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Joy in Practice…No More Sunday Scaries!

One Sunday evening about a year ago I was cleaning the kitchen after a family dinner and having a conversation with my daughter. My daughter is typically an energetic, high-spirited individual and was particularly quiet this evening.  

“Are you feeling okay?” I asked.  

She responded with a sigh and shrugged. ”I’m fine, I just have the Sunday scaries!”

This term was unfamiliar to me so I followed up with, “What exactly are Sunday scaries?”

Without hesitation she responded, ”It happens every Sunday around 5 o’clock when you realize that the weekend is over and you have to go to work in the morning.”

My initial response of laughter was quickly overshadowed by sadness that I, too, had the Sunday scaries. Or, more importantly, the realization that I had always had them and hadn’t known it.  As a nurse I have always loved what I do for a living, but at that point in time the joy I felt for what I did for a living didn’t align with my day-to-day job. Little did I know that a few months later everything would change.

Enter Iora.  

On November 12, 2015 I began my journey to transform health care. The following day I boarded a plane and headed to the All Iora Retreat (AIR) in New Hampshire followed by several days of training at the Nest (the affectionate name for our headquarters). Unknowingly, those six days were the introduction to the experience of “joy in practice” and the beginning of the end of Sunday scaries.

At AIR I learned that one of the nine drivers of the Iora business model is joy in practice.  In 2013, Andrew Schutzbank, VP of Product Development, coauthored an article that highlighted 23 high-functioning primary care practices.  The article focused on physicians and the need to mitigate burnout.  Primary care practices were identified based on successful innovations that resulted in high performing teams, which ultimately created joy in practice.

What makes joy of practice possible at Iora is that we veer from the traditional health care model and focus on servant leadership.  Instead of a hierarchical (or “top-down”) model, Iora values equal input from all Care Team members, regardless of “status”.  Servant leaders collaborate with the team, putting team needs as the priority, thus encouraging the team to embrace Iora values and empower them to become high performers. This type of work environment creates a strong sense of ownership by all team members because they feel they have a voice, they’re heard, and are then invested in the outcomes of their work.

The word culture is inserted into conversations on a daily basis.  To Iorans that seven-letter word packs a huge punch and plays a vital role in our joy in practice.  It is the driving force behind the decisions that we make, how we treat each other, and most importantly, how we treat our patients.  Humility, courage, empathy, creativity, and passion are common values shared by all Iorans.  If Joy in Practice had a heart it would be called Culture because at Iora Joy in Practice is not just a catchphrase.  Happy employees are a priority.

One year ago I was educated on the definition of Sunday scaries.  I remember thinking that this was just part of work-life and the main reason that people were so intentional when planning for retirement; they were planning to find their joy.  One year later I can honestly say I have found mine. And guess what? With that realization, my Sunday scaries are no more.

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This is a question that we hear constantly at Iora Health from investors, Care Teams, and especially from electronic health record (EHR) vendors. Why not buy an EHR off the shelf? Why not work with another developer to build what we want? The short answer is, prior to Iora, Rushika Fernandopulle, MD, MPP, CEO and co-founder of Iora Health, tried all of the above; he and Neil Patel, MD, published a paper detailing their poor experience with eClinicalWorks in supporting the type of care we have at Iora today. So with this in mind, why build our own EHR (or as we call it, Collaborative Care Platform) to which we affectionately refer to as Chirp?

Simple. No one else has built what we need and here’s why:

  1. Other systems are too focused on billing, coding and encounters. Modern EHRs are abstractions of the paper record, with an innate focus on a given encounter and the notes/billable claims derived therefrom, rather than the clinical story of a patient.  Each time a patient and doctor meet, every piece of information must be documented in a way that a third party reading it could understand the patient in their entirety. The most crucial elements of care, anything that occurs outside of a visit, any synthesis done by providers, or any changes over time, are effectively lost in the modern EHR.
  2. We lose the story and the relevant data. Within EHRs, data is either too structured, with infinite checkboxes replacing sentences, or insufficiently structured. For example, errors such as a patient’s son who has been listed as seven years old for the last five years are easily overlooked amidst the clutter of the traditional EHR. This structure results in a jumbled patient story, no ability to analyze clinical data, errors propagated with each copy, and a worsened chance of making good clinical decisions.  

