HIStalk Practice Talks with Greenway’s Tee Green and Vitera’s Matthew J. Hawkins

We spoke with Greenway Medical Technologies CEO and President Tee Green and Vitera Healthcare Solutions CEO Matthew J. Hawkins shortly after the announcement that the two companies would combine. Because Greenway is publicly traded, the leaders were unable to comment on specific aspects of the pending transaction, but shared a few insights:

Hawkins: From a Vitera perspective we are just thrilled with this combination, this transaction that was announced today. We feel it is absolutely a continuation of our commitment to create an incredible business, a platform of healthcare that can take care of our customers’ needs not just today but for years to come.

We mentioned in a note we sent out to our employees that we have had a chance to get to know the Greenway team and know their culture, and the values that they have and their tremendous focus on product innovation and support and service, and felt there is a real alignment with what we are working to build at Vitera as well. So we are really excited about that as well.

We also noted that both Vitera and Greenway solutions are all certified for Meaningful Use 2014 edition and both have achieved patient-centered medical home pre-validation status, and all are ICD-10 ready by the end for this calendar year. So there is a real alignment in taking care of our customers. And that got us excited.

We think that this transaction with Greenway is really a testament to our partner Vista Equity Partners and their vision for what this combination can accomplish in the healthcare space. It’s really a testament to our hard and intense focus on growth and our commitment to take care of our customers today and in the future.

I can’t make too many forward-looking statements other than to say we think that with this transaction and working together to put in place a plan that will allow for a smooth integration at the right time, if and when the transaction occurs. We are very excited about it. Our staff is upbeat, we are upbeat, and we think it is a continuation of our long term goal: to be great partners with our customers in the market.

Green:  As Matt said, this is huge for the industry and certainly huge for our customers and Vitera’s customers –  being able to continue the Greenway brand, the strategy that we developed around electronification and consumerism that is really starting to take hold in this country. We believe there is a going to be a real thirst to improve health and with an innovation platform like this and a customer base like this we think it creates unparalleled opportunities for our teams, our customers, and our business partners.

The leaders could not comment on who would lead the company going forward but noted that plans were being developed for combining the two entities:

Green: A lot of is being worked out right now as far as how as how the synergies are going to roll. Obviously we have some great innovation within these companies and we are putting together that strategic plan over the next 45 to 60 days leading up to closing, and then at that closing we will have the opportunity to share that strategic roadmap with everyone.

The acquisition discussions apparently began fairly recently:

Hawkins: We have been friendly for a while but never had any serious discussion until far more recently. We had a chance to take a friendship in the industry, knowing each other as acquaintances, and feel there is tremendous value to be had by potentially combining these two entities in a transaction like this. Those conversations have been much more recent.

Long term plans for product platforms are still evolving:

Green: If you look at the press release and you look at the brand, obviously as the company continues to evolve, maintaining multiple platforms probably isn’t going to be the long term strategy because that doesn’t create value for your customers or your team. You will see some of that evolution over time.

Hawkins: I will also say the Vitera business has several product platforms today and we expect to continue to support and maintain and provide updates to those product platforms. I will also note that all of our product platforms are set for ICD-10 compliance and we have a clear pathway for our flagship platform Intergy, which is Meaningful Use 2014 edition-compliant, one of very few vendors that have reached that status, so we are pleased by that. We will also continue to support, maintain, and invest appropriately in those products. We need to be emphatic about that.

We are thrilled and excited about the PrimeSUITE of solutions that the Greenway business has. While we don’t have any clear plans as of yet, we like the PrimeSUITE product platform and we also have high regard for the revenue cycle management business that Greenway has put in place. We feel like there are opportunities for the combined entity to be able to take advantage of these RCM solutions while continuing to use the product platforms of their choice.

News 9/24/13

Vista Equity Partners, which owns Vitera, will pay $644 million cash for the publicly held Greenway Medical Technologies. Shareholders will receive $20.35/share, which represents represents a 62 percent premium to Greenway’s 90-day volume weighted average stock price and a 20 percent premium to Greenway’s closing share price the day before the merger agreement was signed. Greenway’s IPO stock price February 2 2012: $10.10. The businesses will continue as Greenway Medical Technologies and market their products under the Greenway name. The combined entity will serve nearly 13,000 medical organizations and 100,000 providers.

