Facebook-like EMR acts like a ‘collaborative health record’ system

Millennials are starting to re-design the EMR systems that doctors have used over the past decade, and they’re giving them a new twist. Vancouver-based InputHealth is a prime example of a fresh approach to collecting and sharing patient information.

InputHealth was founded in 2011 by the company’s CEO Dr. Damon Ramsey and CTO Shawn Jung, who were then in their early twenties and working out of Damon’s uncle’s basement. Dr. Puneet Seth, another millennial doctor, joined in 2013 as CMO to create a dream team that has moved rapidly to develop a modular patient engagement system that offers genuinely useful features and functions that go beyond the typical EMR system.

Many major medical organizations are using the company’s systems. The Mayo Clinic in Jacksonville, Fla., has adopted one of InputHealth’s modules, and many prominent organizations are following suit: the University of Texas at Austin, Sunnybrook Hospital, Jewish General Hospital, University of British Columbia’s Student Health Service, and more.

Dr. Ramsey and Dr. Seth are members of a much-needed group that is growing steadily: doctors with deep IT experience. Ramsey was a Microsoft Certified Systems Engineer at the tender age of nine, and Seth worked at Nortel Telecommunications before entering medical school.

“We built this company from the ground up to address a massive oversight in the existing paradigm of electronic medical records – that the patient does not exist in any meaningful way. From there came a fundamental shift in approach: every patient encounter becomes a data capture opportunity where that data is generated by the patient themselves,” says Dr. Ramsey.

To that end, InputHealth initially developed a patient engagement platform that allowed people to convert paper questionnaires to digital, and to use mobile devices to collect data from patients remotely.

Over the years, the company has added module after module to tackle different areas, says Seth. “We started with our ihQnaire system, which is a questionnaire data capture engine, then we moved on to online appointment booking, to a kiosk system, to an electronic referral system, and to a more robust outcome tracking system which is what’s used at Mayo Clinic, UBC and McGill. The most recent module is an integrated tele-medicine engine that’s integrated into all of this. Our platform is constantly evolving that way.”

Clients were soon clamouring for a full-blown EMR system from InputHealth instead of modular add-ons, says Dr. Seth. “Our clients said they loved the way our system worked and they didn’t want to go back to their EMRs. They asked: ‘Why can’t we do everything off your system?’ We decided to take a risk and develop a new EMR system from the ground up that was genuinely forward-looking.”

Dr. Seth says forward-looking means moving away from the ‘transactional medicine’ model our current healthcare system employs. “Today, EMRs track what happens when a patient is in front of me during a visit. I give them medication and they leave. Instead, the healthcare system is moving to more distributive models like community-based care, where you continue to provide healthcare even when the patient’s not in front of you.”

Traditional EMRs have no capacity at all to manage the workflow associated with continuous, distributed healthcare, he says. The InputHealth team set out to develop a new type of EMR system best described as a ‘collaborative health record’ – a CHR. “Collaborative means that the patient and the clinician and the entire healthcare team work together to deliver care.”

InputHealth’s platform is able to collect data from different sources and make them meaningful with one another, he says. A patient with a mood disorder, for example, might complete questionnaires periodically, as will his spouse, to provide a second view of his condition. The system has the intelligence required to sort out the most significant elements of the two questionnaires’ responses.

“What the clinician will see is a paragraph summary of the person’s condition. The documentation is automatically generated, because the system was able to convert the patient’s responses to a clinical note. Almost 80 percent of a clinical note is actually subjective history-taking. The information can then be trended, visualized and manipulated in various ways.”

InputHealth has many features that go beyond the typical EMR offerings, says Dr. Matthew Chow, a psychiatrist who works at the Youth Wellness Associates clinic and St. Paul’s Hospital in downtown Vancouver.

It’s not just a system for sending out questionnaires to patients to pre-collect information, he says.

