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The 2017 Healthcare Informatics Innovator Awards: Innovation in Clinician Workflow Co-Winner: Skywriter MD

February 13, 2017
by Kayt Sukel
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For more than a decade, Healthcare Informatics has honored those at the forefront of healthcare IT innovation with its Innovator Awards Program. As read in our January issue this year, the Healthcare Informatics Innovator Awards Program again recognized leadership teams from patient care organizations that have effectively deployed information technology in order to improve clinical, administrative, financial, or organizational performance. The Program also distinguishes vendor solution providers that have helped their clients shine in enhancing clinician workflow, exchanging data, or cutting down costs.

Indeed, this year the Innovator Awards program included two tracks for innovation recognition—one for healthcare provider organizations and one for technology solution providers, allowing both sides of the health IT spectrum to submit their examples of transformation. All vendor submissions were given to a selection of Healthcare Informatics expert editorial board members for careful review. The list of all provider and vendor winners in this year’s program could be seen right here.

Over the next few days, Healthcare Informatics will give readers the stories of the four vendor winners in the three above-mentioned categories. These technology solution providers are truly blazing the trail for innovation in the health IT vendor market, and we are proud to honor those whose combination of expertise and innovation are shaping the future of healthcare systems.

The 2017 co-winner in the category of Clinician Workflow is Skywriter MD, a Westminster, Colo.-based company that offers a real-time virtual medical scribe service.  President and CEO of Skywriter MD, Tracy Rue, spoke with Healthcare Informatics about how technology can lead to provider burn-out—and why virtual scribes can not only assist with improving care but also lowering patient costs.

Tell me about Skywriter MD’s vision for clinician workflow in healthcare.

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Tracy Rue:  Skywriter MD was born to assist providers—not only to document encounters but also to do all the work that’s required to keep up with the demands of electronic health records (EHRs).  It’s a solution that takes the “doc” out of documentation, so to speak. And in doing so, it increases efficiencies and access to care but also betters that provider’s lifestyle.  Skywriter MD takes them away from having to be data entry clerks—and also takes the computer away from between them and their patients.

To that end, our vision is to make the workflow more efficient. Having a virtual scribe allows providers to reduce the number of strokes and clicks required across the work day.  Studies currently show that physicians are pounding on a keyboard 30 to 50 percent of their working time, depending on their specialty.  Is that really the best use of their time?  By providing a virtual medical scribe, we can save a physician at a minimum two to three minutes per encounter—which adds up to 60 to 90 minutes of workload per day.  The provider then has that time to spend more time with patients as needed and to better their lifestyle by allowing them to go home by 6:00 p.m. instead of 8:00 p.m. each night. 

It allows physicians to increase access to care all while reducing their work demand—and it takes the computer out from between them and their patients. 

How do you see the competitive marketplace in the clinician workflow area?

This is definitely a market that is growing rapidly. Everyone is looking for a solution to help deal with documentation, whether you are a physician in a private practice or a large health system. EHRs are great but they do add quite a few pain points to providers. 

Let’s face it: a physician really only has three choices about when to document an encounter. The first is during the patient visit. And no one likes that—not the patient, not the provider, and most healthcare organizations don’t like it either. So then physicians could document in between patient visits. But that, of course, decreases the efficiency of the practice. If the provider is spending five to ten minutes in between appointments, that provider is decreasing the access to care.  The third option is doing documentation after hours. And this is when a lot of physicians do it. They document their entire day at 6:00 p.m. or 7:00 p.m. before they go home. Trying to remember everything that happened or inputting all the things from their notes in structured form—well, it’s something that wears on them over time.  It not only interferes with their family life but it also starts to interfere with their love of practice as well. 

So what Skywriter does is make it easier for providers to document. It could be as simple as going through their inbox and pointing and clicking to create the necessary action items. And what we see is a huge return on investment but in terms of provider satisfaction—they can go home and see their family at a reasonable hour—but we also see that ROI in terms of time saved and increased patient satisfaction.

To what do you attribute Skywriter MD’s success?

Skywriter MD was conceived by physicians for physicians. Our goal is to transform patient care, provider lifestyle, and, of course, the financials. And our success comes from our physician focus. We want to help providers so they can, in turn, do the best job and really focus on the patient—not a computer screen. 

When you look at the needs of the industry, you see that human component coming up again and again. There’s no machine that can assess a patient like a provider can and offer the right intervention. But there is a way to help those providers better input data into the EHR structure. And that’s what we do.

First and foremost, Skywriter MD offers providers a U.S.-based highly trained Scribe (skywriter). We have a team concept.  And that concept allows our solution to become much more efficient than typical scribes. Our Skywriters can reduce the overall cost by as much as 75 percent. But, second, Skywriter MD takes away the intrusive nature of medical scribes.  And we do that by using a technological medium. Third, our team concept gives us the ability to virtualize and find the talent wherever they happen to live. They may be college students or even medical students—the best and brightest assistance providers we can find—and we can link them up with any provider. Together, it makes a big difference and takes the challenges away for the provider.

