Dharampuriya: To answer your first question, [one advantage] that we clearly offer over our competitors is that [our product] is extremely affordable. [Editor's note: prices range from US$400 per month per provider under a subscription model, or US$10,000 for the first provider, and US$5,000 for every additional full-time provider under an upfront-fee model.] It is extremely user friendly and our customer satisfaction level is in the high [percentage range]. What makes us unique [is that we have delivered] a software product to almost 25,000 doctors across the country in a span of … ten years.
Our big advantage is that because we are such a customer-focused company, we always get feedback from customers as to where they would like to see the product [heading]. Customer feedback has played a big role in advancing the product to the next level. We did that ten years ago, and we continue to do it today by holding roundtables and invite a focus group to give us feedback on the product and having annual user groups of anywhere from 1,500 to 2,000 users sharing ideas … [about how] to make the product better…. That [is intertwined] with the focus and vision of the company to improve health care in this country.
Although there has been no study in medical literature to my knowledge showing that electronic health records improve the quality of health care, we have made significant enhancements to our version 8.0, which was released last year [that we hope will] show that certain functionalities will improve the quality of health care in this country.
In terms of staying competitive, we have always believed in staying at an affordable price point. [That has allowed us] to target smaller practices, which is the majority of the U.S. market — about 60% to 70% of U.S. practices have [only] one to three physicians. That has been one of our sweet spots…. We have been able to do that at an affordable price point by using as much [low-cost] infrastructure as we can … to build the software platform.
Posts Tagged ‘eClinicalWorks’
eClinicalWorks’ Raj Dharampuriya: ‘Our Goal Is to Make a Big Impact on Health Care Delivery’ – India Knowledge@Wharton
September 11th, 2009 | Popularity: 3% 0 comments | Leave a replyThe Patient is Still the Focus: 21st Century Family Medicine in Sebastopol, California
May 3rd, 2008 | Popularity: 40% 0 comments | Leave a replyEarlier in my journey, when I visited technologically enabled practices in New York and Washington, DC, I wondered aloud to my project officer, Veenu Aulakh, MPH, from the California Healthcare Foundation, if California would also show itself to be a leader in 21st century medicine enabled by technology. There’s no question that systems like Sutter Health, Kaiser Permanente, and Sharp are national leaders – we were looking for leaders in smaller practices, where 90 % of Americans receive their health care.
Then we discovered Sebastopol Community Health Center, part of the Redwood Community Health Coalition.
I got to visit with Jason Cunningham, DO, the Medical Director and full spectrum family medicine specialist, in March, 2008, but I did not get to shadow him providing care. I wanted to come back, and so I did, this time with Veenu. Coming with Veenu also satisfied my desire to do some shadowing with our funders, because they can see things from a unique perspective. I was able to do the same with our New York funders, when Rachel Block shadowed with us in March. Veenu has an industrial engineering background, so she is not a stranger to shadowing or process improvement.
Jason and the staff gave us a warm welcome, and again it was like walking into the 21st Century (instead of the 19th). Not a single paper chart in sight. There was now an automated vitals machine. Care team coordinators (the role assigned to medical assistants in this model) were now using tablet computers to room patients. Jason and the team were further developing their electronic health record, manufactured by eClinicalWorks, to support a medical home practice.
First photographs – click on any to see larger size
To show the possibilities of collaboration in this new world, Jason informed us that he’s going to install the special build of the product known as “Take Care New York,” or TCNY, tuned for population management and with the experience of the entire Primary Care Information Project in New York city. In other words, California patients are going to benefit from an EHR that includes the experience of New York patients, seamlessly.
Proving the viability of a medical home, even in (especially in) the safety net
As space age as this practice looks, it is not funded predominantly through commercial insurance. Sebastopol Community Health Center is a Federally Qualified Health Center, with a funding stream tied strongly to in person visits. Despite this potential limitation, this health center is working to support visit-based AND non-visit based population care in a financially viable way. They are doing this by maintaining visit density, keeping overhead low, and providing team care coordinators with non-direct-patient care time to co-manage panels, assisted by an introspective EHR. Jason showed us how he can query his panel quickly to build exception reports and understand their health, right within the electronic health record. No separate registry is being used here, which means no interfacing and no double-entry of data.
The shadowing experience
We started the day with the team huddle, which was as futuristic as one would hope – each practitioner with a portable version of the electronic health record, reviewing the patients of the day and preparing for each individualized care experience. By now, Jason has discovered the best approach to using an electronic device in the exam room. Even though this site is described as an “alpha alpha” site, the technology seemed to melt into the background of the green rolling hills during the visit. This could be because the team are using low footprint tablet PCs in exam rooms. It’s also because the devices are used strategically for new vs. follow-up visits. The device is always positioned in patient view, with provider facing the patient.
I could also tell that in true continuous improvement fashion, little things have been changed and improved in the system over time. A new field here, a new way of communicating between the team about something here, an idea to use an exam room one way or another with the computers.
