Posts Tagged: iora primary care

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A Second Shot at a Second Career

Medicine is a second career for me. I was previously a chemical engineer, but figured out quickly that I wanted a job that allowed me to develop true relationships with others. When I decided to go to medical school, I knew that I wanted to be a primary care physician so I could care for the whole patient, understanding all of the factors that affect their health.

After I completed my residency, I worked for a large outpatient hospital. Each day I fielded complaints from patients about short visits or the fact that they had to have a different appointment for every concern. I was met with the truth that medicine didn’t actually feel like it was about caring for patients–rather, it was seeing over 20 patients a day, in 10-to-15 minute visits. Only seven years after residency, I was debating leaving it all behind.  

In the process of looking for a new job, I posted my resume on physician recruiter sites. I received multiple calls and emails–none of which I answered. Then one day, on my lunch break while eating a protein bar at my desk, I surprisingly answered a call that I knew was from a recruiter. I listened carefully to the man on the other end of the phone as he spoke about a company that was opening new practices in the Denver area; a company that focused on building relationships; a company that wanted to restore humanity to healthcare. That phone call changed my life–I felt like I was getting a second shot at having the career I’d dreamed of.

I went to Denver to interview with the team and very vividly remember the Denver Medical Director telling me: “This job will be more different than you can even imagine.” I visited one of the clinics and got to experience my first morning “huddle”–a team sitting around a table discussing which patients they were concerned about, who was going to follow up on which items, and the strategy for taking care of all patients coming in that day. I shadowed Health Coach visits with patients (without a doctor present) and saw them talk to people about their health concerns, but also listen to their fears, accomplishments, and goals.

I started working for Iora eight months ago and it is hard to describe how much my life has changed. I am part of an amazing team where every person has an important role in patient care. We have time to build relationships so we can understand patient’s health goals, life goals, and the barriers that keep those goals from being reached. We try to activate the patient to become the owner of their health and I no longer strive to see more patients in a day–I strive to take the best possible care of my patients. I went from wanting to leave the practice of medicine, to wanting to change the practice of medicine. To this day, I am still not sure what possessed me to answer that recruiter’s phone call, but I am grateful each day that I did.   

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Why Iora = Comprehensive Primary Care

Janice* joined Iora Primary Care after moving to the Seattle area from Idaho. In Idaho, Janice had several specialists who she had to see for her many medical conditions. She was pleased to learn that at Iora we do as much care in the practice as possible in an effort to streamline care and save patients from paying unnecessary copays.

Janice came to us with a long history of multiple complex medical conditions, which included chronic pancreatitis, diabetes, vascular disease and long term pain medication usage. Fortunately, one of the gifts that Iora gives their staff and patients is time. We have time to think about our patients from a comprehensive perspective and we ensure that the patient has time with their care team to feel heard and supported on their journey. Janice’s health care team, consisting of a doctor and Health Coach, worked with her to create a plan that would meet her complex health care needs.

We set up a schedule of routine appointments to see the doctor and address Janice’s multiple concerns. In addition, we  set aside time for her to meet with her Health Coach to address diabetes education and customize her medications to better fit her lifestyle. Even though she had been on insulin for years, no one had taken time to teach her about diabetes and how her other medical conditions affected her blood sugar. Through these coaching visits, Janice was able to stabilize her blood sugar and learn about the warning signs associated with it being too high or too low. She called whenever she had questions and, over time, became much more confident in managing her diabetes on her own.  

Beyond diabetes management, we also started working with Janice to address her chronic pain; at Iora we work to balance the need to treat people’s pain with the importance of doing it safely.  Sometimes that means we recommend changes in how people use pain medication and Janice was challenged by the compromises that this process requires. One day after she missed an appointment, I called her and learned that she had left Iora for a different primary care practice. As a team we were sad to lose someone we cared about and who we felt was truly making positive progress and life changes to better herself.

The Turning Point

About four weeks following her departure from Iora Primary Care, we received a call from Janice asking to speak to her former doctor. On the call she said that she realized she had “made a big mistake” and asked if the doctor would be willing to take her back as a patient. She went on to tell us that her new physician told her that in addition to her primary care doctor she would have to see two different specialists to manage her conditions and “I kept hearing in my head my Iora doctor saying ‘we can manage that for you here in the clinic.’ I didn’t want to go to all those other doctors!” Of course we were happy to welcome Janice back to the practice and resume the work we had been doing together towards a healthier, empowered life.

Over the next six weeks, after rejoining Iora, Janice gained new insights into how her choices in life affect her health through participation in one of our chronic disease self management classes. With options like classes, personal meetings with her Health Coach, and visits with her doctor, Janice grew optimistic that her life could become more than just one health crisis after another.

*Please note patient name has been changed to protect identity and private health information.

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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.