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How a Direct Primary Care Model Provider Benefits From an Easy-to-use EHR



Enid, Oklahoma-based Reliant Direct Primary Care, which has two offices in northern Oklahoma and three providers, is a direct primary care provider that sees far fewer patients than a traditional practice.


Dr. Jonathan Bushman, one of the three providers, previously worked for a health system, using an EHR designed to support fee-for-service billing and engineered around serving patients through a transactional delivery model.

“Being held captive by this system, I felt I had lost the ability to focus on the patient and earn patient trust, and the challenges caused by the EHR made my day-to-day activities of caring for patients feel more like a chore,” he recalled. “My main focus at the time was on creating documentation to support billing for specific services, not on what was best for the patient. The process was burdensome and exhausting.”


Bushman and one of his colleagues had spoken at length about different practice models and software. The colleague had mentioned his success with Elation Health, a vendor of an EHR for independent primary care practices, and its integration with other major technology platforms, including Hint and Spruce, for direct primary care.

“I took a look at a demo of Elation and was immediately impressed,” Bushman said. “Elation was the most simple EHR I had seen. It was just all there – everything I needed, right in front of me, on one screen. I almost felt like I didn’t need to have an orientation on how to use it.

“I had come from a large health system that had been required to use Epic and it is this massive EHR that is overwhelming. Elation is just so intuitive,” he continued. “Using it has made both record-keeping and taking care of patients seamless.”

When Bushman transitioned to the DPC model, he knew he wanted an EHR that was built to support the clinical care he provides to patients, not coding and billing. He also wanted an EHR that was easy to use and felt natural with his primary care workflow.

“With Elation, creating clinical documentation; keeping careful patient records; managing tasks, results and messages; and collaborating with other physicians are as easy as they need to be, and the visual experience is uncluttered with a sleek and simple design,” he described. “For years in my previous employment, I had said, ‘I wish my EHR would work for me. I’m tired of working for it.’

“And to me, Elation is that type of EHR,” he continued. “Unlike others, it is designed for the way physicians think. The intuitive design and ease of documentation gave me back more time to spend with my patients.”


Implementation of the EHR was fast and easy, Bushman said, and required minimal training.

“I am able to capture all the important information about my patients in an easy-to-read clinical profile, swiftly review the chronological record for my patients, see all items requiring action, and quickly document an accurate and meaningful patient story and encounter note – all in a simple three-panel view that gives me complete situational awareness of all the clinically relevant information about each patient,” he said.

“Fewer clicks, no more hard-to-find information, no more jumping around between screens and multiple browser tabs per patient,” he added. “Using the practice home page, I am able to easily manage all of my pending tasks, documents for review, messages, medication renewal requests and unfinished notes.”


Accessibility is the greatest result achieved so far, Bushman said.

“Using Elation’s EHR, I have the ability to extrapolate the data I want that makes a difference to my patients,” he explained. “While I no longer have to report, I have all the alerts turned on as if I was reporting MIPS, so I remain aware and can address anything my patients need.

“For example, when I’m seeing many patients within an organization, I can export specific data about patients tagged by organization in a new task list and know within seconds who from this group was ‘last seen’ in the past six months, which is of huge value for direct pay and direct consulting.”

The number of cases solved with patients is increasing while the amount of visits is decreasing, showing an increase in efficiency, he added.

“I’m doing what I want to do. I’m doing it for all the right reasons. It is very satisfying,” he said. “I now have an emotional peace of mind that my colleagues ask about achieving. And while I’m not reporting for MIPS and metrics, the on-demand reports that I can create allow me to monitor and empower touch-points with patients.

“Within the DPC model, the more I can add to communication and reminders for patients, the better. The EHR’s reporting tools allow me to basically create my own metrics, including both touch-points and accessibility.”


“When I talk to colleagues struggling with similar EHR challenges, I tell them to look for an EHR that isn’t built around coding and billing, especially if you’ve chosen to go outside the traditional fee-for-service billing model,” Bushman advised.

“Look for an EHR that maximizes clinical context for each patient, makes documentation easy – helpful even – and produces a useful encounter note.

“Find a platform that helps you manage your day-to-day work, gives you tools to proactively manage a panel or population of patients – not just one patient at a time – and doesn’t add to the cognitive burden of the hard work of patient care,” he suggested.

“Find a vendor with an open architecture that makes integration of other software solutions quick, easy and seamless in the workflow.”