In between patients, I had a great conversation with Jenny, the Center’s Family Nurse Practitioner. She asked for my advice on how to document parts of the patient experience in the health record, and my best answer was to think about where the patient would expect it to be, every time, and put it there. We both agreed, I think, that one of the best things we can do as care providers is to treat a patients’ story with respect by recording it accurately, and making sure it is safely kept where it can be used to support ongoing care by anyone on the team, with all of the appropriate security controls, of course.
Teaching, for a lifetime
Because this medical center is prototyping the future workflow of the rest of the Coalition medical centers, there is always teaching going on of other providers. On this particular day, Harriett, the Care Team Coordinator (a Medical Assistant) was training a fellow Care Team Coordinator on the use of the system.
At one point during the day, Harriett came in for a short break during a very busy morning. I mentioned to her that I noticed that she has a very supportive teaching style. When there was a question, she would make sure that her student learned by doing – she was very good at not taking over the use of the computer, essentially empowering others to learn. A commitment to being an experimental medical center means a commitment to always teaching. I asked about this – how would it feel to be teaching every day for the next few years as the system rolled out, I asked? Her answer was, “This is for a lifetime.”
Fortunately for the Medical Center and her patients, Harriet has been accepted into the Physician Assistant program at University of California, Davis, and Jason has agreed to be her preceptor during her practical work.
I’m Still a Fan
Jason and his colleagues are pouring themselves into to this work, for the benefit of their patients and their community. As I said in March, I am hugely impressed with the initiative to provide the right care first and foremost, with an eye to finances, not the other way around.
» Read more: The Patient is Still the Focus: 21st Century Family Medicine in Sebastopol, California
“A Process, Not a Souvenier” – Sharing After Visit Summaries with DC Primary Care Association
March 23rd, 2008 | Popularity: 58% 0 comments | Leave a replyThe quote in the title is from Mark Snyder, MD, Associate Medical Director, Information Technology, Mid-Atlantic Permanente Medical Group, who once again, volunteered to demonstrate how Kaiser Permanente improves medical care for patients using the latest technology. This happened at Kaiser Permanente North Capitol Medical Center, which takes great care of a community that includes the United States Capitol.
Mark was demonstrating the After Visit Summary, in this case, to a group of leaders from the District of Columbia Primary Care Association, which is currently undertaking an impressive program to implement health information technology in safety net medical centers in Washington. Senior Project Specialist Lauren Mardirosian was in attendance, along with Tracy Knight, NW Social Services Director from Bread for the City, and Deborah Parris, Health Information Manager from Family and Medical Counseling Services.
I set up the visit, with Kaiser Permanente’s help, because I am excited by the fact that our members’ experience can help patients in every care system, locally and nationally. It’s a virtuous circle – sharing our experience brings other experience back that we can use to do even better, and the cycle continues. I have really learned the reinforcing power of sharing in this journey. It’s even more enjoyable when I get to work with colleagues like Mark and Medical Center Chief Doug VanZoeren, MD, who willingly give their time alongside me.
What about the After Visit Summary? Mark showed that by involving the patient in its development, he makes the creation as important as the delivery in achieving its goals – involving patients and families in their care. In an era where we talk about Web2.0, Health2.0, and focus on user generated content, I think this is a great example – we create the record of what happened today, together.
DCPCA is implementing a modern electronic health record system, manufactured by eClinicalWorks, that has this capability. A care system that I visited in Sonoma, California, is already generating these for patients. Sometimes a piece of paper (albeit one that is also available on the Web in real time, on Kaiser Permanente’s personal health record, kp.org) can be as revolutionary as the people who put it together.
Thanks again to DCPCA, Mark, Doug, and Kaiser Permanente North Capitol Medical Center members and staff for their interest in helping patients everywhere.
Pictures: Click on any to see larger. Note: The patient displayed is a test patient. No actual patient information was demonstrated during the visit.
A Medical Home enabled by technology in Sonoma, California
March 11th, 2008 | Popularity: 35% 1 commentWhile in the Bay Area, I had the opportunity to visit with Jason Cunningham, DO, at the Sebastopol Community Health Center in Sonoma, California. The Sebastopol Community Health Center is part of the Redwood Community Health Coalition, which is embarking on an ambitious electronic health record project, using the eClinicalWorks application.
Jason is a Board Certified Family Medicine specialist practicing a full spectrum of the specialty, including OB, pediatrics, and inpatient care. Unfortunately, I came to see the Center after he had finished seeing patients for the day, so I was unable to shadow. However, Jason embraced the idea of a walking meeting, so I could say I shadowed in the community as opposed to the medical office as we put steps on the pedometer.
Jason’s health center is designed to pilot an advanced medical home model, facilitated with a complete electronic health record. There are less patients receiving care at this brand new center while different approaches to care are tested in the practice. Specifically, there is more involvement of support staff in panel management, and a focus on excellent primary care provision, with a goal of creating a sustainable approach across the community. What I was really impressed by is the fact that this work is being done with the current reimbursement system as it is; in other words, the team is working to demonstrate better outcomes and affordable care through a focus on comprehensive primary care, within a safety-net, federally qualified health center system that emphasizes in-person visits. They are not waiting for a change in reimbursement approach to do this work.
