In our recent interview with Lauren Patrick, we discuss her journey into computer science and subsequently healthcare technology. As the founder and CEO of Healthmonix, she is helping practice groups optimize their data and analytics in order to improve their quality of care scores and ultimately, help doctors provide the best care to patients. Our transcript has been edited, but you can listen to the full podcast episode here.
Can you tell me how you got into computer engineering?
So a long time ago in a place far, far away, my father was an electrical engineer. When I was looking at colleges, he suggested that because I was good at math and because he had had a very successful career developing computers as an electrical engineer, I should consider going into this new field of computer science. So I got my undergraduate degree in computer science and then moved into an engineering degree for my Master’s, where I actually built computers, soldered transistors together and made it all work from the ground up.
So you loved computers, and you understood them at a fundamental level. When did you get into healthcare technology?
About 10 years ago, I had had a pretty storied career developing a lot of systems for a lot of different companies, like General Electric, Goodyear, banks, and a lot of other companies, but I felt like it was a time when I wanted to take everything I knew and apply it to something where I could make a difference. I had moved to Philadelphia for personal reasons and knocked on the door of the University of Pennsylvania. They had a really great project they said I could help them with in terms of looking at physicians’ compliance to current standards and quality of care in the arena of diabetes. So that’s how I got into it.
[At that time], quality measurement and quality improvement were becoming the next big thing in educating doctors. Doctors have careers that span 40, 50 years, and what they learned in medical school at the beginning of their career is not always the current standard of care 10, 20, 30, 40 years later. So what we were really working on doing was taking the current standard of care and looking at how physicians were conducting their practices in comparison, and then feeding that back to physicians so that they could then work on changing their practices, improving quality of care for their patients and learning from this whole exercise.
What were the problems you encountered during this time and what led you to decide to start a company?
It was really interesting to see how doctors reacted to it. Every doctor of course, probably rightly so, thinks that they are providing the best care possible for their patients. And as we walked through some of the data that we collected, they were somewhat surprised to learn that perhaps the way they were treating patients wasn’t the current standard of care, and certainly, there’s a lot more to being a doctor than just knowing medicine. Just like there’s a lot more to building a computer system and implementing it than the technology. So then what we had to do was learn how to work with these doctors in a non confrontational manner in order to help them understand where some gaps in care were and how they could perhaps change their practices in order to do better, and that was super interesting and rewarding. I love working with doctors. They’re bright people, they learn quickly, and they all want to do a better job. I have not met a doctor that didn’t want to provide better care for patients where it was available. So it really instilled a love for the whole industry, and then we took what we learned from the diabetes model and we applied it not only to additional diseases and states for Penn, but we started working with other specialties as well. Other companies and organizations started calling me and asking me if I can help them do the same thing for their organizations.
I’ve got to say, I’ve talked to quite a few founders, and that’s a pretty unique story you’ve got. What year did all this happen, and can you tell me a little bit more about the journey?
- I was writing code upstairs in the spare bedroom, and that’s how we started. The first few employees came to the house until we realized, hey, this is going to be a lasting effort, and maybe we should get an office somewhere.
We were really focused on these individual quality measurement and quality improvement programs. And then CMS (Centers for Medicare & Medicaid Services) came along and started what was called at the time the PQRS program. That was the program where they realized that there were a lot of issues in healthcare in America. We all know that we spend the most here. We don’t necessarily have the highest level of quality of care, so CMS was trying to do something about it. And one of the things that they were really invested in was to track some of these quality metrics that we at Healthmonix were already gathering. So they issued a program PQRS that would reward providers for turning in this data to CMS. They would actually get an incentive on all of their Medicare billing if they provided this data to the government.
So at that point, our business shifted a little bit where more and more providers were coming to us, having us help them collect this data for the purposes of the PQRS program. And then what really shifted the program into high gear was when CMS said, “Not only are we going to incentivize you to provide this data to us, but if you don’t provide it to us, there will be a penalty.” So the carrot was nice, but the stick was stronger. As soon as CMS said there’s going to be a penalty at 2 ½ percent on all of your reimbursements if you don’t turn this data in, our business really took off. So there were a lot of late nights and a lot of busy people for the first few years of the PQRS program while we adapted to the growth.
Do you think forcing doctors to measure quality of care scores and report them has improved outcomes? Has it had the kind of change that we’re looking for?
It really needs to be a culture thing. We see organizations where it really does make a difference, and the leaders are saying, “We know it’s imperfect, but it does matter…so let’s start looking at this, and let’s start figuring out how to work with our patients to meet these measures that CMS is putting in front of us.”
Now there are issues around the data being collected appropriately, getting attributed to the right provider, etc. It’s very imperfect, but we have some organizations that are just delightful to work with, because they really do want to make a difference in terms of these scores. And for them, it does matter. But there’s others that are like, “I just want to get this done, check this box off and move on to the other things in my day.”
Tell me more about what it’s like to use Healthmonix. Is it a web browser application? Does it exist on mobile?
Our tool is totally web based. We’re basically a Software as a Service, and it operates on whatever platform you happen to be using. Although I will say that if you’re trying to input data on a mobile device, it’s probably not the best, but you can certainly go in there and access it online through your phone, tablet, or computer and look up patient information, quality information and quality specification information. Most organizations don’t enter the data in themselves, so it’s great when we partner with a company such as DrChrono, and the data flows in pretty automatically. That way, the doctor doesn’t have to do anything, and what they get back out of the Healthmonix tool is in fact the quality data that they need to see so that they can work on improving any gaps in care or know that they’re doing things right.
I have one more tough question for you - if you were magically put in charge of CMS, what would your next step be?
I think that CMS is trying to move in the right direction. I think that the biggest issue is providing these doctors with measurement tools that they feel are most appropriate. The biggest challenge is that there are 200 plus measures out there, and it’s kind of a hodgepodge, and you pick which ones you think are most appropriate…When we go in and do quality improvement programs where we meet the doctors where they are, that’s the most successful. I’ve worked with a lot of continuing medical education folks that do that sort of practice and doctors love it. Done right, it builds enthusiasm for quality improvement and quality measurement and giving them a stake in what those measurements are.
So what would I do? I would do more boots-on-the-ground kind of quality improvement programs with individual practices and groups. The other thing that I think we don’t focus on enough is looking at care that’s being given that’s unneeded. When we talk about value based care in the US, so much of the care that we give is unnecessary or ineffective.There’s a program that I think the American Board of Internal Medicine initiated called Choosing Wisely, which is for physicians to think about what practices, procedures, tests, and medications you really want to prescribe for a patient, because we spend a lot of money needlessly, and if we can at least control that sort of thing, that’s also a big step in the right direction.
Listen to the full podcast episode here.