By Rakhee Langer, vice president, healow telehealth solutions, eClinicalWorks.
When the COVID-19 pandemic hit, it sparked revolutionary change across the health care industry, from a more focused need for ongoing communication with patients and telehealth solutions. Practices immediately had to shift their in-office visits to an online presence — changing with the times.
Initially, there was hesitation from both the patient and the provider whether conducting online visits would prove to be on par with in-person visits. However, the concerns surrounding technology adoption were quickly mitigated and both patients and providers found that telehealth was not just easy to adopt but also facilitated a productive medium for care.
During the peak of the pandemic, almost all visits were conducted via telehealth, helping to ensure the safety of both the patient and the provider. It was key to determine which types of visits could be done over telehealth.
We found that providers across all specialties—including neurology, behavioral health, pediatrics and dermatology—found ways to continue providing effective and comprehensive care. Of course, there are exceptions and certain types of visits that require an in-person physical examination.
However, physicians have found that telehealth is an avenue to conduct pre-surgery consults, post-surgery follow-ups and screenings in which it may not require the patient to come into the office. All specialties, including urgent care centers, have begun to use telehealth as well as solutions for check-in and bill payment that limit contact and thus reduce potential exposure to COVID-19.
Coronavirus has forced practices nationwide to undertake dramatic changes in how they practice medicine. But whatever the means we use to deliver care, there is still nothing as dramatic as saving a life.
Although I had been thinking about and planning to use telehealth for about a year, the sudden arrival of the COVID-19 pandemic left me with no choice. I recognized that there was no way to safeguard my patients or staff if I kept my office open.
I still had some reservations. Would patients use telehealth technology? Would they accept it? Most importantly, would telehealth allow me to deliver the same quality as an in-person office visit?
The answers came quickly and clearly. With healow TeleVisits from eClinicalWorks, getting started was simple and easy for my staff. Patients were thrilled to have a way to receive care without having to risk exposure to the coronavirus by traveling to my office. We transformed our more than 20 daily in-office visits to more than 20 televisits in just 10 days.
Saving a patient’s life via telehealth
And my remaining doubts about the efficacy and quality of remote care were erased in a single encounter.
I was meeting with a new patient who was complaining about vomiting, diarrhea, and abdominal pain. When I asked him to show me what the vomit looked like, he placed a jar containing black vomit in front of the camera.
I immediately knew that he was suffering internal bleeding and instructed him to get to a hospital. His wife ended the call and took him to the ER, where he was admitted. The bleeding was stopped and he received a transfusion.
Five days later, we had a follow-up televisit. He was in good spirits and told me that his life had been saved because of that first televisit.
According to Patient-Centered Primary Care Collaborative, the patient-centered medical home (PCMH) is a “model or philosophy of primary care that is patient-centered, comprehensive, team-based, coordinated, accessible, and focused on quality and safety.” PCMHs power business and clinical processes by using clinical decision support tools to connect patients with members of their healthcare team to improve both the patients’ and the providers’ experience of care. This coordination encourages a stronger physician-patient relationship, leading to better care delivery, more involved and engaged patients and reduced avoidable costs. According to the National Committee for Quality Assurance (NCQA), these models are “transforming primary care practices into what patients want, focusing on patients themselves and all of their healthcare needs. They also are foundations for a healthcare system that gives more value by achieving the ‘triple aim’ of better quality, experience and cost.”
The NCQA recognizes over 10 percent of U.S. primary care practices as patient-centered medical homes. In order to be recognized by the NCQA, these primary care practices must offer access both afterhours and online, allowing patients to receive care when and where they need it. They work with patients to make treatment decisions based on individual preferences and help patients engage in their own health. The practice as a whole works as a team to coordinate care from other providers and community resources to maximize efficiency. Additionally, PCMHs focus on preventive care and the management of chronic conditions to prevent complications and emergencies.
Girish Navani is CEO and co-founder of eClinicalWorks, an electronic health record company exceeding in the B2B field since 1999. Under the leadership and foresight of Navani, the company is expanding its services to B2C with the launch of healow – an app for patients to easily find new doctors, schedule appointments online and access their personal health records.
Here, Navani speaks about his path to eClinicalWorks, he offers his expert insight on EHRs and their benefits to healthcare, and he speak of likely trends that will continue to change the healthcare landscape.
Tell me your story. About how you got here, how you developed your technology and the reasoning for a private company set up?
We wanted to use technology as a way to completely transform the healthcare delivery model to streamline processes, prevent errors and provide easily accessible information to both providers and patients. Not only was our primary goal to make doctors’ jobs easier by providing them with a way to operate more efficiently, but we also wanted to improve the patient experience.
I’m a strong believer in keeping my company private and concentrating on building a solid product. Selling shares and depending on investors means that they will always have a say in how we conduct our business. We use our profits to continue building our company and our products.
What about the leadership inside the company? Is it true the no employees have titles? What’s the reasoning?
I have an open-door policy, which allows the opportunity for anybody to approach me to ask questions and brainstorm ideas. Over time, I’ve learned to listen more. I’m okay with second guessing my own decisions and receiving feedback from my colleagues, even if what they say is “no.”
Yes, our employees do not have titles, but instead, the whole company is team-based with team leaders being the only leadership position. Employees’ careers grow with bigger projects. I think titles are self-fulfilling and short-term objectives that people quickly get tired of. With a team-based structure, employees can work together to achieve successful results instead of individuals striving for the next title.
