5 Questions with John Sawyer, MD Hudson Headwaters Health Network

John Sawyer, MD is an internal medicine physician at Hudson Headwaters, a federally qualified health center in upstate New York. The FQHC’s 150-plus physicians and mid-level providers care for a total of 50,000 patients over 320,000 visits each year. The practice, which uses Athenahealth’s AthenaOne platform, has fully attested to Stage 2 of Meaningful Use, and has been recognized as a patient-centered medical home.

What type of population health management program is Hudson Headwaters participating in?
I am trained as a primary care physician, but Hudson Headwaters provides pediatric and family care, as well behavioral health, women’s health, and dental care. In that way, you could say that we practice the essence of population health management for all of our patients; we’re managing their total health for a good portion of their lives, if not for their entire lives. We are also a patient-centered medical home, which means that we embody a primary care delivery model structured around coordinated, continuous, comprehensive, and community-based care. That’s a lot of “Cs,” but we believe in all of them!

As an FQHC, we are required by law to think about our population’s health. We are responsible for coordinating a patient’s care — from immunization to pap smears — even if we only see that person irregularly and for reasons outside of our control. Our funding is tied to this type of basic care coordination, and we have enormous reporting requirements that cover not only the kinds of care that we provide but also the quality targets we reach. Our cloud-based technology lets us drill down into that data to closely track and analyze our performance. We run population health campaigns using our patient engagement service, AthenaCommunicator, to identify and communicate with patients who are due for care and ensure that they come in to receive it. Hudson Headwaters also has an incredible team of care managers and outreach staff who identify high-risk patients for intervention and who generally ensure smooth care transitions. I credit a lot of their work to our excellent quality metrics. Our illness rates and average hospital and ER visits are quite favorable compared to other Medicaid blocks in New York State.

How has healthcare technology impacted HH’s population health management programs?
Healthcare technology has made coordinating care so much easier for our practice, and it’s made the experience of receiving care better for our patients. Hudson Headwaters has 16 geographically dispersed offices, ranging from Champlain, New York — one exit from Canada — to the central western Adirondacks. That’s over a two-hour spread. We staff outpatient facilities, two busy urgent care centers, and even inpatient facilities at several local hospitals. We work in nursing homes and offer home visit programs. Sharing paper charts between all of those care sites was virtually impossible before we implemented cloud-based health IT services. With them, our care teams are now able to communicate seamlessly. We can see the same patient in different offices, review their charts remotely, and respond to questions during off-hours via the patient portal. It’s a much more streamlined process, and one that has encouraged efficiency and patient engagement. Rural regions like ours historically struggle with patient engagement; having flexible technology that connects us to our patients outside the encounter has been essential.

What types of IT challenges do FQHCs face when it comes to implementing population health management strategies?
It can be quite difficult to get the cost data we need to build a really data-rich analytics model for our population health strategies. We look carefully at utilization, benchmark our providers and locations, and try to identify opportunities to increase quality while reigning in costs. But, we can never get all the data we need. Currently, we use a homegrown solution, running reports out of hospital discharge logs. We have started with our first imports of Medicare data with full cost information processed through Athena’s ACE population management system. It will allow us to define the sorts of care our patients are using and who the most efficient providers of service are. I believe that the transparency and network intelligence offered from cloud-based software will be able to satisfy our data reporting and analysis needs.

What plans does HH have for the next phase of its population health management projects?
Finances have traditionally been tight for FQHCs. It’s really hard to execute your mission when you have no margin, so population health incentives open up a whole world of financial opportunity for us. We need a solution that will unite all of our data with our outreach efforts, to automate tasks and reporting. That way, we can better prove the value we’re creating and get compensated for it. Currently, Hudson Headwaters lives with its feet split between the fee-for-service and fee-for-value world. We participate in a few pay-for-performance programs with private insurers and an ACO with Medicare Shared Savings Program. I anticipate that Hudson Headwaters will continue to compete in the fee-for-value world, as those opportunities continue to appear.

