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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 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 and 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 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 and 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.

Health Data: Little White Lie Detector

Posted on December 31, 2012 I Written By

Mandi Bishop is a hardcore health data geek with a Master's in English and a passion for big data analytics, which she brings to her role as Dell Health’s Analytics Solutions Lead. She fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

As we bring 2012 to a close and ponder the new year ahead, many of us make resolutions to change something in our lives, and frequently, that something is our health. According to the University of Scranton Journal of Psychology, 47% of Americans make New Years Resolutions. Of those, the #1 New Years Resolution for 2012 is to lose weight. Staying fit and healthy and quitting smoking also appear in the top 10. Each of these health-related resolutions translates into quantifiable healthcare data that is, or can be, captured and measured to assist the resolution-makers in achieving their goals. Our calorie consumption and burn can be calculated, our blood oxygen level monitored, our ratio of fat:lean muscle mass tracked over time. If only we were all a bit more like George Washington, and couldn’t tell a lie, the success rate for annual resolutions would be higher than 8%.

The inclination to tell little white lies to protect ourselves from inconvenient, uncomfortable truths exists in all of us. “Do these jeans make my butt look fat,” meets, “Of course not,” rather than, “Yes, your butt DOES look fat in those jeans – but it’s not the jeans’ fault.” “Can Timmy come play,” warrants, “We already have plans – let’s rain check,” in lieu of, “Your child is a brat who cannot enter my home because I prefer to keep all my hair rooted in my scalp.”

Many, if not most, of us extend these white lies to ourselves. The dress that fit last month but doesn’t today “shrunk at the dry cleaner”. Cigarettes only smoked during cocktail hour don’t really count as “smoking”. You count the time you spend standing to give office presentations as “exercise”. You “usually” eat healthy, except for the tell-tale McDonald’s bags in your garbage showing a once-a-day burger and fries habit.

What if there were a way to identify and hold you accountable for these self-delusions – a health data lie detector? Would you change your behavior? Could you achieve your healthy resolution? And might it have a quantifiable impact on healthcare cost if you did?

I had a partial thyroidectomy a few years ago. A year after my surgery, I found I had gained 7 pounds in 11 days, was feeling lethargic and was having difficulty sleeping. As a very active adult who meticulously maintained body weight for a decade, I was disturbed, and convinced that my symptoms were a result of my remaining thyroid tissue failing. I went to my primary care physician to request a hormone test.

The nurse and doctor both agreed that, in 90% of cases, the root cause of weight gain is diet, and they asked myriad questions, capturing all my answers in the clinical notes of their EMR: had I been eating differently, had I altered my exercise routine, had I been traveling. I was adamant that nothing had drastically changed. Given my fitness and history, they agreed to order the hormone test, and a blood vitamin test, as well.

All lab work came back normal. BETTER than normal. So I retraced every detail of my routine over those 11 days. And I discovered the culprit: office candy.

A bad meeting one day led to grabbing a handful of chocolates from one co-workers bowl, which became grabbing a handful of chocolates from each bowl I encountered on my department’s floor…several times a day. Did you know there are 35 calories in a single Hershey’s kiss? 220 calories in a handful of peanut M&Ms? 96 calories in a mini-Butterfinger bar? Turns out, I was eating between 500-700 calories a day in office candy. And that wasn’t all.

Along with the chocolate snacks, I’d fallen into some poor nutrition habits at meals. I started to consume other starchy carbs regularly: the pre-dinner bread basket at restaurants, pizza, pasta, sandwich bread. I didn’t feel I ate to excess, but I also didn’t take into account the difference in nutrient density between the mass quantities of fruits and vegetables I had been eating for years, and the smaller (yet still plentiful) quantities of processed starches I was currently eating.

The changes in diet likely disturbed my sleeping pattern and led to my lethargy, which in turn made my daily workouts less intense and effective at calorie-burning.

