HIStalk Practice Interviews Kyna Fong, Co-founder and CEO, Elation EMR

Kyna Fong is co-founder and CEO of Elation EMR of San Francisco.

Tell me about yourself and Elation EMR.

I founded Elation with my brother, Conan. Our dad’s a family doc and so as kids, we helped him build his practice from scratch. We did everything from rooming patients to billing and negotiating with insurance companies, to installing all the equipment in IT. I managed his practice, and hired and trained all his staff for almost a decade. He was a paper hold-out for as long as possible, but we convinced him to let us build the Elation EMR live in his practice, basically using it as a lab.

Prior to Elation, I did something quite different. I was an economics professor at Stanford. A few years ago, I was fortunate to be nominated as a Robert Wood Johnson Foundation Health Policy Scholar. There I saw firsthand the huge chasm between how policy makers and administrators envisioned technology would transform healthcare and what was actually happening on the front lines of care in my father’s practice and in his colleagues’ practices. It was that exposure that made me passionate about creating technology that supported and strengthened the patient-physician relationship.

At Elation, we built a clinical platform from scratch focused on bringing physicians and patients closer together. We’ve optimized our EMR for the clinical needs of the provider, rather than optimizing for compliance or administrative purposes.

As for my job as CEO, I make sure that we’re focused on our key priorities, that we execute effectively, and that, most importantly, we continue hiring passionate, phenomenal people. Along with Conan, I outline our vision and ensure our strategic direction stays true to our mission and values.

Are your typical customers are on the ambulatory side?

Yep, our typical customers are indeed on the ambulatory side. Our typical provider tends to have long-standing relationships with patients and deliver longitudinal care. As a result, she often has a disproportionate number of complex patients with multiple chronic conditions. Communication is a key part of the service she delivers to patients, and she often coordinates care with a lot of other caregivers as well.

Our providers span most specialties. Over 30 specialties are represented in our current client base, which includes a couple of thousand users from across the country. They range from working in solo practices to 20-plus provider practices.

While many of our users have switched from other systems, we’ve actually noticed a substantial number of "paper hold outs" switching over, too. We’re excited by how our product maintains a lot of the benefits they would miss on paper.

How do you see physicians at different-sized practices using the EHR?

Two of our earliest pilot customers were a solo doc and a 15-provider practice. We found there was little difference between the clinical tasks they needed to accomplish. Having a larger staff, however, does mean there are a number of different workflows to consider. That observation made us ensure early on that our product is workflow-agnostic and avoids unnecessarily locking the user into doing specific tasks in a specific order. In addition to improving the user experience, that approach has also minimized our need to customize extensively based on practice size.

It’s true that needs do differ quite a bit between a solo practice and large groups from a reporting and administrative perspective. As long as we have a system that engages providers and is a source of truth, then we have the data needed to address the range of reporting and administrative requirements. We can then make the data available in a flexible, customizable way via our API.

How do you plan to grow the company over the next three to five years?

It’s no secret that the biggest challenge we’re facing as an industry and as a society is the urgent need to deliver higher quality care at lower costs. At Elation, we aim to enable excellent care, particularly for those 20 percent of complicated, chronically ill patients that account for 80 percent of healthcare costs. Typical EMRs are designed as static repositories of information, but from the beginning we’ve been focused on delivering a dynamic, powerful, clinically-focused tool that empowers providers to manage the overall care of even the most complex patients. Elation’s really designed to be the most solid clinical tool in the provider’s arsenal. We feel this clinical focus addresses a fundamental need that nobody out there is positioned to address.

There’s clearly a mounting demand for something more than the first version of EMR that’s been pushed out there, and user surveys have all highlighted the growing provider dissatisfaction with existing systems. The surveys consistently find a third to about half of physicians are looking to switch EMRs. We’ve invested significantly in helping switch practices to Elation with minimal disruption, making sure we’re bringing up the data they need.

In terms of what we anticipate rolling out down the line, ultimately we want Elation to tell the comprehensive story of a patient’s health and make it securely accessible, adjustable, and actionable to anybody involved with the patient’s care so that caregivers and providers can be on the same page regardless of what system they use. We want to make sure that our system is available wherever needed, and that decision making is therefore informed, consistent, and generates the best possible outcome for the patient. The plan down the road is to expand the Elation platform and definitely bring us closer to these goals.

Each of your employees spends time shadowing physicians. How much time, and how does that clinical presence help shape their ability to do their job?

