Eva Podcast: The Empowered Patient

Podcast S1 Ep2:  The Empowered Patient

Welcome to the Eva Podcast where we discuss all things Health Information Technology (HIT) in relationship to running an out-patient medical practice. We also discuss the technological solutions we’ve created at EvaHealth to help support out-patient clinics across the country. EvaHealth is a company focused on reimagining healthcare with better technological solutions that help medical practices and their patients thrive.

On today’s episode The Empowered Patient we discuss our recent blog post on the ‘The Empowered Patient’ and how Dr.J developed Eva Core. Eva Core is the first interactive and adaptive patient interview in which rules-based algorithms apply artificial intelligence (AI) to interpret the patient data input and present a preliminary document to the patient and provider. We also explore the modern day patient portal and patient surveys, their failures in other systems, and how we’ve done it differently within Eva to empower a patient through their health journey.

Read the Show Transcript

Erin – Welcome to the Eva podcast. My name’s Erin. I’ll be your host where we explore all things health, information technology, and Eva, the first interpretive health record system. So, without any further delay, let’s get this episode started. All right, good morning, Dr. J.

Dr J – Good morning, Erin.

Erin – Thanks for joining us again on today’s blog response and our wonderful podcast. So today I wanted to talk about the blog article that we worked on together, the Empowered Patient and its relationship to Eva.

Dr J – Oh, yeah

Erin – So when I, you know, started working on this particular blog article, I was thinking about myself as a patient, friends, family, and then working with patients and the incredible value behind being an empowered patient and which led me into, okay, what does that, what does empowered patient mean? And for me as a patient, it meant that, that I was able to engage in my care, that I had a good working relationship with my provider and that I was educated and I could seek education when needed, but also that I had some accountability in my own health that I was aware of and that I knew I could make choices around, right? So, I was aware of the choices around that. And, then it got me thinking about Eva Core because when I work with patients and I work with patients with Eva Core this amazing interpretive patient history, it allows me to have so much of a stronger relationship with that patient, but it also is this incredible tool set that’s given to the patient that they can access at any time to learn about their health, their wellness. So, I kind of wanted to talk about the relationship between those two and how you developed Eva Core. Where did Eva Core come from? Kind of talk about what it is a little bit.

Dr. J – So, so the deal is, your, your, your take on it I think is probably pretty sophisticated and we we’re kind of in the real world, there’s a lot of doctors who are working to really do the best job they can, and the system doesn’t support it very well because functional medicine, it takes time and energy to get the patient’s information well and understand it really well. And, in 2003, when we first started this project, we sat down with these so many pages, questionnaires, you know, 15-page, 30-page questionnaires, nobody liked doing them and no provider liked scoring them. It was horrible. So, it just was it was not a win. The information you got was amazing, but it just took forever, and it was so tedious and obnoxious that we decided gotta be a better way. So, we got the team together, the programmers and the director, the project director and all that and clinically we did it for years and got a hundred thousand patients through it before we were done. So, we knew what questions to ask, so it could be quick and crisp, and then long before Open Notes was a thing, we shared the thing with the patient, so the patient could see, if you’re answering these questions this way, it means you probably have a problem with this system, thyroid or your structure, your musculoskeletal structure or whatever. So, it would tell the patient what the doctor would see, the same thing, so that you’d have a really good sharing of information. So, the patient would learn when you have a headache and it starts in your neck, it’s your neck that’s causing the headache, you probably don’t have a problem with dehydration, it’s probably not that. So it would teach the patient. And so, the empowerment of the patient, it goes right along with the the doctor knowing what they’re doing. They know, they know what’s causing the problem. It’s shared with the patient, and then the patient can also kind of step back into that process and say, well, that’s not exactly what I meant and those questions can go deeper. After Eva Core is completed, then the doctor can, the doctor’s job or the provider can do the provider’s job and go deep and get really clear about a diagnosis, What Eva provides is an expert basic assessment that covers everybody’s system without any bias. There’s no preconceived notions going into it. Basically, just asking, how’s your digestion? How’s your genital system? How’s everything going? And the Eva will get that information, it will commit it to the medical record and then the the provider can take it the next step and say, okay, what do you mean by, and get down to the, to the nitty gritty and actually give the patient what they need. And the empowerment for the patient is they actually have something to say about the, the process. They can actually engage with Eva Core and and update those scores. They can understand what that means. They can engage at many, many levels, a portal, like a patient portal that most doctors have in their electronic records. It’s kind of a joke. It doesn’t really help the patient understand anything. It gives them really basic information. A lot of ’em provide the patient with their own address, it don’t make any sense. It doesn’t really help them. With, with Eva Core, you actually get stuff the patient actually gets information that’s helpful. There’s descriptive paragraphs and language about the different systems of the body and how they impact care. It covers how supplements help and different tests help and so the patient really can engage at a level where they can intelligently ask, like you just asked me, what’s a dexamethasone suppression test as it relates to the adrenal gland? And then I can not have to answer the patient at all, that Eva will provide them with that information because it’s, there’s a, an article in there on dexamethasone suppression. So I, I just think it’s really good to understand that Eva Core provides the patient with, with information as it provides the doctor with with information. So, the idea of true shared decision making and patient empowerment and all that, it’s real, it’s not just jargon. It’s actually for real.