What are the biggest IT challenges HH faces at the moment? How will these be overcome?
Interoperability is a big and entrenched problem. Hudson Headwaters needs to be able to exchange health information with other care sites that treat our patients. Even though this exchange is technically possible, there are many economic and business disincentives in the industry that prevent it. Some of the fault lies with the big software vendors, who charge enormous fees to build technical interfaces with other vendor systems. And some of the fault lies with hospitals and health systems, who intentionally lock-in their data to control where patients are able to receive care and where providers are able to offer it. I believe that the free exchange of health information is best for healthcare overall, and I hope that in the future, we are able to meaningfully interoperate with all of the care sites that touch our patients.

Contacts

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

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5 Questions with Brian Loftus, MD CMO, iHeadache MD

Brian Loftus, MD is a practicing neurologist at Texas-based Bellaire Neurology, where he sees close to 20 patients a day with the help of three medical assistants and one office administrator. The practice has used Aprima’s EHR for close to 14 years, and participated in Meaningful Use for three before backing out of the program. As Loftus explains, “It has now become a burden and not worth the extra time, as most of the clinical measures do not apply to headache therapy.”

Loftus is also CMO of iHeadache MD, a digital diary that enables patients to document headache symptoms and frequency, as well as securely share the data with their physician.

How have you seen healthcare IT improve patient access and outcomes? Is the practice working on any new implementations?
EHRs are good for tracking labs, making sure screening tests get performed, and patients make their follow-ups. They generally do not drive improved decision-making processes for most diseases; however, there is nothing about an EHR that specifically supports headache care. It does not make you a better physician. It does make for more legible notes, but if the MD does not type in what they are thinking, then they are no more useful than old handwritten notes when the doctor did not write down what they were thinking.

I type my notes while I am in the room with the patient. By the time they check out, my documentation is complete and they leave my office with a typed plan that states what we discussed about their care, what was done at the visit, a list of current medications, and a plan for follow-up.

Regarding implementations, we are working on integrating our depression, anxiety, and migraine disability assessment screening forms into our EHR. They will be saved as formatted data in the chart and then I can compare these scores over time. Patients will fill them out on an iPad when they arrive. We do not have a timeline established for this, but it is relatively easy and we should have it implemented by the end of the year. Our EHR has also released a brand new version, so we will be upgrading soon.

What prompted you to develop iHeadache?
I would ask patients to keep a headache diary and most could not keep up with a paper diary. They either forgot to fill it out or forgot to bring it to their appointment, so I saw the need for an electronic diary that they could carry with them all the time. As I did medical research studies, it was clear that we could bring quality of life metrics and treatment tracking that we did in studies to routine medical care. Therefore, my wife and I started Better QOL – Better Quality of Life. I was originally a chemical engineer who did computer process control programming for a couple of years before going to medical school, so I have an engineering and software background. We also have a third partner who devotes a lot of time and energy, does the nitty-gritty programming, and oversees a programmer we hired who lives up in New York.

We self funded the development of the app and as we receive funding from advertising, we have added features and over time developed iHeadache Online. My wife and I have not made any money from iHeadache; all profits from advertising are used to further development.

Do you foresee releasing new technologies via the iHeadache company? Will the company grow within the next few years? Do you anticipate gaining additional funding from outside investors?
iHeadache Online and iHeadache App do not sync at the moment, but we have nearly raised the funding to start programming a brand new iHeadache app as well as a mobile-enhanced website for people without iPhones . Both will sync with www.iHeadache.com so people will be able to enter headache data on their mobile devices as well as on the website.

We also started a non profit and our goal is to adapt iHeadache for research use so that fellows, residents, and physicians can use it for their own studies. We have also considered starting a pregnancy registry for headaches, and that may be our next endeavor after we finish developing the new iHeadache app. We would love to do more and develop a multiple sclerosis diary, a chronic pain diary, and diaries for other diseases, but we plan to grow organically as our time and finances allow.

