Readers Write: Putting the Patient First Means Fixing a Fragmented Healthcare Ecosystem

Putting the Patient First Means Fixing a Fragmented Healthcare Ecosystem
By Terry Edwards

The New York Times recently shed light on one of healthcare’s worst-kept secrets: Fragmented care is the norm to the detriment of patients. Too many patients experience disconnected transitions as they move across a variety of care settings. Many patients complain about how each of their providers seem to ask the same questions. This repetition is more than an annoyance; it’s further proof of just how little each clinician knows about the patient’s medical history, and makes it difficult to ensure patients are sticking to the appropriate treatment plan. This disconnect between care settings has a negative impact on providers as well. According to the Institute of Medicine, fragmented care and other inefficiencies cost the healthcare system at least $130 billion annually. Moreover, a survey from the Agency for Healthcare Research and Quality reported that poor communication during care transitions can lead to duplicate testing, medication errors, and lack of follow through on referrals – all of which drain staff and resources.

As our healthcare ecosystem moves toward value-based care and population health management, it is becoming even more critical for providers to get on the same page about a patient and collaborate more efficiently and effectively.

Healthcare professionals understand how important this is to get right. My organization, PerfectServe, recently commissioned Harris Poll to conduct an online survey of 955 medical professionals. Ninety-eight percent of those surveyed (both clinical and administrative) indicated that improved communication with patients is critical to improving population health. While there is consensus that communication and collaboration are keys to success, I have a few theories on why this is still missing from day-to-day practice:

· Misdirected incentives. Much of the healthcare industry remains wedged firmly in fee-for-service. Coordinating care makes little financial sense for physicians, who are paid per task, not for improving patient care. Without the appropriate financial incentives in place, coordinated care is the exception, not the rule.

· Overreliance on the EHR. The EHR was heralded as the answer to everyone’s healthcare problems – from claims to improving the accuracy of patient records, creating greater care team access to relevant information, and better coordination of care. Our survey showed that only about half of hospital-based physicians and primary care physicians in large practice organizations believe the EHR is sufficient for care coordination and collaboration. The EHR has an important role to play in healthcare delivery, but, like most “miracle cures,” it can’t fix everything and needs to be considered in its proper perspective.

· Too little time. Clinicians in all roles are feeling crunched for time to treat patients and handle all of the administrative tasks required of them. According to a 2012 study by the Physicians Foundation, more than 57 percent of physicians report working more than 50 hours per week, and eight out of 10 (81 percent) physicians describe their practices as either over-extended or at full capacity. This makes it harder for clinicians to find the time to reach out to their colleagues to coordinate patient care.

· Gap between clinical and administrative teams. One of the challenges identified in our survey is a wide disparity in understanding between administrative (hospital administrators and office managers) and clinical (physicians, nurses, and case managers) respondents. For example, while 94 percent of hospital administrators say they are familiar with their organization’s population health management strategies, only 61 percent of hospitalists responded the same way. And while administrators might not be needed to coordinate a patient’s care, they’re absolutely critical to making sure clinicians understand organizational priorities in terms of coordinated care and population health. They also need to understand clinician workflow so that they can invest in tools and technologies that enhance rather than impede workflow.

Healthcare organizations are making great strides in tackling many of these issues. Value-based care will encourage clinicians to collaborate more with other care team members to help reduce inefficiencies and ensure smooth care transitions. The move to larger, integrated health systems may help create stronger relationships by connecting providers under a similar umbrella, facilitating referrals within the system. And many healthcare providers are looking at different tools to make sure their clinicians have what they need to collaborate with other care team members easily and through the appropriate channel.

Managing the health of patient populations is no easy task, but providers are rightfully focused on forging a path to get there. To accomplish this successfully, organizations need to create a strategy to transition their fragmented system to one which fosters true collaboration.

Terry Edwards is CEO and founder of PerfectServe in Knoxville, TN.

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Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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News 4/30/15

Top News

UnitedHealthcare partners with American Well, Doctor On Demand, and Optum’s NowClinic to provide video-based virtual visits to its members in 47 states and Washington, D.C. United now covers virtual visits at a cost equal to or lower than in-office visits, putting one more nail in the coffin of the aging primary care business model.

Acquisitions, Funding, Business, and Stock

Providence Medical Group builds out its Dayton, OH headquarters with an eye to potentially adding up to 50 jobs this year. Twenty of those may be ICD-10-credentialed IT staff who will help the growing group better manage its Athenahealth EHR.

Announcements and Implementations

University Physician Associates of New Jersey implements Premium Analytics as part of its MedAptus Charge Capture suite. UPA, which serves the Rutgers Biomedical and Health Sciences and New Jersey Medical School, will use the new tool to assess the impact of the ACA on the setting of care for visits.

