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Join us as we delve into the complexities of modern health care with guest Samant Virk, a neurologist and health care executive. We explore pressing questions surrounding outdated systems and resistance to change in health care technology, discussing topics such as patient-controlled medical records, transparency in billing, coordination between providers, and streamlining insurance appeals.

Samant Virk is a neurologist and health care executive.

He discusses the KevinMD article, “Revamping health care: Tackling outdated systems and shifting mindsets.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Samant Virk. He’s a neurologist and health care executive. Today’s KevinMD article is “Revamping health care: Tackling outdated systems and shifting mindsets.” Samant, welcome to the show.

Samant Virk: Thank you very much for having me. Appreciate the opportunity.

Kevin Pho: So let’s start by briefly sharing your story and journey.

Samant Virk: Yeah. So, as you mentioned, I trained in neurology, trained in pain management and interventional pain as a fellowship, practiced in university settings and private practice. And it was after almost 15 years practicing, my wife basically got fed up with me complaining, and she said, you keep talking about the problems that you’re dealing with every day, why don’t you actually do something about it? She’s seen me do innovative stuff around the house and she knows I’m a curious guy who’s always tinkering with things.

So next thing I know, I started a telehealth company back in 2016, 2017. But the telehealth company was different than what was happening at the time. At the time there was a lot of consumer facing telehealth. I created telehealth to strengthen continuity of care, help doctors connect more effectively with their patients.

So in my practice as a neurologist and in pain, I had a lot of patients who were coming in for follow-ups, for really quick visits, as we all know as clinicians, depending on the specialty. And a lot of them were coming to me from a large catchment area, traveling from an hour or two away. I said, why are these people traveling? Why don’t I just do video calls with them? And it wasn’t about fitting my practice to the mechanisms that were happening in health care, it was just about doing the right thing.

And that evolved into the telehealth company MediSprout. And it was a bit of an uphill battle until COVID, and then all of a sudden all the things that we were trying to speak out into the universe, people started adopting. So that was my transition. And in that time I took on this position full-time in more of the tech space, and I left practice.

Kevin Pho: All right. So tell me about how COVID really validated your vision in terms of how telehealth has a place in daily clinical care. And now that COVID has receded into a more endemic state, what are some of the lasting messages and imprints COVID had on your business?

Samant Virk: Yeah. So from the business standpoint, obviously there was a lot of uptick. All the utility that we provided, getting up and running in practices really quickly, creating mechanisms to schedule video calls that synchronized with people’s EHR schedules, all those things were there.

But I think from a more societal standpoint, it just created acceptance of this technology. There were two big barriers we faced before COVID. One was just changing behavior, obviously, which is always the biggest issue with technology. But it’s also the mentality of, how do I get paid for this?

So both of those things, the joke is, what was the biggest change influence for your health care organization during COVID? Was it technology, was it insurance? No, it was COVID. So that forced people to change their behavior, and then the reimbursement structures were forced to change with it. So all of the barriers that people had before COVID were just broken, and that helped us grow our business, and it helped change mentality.

And I think the thing that has been nice to see since then is, people have realized that this doesn’t diminish the care quality that people receive, it can actually improve it.

Kevin Pho: All right. So let’s talk about your KevinMD article, “Revamping health care: Tackling outdated systems and shifting mindsets.” For those who didn’t get a chance to read it, tell us what it’s about.

Samant Virk: It’s really about the idea that in health care the technology that we’re using is outdated. Many sectors, many industries, have embraced technology change to promote their businesses. In health care we’ve been stuck with outdated technology that was created 10, 15, 20 years ago, and we haven’t adapted.

And specifically, there are multiple technologies that I could point to, but the one technology that I think is the biggest barrier to care is EHRs. The EHRs we use today, the word siloed is overused, but they were created in a rush, in 2006 to 2010, with the federal mandate that incentivized health care organizations to use electronic health records technology. But they were created in a vacuum, and they don’t actually promote the care aspect of medicine, they promote the business aspect. But clinicians and patients are left holding the bag in terms of the work that has to be done.

So we believe that there’s a new type of EHR that needs to be developed, that focuses around the three personas in health care, patients, providers, and health care organizations, that facilitates their goals. And by doing that we believe the whole health care ecosystem can flourish, from insurance companies to pharmaceutical organizations to the medical legal system. But until we change that mindset, we’re not going to be able to change the technology that we’re using. And I’m personally working on creating that new kind of technology right now.

Kevin Pho: So when you say that EHR technology is antiquated, let’s say someone not in our world, patients for instance, what would be a specific example that really can show patients how antiquated EHR technology is?