In short, my weight gain was legit, and the two doctor visits and the lab tests could have been avoided had I been completely honest with myself. I cost each actor in the healthcare system money with my self-deluding little white lie: the office administrative staff, the LRNP, the doctor, the medical coder, the lab, the insurance company, myself. There is also a per-transaction cost associated with each HIPAA-covered request that the doctors’ office EMR and lab information system generated. Given that I have only been to the doctor three times this year, and twice was for this weight gain concern, one could accurately conclude that 66% of my annual medical costs could have been avoided in 2012.

The health data exists within Meaningful Use-certified EMR systems to capture and communicate both the absolute data (height, weight, lab results, etc.) and the unstructured notes data (patient comments, doctor notes, responses to questionnaires, etc.). The capability to automatically compare the absolute with the unstructured data already exists. It wouldn’t take an inordinate amount of effort to program a lie detector to call out many of the most common little white lies.

What would happen to medical cost if we stopped lying to ourselves, and to our healthcare providers? And how high a percentage of the nation’s total healthcare bill could be avoided by this type of analysis? Better still, how much would the healthcare industry change if patients not only took responsibility for their own action/inaction, but modified their behaviors accordingly?

I’ll tell you what happened to me. I dropped the candy and starchy carbs, and I lost those 7 pounds. Keeping them off will be 2013’s New Years Resolution.

Expanding the Healthy Patient – Doctor Relationship

Posted on August 9, 2011 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Patient Doctor Relationship
It seems like this topic keeps coming up in my online and social media reading. Basically, the discussion usually centers around the role the patient plays in healthcare. Many people like to discuss what has been called the ePatient. I instead want to talk about the motivations of patients and their ability to influence the healthcare system.

Patients in healthcare are unlike “customers” in many other industries. I can’t think of a single patient that wants to go and see a doctor. Ok, maybe they like the doctor and they want to get whatever’s ailing them fixed, but to a person I’m sure we’d say that going to the doctor is the last place we want to be. It’s not like going shopping for a new pair of shoes. There’s nothing you get to take home from the doctor. Well, at least nothing that you really want to take home.

Plus, healthcare is an interesting thing, because often it’s not clear if you should go to the doctor or not. If my A/C is broken, then it’s quite clear that I need to call an A/C repairman. Seeing a doctor is quite different since it’s a fine line between when you need to go and see the doctor versus when your body will heal on its own. I think we’ve all hated the doctor visit where they check you out and basically say there’s nothing they can do for you. Well, other than send you the bill for your visit. I guess that’s the cost of the peace of mind that you get from the visit (I know I’ve done that with my kids a few times).

Please don’t take this as me knocking doctors or the healthcare profession. They provide an absolutely essential and critical role in our lives. Without great doctors many of us wouldn’t be here today. My point in this post is that the patient doctor relationship is quite different than the customer business relationship that we’re use to seeing.

Online Patient Portals
Take for example the online patient portal. Many people love to go on (or insert your preferred shopping site) and browse through all the various things they could buy. We all know people who spend hours shopping. I don’t think I’ve ever heard someone say that they wanted to spend hours browsing through their patient portal. You know, someone who just couldn’t wait to see what great healthcare services their doctor could provide them.

The only partial exception to the above reasoning is possibly the chronic patient. If I’m a diabetic patient, then I am going to have an ongoing dialogue with my care provider and the services they provide. I’m going to be interested in monitoring and tracking my care in collaboration with the treatments that my doctor provides.

Is there a reason why we don’t want this kind of interaction for our general healthcare?

Regular Online Interaction with Doctors
Why shouldn’t I go online on a regular basis so that my doctor can assist me in total wellness even when I’m a healthy patient? The difference here of course lies in doctors treating symptoms and illness as opposed to a very different form of care: wellness. To be honest, I’m not sure I’ve seen any doctors who treat healthy patients. Sure, some doctors do provide some pro-active wellness information during a sick visit to the doctor. Regular physicals are the closest we come to doctors treating healthy patients, but how many health people get those? It feels counter intuitive that we would go and see a doctor when we’re healthy or appear to be healthy. However, maybe that’s the shift our healthcare system needs.