As a private-practice physician, what are your biggest healthcare IT challenges?
Aprima is very good at supporting their product. Dell support has been very good when needed, but you do have to have someone to interface with them. Having IT you can call on only when needed is probably the biggest challenge for us. We do not have any need for ongoing IT work, but have needed it when we have upgraded servers. This issue is somewhat by choice. There is a VAR that will run Aprima as a service, and there is a VAR that will place and maintain a server in your office, but I have chosen to have my own server. I am probably more comfortable with this than most. I like not being dependent on the Internet to function and only having an onsite server allows this. I like the multiple levels of backup that we run and the offsite backups that we generate as well. I don’t like having something that is critical for my business to run day in and day out to be dependent on another company. I have had one down day due to server issues in the eight years of my practice.

What best practices would you offer colleagues facing similar situations?
Because most EHR vendors will go out of business, I strongly recommend you use a service that has a server in your office and, if needed, use an outside company to help maintain it. Besides the server’s built-in raid functions, you should have backups. A mirrored drive is not a backup. I back up nightly to one drive, and backup up weekly to a second onsite drive and offsite storage as well. Given how cheap hard drives are these days, the weekly backups will go back for months, and then a monthly backup will be kept for a couple of years in case it is important to get back to something that gets deleted and changed accidentally. In eight years, I have only gone back to a remote backup once, so maybe all of this is overkill. On the other hand, I can remember a company that went out of business because they did not understand the difference between mirroring and backups. There are medical practices that have lost charts due to flooding or fire. There is no reason why this should happen anymore. Of course, all backups should be encrypted whether they are stored onsite or offsite.

For my practice in general – we have been moving to an out-of-network model and charging reasonable prices to become less dependent on payers. Headache medicine has few procedures, and for the most part, we are being paid for our time and our thinking abilities. Insurance has traditionally paid poorly for this. By charging reasonable amounts and offering services not typically found at other practices, I can run the kind of practice I want to have.

Contacts

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

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Readers Write: Physicians Have an Influential Role in Driving Wearables Adoption

Physicians Have an Influential Role in Driving Wearables Adoption
By Dinesh Sheth, founder and CEO, Green Circle Health

Though wearable devices that track personal activity have dominated the consumer electronics market in recent years, one research report from Endeavor Partners indicates that nearly one-third of fitness trackers are abandoned within just six months. For providers, these wearables have advanced from counting steps to measuring heart rates and other physiological parameters, while also presenting one of the most cost-effective methods for ongoing monitoring of health data. Despite consumer popularity, adoption of home-based health monitoring and fitness devices and the use of such data among physicians remains low.

Although the payments for such services are typically not covered by payers, the economics of healthcare services are changing in the shift toward pay for performance. In addition, several new legislative initiatives and incentives – targeted at reducing the cost of treatment and improving outcomes – will pave a dynamic way for patient-provider interaction. The expanded availability of healthcare to millions of Americans through the Affordable Care Act increased costs, and the healthcare industry is prioritizing self-improvement to boost the overall efficiency and productivity in the evolving model. To this end, it is critical that physicians support the adoption of new devices and monitoring technologies to help patients develop healthy lifestyles and ensure long-term success.

Engagement is a Two-Way Street
The fact remains that even today’s high-tech healthcare facilities do not provide a unified view of patient data. Instead, medical records are typically spread across multiple systems and locations, and patients are not engaged in using health records to improve their own health. This can make a truly collaborative effort among physicians, care providers, patients, and family members impossible.

The industry has, in the past, done little to bring the patient into the equation. Initiatives such as Meaningful Use brought very limited results. For patients, remembering multiple usernames and passwords just to view limited data was hardly an attractive option and still fails to centralize the data that is being captured, stored, and shared. Physicians are baited with the promise of an HIE that could seamlessly tie together all medical records, but the reality of such an exchange is unknown.

The idea to bring patient-generated and -managed healthcare data into the system is a topic of intense debate among physicians, but things are changing rapidly. With remote monitoring of home health devices and wearables, patients are able to generate near real-time vitals that physicians can use to offer timely service, which empowers patients by giving them more control of their lives with appropriate help from physicians. Greater levels of shared understanding means that patients are more likely to acknowledge their conditions, understand their options, and follow through on treatment. In this system, the responsibility rests equally with the provider and the patient – enabling both to benefit from the use of health IT on a day-to-day basis, resulting in higher quality care and positively impacting patient health and physician bottom lines.

