Finding the right vendor partner: Revisiting Altitude Family and Internal Medicine

In a previous Voices feature, we had the opportunity to learn about Altitude Family and Internal Medicine based in suburban Denver, Colorado. In this interview, we asked Dr. Hansen how a valued vendor partner, Kareo, is assisting his practice as it embraces new technology and creates better outcomes for his patients.

Free: You said in our previous interview that around 2014, the EHR system that you had in place at Altitude Family and Internal Medicine started to show a little bit of its age. What were some of the problems that you were experiencing and how did working with Kareo help you address those problems?

Hansen: Many of the systems that were more robust a decade ago are still relying on the same technology platform. Unfortunately, as time goes on they can show their age very quickly. As that happens, the youthfulness of such system becomes less and less evident.

The other thing of note for us was really the idea of portability relative to our growth to a second location. We want access to our database wherever we are, at any point in time, whether we are in another clinic or at home getting an after-hours call. Whatever the case may be.

That was definitely a limitation to our system prior to our partnership with Kareo. To continue to use our system, we had to build a very aggressive enterprise-grade fiber tunnel between our two facilities to quickly move data back and forth, but we found even that could become an issue as data tended to bog down. Having use of data outside the clinic became difficult as well, so that is the time that we started looking at vendor solutions that were using newer programming.

We were looking for an integrated solution. We were looking for software that was portable, and we wanted something that was web native and device agnostic. These things are what I would consider necessary in 2015-2016, and then we wanted the ability to expand on them. We wanted to grow our patient outreach. We wanted a robust patient portal. We wanted the ability to integrate other systems, if that was our choice, so we were looking for technologies where we could have custom programming or API’s available to connect to other software seamlessly. 

Free: What would you tell other small practices in terms of your experience working with Kareo?

Hansen: Kareo is a great partner. We made an EHR transition which is a hard thing to do. No matter who you are, transitioning technology is difficult, but we had the time behind us and the presence of mind to really know what we wanted. As I mentioned earlier, we wanted the latest programning, something that was web native. We wanted HTML5. We wanted integration. We were very picky about what we wanted and there were only a few progressive companies we were able to put into a very small list of potential vendor partners. With a bit more investigation, Kareo came out on top.

The point we were at in our business, we weren’t willing to accept any compromise and Kareo has been fantastic. They really delivered on those things we wanted. Transition is always hard, but they worked really well with us. Before we signed on, I spent some time in Los Angeles with Rob Pickell, Dr. Tom Giannulli and a lot of the leaders of Kareo and they really put me in a place to be comfortable with their system and what they were doing.

In short, I was not looking for a software solution. I was looking for a partner and Kareo has been a wonderful partner.

Free: In our previous interview, you mentioned that there is a strong feeling in Colorado that the small practice, as we know it, might be dying out. Do you feel technology is going to help the existence of small practices or are there certain factors that will be just too large for small practices to be able to deal with on their own?

Hansen: I don’t think the loss of a small practice is inevitable by any means, but in the same regard, I think we are going to see a lot of small practices succumb to some pressures just because it is so difficult in today’s market. Again, to make it through some of the issues that face us, you do have to have a very strong vision of your goals, a strong mindset and a strong team you are working with. You have to leverage technology, but the opportunity for small practices to leverage technology in a meaningful and cost effective way has improved considerably. So, it’s going to be tough, but, by no means is it impossible.

Free: How do you see the changing tastes of patients impacting technology choices within small practices? 

Hansen: When it comes down to it, we are here for the patient. To get back to what we were talking about earlier, that may have been a problem with some of the earlier technologies that were evolving 10-15 years ago as well. The technology wasn’t really evolving in a patient-centric fashion. Anything that isn’t evolving in a patient-centric way in medicine is not going to work well.

In terms of looking at patients and consumers, in general, we want more self-service just like everywhere else in our lives. When I go to the airport, if I can go to the kiosk, I go to the kiosk. I don’t go to the desk. It is quicker. I am able to input my information easier than someone else can. That is just how things work. In medicine, that sort of ease of use is something patients want.

Free: How does your practice stay in touch with the desires of your patients?

Hansen: We have a patient advisory panel that we meet with once a month. We talk about our business, the way things are moving in the industry and we get their advice relative to our goals such as implementing a kiosk, for example. We want to be able to make our reception area more of a concierge area. We want it to be a place where we are there to welcome patients and get them involved in their care. We want to make our check-in process a little less business-like and give them a minute at a kiosk versus talking to a receptionist trying to input their information. We brought this idea to our patient advisory panel and they loved it. They wanted it yesterday. They couldn’t wait for it. They want some self-service access, access to their records, labs and those things via a portal. 

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Kareo mobile solutions

We have a lot of different incentives based upon our patient advisory board meetings. We are working, trying to help them with their self-management goals and we really want patients involved in their care. That is one of the big things we are working towards as we integrate and move toward more technology: self-service kiosks, more aggressive portals and more virtual communications.

Free: ICD-10 is just a couple months old in America and many small practices were very concerned about the transition. Do you feel those fears were much ado about nothing?

Hansen: The biggest concern for most of the practices is, “What is going to happen on the insurance side? What is going to happen now that we are starting to submit claims?” At this point, we honestly don’t know. The chance of this massive transition causing a significant cash flow problem for six months, I think, are pretty low. Could it cause problems for some over the first few months? Yeah. I am certain that it might. I have heard both sides of the fence. I have heard people say, “Yeah. Nothing is going to happen,” and I have heard, “You better have six months in the bank,” and I don’t think either of those is going to be the case.

When I look into my crystal ball, it’s tough to say. We always try, as a company, to be as conscious as we can of threats out there, and I think ICD-10 is certainly a threat for the remains of 2015 and into 2016. When I listen to the community, especially the community of private physicians out there, the mood is one more of fear for the most part. It is financial fear. Practices are not sitting on several months of bankroll that they can count on to make it through if the worst case scenario happens.

We are going to see a little bit of a hurdle and we are going to have to rely on some sheltered financial resources. But if practices have spent the past year or so planning for that and they have secured a team of strong vendor partners, I am sure they will not experience any significant problems. 

 

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