Reimbursement Model Challenge
One real challenge with what I just described is the reimbursement model we have in healthcare. We’ve incentivized treatment of sickness and illness. We haven’t (yet?) incentivized treatment of healthy patients and promotion of wellness. This sounds a bit like the ACO discussion that’s become so popular these days. I’ll be interested to see how these incentives play out. Word on the street is the train has left the building and reimbursement is going to be tied to healthcare outcomes in the future.

Healthy Patient Motivation
Unfortunately, another major challenge I see is that healthy patients aren’t really motivated by wellness initiatives. I’m sure that there are people that understand this phenomenon a lot better than I. Although, I think it’s abundantly illustrated when you talk to someone who’s getting older and starting to lose their health.

It seems particularly poignant for highly successful people that start to get older. How many times have we heard during Oprah or a Barbara Walters interview someone talk about being willing to give up all their riches and fame to just have their health (and they often throw family in there too)? All the time! The problem is that it takes old age or some other health incident for people to make healthy living and wellness an important part of their life. Which begs the question of whether even a change in the reimbursement model for healthcare will get unmotivated people to visit their doctors and be “treated” even when they’re a healthy patient.

Gamification of Healthcare
One idea that I find incredibly intriguing is the idea of gamification of healthcare and wellness. The basic concept behind gamification is to create incentives for people to do the behaviors you want them to do. I believe Foursquare was one of the first applications to do this. They would give you electronic badges and crown you as mayor as you did certain things on their mobile app. It was (and still is) amazing to see what people will do for a little electronic badge and the electronic title of mayor (Turns out this works in the offline world as well. There’s a reason boy scouts give out badges, beads and pins.). The question is how can we apply rewards systems to incentivize healthy behavior and wellness?

To be completely honest, I don’t think I’ve seen anyone crack the gamification code in healthcare. Although, I think the concept is just beginning. I predict in the next couple years that we’re going to see some amazing mobile and web applications that really drastically impact our motivation to healthy living.

The closest I’ve seen so far has been something like the Nike+ device and website. It’s a simple device that tracks your running habits either in a watch, iPod or even in your shoe. Then, that device uploads your running data to a website where you can create and track your running progress. It also provides a social experience, but that’s a topic for another day.

I actually find these tracking device/website combinations (see the FitBit and DigiFit as other examples) to be some of the most interesting things happening when it comes to pro active treating of healthy patients. A while back I predicted a whole plethora of medical tracking devices are going to hit the market. This is happening and will continue for many years to come. I heard one guy interviewed who talked about one day (many years from now) having little mini processors attached to every nerve or blood cell in our body. Ok, that’s kind of creepy to think about, but personal monitoring of our body is a burgeoning field in healthcare.

Crunching All the Personal Healthcare Device Data
The question once we’re monitoring all of these various vital signs and health information is what are we going to do with that information. Is it reasonable to think that we’ll be able to use computers to crunch through all the data and provide a self service analysis of all the data collected? Yes, Watson did some amazing things on Jeopardy, but I think we’re far away from the day when this type of self service crunching of all the medical data we collect will be possible.

Yes, that means we’re still going to need doctors and other healthcare professionals who help us analyze the data that we’re collecting and dealing with the health issues that are related to that data. In fact, I predict a whole new breed of doctor will come together that will be specialized at analyzing this data and treating even the healthy patients.

Future Healthy Patient Doctor Relationship
This all comes full circle when you go back to the start of this discussion: the doctor patient relationship. How are doctors going to see all this health information we’re collecting? Where are we going to have these healthy patient interactions with doctors? I predict that it will be through patient portals that are connected to a physician’s EHR.

I and every blogger I’ve ever known has been a stats junkie. We’re addicted to checking our stats. There’s no reason we wouldn’t be just as addicted to checking our health stats on a patient portal. The problem is that the patient portals I’ve seen aren’t there yet. Plus, most doctors aren’t yet ready for this type of healthy patient interaction around such a large set of data. Although, I predict we’ll get there and it will change the doctor patient relationship forever.