As I work closely with many healthcare professionals, I am hearing all the latest and greatest (and usually false) rumors about Covid-19.
The latest one is of special importance to independent healthcare providers, many of whom are turning to telehealth sessions during shutdowns to help enforce social distancing. There is a rumor going around, especially on social media, that the government has essentially suspended all HIPAA privacy rules and is allowing all forms of communication for telehealth sessions. This is simply untrue. To read the full, official statement, please click here (link to HHS.gov article).
In a nutshell, it says this: yes, as of this past week, the government will be temporarily suspending enforcement and fines for some non-compliant platforms, but not all of them, including FB Live, Twitch, and other public platforms.
However, we are advising clients, prospects, and all providers we know to be careful about employing non-compliant platforms, even in light of the new, temporary waivers. We have four main reasons for issuing this advice:
1) Privacy rules are in place to protect patients, and our ethical duty to do that does not end just because we (temporarily) cannot be fined for failing to do so. Applications like Facebook Messenger, consumer-edition Skype, and FaceTime are not subject to BAAs and you (and by extension your patients) are therefore not protected in case of breach. Indeed, the HHS statement underscores your responsibility as a provider to protect your patients' privacy even in the temporary absence of enforcement. And you must be cautious of even HIPAA-compliant teleconferencing applications that are not telehealth-specific, as the security nightmare with Zoom has shown us.
2) From an operational point of view, consumer applications like FaceTime are not optimal, since they are not integrated into a practice's workflows and have no functionality to help with things like scheduling. A robust telehealth platform like EMRx's, by contrast, is simply another feature in an overall patient portal that allows you and your patients to manage the entire interaction, from setting the appointment to holding the secure, HIPAA-compliant telehealth session, to having the patients pay their co-pay/fees, to following up with messaging/labs/notes/prescribing (as applicable). Burnout among healthcare professionals was already high before this crisis; let's not make it even worse by forcing staff to jump through extra hoops by using applications that sit entirely outside their workflows.
However, we understand that in the middle of a crisis, practices that do not already have an EMR with telehealth may not have the time and resources to make that switch. That's why we also offer a standalone telehealth application that is true telemedicine, not simply a video chat tool. Our platform- and vendor-agnostic Blum Telehealth is the first Bluetooth-enabled telemedicine app, allowing physicians to monitor vital signs such as temperature and blood pressure, and even to look into patients' eyes and ears.
3) From a best-practice point of view, we do not recommend that practices get in the habit of using non-compliant platforms. Sooner or later (and quite likely sooner), HHS will rescind the enforcement waiver. So we recommend asking yourself this: were you aware of the HHS article above? Possibly. Also quite likely you were not, given how chaotic everything has been. So will you be equally unaware when the rescission of the waivers is published? HIPAA fines range anywhere from $100 to $50,000 per violation. That's a lot of long-term downside risk to save very little money in the short term.
4) We all need to start thinking about the "New Normal." Practices of almost every kind are under tremendous financial strain thanks to this crisis. And let's face it, with all the rules, regulations, bureaucracy, paperwork, bad technology, and the constant insurance company push-back on claims, it was already a challenge to be an independent provider to begin with. For example, on average, the insurance companies make practices resubmit one out of every three claims at least once, with an average re-work/re-submission cost of $25 a claim. We are projecting those rejection rates to climb in the months to come as insurance companies scramble to cut their losses from Covid-19 coverage. (That's a polite way of saying they are going to try and claw back as much as possible from you, the healthcare providers.) We broach this in the context of these temporary enforcement waivers because we are concerned that the waivers represent a bad opportunity for many independent practices to delay making the changes they already needed to make to stay financially viable in the long term. Practices that fail to adapt to the New Normal, practices that were already under pressure to begin with, are going to struggle to stay afloat if they do not act now.
In summary, please be careful about the decisions you make regarding telehealth, and be sure to consider those decisions in the larger context of your practice's long-term health. Reach out to us today and we can get you up and running on a safe, fully compliant teleheatlh platform at a reasonable cost and in a very short time frame. And if you need the standalone application, we are pleased to offer that free of charge until September 13, 2020, or the end of the pandemic, whichever comes first. (For other ways we are helping out with the Covid Pandemic, please see our official response statement.)
