One of the biggest issues in our healthcare system is the disconnect between cost visibility and care delivery. Doctors are typically trained to deliver the best care they possibly can for the indicated diagnosis, as well they should be. But they rarely have at hand the information necessary to determine if that course of treatment will be financially feasible for the patient. If there are no alternatives and the patient needs the indicated treatment to live, then it's a moot point. But in many cases, there are indeed alternatives, so arming doctors with better insights into the cost of treatment for that particular patient can mean the difference between that patient getting the care they need and not getting that care due to financial constraints.
Take medications. When you as a doctor prescribe a drug, you normally have absolutely no idea how much it will cost that particular patient. With all the differences in plans and programs and copay assistance policies, who can know? It could be free for Joe Smith, your 1 o'clock patient, and cost $500 a week for Jane Jones, your 2 o'clock. And while hopefully Jane would call the office and explore alternatives if that's the case, she may very well not; she may simply not take that medication and hope for the best, which can be a deadly strategy.
That's all about to change. Later this year, we're releasing a new feature that will tell you the doctor right there on the screen in your EHR what the medication you're about to prescribe will cost for that particular patient based on their profile. It will even suggest alternatives in case the pricing is not feasible for the patient. It will take into account not only that patient's particular insurance plan, but also membership in programs like GoodRx.
Think back in your career about how many times you've experienced or heard of cases of patients dying or suffering because they neglected to take the medications they were prescribed. In many of these tragic cases, the cause is simply failure to adhere to the treatment protocol. But in many others, the cause is financial: the patient simply couldn't afford the prescribed pharmaceutical(s). This new feature won't solve all our problems: there will still be cases where there are no affordable alternatives for the patient. But it is an important new tool for doctors to reduce non-adherence and to help more patients get better faster.
This is yet another game-changer from EMRx, not just for doctors but for their patients. Contact us today and let us schedule a demo to show you the future of EMR.
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!
Covid-19, the deadly and highly contagious disease caused by the novel coronavirus that was first reported late last year, has already tested our country’s healthcare delivery system, and it is almost certainly not even close to peaking yet as of this writing. Here at Fast Layne Solutions, we are, as always, focused on how to help small- to medium-sized independent medical practices, so this blog post outlines our response, including our advice and the steps we intend to take to help our clients and our country. It will be updated as events unfold and as we add more measures.
Let’s start with social distancing. It is absolutely vital that we minimize human-to-human contact to stem the spread of the virus. For any medical procedure that does not require in-person consultation, we strongly recommend e-visits, aka telehealth. If your office is not already equipped to do telehealth visits, please contact us. For the duration of the Covid-19 pandemic, we are waiving much of the implementation cost for our clients and, for qualifying practices, will amortize the rest over one year. We can get practices set up on telehealth extremely quickly and we have two versions: one is embedded into the patient portal that we provide with our EMRx and Revenue Cycle Management offering (see iClaim below), while the other is a standalone app that is Bluetooth-enabled and vendor/platform-agnostic and can be rolled out in a matter of days. In either case, with just a few clicks, you can be seeing a patient anywhere in a secure, HIPAA-compliant environment. (Because Apple will not sign a BAA, FaceTime, for example, is not compliant. Do not make that risky and potentially expensive mistake. Please see our statement on the HIPAA telehealth enforcement waivers for more information.) In the embedded version, in the same portal where you hold the telehealth session, your patients can make appointments and even pay for their visits, as well as message your office, review their records, and check lab results.
Another way your office can facilitate social distancing is to get rid of the old practice of having patients arrive early to fill out paperwork. Using our portal, patients fill in their paperwork online in advance, and your office staff see it as highlighted entries ready for them to check and confirm before making them permanent entries into the patients’ records. As noted above, that same portal can also minimize face-to-face interactions by facilitating online payments, scheduling, records and results retrievals, and messaging.
Now we need to discuss an unpleasant topic, doctors and practice administrators. The insurance companies have waived certain co-pays related directly to testing, but this will not impact any other costs to patients, including actual treatment. Independent doctors already struggle with denials, claim rejections, and outstanding patient debt even at the best of times. During this crisis, those problems will only grow. So let’s look at how we can use technology to minimize the impact on your practice so that you can continue serving your patients:
Technology has an important role to play in this crisis, and we are ready to help you implement it quickly and efficiently to minimize negative outcomes for both you and your patients. And to help even more, we will be offering all the basic features of our standalone telehealth app free of charge until the pandemic is over or until September 13 2020, whichever comes first.