Hello Health, which offers a “no-cost” EHR and patient portal, announces integration with CollaborateMD’s billing/PM system. Hello Health has a pretty unique business model that requires patients to pay a monthly subscription fee for access to the practice’s portal. Fees start at $4/month/patient and the revenue is split between Hello Health and the practice. In order words, practices get a free EMR, patients pay for access, and the practice generates a bit of extra revenue. I don’t understand why a patient would pay for portal access when they could visit another doctor down the street and likely get portal access for free; however, the model seems to be working. Practices running the CollaborateMD platform will be able to apply the revenue generated by Hello Health towards their monthly subscription fee.

The American College of Physicians releases ACP Smart Medicine, a web-based clinical decision support tool for internal medicine physicians that provides access to  hundreds of evidenced-based recommendations on diagnosis, therapy, prevention, and screening.

A British Columbian online newspaper offers some insights into the province’s EMR adoption program, which has extended $78 million in subsidies to private practices since 2006. I was aware that the various Canadian provinces offered incentive programs for EMR adoption, but never knew many specifics. The BC’s program is based on the assumption that 30 percent of the benefit of converting to an EMR accrues to the physician, so only 70 percent of the investment is subsidized. If a physician converts to one of four approved EMRs, the government reimburses the lesser of $7,000 or 70 percent of a one-time implementation fee, plus 70 percent of operating costs each year to a maximum of $2,850 the first year and $4,500 in later years. The government will also pay subsidies for non-certified EMRs if the physician can prove it improves health outcomes and meets certain privacy, security, and interoperability expectations. Since 2006, EMR adoption by general practitioners has increased from 15 percent to approximately 80 percent. Interestingly, adoption is higher in rural communities than urban centers, where adoption rates are only about 55 percent; however, fewer solo physician practices have adopted EMRs and solo practices are more prevalent in urban areas than rural locations.

Kyruus joins athenahealth’s More Disruption Please program to offer athenahealth providers access to the Kyruus ProviderMatch system for matching patients with specialists.

Sunshine Pediatric Clinic (PA) goes live on ABEL Medical Software EHR.

The FDA issues a final guidance for mobile medical apps, saying it will exercise “enforcement discretion” for most apps since they pose minimal risk to consumers. The FDA does not intend to exercise enforcement for the majority of health and wellness apps for self-managing a disease or condition, nor for apps to track one’s health information, exercise, or diet. FDA’s oversight focus will be on mobile medical apps that present a greater risk to patients if they do not work as intended, such as those intended for use as a medical device accessory (such as viewing a medical image on a smartphone) or those using a mobile platform as a medical device (like an app that allows a smartphone to be used as an ECG to detect abnormal heart rhythms.)

Email Inga.

From the Consultant’s Corner 9/21/13

Get Ready, Here it Comes: Tips to Prepare for MU Stage 2
By Jason Drusak

This year is flying by. It seems like just yesterday that Meaningful Use (MU) Stage 1 kicked off. As we head into the last half of 2013, we’re thinking about the move from MU Stage 1 to MU Stage 2.

Since 2014 is implementation year for Stage 2, you’ll need to prepare for it in the third and fourth quarters of this year. So, how do you prepare? I haven’t seen any exact steps to follow for Stage 2, so I offer these five tips to help with an effective ramp-up.

Create a review team

You need to involve clinical, financial, and technology stakeholders in MU Stage 2 plans because Stage 2 reporting requirements are more clinical in nature than MU Stage 1. On the technology side, you need someone who’s responsible for the application, plus someone on the reporting side. In fact, I’d say that data gathering and reporting are the most important aspects on the technical side. After all, if everything isn’t entered correctly, the reports won’t be appropriate. 