Transforming Approaches in Healthcare
The prevalence of activity trackers and a wider availability of technology that measures vitals have created new dynamics, both internally and externally, for healthcare providers. Traditionally, physicians have learned their soft communication skills at the patient bedside, something often considered to be the natural ability of a given practitioner. But medical students today receive instruction on techniques for listening, explaining, questioning, counseling, and motivating. With the use of electronic devices and modern technologies, an ongoing need for training has been created for communication using different methods. Similarly, better communication among nursing staff and physicians has positively impacted healthcare outcomes.

The data provided by today’s health-monitoring devices enables physicians to guide patients toward healthier lifestyles and reduce healthcare costs with greater effectiveness. As a result, physicians can better manage chronic conditions and avoid unnecessary episodic care. This ongoing engagement among physicians, other care providers and family members will help overcome the digital barriers that exist within the healthcare industry. Being connected on the health front, having access to the prescriptions and notes of your physician, getting reminders for your appointments, and being able to transfer information to any care giver is what makes the difference. When addressing existing hurdles in the healthcare system, technology helps to prioritize engagement among patients and providers, resulting in timely care, better outcomes, and reduced costs.

Overcoming More Challenges
Technology’s rate of change will always outpace regulation and as a result, healthcare administrators and staff may be struggling to keep everything secure, well-documented, and linked back into their EHRs. But, just as verbal communication is documented by a physician’s notes, some of the instant communication will have to move into the EHR via notes and other means.

In the wake of all this data being available, the challenge of physicians being able to receive this data and integrate it into their EHRs also looms. Providers need to have a proactive and elaborate approach in managing the increasing volume of inbound data, taking into account the likelihood that more patients will eventually adopt better devices and methods of health-data sharing.

By overcoming these challenges, physicians will eliminate unnecessary visits and quickly adjust treatments and attention as-needed. The quantitative benefit for the healthcare industry is a reduction in costs and the ability to see a greater number of patients when they need help in a most effective way, while the qualitative impact is an improved patient experience with better outcomes and being more in tune with evolving patient ‘adopted’ behaviors.

Dinesh Sheth is founder and CEO of Green Circle Health.

Contacts

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

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5 Questions with Murray Fox, MD CEO, Premier Patient Network

Murray Fox, MD is the newly appointed president and CEO of Premier Patient Network, a Texas-based physician alliance created from the merger earlier this month between Premier Patient Health Care and Patient Physician Network.

What was the impetus for creating the Premier Patient Network? Do you foresee expanding beyond the Dallas-Fort Worth area?
Simply put, we are two organizations (Patient Physician Network and Premier Patient Healthcare ACO) representing independent physicians with complementary strengths and needs. The Patient Physician Network has strength in commercial healthcare contracts. The Premier Patient Network ACO has strength in the Medicare Shared Savings Program and technology designed for a value-based environment. By joining together, independent physicians now have a support infrastructure enabling them to thrive in a value-based environment.

With regard to our location, at this time we are focused on getting our physicians ready to participate in the changing environment. We believe that we represent a large number of physicians who wish to remain independent who belong to physician organizations similar to ours. If we are successful and may be of assistance to others, we welcome that opportunity.

As CEO, what will be your biggest job in getting Premier Patient Network off the ground?
Communication! Communication with the physician members, the payers, and employers. Physicians are very busy people. Achieving movement with physicians has been likened to herding cats. Dealing in the commercial space is different than dealing in the Medicare space. Rules and regulations are different for independent, non-financially integrated physicians in the commercial space. In addition, significant communication will be required for physicians not accustomed to the value-based payment system. The team concept with patient care coordinators and more efficient use of physician office personnel will also require physician adjustment.

