HIStalk Interviews Marisa MacClary, CEO, Artifact Health

Marisa MacClary, MBA is co-founder and CEO of Artifact Health of Boulder, CO.

Tell me about yourself and the company.

I co-founded Artifact with my partner Meir Gottlieb in 2014. Artifact is first to market with a solution that makes it easier for physicians to manage an important administrative task for the hospital — clarifying physician documentation for accurate coding.

The query process has a huge impact on the hospital’s quality data and reimbursement. Typically this task is extremely burdensome for physicians. It’s the last thing that they want to do in their day. We at Artifact Health have tried to change all that. We’ve taken this burdensome task and made it lightning fast and easy. The result is happier physicians, better quality scores for the hospital, and accurate reimbursement.

How extensive is the problem of hospitals having to ask doctors to provide answers to CDI and coding queries?

It’s extremely common. All hospitals, large and small, struggle with this process. Today in most hospitals, physicians are interrupted by CDI staff with these questions about their documentation. They are fielding the questions by email, fax, handwritten notes, or perhaps in the in-basket or message center for Epic and Cerner users. Typically it’s a time-consuming, multi-step process that physicians find very burdensome. They often ignore it because it’s not directly correlated with patient care, or at least it’s not the top-of-mind goal that they have for that day.

My partner and I have been working in healthcare IT for all of our careers, specifically, designing software systems for physicians. Through that, we have a lot of appreciation and empathy for clinicians. We saw this process as one that could have a better, faster, and easier workflow. So much for the hospital hangs upon it in terms of their quality scores, their rankings, and their reimbursement.

That’s why we decided to narrowly focus. We wanted to build a standalone platform that could work across any EMR system, any coding system, and address this one very big and important problem, which is the physician query workflow.

What is the mechanism for physicians to receive these messages and respond to them?

We decided to make the main mechanism the mobile app, because we felt that that was where healthcare was moving as one of the technologies that was going to become important to physicians. We made that decision early on. I remember in early conversations that people were saying to me, “Physicians aren’t going to want to use their phone to answer queries.”  We bet on that. We started developing in 2014.

That has been the most delightful and pleasing delivery mechanism for queries. They can answer them any time. A lot of the feedback we receive is, “Wow, you’ve enabled me to make my downtime productive. I can answer queries when I’m in an elevator or walking between meetings.” It’s so much easier for them to do that than having to log into the EMR and all of the steps that it would typically take to respond to a query. Now we can distill that down to a 30-second action on their mobile device.

Do they just leave the app open all the time? Is in intuitive enough to use so that not a lot of training or setup is needed?

We built it intentionally so that providers would not need to be trained. It’s something that they can download and immediately know how to use.

They don’t leave the app open, typically. They’re notified through a variety of ways from Artifact that they have open queries. They can be notified by email, text, or push notifications to the phone. Then they can stay securely logged in for a period.

It’s very fast and easy for them to open the application and respond, but we also were cognizant of physicians who might not want to use a mobile device. We have an ability for them to go to the website and answer over the web. Also, we’re integrated with some EMRs, so that when they’re charting, they can also click over to answer queries in Artifact. We give them a variety of ways to access Artifact and respond to queries.

Can they answer most of the queries off the top of their head or do they need to have the chart or documentation open?

When a query is sent to a provider, the clinical documentation specialist or coder is required to enter supporting information for that question. They have that supporting information in front of them in Artifact when they answer the question. We also have the ability to attach documentation from the EMR, so they can pull up a progress note or a discharge summary and review that before answering the question.

I would say about 95% of the time, they do not have to go back to the chart to respond to queries. For some very complicated patients, it might require them to do that, but most of these questions are pretty straightforward and they can answer them quickly and easily.

What feedback do you get from physician users?

They actually call it joyous. We were launched at Johns Hopkins, where we got started as part of their Joy of Medicine initiative as a give-back to the physicians. They are actually really delighted by it.

We also have a gamification piece. We track them and show them their scores compared to their peers on response rate and response time. We’ve gotten so much positive feedback about that that we just recently added an ability for them to share their scorecard over social media, just because they enjoy that. We made it fun for them.