Erin – Yeah. Yeah. I, I think also, you know what I love about our patient portal and so we have Core inside of it, they can take it at any time. But what I also love about our portal is, you know, we had talked about this before as Eva Core, as the wellness monitoring system, but then we have our labs as our disease monitoring system, right? And what’s nice about the portal is when you get a lab result you can write to your patient directly as you review that lab. “Hey, everything looks good. The areas of concern are of no concern or, you know, within normal limits for you”, or, “these are some areas that I’d like to discuss with a little bit further. Nothing of concern, but just to kind of get you on the same board” and you bring ’em in. You can send them a message directly and what’s happening with other systems that I’ve worked with right now is patients are getting results from labs, pathology, all of that before a provider gets a chance to review it, right? And even if the provider does get to review it, the probability that they’ll be able to contact that patient or have someone contact them to have further like discussion about it is really difficult if, if there’s a time sort of lag. And so what do patients do? They get on Google and I love it. You know, I do it too. And then what does that mean? That means that actually takes the power away from the patient because what is Google? What is that massive search index? You get unlimited possibilities, which can be really scary, right? Or not scary enough. So, but generally, mostly really scary and I love that our portal gives patients, the ability to not only check out Core, have this educational piece that’s always accessible, but to message us for you to message directly when lab results come through. So, you don’t have to schedule an appointment if you don’t need to. And it also gives the, the ability to, if they have this really good relationship with like a supplement, a basic supplement that they like, they can order it, I mean, this Portal is an empowerment portal. And yeah, I’ve worked with a lot of patient portals. I think everybody has, is a patient of them at this point, and you just get all this stuff thrown at you and if you don’t have a background in healthcare, you’re like, what is this? How do I work through?

