A few weeks before we published Dave Chase’s first article for this blog, 5 Survival Strategies for Small to Medium-Sized EHRs, I reached out to him on LinkedIn and asked if he was interested in participating in a new column I was starting where I ask interesting, inspiring and even controversial health IT professionals five questions. Dave undoubtedly falls into the first two categories.
Dave is co-founder and CEO of Avado, a startup that has developed unique patient engagement technology that helps organizations meet Meaningful Use stage 2 patient engagement criteria, and hopefully establish more meaningful patient relationships. Most recently, Avado was featured at TEDMED 2013 as member of The Hive, which highlighted “50 innovative startup companies.” And, as many of you know, Dave is a tireless writer, frequently publishing articles on patient engagement in Forbes, TechCrunch, KevinMD, and others. He is the co-author of “Engage! Transforming Healthcare Through Digital Patient Engagement” published by HIMSS.So, alas, here is the latest installment of “5 Questions With.” Special thanks to Dave Chase for participating.
1. First off, congratulations on the news, released at HIMSS13, that Avado received $1 million in seed funding, which I imagine confirms that others really believe in what you’re doing. On that note, there are thousands of startups in healthcare of different stripes that have a great website and a cool logo, but aren’t gaining traction like Avado has. What are some of the most common mistakes you see among other entrepreneurs looking to disrupt or just simply gain traction in the industry?
We’ve made our share of mistakes. As a skier, I describe health IT startups as the “double black diamond in white-out conditions of startups.” You’ll get beaten around, but if you survive it’s a heckuva accomplishment. One of the mistakes we’ve avoided is expecting things to come quickly and burning through too much capital too quickly. If you can survive longer and you do a good job of listening to the market, your odds of survival go up dramatically. If you are 50% right on Day One, you are world class. In other words, the mistake is to have too much hubris and think you have all the answers right out of the chute. One of the ways of burning through capital too quickly is spending too much on sales and marketing too early. Of course, building too big a team burns through capital quickly. While we have a sense of urgency, we realize patience matters.
2. With ACOs, patient-centered medical homes and Meaningful Use requirements, patient engagement is the shiny, new component of the modern healthcare system that rightfully is receiving a lot of attention. Will patient engagement supplant hospitals’ old patient experience efforts to create a real relationship with patients?
Absolutely, 100% yes. Most patient experience efforts I have seen are purely marketing. Frankly, the category we get lumped into most of the time is patient portal. For 99% of what we have seen, the patient portals have primary been checking a marketing checkbox and simply focused on administrative functions. Certainly there’s no issue with improving upon administrative hassles, but that still wildly underestimates the importance of patients as well as their families and caregivers.
3. The motivation to engage patients is obviously there for the providers, but what about for the majority of patients? Other than chronic illness or fear of immediate death, how can systems and technology capture patients’ attention and get them engaged?
Stephen Wilkins has a lot of good things to say about this on his Mind the Gap blog such as Patients Are Often More Engaged In Their Health Than Providers Think. If you really want to get patients engaged, you need to be engaging and it needs to be integrated into provider’s core job. Wilkins has some great insights in HIT-Driven Patient Engagement Is A Bust – Effective Patient Engagement Begins With The Doctor-Patient Relationship. There are two main themes with those who have had success with patient engagement. First, it’s about the money. If a provider doesn’t have a reward system that encourages patient communication outside face-to-face appointments, it’s going to be tough sledding. Second, it takes two to tango. As long as you’ve applied some basic best practices, patients will engage if there is a trusted person on the other end of the communication.
4. With the pressure to adopt and use EHRs, to engage patients in a meaningful way and to justify their salaries in face of reduced reimbursement, physicians are under tremendous scrutiny. In what ways do you think they can adopt, survive and even thrive in the modern healthcare system?
That’s a HUGE question. My feeling is that the vast majority of physicians are incredibly smart, well-meaning and hard-working. However, good people are often buried in a model that is a Gordian Knot designed by Rube Goldberg that doesn’t put their best foot forward. Picking the right model to practice in is more important than ever. When physicians are able to operate in models where payment is aligned with outcomes, they can achieve amazing things. Despite understandable fears, there is often a pleasant surprise, as Dr. Bob Margolis (CEO of HealthCare Partners which is in a value-based model) shared recently:
You get to the tipping point, where the physicians go, ‘Wow, life is a whole lot better.’ You know, I only have to see 20 patients a day and I go home at night and I feel like I really helped them’—as opposed to, ‘I saw 45 patients, worked until 10 o’clock because I had to then do all my paperwork, I’m tired and I can barely pay the bills because Medicare and the commercial insurers are cutting back on my reimbursement.’
5. So many mobile health and larger SaaS/Cloud-based products are developed on platforms that are not designed with future EHR integration in mind. What is Avado’s view on integrating with the EHR? And, do you think doing so is necessary for the long-term success of patient-facing technologies?
To achieve the goals both providers and patients have, integrating with EHRs is critical. Having said that, there are other items that are just as critical to integrate with such as biometric devices, labs, pharmacy, patient-generated data, etc. This is readily apparent when you look at CareMore and other pioneers in value-based models. They rarely speak of their EHR. Rather, they speak about their Longitudinal Patient Record that is a superset of the EHR. That is the lynchpin of their model.