The number of hours varies, but the key for us is what employees see the physician doing during their shadowing sessions. We ensure that every single team member, including engineers, has at least one training session where they shadow a physician for an entire day – from when the doors open and the staff start preparing until the doors close. Shadowing for a complete day sheds light on the diverse context that physicians work in, and fleshes out a much more realistic picture than simply shadowing isolated activities independent of one another, which we found can be misleading.

People ask why we shadow and how it affects the product we deliver. One thing I will say is that it makes a tremendous difference when every single person who takes part in creating not just the product, but also the overall experience, has context for what’s going on in the practice. Even thinking and understanding the difference in context between being inside the exam room versus being between visits makes a huge difference. That ingrained awareness within the company creates so many valuable checks on the end-user experience that we ultimately deliver.

It’s really hard to understand the degree to which providers are constantly clicking, switching, and multi-tasking. With shadowing, you see with your own eyes how physicians deal with documentation while simultaneously returning phone calls, coordinating care with other providers, and communicating internally with staff. I think that seeing that drills into us the importance of details and how frustrating even the smallest details can become. I think we end up having a much more flexible product because of the shadowing and really trying to expose ourselves to the user’s experience.

Why choose the name Elation?

We wanted our focus on user experience to come across first and foremost. It’s the emotion we want users to feel when they’re using our product. We thought it would express our commitment to that as a company.

You made the case recently that Elation has more satisfied customers than Apple – a pretty bold statement. How are you measuring customer satisfaction?

We use the Net Promoter score, a universally recognized method that companies of all types across the world use to measure customer loyalty and experience. The reason we chose the comparison sample is because Apple has really set the gold standard for simple and intuitive user experience, as well as deep customer loyalty. That’s the bar we want to hold ourselves to.

Traditionally, B2B businesses haven’t been held to the same high bar as consumer businesses, because selling to businesses used to mean that you could rely on restrictions and long-term contracts and switching costs to really capture the customer. But the world is changing. We don’t lock our customers into long-term contracts. We have to earn their business month after month, so it’s really important for us that we know whether or not we’re delivering.

We also have deep influence from Ideo, a design consulting firm whom we’re grateful to have as our supporters. We believe if we continue delivering a phenomenal, delightful experience to our users, we’ll come out on top.

Do you see user experience becoming a true differentiator within the EHR market, especially as we’re seeing it continue to consolidate?

Yes, absolutely. As I alluded to before, I think customers in this market increasingly recognize and understand that an EMR whose user experience distracts and encumbers the physician is actually detracting from patient care. As patients become more complicated and costs become more critical to control, you see providers starting to demand an EMR that enables them to become more clinically effective and manage the patient’s overall care.

I think we’ll also see the market responding to systems that not only improve the physician’s user experience, but the patient’s experience as well. Within the EMR market, as data formats become more common and standardized, physicians will be empowered to move from EMR to EMR more easily. We’re already seeing a lot of that happen today, with well over half of our new users switching from other systems.

What’s your take on scribes, and how do you see your customers reacting to them?

Scribes are certainly an indication that EMRs are adding to the burden of physicians rather than lightening it. I can’t think of a single industry where technology makes its users less productive and everyone says, “Oh, that’s okay.” A lot of the EMRs out there, especially the ones practices rush to adopt to get Meaningful Use dollars, are built with the express purpose of shifting administrative and compliance burdens for physicians, which I think drives some of the demand for scribes. We couldn’t disagree more with that approach. At Elation, we’re definitely determined to lighten the physicians’ burden and enable them to keep patients as their first and foremost priority.

What lessons did your team learn from watching Practice Fusion go through its recent downtime?

We use Amazon, so we are a cloud-based service as well. While we do rely on third parties to help deliver our solution, we feel fully responsible for our users’ experiences. Based on our own experiences running a practice, we know access to records is critical, even if it’s only read-only. We make sure we have multiple levels of redundancy to ensure our users have access to their records any time. In fact, our users have access to back-up, read-only versions of our system that we run as a separate site on completely independent infrastructure.

Also, our customers can reach us any time and get a response within 30 minutes for all urgent issues.

We definitely place support and responsiveness as top priorities, ensuring our practices always have access to their records in order to deliver care. Those qualities are the two most frequently referenced in our customer testimonials.

Any concluding thoughts?

Our first resolution is simple: Focus on physicians so they can focus on their patients. We all know technology has enormous potential to enhance patient care and reduce costs, and to make that a reality, we need to start with an intuitive, clinically-focused tool that physicians can actually use and rely on for care, even for the most complicated patients. The rampant productivity loss and provider distraction we see today only hurts patients in the end. We’re determined to work with providers to change that and really enable them to focus on delivering excellent care to their patients.

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Contacts

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

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