Dr J – Well, that’s, I think the thing with, with Eva is that it’s actually developed alongside a clinical practice. So as Eva has developed over the last 20 years, it, it didn’t happen in some programming shop or in a business, the insurance business. It happened in an office where lab would come in and because of the law that was passed last year that requires the patients to be able to get lab immediately as it’s available, the, the many practices, they just kind of vomit that information out into the patient’s world. And then the patient looks at it with absolute fear because a couple of insignificant findings are red flagged that they don’t really mean anything clinically, they’re not gonna hurt the patient. It’s not a problem. They look it up and they think for sure they’re gonna die, and they’re panicked and they’re completely stripped of any kind of understanding and any kind of power. They’re, they’re completely stripped. And we built this over the years so that, It actually tracks with the patient experience the lab is drawn and within several days it becomes available to us. We have to act on it. We can’t just let it sit there in the queue for weeks, right? We have to act on it, but that’s, it’s appropriate to act on it. Patients are waiting. We want to treat them with the respect they deserve. So, when we get the lab in, typically within 24 hours we will pull it, I, with me, it’s an hour or two. I don’t wait a very long time, and I’ll comment on it. Say, “Hey, you looked at your thyroid, it looks, or, you know, those numbers we were looking at are a little concerning. Why don’t you come in, we’ll, we’ll go through it.” So those, those, those processes, they didn’t just kind of get stuck in the program because they’re required by the law, they were developed over time because they benefit the patient. They give the patient control over the process. They give them understanding. They don’t have to kind of try to navigate the fields of Dr. Google on their own. They’re given information like, yeah, you, you probably do have a low grade infection. Let’s, you know, if you wanna look it up, it’s you know, it’s, it’s some, it’s some kind of, you know, gastritis looks like it’s hpylori. I don’t know, but that’s what it looks like. Why don’t you look it up and then we can talk about it then. Then there’s guidance and empowerment and education and all of that works together. And because it was, it, the whole thing was developed on a clinical bench, like in our, we cobbled it together over the years as we saw patients and took care of them. Monitoring does, does this help you to get this information? Yes. We’ll include it. Does this help you? No, we’ll pull it out. So the way that the system is structured, it provides the patient with good data that causes them to be at, at peace with the process and be able to be really empowered. And it provides a provider with all that they need to do it quickly and efficiently without having to just juggle incredible volumes of nonsensical charts. Aad click, click, click, click, click, it’s so, it’s, it’s fast and it’s, and it’s effective, but primarily all of that has happened because it’s been a long time developing it so that it works really, really well in a functional practice that pleases patients who are willing to pay cash for the service. They’re, that’s good enough that patients are saying, this is extraordinary, I’m, I’m gonna, actually, this is not run of the mill, rhis is not a copay relationship, this is actually something special. So all of that works together to create an environment where the care is excellent and far above the standard that’s normally expected and people are willing to pay for it because they feel like they’re getting this more than they would in a, in a standard practice setting.

Erin – I, I’m excited for a world where when we say empowered patient, it simultaneously means empowered provider. Yeah. And that is that relationship. To me as a nurse, my goal has always been to support that relationship. I have my own relationship with the patient, but my goal is to support that dynamic because, that’s why they’re there. That’s why we come in. That’s why we ask the questions we ask. We are working towards wellness, right? And, and navigating whatever else comes our way as a human being. And so most systems, I say, I think when they say empowered patient, sometimes we as healthcare go, woo, what does that mean? What can of worms are we opening here? Like, what are we gonna, how are we gonna have to adapt to respond quick enough? Well, what I love about, I…

Dr J – I have a mind picture of it. I think that really works really well for me. I don’t know if it, if it communicates clearly to everyone, but when you think about what happens in a war, you have a medic and the medic is part of the team, and someone goes down on the field, they, they get injured in some way and they say “medic” and the medic runs out to the, to the person who was injured, which is a heroic act, taking some risk really sticking their neck out, and then they attend to the person who has the need. They get them well enough that they can go back to the fight and they can continue with, in the patient’s case, their life and the the provider. and the patient have a relationship where the patient knows they can rely on that person to provide them with what they need. And when they ask for help, “medic,” the medic comes running, provides the help, and empowers the patient to go on into the fight. And that medic is willing to stand there in that place where if there’s a need, they meet with the patient and handle it, and then they get out of the way and let the patient continue on their way so that the patient can actually be heroic in their own way that they can be empowered. It’s not a in some way just they’re, they’re disconnected, they’re not, they’re on the team. The doctor and the patient are on the same team. The disconnection has come because insurance companies and business people and administrators and people who are not directly involved in care have gotten in the way of it. And this eliminates it. Eva allows for independent practice to be done at a level that reestablishes the connection between patient and provider. And it does because it, it gives that same, we are on the same team, we’re working with the same information, and we’re heading for the same goal, which is you, to be well, well enough that you don’t have to address disease as much as you do promote wellness.

Erin – Yeah, I, I definitely see that. It’s sort of like the current system is, “Medic” and then you run over there and there’s a guy standing over you and you’re like, all right, I’m gonna do this cuz this is, what’s this? Well I’m not gonna approve that because of…

Dr J – Or, or you yell “medic” and there’s somebody and you look back and there’s a guy in the medic tent, you know, having lunch saying, I’ll get there. Just gimme a minute. Yes.

Erin – Yeah, that’s not Absolutely.