What is your vision for the future—both in terms of challenges and opportunities—when it comes to clinician workflow?

The need for virtual scribes is growing rapidly. And our concept, where we collaborate with providers for accuracy, is important. Most people who are in this space—or who want to get into this space—know that the future is as much about the people as the technology. There may be some future where machines can enter data in a structured format, in a voice like real people, but we’re not there yet.  So having the ability to use this solution to help improve patient workflow is something that makes for not only better healthcare for the patient—but also a better lifestyle for the provider.


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Allscripts Sells its Netsmart Stake to GI Partners, TA Associates

December 10, 2018
by Rajiv Leventhal, Managing Editor
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Just a few months after Allscripts said it would be selling its majority stake in Netsmart, the health IT company announced today that private equity firm GI Partners, along with TA Associates, will be acquiring the stake held in Netsmart.

In 2016 Allscripts acquired Kansas City-based Netsmart for $950 million in a joint venture with middle-market private equity firm GI Partners, with Allscripts controlling 51 percent of the company. With that deal, Allscripts contributed its homecare business to Netsmart, in exchange for the largest ownership stake in the company which has now become the largest technology company exclusively dedicated to behavioral health, human services and post-acute care, officials have noted.

Now, this transaction represents an additional investment for GI Partners over its initial stake acquired in April 2016, and results in majority ownership of Netsmart by GI Partners.

According to reports, it is expected that this sale transaction will yield Allscripts net after-tax proceeds of approximately $525 million or approximately $3 per fully diluted share.

Founded 50 years ago, Netsmart is a provider of software and technology solutions designed especially for the health and human services and post-acute sectors, enabling mission-critical clinical and business processes including electronic health records (EHRs), population health, billing, analytics and health information exchange, its officials say.

According to the company’s executives, “Since GI Partners' investment in 2016, Netsmart has experienced considerable growth through product innovation and multiple strategic acquisitions. During this time, Netsmart launched myUnity, [a] multi-tenant SaaS platform serving the entire post-acute care continuum, and successfully completed strategic acquisitions in human services and post-acute care technology. Over the same period, Netsmart has added 150,000 users and over 5,000 organizations to its platform.”

On the 2018 Healthcare Informatics 100, a list of the top 100 health IT vendors in the U.S. by revenue, Allscripts ranked 10th with a self-reported health IT revenue of $1.8 billion. Netsmart, meanwhile, ranked 44th with a self-reported revenue of $319 million.

According to reports, Allscripts plans to use the net after-tax proceeds to repay long-term debt, invest in other growing areas of its business, and to opportunistically repurchase its outstanding common stock.

The transaction is expected to be completed this month.

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Study Links Stress from Using EHRs to Physician Burnout

December 7, 2018
by Heather Landi, Associate Editor
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More than a third of primary care physicians reported all three measures of EHR-related stress
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Physician burnout continues to be a significant issue in the healthcare and healthcare IT industries, and at the same time, electronic health records (EHRs) are consistently cited as a top burnout factor for physicians.

A commonly referenced study published in the Annals of Internal Medicine in 2016 found that for every hour physicians provide direct clinical face time to patients, nearly two additional hours are spent on EHR and desk work within the clinic day.

Findings from a new study published this week in the Journal of the American Medical Informatics Association indicates that stress from using EHRs is associated with burnout, particularly for primary care doctors, such as pediatricians, family medicine physicians and general internists.

Common causes of EHR-related stress include too little time for documentation, time spent at home managing records and EHR user interfaces that are not intuitive to the physicians who use them, according to the study, based on responses from 4,200 practicing physicians.

“You don't want your doctor to be burned out or frustrated by the technology that stands between you and them,” Rebekah Gardner, M.D., an associate professor of medicine at Brown University's Warren Alpert Medical School, and lead author of the study, said in a statement. “In this paper, we show that EHR stress is associated with burnout, even after controlling for a lot of different demographic and practice characteristics. Quantitatively, physicians who have identified these stressors are more likely to be burned out than physicians who haven't."

The Rhode Island Department of Health surveys practicing physicians in Rhode Island every two years about how they use health information technology, as part of a legislative mandate to publicly report health care quality data. In 2017, the research team included questions about health information technology-related stress and specifically EHR-related stress.

Of the almost 4,200 practicing physicians in the state, 43 percent responded, and the respondents were representative of the overall population. Almost all of the doctors used EHRs (91 percent) and of these, 70 percent reported at least one measure of EHR-related stress.

Measures included agreeing that EHRs add to the frustration of their day, spending moderate to excessive amounts of time on EHRs while they were at home and reporting insufficient time for documentation while at work.

Many prior studies have looked into the factors that contribute to burnout in health care, Gardner said. Besides health information technology, these factors include chaotic work environments, productivity pressures, lack of autonomy and a misalignment between the doctors' values and the values they perceive the leaders of their organizations hold.

Prior research has shown that patients of burned-out physicians experience more errors and unnecessary tests, said Gardner, who also is a senior medical scientist at Healthcentric Advisors.