To further assist doctors and their patients at this difficult time, Fast Layne Solutions is also offering a monthly 5% rebate to any of our clients who are in a position to offer medical care to uninsured patients, in order to help them defray those costs. This offer remains in effect until the pandemic is declared over in the United States.
For the duration of the crisis, we will also be donating 5% of our clients’ monthly invoices to the Center for Disaster Philanthropy’s Covid-19 Response Fund. We will also be earmarking 5% of all 2020 corporate profits for Covid-19 relief.
We want to close by thanking our tireless and brave healthcare workers who will be on the front line in the battle against Covid-19. You are our heroes and America’s best hope.
Last week, we talked about the challenges facing a fictional doctor, Dr. Janelle Smith, a young endocrinologist trying to serve the South Side of Chicago as an independent practitioner. When we left off, she was facing an impossible choice: stay in her private practice but barely scrape by, or join a large hospital and let go of her dream to serve her community. But it's a false choice, because all those problems we described actually have solutions.
Let’s take her EHR. Her total annual costs, including maintenance, updates, and training, for her current system exceed $25,000 for the practice. And that’s just what she pays to her provider. What she’s not capturing in that figure is the value of the time wasted by her and her PA due to how complicated and user-unfriendly her system is. So she sits down and runs the numbers: she and her PA are averaging 10 minutes per patient encounter and they see 40 patients a day. To her horror, she realizes that almost an entire headcount is dedicated just to charting. But a tablet-optimized, Cloud-based EHR like NextGen’s EMRx costs a fraction of that, and because it was designed by doctors, it’s intended to get doctors through the charting process as quickly as possible, in an average of just two minutes per encounter. Her first year savings alone are going to be almost $10,000 just for the software, and it leads to productivity gains equating to getting ⅔ of a new headcount for free. She almost has enough to add a second PA and expand her practice. And she’s just getting started.
Now let’s look at her overhead. She has a staff of five, including herself. Of those, three produce no revenue whatsoever and are not involved in providing care to her patients. They spend their days in purely administrative tasks, as noted above. But how much of that work is even necessary? Very little of it. With a full-feature practice and revenue cycle management suite, claims are generated automatically based on the integrated EHR, and reviewed by experts who handle claims for many offices, getting her practice out of the billing and claims business. (Any self-pay bills can be printed with a push of a button.) And because those claims are scrubbed by the advanced iClaim claims management system, the rejection rate is under 2%, and the payments hit Dr. Smith’s account within just a few days, thanks to the separate clearinghouse the system uses.
Patients can now fill out their paperwork in advance through the patient portal. They can also submit their medical records requests there, make appointments, and even pay their bills. And all benefits verifications are now automated and executed with the push of a single button when the patient checks in. And denials? A thing of the past thanks to a rigorous and automated verification system.
So the work of three staff who had been working 45-50 hours a week can now be done by two staff members working 40 hours a week. Now Dr. Smith has a receptionist/admin working no overtime and a far less stressed-out office manager working a normal schedule. Including overhead, salaries, and overtime, she is saving over $50,000 a year. That’s the rest of the money she needs to add that second PA or a nurse practitioner!
She also implements ChoicePay, cutting her credit card transaction fees to 1.79%, saving her money, allowing her to take payments online, and giving her a fully HIPAA-compliant merchant services solution that is seamlessly integrated with her billing system.
Her overall financial situation starts to improve dramatically as her AR days fall and she all but eliminates write-offs and bad patient debt caused by denials. Cash flow is excellent, with payments coming in within days of service provision. She’s no longer worried about making payroll. Her staff of five is now three healthcare providers, all of whom are caring for patients and generating revenue. She’s thriving. She’s able to dedicate more hours to her free clinic. She’s no longer living month to month; on the contrary, she’s making bold plans to expand to a second location.