Using an EHR should feel easy, he added. There should be options to customize it to one’s practice needs, and it should not distract one from patients, he said.

“It should support the needs of other members of your primary care team and allow for delegation of tasks and responsibilities across the care team,” he said. “Information should be easy to file and retrieve, and health information sharing should be a key feature.

“There should be an easy prescribing process and there should be integration of external pharmacy data as well as individual patient formulary information.

“There should be easy, effective and efficient integrations with laboratories for orders and results,” he concluded. “It should be easy to manage the patient relationship through secure communications and refer patients outside your practice, sharing pertinent information between collaborators in a patient’s care journey.

“The legacy I hope I can leave is a practice that centers my patients, thanks to the DPC model and an EHR that enables, rather than erodes, the care experience.”

Twitter: @SiwickiHealthIT
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Healthcare IT News is a HIMSS Media publication.

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Singapore’s Public Health System Rolling Out the Clinician’s ZEDOC Platform



Singapore’s health tech agency Integrated Health Information Systems has partnered with Auckland-headquartered digital health firm The Clinician to deploy a patient-reported outcome and experience measures platform across the island state’s public healthcare system.


The Clinician’s ZEDOC platform, the company describes, assists healthcare providers in managing patient-generated health data outside the hospital through digitisation. Integrated with HIS, the system supports timely exchange of health data and information between providers and patients, including subjective PROMs and PREMs, objective wearable device data, and other communication or educational materials. By streamlining the digital collection of critical health data, ZEDOC is able to render real-time, actionable information crucial for improving health outcomes and experiences.

The partners are working on multiple ZEDOC integrations with existing health information systems (HIS). A privacy-preserving hybrid infrastructure has been implemented which ensures that all personally identifiable information stays within the IHiS’s private health cloud while all anonymised health data are collected through a secure commercial cloud platform.


Singapore intends to measure and improve health outcomes and patient experience with the rollout of The Clinician’s ZEDOC platform. Their partnership will “bolster patient engagement and enable clinicians to more effectively assess patients’ health status before, during and after receiving a health service – closing the loop when they are outside the hospital,” said The Clinician CEO Dr Ron Tenenbaum. It will also allow providers to deliver “more holistic and personalised care for patients by taking into account their perspectives for the first time,” he added.

To demonstrate the benefit of routine collection and analysis of PROMs, The Clinician shared that this has resulted in over 50% reduction in 90-day complications for hip and knee surgery patients in one study and a five-month improvement in the survival of cancer patients in another.

Among benefits for care providers, the ZEDOC integration will replace existing paper-based forms with an integrated digital platform that automates data capture, as well as benchmark outcomes across providers to reduce variability and waste. For patients, they can become more involved in the treatment decision-making and be informed early of health risks and warning signs.


Last month, Cabrini Health and The Alfred, two of the largest healthcare providers in the Australian state of Victoria, deployed the ZEDOC platform to automate the collection and analysis of health data from colorectal cancer patients. The installation is said to adhere to the colorectal cancer standards outlined by the International Consortium of Health Outcomes Measurement.

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EU Analysis Highlights Digital Health Lessons From COVID-19



An EU analysis has outlined the effect of COVID-19 on healthcare systems in Europe and the role of digital innovation in building their resilience.

Experts from the Organisation for Economic Co-operation and Development (OECD) and the European Observatory have published a set of 29 country health profiles, covering all EU member states, as well as Iceland and Norway. A companion report also highlights a selection of cross-country trends.

Speaking at a virtual launch event on Monday (13 December), Josep Figueras, director, European Observatory, highlighted two main lessons learnt from the use of technology in the pandemic.

Using telemedicine as an example of digital health innovation, he said the number of teleconsultations had increased in all EU countries during 2020. However in some countries, such as France, teleconsultations had decreased when lockdowns ended.

“The key issue here is how we harness and sustain innovation – how we make sure that these improvements in the use of telemedicine (as an illustration of the use of other digital technologies) can be maintained and sustained to increase the effectiveness of the health system,” Figueras said.

He also highlighted that the technology for telemedicine and other innovations was already available in many European countries before the pandemic but was not being used.

Figueras asked: “What did we do within the pandemic that literally within a couple of weeks, we got all this telemedicine in place?”

To sustain the use of telemedicine and other health technologies, he said it was important to look at the regulatory measures, financial incentives, training and changes in culture needed.