In terms of the layout of the medical center itself, you can see from the images below that there is a focus on bringing the patient into the care experience. The patient sits across from the physician, and the computer, a tablet PC, is arranged so that both physician and patient have access to the information being used. Jason is also using after visit summaries with his patients, as shown in the image (test data shown), so that they leave with a written description of the visit and next steps. I of course think this is a key part of patient centered health information technology.
The surrounding community is both beautiful and also working diligently to provide access to regular, quality, primary care across the population.
Images, click on any to see full size
» Read more: A Medical Home enabled by technology in Sonoma, California
We did it! Thanks Affinity Health Plan and Urban Health Plan!
February 23rd, 2008 | Popularity: 28% 1 commentThe expression of happiness in the title is a reflection of the milestone that this was in this journey. It was the first time that we went to the Gemba (“the factory floor”) with health plan leaders and delivery system leaders together, to talk about patient centered health information technology.
We were guided by Urban Health Plan’s inspiring CEO and Chief Medical Officer Paloma Hernandez and Samuel De Leon, MD, who allowed us to observe the process of care at their Bronx, NY-based care system. Invited guests included Susan Beane, MD, the Chief Medical Officer, and Linda Erlanger, the Director of E-Commerce, from Affinity Health Plan, which, “..for 18 years, has been operating managed care programs designed to address the needs of low-income populations. We are a mission-driven organization, striving to achieve positive change in the lives of the families and communities they serve.”
The goal was to do something we had not done before, bring stakeholders together to see the the actual place where the facts of health care impact the patient (for a nice description of the philosophy behind this, based on work done at Toyota Motor, see this post).
First, some photographs. Click on any to see full size.
Asthma, an Epidemic in this Community
I shadowed Mayra Nadal, MD, who is a pediatrician, and like all of the other physicians at Urban Health Plan, are using a fully functional electronic health record, manufactured by eClinicalWorks.
After a few visits, I noticed that several of her patients had severe asthma, and were being treated very intensively. One patient, a young boy, was on multiple ambulatory medications yet he was still not able to breathe normally.
I learned from Mayra that this is a sad reality for this community – this population is at exceptionally high risk for being affected by asthma. This is well known in the community. What I saw in the exam room were the best attempts of this care system to blunt the impact of this disease (and Urban Health Plan has distinguished itself nationally as a leader in managing chronic illness). Mayra showed me that they had taken extra care in the build of the EHR to include standard asthma histories and tracking of asthma plans because of the prevalence. The tools looked very complete; at the same time, they are the tools an informaticist wish they didn’t have to build. It doesn’t seem right that children in the Bronx community should grow up without an expectation to breathe normally.
Mayra was very facile with the EHR, and like me, prefers the use of an EHR because she can type faster than she writes. When I asked about online access to health information to patients, she was receptive to the idea that patients’ families would have access to ordered tests, if they had Internet access. This might be useful for things like newborn screens and other screening exams.
Overall, the impression I got from observing physicians here was one of competence using a state of the art EHR in practice. It is also worth noting that Samuel De Leon, MD also provided a very visible optimistic brand of leadership throughout this part of our experience.
On creating a prepared, proactive care system
» Read more: We did it! Thanks Affinity Health Plan and Urban Health Plan!
Disparities in clinical care – avoiding them in HIT; California CHC implementing an EHR
December 24th, 2007 | Popularity: 26% 0 comments | Leave a replyPCHIT links for December 19th through December 21st:
- RCHC Redwood Community Health Coalition chooses eClinicalWorks – A California Safety-Net system that is implementing an electronic health record.
- Racial Profiling: The Unintended Consequences of Coronary Artery Bypass Graft Report Cards — Werner et al. 111 (10): 1257 — Circulation – I am starting to dig a little into disparities research. The authors point out that the benefit of CABG is the same for diverse populations, yet the performance is not the same. Should we think of HIT in a similar way? I am worried about profiling in the
- How Do Physicians Use the Internet for Work-Related Activities? – iHealthBeat – 39 % say they e-mail online with patients, 20% in 2005, with NCI estimate at 10%.
eClinicalWorks; Interesting Tools for Medication Adherence; e-Primer from Project HealthDesign
December 19th, 2007 | Popularity: 31% 0 comments | Leave a replyPCHIT links for December 13th:
- New E-primer ? The Need to Know: Addressing Concerns about Privacy and Personal Health Records – Quote:”Project HealthDesign teams have found that while confidentiality is important to end users, they are often willing to share personal information in exchange for specific benefits and functions? “
- eCWusers.com :: An Independent Users Group for eClinicalWorks – A user forum that is publicly hosted by users of the eClinicalWorks EHR
- Create a personal MedActionPlan? for every patient – Interesting approach to guiding patients on medication regimens
- EMR – Electronic Medical Records and Practice Management for Clinical Practices by eClinicalWorks – eClinicalWorks Patient Portal information
- HIMSS – National Capital Area – Forum on focusing on the consumer in health care, January 17, 2008