Dr J – We, I want to reestablish the really the, I think most people become providers cuz they want to care for people, which is a beautiful, heroic act. It is not a it, it, it’s not just a job. It’s, it’s a incredible calling and it can be so much fun and so rewarding and fulfilling, but clicking a record system and filling out forms and doing that for a living is not fun. It is not what people are trained for in medicine, and, and ultimately it becomes a thing that gets to be so frustrating. It, it pretty much makes everything in medicine toxic, that doctor-patient relationship the day-to-day work of doctor and, and Eva to a great extent eliminates all of that. It makes all of it much more like it was intended to be in the beginning, which is a relationship between two people who can really help each other to to thrive. So, yeah.

Erin – And, speaking on kind Eva Core and Eva Core interview survey I, wanted to talk about the other capability of Eva, which is, you know, practices are able to build custom surveys to supplement the Eva Core. So, Eva Core is adaptive, it’s interpretive, it’s got AI algorithms, tons of, tons of time, experience, and testing with lots of patients. And then we have the ability to create surveys to just ask to a patient. I’ve seen some practices really overdo the survey area where they essentially are wanting surveys to replace charting, and I wanted to talk about the power of a simple questionnaire, how you can get so much more out of simple, concise surveys or questionnaires rather than these research-oriented in-depth, hour-long questionnaires.

Dr. J – Right. So, Eva was, we initially did it, we used the the the guideline of the science of integrative medicine, functional medicine all the high-end alternative medicine questionnaires. And they were very, very good, extremely long, incredibly complex. Lots of ’em required to have as many possible answers to each question, and we found that it was very cumbersome to, to actually score it as the provider, but more than that, patients hated it. They could do it one time, and if you ever asked ’em to do it again, they would just say, I, I’m leaving, I’m never coming back here again. I don’t wanna do this. So even on Eva Core, we’ve learned that a very simplified version of questioning is far superior, cuz patients do it completely, they’ll pay attention, they can do it for 15 minutes. Longer than that, when you’re asking for a half an hour of questionnaire filling out, you get less and less quality answers, and when we do those sub questionnaires, the ones that practices can do individually, the same rules apply. Less is more so that if a patient has a specific problem you’re interested in, like they have an acute infection, you only wanna ask questions that are directly related to that. Do you have a fever? Do you have a cough? Do any of your household contacts have this so that you have a multi list of questions that they can fill that out in a few seconds. It takes maybe 20 or 30 seconds, minute tops. Then you’ll get that information in the chart and it says, the patient says they have a fever, that they have a cough, and that family contacts do have the same illness. Eva does all that and writes all that out, a complete and comprehensive evaluation. From Eva is just gonna be a whipping to the patient who’s already filled out Eva Core in the past. They’re not gonna wanna do it. And we’ve done this in our practice for many years. Patients rebel and they say, I don’t wanna do it, or they just don’t do it. And then your staff has to walk into a room and work with them on it, and it’s not effective. So, our recommendation to everybody who does those the, the questionnaires within the practice is keep ’em really, really short. Just the questions that are absolutely critical and then to dive deeper when you’re with a patient, like you do in every interaction, then you can ask the other questions. The ones that are that are more telling like you have a headache. Well, is this the worst headache you’ve ever had? Okay, so let’s look at some other issues like possibly meningitis and, and go deeper. But you don’t want that in your basic questionnaire that’s unnecessary. And and patients just rebel against it. They won’t do it, and you’ll wind up in a situation where you’re not helping the patient, but you’re actually hurting them. And we know how to do that so we’ll, we’ll train you too with with Eva how to do those things so that it doesn’t become, you know, it doesn’t become difficult to figure this out. We have, we have it down to the point where it’s simple. It, it’s important too to understand Eva Core. It, it has a conditional AI so it, the, the artificial intelligence, the, the question will be asked, do you have back pain? And if you say no, it doesn’t ask any more questions. Yeah, she just lets it drop. If on the other hand you say, yeah, I have back pain. Then the questions come up. Well, is it shooting down your leg? Yes. Is it severe enough that it affects your ability to function? Yes. The then those things get recorded in the, in the record, and it’s basically patient complaints of back pain radiating the leg. It affects their ability to function, and that’s all written out so that documentation is complete and that documentation, if reviewed by a provider, qualifies legally for being a. compete Interview and questionnaire, and then the question can ask, can be asked. Wow. With that with that low back pain, has, has that ever been a problem before? like that. And if you have further questions, you wanna go into more detail? Oh yeah. It happens to me every summer, every time I go out in the field and start lifting hay bales. Oh, okay, so this is normal for you, but just a little worse. So those questions can be refined. And I think with with our practices that are doing those sub questionnaires, we’re really getting to a place where that is beginning to be understood.