Learn from what you’ve done

Stage 2 is the same as Stage 1 – but different. Look at what worked well in Stage 1 and learn from any mistakes you might have made. What would you do differently? With Stage 1, you focused on installing workflows to capture data for certain measures. Moving to Stage 2, you need to be sure you’re entering the actual data correctly for those measures. If there was an issue with data entry on a navigator section or an issue with a grouper or measure configuration: review setup and build for data entry, data gathering, and reporting output.

If in Stage 1 a site had issues in one of these areas, now would be a good time to assess how data is being entered for each measure in order to iron out the troubles before they become even larger in Stage 2. It’s important to review the workflows so that data entry is accessible for the clinician, as well as the system build for each measure. Additionally, you’ll want to confirm that data capture pieces are in place and configured correctly. Evaluating which reports are used to monitor progress will help ensure that they are formatted in a way that is easy to read and provides value.

Conduct a gap analysis

Compare Stage 1 work with Stage 2 requirements. Are there areas where you need to catch up? Data measures are changing and you will need to collect additional data; go ahead and set up workflow changes to capture that data now. For example, the threshold for the smoking measure is moving from 50 to 80 percent. Now is the time to put the new threshold in place.

Adjust monitoring reports for these measures so you can see which ones will meet the new requirements and what areas may need to be investigated for any shortcomings. One new core measure is lab orders must be directly entered into CPOE greater than 30 percent. Even though you don’t need the data today, turning this measure on and completing the build now will show your progress for compliance with this measure and will give you time to make any necessary changes before Stage 2 arrives.

Check your software

This is not the time to be retro. Examine the level at which your software is operating and be sure it’s up to date. I’ve noticed that major updates tend to come out about every other year – along with ongoing patches and fixes. Work with your technical team to look at big and small updates, allowing time for any needed upgrades. As obvious as it sounds, make sure you’re getting all the MU updates as soon as they’re available. Don’t wait until 2014 when Stage 2 is being implemented to get the latest versions of your programs. 

Test first

Don’t cram the night before the exam. Your upgrade plan needs to include testing before go-live. I’d say it’s close to impossible to test a report without some type of real data. You may have to scramble it to make it unidentifiable, but you need a realistic data environment for testing something as big as MU Stage 2.

MU Stage 2 is coming whether you’re ready or not. Stay ahead of the game by preparing for the 2014 implementation today.

Jason Drusak is manager of consulting services at Culbert Healthcare Solutions.

News 9/19/13

Despite an increase in hospital employment, more than half of all physicians worked for themselves in 2012 and 60 percent were in practices wholly owned by physicians, according to an AMA report. Other notable findings:

• Last year 29 percent of physicians worked either directly for a hospital or for a practice partially-owned by a hospital, compared to 16 percent in 2007/2008.
• The percentage of physicians who were practice owners in 2012 dropped eight percent from 2007/2008.
• Eighteen percent of physicians were in solo practice, compared to 24 percent five years ago.
• 45.5 percent of physicians are in a single specialty practice.

Despite the AMA’s conclusion that private practice “remains strong,” I predict we’ll see a different story in another five years. The ownership breakdown listed above indicates that younger physicians are less likely to be self-employed than their more senior peers. As the older physicians retire, the percentage of privately-owned practices will surely shrink.

PCMH practices report higher operating costs per patients than non-PCMH practices, according to an MGMA cost survey. Also higher: total medical revenue per patient at PCMH practices. The higher operating costs for PCMH practices are in part attributed to higher staff/patient and provider/patient ratios.

Amazing Charts names John Squire (Microsoft) president and COO.

ONC releases online tools for providers and HIEs to educate patients about the electronic sharing of health information.

MU Stage 2 is accelerating EMR-specific patient portal adoption, though the trend is negatively impacting best-of-breed vendors that are not as well equipped as EMR offerings, according to a KLAS report on patient portals. Athenahealth, Epic, and Allscripts were the top-performing vendors.

Emdeon earns high customer satisfaction ratings in a separate KLAS report that examined enterprise patient access solutions.

Quality Insights of Delaware REC is offering free, one-year subscriptions to NeHC’s Consumer eHealth Readiness Tool to up to 50 of its clients.

