Eva Podcast: The Journey to an EMR Solution

ERIN – Welcome to the EVA podcast. My name is Erin. I’ll be your host where we explore all things health, information technology and EVA, the first interpretive health record system. I’m excited to explore anything that has anything to do with healthcare and technology because at the heart of who I am, I’m just a big old nerd, and being able to join a company where I can be the biggest nerd that I am, have these conversations, but at the same time build this incredible system and help transform healthcare practices across the nation is pretty much a dream job for me. This podcast allows me, my team, and all of our guests to explore how technology can and will transform healthcare, which is what EVA does. So, without any further delay, let’s get this episode started.

ERIN – Okay. Welcome, Dr. J. I’m excited.

DR J – Hi, Erin.

ERIN – Today’s gonna be a good day. So, I wanted to take this time to talk about the blog article that we worked on together, the Existential Crisis of the Electronic Medical Records System or Health Record Systems. What I wanted to focus on really is, when I started working on this article or this blog, I was really thinking about your story the story of why you’ve dedicated so much time and energy and really financial dedication as well to make something like EVA. First, I wanna talk about how you started to see the crisis of the EMR experience, and then kind of where you went from there.

DR J – Yeah. So really, and I think this is where this discussion got so exciting for me cuz the term existential crisis is used all the time and what, what it really refers to is that it threatens the existence of you or the system that you’re working in and there’s no question that the EMR model is so bad and so threatening to the continued existence of any physician or provider who really wants to do their best work, they, you can’t do it in the existing EMR system.

So when I started doing this I started with Medicare in 1988 or 89 with that dial up modem doing billing online, and I did it myself in in my little cottage that I had when I first started teaching at the medical school and doing a house call service. And it was horrible. It, it worked after tons of really, really hard work and studying, trying to figure it out and switching the modem settings and all this stuff, but it did work, but it was incredibly hard to get it to work.

After that, we opened to practice and we had an EMR that was a local vendor and it took a full-time practice administrator and another person who was working on it for it to run at all. We had constant problems. That was back in the day of floppy drives and all that stuff. It was the early nineties and that didn’t work at all in terms of accelerating or or making our business higher quality. So we, we kind of went through two or three EMRs within, I’d say probably two or three years, and it was very unfulfilling and it was very much the infancy of the EMR world, basically glorified word processing. It didn’t really help very much on any level except that we were interested in, wanting to do something fascinating.

But shortly after that, working in a more integrative medicine model I got interested in functional medicine and really investigating the deep roots of illness and how you can treat patients to create wellness rather than treat illness as your primary focus and there was nothing that existed to really technology wise accelerate that. So that’s when we started building EVA Core and this was independent of the EMR process. We had an EMR in the practice constantly, aside from the actual logic of EVA Core, and we developed them side by side for five or six years through the 2003 to about 2008, and then started switching EVA Core into a comprehensive practice platform that included an EMR all the while rotating through every two or three years, we’d get a new EMR because they were so inadequate to meet the need of a really cutting edge practice that was high speed, procedurally oriented, financially rewarding. It, it just didn’t really work. And every time that we got involved, it seemed that there was just more more drag on the system from the EMR. It didn’t improve, but created obstacles and we had the wherewithal to continue to move through different systems because we had good people which I don’t think most practices really have that much latitude in what we did. And so we did that and continued to develop EVA alongside until with frustration after many, I would have to say we went through probably 8 or 10 EMRs over that period of time. Where we launched our own for our practice management probably in 2012 or 13, and which was full service EMR and it was rudimentary, but has developed now into what EVA is, which is a practice workflow system that accelerates every part of the practice and allows for a massive switch back to one-on-one provider patient relationship time, away from repetitive drone activity, clicking, clicking, clicking and filling boxes and and fulfilling EMR requirements rather than patients need.

