What You Should Know:

– The U.S. has seen a consistent decline in primary care clinicians since 2014 due to fewer clinicians entering the workforce, increased rates of burnout and decreased direct patient care, according to the latest evidence report from the Primary Care Collaborative and Robert Graham Center.

– The report, Health is Primary: Charting a Path to Equity and Sustainability reveals the United States has seen a consistent decrease in the number of primary care clinicians since 2014, caused by a decline in the number of clinicians entering primary care, burnout leading to retirement, and decreased direct patient care time. In 2019, there was a net loss of 10 clinicians per 100,000 people across the United States. Spending on primary care fell from an average of 6.2% in 2013 to 4.6% in 2020. 

Multifaceted Approach to Rebuild Primary Care

Experts recommend a multifaceted approach to rebuilding primary care that outlines steps policymakers, providers, and employers can take, including:

– Offering more primary care training opportunities and incentives for clinicians to select primary care as a specialty,

– Collecting accurate and transparent workforce and primary care financing data,

– Establishing a hybrid primary care payment option alternative to fee-for-service for accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) and more broadly across public and private programs, 

– Crafting solutions to mitigate the primary care barriers of high deductible health plans, and

– Supporting today’s primary care workforce by lowering administrative burdens and building diverse teams to address the range of patient primary care needs.

Having access to a regular source of primary care is associated with fewer emergency department visits and hospitalizations, lower odds of dying prematurely, and lower healthcare costs. Data from MSSP, Medicare’s largest ACO program serving 11 million beneficiaries, consistently indicates that primary care-focused ACOs (more than 75% of clinicians are primary care) provide higher-value services on a population basis, producing more than twice the savings as hospital-based ACOs. In 2022, MSSP saved Medicare $1.8 billion.

Factors Contributing to Primary Care Access Issues

The report examines the supply and demand factors that contribute to primary care access issues. It also considers innovations such as direct primary care, telehealth, and retail clinics that aim to provide more equitable access but may pose unintended community-level financial burdens and access issues. Despite increased uptake of these care options, one-in-four U.S. residents currently do not have a relationship with a primary care clinician, and 40% of adults in the United States failed to have a primary care visit in 2019. These trends have been exacerbated by the COVID-19 pandemic, suggesting that the situation may be more dire than the report’s data reflect.

“High-tech healthcare grabs the headlines, but high-touch, personalized primary care with tech support keeps people healthier at a lower cost,” said Ann Greiner, president and CEO of PCC. “If we are serious about improving the health of everyone in every community, policymakers need to step up to strengthen primary care, making it attractive to clinicians and delivering what patients want – comprehensive team-based care.”

What You Should Know:

– Banner Health forms a strategic partnership with Phoenix-based evolvedMD to place mental-health providers at Banner’s primary-care clinics, making it easier for people to receive mental health services they may need.

– The integration of mental health services in primary-care settings will be phased in at Banner Medical Group sites throughout metro Phoenix, starting in the East Valley at Banner’s East Mesa and Queen Creek locations.

– Under the program, a licensed behavioral therapist works with the patient’s primary care providers to provide mental health expertise, psychiatric consultation, ongoing clinical support, case management and insurance support and navigation.

What You Should Know: 

– Fold Health,a San Francisco, CA-based platform supporting value-based primary care raises $6M in funding from Iron Pillar and global angel investors. 

– Fold partners with leading value-based primary care groups, ACOs, health systems, health plans and digital health companies, to 10x the reach and effectiveness of collaborative care teams in their mission to radically improve outcomes.

Supercharge Primary Care

Despite the rapid shift to value-based care payment arrangements, existing solutions fail to support the needs required for success in outcome-based payment models: data-driven, consumer-centered, prevention-focused care. As a result, many primary care providers have resorted to investing in disjointed point solutions or building out their own tech suite, which takes valuable time away from treating patients. Fold Health’s platform integrates with electronic health records (EHRs) to enable customers to use modular tools to support their unique needs and optimize existing technology investments. Eliminating providers’ need to build software solutions from the ground up, Fold Health enables advanced primary care groups to achieve 3x tech-related cost savings.

Fold Health’s Capabilities

Fold Health’s Platform offers an integrated suite of capabilities including:

• ClinOps Efficiency Engine: A workflow engine that automates 60% of the work required to succeed in value-based care – including care gap closure, transitional care management, annual wellness visit completion, high-risk patient engagement, and attribution growth and protection.
• Care Team Enablement Suite: Unifies patient data, task management, omnichannel communications and scheduling to keep complex collaborative care teams in tight coordination.
• Patient Enablement Suite: A fully white-labeled patient web and app experience that allows patients to conveniently work with their care team, including self-scheduling, chart access, notifications management, and wearables/RPM data integration.

Expansion Plans

Fold Health continues to scale operations, most recently opening an R&D office in Pune, India in 2023. The company is also looking to rapidly expand it’s headcount across the US.

HealthJoy, Teladoc Health Launch Virtual Primary Care

HealthJoy, a benefits navigation platform that amplifies employer benefit strategies expands its partnership with Teladoc Health to introduce virtual primary care. HealthJoy Virtual Primary Care, powered by Teladoc Health, provides a fully integrated primary care experience that supports members throughout their entire healthcare journey. The solution will further enhance HealthJoy’s comprehensive suite of virtual care offerings that already includes adult and adolescent mental health, chronic care management, dermatology, employee assistance program services, musculoskeletal therapy, nutrition, tobacco cessation, and urgent care.