Erin – Yes.

Dr J – But Eva Core at the beginning of a patient interaction or a patient evaluation, when you first see a patient, may be very, a year ago than it is today. So sometimes when a patient has a substantial change in their overall wellness, somebody comes in, they’re really super healthy, and they’ve got that low back pain, and that’s it. A year later they’ve got that back pain, but they, they’re having all sorts of other problems. They’re fatigued, they’re irritable. So something has changed. So I recommend, anytime there’s a big change in the health status, you don’t do a sub questionnaire, you could do a complete Eva Core again, and a patient who’s done it once, it will only take them 10 minutes to repeat it, and it’ll be absolutely comp complete, and great documentation so that nothing’s missed.

Erin – So that leads me into kind of the last thing I wanted to touch on, which is teaching patients what Eva Core is, because we all have filled out surveys before. We actually don’t generally have a lot of faith in them or trust in them. We think we’re filling out a piece of paper.

Dr J – Who knows if someone’s ever well, we’re like them, even a little bit hate them.

Erin – Yeah, we usually hate them. And to be fair, some, there are lots of places where you fill out tons of paperwork and yeah, the provider actually doesn’t see it. It gets translated in some way by whoever to them

Dr J – They’re stuck in a drawer. Stuck in a drawer is the most common response drawer. You grabethat paper and stick in a drawer, and then they ask the real questions. They’re interested in.

Erin – Yes, exactly. And it’s sort of like, okay, so when we brought on Eva Core , you know, learning what Eva Core is and what Eva Core can do for you, it’s, it is a learning curve because it has never been done before. It is not something that you can refer to, right? And so it’s sort of like the patient education part for me was simply it was insisting that they did it, you know, and they kind of threw a little bit of a tantrum, which was fine, but then the moment that they walked in the room and I pulled up on the screen their Eva Core results and we, and they looked at it and then I showed them if they weren’t familiar with their portal yet, cuz there is a little bit of an education period with the clinic as they first bring on Eva, right? And then you teach, you show the patient that once, that one small moment and that moment of investment and time with them to show them what it is, like, what it outputs for them, translated to their lifetime as a patient, because now they knew anytime they filled that out, they would get this. They would get something from it and they didn’t need me to get something back that it was there. And so I think, you know, how did you, in your practice through the years of trialing and building Eva, how did you get patients on board with Eva Core to the point where, I mean, I’ve seen it in your practice being there with new patients and then those that are returning, like they love Eva Core, like they are thrilled to fill out their Core, you know what I mean? It’s not like the end of the world for them.

