Q: Did you plan to become involved in healthcare technology when you
entered medical school? What was the impetus and what does it take for a
physician to become a health information technology (HIT) entrepreneur?
A: I liked both medicine and computers
growing up, so I studied Biomedical engineering at the University of Pennsylvania, where I wound up programming and working with a variety of PhDs and MDs. When I went to the University of Illinois College
of Medicine, I was fortunate to have a mentor in Arthur Elstein, PhD, who had
founded the Society for Medical Decision Making and created our med school's initial Informatics Department. I became his
research assistant, worked on a variety of informatics projects and realized
that I wanted this to be part of my career.
Over the years, in addition to being a
PCP, I accumulated a diverse set of technology and business experiences, from
serving as the Medical Director of IT for a large primary group to starting a consulting
company to serving as the Chief Medical Officer for two publicly traded
companies in the IT space. Then in 2008 I was able to merge technology and
innovation when I received philanthropic funding to start the SzollosiHealthcare Innovation Program at Northwestern, and have been able to learn a whole
new skill set of design thinking and methodologies.
Over the years, I also advised a number
of startups, but eventually realized that to make the biggest impact (and have
the most fun), I should be starting companies myself. I knew I could bring an interesting variety
of real world clinical, IT, Innovation and business skills to certain
healthcare problems, but quickly learned that the key to success is always finding
great people that can execute on a vision… and I've been very fortunate in
finding the right people with which to partner.
For physicians interested in being
entrepreneurs, my advice is to try and get a good variety of experiences, and
then become part of a team so that you don't have to give up your "day
job" of seeing patients. You will
find that keeping your day job will help financially during the early times,
will allow you to add in more real world flavor to your company, and will satisfy
a part of your soul that only taking care of patients can do.
Q: Do you still believe that the electronic medical record is dead and that
instead, innovation in HIT rests on apps?
A: I do believe that "EMR version 1.0"
is dead, in the sense that this early vision of the EMR was mainly focused on putting
data into electronic media for legibility and easy access, with an overall bias
towards billing and compliance rather than making clinical care easier and
better. And while those were important
building blocks, the result has been difficult to use EMR systems, especially
in the primary are arena.
So now we are evolving to EMR 2.0, where
the classic EMRs become the platforms upon which innovators can build an
amazing variety of apps that fulfill every doctor (and patient's) dreams! Imagine what might happen if thousands of
programmers were able to easily build "EMR Extender Tools" on top of (or
within) all the EMRs which are deployed… how many great apps might we see that
would never come from the traditional vendors because there are simply too many
ideas and not enough time.
Already we have seen a surge in EMR
Extender Tools which provide content, decision support, and analytics
programs. And we are now starting to see
apps that focus on truly improving the workflow of care to create both
major efficiency and quality improvements. Ideally, future EMR Extender Tools
should have enough flexibility to adjust for multiple styles and types of care,
whether supporting a Cardiologist in California, a Rheumatologist in Rhode Island, or a Neurosurgeon in Nebraska..
We are also seeing that some EMR vendors
have started to readily embrace this concept of being an open platform, while
others have been slower. But I suspect
all will come along because in the history of technology, a well known truism
is that "closed wins early, but open wins late".
Q: Why did you decide to focus on medication refills when creating your
company healthfinch? How does streamlining the process affect population health?
A: We wanted to start with a workflow which
affected the majority of primary care doctors, but one they would happily
"give up" because losing it was non-threatening both clinically and financially.
The medication refill process was the perfect scenario for us - it is a
constant chore for any PCP, with the average doctor getting around 15-20
requests a day, which takes up to 30 minutes of their time to properly manage,
and they never get paid for it!
We thus created RefillWizard as a
workflow automation tool that intercepts any incoming refill, reviews it in a
cloud-based rules engine, routes it to the appropriate person (e.g. RN, Pharm
tech, MA) and instructs them on how to handle it. With this tool supporting care redesign, the doctor then only needs to be involved in
the 10-20% of refills where their judgment is truly required. This made for easy adoption since it actually
decreased the amount of work for physicians. Additionally, we found that that the quality
of care could actually improve due both to the speed of answering refills and
the consistent use of evidence based rules.
Our philosophy is actually a very
different take on population health.
Rather than focus on computerizing the 20% of care which is most
complex, we instead focus on building tools to automate and delegate the 80% of
care that is relatively routine. This has two implications for population
health. First, since physician time is a HUGE commodity for population health
programs, freeing up their time from routine, repeatable tasks allows doctors
to take care of a higher volume of patients, focus more on high risk patients, and/or
simply catch their breath and keep their sanity. Second, by using the med
refill process as a model for how to centralize and standardize certain workflows,
we help create the type of team-based infrastructure and culture that will be
needed in the future to efficiently manage large populations. Refills first,
then other workflows later!
A: In
other industries, it has become clear that making the front line workers happy
invariably results in better products and service to the customers (think
Southwest Airlines, Google, or read Shawn Achor's "The HappinessAdvantage"). Healthcare should
learn from these lessons, and we strongly believe that by focusing on creating tools which make doctors happy, the patient will invariable benefit as well. In fact, a recent article (From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider) strongly suggests that we should expand the Triple Aim to include physician & staff satisfaction as soon as possible.
We believe in this deeply, and so one
of healthfinch's driving mantras is to Save our Primary Care Physicians, and we
do this by waking up every day thinking about how to use HIT to make life
easier for physicians and better for patients.
In other words, this is not your normal healthcare software
company. Our first goal is to literally
improve doctor happiness (without hurting quality of course). And at the same time, we believe
we can "sneak in" a variety of quality improvements by helping to
ensure consistent use of evidence based guidelines in routine workflows (and ps, doctors are happier when quality goes up as well).
I
think that EMRs have gotten a bad rap as always creating more work for
physicians. Of course, that should be no
surprise as the traditional EMR vendors are understandably focusing on functionality that is mandated by various regulations (i.e. documentation and billing and MU) over holistic
usability. And that is a problem since
no matter how good a function might be, there is no quality without use, and
there is no use without usability.
However, I believe that the Golden Era of using HIT to lessen the
workload for physicians is just around the corner! .
Q: What are the three key HIT strategies physicians
should adopt to improve healthcare delivery?
A: First,
we need to optimize our use of HIT to make doctors much more efficient and
happier. I call this Get SAD to Make Doctors Happy:
- Simplify
their interaction with EMRs, such as by minimizing their direct hands on
experience (e.g. scribes, voice recognition, Google Glass) or using data
visualization to help make the cornucopia of data easier to view and
understand
- Automate as
much of the workflow as possible
- Delegate the
things that can be delegated to the appropriate person on their team
Second,
we need to better manage large populations of patients. I call this Get FAT to make the Population Healthy:
- Financial
incentives need to be aligned around volume rather than value
- Analytics
will be used to risk stratify and understand our populations better
- Team based
care which will spread the workload appropriately across all the members
of the team.
Third
we need to devote time and resources to being more innovative. I call this The Three EEEs of Innovation:
- Explore new
technologies and thinking to get some insight and ideas on what you might
do and how you want to prioritize
- Experiment
by building prototypes and pilots to test new ideas, care models and
technologies. Iterate often until
you have both a good clinical use case and business case.
- Expand the
innovation to the rest of the organization
If
we can do these three things effectively, we will find that we don't really havea shortage of physicians, just a shortage of using them efficiently. And the
future will be one where the typical physician sees less patients face to face,
but is able to take care of more patients every day using an IT empowered,
team-based approach that utilizes everyone to the top of their license and
improves the quality and experience of care for both patients and providers.