As you look back through this scenario and consider the impact on the South Side, you can see the obvious benefits in terms of keeping quality care in the area and helping a local practice thrive. But you might have one concern. What about that biller? Yes, the practice still employs five people, but that biller is out of a job, and that isn’t good for the community. That’s why Fast Layne Solutions is proud to announce an initiative to create jobs in the communities we serve by training and equipping claims handlers in those neighborhoods. For example, we are committed to adding one new job for every five providers we serve on the South Side of Chicago. Note we’re saying providers, not clients, here. So a single office with, say, three doctors, one physician’s assistant, and one nurse practitioner would lead to a new job on the South Side. We will provide the training and the equipment, and the claims handlers can not only work from home, but also set their own hours, since we require only that a certain number of claims be processed within a given week. Think about what that means for, say, a single mother. Single mothers in economically vulnerable neighborhoods often struggle to find sustainable employment because working outside the home simply doesn’t pay once you account for childcare. But if you have a job that can be done from anywhere and at any time of day, you have the flexibility to earn a good living while still caring for your children.
The term “win/win” is thrown around a lot, but that’s truly what this is. We are giving practices the tools they need not just to survive but thrive in a challenging environment, while also creating new jobs in the community, jobs that involve highly valued, transferable skills.
Want to learn more? Email us today and let’s set up a free, no-obligation practice analysis. If we can’t prove that we’ll save you more than we will charge you, we just won’t ask for your business. It really is that simple.
February is Black History Month, and to celebrate, Fast Layne Solutions would like to pay tribute to some of the key African-American pioneers in the field of medicine.
Dr. James McCune Smith (1813 – 1865) was the very first African American to hold a medical degree. He was the valedictorian of his graduating class in medical school at the University of Glasgow in Scotland. After completing his degree and then an internship in Paris, he returned to the US, where he had a long and successful career that included being the first Black man to run a pharmacy in the United States; publishing articles in respected medical journals; and conducting extensive research, especially in the area of refuting racist theories about the connections between race and intelligence. He accomplished all this despite the many obstacles 19th-century America put in his path: he was refused admission to medical schools in the US due to his race, and was never accepted by the American Medical Association or even local medical groups. He was even once refused passage on a ship to return to America due to his race. Smith was an ardent abolitionist, and died just before the ratification of the 13th Amendment abolishing slavery.
Dr. Helen Octavia Dickens (1909 – 2001) was the first African-American woman to be admitted to the American College of Surgeons. She completed her medical degree at the University of Illinois College of Medicine in 1934. In 1942, she passed the boards to become the first Black woman to become a board-certified Ob/gyn in Philadelphia. She served as Director of Obstetrics and Gynecology at the Mercy Douglass Hospital in Philadelphia for almost 20 years, and did extensive research into the areas of teen pregnancy and sexually transmitted diseases, using the results to educate young women. As a doctor who faced the double challenge of overcoming both racism and sexism in her personal and professional lives, she was a true pioneer in both medicine and the fight for equality.
Dr. Robert Fulton Boyd (1855 – 1912) was the first president of the National Medical Association, an organization he and others founded in response to the racial segregation of medical facilities and schools and of other medical associations. Born into slavery, he went on to become a superlatively qualified healer, earning a degree not only in medicine but dentistry, on top of a Master of Arts degree. In 1893, he was appointed professor of gynecology and clinical medicine at Meharry College in Nashville.
Mary Mahoney (1845 – 1926) was the first African American woman to be awarded a nursing degree in 1879. She was also among the first Black women to be admitted to the American Nurses Association (ANA). She was a co-founder of the National Association of Colored Graduate Nurses (NACGN), which made significant contributions in the area of ending racial discrimination policies in their field. (The NACGN later merged with the ANA.) She was a civil rights pioneer in other ways, too: she was among the first Black women to register to vote in Boston after Suffrage. She was honored with induction into both the ANA’s and the National Women’s Hall of Fame.
Despite the great strides made by these and other brave African American pioneers in the field of medicine, to this day, Black medical professionals face challenges unknown to their white counterparts. Sociologist Adia Harvey Wingfield of Washington University has studied this subject extensively and her work shows we still have a long way to go. That’s doubly true for African American women working in medicine. Wingfield reported cases of Black female doctors regularly being called “miss” by people who assumed they must be nurses or orderlies. And the “new economy,” with its emphasis on contract work, has presented even more challenges, as Black medical professionals are disproportionately pushed into such arrangements, limiting both job security and upward mobility.
Every February, Black History Month provides us with myriad inspirational stories telling us how far we have come as a society, along with new milestones showing that we continue to make incremental improvements. But it also a sobering reminder that we still have miles to travel before we arrive at that “not too distant tomorrow [when] the radiant stars of love and brotherhood will shine over our great nation with all their scintillating beauty.” But we will get there. Dr. Martin Luther King never doubted that vision of his, and he never abandoned hope. Nor should we.