So we, we’ve come a long way and I see the entire industry struggling. Every couple of days I read an article about the frustration, anxiety, burnout really to the point of career suicide where they’re just, they just wanna end their job cause they can’t stand working within the context of existing EMRs and ours is actually exciting to use. It’s, it’s, it’s really delightful. It’s, it’s good to look at, it works really fast for patients. Actually yesterday I was sitting with a patient who was she’s unfamiliar with our owning and developing the EMR, she said, this is the best thing I’ve ever seen, I actually can work with you while we’re talking on this screen in the visit and it’s incredibly gratifying and the quality of care we provide her. Her note was actually fascinating. I dunno if we have time for it, but it’ll take me one second to to, to get it because it was so good. She said, quote, you’re the best doctor she ever visited with amazing patient experience, Loved it.  And, that’s not something you hear from doctor visits. That just doesn’t happen. But with the, with the ecosystem, we have a comprehensive patient engagement within the system, and the quality of that entire interaction is so high that it changes it from being an EHR to really a patient engagement and management magnifier, amplifier accelerator. It’s just a really gratifying experience rather than a frustrating one.

ERIN – Yeah, I have to agree. You know, from I, so I came into the world much later than you, like Health World. But before, you know, I entered this field I worked with all kinds of information management systems. I mean, that was my job and kind of being a translator from, for software companies or universities, whatever I was working with and when I came into the health field as a nurse and happened to jump in right around, you know, when I started to feel good on my own, you know, COVID hit us and, and I thought, oh my gosh, these systems keep failing me in my workflow for the day and then when I went outpatient, I, it was the same deal where I was really naively surprised at how difficult the technology was to navigate and how it didn’t support the patient experience. I mean, I experienced that as a patient, like I knew there were some failures or there was something happening that wasn’t making my care feel adequate or individualized at all, like I was getting lost in a system, which I literally was, and now knowing from the other side, I’m like, oh my gosh. So then when my job became to find an EMR or EHR for a clinic that was doing really well, searching through the massive quantity cuz right, the market today is saturated with tons of options, but it’s the same pattern like you see every system is offering the same sort of platform, it looks a little bit different but the experience is generally the same, and the patient really isn’t the point of focus. So when I, I mean, happened to be introduced to EVA through a rep, you know, who was like, hey, you should look at this and then experiencing EVA as now a patient of, you know, a practice who’s using it as well as using it as an RN, I mean it was, it’s totally different, it’s completely different experience than any other system I’ve utilized. It’s hard to communicate that to people now, cuz you go and try to talk, you know, part of my job now is to talk to practices and try to explain this to them and I, I mean, I got hung up on twice yesterday, you know, and I send out all these emails, well, you know, to be fair to them, how, I mean, they get, they’re bombarded by everybody’s saying, you know, use this system. But for me it’s sort of like, I just wanna have a conversation with you and know what your clinical workflow is and how I can help you. And if you tell me that there’s, if you say to me that you wanna do something that I know we can’t do, I’ll tell you we can’t do it, but I’ll, I’ll talk to Nathan and Jeremy our developers and, and we’ll build it. But you know, if we can’t do it yet, which I haven’t run into that at all, but you know, one day I’m sure we will, we’ll develop it. And I think that’s the other thing is EVA is used every single day in your practice still, so it’s not, it’s not your primary, you know what I mean?

DR J – Well, it’s interesting cuz I we’re, you know, talking about the existential crisis, none of the other systems people will ask, well is there something like you that we can use? Well, there’s lots of systems that work better than other systems, but the thing with EVA is that it from the very beginning of 2003, we had two master’s degree programming students with a project developer come into the office and sit in the office in two of our rooms, and, and we actually like goodwill hunting formulas and the whole thing to get the artificial intelligence, very rudimentary algorithm work in 2003 in the practice and then we tested it and we’ve done over a hundred thousand patient visits with that algorithm to test it and refine it, make sure it’s things that patients like to use so that they are engaged and they like it. And, also it’s very profitable for me to be able to spend 30 seconds instead of 30 minutes gathering all the information I need to make really good decisions and then take it from there to the next step because it is done in the practice. All those development steps where you’re saying, you know, and then, then they’ll develop it. There’s not a lot left that is necessary to be developed in, in a regular workflow of an office, cuz we’ve been doing it for almost 20 years so it’s, it’s extremely refined and you know, and it takes away that whole dread of my day today is gonna be, at least half of my day, is gonna be working with a system I hate. Instead, a very small amount of my time is spent doing things. I, I would say that I hate, there’s almost zero, but there are some things that need to be done that are phone calls to patients who are, you know, having a hard day or whatever that, that aren’t the most fun things to do, but the other stuff, when it comes to EHR, it’s really, it’s a joy. It’s fast, it’s clean, it doesn’t get in my way at all. It, it, it actually helps me. It’s like when somebody walks in the room with a sticky note and asks the question, what do I do? and I give them the information, say, and they go and take care of it. And it happens in seconds and EVA’s like that, except you’re not paying an employee and your workflow’s not interrupted by somebody sticking their nose in and asking you question. And I can take a patient visit from, hey, hey, Dr. J, I have a patient who’s got an issue to I say, great, I’ll take care of it, make a phone call, run the telehealth, do the billing and everything in three or four minutes and it’s entirely done. The checkout, the payment, everything’s finished and it’s documented and shows up on the schedule as a completed visit. And the documentation is excellent and all of it works. And new features as they come along are going to be things that are enhancements to the technology that exist in the rest of the IT world, not, it’s like the medical flow, it’s handled and it’s done. So the existential, I’m gonna quit, it’s so bad I’m gonna quit, that’s, I think that’s over. I think we’ve got that handled. Now the question is are we going to be able to convince doctors that after all their miserable experiences, 8 or 10 EMRs in my case is our, is our system gonna be that much different? And I, I absolutely know that it is because it’s the only one I know of that’s been developed this way.

