Electronic Health Reporter

Dr. David Lischner started Valant Medical Solutions in 2005, a web-based EHR and practice management solution designed specifically for the mental healthcare practitioner. Because he went to school to practice medicine and not administer paperwork, he set about creating a tool that would not only afford him more time free from his practice, but also provide a secure record keeping solution that is integrated with a clinical support tool – allowing him to be a better doctor to his patients. Simply put, he and the team have developed a SaaS tool that intuitively enforces measurement based care.

Despite expert literature highlighting the potential importance of evidence-based-care in psychiatric practice, most doctors simply do not employ these measures. As we know, those physicians who don’t start showing off their patient outcomes to insurers are going to be weeded out by both the federal EHR incentive program and the Affordable Care Act. Valant provides this market, along with the early adopter forward thinkers with both useable solutions to age old problems and readied answers to future concerns — of which there are many within this industry, and this specialty particularly.

The following are his thoughts about EHRs, building a software business and why he chose to start Valant Medical Solutions.

As a practicing psychiatrist with a successful group practice, why did you venture into the EHR space and develop your own software?

I loved seeing patients. I loved being in private practice. But I wanted to have an impact on a larger scale. And, I also discovered that I loved starting and growing businesses.

I didn’t like the solutions that were out there to help me manage my practice. They were either focused on primary care and other specialties or too narrowly on just one type of mental health care provider or practice. I also saw that web-based software was beginning to transform business processes in other industries and thought that this must be possible in healthcare, and specifically in behavioral health care. Finally, and this was a more distant motivation, I wanted tools that made it easier or even fun to practice in an evidence based fashion.

Why does Valant Medical Solutions matter to mental healthcare? How are you changing the landscape?

It makes sense to have one organization that is entirely focused on mental healthcare.  Long before the EHR incentive program was established, we had to pass a very high bar for usability and overall business value. At the end of the day, the decision maker was — and still is — the clinician. The discipline we developed in those early days with respect to user experience has served us well as we’ve grown.

We matter because we live, breathe and sleep mental healthcare. We now have the capacity to deliver solutions for all segments of the market and help solve big problems across the entire industry. One of these is that behavioral health care providers, myself included, have been slow to adopt measurement as a core part of our day to day practice, despite there being overwhelming evidence that doing so improves patient outcomes. We simply have not had the tools to do this. It’s not enough to provide a tool for capturing outcomes data; there has to be an end-to-end platform that captures patient outcomes data and then reports and shares it when appropriate with collaborating providers. Ideally, one can later to use it to support improved population health.

As an EHR provider, we have designed the front end right, allowing our clinicians to capture the data they need without being slowed down. In fact, we have clinicians tell us that they are more efficient than ever before. People are slowly and surely connecting the dots … If you improve value at scale, you change the landscape. That’s how we are transforming behavioral health care.

What has been your biggest hurdle to overcome?

I think that getting started is always the biggest hurdle …. Getting those first 300 to 400 customers or so. We started with a $100-a-month Google ad-words campaign and then grew it from there. We made a point of boot-strapping the business in the early days so that we could prove that this was all going to be worthwhile before taking in institutional investment. So, we had to learn to get by with limited resources, be very capital efficient, and still delight our customers.

Maintaining focus on this one niche market was always going to seem tricky. Mental healthcare represents 7 percent of all of healthcare. So, it’s much bigger than it may seem. But there could have been a temptation to try to be all things to all customers, which in the end would have diluted our offerings and compromised our customer experience. Staying focused has been vital for us and our customers in many, many ways and has turned out to be a great way to do business.

What is your projection for the mental health IT space?

Some specialties such as oncology, nephrology and dermatology lend themselves to the niche solution. Behavioral healthcare is one of those specialties. As the need for practices and other stakeholders to differentiate themselves (by showing better and better outcomes for patients and populations of patients,) the focus on specialty solutions, particularly platforms, will grow. In the private practice market, care will continue to be provided by independent practices. But these practices will team up more and more with collaborating providers and practices in what will amount to distributed but collaborating networks. The lines between public and private will blur some as payers assume more and more of the responsibility for managing care in public behavioral health. And, in the public behavioral healthcare setting, the problem of compliance with government regulations will persist. Some of these projections have some relationship to higher value care. Unfortunately, many do not …

The current EHR solutions fail to solve the problem without disruption of clinical and administrative work flows. The true challenge for vendors like us is to come out with a solution for delivering compliance while actually increasing efficiency. We’ve done this with our platform for capturing outcomes data. We plan to extend that platform to tackle compliance and feel very optimistic that we’ll offer something unique.

Why is measurement-based care so important?

Simply, we have to measure what we do to know whether or not it is working. Regarding this industry in particular, we have relatively high placebo rates. It’s not hard to convince ourselves that what we are doing is working on average because most of us are natural healers who are great at the non-specific aspects of care. But that’s not going to be enough for patients any more. It’s also not going to be enough for the other entities that are paying for care such as employers and insurance carriers.

Mental healthcare providers are going to be held accountable for showing that what we are doing works even better than placebo and that we are being tenacious about improving outcomes. Those who are responsible for populations of patients will need to show at an aggregate level that what they are doing works. You simply can’t sustain a system without accountability.

When I first graduated from residency and started a practice, I had a consult group. We talked about cases and I brought up cases when I felt stuck, when the outcomes were not improving and I wasn’t sure what to do next. In other words, the consult group served as an accountability forum. All it took was for me to talk about how what I was doing was not working to be prompted to make a change, even if there were variables holding me back, such as my lack of confidence with a treatment modality or the patient’s anxiety. My colleagues would hold up a mirror so that I could see that I was not acting when I needed to, which would prompt me to do the difficult or uncomfortable thing for the good of my patient. I think of measurement-based care in the same way, except it’s scalable. This accountability is lacking across the entire industry and providers are hungry for tools to help them with this. This has been validated by the way our customers across the continuum — from private practice to large public mental healthcare facilities — have responded very well to our platform for auto-triaging patients and capturing outcomes data from day one to support measurement based care.

Where do you see Valant over the next two years?

I see us covering more ground in this industry. We are on the only complete SaaS solution in the private practice market that is focused on the specific needs of behavioral healthcare professionals. We are also the only solution that spans across the public/private continuum. The team looks forward to adding features that allow us to deepen our connection with the private practice market including real behavioral healthcare specific clinical decision support and tools that support integrated care. Simultaneously, we will penetrate deeper into the enterprise market including public mental healthcare, but also hospital-based practices and integration with care management platforms for employer based populations.

We have great plans to solve a host of big industry and practice problems that exist on the back end, but must be solved with great solutions for the front end that delight and help the clinician help the patient at the point of care.