Innovation and Impact on Reporting and Documentation in Gastroenterology
Section Editor
Vivek Kaul, MD
Professor of Medicine
Center for Advanced Therapeutic Endoscopy
Division of Gastroenterology and Hepatology
University of Rochester Medical Center
Rochester, New York
While previous editions of this column have highlighted advances in endoscope and device technology, there also has been significant progress in other aspects of endoscopic practice, particularly endoscopy reporting and documentation technology. This is an integral component of modern-day GI practice, regardless of setting.
The latest endoscopes and novel devices typically receive a lot of attention, but endoscopy documentation platforms are relatively low-profile, “back-room” workhorses that ensure clinical information, endoscopy images, and data are captured accurately, efficiently, and consistently with each procedure, day after day, even in the busiest and most complex endoscopy units in the country.
In this era of electronic medical records, Provation has remained at the forefront of the endoscopy documentation and reporting business, with an impressive array of milestones over the years. The company recently celebrated its 30th anniversary, and since then, I had the opportunity to discuss the early years of Provation with its co-founder Dan Steinberger, MD, and President Ankush Kaul, both of whom offered insights into the company’s current and future plans. In this first part of a two-part series, we focus on the company’s inception and formative early years. In the next installment, we will discuss the company leadership’s vision for growth and diversification regarding big data and AI-based ventures.
Dr. Kaul: Tell us about the origins of Provation and the early challenges you faced.
Dr. Steinberger: Provation’s journey began in 1984, when Czech physician Zdenek Maratka, MD, published his seminal work “Terminology, Definitions, and Diagnostic Criteria in Digestive Endoscopy: OMED Nomenclature of Digestive Endoscopy.” The standardized terminology introduced by Dr. Maratka provided the framework, as well as the definitions, for most of the Minimal Standard Terminology used in this field.
Fast forward to 1994: Sean Benson and I decided to start a software company focused on medical software for patient records. Around this time, we encountered Oliver Cass, MD, a gastroenterologist who had already developed some gastroenterology-related software. We worked with him to build a company around his software ideas. Because the gastroenterology field already had standardized terminology—thanks to Dr. Maratka, GI lent itself extremely well to procedure documentation—the concept that would eventually become Provation was born.
| Provation’s Product Portfolio | |
| Products span the entire patient procedure, from pre-op through post-op recovery and follow-up, including: | |
| Physician and nursing documentation |
|
| Anesthesia documentation and anesthesia information management system |
|
| Order set and care plan management |
|
Initially, we couldn’t find programmers willing to work for sweat equity, so Sean and I decided to learn coding ourselves. I bought a programming book, and with Sean’s background in mathematics and some previous programming experience, we managed to get the project off the ground.
Another notable challenge that comes to mind is when we presented our product to the European Society for Gastrointestinal Endoscopy. The night before the presentation, a last-minute change to the code caused the program to fail. Sean spent the entire night fixing it. Despite the setback, the presentation was well received and represents a major milestone in Provation’s history.
| Provation Milestones | |
| 1994 | cMore Medical, now Provation, is founded |
| 1996 | cMore Medical launches its first-generation procedure documentation software, Provation MD |
| 1997 | cMore Medical changes its name to Provation Medical |
| 2006 | Provation is acquired by Wolters Kluwer |
| 2007 | Provation launches Provation Order Sets |
| 2009 | Provation launches Provation Care Plans |
| 2014 | Provation celebrates 20th anniversary |
| 2018 | Provation is acquired by Clearlake Capital and launches its cloud-based platform, Provation Apex |
| 2020 | Provation acquires MD-Reports and ePreop |
| 2021 | Provation acquires iProcedures and endoPRO |
| 2021 | Provation is acquired by Fortive |
| 2024 | Provation celebrates 30th anniversary |
Dr. Kaul: Who was your first customer and what was their experience with this technology?
Dr. Steinberger: Our first customer was Hennepin County Medical Center (HCMC), in Minneapolis. Our “office” was essentially an old patient room in a closed ward down the hall from the GI lab. We would arrive early in the morning and wait for the physicians to complete their first GI procedures of the day. They would then document these procedures using our software.
As they did so, we would take very detailed notes, listen to them very carefully, observe them closely to see what really was or wasn’t working. And then in the afternoon, we’d go back down the hall, change the code, make a bunch of fixes, test it, roll it back out, and start all over the next day. We probably deployed around 150 release cycles over the course of a six-month period.
I recall one physician who provided very frequent and candid feedback during this trial phase at HCMC. While understandably frustrating at the time, the feedback he provided was invaluable, made the product stronger and more practical (and relevant) to the end user. We made numerous adjustments based on his input, which ultimately made our product more user-friendly for everyone.
