Meeting Changing Demands in Health Care: Novel Uses of Technology Are Key

Google Glass Is Ready for Work

Medical scribes offer physicians a second set of ears to capture patients’ concerns, medical histories, and information critical to updating their medical records, while allowing the physician to focus on the delivery of care. But this medical-scribing process isn’t always problem-free.

Recently, Edmonds Family Medicine’s CEO and practice administrator, Marcy Shimada, decided to offer Augmedix—a virtual medical-scribe service that connects medical scribes and physicians to practices remotely—to her practice in the hopes that it would relieve some of the burden of charting and medical notes that were keeping doctors at the clinic after hours. The service is utilized through Google Glass, so each of the practice’s 33 physicians wear the device during their patient appointments.

Google Glass facilitates a live video feed into the exam room so that the assigned medical scribe can hear and see the medical exam in real time as it is performed by the provider. This allows the provider to focus on the patient rather than worry about getting all the details down in their notes during the patient’s visit. The patient experience benefits from this uninterrupted attention, and the doctor can fill in any additional notes they have later when they review the scribe’s work. Reducing the hours it takes to capture a patient’s medical information offers physicians better work-life balance, and ultimately helps to reduce burnout.

While electronic health record (EHR) interfaces increasingly offer more intuitive ways to integrate with a physician’s workflow, errors around data entry or technical issues with the platform can keep them from being fully utilized. Furthermore, many patients feel that their physician is staring at a computer screen more than engaging with them, a huge barrier to patient satisfaction.

In addition, physician burnout—due to a provider shortage and the resulting increasingly long hours and mounting paperwork—has become a growing issue for health care organizations struggling to recruit and retain their physician care providers. According to a recent article in Becker’s Hospital Review entitled, “A Burnout Epidemic: 25 Notes on Physician Burnout in the US,” “Fifty-one percent of physicians reported experiencing frequent or constant feelings of burnout in 2017, up from forty percent in 2013, according to Medscape’s annual survey.”

Yet, after just a few months, the results of this Augmedix/Google Glass pilot project at Edmonds Family Medicine show promising signs of alleviating fatigue for the providers using the technology.

“These doctors are getting home in time to have dinner with their families, and feeling less overwhelmed by the volume of paperwork and charting they were previously experiencing,” shared Shimada.

Additionally, the physicians report being very pleased with the scribe service, noting that their scribes had captured all details with great accuracy and quickly gained a sense of their communication or notation style, and that even substitute scribes, filling in when their assigned scribes were out, created a fairly seamless experience.

“I find that I’m saving myself at least a few hours of additional paperwork each night, and the quality of the service has been very high, in my opinion,” shares physician Andrew Thurman, who ramped up his use of the technology over time and now uses it for all his patients. “I feel like it offers time savings. The notes [in the patients’ charts] have more verbiage and are more accurate, which makes it easier to bill correctly.”

While most patients—90 to 95 percent so far—consent to have their physician use the technology during their visit, there are some who fear the risk to privacy, or have other reservations regarding Google Glass or the scribing service. However, “Most patients are intrigued,” says Thurman. “The patient can see when the device is in use by the green light on the corner.” If the medical assistant prepares the patient by talking to them about Google Glass use and the reasons behind it, most patients are pleased that their physician is using the technology.

Shimada is pleased that Augmedix continues to slash hours of charting from her provider’s work days. While the organization is not necessarily looking to increase patient volumes, they are reporting a time savings that is creating better work-life balance for the staff and satisfaction in those who are using the service.

A Washington State Orthopedist Makes Strides in Cutting-Edge Implants

James W. Pritchett, MD, has been designing joint implants and the surgical tools to place them for more than 30 years. In that time, the goals and expectations of patients have changed dramatically. The average age of a joint replacement patient is 70 years, with some younger populations of individuals who engage in professional or extreme sports. While in the past a 10-year lifespan for a joint replacement was considered pretty great, orthopedic implants have more than doubled their lifespan, offering patients who receive them considerable freedom and lifestyle flexibility.

Joint replacements in the United States exceed one million per year today, and this number is expected to grow rapidly over the next two decades, with patients under age 65 expected to outnumber those who are older. Athletes in particular have taken advantage of the benefits of joint replacement after injury, with the hopes of performing exactly as they did pre-injury. Dr. Pritchett, who practices in Seattle, has a diverse patient base, including many elite athletes such as NBA players, competitive surfers, and professional golfers and runners. Some discover that they perform in their sport even better after a joint replacement than they did with their natural joint.

Improvements in implant design can be attributed to a number of factors. Dr. Pritchett says that more thorough testing, with cyclic loads way beyond that of the body, is the new norm. “Previously, 10 million cycles was considered standard, which equates to about a 10-year lifespan for a joint,” he says. “Now, 30 million cycles has become standard, adding 30 more active years on the joint. More sophisticated electronic health records and big data sets also offer a better measure of how joint replacements perform over a full range of time as patients age.”

Additionally, hip implants are being made to look and function more like a natural hip joint. The new implants can match the exact ball diameter of the patient’s hip, and are attached to the skeleton with a new porous metal that the bone grows into, creating a permanent bond. This is a big step up from the cement that was used previously. Finally, the old joint replacement used to act like a hinge, but now a more exact match of the ball joint allows for a complete range of motion.

Improved reporting of patient outcomes in medicine at large has also delivered unique insights and better informed design choices. According to Pritchett, “Traditionally, in medicine, doctors reported outcomes that were based on their own scientific interests. Now feedback is collected around the issues that matter most to the patients.”