Dr J – Well, I think, I think part of it is my own enthusiasm about it. When I, when I talk to patients I, I, I obviously am proud of the work that we’ve done with it and so I encourage them. I said, you really need to do this. This will be amazing for you. You will love what it shows you. Please trust me on this. I know it’s, you don’t like filling out anything, but we’ll use it in a way that will really it’ll wow you. And then we have, in each room we have large touchscreen TVs, so that the Eva Core pops on the TV and the graphic information is provided to the patient. They can see it. And most of the time people don’t really ever make a connection between emotional issues like depression and other problems. They just think, I’m depressed. I don’t wanna talk about it. It’s just a bummer. But if you can show them, look, see this, your thyroid seems to be a real problem for you and you’re depressed. Did you know they go together and there’s this gigantic aha. Oh my gosh, you knew that, you could see that. And that’s, that’s, you know, as plain as the nose on your face. It’s obvious these things are just clearly connected. Let me show you how. And I think most patients who have anything of substantial problems, anything they’ll see those connections and be super thrilled to recognize that there actually is something they can do about it. It’s not just their condition, right and that’s their, their lot in life and that’s their destiny. But we can show them functionally you have a problem here with your bowels not moving well and it looks like you have a fungus overload problem. So you know they go together, right? And it’s like, what? How could that be? What’s fungus? They don’t understand any of it until you show it to them graphically. And there is that. Wow. That’s amazing. I don’t know that people love doing anything about their health. When they’re sick, they love getting better, but once they’re healthy, I think people like to just kind of leave it on autopilot. Sure, and with Eva Core, they kind of can stay on autopilot. If all their scores are good on Eva Core, they do that once a year, we can be pretty sure that they’re doing well and that they’re staying well. And that’s what we’re offering ’em. So to a wellness patient who’s gotten really well and they do their Eva Core once a year, sometimes we do it at 18 months, they can see they’re maintained, their health and wellness is intact, and we can encourage them, Hey, do that. Let’s make sure that you’re, you’re still cooking. And and then they can look at their scores and see that they’re doing well. And I think it comes down to the, our enthusiasm for it in the practice. And I think as, as doctors and providers use this, they become more enthusiastic over time. At first it’s because it’s a new concept. It’s kinda like, oh gosh, another survey or another questionnaire. It’s not. It’s a comprehensive patient engagement system. Like the whole Eva platform is designed to create an opportunity for the patient to engage at a level where they’re gonna learn what they need to do to be really, really healthy. Not just eat a spec, special diet or do whatever, but they can identify when their health is shifting in a negative way they can get in front of it and, and make a change or two that will cause them to be healthy and or call us in, say, Hey look, there’s some changes I’m concerned about. I’ve noticed a shift in my function at this level. And, and, and then they’re, they’re, they’re aware that they have something they can do about it. They’re empowered to change things based on their experience. Their symptoms do matter, their experience of their life does matter, and Eva Core respects that and can actually take that information and translate it into actionable graphic data for the provider and the patient. So, it’s, it’s really, it’s absolutely mind blowing the difference in providing care when you have that level of information, that transparency where the patient shares it completely and “medic,” you’re on the same team. Yeah. You, you’re, you’re working for the same goal. Get in the fight. Have a enjoyable, exciting life, and don’t let illness be your destiny, but wellness. And we can shift that curve away from illness and towards wellness with Eva Core.

Erin – And then when all of that is happening, it’s such, it also, whether this was your intention or not, it is the perfect business model because it, your return on investment is higher, the amount of time you spend with your patient is valuable. It’s not a, you have all this information laid out before you, so you, you weren’t wasting time, your time or the patient’s time. You move efficiently. Your whole team’s on the same page. Your patient’s happy and you continue that cycle over and over and over again because you’ve got this expert virtual assistant who’s your long-term forever employee, right? No turnover, right? Who’s gathering all this information for you, supporting your patient too, the patient’s assistant as well as yours. So the business model of it, I mean, that’s what’s also so beautiful is like we’ve got this incredible system for you and the patient, but then the business model of it is incredibly successful too, so you can continue doing it, right? It keeps going well.

Dr J – Yeah, and, and ultimately where we’re heading with medicine is that cognitive work. The thought process of figuring out what’s wrong with a patient and what to do is becoming more and more something that’s going to be done by artificial intelligence. But nothing will replace the relationship between a doctor and a patient that nothing will ever do that. There’s no system that will do that, but because we create a a system that crunches down that cognitive piece to the minimal part that could possibly be, it expands the possibility for relational time where you actually engage with a patient. And procedures and procedures are where our doctors are going to in the future, need to focus. If they’re going to make a a healthy living and, and do well, they’re gonna have to be procedurally oriented and they’re gonna have to be comfortable with that and they’ll have to keep their cognitive work to the most efficient level that it can possibly be done in. And Eva creates all of that possibility. And the documentation that Eva creates because of all that is so good that there’s no question that the care that’s being provided is appropriate and complete. So it’s, yeah, it’s a really, it’s an amazing way to look at Eva too, when you take really great care of patients, it makes your business better, your business grows, and it does, you do better. Yeah. Yeah. It’s just a natural progress.

Erin – So, all right, well, I’d like to end on that cause that’s like the perfect way to end. Thanks for spending your time with me today.

Dr J – Yeah, you bet. It’s always fun.

Erin – All right, cool. I’ll see you next time.

Dr J – Okie doke. Talk to you later.

Erin – 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.

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Eva Podcast: The Empowered Patient