What drew you to healthcare? Why does it stand out for you?
I have always worked in technology, and in 1999, I heard a lecture in Geneva about using wireless computing in healthcare and the idea of “connected healthcare” really stuck with me. I loved the idea of a doctor and patient sitting in the doctor’s office reviewing charts on a tablet instead of pieces of paper, so I wanted to build a technology that connects all parties involved in healthcare, including the doctor, patient and insurance company.
Collaboration has proven to be key when moving to a meaningful use certified electronic health record, time and time again. The same can be said about upgrading to a MU certified EHR.
From a single site opened in 1996, Santa Rosa Community Health Centers (SRCHC) has become a major provider of healthcare services in Sonoma County with more than 102 participating providers serving a patient population of 40,000 through eight facilities.
Services include family planning and reproductive health, HIV, mental health, obstetrics, outreach and education, pediatrics, primary care, senior and older care and teen services. SRCHC is a federally qualified health center, and provides more than 183,000 medical visits each year.
Guest post by Girish Kumar Navani, CEO and co-founder, eClinicalWorks.
In a world becoming more and more connected by technology, we have countless resources that fit in the palms of our hands. Thanks to smartphones, we are empowered to shop, bank and manage our social networks and more – whenever and wherever we choose. And companies are working in new ways to meet our needs by building apps and optimized websites that make our lives easier.
This notion of consumerization – the power of the consumer to drive technological innovation – is taking hold in healthcare. It means giving patients tools to track, understand and maintain their health, and meeting their demand for easy access to their doctors and personal health information. Empowering patients in this way could lead to big changes in our healthcare system.
Dr. Sumir Sahgal moved into private practice in 1999, leaving the hospital setting for good. For some reason, he felt he could do more, contribute more positively to the community, as a care provider if he was running his own practice.
Since then he’s built a thriving medical practice, Essen Medical Associates, that has 25 healthcare providers who provide services in 20 medical facilities including nursing homes, hospitals and in one of five multi-specialty offices (with more coming online) owned by the practice.
Based in the greater New York City metro area, Sahgal’s practice, a certified medial home, serves more than 15,000 active patients per year. But true to his calling in that he wanted to do even more to provide care to patients, in 2005 he started down a new path that, at the time, most of the people he spoke with said he was making a costly mistake.
Of the population he’s served, there were several dozen (80 patients, in fact) that were home bound. Other than the random hospital visit, they received no care. That is until Sahgal opened EssenMED House Call Service.
EssenMED House Call Service primarily provides care for elderly home-bound patients in the Bronx, Manhattan, Brooklyn, Queens and Westchester. It is currently one of the largest private medical house call programs in New York.
“We opened a house call practice in the Bronx and everyone thought we were crazy,” Sahgal said. “We serve some pretty tough neighborhoods.”
After six months, the practice’s leaders evaluated the program. It made no financial sense to continue the service, he said, but there was an inherent value in the service his practice provided, and that’s all that mattered. The house call service fit his patients’ needs and they were receptive, and word of the program spread.
First slowly and then much more quickly. In seven years, the number of patients has doubled each year. There are now 1,800 being cared for by Essen’s nine caregivers.
“Through word of mouth, patients kept calling,” he said, “and eventually we had enough volume that it created efficiency in the program. Patients gravitate to where they can get the best care.”
The investments the practice made in electronic and mobile technologies also helped. Without his EHR, he currently uses eClinicalWorks, and being able to access patient data through iPad, the house calling practice is almost no different than the office-based practice.
“Healthcare technology helps create efficiency, and since we’ve moved to eClinicalWorks, our coordination of care has gotten much better,” he said.
All of the information needed to care for patients is on hand through mobile technology. In many ways, his staff is just as efficient in the homes of the patients as they are in the practice setting.
Much of the business’ success can be tied directly to the current technology in place.
All of the information is available wirelessly through the practice’s server including labs and documentation. “It’s like truly transferring the office to the home,” he said. “We can prescribe directly from the patient’s house.
The technology has helped him grow his practice and open communication lines with colleagues and share information, as would be expected, making for a much easier documentation process, especially for staff members in the field.
“The technology has helped us improve care and increase patient engagement. With improved patient engagement, patients have better access to their health information, access their medications and communicate with us, which helps us improve care,” he said.
As devices and capabilities continue to improve, Sahgal is confident that the same can be said for patient care, which he’s extremely passionate about. He’s in the business of practicing health to help people have better or more comfortable lives.
His approach is also saving money for the overall system. The more home care is available to patients, the less likely they are to seek care in the hospital. Likewise, the more comfortable patients are as they manage their conditions or approach the end of their lives.
The patient’s response to the technology has been overwhelmingly positive, he said, especially when he’s able to provide video consultations with patients through his iPad and perform remote triages and blood pressure checks from miles away. The services provided by Essen save patients from unnecessary hospital visits and many thousands of dollars in the process.
At this point, one of the next things that can be done to improve care is for interoperable systems to be fully engaged and useable by caregivers despite the vendor in which they employ. But, for now, the technology is in place to allow for the patient to be the central figure in this play, not the technology.
Serving patients in their space and in their areas of comfort is not a common business model and is much easier now than it has been in the past. Dr. Sahgal says his work is his calling, something he does because he loves providing care.
It’s not always easier either: “You are in the field, there are environmental factors to deal with; we have our war stories. But we’re able to provide TLC in the patient’s home, where they are most comfortable,” he said.