Lifesum and ŌURA Partner to Connect Nutrition and Sleep

Lifesum, the leading global healthy eating platform, has unveiled a sleep tracking feature in partnership with ŌURA, the company behind the smart ring that delivers personalized health data, insights, and daily guidance, which will allow its users to understand how their dietary choices impact their sleep patterns—and vice versa. The partnership will build on their integration of Health Connect by Android to give Lifesum users another important layer of health data to track. The sleep tracker function will be offered to Lifesum Android users who opt in to the open beta, and the company will roll out the service to all Android users in the coming weeks.

Neuronic and Santa Clara University Partner to Develop Next-Gen Neurotech for Photobiomodulation

Neuronic, a multi-national company focused on light therapy technology, and Santa Clara University (SCU) in Silicon Valley announced a partnership to develop a research project to study photobiomodulation (PBM) guided by real-time brain activity, which will be led by Dr. Julia A. Scott and Dr. Sally Wood.  To address this concern, the research team plans to improve the efficacy of PBM delivery, a non-invasive therapy that uses near-infrared light to pass through the skin and activate molecules that improve blood flow, reduce inflammation, and increase cellular energy.

The researchers hope that their findings will pave the way for more conclusive evidence regarding the effectiveness of PBM for brain injury and neurodegenerative conditions. Further, they envision a future where clinicians can tailor treatments to the individual needs of each patient through the use of real-time electroencephalogram (EEG) data, thereby optimizing results. To achieve this goal, the team will conduct small-scale studies of the device on healthy adults to assess the effects of PBM on brain activity and evaluate protocol designs.

Patient Discovery Partners with AmerisourceBergen for Cancer Care Equity

Patient Discovery Solutions joins global healthcare company AmerisourceBergen’s Trusted Vendor Program. The collaboration enables community oncology practices, hospitals, and health systems nationwide access to Patient Discovery’s Equitable Care Platform, allowing care providers to proactively identify and address social determinants of health to better inform providers and help improve outcomes for cancer patients. AmerisourceBergen’s Trusted Vendor Program is comprised of a portfolio of cutting-edge operational and clinical care solutions. As a partner, Patient Discovery’s Equitable Care Platform will seamlessly integrate within a participating practice’s current systems, helping to improve information exchange for delivering equitable care across multiple sites of care.

Opus EHR Partners with Aroris to Revolutionize Behavioral Health Practices

Opus EHR, an innovative behavioral health solutions provider partners with Aroris, a contract negotiation company, to provide cutting-edge technology solutions that help behavioral health practitioners save time and money while managing payer relationships more effectively. The partnership aims to equip both current and prospective clients with all the necessary tools and features to grow and scale their practice, optimizing profitability from their business efforts.

Doceree Further Expands Global Footprint With Partnership With Hello Health Group 

Doceree, a global platform building unprecedented solutions for HCP programmatic marketing with proprietary data tools, today announced its long-term partnership with Hello Health Group, a leader in health & wellness content development that drives consumer and patient engagement. The latest collaboration will accelerate growth for both companies by combining the world-class HCP targeting and reach capabilities of Doceree with Hello Health’s leading patient and consumer reach and engagement solutions, and strong geographical presence in the South East Asian region. The partnership further establishes Doceree’s presence in eight key markets – Vietnam, Indonesia, Malaysia, Cambodia, Myanmar, Singapore, Philippines and Taiwan.  

West-Com Nurse Call Systems, Vitalchat Partner to Bring AI-Enabled Virtual Care Solutions to Healthcare Facilities Nationwide

West-Com Nurse Call Systems and Vitalchat partner to provide hospital systems and other healthcare facilities nationwide with virtual care solutions using artificial intelligence to meet the needs and demands of patients, caregivers, providers and IT leaders. Together, these solutions increase patient and caregiver safety, improve clinical collaboration, enable specialty access and provide for off-site family connection and engagement. They are available through a network of more than 70 active distributors around the country.

What You Should Know:

• Emory Healthcare (EHC) today announced a partnership with NeuroFlow to support and improve the delivery of psychiatric services for both patients and providers at their Brain Health Center and several sites across Georgia.
• NeuroFlow, which offers a cloud-based registry and enterprise platform to help facilitate collaborative care, will support EHC clinical services’ data-driven approach to patient care, with a sharpened focus on improving communication between care teams, including primary care providers, behavioral health specialists and care coordinators.
• The implementation of NeuroFlow in Emory Healthcare’s primary care clinics will begin in May 2023, with plans to expand to additional clinics throughout the year.

Increasing Access to Behavioral Health Services

The strategic partnership will seek to complement and scale Emory’s new collaborative care model (CoCM) within its primary care clinics. The CoCM is part of Emory’s Integrated Behavioral Health (IBH) Program, which was formed by the Department of Psychiatry and Behavioral Sciences to help meet significant access demands for behavioral health services in the EHC network. CoCM is embedding licensed specialists called behavioral health care managers (BHCMs) to work in EHC primary care clinics alongside primary care clinicians to provide psychotherapy onsite and serve as liaisons with psychiatric consultants.

Through NeuroFlow, Emory patients are given 24/7 access to self-directed content that reinforces psychotherapy guided by the program’s BHCMs and provides care teams with frequent measures of patient progress. This engagement between office or telehealth visits supports traditional care and can lead to faster recovery, better overall outcomes and fewer readmissions.

“This collaboration introduces the type of technology needed to assist our healthcare providers and patients in bridging the gap between mental and physical health,” says William McDonald, PhD, chair of Emory’s Department of Psychiatry and Behavioral Sciences. “While our teams already practice collaborative, integrated care, this partnership serves as a driving force to expand and enhance these endeavors throughout the Emory ecosystem, ultimately resulting in improved outcomes and reduced costs.”