Samant Virk: It’s as simple as, how do I get my medical records? The government has passed a law that says those medical records are and should be owned by the patient, and to this day, I myself had to get medical records from a health care organization down the road, and I had to go to their office to sign documents to get my records. And that is just the tip of the iceberg in terms of how they create challenges.

I think the information sharing, again, laws have been passed that require information sharing, but there’s a lot of dragging of feet, because these business models that they have are so established on older mechanisms to conduct their businesses. The EHRs are a business and they had an interest to preserve it, which is perfectly fine, but those business interests clash with our health care needs. And until we can coalesce those two things, we’re not going to be able to make progress.

I mean, medical records is one thing, consultations between clinicians is another thing. But I think the most central aspect is centralizing data around patients. Until we do that, we’re not going to be able to manifest or harness the capabilities of AI, for example, which everybody talks about. Until we do that, we’re not going to be able to create the efficiencies.

All of preventive care is premised on the idea that you have comprehensive information. You cannot treat a person who has diabetes effectively unless or until you know their history with heart disease, with hypertension, with other comorbidities. And right now our technology does not advocate for that. So those are just some of the examples of how that needs to change.

Kevin Pho: And when you say that EHRs are siloed, is it that a lot of EHR systems simply don’t talk to one another if they’re from a different company? Or if a patient comes from a different health care system, it’s sometimes not easy to get their records into their current EHR?

Samant Virk: That’s exactly it. I think the way that people are trying to rework this connectivity is through EHRs connecting with each other. We just, the way we see it, it’s actually creating more complexity to the system. There’s so many EHRs, and the EHR within each health system is its own unique instance. So if you try to connect all of those across the board, it creates, and many of them have different languages that they work in.

We just believe a much simpler way is to let the patient get access, allow the patient record to be the source of truth, and then you don’t have to deal with all of these backend technology integrations, which are honestly creating things that are much more difficult to manage.

Kevin Pho: So whose fault is this, that we’re dealing with such antiquated systems, or the fact that innovation in EHRs is so behind the times? Is it the fault of the EHR companies, is it the fault of the government for really pushing things too fast, is it the health care system? So who’s at fault here?

Samant Virk: It’s hard to put blame on, I think it was a natural evolution that, unfortunately, there was no overseeing body that helped direct that evolution.

As we know, when the iPhone came out in the early 2000s, technology is moving so quickly and at such a pace, and we had so many health care issues. I think there was a great initiative by the government to promote the idea of digitizing health records, but unfortunately it wasn’t done with the foresight that was necessary to create the infrastructure that would serve our long-term needs.

So maybe it was a little bit the government, the EHR companies, hey, they’re businesses, they took advantage of what the opportunity was out there, and they did it unfortunately in a way that was very shortsighted. But people don’t have those horizons.

So between the EHRs, the government, health care organizations themselves, which are honestly just trying to get through their days and their years, I think there’s multiple personas that are maybe to quote unquote blame. But we see it as a natural evolution. That doesn’t mean there shouldn’t be a course correction. We think that course correction is possible without necessarily harming the existing structures that are in place.

Kevin Pho: So tell us what a patient-centered EHR would look like in real life, and maybe outline some of the paths that we can get to your vision.

Samant Virk: Yeah. So the vision is focused on the idea that there’s this centralized entity of patients, providers, and health care organizations, around which data flows seamlessly. The patient is the conductor of that data, they can own it and they can decide where it should go based on who they want to have it. But then, within those organizations, once they open it up, the organization that they’re engaging with can have ownership of that data if the patient allows them to.

So we see a world where a patient account, quote unquote, in a solution would have the ability to tie into the other places where their records are currently kept, and they would be able to accumulate it under one account.

It’s no different than having an Amazon account. All your information is there, everything you’ve done, all of your histories there. Amazon integrates with different businesses where they post their products, and they’re able to pull in the information from those systems and keep it all in one cohesive place.

It’s just re-engineering where that information flows, and the technology is there to do it. And now the doors have been opened with the Cures Act passing. I think there’s this amazing place that we’re in, where the technology being there, the legal infrastructure allowing it to occur, and now just somebody needs to take the ball and run with it and create these patient-centered accounts rather than organization centered accounts.

Kevin Pho: Now, hasn’t this been tried in the past? I remember hearing about Google Health, kind of a similar concept, where patients would have a cloud account and it’ll get auto populated with their medical information or drug information. And sometimes these EHR companies would treat that information as proprietary, so they’d be less than enthused when sharing that information, which would defeat the purpose of having these patient-focused accounts. So what makes this time different?

