One innovator cites 2021 NASEM study: Primary care supply growth equals improved population health.
Kyna Fong, PhD, is the CEO and co-founder of Elation Health, a platform for independent primary care practices that strengthens the relationship between patients and physicians.
Fong's expertise as a health economist and digital health leader has been featured in publications including Forbes and Fast Company, and she is the recipient of several awards, including The Top 100 Harvard Alumni In Technology Of 2021. She holds a PhD in economics from the Stanford University Graduate School of Business.
Kyna Fong, PhD, is the CEO and co-founder of Elation Health. Photo courtesy of Elation Health.
In a recent interview, Fong spoke with HealthLeaders about the continuing woes of electronic health record (EHR) technology, and other obstacles keeping healthcare from becoming more seamless through digital technology.
HealthLeaders: What is the biggest challenge with electronic health record (EHR) technology?
Kyna Fong: The greatest challenge with most EHR technology today is that it wasn't built for physicians. These companies have built EHRs for billing and coding compliance, to then sell to administrators. How doctors feel about using the technology, how it impacts their relationship with their patients, how it drives them to serious burnout—it's just not part of the traditional EHR business today.
At Elation, however, we have always put the clinician first. For the last decade, we've been designing technology to recognize the sanctity of the provider-patient relationship, and to drive human interaction to support health that cares—to make it more personal, not less.
HealthLeaders: Why is rebuilding and supporting primary care so important to the health of the healthcare ecosystem?
Fong: A May 2021 NASEM study concluded that primary care is the only discipline of medicine where a greater supply is equated to improved population health, longer lives, and greater equity. Operating on the front lines of healthcare, primary care providers are uniquely positioned to serve as the keystone of a modernized, high-functioning healthcare system that can enhance patient care and reduce healthcare costs. Primary care is the heart of a sustainable healthcare system, and I believe we will be in a much better place when three things happen.
1. Independent primary care is recognized and paid fairly for delivering the tremendous value only primary care can provide
2. Technology enables, not disrupts, the craft of medicine and the sanctity of the physician-patient relationship
3. Every patient has a primary care provider they trust
HealthLeaders: Do you believe primary care can be fixed?
Fong: Absolutely! I wouldn't be here if I thought otherwise. At Elation we've found it isn't primary care that necessarily needs fixing, it is the broken economics surrounding primary care. The vast majority of primary care providers are trying to do right by their patients and are being fought at each turn by the existing payment models and incentive structures. We're seeing tremendous strides, especially over the past eighteen months of the pandemic, towards value-based options and models that economically align physicians with the health of their patients. I predict an unlock in primary care on the horizon, where primary care providers will take the driver's seat in making healthcare sustainable again.
HealthLeaders: What are the positive and negative impacts of traditional EHRs?
Fong: Traditional EHRs were designed for fee-for-service coding and keeping patients inside a subspecialty-driven health system silo. Instead of improving patient care as EHRs originally intended, those design missteps have led to a host of negative consequences, made worse by the pandemic, including wide-scale physician burnout and depression. Traditional EHRs work best in subspecialties where there is a narrow focus on a specific problem, and they work poorly when supporting the comprehensive, proactive, collaborative, relationship-based nature of the work of primary care. To correct this, EHRs need to be rebuilt from the ground up with a completely different lens—one that is care-driven rather than billing-driven.
Unfortunately, it's hard to imagine today's incumbent EHRs keeping up with this changing environment. Not only are they mired in old technologies from decades ago, but their design is aptly described as "death by a thousand clicks." Their companies are burdened by decades of investment in the old model of fee-for-service care. We are beginning to see tremendous innovation in clinical technology, particularly in those parts of the healthcare system that are not beholden to legacy vendors, i.e. independent practices and upstart innovators. With that innovation, I anticipate those providers will outperform and leapfrog traditional enterprise healthcare systems. There's a reason every new primary care upstart on the market today either builds their own technology or uses a modern API-based EHR platform like Elation that is set up for longitudinal, collaborative, patient-trust-driven care.
HealthLeaders: What can be done about the complexity and costs from EHRs that have long burdened physicians?
Fong: There's so much amazing work that EHR technology can take on for clinicians to reduce overhead and allow them to focus on their craft, if done right. These systems need to be accountable to clinicians and match the way they care for patients; technology should create delight rather than anguish so that clinicians can focus on building the kind of trusted provider-patient relationships we know are essential to better health, without the hassle of getting paid at a price point that independent doctors can afford. The key is putting the clinician and patient experience first.
When my brother and I set out to build Elation, we saw EHRs turning physicians into data entry clerks -- taking precious time away from patients and focusing it instead on checkboxes and dropdowns. After countless hours shadowing physicians and watching how they use medical records in their practices, we prioritized making Elation an intuitive system that enhances rather than detracts from the doctor's relationship with the patient.
HealthLeaders: Is there a model where EHRs can be successfully implemented without traditional barriers?
Fong: The EHR industry has manufactured a lot of barriers to implementation—whether it's the lack of usability in the user interface leading to hours upon hours of required training; the storage of data in proprietary formats to restrict data access and transfers; the barriers to integrating with adjacent products due to a combination of price gouging and antiquated technologies; or the byzantine contracts full of red tape. At Elation, we've worked hard to overcome these obstacles and make implementation as painless as possible.
HealthLeaders: What are you hearing from physicians relating to EHRs? How is technology making a difference in healthcare for their patients?
Fong: For our customers, technology is making all the difference. Primary care is by nature collaborative. It can't be siloed. In designing for primary care from the start, Elation's EHR technology had to be open and connected. Patient information is managed in a Collaborative Health Record (CHR) where medication lists, lab results, and notes can be shared in real-time across our network within the patient's care team. We also have a very active application programming interface (API), with around 300 partners building on top of Elation today, some of whom are making more than 30,000 API calls daily to the system. Technology for this model has to support the physician-patient relationship first, and it has to support the cognitive expertise of physicians, not just the counting up of billable services.
HealthLeaders: Who has more power these days: independent physicians, patients, or healthcare systems?
Fong: While asking who has the power is an important question, especially in this moment, we must also ask: What is the impact of that power? President Biden recently reminded us of a tangible impact of this power when he said to "the nation's family physicians and general practitioners...you're the most trusted medical voice to your patients. You may be the one person who can get someone to change their mind about being vaccinated." Ultimately, we want patients to control the money, have power of choice, and be fully informed about their health and how to navigate the complex healthcare system. Primary care physicians are uniquely positioned to partner with patients toward this end, through education, coordination of care, and advocacy.
We must also consider power within the context of the existential threats facing healthcare systems today—the U.S. spends on average twice as much on healthcare compared to other developed countries, while Americans are getting sicker with 60% affected by chronic disease. Despite the U.S. healthcare system having mastered managing symptoms and saving lives, it continues to overlook restoration, disease prevention, and wellness promotion to the detriment of patients and the physicians who care for them.
HealthLeaders: Interoperability is an ongoing challenge with EHRs. How important is interoperability across a patient's care team?
Fong: The success of primary care requires clinicians sharing information and knowing what is happening with a patient's health longitudinally, across all settings. For many of our customers, interoperability is the most important aspect that can either enhance or hinder a patient's care team. Increased interoperability between EHR systems will make healthcare data more universally shareable, facilitating patient care and allowing for seamless referrals and transitions between health providers. No faxing necessary.
“Instead of improving patient care as EHRs originally intended, design missteps have led to a host of negative consequences, made worse by the pandemic, including wide-scale physician burnout and depression.”
— Kyna Fong, PhD, CEO and Company-Founder, Elation Health
Scott Mace is a contributing writer for HealthLeaders.