What You Should Know:

• A new report released by TytoCare, a virtual care company enabling accessible, high-quality primary care from home, revealed insights into how health plans and organizations can drive virtual care engagement.
• While key elements that patients value in virtual care offerings include cost and time savings, and the ability to reduce Emergency Department (ED) or urgent care visits, people want to see doctors they trust or and are more likely to adopt virtual care when recommended by their primary care physicians (PCPs).

Understanding and Improving Virtual Care Engagement

TytoCare, a virtual care company, has released a report on how health plans and organizations can increase virtual care engagement. The report is based on a survey of more than 1,000 Medicaid and commercial health plan members in the United States. Key findings include:

• 78% of respondents consider virtual healthcare offerings to be an important factor when selecting a healthcare plan.
• Time and cost savings are the top drivers for virtual healthcare adoption.
• A healthcare provider is more likely to influence the use of virtual care than a family member or an insurer.
• Clinician involvement is critical for both Medicaid and private insurance carriers.
• 90% are willing to forfeit the wait for their PCP to get quicker access to care in a crisis.

TytoCare’s Home Smart Clinic is a solution that combines their handheld remote examination device, AI-backed smart diagnosis support, and Tyto Engagement Labs to provide high-quality, accessible virtual care in the home.

The survey also found that 73% of respondents who utilized virtual care did so two or more times per year, with 46% using it three or more times. Additionally, 81.4% reported that they would be interested in using virtual care programs if they had access to specific devices that offered features above and beyond video calls.

In summary, patients value cost and time savings in virtual care offerings, but they are more likely to adopt virtual care when recommended by their primary care physicians. Clinician involvement is critical, and recommendations from family members or friends are less effective in motivating people to adopt virtual care. TytoCare’s Home Smart Clinic is a solution that drives engagement rates in virtual care by providing high-quality, accessible virtual care in the home.

The healthcare workforce is in crisis. From devastating staffing shortages to unmanageable levels of stress and burnout, today’s healthcare workers are desperate for some relief. Unfortunately, exacerbating these already significant challenges is an increasing rate of workplace violence in healthcare. 

According to the results of a study published recently in the American Journal of Preventive Medicine, about one-third of public healthcare workers have experienced at least one incident of workplace violence during the COVID-19 pandemic. And that’s just one of many reports that demonstrate the severity of the issue. 

There are some very important things that can be done to better protect healthcare workers, but at the top of that list should be elevating workplace safety to a key performance indicator (KPI) for healthcare systems. Unless there is a top-down focus on this issue, healthcare workers will continue to be putting themselves in danger simply by going to work and attempting to provide care to the people most who, according to a study in the Annals of Medicine and Surgery,  are most likely to engage in violence against them.

Nobody outside healthcare knows how bad it’s gotten

Although workplace violence in healthcare is an issue for all types of healthcare workers, it is most often nurses who bear the brunt of workplace violence. Last year, a Press Ganey analysis surprised many, stating that an average of 57 nurses are assaulted every day — that’s about 2 every hour. While terrifying incidents of shootings may make the news, every day, all across the United States (and the world), nurses are punched, spit on, kicked, and otherwise harassed. 

Too often, this is considered just “part of the job.” When examining nonfatal workplace injuries and illnesses across all sectors, healthcare workers account for about three-quarters of all incidents, according to the Bureau of Labor Statistics. Such incidents have certainly increased since the onset of the COVID-19 pandemic, but violence against healthcare workers was already trending upwards, with the rate of injuries related to workplace violence perpetrated against medical professionals growing by 63% between 2011 and 2018.

 The importance of leadership involvement in preventing hospital incivility and violence 

Leaders play a pivotal role in preventing hospital incivility and violence by sending a clear message that certain behaviors are not acceptable and will not be tolerated in the workplace. In nearly every other industry, individuals who display threatening or inappropriate behavior are removed from the workplace. However, in the healthcare industry, healthcare workers cannot simply send badly behaving patients home. Instead, leaders must develop systems and protocols to ensure the safety of everyone.

Leaders can implement policies and procedures that promote a safe and respectful workplace. For example, they can provide training for staff members on how to recognize and de-escalate potentially violent situations. This training can include techniques for communicating with agitated or aggressive patients, as well as strategies for diffusing tense situations before they escalate into violence. Leaders can also develop escalation plans that outline clear steps for dealing with violent or disruptive behavior, such as calling security or involving law enforcement.

Additionally, leaders can establish reporting systems for incidents of violence or incivility. These systems encourage staff members to report incidents without fear of retaliation and provide a clear and consistent process for addressing reports of violence or incivility. Leaders can ensure all staff members are aware of these reporting systems and that they understand the importance of reporting incidents in a timely and accurate manner.

By prioritizing workplace safety and taking an active role in preventing incivility and violence, leaders not only create a safer workplace for staff and patients but also foster a more positive work environment where employees feel valued and supported. This, in turn, can lead to increased job satisfaction, reduced turnover rates, and improved patient outcomes. 

How Digital Technology can Help

Mitigating workplace violence is not a one-and-done initiative. It is something that healthcare organizations must consciously address every day, and no single intervention or policy will solve the issue. However, digital engagement technology has the potential to improve communication between patients and the care team (and among the care team) and increase transparency around activities related to a patient’s care, giving them more insight into what is happening around them, which can help to prevent violent incidents. 

Digital health technology, via either TVs or mobile devices, can be used to provide clear prompts to patients and their families, clearly communicating that any physical or verbal violence or abuse will not be tolerated. This same technology can be used throughout the facility or specifically on high-risk units to communicate when a patient is displaying violent behavior. 