In this latest study, researchers found that doctors with insufficient time for documentation while at work had 2.8 times the odds of burnout symptoms compared to doctors without that pressure. The other two measures had roughly twice the odds of burnout symptoms.

The researchers also found that EHR-related stress is dependent on the physician's specialty.

More than a third of primary care physicians reported all three measures of EHR-related stress -- including general internists (39.5 percent), family medicine physicians (37 percent) and pediatricians (33.6 percent). Many dermatologists (36.4 percent) also reported all three measures of EHR-related stress.

On the other hand, less than 10 percent of anesthesiologists, radiologists and hospital medicine specialists reported all three measures of EHR-related stress.

While family medicine physicians (35.7 percent) and dermatologists (34.6 percent) reported the highest levels of burnout, in keeping with their high levels of EHR-related stress, hospital medicine specialists came in third at 30.8 percent. Gardner suspects that other factors, such as a chaotic work environment, contribute to their rates of burnout.

"To me, it's a signal to health care organizations that if they're going to 'fix' burnout, one solution is not going to work for all physicians in their organization," Gardner said. "They need to look at the physicians by specialty and make sure that if they are looking for a technology-related solution, then that's really the problem in their group."

However, for those doctors who do have a lot of EHR-related stress, health care administrators could work to streamline the documentation expectations or adopt policies where work-related email and EHR access is discouraged during vacation, Gardner said.

Making the user interface for EHRs more intuitive could address some stress, Gardner noted; however, when the research team analyzed the results by the three most common EHR systems in the state, none of them were associated with increased burnout.

Earlier research found that using medical scribes was associated with lower rates of burnout, but this study did not confirm that association. In the paper, the study authors suggest that perhaps medical scribes address the burden of documentation, but not other time-consuming EHR tasks such as inbox management.

 

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HHS Studying Modernization of Indian Health Services’ IT Platform

November 29, 2018
by David Raths, Contributing Editor
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Options include updating the Resource and Patient Management System technology stack or acquiring commercial solutions

With so much focus on the modernization of health IT systems at the Veteran’s Administration and Department of Defense, there has been less attention paid to decisions that have to be made about IT systems in the Indian Health Service. But now the HHS Office of the Chief Technology Officer has funded a one-year project to study IHS’ options.

The study will explore options for modernizing IHS’ solutions, either by updating the Resource and Patient Management System (RPMS) technology stack, acquiring commercial off-the-shelf (COTS) solutions, or a combination of the two. One of the people involved in the analysis is Theresa Cullen, M.D., M.S., associate director of global health informatics at the Regenstrief Institute. Perhaps no one has more experience or a better perspective on RPMS than Dr. Cullen, who served as the CIO for Indian Health Service and as the Chief Medical Information Officer for the Veterans Health Administration

During a webinar put on by the Open Source Electronic Health Record Alliance (OSEHERA), Dr. Cullen described the scope of the project. “The goal is to look at the current state of RPMS EHR and other components with an eye to modernization. Can it be modernized to meet the near term and future needs of communities served by IHS? We are engaged with tribally operated and urban sites. Whatever decisions or recommendations are made will include their voice.”

The size and complexity of the IHS highlights the importance of the technology decision. It provides direct and purchased care to American Indian and Alaska Native people (2.2 million lives) from 573 federally recognized tribes in 37 states. Its budget was $5.5 billion for fiscal 2018 appropriations, plus third-party collections of $1.02 billion at IHS sites in fiscal 2017. The IHS also faces considerable cost constraints, Dr. Cullen noted, adding that by comparison that the VA’s population is four times greater but its budget is 15 times greater.

RPMS, created in 1984, is in use at all of IHS’ federally operated facilities, as well as most tribally operated and urban Indian health programs. It has more than 100 components, including clinical, practice management and administrative applications.

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About 20 to 30 percent of RPMS code originates in the VA’s VistA. Many VA applications (Laboratory, Pharmacy) have been extensively modified to meet IHS requirements. But Dr. Cullen mentioned that IHS has developed numerous applications independently of VA to address IHS-specific mission and business needs (child health, public/population health, revenue cycle).

Because the VA announced in 2017 it would sundown VistA and transition to Cerner, the assessment team is working under the assumption that the IHS has only about 10 years to figure out what it will do about the parts of RPMS that still derive from VistA. And RPMS, like VistA, resides in an architecture that is growing outdated.

The committee is setting up a community of practice to allow stakeholders to share technology needs, best practices and ways forward. One question is how to define modernization and how IHS can get there. The idea is to assess the potential for the existing capabilities developed for the needs of Indian country over the past few decades to be brought into a modern technology architecture. The technology assessment limited to RPMS, Dr. Cullen noted. “We are not looking at COTS [commercial off the shelf] products or open source. We are assessing the potential for existing capabilities to be brought into “a modern technology architecture.”

Part of the webinar involved asking attendees for their ideas for what a modernized technology stack for RPMS would look like, what development and transitional challenges could be expected, and any comparable efforts that could inform the work of the technical assessment team.

 

 

 


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