Dr. Kaul: In your view, what event was a significant turning point for Provation?
Dr. Steinberger: A major turning point occurred when we went live at Massachusetts General Hospital, in Boston, in 1997. We had to rapidly develop new features, such as networking, image capture, and HL7 file transfers. The feedback from expert gastroenterologists, although initially daunting, was incredibly valuable and helped us refine our product. Despite numerous challenges, including a corrupt database and untested features, we managed to get everything working just in time for the launch date.
Dr. Kaul: The company has several product offerings in both the GI and anesthesia space. Are there any products you are most excited about?
Ankush Kaul: I’d say the way we approach adding value is by looking at the entire procedure journey—pre-procedure, intra-procedure, and post-procedure—and identifying how we can support providers, nurses, administrators, and patients in each of these stages.
Today, we’re successfully doing this across all these areas, especially in GI and anesthesia, but we’re really focused on scaling that impact. While products like Provation Apex, Provation MD, Provation iPro, and others are key to our offering, they’re just a part of the broader picture. We have a wide range of products, all of which align with these categories, and we’re excited to expand our solutions to add even more value in these critical areas.
The ultimate goal is to support those who are dedicating their days to ensuring patient safety and delivering quality care, and we’re continuously looking for ways to do that even better, whether it’s before, during, or after the procedure.
Provation Apex Trio Provider Screen.
Dr. Kaul: What should GI consumers know about your products or the company that they may not be aware of?
Ankush Kaul: Over the past 30 years, we at Provation have focused on understanding how health care professionals approach a procedure and patient care and translating that thinking into an intuitive user interface. Our goal is to take the complexity of your decision-making process and make it as simple and efficient as possible. That philosophy remains central to our mission.
Another key part of our ethos that folks should know is that while products are essential to our business, the question we constantly ask ourselves is how we can best serve you and the broader healthcare ecosystem. One example is that we are committed to interoperability—making it easier for you to work across different systems without the need to input redundant information. We want to simplify workflows for everyone involved, ensuring that our solutions help you deliver quality care with minimal friction.
Facilitating analysis of procedure volume and provider productivity data (productivity dashboard).
As for AI, we’re definitely exploring it, but we’ve made a deliberate choice not to chase the latest technology trend just for the sake of it. Instead, we start by identifying the customer problems we want to solve and then use AI as a tool to address those challenges. While AI will play a role in our products moving forward, it’s always in service of solving real-world problems, not just for the sake of using the latest buzzword.
Dr. Kaul: From your perspective, what are some of the biggest unmet needs in the industry right now?
Ankush Kaul: One key challenge is the issue of administrative and cognitive burden. Healthcare professionals shouldn’t have to spend time on documentation; it should be automated. Unfortunately, that’s not the reality, and the burden of managing documentation and not being able to move quickly to the next case is a significant challenge we understand and are working to address.
Recording & monitoring endoscopist quality metrics data (quality dashboard).
Closely related to this is the issue of interoperability between systems. If we center the patient in the equation, the goal is to have a seamless system where healthcare doesn’t operate in silos. We always ask ourselves how we can make data exchange between different systems as smooth and efficient as possible to provide the highest quality and safest care for the patient. Interoperability is becoming even more critical as healthcare systems grow larger, whether they’re academic or private institutions. It is increasingly urgent for health systems to work together more seamlessly than they currently do.
On a slightly different note, there’s an opportunity in leveraging the vast amounts of data we have, both structured and unstructured. If we can provide real-time insights from these data, it will help providers, nurses, administrators, and patients make more-informed decisions. It’s about identifying trends, enhancing patient safety, and improving outcomes.
Image Association localizing and integrating documentation of pathology (polyps) within procedure report.
Summary
The last few decades have witnessed several major paradigm shifts in medicine. The evolution of electronic medical records has certainly been a significant change in the way we now practice medicine. Endoscopy procedure documentation and reporting has now come of age and represents a major advance in our field. An effective endoscopy reporting system not only improves accuracy, but has best-practice, quality, and medicolegal implications. Such systems also facilitate data retrieval for a variety of purposes, ranging from quality improvement initiatives to clinical research. In this issue of Tech Spotlight, we gained valuable insights into how a leading entity in this field was founded, what the early challenges were, and the scope of current applications, while getting a glimpse into the future. In a subsequent review, we will dive deeper into the plans for future innovation and how this technology may help shape GI practice in years to come.
Dr. Kaul is a consultant to Provation Medical and a member of the Gastroenterology & Endoscopy News editorial board.
This article is from the March 2025 print issue.
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