ERIN – I know it is because I did it. You know, I went, I made it for a clinic that was struggling with, went through multiple EHRs, you know, and, and then bringing this one on, it completely transformed the practice in that it took it to the next level where that the owner provider could hire other individuals to come in and like, make more money, more providers, support patients more thoroughly so that, you know, the, their lifestyle was more balanced. You know, which I believe that if your lifestyle is balanced as a healthcare team member, whether you’re front desk, business, clinical, whatever, that you are able to give better care, right? Because you gotta take care of yourself to be able to give good care and our systems didn’t do that, they, they made your job so fractured and difficult. And EVA doesn’t just help the clinical, right? EVA helps. EVA is the assistant for your front desk person, like whoever is working with EVA, she is helping you. So it’s like having an extra employee in each area of your clinic in one day. Right. Not just one. So it’s like five for one, you know, like that’s how I viewed it.

DR J – Well, we have a tiny staff. We have a very, very small staff and, and do two or three times the the billing and collections that that an average practice our size does because of EVA. Because we have that that capability and every, like you said, everybody who’s involved, the admin, the reception people, all of that, they have their work is twice as easy because all of the stuff that would normally be clicking away trying to get through a system is actually augmented by EVA. Not it’s not an it doesn’t present an obstacle, it, it presents a helping hand, like, oh, I’ve got that. Oh, I’ve got that. I’ve worked with people who, they’re just, they’re like radar on that, they, they already know what you need. That’s EVA. She already knows what you need. She’s got it done and after a period of time, it’s starts to become like a relay race where the handoffs just so easy, you reach behind you and it’s right there.

ERIN – And that’s, yeah, it’s just like surgery. It’s like the best first assist.

DR J – That’s great. That’s a great way to put it. I really like that. True. Yeah. And I think that, and I think that we’re, as we’re now, we’re a year into past beta and into, you know, licensing practices and working with them and and our feedback is consistently, oh my gosh, where have you been? And the, the reality is that, you know, we have been refining this to the point where it is now. It, it creates a cure for the existential crisis of burnout EMR frustration. Every article in management magazines that I read starts with if only we could get the EMR thing straightened out and yeah. And we’ve got that. We’ve got that handled.

ERIN – I’d like to end on, you know, part of our reality now as a group, a small group of people bringing forth this, you know, amazing, EVA’s awesome. I love using EVA and I, I, I wanna build out custom EVA, everything for everybody because I love doing it. I’m really good at it, and because I know that I will make something awesome like, I know it’ll work, you know, which is a huge satisfaction piece and I think that part of moving forward is us declaring that we are different. And one of the ways that we’re also different is like the idea behind EVA is to have as a team behind EVA, to have relationships with our practices that are relationships, they are individualized. It’s almost like we are caring for our practices, right? We’re providing the same kind of care, because we can do that with our systems. So it’s not to have 5 million practices on board and, you know, a hundred thousand patients, it’s okay, great. If that happens, wonderful, but really our, our idea behind EVA Health as a company is to, is to do something different, right? And that’s to support practices and the health of the practice, not just the patients.