Digital signage can also be used to indicate a room where there is a potentially aggressive or violent patient, and facility-wide alerts can be sent to communicate to entire floors or units when there is an issue. These tools can be customized to hospital codes so that all staff members quickly and easily know what they should do in the event of a violent incident.    

The healthcare industry needs outside support to prevent workplace violence 

Despite advancements in digital technology and tools for healthcare workers, the issue of workplace violence remains a pressing concern for healthcare professionals. Nearly a year ago, thousands of nurses marched in Washington, D.C., asking for changes to nurse-to-patient ratios, the staffing shortage, and workplace violence. And before that, Democratic Representative Joe Courtney introduced H.R. 1195, the Workplace Violence Prevention for Health Care and Social Service Workers Act, aimed at putting processes around workplace safety. Under the act, any company, facility, or organization to employs healthcare or social service workers would be required to:

• Conduct a risk assessment 
• Develop and implement a prevention plan
• Ensure all employees receive workplace violence prevention training 
• Investigate all occurrences of workplace violence 

But the bill, which has been passed by the House of Representatives, has stalled in the Senate–

despite support from the American Nurses Association and National Nurses United, the nation’s largest nurses union. 

The bottom line is that we must  do better by nurses and other healthcare workers. We have the digital technology and tools to arm them with better ways to communicate with patients and with each other. But we need understanding and support from executive leaders. Leaders have an opportunity that is powered to a meaningful degree by technology yet centered on human connection and one that explicitly rejects the notion that violence and safety threats are “part of the job.” It is incumbent upon healthcare executives to elevate the safety of the care environment to the top of their organization’s system-wide strategic plan and make it a key performance indicator for leaders at all levels. 

About Katherine Virkstis
Katherine Virkstis is Vice President of Clinical Advisory Services, at Get Well where she leads the company’s nursing and clinical vision. Katherine has worked with hundreds of executive teams at healthcare organizations in more than 50 countries and is trained as a primary care physician.

References:

1. https://www.ajpmonline.org/article/S0749-3797(22)00507-4/fulltext
2.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9206999/
3. https://www.bls.gov/iif/home.htm
4. https://www.pressganey.com/platform/ndnqi/
5. https://www.congress.gov/bill/117th-congress/house-bill/1195/text

What You Should Know:

• Innovaccer Inc. announced that Emcara Health, PopHealthCare’s national value-based medical group that delivers advanced in-home primary care for seniors and vulnerable populations, has selected Innovaccer’s Best in KLAS data platform to accelerate its ability to drive growth and rapidly scale Emcara Health’s integrated care solution to more communities nationwide.
• The Innovaccer data platform will enhance Emcara Health’s ability to create unified patient records that provide a 360-degree holistic view of patients by integrating data from myriad EHRs, HIT systems, and third-party community data (such as SDoH). Interoperable, EHR-agnostic physician engagement will further providers’ efforts to close coding and care gaps at the point of care and make informed decisions that drive better clinical outcomes. 
• Data-driven, customizable TCM protocols will help ensure effective care coordination with automated transitional and chronic care management for at-risk and rising-risk populations.

What You Should Know:

• Walmart Health announced its expansion into the state of Oklahoma, with four new health centers in the Oklahoma City area in 2024. This expansion into Oklahoma is a continuation of Walmart Health’s commitment to making quality healthcare more convenient, accessible and affordable for customers in the communities we serve.
• The new state-of-the-art facilities will be approximately 5,750 sq ft, located beside Walmart Supercenters, and will feature Walmart Health’s full suite of health services to provide care to busy families. These services may vary by location, but include primary care, labs, X-ray and EKG, behavioral health, dental, hearing, select specialty services, community health and telehealth. This includes integrating Epic’s electronic health record system across all our Walmart Health locations
• This announcement comes on the heels of Walmart Health recently sharing plans for the addition of 28 new health center locations to its portfolio in 2024 in Missouri, Arizona and Texas.

Electronic medical records (EMRs) – software systems where physicians, nurses, and other healthcare workers store, retrieve, and act on clinical data – are fundamentally broken. This sentiment is so widely shared among healthcare workers that it has become almost trite to point it out. Patients feel it too – we’ve lost count of the number of times we’ve heard “isn’t it in my chart?” when we ask a question during a clinical visit.

Unfortunately, the vast majority of EMRs do not facilitate storing, retrieving, or acting on information in an efficient or intuitive way. The most broken element of most charts is the free-text segments – where clinicians store narrative text data about the patient’s medical concerns, their own diagnostic impressions, and their treatment plans.

Free-text segments are critical both to pass information forward into the future and to collaboratively manage information across a team of generalists and specialists in different roles. It’s not possible to store all of that information in your head anymore, even if it was feasible 50 years ago (which is also doubtful). It’s a disservice to patients to imagine that we could. So we need a good electronic system to help. There are many ways a clever system designer could build software to organize free-text data for a single patient – data about multiple medical topics, collaboratively stored, retrieved, and used by numerous healthcare professionals, evolving over the course of years. An ideal system would, at a bare minimum, make it easy to store and organize information intuitively, such that it would be quick to retrieve relevant data later.

The specific way that most clinicians and EMR companies (in America, at least – we can’t speak to anywhere else) have chosen to organize this data is empirically terrible. It’s terrible because clinicians hate using it. It’s terrible because you can’t find relevant information quickly because charts are riddled with useless, out-of-date, and erroneous information, scattered across hundreds of different documents. The information which is both relevant and correct requires herculean effort to find. Clearly, the EMR is failing at its most basic job. Beasley et al elucidated a great framework for this ‘information chaos’ over 10 years ago, and it’s still accurate.