We often hear about so-called ‘food deserts,’ areas where it is difficult to impossible to purchase healthy, nutritious foods. But did you know there are also healthcare deserts? These sections of both rural and urban America have a shortage of doctors and healthcare facilities, and the impacts are deadly. And the effects disproportionately fall on minority communities. For example, on Chicago’s South Side, the death rate from diabetes is twice that of other neighborhoods in the same city. The result, when compounded by other factors such as poverty and poor access to nutrition, is that America has a huge life expectancy disparity, and it’s getting worse, not better. In fact, the gap is now 20 years when comparing the wealthiest zip codes to the poorest.
Fast Layne Solutions is dedicated to fighting this trend by helping doctors in these areas to become more financially viable and to thrive in these environments, even as we also develop plans to help these communities in other ways. Today’s blog is an introduction to how our solutions can help, and next month's installment will reveal exciting news about how we plan to do so while keeping jobs in the community.
First of all, why is it so hard for independent doctors to thrive in these communities? Mainly it’s a question of economics. It is extremely expensive to be an independent doctor these days. Quite aside from the fact that new doctors are starting their careers hundreds of thousands of dollars in debt, it is also financially burdensome to practice in the current regulatory and competitive environment.
This month and next, we are going to be looking at the journey of a fictional doctor, Dr. Janelle Smith, a young endocrinologist determined to make a difference in her South Side neighborhood, but who’s struggling to overcome the obstacles facing so many independent doctors, especially in the more economically-challenged areas of America’s cities.
Dr. Smith has just finished medical school and residency and is now ready to dedicate her life to fight diabetes among the area’s poorer residents. Dr. Smith is already in debt from medical school. She owes $200,000 in student loans. But she’s determined to help fight the diabetes epidemic that is cutting so many lives short in her neighborhood. So she raises some money and opens her clinic. She plans to stay viable by serving a wide range of patients: those who have private insurance, a few who are self-pay, some Medicare, and a very large portion of Medicaid patients. She also hopes to do a free clinic session every Saturday for four hours. She hires a biller, a receptionist, an office manager, and a physician’s assistant.
Once she is up and running, she quickly builds a large patient base. Yet she’s not thriving, and her cash flow is terrible, with her average accounts receivable days at around 75. Reimbursements are slow, expenses are high. Her biller spends all day fighting the insurance companies over rejected claims. She’s paying over 3% on credit card transactions for co-pays and self-pays. Her staff seems to spend endless hours on mundane, unproductive tasks like setting up appointments and doing reminders by phone, calling insurance companies for verifications, reworking the hundreds of claims that get kicked back from insurance for seemingly pointless reasons, dealing with write-offs over unexpected denials, going through mountains of paperwork for patient forms that the receptionist must then manually enter…...the list is endless. And Dr. Smith herself has no life. If she isn’t seeing patients, she’s catching up on charting in her tortuously cumbersome EHR (that she can barely afford). And it’s not like she has a choice: as a doctor taking Medicare, she has to start reporting her MIPS performance by her second year, and her state Medicaid program also has reporting requirements. She MUST use an EHR.
Dr. Smith is getting by, but she’s frustrated. She thinks of the stereotypes she grew up with: rich doctors driving Mercedes, taking off Wednesday afternoons, living in mansions. Not that she became a doctor for those reasons: if she had, she could have taken a cushy job with one of the large hospital systems. But still, it would be nice not to feel that her practice and her own financial situation was a month-to-month crisis waiting to happen.
One evening, after yet another 14 hour day, she gets a phone call. It’s a recruiter from the large hospital system in town. He’s familiar with her work, knows her impressive education and residency history. He throws out a number. A number that would mean no more stressing out about student loan payments. No more worrying about making payroll next month.
And no more independence. And no more serving the community she grew up in. In fact, no more living or practicing in her old neighborhood at all. To avoid an excessive commute, she’d have to move to the north side of town. And it means working as an employee for a corporate provider. No more being her own boss. No more serving the South Side.
Is this really what it comes down to? A choice between doing what’s right and barely scraping by on the one hand versus giving up her independence and her dream of serving the community where she grew up on the other?