The AHRQ offers a toolkit to help office-based physicians and their staff improve their processes for tracking, reporting, and following-up with patients after lab tests. The guide includes an EHR evaluation tool to understand how a practice’s EHR can help with test ordering, tracking, reporting.

New Jersey-based Medical Transcription Billing Corp., a provider EHR/PM/RCM solutions for physicians, announces plans to conduct an IPO of its common stock.

Email Inga.

HIStalk Practice Interviews Jeff A. Drasnin, MD, ESD Pediatric Group

Jeff A. Drasnin, MD is a partner with ESD Pediatric Group of Cincinnati, OH

Tell me about yourself and the practice.

We are located in Cincinnati, Ohio. We have two office locations, one more of a city office and one more of a suburban office. There’s a total of seven practitioners, five of which are physicians and two nurse practitioners. The practice was founded all the way back in the forties, so it’s kind of grown over the years. We provide care to primarily insurance-carrying patients, although we do do a percentage of Medicaid.

We have about 10,000 patients in our practice, so I would call us kind of a medium-sized pediatric practice. We are not hospital-owned. We are affiliated with Cincinnati Children’s just in the sense that we take care of patients there, but we are not on the payroll of Cincinnati Children’s in any way. But when we started looking for IT solutions going back to the mid-2000s, we were in an all-paper situation as people were back then. We outsourced our billing in order for someone to do our collections for us. Years and years ago we did our own collections, but doctors doing collections – it’s kind of like bicycle mechanics fixing cars. It’s not really what we’re designed to do.

We used a company that we didn’t like because we never knew where our money was. But we also knew that we didn’t do it very well, so initially the electronic piece for us came in the form of collections. That’s where we got hooked up with athenahealth in 2007, because their web-based technology really improved our collections. You can’t run a practice and/or a business without the cash. That was the first piece. And then as things moved on, we wanted to go completely electronic and we picked up the second piece of their offering, athenaClinicals in May of 2009. Our first step was to get our financial house in order, which we were able to do, and then we moved on to the clinical aspects and have been running with that ever since.

Tell me about the selection process for both the financial and clinical pieces.

A lot of it was luck, and I’ll say that to this day. We had several different vendors come and make presentations to us. Initially, we had found athena through one of my staff that went to another medical office and said, “Hey, what are you guys using? What do you got?” And then I followed up on that and started calling some practice administrators in town that had already used a collections piece, asking who do you use and do you like them and what regrets do you have and what could be better, etc. And when I talked to the group that was using athena at the time, the only regret this office manager had was that they didn’t choose them sooner. That was it. And now, six years later, I would actually give the same answer if somebody asked me that question.

The thing that we were upset about with our collections company is we didn’t know where our money was going. Our staff punched all these claims into the computer and then we sent it to this other company. We never knew what was coming. We just literally sat there and watched the bank accounts on a daily basis, kind of hoping we’d get something. But we had no idea what was coming, what was being written off, what wasn’t being paid per contract and all those things. With athena what we liked the most was that it was very transparent, that no claim was going to be written off by them. If we wanted to drill down on even a single claim, we knew where it was, and they did the vast majority of the work. We didn’t get rid of any staff – we repurposed people to do better things. Our days in account receivable went from being in the forties or fifties down to somewhere like 16 or 17 now.

Our cash flow has been much smoother in the sense that I didn’t have to hope and pray that we were going to get money in the account today. I know roughly X number of dollars comes relatively smoothly into the account on a daily basis, which is kind of nice. You can budget things and go from there.

So, we were on athenaCollector for a couple of years. Then we started looking at the medical records, and it just made sense to us to use one that was integrated. I know some of the other practices in town that use athena for their collections and they use a different medical record system. And everything’s fine and they don’t have any problems with that. But the way we looked at it, if athena can do the EMR piece anywhere close to as well they do the collections piece, well, let’s just choose them. We’ve had a great experience so far, and again we’re going on over four years now. I still have no regrets.

Did you seriously look at any other EMRs?