In our study, we used the information chaos framework: particularly, the two hazards described in the Beasley paper as “information overload” and “information scatter”. We examined a corpus of >100 million free-text notes written by thousands of different healthcare workers at our hospitals and clinics to quantify information overload and scatter. Information overload is pretty easy to quantify. We just counted the total free-text data in the corpus; this was ~32 billion words, eight times the size of the English Wikipedia at the time we checked. It was astonishing to us that a single academic healthcare system in one city in one country over 6 years produced eight times more free-text data than the global resource dedicated to capturing all of the human knowledge worth knowing. Not all of that information is relevant to a particular doctor visit or hospital admission, to be sure, but a clinician is still responsible for knowing the subset of the information that is relevant. To do that, you need a system that facilitates finding the relevant information among the irrelevant noise. The more noise there is, the more infeasible this gets and the more acutely healthcare workers feel the pain of a badly designed system.

Speaking of noise, we next looked at a subset of information overload well-known to clinicians – duplicate information. This is information that is already in a patient chart, but for whatever reason a clinician sees fit to repeat it again in a separate text document in the same chart (in clinical parlance, each individual document is called a “note”). We found that just over 50% of words were duplicated, that this fraction has been increasing over the past 6 years, and that this phenomenon is ubiquitous across all patients, clinicians, and healthcare worker types. That means 16 billion words have been duplicated over the past 6 years in just one health system. Many clinicians who reached out to us were surprised that the fraction was so low – predicting that 70% or more would be duplicated. This staggering statistic illustrates the degree to which the current free-text information management paradigm is broken. It should be a call to action – to deeply revamp documentation to save patients from medical error and clinicians from information management burnout.

“Now, wait a second!” some clinicians might be saying. “Sometimes information stays the same, so it makes sense to re-document it!” For instance, if a patient has a cough on July 3rd when they see you in the clinic, and they still have the same cough on July 12th, maybe you re-write (or more likely, copy and paste) the phrase “patient has a productive cough” in the July 12th note. Of note, information gets duplicated both across time (from past notes into future notes) and across teams (from one doctor or nurse’s note to another). Doesn’t it make sense that if information stays the same over time, you should re-document it?

Well, it would make sense if you take for granted everything about the underlying documentation paradigm, which you certainly shouldn’t. The obvious responses by anyone familiar with modern word processing software outside of a healthcare context are “(1) Why do you have to make a new text document every time you see the patient? Can’t you just edit the old document and track changes?” and “(2) Why does every healthcare worker have to maintain their own separate set of text documents? This sure sounds like a lot of wasted effort finding and collating information from other people’s notes. Can’t they just collaborate on a single shared document?” It’s hard to argue with these points. Sure, we all know colleagues who still send around multiple versions of word documents with convoluted names like “prospectus_020122_jsedits_v2_finaledits_060220” when collaborating, but we can likely all agree that collaborative documentation systems like Wikipedia or Google Docs provide much better software paradigms for collaborative editing of a text document which evolves over time. There’s absolutely no principled reason we can’t have a similar model in clinical documentation systems.

We believe that what we call the “note paradigm”is a key cause of massive amounts of duplication. The “note paradigm” is simply the two assumptions contested in the above paragraph: (1) that every new patient encounter requires a new document, and (2) that every healthcare worker must create their own documents. When a phenomenon is as ubiquitous and predictable as duplication, we can’t blame it on individual clinicians being “lazy” or even individual EMR vendors designing slow software or overwhelming user interfaces. The problem is deeper than the EMR level. It’s at the paradigm level, which underlies the assumptions about how documentation is done, how documentation systems should be built, and how medical care is regulated by the government and billed by insurance companies. It’s taught in medical schools that you have to write a “progress note” every time you see a patient, and that different specialists have to write their own “progress notes”. At this point, the note paradigm is the water we swim in; it becomes hard for many to even recognize that it is a specific design choice, or that it could be otherwise.

It’s easy to see how the note paradigm leads to information overload if you think about documentation incentives. Imagine a primary care clinician responsible for a patient with 5 different medical problems, all of which require adjustment of medications and 3-month check-ins. In this situation (assuming no eidetic memory), every 3 months, the clinician will need to remind themselves of all the relevant information about those problems, gather new information, incorporate it into decision-making, and document the new current state of the patient’s medical problems after the visit. Under the current paradigm, their choices are either (1) to use each of their notes as a complete and comprehensive state-of-the-patient, adding new information each time but keeping all of the old information around, or (2) just document the changes from the last visit to this visit in each note. Choice (1) leads to high information duplication as old information is persisted in every new note, but low scatter because all the relevant information is in the most recent document. High duplication increases textual errors as out-of-date information is perpetuated without change. On the other hand, choice (2) leads to shorter notes, low duplication, and high scatter because the information is now only contained in the entire set of notes, not just the most recent. High scatter necessarily increases the time needed to collate and synthesize the relevant text as all notes would need to be reviewed at every encounter to get the full story.

So without implementing a collaborative documentation system, there will remain an extremely strong trade-off between duplication and scatter and this will play out differently depending on the author’s role in a patient’s care. In particular, we’d expect that healthcare workers who treat patients’ medical problems over time (primary care doctors, psychiatrists, or specialists) would prefer to minimize scatter at the cost of high duplication. Extra work is done upfront to collate information so it can be copied forward and persistently available with minimal work. On the other hand, healthcare workers who treat patients’ problems temporarily (urgent care doctors, surgeons, nurses answering triage phone lines) would have no incentive to collate information and so would write brief notes that capture the problem at hand at the cost of high scatter. The real loser in these situations is the patient, who would be better treated if the long-term care team knew about the short-term problems, and the short-term care team had all the relevant context of the patient’s long-term care plan. 