“Something the pandemic has taught us loudly and clearly is the importance of digital innovation – not only the new technologies, but the ability to implement them,” Figueras added.


The State of Health in the EU cycle is a two-year process initiated by the European Commission in 2016, designed to improve country-specific and EU-wide knowledge in healthcare.

It aims to gather data and in-depth analyses on health systems and make the information accessible to policy makers and stakeholders.


During the pandemic, digital tools have been used in the EU to boost public health measures such as the implementation of the EU Digital COVID Certificate, vaccination booking systems, and cross-border interoperability for contact-tracing apps.

There has also been investment in EU-wide COVID recovery initiatives such as the EU4Health programme.


Maya Matthews, head of unit performance, European Commission said: “COVID-19 illuminated the fact that in many European countries we do not have a strong public health system. We cannot do testing and tracing. Even surveillance is done sometimes in a very fragmented fashion.

“I think if one thing comes out of COVID-19, it’s to say that public health matters – that public health is a very important part of health systems and has not really received the attention it deserves.”

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Clinical Messaging Platform Hospify to Close, Bupa Arabia Invests in Global Ventures, and More News Briefs



Clinical messaging platform Hospify to close

British healthtech startup Hospify has announced it will close its secure clinical messaging platform on 31 January 2021.

Hospify said it suffered a decline in demand after the government suspended the UK 2018 Data Protection Act in relation to healthcare last year for the duration of the COVID-19 pandemic.

It also cited difficulties caused by “post-Brexit uncertainties surrounding the future of the UK’s data adequacy agreement with the EU”.

A statement from the Hospify team says: “It’s a sad end to a wonderful vision, a vision of universal health care communication that was both free of data exploitation and free at the point of use.”

Insurance giant Bupa Arabia invests in Global Ventures

UAE-based international venture capital firm Global Ventures has announced new investment from Bupa Arabia, the leading health insurance company in the region.

Bupa Arabia’s participation in Global Ventures Fund II as strategic partner aims to foster the healthcare ecosystem in the region and particularly in Saudi Arabia.

The investment is part of the Bupa Arabia’s strategy to participate and invest in disruptive healthcare and insurance technologies, amongst other targeted growth sectors.

Noor Sweid, Global Ventures founder and general partner, said: “Bupa Arabia shares our outlook and ambition on the digital health sector, and its potential for technology and innovation to deliver long-term economic benefits particularly in emerging markets.”

Liverpool Heart and Chest Hospital achieves EMRAM Stage 6

Specialist NHS trust Liverpool Heart and Chest Hospital (LHCH) has been awarded Stage 6 of the EMRAM, or Electronic Medical Record Adoption Model, by HIMSS.

The EMRAM measures the adoption and maturity of a health facility’s inpatient EMR capabilities from 0 to 7. Achieving Stage 6 means the trust has established clear goals for improving safety, minimising errors, and recognising the importance of healthcare IT.

Kate Warriner, chief digital and information officer said: “Digital excellence must be the cornerstone if we are to continually improve the care that we provide for our patients in the years ahead. Therefore, whilst we are rightly proud of this achievement, we have ambitions for further pioneering innovation and advancing our use of technology to become a Stage 7 hospital.”

More than $110m raised by Sheba’s ARC Innovation Center

Israel’s Sheba Medical Center has announced that six companies from its Accelerate Redesign Collaborate (ARC) Innovation Center raised more than $110 million (EUR97.2m) in 2021.

ARC brings new technologies into the hospital and community ecosystem focusing on digital health technologies including precision medicine, big data, artificial intelligence (AI), predictive analytics, telemedicine and mobile health.

Sheba MedTech startups receiving investments this year included: Aidoc, BELKIN Laser, Starget Pharma Append Medical, Innovalve Bio Medical and TechsoMed.

Professor Eyal Zimlichman, ARC director and founder, said: “The ARC Innovation Center has been focusing on ground-breaking, innovative technologies with a prime directive to redesign healthcare.”

Konica Minolta named as part of NHS Digital Documents Solutions framework

Konica Minolta Business Solutions (UK) Ltd has been named as one of 46 suppliers on the new ?5 billion Digital Documents Solutions framework.

The firm will provide solutions across five key areas: internal print, external print, digital mail room, scanning and electronic document management solutions.

Jason Barnes, head of public sector, Konica Minolta, said: “Having been chosen through a competitive tender process, we are especially pleased to be newly appointed to the LPP framework, which deepens and furthers our reach into the NHS health sector.”

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