Healthcare IT From a Patient Perspective

We spend a lot of time here at OVP meeting with entrepreneurs determined to make the healthcare system more efficient and effective.  For me, many of those meetings are somewhat abstract, as I choose to enter the healthcare system myself as infrequently as possible precisely because I find the system both inefficient and ineffective.  Yet, as pain in my knee from an injury picked up playing soccer lingered, I decided to overcome my aversion for visits to the doctor and have it checked out.  I have a friend who is an orthopedic surgeon, and he told me to call his office and they would squeeze me in.  Thus began a long and enlightening journey through two different hospitals that provided a different level of insight to the confusing and convoluted world of providers and payors than is achievable reading healthcare IT business plans, blogs, and industry reports – and suggests that developers of such IT solutions should spend more time doing the same and building solutions with the end user in mind.

A few “highlights” (in the sense of amazement they generated) of the experience:

• When I first called about a week before Thanksgiving, the scheduler informed me that the practice did not have any openings until mid-January.  When I reached back out to my friend to see if he could find a time in his schedule, he found me an opening the next day; I arrived to find myself as the only patient in the office
• He explained the issue related to their recent implementation of an EMR system from Epic, which caused them to intentionally schedule 75% of their normal patient load for three months to be able to work through the kinks of the system
• The Epic system is so complicated that Epic provides a full-time, on-site representative for that entire three month period to answer questions and help the staff onboard to the EMR.  While I was there, the Epic rep was called in twice to answer a question, and my visit was the last day of the three month training period; the practice was dreading how they would survive without the rep nearby
• When scheduling my MRI, they took all of my information to “pre-register” me, a process that took about 10 minutes on the phone; I arrived at the hospital and the receptionist at the registration area instructed me to fill out the exact same information again on a paper form before directing me to another woman at a registration desk who asked me to confirm that same information again as she typed it into the computer; in total, the registration process took about 25 minutes.  I then went to the imaging department and filled out much of (though not all) of the same information again on a paper form, and confirmed it one more time for the radiology technician as she entered it into the computer.  For those counting at home, that adds up to six times of providing my personal information across the physician office and hospital, three employees who keyed that information into the computer, and three paper forms that are now stored somewhere
• Through the entire experience, I never saw or heard a single estimate of what this care would cost, despite having a high deductible insurance plan that would require me to fit most (if not all) of the bill
• My first communication from my insurance company was in fact a denial of coverage for a knee brace I required – which I opened literally minutes before I met the rep to ensure the custom-made brace fit properly nearly two weeks after I had ordered it

As someone who invests in healthcare IT solutions intended to directly address these very inefficiencies, the experience certainly validated the Osage Ventures belief that technology can revolutionize the healthcare industry.  However, it also demonstrated how far those technology solutions have to go before truly having an impact.  Current stats suggest that nearly 60% of physicians use an EMR system[1], up from just 30% in 2006, and the EMR market is expected to grow to $6.5 billion in 2012, a sixfold increase over 2009[2], on the surface implying the huge government incentives under ARRA are having their intended effect of driving a technology revolution in healthcare.  Yet the almost universally disgruntled sentiment among physicians I have spoken with about their EMR experiences, all of whom have had a system foisted upon them as part of a rollout at a large hospital, suggests EMRs – and all of the other HIT breakthroughs they will enable once medical data is digitized – are a long way from delivering their promised benefits.  The cost (estimates suggest the average EMR system costs $46,000 per physician to implement, which don’t include the three months of reduced patient loads and numerous headaches once the Epic rep is no longer there for handholding) and complexity of the systems that don’t easily fit into physician workflows are the most recently cited reasons for slow (or begrudging) EMR adoption.

These issues feel addressable by new innovators that can leverage the economics of the cloud to build a solution designed around the needs of the end users – physicians, nurses, their staff, and to a lesser extent patients.  While we are wary of EMRs at OVP given the fits and starts of the industry, the huge number of providers (at last count it exceeded 400), and the increasing concentration among large players, we have seen many entrepreneurs who recognize the need to create physician-focused HIT solutions, while other prominent startups such as PracticeFusion and ZocDocs have grown quickly by taking a simple and user-centric approach.  As just a few examples, we have recently met with several startups that are bringing gamification and social network approaches to the world of employee wellness, and others building solutions to allow physicians to access critical patient information on their own mobile devices using simple, intuitive – and very consumer-like – user interfaces.  Our portfolio company Instamed is attempting to solve the real-time communication disconnect between payors, patients, and practices to avoid situations such as rejection of coverage after a custom-built knee brace is already produced and delivered.  I hope these entrepreneurs succeed, and inspire others to do the same, as I really am tired of filling out the same form six times.

[1] CDC/NCHS National Ambulatory Medical Care Survey

[2] Frost & Sullivan, October, 2011