This trade-off is exactly what we empirically see when we plot scatter vs. duplication for different note types in our study. Some note types have high duplication and low scatter, exemplified by physician progress notes which aim to summarize the entire current ‘state of the patient’. These notes are comprehensive (low scatter) but duplicate lots of past information. Other note types have high scatter and low duplication, exemplified by note types that document a single isolated event e.g. (“result” notes, which comment on the results of a particular lab test; or telephone encounter notes, which document a short phone call with a patient). Very few note types have both high duplication and high scatter, except for those that are almost entirely auto-generated boilerplate text. From this picture (and our own clinical experiences), we can infer that clinicians often duplicate text because the highly scattered alternative would be worse.

The electronic medical documentation system is broken and causing clinician burnout. It affects every patient and clinician, regardless of their medical problems or clinical role, and it should be taken seriously. If we want to fix the problem, we need to properly identify and label it. The software wrappers – the systems we use every day – are only a symptom of the real problem, the note paradigm and the underlying assumptions about documentation. Individual rules to “ban” or “limit” duplication provide a solution for a different problem, not for remedying the root cause of duplication. To address that, we have to understand the motivation, which is clearly to minimize scatter, and so any limitation on duplication has to be paired with a non-duplicative tool for decreasing scatter or increasing information density per screen. Acknowledging these problems is easy. Fixing them on the other hand, will require deep cultural changes in medical training and practice, as well as changes in the billing practices, governmental regulations, and legal requirements surrounding medical documentation. But what better way to answer the question, “Isn’t it in my chart?”, than “You’re right! It’s right here.”

About Subha Airan Javia, MD

Subha Airan Javia, MD, FAMIA, is the CEO of CareAlign, a clinical workflow management technology company. She is also a hospitalist at Penn Medicine.

About Jackson Steinkamp, MD

Jackson Steinkamp, MD, is an internal medicine resident at Penn Medicine with a degree from Chobanian & Avedisian School of Medicine at Boston University.

Hint & Eden Partner to Expand Virtual Direct Primary Care Offering Nationwide

What You Should Know:

• Hint Health, the company powering the Direct Primary Care (DPC) movement, and Eden Health, a leading national virtual and in-person primary care provider, today announced a partnership to expand the Hint Connect footprint with a virtual DPC offering across all 50 states.
• This partnership allows employers to offer a DPC network nationwide for patients who don’t have convenient access to a DPC practice in their communities.

Innovation in Healthcare Via In-Person and Virtual Direct Primary Care Plans

According to a poll, less than half of Americans are satisfied with the quality of U.S. healthcare. Long wait times to see a doctor, short appointments, and lack of coordination between care settings leave patients feeling like no one cares about them or their health. Furthermore, healthcare costs continue to rise despite a worsening patient experience. 

The benefits of Direct Primary Care include:  

1. Access: DPC physicians typically offer same-day or next-day appointments and use technology like telemedicine, e-mail, and text messaging to make themselves more accessible to their patients on demand.
2. Quality: DPC providers are able to spend more time with their patients. Standard primary care providers only have an average of 17 minutes to spend on each patient; with DPC, providers  spend up to an hour with patients to uncover the root cause of complex health issues and offer holistic care.
3. Cost: DPC is proven to sharply decrease costs and utilization in higher cost of care settings, including emergency department, hospital inpatient, and outpatient specialty costs. With DPC, patients pay one transparent, monthly fee and know exactly what is covered. They are able to visit the doctor when needed, instead of waiting until healthcare concerns get worse. 

Hint Connect is a nationally scaled network of Direct Primary Care practices that excels at building trusted clinical relationships locally. When employers or plans offer Hint Connect, members can choose between a fully virtual primary care model or an in-person/virtual hybrid based on their personal preference, geography, and health needs. When members select the in-person/virtual hybrid model, they and their families register with Hint Connect and choose a nearby DPC location. There is no copay or coinsurance for visits. 

When members choose the fully virtual primary care experience with Eden Health, they will be able to  connect with their provider within minutes and at the touch of a button, 24/7/365. Unlike many other telehealth  solutions, patients meet with the same clinician throughout their care journey, allowing them to develop a trusting, longitudinal relationship with their provider. All clinicians are fully-employed by Eden Health and are dedicated to serving their patient panel virtually. Patients receiving virtual care through Eden Health have access to primary care, urgent care, chronic disease management, wellness and care coordination services, all through a single app and free of cost. 

“Eden Health clinicians are more than just someone picking up extra hours after their full-time shift ends,” said Hint Health CEO, Zak Holdsworth. “Eden’s pioneering work to champion a true virtual Direct Primary Care model will allow us to further achieve our mission of making DPC the new standard in U.S. healthcare.”

This partnership means that employers and plans will no longer have to make the tough decision between local options and virtual-only options. Instead, employees will have the opportunity to choose the plan that’s right for them to receive the highest quality, full access, primary care for one flat membership fee built into their health plan. Hint Connect simplifies enrollment and eligibility management, billing, and invoicing for a seamless benefit management experience. 

Together, Hint and Eden offer a uniquely comprehensive solution for organizations looking to solve the national problem of healthcare access and quality.

What You Should Know:

Audio-only telehealth visits for both primary care and mental health services remained common at safety net clinics in California since the start of the COVID-19 pandemic, according to a new RAND Corporation study.

The RAND study published in the Journal of the American Medical Association found that in August 2022 audio-only visits still accounted for 1 in 5 primary care visits and 2 in 5 behavioral health visits among people who received care at Federally Qualified Health Centers in California.

