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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.

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