Yeah, we did. In Cincinnati, there’s a group of pediatricians that were using NextGen, which is a little bit supported by Cincinnati Childrens in kind of a weird way, with the Stark Law exemptions. And we looked at that, we looked at Allscripts, we looked at a couple of other different ones. But we were very much attracted to the web-based concept. We loved the fact that we were not going to maintain servers at our office.

We’ve got one IT guy who comes here every once in a while just to make sure that all the computers are up and running, the network’s running okay, and when people have log-in problems or a computer gets spammed or something like that. And that’s the extent of our IT costs. And that’s amazing. We don’t even have a T1 line. We have a DSL or a cable line, depending on which office we’re at. And as long as that is active, we’re ready to roll. And if there’s ever a glitch in the system, which there’s not been in a long time, you’ve got a relatively large company that is working to get every provider back up on the network at the same time. If we use something software-based and a server goes down or something happens, then I got to call my IT guy, he’s got to run over, he’s got to figure out what’s going on in my system, and it’s on my dime to get all that going, as opposed to being part of the subscription. We really like the subscription component, because the fees that we pay are very similar to just maintenance fees on software. The subscription fee for athena depends on what you’re using and it is not all that different than what you’re going to pay to maintain your software-based system.

We also looked at start-up costs with the other systems. Our start-up costs with athena were relatively minimal. But other pediatric groups here in town have spent tons and tons of money just getting up and running. We didn’t and that was huge for a small practice like ours. Prior to athena doing our collections, we really struggled from a cash flow perspective. Cash flow is just not an issue now. We’re busier than we were 10 years ago, but that’s only part of the reason why we’re in order. I think the number one reason is that the financial ducks are in a row and now everything is tied together.

Tell me about implementation process and how you got physician buy-in and  changed workflows.

We liked our workflow and my goal when going electronic was to have an EMR that allowed us to still work in our office the same way that we always worked, because over the years we found a way that we felt works well. Two of the partners are on the younger side and like computers and we sold EMR as a positive from the beginning. We got all the physicians on the same page first, and then we took that positive message to the staff. I think if you don’t have the physicians on board – and that’s sometimes hard within larger groups – then there are those who basically sabotage the whole concept. Once people get thinking it’s going to be hard or difficult, then you’re behind the eight ball.

We were very lucky in the sense that there were two of us who researched and set things up and the other three partners said, “Whatever you guys think is best, we’re going to be with you on it.” And what we did is looked at our workflow. When we did the implementation we had two athena staff members come out to Cincinnati twice. They were also here on our go-live, they looked at our workflow to set up all the pathways so that we could run our office electronically the same way we’ve been running it before – but do it better. They came in and did a lot of groundwork and a lot of things were done remotely.

Since we had been on the Collector system for a while, athena could fill in a lot of things based on claims data, such as shot records and diagnoses, going back two years prior. We looked at our schedule going forward, picked a go-live date, and then we did what’s called a rolling abstraction. We decided as docs which types of things we wanted at our fingertips that should be scanned into the system for easy access. We didn’t scan entire charts; we scanned parts of charts.

We put in the information for all our upcoming well-checks and all of our pre-scheduled appointments and then we tried to put them in as quickly as we could when appointments were made. Within several months, we went from A to Z and back-filled everybody.

The other thing that myself and my other IT partner did was to make two sheets of paper that we presented them to the staff. We said, “Here’s how we do this task today.” With the next piece of paper we said, “Here’s how we do the same task tomorrow,” – meaning when we go live. Once our staff saw that they knew it really wasn’t that big of a change.

So with a vaccine, what do I do? Well, I used to go write the lot numbers in the log book. Now I go to my laptop and I enter my log numbers here. For a strep test I used to go write in this log book and I’d go put it on a little sticky note piece of paper and I’d stick it on front of the doctor’s chart. Now I go in the computer and enter the result, etc. We ran through that and you could see that there was a lot of nodding in the crowd and that’s where the real buy-in from the staff started.

We did that prior to the go-live so that when the go-live came, it was like, oh, okay, we know how we’re going to do it. And we actually did not change our schedule. We didn’t cut back at all. We just hopped on the bike and started riding. And it really wasn’t an issue.