DR J – Well, it’s so interesting cause you’re, you’re saying the, the same thing that happens clinically where EVA is so competent at creating just a slick workflow where things just may just work because we’ve done it for so long and we’ve, we’ve made a bazillion mistakes along the way and we’ve had a bazillion successes to correct them on the way there. But the same thing applies to the company side, where there’s bandwidth on the clinical side that we’ve developed by virtue of 20 years of work, but also from the customer support and the service to the practices, because our staff, the way that EVA’s built, even down to the you know, the, the databases and all the work that we’ve done to make it very slick in terms of the way that we can onboard practices and do those things, it provides bandwidth so that our people on the development side can talk to a practice if they’ve got a business problem where they’re, they’re just not connecting with the patient in terms of follow up we can show them how to do that. We don’t do business coaching per se, but we wind up doing a lot of business enhancement because it’s intrinsic to the EVA process. It, EVA is, it stands for Expert Virtual Assistant, and we do that at every level from business strategy all the way through to how do you give the shot and make sure that every element of that injection is billed properly, the inventory’s up to date, the safety and expiration, everything is, it’s all good and EVA’s handled it all. All you have to do is connect with the patient and give the shot. And same thing with the practice. When they work with EVA, all they have to do is be a a licensed user and they have access to all of the success that we’ve had and the bandwidth that we have now got cause of EVA to give support at every level.

ERIN – I agree. Yeah, it’s, yeah, it’s different. Like, not, not just the platform, but everybody that’s part of the team and how we’ve each, each one of our journeys has kind of collided and how we end up working together, you know, which we’ll talk about in other episodes. But it really speaks to our mission and what EVA hopefully will do for so many practices just to make their life simply better. I mean, that’s, it’s the best I knows.

DR J – Great. And you said, you said, as we started, you said, as we started, you said I came into the world a little, a little bit later than you, blah, blah. It’s like, actually you came into the world way later than me cause I’m, I’m in my sixties and you’re not. And I’m from the era, I’m the era of patient care where it was patient care and the EMR had not invaded that space and created that incredible difficulty. So I have been able to taste from the beginning of my career, just the joy of being able to help people and not have administrative overload. And we’ve restored that now. And you have generationally, you’re in that in that group of people whose technology is, technology is really good to use and there’s new tech rolling out all the time. And in healthcare we just haven’t seen much of it. But EVA’s like that. So it restores the, the ancient way, which is doctors get with their patient and the presence of the doctor with their patient is a healing experience if it’s done right. Just that. And we’re restoring that at every level. And that is, it has to do with, we’ve been at this a long time and medicine is gonna be, is gonna be a great career forever no matter what, but we really wanna restore it quickly, we don’t wanna wait for, you know, 20 or 50% of doctors to have to get outta practice and, and leave because they just can’t stand it anymore. And I think we’ve got the, the antidote to the poison of EMR with EVA.

ERIN – I agree, and I’m so glad that, personally, I’m so glad that you’ve spent so much time doing it because you’re right, I didn’t know a time before and to be able to experience what it is today and then to get a taste via using EVA in a clinic of what it felt like to give care before it rejuvenized my career and my mission. Through a really hard time in healthcare and so even though you know now I work for you, I’m, I’m honestly super grateful for all the work that you have put into creating a system like this. Because we need it right now. We are tired and we need it.

DR J – We, well, you know what, and we need it. Well, you just, you just made, you just made up a word rejuvenized. Nice. It’s to rejuvenate and re-energize. Yes. There we go. This is what you’re saying. I know. It’s great, but I, I really feel like that, that that really does speak to the whole EVA thing. We are creating something that is really so fresh and it’s so exciting to be able to say, wow, it’s been a long time. We’ve been working on it and it’s bearing fruit now at so many levels. We have practitioners experiencing what I experienced many days. That, that little note I shared, this is the best experience I’ve ever had in a doctor’s office. That’s available. We can rejuvenate and energize practices really just by virtue of them onboarding EVA and, and having her as part of the team. So great talking with you. I can’t, can’t wait to do the next one.

ERIN – All right. Well, thank you so much for your time and I’ll see you on the next podcast.

DR J – Awesome.

ERIN – Okay. Bye Dr. J. Okay. Well, that’s it for today. Thanks for joining me on the EVA podcast. I’m Erin, your host, and I’ll see you next time.