Is the Juice Worth the Squeeze? Innovation, Technology and the Business of Family Medicine

J. Paul Dow, MSHI, eHealth Innovation Strategist, AAFP

Technology has advanced the ability of clinicians to treat patients since the beginning of medicine. In the past, many of these tools were developed over long periods of time and at great cost. This limited their implementation and benefits to large academic facilities. For example, Magnetic Resonance Imaging (MRI) systems provide valuable diagnostic insights to physicians; however, the revenue required to install and maintain that level of technology can be cost prohibitive. These innovations are becoming cost effective for a range of family practices as technology becomes more reasonably priced and cloud-based. The challenge is to find the right tools that add value to your patient care continuum without burdensome disruptions to your workflow.

The American Academy of Family Physicians has funded a three-year project to discover, test, and recommend various classes of technology to help a broad range of physicians simplify the administrative aspects of healthcare. Care providers are spending too much time creating documents to support billing activities rather than providing care. Ultimately, the decision to implement a solution rests on each practice evaluating the unique challenges that are presented.

COVID-19 has changed the way a physician practices and the frequency with which a patient utilizes clinical resources in America for the foreseeable future. The almost instantaneous transition to telehealth has proved to be complex. Some practices were not ready for the sudden shift

and are still playing catch up. Decreasing revenue only adds more pressure to selecting technology partners. Selecting the right solution should add to your overall efficiency as well as the bottom line. Choose wrong and you may destroy a delicate work/life balance and put your financial viability at risk. How can you decide which tool is the best choice for you and your patients’ benefits? This article will provide four questions each physician/owner must ask themselves before considering a purchase.

WHAT PROBLEM ARE YOU TRYING TO SOLVE?

COVID-19 has suddenly added numerous layers ofcomplexity to your delivery of care. Social distancing has made the standard clinic arrangement problematic and requires a rapid implementation of telehealth. Clearlydefiningtheproblemsthatexistin yourworkflow will make sorting the solutions easier.

Do you need to find a way to interact with patients remotely? Some electronic health records (EHRs) have built-in telehealth solutions. If yours does not, there are many vendors willing to share one with you. Additionally, many have COVID-19 specific technology such as symptom checking. This may prove useful in the short term. However, it most likely requires another separate log-in and might not share information with your EHR if the tool is webbased. This increases the administrative requirements and might even require double documentation.

Are you trying to use your practice management software but it does not have the flexibility to allow patients to self-schedule visits? This may be a function of telehealth software that has more functionality which usually means a slightly higher cost. There are no perfect technology solutions and many of the items involved with telehealth are out of your control: the network reliability, the patients’ abilitytohavea suitabledevice, updated torecommended software levels, with access wi-fi are some of the most critical to consider. Sometimes a simple phone call may be all that’s possible when there are so many variables.

HOW COMPLEX IS THE IMPLEMENTATION?

If you attend any health technology meeting literally every vendor declares that their product is one of the few that works with every EHR in existence. The number of EHRs that are easily compatible with most products is usually much smaller. If your practice is large enough to have technical support staff there still mightbe substantial effortrequired from yourpractice, the solution vendor, and the EHR vendor in concert to implement a solution. Additionally, there is the need to update your clinical workflows to accommodate this new tool. New technology may require your practice to adjust how its day-to-day operations flow. Physical distancing guidelines mean fewer patients entering your clinic. Office staff may need to complete a virtual technology assessment of the patient prior to the scheduled telemedicine visit. This would look like a staff member contacting a patient twenty to thirty minutes prior to the appointment to confirm the ability to connect remotely as well as to discuss the symptoms and treatment goals for the visit. Patients are also experiencing this new reality. It may require a few visits for them to understand the new processes. You also may need some time to adjust how you interact with and interviewthe patient. The same questions will exist: should I lookat the patient orthe computerscreen? Will theybe able to pickup on my non-verbal cues to keep the conversation moving? Will they ask “one more thing” right before you end the encounter?

HOW MUCH ARE YOU WILLING TO SPEND?

Numerous companies are offering telehealth services and solutions at a low price, or even for free, some for up to a year. After the initial period the pricing structure varies. Some use a per encounter pricing model, others have a flat fee per provider, per month. Still others provide freemium pricing, allowing users basic functionality and only charge for more advanced technology, such astointegratewith otherpracticemanagementsystems. Otherfees and overages may be applied to your contract, as well as penalties ifyou decide the product is not right for you or your patients. Ifit is the product you want, and it seems like a fit for your practice, you may consider connecting it to your EHR. One additional aspect to explore is that the solution maywork, but mayhave additional high cost items ($10,000 - $20,000 ormore) forinterfaces thatmayneed to be upgraded annually for another tidy sum. In this case it might be worth looking at a consumer grade tool such as Google Meet which is free to implement and works on a wide range ofdevices. It might not integrate with your documentation tools but you may be able to use your personal devices relatively easily.

HOW LONG TO DEMONSTRATE VALUE?

COVID-19 has put a tremendous strain on primary care. Decreasing patient volumes even with the transition to telehealth may not be enough to maintain practice viability. In these cases, technology is not a get-rich-quick scheme. Considering the complexity of a new tool, plus the time to develop new workflows, as well as finding time to train staff and acclimatize patients, it may take a month or two, sometimes longer, to realize the positive revenue flow from the technology.

Technology advancements, including telehealth, has proved to be a benefit to clinicians but adding it to day-to-day operations can be difficult. The publichealth emergencythatis COVID-19 has had a hugeimpacton manyfamilypractices. Transitioningtotelemedicine so quickly and so completely has proved to be a challenge for even the best prepared practice. As we begin to assess how to face the new future of medicine, answering a few questions can help with technology planning and finding the right tool at the right price for your practice.

If you have further questions or would like to learn more about the AAFP Innovation Lab please contact Paul Dow via e-mail at pdow@aafp.org.