Something that I hear from many of my compatriots who are also physicians is that with their go-lives they wean down the schedule and it’s chaos and craziness. We just didn’t have that. Maybe we were lucky, maybe some of it’s athena. I’m sure a lot of it’s athena. I think some of it was probably us, too. You got to have buy-in and you’ve got to have buy-in before you do it. And I think that’s where we were in one sense very lucky.

What kind of devices are the physicians using for their charting?

We started out with Lenovo X61s, which were tablets with pens. We bought 15 or 20 of them. The physicians and the medical assistants were all using the same one, but the girls on the phone just used desktop PCs. We ran those until probably about a year ago. Those were Windows XP and they were fine and still functional, but as athenaClinicals has gotten more in depth, in order to create these screens that are our chart, you’ve got to have a processor that’s going to pound through some of that. We found these basic dual core Intels were fine, but things were slowing down a little bit.

The most frustrating thing that could happen to any physician or any provider is slow. When you click on something, it better come up right away. We’ve upgraded and our physicians now carry Lenovo Yogas, the Windows 8 touchscreens. Those were a little bit on the expensive side, so for the staff we ended up getting Acer Windows 8 touchscreens and they work great. They love the touchscreen because there’s a lot of scrolling in Clinicals and using that finger on a touchscreen is great.

Do you enter any free text?

I do still enter a fair bit of free text. I’m a fairly good typist. We have templates and lots of clicks but I still find that when I write down the history for a patient, I still like to type a couple sentences. So I’d be lost without my keyboard.

Are you typing in front of the patient?

I try not to do too much typing with the patient. I carry my Yoga into the room and I use it mostly for reference. Sometimes I’ll enter in a couple orders if I can multitask that and still maintain eye contact. I try not to stare at my screen in the room, but I like it because I can see what the last antibiotic they were on. I can see where their favorite pharmacy is. I can look at a shot record. I have the information at my fingertips to answer any questions that the parents are going to throw at me.

But, I try not to type my notes in there. I don’t want to change how I see my patients -I like how I see my patients. Instead of a folder, I carry the computer. I make a couple of quick notes, I put in orders, prescriptions, and things that must be done in real time. I do those pretty quickly. But a lot of times, I’ll fill in my charts later.

In the good old days when I was on paper, I would do the same thing. I would have a big pile of charts. I’d call my wife when I was done seeing patients and she would ask, “How many charts you got?” Well, I got like 15, so she says, “Oh, it’s going to be like, what, 45 minutes or I’ll see you in an hour?”

Whereas now with it being electronic and web-based, as soon as I see my last patient, I walk straight out the door. I’ve got young kids and I’m home for dinner on time every night. I play with the kids, help with their homework, put them to bed. And then I’ll polish off my charts on the couch with my feet up and ESPN on. From a lifestyle perspective, it was a game changer. I coach tee ball, I coach soccer. I can get to my kids’ practices because as soon as I’m done, I’m out the door and I can tinker with that later. It’s huge.

Are you or have you attested for Meaningful Use?

As pediatricians, we are kind of screwed, unless we take care of a Medicaid population, which we don’t, really. We don’t meet the 20 percent criteria. We applied for it but we’re not going to get any Meaningful Use money. But we’re using those same things for things like patient-centered medical home.

Are you using the EHR for any quality reporting initiatives?

Yeah, we’re actually in the process of getting the PCMH, the patient-centered medical home. The beauty of athena is all of your data basically lives in databases and can be sliced and diced in whatever way that you want to. I’m blessed that I have a practice administrator who’s also a CPA, who runs reports on this stuff all day long. She ran reports from the collections side for years before we went to Clinicals. And now, we can slice and dice and pick out populations and produce data very, very easily, which is tremendous for us.

We need that for PCMH. You have to prove that you do it better. We have an asthma initiative and take it one step farther using athenaCommunicator. Every year when flu shots come around, we send emails, texts, phone calls to all of our asthmatics. We actually are in a friendly competition with our other compatriots in town to try to see who can get more of their asthmatics their flu shots. We keep track of that stuff.

