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Restoring Humanity to Health Care – My Experience Part 2

Posted on February 27, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It seemed appropriate for me to follow up with part 2 of my experience with a new wellness focused medical practice called Turntable Health, an operating partner of Iora Health. In case you missed part 1 of the journey, you can find it here.

Walking into the clinic, there was a different feel. It felt more like walking into a local coffee shop than going for a doctors appointment. The lobby was so inviting that I wondered if some in the community used it as a place to go and work on occasion. I spend a fair amount of time in the Downtown Las Vegas tech community, so it wasn’t a surprise that I actually knew a few of the people in the lobby. So, I was able to connect with some friends while I waited for my appointment.

The check in process was simple and I was invited back by my health coach. In this case the health coach acted very much like an MA or nurse in a regular medical office, but the feel was more friendly an casual. We both knew we had an hour together so there wasn’t the usual frenetic pace the accompanied a doctors office.

I had a couple paper forms to sign (yes, the signature is still often easier on paper), but no major health history to fill out or anything like that. They had a one question survey that I think was about my current state of wellness. Over the hour the health coach did ask many of the questions that would be on a normal health history form and key them into the Iora EHR system. It was a unique approach since it gave me the opportunity to talk about the things as we went through them and many of the things we talked about (ie. my family health history) came up later in my conversation with the doctor.

The exam room looked quite a bit like any other exam room you might visit. The colors and lighting were nice and they had little touches like this local art work display in the exam room (see picture below). It’s kind of interesting to think about a doctor’s office as a kind of local art gallery.

At one point in the conversation with my health coach, we talked a bit about fitness tracking and she quickly emailed me some fitness apps that she liked. Little did she know that I write about such apps and that industry for a living on Smart Phone Healthcare. It also illustrated how much of a need there is for someone to be a trusted content curator of the 30k+ mobile health apps out there. Especially if we want healthcare providers to make a dent in actual usage of these to improve our wellness.

After completing her assessment, my health coach left the room and came back with the doctor. When he came in he told me that my health coach had talked with him about me and my health (in a normal practice this amounts to “Fever in room 3”) and he wanted to talk to me about a few of the issues I was dealing with. When he did this, the doctor and my health coach came into the room and we all sat around a small table. It was almost as if I’d just sat down for hot chocolate (I don’t drink coffee) with my doctor and my health coach.

There were a few differences though. When my doctor sat down he plugged in a chord to display his computer screen (my record) on a big plasma monitor that we could all see. I’m not sure why my health coach didn’t do that too. I almost moved over next to her to watch her enter the data, but I felt like that was just my inner EHR nerd coming out. Plus, I didn’t want her to necessarily know my background in that regard and that I’d be writing about the experience later. I wanted to see what they usually did for patients.

Because we were all sitting around the proverbial exam room “coffee table” I didn’t feel rushed at all. We talked about a couple sports issues I’ve been dealing with and ways that I could make sure they don’t continue to get worse (since I’m definitely not stopping my sports playing). We also spent some time talking about how to work on some long term wellness tracking around high cholesterol and diabetes.

After the visit, I realize that in many ways it wasn’t any different than a regular doctor visit. I could have gone into any doctor’s office and discussed all of these things and likely gotten similar answers. I think part of this is Turntable Health still working on the evolution of how to really treat a patient from a Wellness perspective. However, while many aspects of the treatment were the same, the experience felt different.

The long appointment time. The health coach. The doctor that wasn’t rushed all contributed to a much different visit than you’d get in most doctors’ offices. You can be certain that had I gone to a doctor for my sports issues, we wouldn’t have talked about things like cholesterol and diabetes. There wouldn’t have been time. Was the care any better or worse? It’s the same care that would have been provided by other professionals, but the care was given room to breathe.

As I left the visit, a part of me did feel a little disappointed. You might wonder why after this glowing review of the unique experience. I think the disappointment came from some improperly placed expectations. I’m not sure I really thought deeply about it, but I wish I’d realized that they’re not going to solve your wellness in one visit.

When I think about my psyche as it relates to doctors, I’ve always approached a doctor as someone you go into and they fix you and then you go home. When applying that same psyche to a wellness based approach to medicine, it leads to inappropriate expectations. Wellness is a process that takes time to understand and address. In fact, it’s a process that’s likely never done. So I think that led to my gut reflex expectation of what I’d experience.

I think one way Turntable Health could help to solve these expectations is to do a better job on the first visit to describe the full model and plan for what they want to accomplish with a patient. Otherwise, you really just feel like you’re going in for another doctor’s appointment. I’m not sure if that’s a cool chart of all their services and how they help me improve my wellness or if it’s a list of ways that they’re working to help improve my wellness.

Basically, I wish they’d over communicated with me how Turntable Health was different and how they were going to deploy a suite of professionals and services to better help my overall wellness. It’s easy for those working at Turntable Health to forget that new patients haven’t seen their evolution and don’t know everything they’ve done to improve the primary care experience.

A few other things I’d have loved to seen. First, I filled out their 20 minute (I think it took me 10-15) survey before the appointment. I didn’t get any feeling that the health coach or the doctor had actually seen the results. In fact, the health coach asked me some of the same questions. Redundancy can be appropriate on occasion, but it could have made the visit more efficient if they already knew the answer to those questions and instead of getting the info they could have spent the time talking about the answers as opposed to getting the answers. Plus, I’m sure my answers would have triggered some other discussions. It all made me partially wonder why I filled out the survey in the first place. Were those just part of some research experiment or were they to help me improve my health?