Payers are also very busy trying to keep their members happy and saving money while maintaining quality healthcare. Patient Physician Network has long been known for very high quality scores and cost efficiency. Premier has demonstrated both in the Medicare Shared Savings Program. Helping payers embrace the new Premier Patient Network entity will take time. The employers have the hardest time because of the demographics of their employees. It is very difficult for one physician group to satisfy all of the needs of a given employer owing to the large area of the employee footprint.

How will technology impact the work of the Premier Patient Network in assisting independent physicians to keep up with today’s changing business/reimbursement models?
Approximately 5 percent of a patient population is responsible for 60 percent of the cost. Our technology is new but already proven. It is a critical tool in supporting physicians to more effectively manage patient populations to deliver the highest quality care at the lowest possible cost while appropriately prioritizing resources to sicker and over-utilizing patients. Participating physicians will now have timely information at their fingertips, providing insights on who needs care and how to demonstrate the delivery of that quality to payers so they are appropriately compensated for providing it.

What are the biggest IT challenges faced by physicians within the Premier Patient Network? How will its operating model assist them in keeping up with Meaningful Use, transitioning to ICD-10, etc.?
Disparity. With over 800 physicians in more than 400 offices with numerous different EHR and PM software programs, connecting all of the physicians is a very large and costly task. Clinical Pathology Laboratories has had to solve this problem in order to communicate with their physician clients. They are a partner in providing this connectivity.

Regarding Meaningful use and ICD – 10 preparations, although the independent physician offices are ultimately responsible for their preparation and participation, Premier Patient Network has provided in-service and webinar information to help prepare for the changes.

Have you/will you enter into any partnerships with local health systems or payers, especially regarding utilization of healthcare IT to increase access to care and improve outcomes?
We will look to the health plans for single source data dumps. We have proprietary software to analyze and present the data to the physicians to ensure access, quality and cost efficiencies.

We have relationships with ancillary providers to accept the responsibility for the total continuum of care including pharmacy, home healthcare, radiology, and laboratory. We continue developing relationships with hospitals under our contracts as downstream providers and partners.

Contacts

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

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5 Questions with Shashi Kusuma, MD CEO, Symplast

Shashi Kusuma, MD is co-founder, chairman and CEO of Symplast, a Fort Lauderdale, FL-based mobile medical software startup for plastic surgeons and med spa physicians. Kusuma is also the owner and medical director of Suria Plastic Surgery (FL), which he founded in 2010 after relocating from Cleveland where he worked as an attending surgeon at Cleveland Clinic. SPS has not attested to Meaningful Use due to the burdensome nature of its requirements, and the “sheer aggravation and mental stress” it caused staff. The practice uses different IT systems for different purposes. “We currently use an outdated client/server legacy system for clinical documentation,” Kusuma explains. “I elected not to renew their support package nearly 18 months ago, as I felt I was being overcharged and underserved. We use a different system for multimedia and a different system for IT support.”

“I grew up with EHRs from my first day as a resident at Vanderbilt University, where we used a system called MARS,” Kusuma adds. “I’ve also used Vista, Epic, Cerner, Meditech, and many others. While the intent of these solutions was good, the true benefits were never realized. As most of my colleagues would attest, these EHRs took away from our abilities to be doctors, discouraged us from using common sense, and prevented us from connecting and developing a true relationship with patients. It really took the fun and fulfillment away from the original intent of being a doctor.”

What was the impetus for creating Symplast?
I was looking for a better experience as a doctor. I worked so hard to become the best doctor I could be, but I wasn’t having fun and engaging with my patients as much as I wanted to. The idea for Symplast came to me after another long night at the office finishing up notes and tedious administrative tasks. These duties wasted a lot of my time, did not help me treat my patients, and took me away from my family.

I was beyond frustrated with the deficiencies of medical software solutions: the impersonal nature; the impracticality; the poor designs; the long, frustrating hours; the fragmentation; the lack of innovation … I could go on and on. Despite searching long and hard and wide, I could not find what I thought was a great system. People became resigned to what was available and did not have the energy or time to do something about it. The conversation always seemed to emanate from businessmen, entrepreneurs, and software personnel, and not from the providers and doctors who were on the front line.