In closing, a heartfelt thank-you to everyone in the medical and mental health community. Your dedication during this dark time for our country is an inspiration and gives us all hope. Please stay safe!
In an average day in clinic, I might see 15 patients, get 75 emails, 10 secure messages, 3 pages and 5 EMR messages in my inbox. Not too long ago, some emails were from frustrated colleagues, asking me to do something for a second or third time. Sadly, some were from parents of my patients, kindly reminding me that they were sitting in the lab waiting for the orders I forgot to place or trying to book their colonoscopy, for which I had forgotten to submit the form.
I pride myself on making sure my patients and their families feel cared for and supported, yet here I was dropping balls, overwhelmed by emails, camp forms, 504 plans, orders to place and callbacks. I needed help and jotting chicken scratch on the back of clinic notes, Post-Its and even a little black book wasn’t enough.
I had an incredible team of nurses and administrative assistants, yet there was no effective way to collaborate; the time, effort and inability to close loops made it almost easier to do things myself. I was burning out, increasingly frustrated and weighed down by the “toil” of practicing medicine. The dozens of clinicians and healthcare teams we later interviewed were feeling it too.
Healthcare, Meet Design
Last year, I received an email out of the blue. Keather Roemhildt, a veteran user experience designer from the Silicon Valley, was interested in applying her talents to problems in healthcare. Well, I though, we certainly have plenty of those.
Just a few weeks later she spent an “afternoon in the life” of our busy gastroenterology inpatient team and was captivated by the potential. After just a few hours together she saw the awesome re-design challenge that is healthcare and was willing to work together to build something that could bring the joy back to healthcare for providers and improve the quality of care for patients.
Boiling the Ocean
We spent several days in clinic together and countless late nights on Zoom from Boston to San Francisco designing solutions for how we could make things better. We thought we’d start off small and redesign the electronic medical record (EMR) [sarcasm]. Over our first several months, we built a beautiful user interface, a visual story chock full of icons, graphs and all the things that us clinicians find frustratingly inadequate about existing options. We explored navigating this EMR by voice, freeing up the hands of clinicians and getting their eyes back where they belonged, on the patient. Our explorations led to three things that have been part of the software revolution in every other industry — except healthcare: communication, collaboration and task management.
The Digital Divide
I began reflecting on my life outside of medicine, my Apple fanaticism, my dependency on elegantly designed productivity tools like Evernote and Dropbox. The ease of asking my wife to pick something up at the supermarket by simply adding it to our shared to-do list on Wünderlist. How platforms like Slack, Asana, Trello and many others have become engines for collaboration and communication, eliminating hundreds of dead-end emails.
Yet, in healthcare, we’re forced to use antiquated software and click our way through poorly designed interfaces, because HIPAA and the nuances of healthcare have scared off the disruptors. Increasingly, the lack of HIPAA-compliant corollaries to the apps that have changed our lives outside of medicine is helping lead to insecure and risky use of many consumer apps.
Keather and I started to realize that beyond the crappy design of the EMR, there was no system to collaboratively manage the workload. Despite the fact that healthcare is a team sport, we all are forced to do it alone.
Not surprisingly, when we asked 14 colleagues about stress resulting from fear of forgetting to do something for their patients, the stress level averaged a 3.9 out of 5. This is despite having dozens of communication platforms: email, EMR message centers, secure and insecure text messaging. Sadly, most of these platforms end up creating more work as a byproduct. Unread and flagged emails quickly get buried, paper notes get thrown out or lost, tasks continue to pile up. Unfortunately, loops are rarely closed as the cognitive load is simply too much and the inertia to generate a formal email or place a message in the EMR is too cumbersome. In the end, we work in our silos, slowly chipping away at the tasks that adds up over the course of the day and week. We spend nights and weekends catching up on notes, billing and the seemingly mundane to-dos that we’re able to remember. And we’re all stressed about dropping balls, forgetting to do something for our patients who we took an oath to care for and protect.
