As a primary-care physician in practice for two decades, Dr. Lyle Berkowitz had lots of experience with busywork that kept him from working at the top of his license.
Then came patient electronic health records (EHRs), which added exponentially to demands on his time. He often found himself involved in data entry and other clerical tasks.
He began working to develop tools and strategies to free himself and other physicians from EHR-driven drudgery. His efforts took him to the 2010 Mayo Clinic Innovation Summit, where he met Jonathan Baran — a young Ph.D. student at the University of Wisconsin-Madison. Berkowitz had just given a talk about how automation tools to handle routine tasks could be built on top of EHRs to make doctors' lives easier.
The two quickly found common ground in their research interests and a shared entrepreneurial spirit. Baran suggested joining forces to create a suite of clinical automation tools, with him handling the software engineering and Berkowitz bringing the clinical know-how.
“I'm an engineer by training, and my work focused on building software that makes physicians lives easier while also thinking about the EHR data,” said Baran, co-founder and CEO of Madison-based Healthfinch. “In the early days, I was working on this from an academic perspective, but it became apparent to me that the impact I was hoping to make was not going to happen on the academic side but had to happen on the commercial side.”
The partnership eventually grew into Healthfinch, which launched in 2011. The company's first tool, Swoop, automates the prescription refill process using a cloud-based rules engine.
This task was a natural starting point because it fulfilled two important criteria: it saved physicians a significant amount of time; and it could be safety automated or delegated to other staff using pre-defined protocols.
Here's how Swoop works: When a refill request is entered into the EHR, it runs through evidence-based protocols that determine where the request should go next.
The software identifies uncomplicated refills and delivers them to a nurse, pharmacy technician or medical assistant for approval. More complex cases are routed to a physician.
Swoop also saves time and improves accuracy by pre-populating the refill request with information such as visit dates, lab dates and lab results. Nurses no longer have to look up charts and manually provide that information.
“All the nurses say Swoop is great. Yes, it was a change in workflow, but it has shifted the time they spend on paperwork to more time with the patient,” said Stacey Clark, assistant vice president of ambulatory clinical operations at UT Southwestern in Dallas, who has been using the app since 2015.
However, Swoop didn't work perfectly right out of the gate. Berkowitz and Baran tweaked the product through hundreds of iterations before getting to a version they liked. The biggest challenge was accounting for the nuances of the clinical workflow that weren't immediately apparent.
After refining Swoop, the company developed a new practice automation platform called Charlie, which includes Swoop. It added a program called Scout that help prepare for scheduled visits and another called Patrol that scans patient charts for care gaps. Chirp was added on to send patient letters, portal messages, secure texts or deliver automated telephone call reminders.
Today, Healthfinch has grown to 30 employees and serves dozens of healthcare organizations like Scripps Health in San Diego and UT Southwestern Medical Center in Dallas. Its automation applications support more than 2,500 doctors. The firm claims a 70% reduction in prescription refill requests going into physician inboxes.
“Swoop allows the providers to not see as many tasks in their inbox–and if they don't see them, they don't do them,” said Monica LaJoie, Prescription Refill Center Nurse Manager at Scripps. The system has been live with Swoop since August 2015.
Charlie works within EHR systems like Allscripts, Epic and Athenahealth. But each adaptation differs in terms of workflow integration and requires a different implementation process. Healthfinch doesn't require much additional training for staff, and can be implemented by a system within 90 days, Baran said.
It isn't a one-size fits all solution. Systems using Healthfinch must first put in place protocols for standing prescription orders that determine when a nurse can safely act on the physician's behalf. That requires standardizing workflow across multiple worksites.
“The challenge is that when you're offloading a hundred physicians' worth of work onto 200 individuals, each one will take a different set of steps—one nurse takes five steps, another nurse takes twenty steps,” Baran said. “So the second step is standardization of workflow to say how many steps and what they are, signed off by all stakeholders in the organization.”
To ensure the standards are followed, the third step involves creation of a dedicated, centralized team responsible for keeping everybody on track. Only when the practice has achieved efficiency and standardization can the last step of automation be layered on top of the workflow.
Doctors supported by Healthfinch have seen the elimination of 80% of routine work like refill requests and pre-visit planning. That's saved physicians 15 to 20 minutes per day for each task.
“With EHRs, we gather so much information that you can never really use well, and it's hard to manage if you don't have the tools,” Clark said. “We need more tools like Swoop to help mine the data and manage the workload.”
“We don't really have a shortage of physicians, we just have a shortage of using them efficiently,” said Berkowitz, co-founder and chief medical officer of Healthfinch. “We are giving them back a half-hour per day, they're able to leave work early and see their families, and have a better life.”
Meeri Kim is a freelance writer based in Los Angeles.