For physicians, there’s not much fun in the technology that they use today. The fact that they can get something done and resolved is huge for them. Getting it off their plate quickly has been the key to their happiness. We hear that across the board from all of our customers. That’s been the deciding factor for many of our customers to move to Artifact.

How important is it that AHIMA and other groups have standardized the queries?

That’s an exciting part of our business as of recent times. We forged those relationships early last year and it has proved to be well received by our customers. Hospitals are building and creating their own templates or they rely on the expertise of their CDI staff and coders to create compliant queries. The query is the greatest compliance risk in CDI. Hospitals can be audited for and penalized for sending leading inquiries. There are many examples of that.

Hospitals are very concerned about being compliant in their query workflow. Having expert organizations like AHIMA and HCPro come in and provide templated queries that are written in a non-leading way, and to help them understand which clinical information they need to be entering into that query to help the provider answer it appropriately, has been such a relief. 

Our customers see it as a huge burden lifted for them. It takes away the time they spend putting together these templates, but more importantly it allows them to enforce standardization across the organization. Some of our larger customers, such as hospital networks, are trying to get control of their facilities by pushing out standardized templates to everyone and then being able to track them. That is a huge asset in helping them manage the risk of being compliant in this workflow.

What lessons have you learned about communicating effectively and efficiently with physicians?

We’ve learned a lot. Much of it was from our history of working with physicians for years. It’s also looking at the tools that they have at their disposal today, which they often say feed burnout and take time away that they could be spending with patients.

We’ve learned that just like anybody, they want things to be easy, especially when it comes to administrative tasks that take them away from patient care. It seems obvious, or at least it was obvious to us, that we needed to design something that made this a simple and fast process. Whenever we are designing a new feature in Artifact, we always have the physician as the first stakeholder in mind and think about how that physician would want this to work.

With every decision we make, we err on the side of what will make it easier and more pleasing for the physician. That’s important. Physicians are tricky customers. You have one shot to get it right for them. One strike and you’re out. 

That was probably the hardest part of building this application. Building something simple is actually quite complicated, and being able to get it right the first time so that you’re adopted is essential for hospitals then who are pushing technology out to their physicians. Physicians can kill a pilot in a minute if they don’t find it useful.

That was probably our biggest challenge and I’m happy we were able to accomplish it. A testament to that is that we haven’t changed the physician application very much over the years since we launched. We did our homework and got it right the first time.

Do you see an opportunity to take what you’ve learned and extend it into other forms of physician communication?

It’s a good question, because once we go live at a customer site, that’s always the next question they have. “What else can we drive through Artifact? We’ve engaged our providers in a way that we’ve never been able to do before. What else can we throw into Artifact to get done?”

We are very careful about that. As one of our advisors said to us, “Don’t step on the joy.” What he meant by that is. “It’s absolutely joyous that I’m barely cognizant that I’m in your application. I’m in it quickly and I’m out. Don’t make me hang out in it.” There are a lot of opportunities for expansion of Artifact, but we’re extremely careful about the ones that we’re going to take on.

The easy ones are when hospitals are coming to us and saying, “We also have queries on professional fee billing that we want to send out. We also have queries now in the outpatient environment, especially with value-based care payment models on HCC coding.” It’s been an organic expansion for us starting off in inpatient coding, but physicians demand that all their documentation-related queries come through Artifact because they find it so easy to use.

That’s where we’ve seen the most expansion of our product within our customer sites. But I do think there’s applicability in other areas and we’re absolutely looking at that for sure, and across other industries as well.

Will artificial intelligence, machine learning, or natural language processing affect what you do?

It’s not an area that we’ve dived into quite yet. But an interesting AI application is CDI prioritization. It dovetails nicely with our approach. In essence, it allows a hospital to identify cases where there is a very strong query opportunity. Having that piece of technology bolted on to Artifact makes a lot of sense, because you can queue up that query opportunity and Artifact then allows you to deliver it and take it over the finish line. We definitely see that as an application worth exploring in the future.

Do you have any final thoughts?

We are at the beginning of this, where our standalone application allows us to continue to work with customers across all different EMR systems and coding systems to help enhance this workflow. It’s an important culture shift that happens within hospitals when you give physicians technology that they find easy and convenient to use. Our goal at Artifact Health is to continue to build software solutions that appeal to physicians and to help hospitals and practices achieve their goals as well.