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HIStalk Interviews Richard Atkin, CEO, Greenway Health

May 13, 2020 Interviews 2 Comments

Richard Atkin, MBA is CEO of Greenway Health of Tampa, FL.

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Tell me about yourself and the company.

Greenway Health’s customers are predominantly physician-owned practices, Federally Qualified Health Centers, and community health centers. We offer a broad range of solutions to those customers. 

I’m an engineer by education and training, so I tend to think about problem, process, root cause, and solution. I’ve been fortunate enough to have been in healthcare for over 25 years in a number of roles, a number of them at the CEO level, with companies such as Sunquest Information Systems, Spacelabs Medical, and Datex-Ohmeda, which is a part of GE Healthcare. Most of those are in the acute care space, so the transition to Greenway and ambulatory care has been a pretty exciting journey for me.

What technologies have seen uptake during the pandemic that will remain in the mainstream afterward?

Certainly the pandemic has validated the role of the electronic health record and the importance of the data that’s within it. I think it will also create an interesting dialogue between what is personal about the data and what can or should be shared for the benefit of the greater good. That’s one aspect that will become increasingly discussed going forward.

You mentioned telehealth. As restrictions ease and there’s a return — not to normal, but to a new normal — technologies for remote consults and ensuring that those consults are seamlessly included in the patient record will become increasingly important. The pandemic has created an awareness that you don’t always need to be face to face to get the advice and the treatment that’s required.

The importance of patient engagement solutions such as portals and messaging will, along with the telehealth, become increasingly important. The connected patient and the use of the internet to that ensure information flows seamlessly. All of those are going to be more important. It probably put more context to the new regulations, like 21st Century Cures, which were aimed at making data more liquid and transportable. It’s going to be an exciting time.

The other thing that was occurring but will be accelerated is the view that fully cloud-native solutions —  SaaS, cloud solutions, hosted solutions — create added benefit. They maybe reduce the reliance — certainly in practices, which are relatively small companies or organizations, small businesses — on in-person back office support through the increased use of SaaS solutions.

Are you seeing new demand for public health reporting from EHRs?

Public health and population health are always being discussed. The adoption has been lower than previously anticipated. A large proportion of our customers, the Federally Qualified Health Centers and community health centers, operate in that public health space.

Most of the discussion about data or information has been that it’s personal and private, and therefore is owned by the patient. Of course, that’s still true at a very large level. But for the public good — for public health, social determinants of health, and the management of things like a pandemic – there is a need to be able to share information, which currently could be difficult with the focus that has been on PHI as the primary driver of the conversation around data and information.

Do you see more emphasis on specific patient privacy concerns related to EHRs?

That has always been a significant part of the ambulatory space. Protected health information and the privacy associated with that has been restrictive in terms of how we use data. I understand the concern about selling information or having a commercial relationship around the data. I was really referring to public health and pandemic data analysis and management, even to the extent as we come out of the COVID-19 pandemic, the way in which we could use data to ensure that the ambulatory practices get the support that they need.

Greenway serves largely physician-owned practices or independent practices and businesses. Headlines around the pandemic are largely about the acute care space, and rightly so since they are on the front line, with bed shortages and the impacts on staff. Those are real challenges.

For the ambulatory segment, the issues are significant in the physician office space. Around 97% are reporting a reduction in revenues. There’s about a 60% or 70% reduction in visits, a 75% to 80% reduction in revenues, affecting over 97% of those practices. Those are huge issues. Many of them have had to furlough, lay off staff, or even close the doors, particularly those that serve the more elective elements of ambulatory care. 

Restarting those businesses is going to be challenging. We could use analysis of data to help, whether at the state, local, or even the national level. Some of the data that is currently blocked by PHI could help signal when and where practices need help. That’s a very different use of data than selling it to a pharmaceutical company or trying to monetize it. We need to get our arms around public health and public good as we think forward beyond the pandemic.

Are those independent practices at risk of closing or being acquired by health systems that have deeper pockets?

Those are real risks. Maybe for context I can describe how we’ve been dealing with that during the emergency, because many of our customers are operating at very reduced levels of visits. We pulled together a team early, led by our chief medical officer, Dr. Nayyar. The regulations are changing rapidly, being alleviated. Telehealth is one example, but there are many others, including billing requirements. Our team is reviewing, multiple times a day, any changes in the information at the state or the national level. We have ensured that the EHR solutions have the right workflows within them — diagnosis codes, CPT codes, billing codes, et cetera. Then we’ve put together a series of educational webinars, largely around the business aspects of running a small business or small practice. What grants are available, small business loans, how to apply for the loans, some of the criteria.

We are focused, at the moment, on helping them get through in the best way they can. Our view is that if we do that, first, that’s our responsibility as a partner. Second, if they come through this in the best shape possible, then we can work with them beyond this pandemic into the new normal.