Researchers say the higher rates of audio-only telehealth in safety net settings raises questions about the quality of care and equity for low-income patients, since the effectiveness of audio-only telehealth has not been established.

Key findings of the report include:

• The number of primary care visits increased by 8.5% from February 2020 to August 2022, while the number of total behavioral visits increased 23% during the same period. The increases are likely the result of being able to widely offer telehealth services, even as the clinics lost staff members.

• audio-only telehealth visits for primary care services peaked in April 2020, while audio-only visits for behavioral health peaked in March 2021.

• Within primary care, the decline in audio-only visits from the early pandemic peak appears to coincide with the return of in-person visits rather than growth in video visits.

• For primary care, the proportion of in-person visits increased from 30% in April 2020 to 71% by August of 2022.  Over the same period, audio-only visits decreased from 67% to 21%, while video visits increased from 4% to 7%.

• For behavioral health, the proportion of in-person visits increased from 20% in April 2020 to 37% in August 2022. During that period, audio-only visits for behavioral health care decreased from 74% to 39%, while video visits increased from 8% to 23%.  

• Federally Qualified Health Centers’ continued use of audio-only telehealth may be a result of the clinics and their patients not having access to the technology needed for video telehealth. In addition, since California’s Medicaid program (Medi-Cal) granted permanent payment parity for audio-only visits, there are no financial incentives for the clinics to limit audio-only visits.

What You Should Know:

– AristaMD, a digital healthcare company specializing in eConsult and referral management services, today announced the launch of a unified care transition platform.

– The platform seamlessly integrates patient-to-provider matching, electronic referral processing, and eConsults into one single interoperable solution for primary care providers (PCPs). The end-to-end referral solution ensures that all patients receive timely care from the right provider in the right setting and that patients with issues that can be resolved via a peer consultation can receive care directly from their PCP.

AristaMD eConsults Key Features

With AristaMD eConsults, PCPs can request guidance from virtual specialists on specific patient cases, with responses being delivered within hours. More than 73% of eConsults result in the PCP being able to treat the patient without a referral immediately, and over 30% of cases result in a new diagnosis. When a face-to-face referral is necessary, AristaMD’s referral management services match patients to the most appropriate specialists based on the patient’s insurance, location and the sub-specialty required. Referrals can be electronically ordered, removing the legwork of traditional phone and fax while creating the opportunity for PCPs to receive closed-loop electronic communication with specialists that improves overall care coordination.

Additional key benefits include:

● Improved referral intelligence, using customizable algorithms that route patient referrals to the right provider or, when appropriate, to an eConsult
● Expedited testing, diagnosis and treatment to ensure the right provider treats patients in the right setting.
● Increased clinic efficiency – staff can process more referrals in less time by eliminating antiquated procedures and streamlining referral activities into one platform.

A common thread throughout my conversations at ViVE was the increased competition for health consumers. Larger health systems are continuing to be fragmented by smaller specialties, like Northwell Health, which reported their outpatient care volumes are continuing to rise. Free-standing surgery centers, ER, urgent care, primary care, imaging centers and so on, are monitoring large healthcare systems looking for ways to extract the most profitable arms and business from them. As this continues to play out in tandem with the losses caused by the pandemic, the health industry is on the trajectory for more rapid change. In order to prevent this siphoning off business, strategic health leaders will take a hard look at how they are engaging patients and make sure they’ve adopted the right technologies to connect with them successfully and meaningfully.

I was encouraged by the overall emphasis on the health consumer experience at ViVE this year. Now more than ever, industry experts are coming together to leverage the mountains of data at our fingertips and building platforms that allow that data to flow securely through a digitized healthcare system. It’s no secret that data-driven, highly personalized healthcare journeys increase patient engagement, which in turn, drives better health outcomes and unlocks value opportunities to advance business goals, notably expanding market share, increasing revenue and reducing overall expenses. The growing consensus is that focus on experience will drive meaningful improvements to how patients interact with and manage their care.

ViVE attendees this year reiterated the challenges health systems face when working with multiple vendor solutions. Coordinating and integrating across multiple vendors can be frustrating and expensive. However, this challenge also serves as an opportunity for organizations to focus on strategic partners and vendor consolidation. By consolidating vendors, hospital systems can improve efficiency and interoperability while also increasing savings. Consolidation can save valuable time and resources and reduce risk in supply chain and spend management. Many health systems may begin to exploring the benefits of vendor consolidation and searching for partners who can incorporate more of their organization’s needs with a unified enterprise-wide approach. 

There was no sugarcoating it at ViVE: some health systems are in financially dire straits. For reasons we’re all too familiar with, expenses are high and revenues are low. It’s forcing a reckoning for provider and vendor organizations alike. Providers must pick and choose the vendors they continue doing business with, and vendors need to facilitate exceptional returns on investment. The good news is providers want and need collaborative partners, so the vendors that can transcend transactional relationships to provide high-yield, enterprise-level solutions are standing out. By ditching the cookie-cutter and reactive approaches, exceptional vendors are adding value, driving adoption, and truly making a difference in the quality and quantity of care health systems have the bandwidth to provide.

ViVE showed us this year how increasingly reliant the healthcare ecosystem has become on data and how many companies are driving value in their products around data and analytics capabilities. Across presenters and exhibitors from different sectors of the field, there was a universal agreement that data – and as a result, data storage – is what enables vendors to offer their solutions to the market and provider organizations to successfully deploy those solutions. Healthcare has always been an ever-changing industry, and as needs continue to evolve, companies must focus on giving providers the ability to optimize patient care, which will enable the best business and clinical outcomes across the healthcare ecosystem.