After the third email from my admin reminding me to do something, I realized I needed a system and a process. As the great Atul Gawande suggested in the all-too-relevant The Checklist Manifesto, checklists provide a “cognitive net…that catch the mental flaws in all of us.” I was using Wünderlist, a beautifully designed checklist so effectively in my home life, why not try it at work I thought?
I was easily able to convince my core team, my administrative assistant, and nurse to try out a shared to-do list; they probably thought getting in touch with me couldn’t get worse. Since Wünderlist isn’t HIPAA compliant, we decided to only use patient’s first names and not put any PHI on the app.
So I invited my team to our “GI clinic” list on Wünderlist and within minutes, we were assigning tasks to each other. We sifted through our unread emails for all the outstanding stuff that was pending and suddenly had clarity on what the tasks were and who was assigned to them. Perhaps more impressive was how fast things came off the list. We all felt motivated to clear the list as quickly as we could, since nobody wanted a task assigned to them languishing for the group to see. Checking that box announcing that you completed your assignment was deeply satisfying.
Wünderlist for Healthcare
Suddenly we had a minimum viable product. Without a dollar spent or an engineer writing a single line of code, Wünderlist had provided us with a proving ground. Over the next several months, my colleagues and I completed nearly 1,000 tasks and learned invaluable lessons about what was needed to make something like this truly impactful in healthcare.
My team had never been more efficient. We were collaborating on tasks that might have never risen to the level of an email or EMR message. The truth was, few of these items were even EMR-worthy, mostly administrative chores. Suddenly we had clarity, we had accountability and we were all on the same page.
Using a shared task list brought a life-changing reduction in my stress level. I had a place where I could easily deposit all the inbound requests, reminders and minutiae that had previously weighed me down. Tasks were declared and assigned by design, so an email or EMR message was no longer necessary. The barrier to entry was incredibly low, and the ability to work together, collaborate and communicate was transformative.
We learned from pioneers like our friends at TigerText: create an indispensable tool for healthcare, fundamentally built on a technology that is ubiquitous in the consumer world. Our solution couldn’t be just HIPAA compliant, it had to integrate into the workflow of providers. Fortunately, for us there is no incumbent system or workflow, our largest competitor is the Post-It note. The scary truth is that most providers don’t have a process for remembering their to-dos, let alone a shared one.
Getting Accelerated @Boston Children’s Hospital
So we had a good idea, a great MVP and a bunch of market research validating the pain point and our proposed solution. Thanks to Keather, we even had killer designs for our mobile app. You know where that gets you as a healthcare startup? Nowhere, fast. We still had to develop the technology, figure out the sales and marketing, and prove our value proposition, for starters.
Fortunately, we had the opportunity to apply to the Innovation & Digital Health Accelerator at Boston Children’s Hospital where their impressive advisory board selected our idea (then called HeyDoc) to be accelerated in 2016. This enabled us to work with talented software engineers, startup analysts, marketing experts and graphic designers who helped to create the working app we now call Dock Health. In collaboration with HT Developers, we began a closed beta program in early September, using our native iOS app and responsive web platform at Boston Children’s Hospital. We’ve already learned a ton from our users and continue to improve upon it daily. We’re excited about the future, with our public launch at Health2.0 and our first external pilot at UC-Irvine School of Medicine to kick off in the next few weeks.
Into The Wild
Nothing has been more exciting than to see the impact of our product in the hands of real clinical teams. We have a long journey ahead of us, but we know that we are going after something of critical importance.
Clinician burnout is an emerging epidemic, in large part due to the administrative burden of patient care. The triple aim — improving patient experience and patient care, and lowering costs — can only be accomplished if the providers are able and willing to work towards that important goal. We believe in the quadruple aim, and that easing the administrative burden will make for happier, more productive providers. While something as simple as a to-do list for healthcare might seem trivial on its face, we believe that a secure hub to store, prioritize and collaboratively delegate a mounting number of tasks may very well change the game of healthcare. And that’s just the beginning.
To learn more about Dock Health and sign up for secure team collaboration and better patient care, click here. We’ve got a better way to-do healthcare.