I was quite interested in their portal and what it offered (obviously, since I’m a techguy). It seemed like the framework as opposed to a fully fleshed out solution. I could see where it could grow to something more powerful, but was disappointing on first login. In one area called measurements it had graphs of my Blood Pressure, Fasting Glucose, and Weight. Unfortunately, after one visit they only had one data point and now way for me to easily upload all my weight measurements from my iHealth scale. Hopefully integrations like that are coming since that data could definitely inform my wellness visits. I guess they need to work on the first time user experience for the portal. At least I can schedule appointments through it.

I imagine some of you are probably looking at this as a pretty major investment in my health. Some might even think an hour long appointment would be more time than they want to spend with the doctor. I get that and I don’t always want my appointment to be that long. In fact, now that I have my baseline, I hope that many visits become an email exchange or other electronic method that saves me going into the doctor at all. However, as I’m getting older, I see this as an important investment in my long term health. Hopefully this investment has a good ROI.

With that in mind, I’ll do what I can to keep you updated on my experience. Since I’m on a journey of wellness, I imagine this is Part 2 of Many. I hope you enjoyed the look into my experience.

Restoring Humanity to Health Care – My Experience Part 1

Posted on February 26, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In light of yesterday’s short story post, and also my post on EMR and EHR about concierge medicine, I thought it timely for me to document might entrance into what many are calling the next generation of healthcare. They talk about it as primary care that puts people first.

In my case, it’s my recent membership in Turntable Health, an operating partner of Iora Health. When I had to switch insurance plans this year, I decided to try out this new approach to primary care. The insurance plan I chose included a membership to Turntable Health. For those not familiar with Turntable Health, it was started by the infamous ZDoggMD and is backed by Tony Hsieh’s (CEO of Zappos) Downtown Project in Las Vegas.

To be honest, I’m not sure exactly what I’ve gotten myself into, but that was kind of the point. I can’t remember the last time I went to a primary care doctor. In fact, if someone asked me who my primary care doctor was I wouldn’t have an answer or I might mention one that my wife visited. I’m a relatively healthy person (luckily I have some good orthopedic friends for my sports injuries) and so I’ve never felt the desire to go in and see my doctor. I feel healthy, so why should I go and pay a doctor to tell me I’m healthy? I think this view is shared by many.

Will Turntable Health be able to change my view on this? Will they be able to take a true Wellness approach to things that will change how I view primary care? I’ve written for years about Treating a “Healthy” Patient, and so I’m interested to see if Turntable Health is making that a reality.

One thing is for sure. They’re taking a different approach than most doctors. I scheduled my first appointment for later today (Side Note: Not sure what it says that it took me 1-2 months to schedule my first appointment.). They slotted me in for an hour long appointment (a requirement for the first appointment) so that they can really get to know me and my wellness needs. Plus, they said I’d get a chance to get to meet my care team. A care team? What’s that? I’ll let you know after my appointment, but looking at their team I’d say it includes physicians together with health and wellness coaches.

The idea of a team of people thinking about my and my family’s wellness is intriguing. Although, I’ll admit that this wasn’t the biggest reason I chose to sign up with Turntable Health. It was part of the reason, but I was also excited by the idea of unlimited primary care. With unlimited primary care, it opens the door to things like text messages or eVisits with your doctor since they’re truly interested in your wellness and not churning another office visit to get paid.

With a family of 4 kids, there are dozens of times where my wife and I debate whether an office visit is needed. Every parent knows the debate. Am I just being paranoid or are they really sick? Is that rash something that needs to be treated right away or should I give it some time? Final answer: Let’s just take them in, because I don’t want it to be something bad and then I feel like I’m an awful parent because I chose not to take them in. I’m hopeful that with Turntable Health we can alleviate those fears since we don’t have to pay for the visit and we can start with an online visit which saves us time. That’s extremely compelling to me.

I can already say that my experience has been different. After scheduling my first appointment, I got the usual email confirming my appointment, offering directions to the office, and inviting me to fill out an “Online Health Assessment.” I thought it was cool that they were asking me to fill out those lengthy health history forms electronically before the visit. Turns out I was wrong. It was a survey style assessment of my health and wellness. They asked questions about my mental and physical health. They asked about my diet and exercise. They even asked about my quality of life. There weren’t any questions about my neck issue or the pain in my hand, let alone my allergies or past medical history. I wonder if they’ll do that when I get to the office. Plus, I’ll be interested to see what questions they ask me about that true wellness assessment.

Like I said, this appointment should be interesting. To be honest, I feel like I’m learning a new healthcare system. I know what’s appropriate and how the regular doctors office works. Here I’m not sure what’s right or wrong. Take for example the list of health and wellness classes Turntable Health offers with their membership. What other primary care office offers Tai Chi, Hot Hula and Meditation courses? I might even have to start doing yoga. Why not? It’s free. Although, what a different approach to Wellness.

There you go. There’s part 1 of my introduction into a new model for primary care. How will it go? We will see. How will they handle the fact that I’m a picky eater and that doesn’t jive well with many of their perspectives on Wellness? Will they really care about my wellness enough to reach out to me beyond appointments? How will my family and I react to this outreach? Will we stonewall them or will we embrace the increased interaction? It will be a fun journey and I hope you’ll enjoy me sharing it with you.

All in all, it does feel like they’re trying to restore humanity to healthcare. We’ll see how much we like humanity.

Update: Check out part 2.