OK. How is Chirp different?:

  1. Chirp is designed to support a clinical team that cares for a population of patients. By first emphasizing communication about the administrative aspects of health care (faxes, follow ups, lab reviews, check ins, etc.), teams are able to accomplish everything necessary for their individual patients within one workflow. Chirp shifts us away from encounter-based care, hunting through multiple software systems, toward a work task structure, so that the care of a population can blend in seamlessly with an otherwise busy clinical day. Teams can spend their time in relationship-based primary care, rather than in an endless stream of seven minute visits. Other EHRs have the care of individuals and populations as two separate systems for two separate audiences and completely miss that a population is comprised of individuals who need care.
  2. We need the ability to innovate constantly. The Iora Clinical Model is always evolving. Decisions that made sense in 2012 make less sense in 2016 as we grow and learn. With a third party product, we have no hope of convincing someone else to build what we need. With our own software and amazing team, we have the ability to test things and move forward with changes in real time based on real world experience. This process replaces the slow, usually inaccurate, large changes done in one sitting to a software platform.

At Iora we are building an entirely new model of care delivery; we have been able to innovate payment, team composition, physical space, workflows and of course, our software.  It is the ability to grow all of these elements at once that has led us to create a model of care that lets us truly connect with our patients and help them solve their problems, each and every day. Chirp is a vital part of the puzzle that makes that possible.

Health Coaches, Cori & Audra

Medicine Coupled with Compassion

Modern medicine is incredible. We can give you a pill and lower your cholesterol, give you a pill and lower your blood pressure. We can set a broken bone. We can save lives; we can extend lives. We can fix so many problems. It’s totally amazing.

But then there are all these health problems that biomedicine doesn’t have a quick-fix pill for. There’s no pill for loneliness, and it’s a common problem that definitely affects your wellbeing. There’s no quick answer for losing weight, or getting fit. Balance is a really important issue at our clinic. So many of our patients are afraid of falling and feel unsteady. There’s often not a quick fix for improving balance. I think that most of the time, when it comes to health problems like these, patients are kind of left to go it alone. Part of the health coach role is to support patients with problems that take more time. No doubt they have to put in the legwork, but they don’t have to do it alone.

Sometimes the role of the health coach is just to hear the patient and understand what they’re going through. At the Shoreline clinic we have two patients named Dan and Mary Ann. They have been married for a long time. And it is really obvious when you meet them that there’s a lot of love. They just have a very kind way of interacting with one another.

Dan was diagnosed with Alzheimer’s disease at a fairly young age: in his mid-sixties, which was devastating for Mary Ann. And this last year was particularly hard because Dan’s condition worsened quite rapidly. And as it worsened Mary Ann had to take on more and more caregiving responsibilities.

Audra is a health coach who works in Shoreline with me: Mary Ann and Dan are on her patient panel. For any of you that have been caregivers, you know it can be really taxing work. At one point Mary Ann was sending emails to her health coach, Audra, nearly every day. Often Audra would have really solid advice for her, or something tangible to offer. With the support of Dr. Levine and Debbie Yoro, our clinical social worker, the team provided care that was so far above and beyond the status quo. But sometimes Mary Ann would come to Audra with problems that didn’t have a clear answer. When this happened Audra would just hear her out and be there with her. What resulted was really special. Mary Ann developed a very trusting relationship with Audra and the care team as a whole. It was clear that Mary Ann felt like we were on her side: that we were a team. She knew we had her best interests at heart.

There’s no cure for Alzheimer’s disease. But what is so great about the Iora model is that it recognizes that, yes there is value in fixing people’s problems, but there is also so much value in helping them cope when their problems can’t be fixed. Mary Ann sent us a note recently and it included a quote from the poem ‘Kindness’ by Naomi Shihab Nye. It read, “Then it is only kindness that makes any sense anymore; only kindness that ties your shoes and sends you out into the day.” What I love about Iora is that it’s not just medicine. It’s medicine coupled with compassion. It’s difficult to measure the value of human compassion in medicine. But when you hear stories of real human experiences, it just intuitively makes sense. The care that is provided at Iora is so exceptional partly because we recognize the value of the healing relationship and actively work to foster meaningful connections.