Ideal Life integrates the Nonin 3230 Smart wireless finger pulse oximeter into its remote-monitoring platform for chronically ill patients.

Athenahealth and Liaison Technologies develop a HL7 interface and interoperability guide, enabling rapid deployment of new lab, imaging, and other HL7 messages. Data will be exchanged between Liaison’s EMR-Link lab hub and the athenaNet platform.

Surescripts leverages PDR’s extensive library of electronic prior authorization forms to expand coverage of its CompletEPA electronic prior authorization solution. Through the collaboration, CompletEPA will be available to nearly 300,000 physicians, and capable of processing benefit data for nearly all patients in the U.S.

Research and Innovation

A Family Medicine for America’s Health survey of people suffering from chronic conditions reveals that 72 percent are not receiving the tools and support necessary to live healthy lifestyles. Between 35 and 44 percent note they do not receive information on managing their conditions, or support and advice about their medications. The survey results don’t dive into the role healthcare technology could play in ameliorating these statistics. It would be interesting to see how many respondents actively promote use of their portals to this same patient demographic.

Health Affairs outlines three themes related to eliminating waste in physician practices – the result of 10 focus group discussions with 62 primary care and specialty physicians in the northern Midwest:

1. Nudge choices, but preserve and promote clinical judgment.
2. Promote relationships and communication.
3. Encourage low-tech, high-touch care.

Telemedicine

Wired dives into the ambitions of Sherpaa, a telemedicine startup that wants to bypass remote video consults in favor of text messaging. The company, which counts Etsy and Tumblr among its 100-plus clients, claims it can serve 70 percent of its patient queries with text and picture messages.

Other

Tattooed Apple fan boys (and girls) may want to think twice about purchasing an Apple Watch. Users with dark ink on their arms have noted the watch’s inability to detect direct contact with the skin, and the subsequent inability of heart rate sensors to read their pulse.

ITriage offers HealthAtHand.com to help consumers test their knowledge about how the U.S. healthcare system works, including how to read a pill bottle. I earned two out of four stars, scoring 26 out of a possible 42 points. I blame my mediocre performance on the questions related to deductibles and insurance networks!

The folks at HP were kind enough to invite me to sit in on a Google Hangout demo of the company’s new ElitePad Healthcare Tablet. Reid Oakes, HP’s senior director of worldwide healthcare, highlighted the “relevant interaction” the tablet can bring to the physician/patient encounter. The handheld device, which includes full dictation capabilities, literally increases engagement time since the physician’s eyeballs are are free to gaze at the patient rather than at a desktop for data entry. Oakes also mentioned the durability of the device, suggesting a game of tablet Frisbee is not outside the realm of possibility.

GE Healthcare’s Keith Boone tweets from the Centricity Live event, where I can only assume Mark Segal’s question to the audience garnered less than a handful (get it?) of responses.

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Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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News 4/29/15

Top News

Dallas-based Teladoc files an antitrust lawsuit against the Texas Medical Board to prevent a rule from taking effect in June that would restrict the practice of telehealth. “It is clear that the medical board acted only when Teladoc consultations became sufficiently numerous to be perceived as a competitive threat to brick-and-mortar physician practices,” explains Teladoc CEO Jason Gorevic. The company’s case asserts that the medical board is illegally limiting competition by requiring an in-person visit before physicians are allowed to treat patients. 

In related news, Teladoc files a confidential Form S-1 with the SEC, expressing an intention to file an IPO after the SEC’s review process.

Announcements and Implementations

MDToolbox’s MDToolbox-Rx e-prescribing system receives the Surescripts White Coat of Quality Award for the third consecutive year.

North Florida Women’s Care selects Keona Health software to help it better triage patient calls at its three locations. Keona Health expanded to internal medicine last month via implementation of its tool at Wake Internal Medicine Consultants (NC).

The Everett Clinic (WA) implements the Visual TruView AANPM and OptiView XG solutions from Fluke Networks to monitor its network and applications, including its Epic EHR, running at 25 facilities in eight communities.

The American College of Medical Scribe Specialists partners with the American Academy of Urgent Care Medicine to offer AAUCM members a scribe program specific to urgent care, and discounts to membership toward certification.

EHR Solutions adds Dragon Medical Practice Edition 2 to its line of speech-recognition software.

Government and Politics

A GAO report examines the ways in which electronically readable cards could be used by Medicare to replace paper Medicare cards, which display the Social Security numbers of beneficiaries. President Obama signed off on legislation earlier this month that mandates the numbers be removed from Medicare cards within the next four years. WEDI, which contributed to the report, is working with the Sullivan Institute for Healthcare Innovation, MGMA, and HIMSS as part of the Virtual Clipboard Initiative to develop a next-generation digital health ID card.

