes and workflow in line, something changes and you have to tweak them again. No better example of that was the proposed changes to E/M that came out yesterday. While we wait for that to play out, here’s one look at the trends influencing RCM strategies this year, according to Healthcare IT leaders revenue cycle lead Larry Todd, CPA.

Mergers

As healthcare organizations merge, many legacy systems begin to sunset. That drives them to roll out new systems that can support organizational growth. Health leaders need to figure out how to retire old systems and embrace new ones during a revenue cycle implementation. “Without proper integrations, many organizations will be challenged to manage their reimbursement processes,” Todd says.

Claims denial challenges

Providers are having a hard time addressing claims denials and documentation to support appeals. RCM leaders need to find ways to tighten up these processes and reduce denial rates. They can do so either by adopting third-party systems or working within their own infrastructure, he notes.

CFO engagement

Any technology implementation will have an impact on revenue, so CFOs should stay engaged in the rollout process, he says. “These are highly technical projects, so there’s a tendency to hand over the reins to IT or the software vendor,” notes Todd, a former CFO. “But financial executives need to stay engaged throughout the project, including weekly implementation status updates.”

Providers should form a revenue cycle action team which includes all the stakeholders to the table, including the CFO and clinicians, he says. If the CFO is involved in this process, he or she can offer critical executive oversight of decisions made that impact A/R and cash.

User training and adoption

During the transition from a legacy system to a new platform, healthcare leaders need to make sure their staff are trained to use it. If they aren’t comfortable with the new system, it can mean trouble. Bear in mind that some employees may have used the legacy system for many years and need support as they make the transition. Otherwise, they may balk and productivity could fall.

Outside expertise

Given the complexity of rolling out new systems, it can help to hire experts who understand the technical and operational aspects of the software, along with organizational processes involved in the transition. “It’s very valuable to work with a consulting firm that employs real consultants – people who have worked in operations for years,” Todd concludes.

Important Patient Data Questions Hospitals Need To Address

Posted on I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Obviously, managing and protecting patients’ personal health information is very important already.  But with high-profile incidents highlighting questionable uses of consumer data — such as the recent Facebook scandal – patients are more aware of data privacy issues than they had been in the past, says Dr. Oleg Bess, founder and CEO of clinical data exchange company 4medica.

According to Bess, hospitals should prepare to answer four key questions about personal health information that patients, the media and regulators are likely to ask. They include:

  • Who owns the patient’s medical records? While providers and EHR vendors may contend that they own patient data, it actually belongs to the patient, Bess says. What’s more, hospitals need to be sure patients should have a clear idea of what data hospitals have about them. They should also be able to access their health data regardless of where it is stored.
  • What if the patient wants his or her data deleted? Unfortunately, deleting patient data may not be possible in many cases due to legal constraints. For example, CMS demands that Medicare providers retain records for a fixed period, and many states have patient record retention laws as well, Bess notes. However, if nothing else, patients should have the ability to decline having their personally-identifiable data shared with third parties other than providers and payers, he writes.
  • Who is responsible for data integrity? Right now, problems with patient data accuracy are common. For example, particularly when patient matching tools like an enterprise master patient index aren’t in place, health data can end up being mangled. To this point, Bess cites a Black Book Research survey concluding that when records are transmitted between hospitals that don’t use these tools, they had just a 24% match rate. Hospital data stewards need to get on top of this problem, he says.
  • Without a national patient ID in place, how should hospitals verify patient identities? In addition to existing issues regarding patient safety, emerging problems such as the growing opioid abuse epidemic would be better handled with a unique patient identifier, Bess contends. According to Bess, while the federal government may not develop unique patient IDs, commercially developed master patient index technology might offer a solution.

To better address patient matching issues, Bess recommends including historical data which goes back decades in the mix if possible. A master patient index solution should also offer enterprise scalability and real-time matching, he says.