“The questionnaires are adaptive. Depending on how the patient answers, the system asks follow-up questions, something that intake forms can’t do. I spend my time during the actual appointment talking to patients about their concerns instead of collecting data because InputHealth has already done most of that job for me.”

The natural language output reports the system generates are particularly helpful in the mental health field, where reports are very narrative.

“Instead of looking like a survey – yes/no, 3 out 5 – it actually creates nice sentences, as if I had taken the information and dictated the report myself: ‘The patient reported that he had these symptoms for a week and it affected his life in this way.’”

However, Dr. Chow believes the system would be equally useful in more data-driven medical fields such as cardiology, for example, because it can also collect vital signs remotely in advance of a visit and generate meaningful clinical notes based on hard data.

“Cardiologists need to collect all manner of information – height, weight, medications, and so on. InputHealth can collect all of those things ahead of time and spit them out in a readable format. It can detect trends and display them in graphical format. It can also track vital signs over time. The patient can punch in their blood pressure results every day. And you can set up alerts in InputHealth to notify the doctor if there’s more than, say, a 10 mmHg change in the systolic pressure.”

On the administrative front, Dr. Chow says there are fewer no-shows for his appointments using InputHealth, and he can use questionnaire completion – or lack thereof – to predict no-shows and other patient behaviour.

“In the past, about 20 to 30 percent of patients don’t show up for appointments, but this is not uncommon in the mental health field. Now my no-show rate is about 1 to 2 percent. And I can see if someone’s filled out their questionnaire or not at my end.

“If they haven’t, I know they probably won’t show up. I can now reliably predict who’s engaged and who’s not. So I have a shorter wait list now and I waste less time on admin. Patients clearly feel invested because when they fill out the questionnaire, they want to show up.”

For all its complexity, it’s very easy to learn how to use InputHealth, he adds. “It feels like using Facebook instead of Excel. You just learn how to use it intuitively. Even my less technologically inclined staff can pick it up within a few days, unlike other EMRs that require weeks of training.”

InputHealth’s customer service team is extremely responsive when he’s asked for help or reported a bug. “If there’s something I don’t understand or a feature I don’t like, I usually get a response within five or 10 minutes. Their people are always in touch because they do a new release of the system every few weeks. And I always get little pop-up messages when I log into InputHealth to notify me about new features.”

Overall, the system has a modern, 21st century look-and-feel that works intuitively like iPhones, iPads and other technology that everyone’s accustomed to using in everyday life, says Chow. “The feeling I get from other EMRs is that they’re essentially mainframes with a user interface slapped on top, whereas InputHealth was created from the ground up to be usable. InputHealth is a lot like Apple in the sense that I really feel that the user experience is top-of-mind, not a second or third consideration.”

At present, InputHealth is the solution of choice for niche practices such as mental health clinics, community care centers, chronic pain clinics, and perioperative clinics, says Dr. Seth. “It’s useful for any type of practice that sees one or two different types of clinical conditions and requires routine data collection. The market for our system right now is enterprise organizations such as hospital networks and academic institutions – healthcare organizations that need to know how a patient population is doing in a specific region.”

However, the company is laying the groundwork to expand its reach by pursuing certification in Ontario and other provinces as a full-fledged EMR system that any medical practice, big and small, can use. “We’re doing the development work needed to create a robust product that can replace existing EMRs altogether. We believe we’ll be able to replace traditional EMR systems over time.”

The company is working to fulfill the regulatory and other requirements needed to launch InputHealth as an EMR across Canada. All the provinces have different rules governing EMR system certification, and provincial laboratory and other systems are at different stages of development and integration, explains Dr. Seth.

“In British Colombia, for example, InputHealth can replace all the functions of an EMR. Our collaborative health record is a full-blown system that a clinic can use in its entirety, because we’ve integrated it with B.C.’s provincial billing and lab systems. In Ontario, we’re working toward that and we’re actively collaborating with Ontario MD. If you’re using Practice Solutions or Accuro in Ontario, depending on your practice type, very soon we’re going to be able to say we’re ready to take you on.”