Senate health committee Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA) announce a bipartisan committee working group to identify ways to improve EHRs. Specific goals include:

• help doctors and hospitals improve quality of care and patient safety;
• facilitate interoperability;
• empower patients to engage in their own healthcare through convenient, user-friendly access to their personal health information;
• leverage health information technology capabilities to improve patient safety; and
• protect patient privacy and security of health information.

People

The Greater Miami Chamber of Commerce recognizes Modernizing Medicine Co-Founder and CEO Dan Cane as Technology Entrepreneur of the Year. Cane and the company seem to be riding high, thanks to the acquisition of Aesyntix Health late last year and a promising collaboration with IBM Watson. You can check out my recent interview with Cane here.

Telemedicine

Tech Republic profiles Maven, a startup born out of the Female Founders Fund that bills itself as the “first digital health clinic for women.” Currently in beta, the online clinic offers services for pregnancy prevention, pregnancy, and prenatal and postpartum care. Its business is model seems unique in that it allows patients to remain anonymous and receive healthcare “education” (and thus no prescriptions). Like most telemedicine vendors, its ability to scale will be contingent on the ability of its physicians to practice remotely across state lines.

The telemedicine pricing wars have begun. Bypassing the $40-and-up per-visit fee charged by many telemedicine companies, Family Covered launches a family plan of unlimited telemedicine visits for $29.95 a month. The Newport Beach, CA.-based company launched in 2014 as part of the Modern Care Plans family of service lines.

MyOnCallDoc launches mobile apps for Apple and Android. Out of curiosity, I looked at MyOnCallDoc’s pricing plans, and they charge just $10 a month for a family plan, though their website doesn’t mention if that includes unlimited telemedicine consultations.

WellHealth Quality Care, Nevada’s first multi-specialty ACO, selects TruClinic’s telemedicine platform. WellHealth will initially roll out the service to its family practice, pediatrics, obstetrics, ENT, and cardiology providers, plus wellness programs such as diabetic counseling.

Kaiser Permanente upgrades from serving patients once a week out of its mobile clinic behind the local Kmart to building a new primary care facility in Tehachapi, CA. The outpatient facility will also utilize “state-of-the-art” telemedicine technology to connect patients to specialists across Southern California. Patients will also be able to check their KP.org medical record (Epic, if my memory serves me correctly) at the new Thrive Bar.

Other

Could the “Selfie Arm” be next year’s big giveaway at HIMSS? Developed by Aric Snee and Justin Crowe – artists known for experimenting with the relationships between humans and technology – the creep factor will likely be too high. The arm’s flesh tone reminds me of a cadaver.

Sponsor Updates

• ADP AdvancedMD announces the launch of its SmartPractice e-letter for independent practices.
• The local paper looks at how several HIStalk sponsors including Nordic Consulting are making an impact in their native Madison, WI.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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News 4/28/15

Top News

The Institute of Medicine will rename itself the National Academy of Medicine effective July 1, 2015. The change is part of a larger internal reorganization to more effectively integrate the work of the National Academies of Sciences, Engineering, and Medicine.

Acquisitions, Funding, Business, and Stock

New York-based software development and IT consulting firm Algonquin Studios rebrands as Algonquin, and announces it will focus solely on healthcare clients moving forward. The company is undergoing significant expansion of its office space in downtown Buffalo.

Government and Politics

In an effort to ensure more accurate subsidies, CMS decides to automatically re-enroll and re-calculate the subsidies of consumers who don’t return to Healthcare.gov to update their eligibility for tax credits in 2016.

People

Medical kiosk vendor HealthSpot hires Gail Croall, MD (Anthem) as chief medical officer; Eric Eichensehr (Levitate Technologies) as CTO; and Bruce Roberts (RxEngage Partners) as COO.

Research and Innovation

A survey of small-practice physicians finds that close to a third are “not at all confident” their organizations will be adequately prepared or their employees adequately trained in time for the October 1 ICD-10 deadline. To make matters worse, 33 percent feel that there should be no transition, making me think that perhaps it’s the issue of change, rather than technology, that is keeping physicians from timely preparations.

A Northwestern University Feinberg School of Medicine study finds that patient portals may widen the digital divide between the underserved and more affluent. The study showed white patients were 2.5 times more likely to be registered as portal users than African-American patients, while those with good health literacy skills were 3.5 times more likely to be registered with the portal than those who didn’t have those skills. Study co-author Sam Smith puts the portal problem in perspective: “If we now further complicate what it means to be a patient by asking people to be engaged outside the doctor’s office – on the Web or by mobile phone – and if these same groups of patients are not as capable or ready to assume these new roles, we may further exacerbate the disparities that already exist.”