Samant Virk: It’s different because the law is different, one. But also because it’s not just a patient-based account. This is a patient-based account that is seamlessly integrated with the provider and health care organization account.

So for example, it’s still the health care organization that would sign up for the account, and then, if you’re my clinician and you wrote a note, that note would be shared with me. But simultaneously, if I saw another clinician that wrote a note, I would be able to share that note in turn with you. So it does include the provider and the health care organization as part of that ecosystem.

Where the Google Health and the Microsoft HealthVault did not succeed in the past, they were hindered by that kind of, like, patient only. They were expecting the patients to get their information from their doctors’ offices, populate it, enter in their blood pressures. It was totally separate from the clinician’s purview. And the law also wasn’t in their favor, patients had a really hard time getting their information. Not that it’s that much easier now, but we just see that ecosystem being more comprehensive, being more of a capability to help this succeed.

Kevin Pho: Now, as you know, there are a couple of big EHR players that almost monopolize the market. Would something like this require cooperation?

Samant Virk: Yeah, it would require their cooperation, and that is where the Cures Act comes into play, and some of the other legal progress that we’ve made over the past couple of years, where you can go to one of those larger EHR players, and if you have the patient signature with a piece of paper on it, that EHR company would have to comply with sharing that information for that patient.

So yes, it would be a challenge, but it doesn’t mean those EHR companies no longer have a place or a function. They can still work with that health care organization. It’s just that we’re empowering the patient to have more access and control of their information, to be able to keep it for themselves and share it with who they need.

So yeah, we don’t want to, you know, change is hard, and including those players in that change is part of what we want to do. We want to bring them along with us.

Kevin Pho: So I’m a primary care physician. So give us a scenario where, from the primary care physician standpoint, how your vision would change my workflow, or how it would be different from what I’m dealing with now.

Samant Virk: Yeah, so primary care is a great example, because one of the initiatives, we have a couple of core focus areas over the next, we’re thinking in decades, over the next decade or 15 years, which is preventive care.

As a primary care physician, we want to be able to harness all of the patient’s information. So you can see their Apple Health information. If there’s a sleep device they use, that information. If they saw a doctor, if they moved from another location across the country and they were seeing a primary care doctor there, you’d be able to see those records. You’d be able to track their diabetes more effectively through whatever app they’re using. You would just have more as a clinician.

And this is where one of the topics that comes up is, is this going to take the place of clinicians, these devices and this AI? No. We just want to get you, as a primary care clinician, all of the relevant information you need to help guide the patient as effectively as possible.

So I think that’s the answer to your question. We want to get you all the best information possible so you can use your intellect and your talents to help guide your patients more effectively. Right now, too many primary care physicians are making decisions based on piecemeal information, and it just doesn’t do the job for prevention or for regular care.

You can see notes from other doctors, for example. What’s going on with your mental health history? Hey, here’s the note from my therapist, this is what’s happening. That’s much more powerful as a primary care physician than just guessing or trying to make phone calls.

Kevin Pho: We’re talking to Samant Virk. He’s a neurologist and health care executive. Today’s KevinMD article is “Revamping health care: Tackling outdated systems and shifting mindsets.” Samant, let’s end with some of your take-home messages that you want to leave with the KevinMD audience.

Samant Virk: Yeah. The past few years, in my transition from clinical care into technology and an executive role there, there’s been a lot that I’ve learned.

I think one of the things that I want to remind clinicians of, that’s been reinforced to me over the past few years, is we forget as clinicians sometimes that without us, and without us seeing patients, the whole health care ecosystem stops. There’s no prescriptions, there’s no imaging, there’s no lab tests, insurance doesn’t exist. Your ability to influence the system is immense.

So whether you’re in a large organization or a small organization, you should advocate for what you need and what you want. And if you can do that with a group of colleagues, I believe, and I’ve seen, that there’s no more powerful ability to create change, because everyone knows that without the clinician making decisions, no one else honestly has a job. So don’t forget that from the clinical side.

And if you’re in an organization that’s implementing technology, get involved with it. I totally understand how it’s so easy to get consumed by clinical care and keeping your eyes to the ground and focused on patients. But if your organization is bringing on new technology, insist on being part of the process, having a say. There’s too many administrators, too many people without a clinical background, who are making these decisions, and unfortunately, as we’ve seen, they have not resulted in being very helpful.

So I’d say those two things are points that I try to relate to clinicians regularly.

Kevin Pho: Well, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.

Samant Virk: Thank you very much for the opportunity.