There are reports that many physician-owned businesses might look to the local hospital to acquire them. Of course, those hospitals themselves are being significantly impacted, so that may or may not be the real path, or maybe it’s a private investment.

Ambulatory care is where we all, as a population, interact most with the healthcare system. We rely on the acute care space when we really need it. But on a day-to-day basis – for preventative medicine, routine visits, even medical exams for schools and sports as they restart, and so on — it’s the ambulatory part of the healthcare system. My view is that while it will be affected like every other part of society and the economic system, it will survive. It’s a much-needed part of the healthcare system, and it’s just that their needs will be a little different. Part of the solution to that is the technologies that we just talked about.

The pandemic took patient portals from an “only in healthcare” disdain to becoming a central point of presence that providers are using to launch new patient-facing technologies, such as chatbots and telehealth visits. How are patient portals being viewed now?

I agree with you. The patient portal is a critical and essential part of the suite of solutions. It always has been talked about that way, as you imply in the question, and yet the full adoption and then the full utilization of the portal has been relatively low.

Like telehealth, I think this will be one of those catalysts to say that the best way to interact with the patient — to keep the conversation going between the physician and the patient, particularly in the ambulatory space — is via a portal. There’s much more that you can do with it than pay your bill.

We are seeing the patient portal as a key part of our strategy. We included it in our product strategy under the heading of healthy outcomes. That’s where the patient-centric solutions are, along with some other ones like the population health and public health that we talked about. The role of ambulatory care is just as much to ensure that the population is healthy and doing the proactive things to stay healthy as it is to treat the illnesses that people have.

How would you characterize the state of interoperability?

It is still embryonic at best, let’s say. I don’t think the technologies, or the history of technology, have helped greatly, since healthcare was pretty early to adopt software solutions. The vast majority of EHRs on the market were designed or architected more than a decade ago. In fact, a decade-old EHR is still considered a relatively new entrant. And yet our view of what interoperability, user experience, ease of use, and connectivity should look like has changed dramatically in the last decade. 

EHRs generally in the industry are somewhat of an inhibitor to the ability to have true data liquidity and ease of interaction and interface. That’s one reason that Greenway and Greenway’s board is committed to developing a next-generation solution that is fully cloud native.

While the state of interoperability is embryonic, the vision for what it can create is well formed. The pandemic and various other elements of even recent legislation will force an acceleration of the view of how we ensure that the data is available where and when it’s needed for the best results, for both the patient and for the healthcare system overall.

Do you have any final thoughts?

Our focus is on supporting the ambulatory physician practices and community health centers. We’ve done a lot to help them in the present pandemic, including launching a new revenue cycle product. But they are really hurting. The ambulatory practices are hurting in a way that doesn’t grab the headlines as much as it does about the acute care.

Our customers need a lot of help to return to a new normal. That’s what we are committing to. But I really hope that as your readers read this interview, they realize that there is something else here. A healthy healthcare system in the US requires a healthy ambulatory segment, too. We need to ensure that they survive and do well beyond this pandemic. That’s our focus.

To all of your readers, just be safe and be well. We will get through this.



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Currently there are "2 comments" on this Article:

  1. I appreciate Richard’s categorization of interoperability as being embryonic. That evaluation is refreshing honesty.

    I mentioned the interoperability exchange challenge in my note on the interview with Dr. Hu. Exchanging the top 100 most frequently used domain items, then the top ten disease conditions in a longitudinal record — reconcile and incorporate those into the receiving EHR, then export them back out.

    Richard, what do you see as the necessary next steps to improve interoperability? What impediments does your solution experience in these endeavors?

    Brody

    • Thank you for the question, and for your feedback. In our view, a critical step toward improved interoperability will be to build a robust Fast Healthcare Interoperability Resources (FHIR) solution with the ability to search, read, write, and update. FHIR alone will not solve the problem, however. There should be a focused agreement to standardize data entry with use of reference and master data management services to ensure all exchanged data is accurate. To do this, there will have to be mapping and transformation requirements to bridge the data gap due to terminology differences and semantics requirements that FHIR imposes. There’s a lack of true standardization in healthcare, given the number of datapoints — from diagnosis to labs to procedures with bitemporal data management to understand the true clinical intent at time of documentation and information blocking considerations. I see ongoing collaboration within the industry for data quality as a viable path forward. This collaboration should focus on multi-directional data integration, and not just on sending and receiving information from one system. The CommonWell Health Alliance, Sequoia Project, Argonaut project, and the DaVinci project are excellent examples of competitors working together to address interoperability for better patient care. While these are great examples of collaboration, they still have not achieved complete interoperability. While we are still in beginning phases on interoperability in the healthcare industry, all of these challenges do still hinder solutions. Going forward, it will be important to deliver not only 21st Century Cures requirements, but to deliver a full interoperable solution. Thank you.







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