Other

David Blumenthal, MD, president of the Commonwealth Fund and former head of ONC, pontificates on the future of healthcare, daydreaming about the role the smart home (and Uber) will play in the automated care of aging parents, and the quality and deductible data that will soon be at our fingertips in a single click. He ends with a dash of reality, calling for increased interoperability, privacy, and security of cloud-based health data.

Emily Queenan, MD recounts her decision to relocate her Rochester, N.Y.-based family medicine practice, which used “the latest in 21st century technology,” to Canada after losing too much sleep over attempting to conquer America’s broken healthcare system: “I spoke with other physicians, both inside and outside my specialty, about alternatives. We invariably ended up talking about the tumultuous time that the U.S. health care system is in – and the challenges physicians face in trying to achieve the twin goals of improved medical outcomes and reduced cost. The rub, of course, is that we’re working in a fragmented, broken system where powerful, moneyed corporate interests thrive on this fragmentation, finding it easy to drive up costs and outmaneuver patients and doctors alike.”

Apple Watch officially launches. Should I ever be in the market to be even more connected and quantified than I already am, I’d probably opt for the $349 Sport model. I do wonder how well it would hold up during one of my ALTA doubles matches.

Like many consumers, I switched health insurance plans earlier this year and am still getting used to Medi-Share’s business model. I was pleased to read in their latest marketing materials that they see value in offering their customers digital health tools from CareSync and BridgeHealth Medical.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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5 Questions with Rushika Fernandopulle, MD CEO, Iora Health

Rushika Fernandopulle, MD is CEO and co-founder of Iora Health, a chain of primary care practices that employs 160 at facilities in six cities across the country. The four year-old company, which expects to double in size this year, interacts with thousands of patients a week – many via email, phone, text, and video. Iora Health has opted out of Meaningful Use in favor of focusing on, as Fernandopulle puts it, “the goal of building a technology platform to allow us to deliver better care for our patients, period. I’m not sure I agree with the fundamental premise that the government should decide from the top what features should be in our platform. We should decide this bottom up based on our needs. One would think the failure of Soviet style central planning would inform this.”

The company serves patients through relationships with employers and payers like Humana, and places a strong emphasis on customer service. “We start by hiring physicians and other staff who understand we are in a service industry and have the right culture,” he explains. “During training, we expose people to excellent service industries outside of healthcare (e.g.  Apple, Zappos, Ritz Carlton), and build our system to help us provide excellent service. This isn’t a program or initiative – it is at the core of who we are.”

Iora Health has been described as wanting to be “the Starbucks of healthcare.” What sort of cultural and technological challenges are you encountering in scaling primary care nationwide?
We did something a little crazy but strategic right from the start. Our first two practices opened within a few weeks of each other back in 2012. They were in Hanover, N.H. with Dartmouth College, and in Las Vegas with the Culinary Union. I don’t know of many others who would do this. We did it because we want to transform healthcare, and we knew then that in order to do that we had to think about how we would scale from the start. Today, if you go to either of these – or the 10 other practices we have around the country – you’ll see that the culture is the same.

This goes for tech, too. We didn’t build our system to support one practice. We built it to scale. Because we built it and have a team dedicated to it, when we want to change anything, we can – we don’t have to put in a request to another company and get in a queue. We prioritize our needs and implement them.

What was the impetus behind developing rather than buying an EHR off the shelf? Did you test drive any? If so, from what vendors?
Existing EHRs, not surprisingly, are built for the current business model – to increase coding and billing. We have a fundamental job to do – to improve the health of our patients and keep them out of trouble. I have worked with a number of EHRs prior to founding Iora Health and struggled to use them in our very different care and business model. For years I tried to get some of the existing vendors to adapt their products for us, and realized that – as with our care model – we simply had to start from scratch.

How long did EHR development and roll out take?
Our tech team develops and rolls out iterations of our platform every two weeks. The first instance was built in six months, which is unheard of in the EHR world! We build with MVP (Minimum Viable Product) in mind and then get feedback from the care teams and improve. The development team, by the way, includes doctors, health coaches, and other members of our care team. This isn’t a system that was built in a backroom separate from the care and delivered a year or two later!

What sort of features are unique to your EHR?
Some unique features include: the patient’s ability to view their entire chart, schedule encounters (video, phone, and in person), and send us data; robust, proactive task management; patient stratification and population management; and a wide lens where our care teams can see what is happening to our patients in the rest of the healthcare system. 

What will the next few years hold for the company? Will you look into offering telemedicine services, or other digital health offerings?
We are really excited about the future. This year we closed our Series C funding and already opened one practice with Hartford Healthcare. We will double in size and expect to double in size again next year. What’s fundamental about our vision and our success is that we built this around relationships and culture. We think it’s silly to think of telemedicine as a separate thing. From the beginning we have based our model on continuous healing relationships, and that means being able to interact with our patients using the technology they are already using in all the other parts of their lives.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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