For example, when Dr. Pritchett began to ask his patients about their sexual function after their hip replacement—a topic that was nowhere to be found in existing medical journals—he discovered that there was indeed a design shortcoming in this area. This feedback informed the design of a new, more stable hip. The goal is to not place any limitations on the activities a patient can enjoy after surgery. In the past, undergoing a joint replacement still meant that you would likely have long-term limitations on motion and activity. That is no longer the case.

However, to this day the patient story that stands out most to Dr. Pritchett is that of a patient who was neither middle aged nor athletic. Coerced by a friend to come in, the 31-year-old female patient was suffering debilitating hip pain, causing her to stay home outside of work. “She has no life,” her concerned friend reported to Pritchett. The young woman’s only hope was of pain relief. She said that she didn’t think she would ever have a family. Pritchett convinced her to have the surgery.

After the surgery, which had gone beautifully, Dr. Pritchett noticed the young woman’s mother in the hallway crying. Concerned that something had gone wrong with his patient, Pritchett headed into the patient’s room, and checked to see how her recovery was coming along. Everything looked great. He then approached the patient’s mother and asked, “What is the matter?” to which she responded, “This is the first time I’ve seen my daughter walk normally her entire life.” At that moment, Dr. Pritchett realized that the joint replacement had not only offered the patient a chance to alleviate her chronic pain, but had changed her entire life—and her mother’s life, too.

Living a normal life was something the young woman had never envisioned for herself, and today, she is the mother of four children. For many of the athletes who come in to Dr. Pritchett’s office, getting “back in the game” is usually the primary goal. Yet for the young woman, simply not being handicapped by pain, and feeling normal, was the goal.

This experience has stayed with Dr. Pritchett as a humbling reminder of the importance of continuing to advance the design and surgical replacement of joints. The goal, according to Pritchett, is that each patient “is not prevented from realizing their potential, whatever that is.”

Dr. Pritchett has contributed to the body of knowledge in this area through his original research and over 160 published scientific papers. The extensive experience of his practice stands out in the Pacific Northwest. They have performed more than 5,200 cross-linked polyethylene and metal joint-resurfacing procedures, with patients using their new joints as soon as the effects of anesthesia wear off.

Carena Virtual Health: A Way to Extend House Calls

Carena, a telemedicine startup based in Seattle, was founded in 2000 to provide on-demand care to patients by partnering with larger health organizations, as well as through employee health programs. In order to provide virtual house calls as an extension of their existing care-delivery system, the company began development in 2007 and successfully launched their very first virtual-services platform in 2010.

Virtual care, for Carena’s leaders, seemed like a natural extension of the traditional “house calls” that have been a form of medical care delivery, performed in cultures around the world, for hundreds of years. The opportunity to bring the consumer’s experience back to a high level of access and personalization could not be better timed, given a health care environment where many patients’ access to care is being increasingly limited.

The first clinic to adopt their virtual-care services was a Franciscan hospital in Seattle in 2012, which integrated the technology into their regular care without issue. They have since grown rapidly and now work with over 120 hospitals across the United States, offering services to 18 million people. Their services allow the partnering hospital’s clinical team to redefine care delivery and extend consumer access, particularly among rural populations. Among the benefits reported by Carena’s partnerships are:

  • Lower hospital readmission rates
  • Improved patient outcomes
  • Decreases in physician burnout

Patients report high levels of satisfaction with the 10 to 15 minutes on average that it takes to talk to a doctor. For example, parents who are up late at night with sick children can have their anxieties and questions addressed without an unnecessary trip to an emergency department. The cost of a Carena patient visit is $10 to $35. The majority of the negative feedback they receive from patients focuses on access to medication, as Carena providers are cautious prescribers.

“We’ve found, for most patients, when something happens with the patient’s or their family member’s health, they hope for three things: I hope it’s not serious; I hope I can see my doctor; I hope it is paid for,” says president and CEO Ralph Derrickson. Often patients simply need to speak to someone medically licensed who can answer their questions or concerns.

The care Carena offers has benefited Derrickson personally. He became one of Carena’s first patients when he contracted shingles on a trip and needed urgent medical instructions while in a remote location. Most of the time, Carena patients want to talk to a provider more to discuss anxieties about their health than to address an actual urgent medical condition. But in addition, Carena serves in an urgent-care capacity, offering an important alternative to the emergency department. “This is a tremendous value- add to the patient-experience component that health systems provide to their enrolled patient populations,” says Derrickson.

Patients with chronic conditions often find benefit in access to virtual-care services. Additionally, for patients who have been recently discharged from the hospital, virtual care can be critical to preventing hospital readmission.

However, the road to providing these services to patients is not without barriers. Medicare patients are not always covered to receive virtual care, as parity laws lower reimbursement rates. For some of these patients the emergency department is covered, while virtual care—the most cost-effective option—is not. Additionally, variations in state licensure requirements, and the absence of a national standard of licensure for practicing virtual medicine, presents challenges and red-tape barriers for the company.

Yet the Carena model is working. Companies such as Microsoft, Costco, and Boeing are using Carena to supplement their self-insured plans to help keep costs down. And hospital and health systems are using Carena to support their employee populations and as a way to extend the primary-care arm of their systems, as well as market to new patients.

But the key is, virtual care protects the sanctity of the office visit and doesn’t change who patients see—just how consumers access their care. And for health care providers, teaming up with a virtual care provider extends their ability to care for patients without having to pack more patients into their already full schedule.