ViVE was truly an innovation summit. All of us share a common goal – to enable the healthcare system to operate as efficiently as possible. The spirit of collaboration was high and we found that our partners and future partners were asking us how we could best work together for the success of our mutual customers. We need an ecosystem where solutions work together seamlessly and move away from disparate solutions that force our customers to work in a siloed fashion. We’re all trying to improve the system, focus on what the market needs, and make healthcare work for everyone.

The adoption of virtual health has increased dramatically since March 2020, with 150 million telehealth claims in less than two years. Like other revolutionary innovations throughout history, healthcare innovation is necessitated by time — and unmet needs. So many struggled to create virtual care solutions during the pandemic, and many technology companies jumped into the telehealth space because of the unmet needs of patients. But the pandemic era is soon coming to an end, leaving telehealth to settle into a new normal.

The healthcare industry is changing rapidly. Because numerous moving parts and innovations are at the heart of this transition, the journey hasn’t been entirely linear. The industry has matured; at this stage, the future of virtual care needs less noise and more customer-focused technology to deliver much-needed care.

The telehealth space is witnessing consolidation, acquisitions, and partnerships, enabling a smoother landscape for hybrid care. However, once the public health emergency (known as PHE) funds end, waivers will go away, and many patients will be left without care unless more action is taken in telehealth.

So, What Comes Next?

The new model of care going forward (reimbursements or not) is destined to be a hybrid approach. In some ways, hybrid healthcare could be labeled the “future of telehealth.” A combination of both in-person and virtual appointments, hybrid programs allow providers to care for more patients in myriad ways. A hybrid healthcare system has many benefits. One is the ability to bring in virtual specialists to improve the quality of diagnosis without wasting time or travel.

The hybrid experience allows a primary care doctor to consult with specialists a thousand miles away and provide in-person, cross-care to local patients. As the U.S. continues to move away from fee-for-service models to value-based care, hybrid healthcare will be critical to managing costs and patient loads. Hybrid healthcare combines the best of both worlds: the convenience and accessibility of telehealth and the complete continuum of care for patients who need more care in person. The hybrid model puts the patient at the center of the experience, as it becomes more about convenience, cost, and access.

Hybrid healthcare also gives us better tools to treat patients with chronic illnesses. An estimated 157 million Americans live with chronic conditions, and about 75% of healthcare costs are spent on these patients. With the ability to check in via telehealth in between appointments, providers can see these patients more regularly, keeping them healthier and happier.

Because so many procedures and exams require in-person appointments, physical care delivery will always remain. Healthcare providers who don’t seek additional patient support beyond physical care will fail to accommodate the new normal they find themselves in. Hybrid healthcare is a modern opportunity to reach more patients, keep them engaged in their health, and improve clinical outcomes.

Here’s how your healthcare organization can provide quality hybrid healthcare in the year ahead:

Move to a value-based care model instead of fee-for-service

Value-based care (or VBC) is centered on delivering efficient care that is used wisely and accurately documented. VBC supporters claim that it lowers healthcare costs and improves patient health compared to fee-for-service care. The VBC model compensates medical professionals for their attention to the standard of care they deliver, as opposed to the number of patients seen; this incentivizes quality over quantity. Payment for VBC services is determined by how well these services work to keep patients healthy and avoid sickness.

VBC initiatives encourage better patient care, healthier communities, and long-term cost savings. Notably, they have become more noticeable since the Affordable Care Act shifted the emphasis from counting the care provided without accountability to measuring patient outcomes.

Lobby for reimbursement around telehealth once the PHE ends

Many of the waivers put in place to aid providers during the pandemic expire once the present public health emergency is over. The major exception is telehealth, which has an extra 151 days before losing flexibility and includes allowing patients to get virtual care from home. Medicare does not have distinct payment rates, and reimbursement depends on the facility.

Payment parity between in-person and telehealth appointments is a myth. Many times, for example, because of the way the virtual visit is “covered” or “reimbursed,” patients end up paying more out of pocket to make up for the lack of payment given to the provider. Be involved in your state legislature to ensure waivers are extended and that hybrid healthcare solution are included in new bills.

Continue using telehealth to increase efficiency and ROI

It will be necessary for modern healthcare providers to continuously engage the patient community via telehealth. The goal is to encourage usage and adoption to remain high as more data and clinical outcomes can be tracked and proven successful. Over time, continued research and investment in telehealth will create new innovative healthcare networks that can support patients even more.

As for ROI, workloads that waste time, money, and resources can be streamlined via telehealth, thereby increasing corporate efficiency. According to a 2021 poll by the COVID-19 Healthcare Coalition, almost 80% of telehealth patients were satisfied with their care and felt a sense of access and continuity of care. Happy, healthy patients are the lifeblood of any healthcare organization, and telehealth helps you further those goals. Additionally, those patients are more likely to consider other services or seek inpatient treatment at your facility. Even a 5% retention rate could boost ROI by 95%, according to Bain & Company.

Every industry goes through periods of technological transformation, and healthcare is coming to another pivotal moment: the end of a public health crisis that changed the landscape of the medical field entirely. As hybrid healthcare becomes the new normal in telemedicine, we are seeing health systems work towards streamlining fragmented technology solutions to a more enterprise digital strategy.

About Eric Bacon

Eric Bacon is the President at AMD Global Telemedicine, Inc. He has 20 years of experience designing new medical devices and telemedicine solutions that are deployed in more than 100 countries and used in millions of consults. During his time at AMD, Eric and his team have transformed and expanded the company from a provider of medical devices to a software development and technology company focused on effectuating change and impact across the healthcare industry.