I also observed a growing trend within our practice and the practices of my colleagues: the role of smartphones in the doctor-patient relationship. Patients were introducing smartphones into the equation, sharing post-surgical photos, conducting virtual consults over their mobile devices, and taking selfies from their consultations. I knew that this was the future of healthcare IT. People today want on-demand input and consumption of their data. Multimedia is crucial, and smartphones enable communication to go from a text-oriented manner to a visual medium. Handing you a three-page printout of instructions is not as effective as sending you a 30-second instructional video that you can consume on your smartphone.

The timing for Symplast seemed perfect. Smartphones have evolved to the point where the camera quality, screen sizes, and voice-dictation accuracy are ready to be introduced into the exam room. The real mobile technology matured to the point where sophisticated applications can run seamlessly and natively on your device, eliminating the need for plugins and online portals.

The true potential for Symplast is to merge these disjointed modules into one complete solution, becoming a mobile ecosystem that integrates technology such as secure communication, telemedicine, patient engagement and big data into one complete solution. Symplast can leverage mobile tools to drive costs down, increase ROI, and improve the overall experience for both the patients and the care providers. 

The idea for Symplast has evolved over the past three years. The actual development has been underway for about 26 months. We now have five full-time employees and 12 developers, as well as an advisory board consisting of surgeons and physicians, seasoned businessmen and CEOs, ancillary medical care staff, and IT professionals.

What unique challenges do plastic surgeons and med spa providers face when it comes to selecting, implementing, and using healthcare IT?
Plastic surgery is a true market-based economy in medicine. As plastic surgeons, we must rely on our reputation and our outcomes to attract new patients and customers. We deal with a highly educated audience that has done extensive research and price comparisons. Marketing is critical if you want to survive in this specialty. Our field is unique in this sense, and so the healthcare IT solution needs to placate this reality.

We need robust patient engagement tools with automated, personalized communication offerings that will help us increase practice revenue. The biggest frustrations we experience with the current software offerings for this specialty are the complexity and fragmentation of the platforms that lack true patient engagement, marketing, and multimedia features.

Symplast was founded by three practicing plastic surgeons who understand first-hand the unique challenges this field faces on a daily basis. That’s why our product is specifically targeting plastic surgeons and med spa providers to start with. Patients in these fields demand a certain level of engagement and communication that Symplast delivers.

How does Symplast’s PM and EHR tools help meet these needs?
We don’t classify Symplast as just an EMR/EHR or PM. Symplast is a complete mobile ecosystem that provides every module a plastic surgery practice or med spa needs to operate on a daily basis. While the EHR is certainly one component of Symplast, we also include PM, patient engagement, multimedia, inventory management, cosmetic quotes, financial reporting, automated marketing, and more. Symplast allows you to run your entire practice from your smartphone, tablet or PC.

We understand how important security is for SaaS cloud-based solutions, and that is why we have three layers of security that ensures your data is 100-percent safe. No data is stored on your device; it is all encrypted and stored in the cloud.

How did beta testing go? What type of feedback did you receive, and how does the final technology reflect that feedback?
Beta testing was tremendous. As expected, we learned and made enhancements to the UI/UX of our technology. We understand that there is no such thing as a “perfect” product. We will continuously push ourselves to improve and innovate, and user feedback is a critical element to that objective. This is just the beginning.

On a personal note, I find it inspiring that you have provided free care on several occasions in India. How have you seen healthcare technology impacting such patient populations?
This is actually a great example of how mobility is transforming healthcare. In the past, I wasn’t able to properly engage with patients when I traveled. Now, thanks to the penetration of smartphones and mobile devices, I can truly interact and connect with these patients. Millions of people around the world have grown up in the mobile age, completely bypassing the desktop generation. They will now be engaged with the Symplast ecosystem. 

Symplast is actually in the early stages of creating a partnership with some charities that would facilitate the use of our patent-pending mobile technology in medical missions around the world in the near future. This is the mobile world we will live in very, very soon.

Contacts

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

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