And with a couple of payers in town, there are actually P4P payments that we get based on hitting certain percentiles and it is very easy for us to report that. If we didn’t have the electronic system, we wouldn’t have the same ease. It’s one thing to have your data in a computer. It’s another thing getting your data out of the computer and that’s where a lot of practices that I’ve spoken with have issues. Practices who are not on athena and who are even more progressive than us, who got on electronic records even earlier than we did and have systems that produce good notes, but, they can’t get their data back out. They can’t run reports.

With athena, we can create the vast majority of reports ourselves, and if there’s something a little more detailed, then you can pay athena to do it for you. But we really haven’t needed to do that much. But we use the Communicator to improve patient care. We use it to schedule density. We work kind of like a dentist in the sense that, if it’s been six months since your last cleaning, you better believe you’ll got a postcard in your mailbox. We do the same thing electronically, so every time we see a patient, we put a tickler into athena that will tell the front desk to make that next appointment, whether it’s a check-up or a follow-up appointment. If they don’t make that appointment, we use the tickler to start calling the house.

For example, for a pediatrician, it’s check-ups. We want to get all of our patients in on an annual basis because we think that’s important, obviously. Once kids get a little bigger and don’t need a form filled out and are otherwise healthy, parents sometimes don’t take them in, even when insurance plans are paying for well childcare once a year.

Now they’re aware that they’re due for their check-up and they’ll come in. In my practice, we don’t have an open check-up appointment until mid-November. Our schedule’s booked. Not only is it better care, but from a financial perspective, it’s been tremendous for us. Same thing for our asthmatics. We like to see our asthmatics every six months so they get their tickler for an annual check-up, and in between at six months, we want to do an asthma check with them. We use the system to send emails and 80 percent of our patients active on our patient portal.

That’s an impressive number.

It’s amazing. I get messages and you can easily send back messages. The patient portal is mobilized so if you have an iPhone or an android, it pops up on your phone. I’ll have parents email me questions or send it through the portal and it pops right in my system and I answer it. They get an email right away and tell me that I’ve answered their question. I may go back and forth with them two or three times in the course of a morning and there’s no nurse involved in that. That type of communication is just insane, in a good way. Tthe families that use that are just blown away by the ease at which they can do that, that you can actually email your doctor and you might have an answer in 10 minutes. I come out of a room in between patients, look at the computer, click on a message, and answer it. It’s very easy and that’s really changed how we roll.

People don’t realize how cool it is until they do it. I joke around with some of my parents, and say you guys haven’t “portalized” me in a while. And then sure enough, at the end of the day I’ll get a message after they get home or something. For very easy, simple questions it streamlines care. And doesn’t cost me any time. If you were to call the office and talk to the nurse, what does the nurse do? She puts your question in the computer, sends it to me, I type it back to her, then she calls the patient back and says Dr. Jansen said this. Whereas with the patient portal, you can get a very quick question and it’s very, very easy. That’s the whole Communicator component – the patient portal, the reminder calls, the ticklers. When they send out those calls, the parent answers the phone and then presses a button, and can actually talk to a live operator at athena who actually schedules the appointment. That’s how our schedule stays so full to very little effort of my staff’s part. It’s pretty amazing.

Anything else that you’d like to add?

I could talk about athena into the night. I think that it’s helped make a small practice like ours look like a much bigger practice because we’ve got a multi-million dollar company behind us and everything that we do is run through them. Everything about the way that my office runs is different. We have two offices. Before, we had a phone room in both offices. Now it’s all centralized. The first part of it was to get the dollars in order. The second part of it was to improve the care. Those two things go hand in hand. I think that when you use a fully-integrated system–a collections system, an EMR system and then some sort of patient portal communication system – when you put all those together on the same platform, they seamlessly integrate.

And over time, they improve. Being web-based we get an update once a month or every other month. They’re not major things, so they don’t throw off everybody’s workflow. But a new button here, a new thing, a new that. And we don’t have to put any effort into that.