Absolutely not. She’s facing a false choice, because, like so many doctors in America, she simply does not know that there are solutions to all her problems. Tune in next week and we’ll see how Dr. Smith can turn her practice around and live her dream of serving the South Side as a thriving, independent doctor.
In December, Fast Layne Solutions CEO Christopher Hughey sat down for an interview with Business Innovation Factory founder and author Saul Kaplan to discuss the state of healthcare delivery in the United States and how innovation must play a role in fixing the complex issues facing it.
According to Kaplan, the current American healthcare delivery system is a product of the industrial revolution and, in its current state, leaves too many people behind. It is a hard-working system with a lot of well-intended actors trying their best to help people. The question is how do we open it up to change, given that it is a self-fulfilling system, a system set up to protect itself and the status quo?
What people fail to understand is that the drive to provide universal healthcare is not a fix, but rather a precursor to the actual fix itself. Getting everyone covered is important, but will do absolutely nothing to address issues like trying to change incentives, innovate, disseminate information to stakeholders more efficiently, educate patients, and motivate people to take responsibility for their health.
Technology is an important component, but it is a double-edged sword: it can help innovate, but it is often used to simply reinforce the weaknesses of the current model. Kaplan cites the example of artificial intelligence (AI): look how many healthcare and pharmaceutical companies are using it not to improve patient outcomes, but simply to make themselves more efficient and profitable.
At the core of the challenge is the very nature of the system itself. We built an Industrial Revolution-based system to help people who are sick, and America is excellent at providing that expertise. But what we are failing to do in the post-Industrial modern age is proactively help people stay well in the first place. It is therefore an antiquated, reactive sick-care system, not a proactive wellbeing system. Ideally, we want both: help people stay well and address their issues once/if they get sick.
A big challenge to changing the system is that so many people start with the financial considerations and work backwards from there. At the Business Innovation Factory, Kaplan’s team starts at the front end: what is the problem we are trying to solve and how can we solve it in a way that delivers value in an economically viable model? That idea is at the heart of Kaplan’s new initiative “Luna You,” a woman-centered maternal wellbeing program that is focused on helping minority women improve pregnancy outcomes by educating and empowering them through outreach, personal coaching, and connecting to the needed medical and social service care. It is centered on the idea that health outcomes are better when patients have increased agency and can take ownership of their health once you give them the tools they need. It kicked off on 1 January of this year in Providence, RI, and will hopefully expand nationally once established.
Why start with one of the toughest problems in the American healthcare system? After all, many articles have cited minority maternal health and pregnancy outcomes as one of the greatest failures of our delivery system and it is a problem fraught with big social issues as well, not least of all the racial component. According to Kaplan, it’s part of his counterintuitive approach to innovation: “Never mind the low-hanging fruit. Give me the absolute hardest problems first. If I can solve those, the rest is easy.”
Does Kaplan expect resistance from the medical community in his attempts to intervene in these challenges? That is actually the beauty of such empowering programs: instead of asking permission of the Powers That Be, the large institutions, they are going straight to women, empowering them, and then going to the providers with them, hand-in-hand in partnership. The goal is to get outcomes on par with the those of the general population, and Kaplan’s team will be measuring their success accordingly.
To close out our interview, I asked Saul what he would change about how healthcare in America innovates if he could wave a magic wand and get those changes done immediately. He focused on three things: 1) Changing mindsets. Too many are at one extreme or the other: they either want to tweak timidly and incrementally or blow up the whole system and start over. So first and foremost we need to define what we mean by innovation and get everyone on the same page. 2) We must get far better about focusing on human-centered design and “shifting our lens” to move away from views that see the world in terms of what’s in the best interests of the existing institutions and towards what is in the best interests of the people those institutions are supposed to be serving (i.e. patients and those seeking to avoid becoming patients by improving their overall wellbeing). 3) We have to get more comfortable with exploration. Our current mindset is that we can analyze our way to solutions, that if we just capture enough data we can predict the future and increase profits. But that is antithetical to exploration and innovation because it leads to safe, risk-averse, incremental improvements at best. We have to be more comfortable with failure, with risk, with true exploration, because otherwise we will stay mired in the status quo.
We’d like to thank Saul for sitting down with us and sharing his unique vision. For more information on how the Business Innovation Factory is helping bring innovation to the healthcare system, please visit the BIF website.
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.