Stationed in Atlanta, Dr. Chris Kuzniak is a practicing surgeon turned entrepreneur with strong points of view on how technology advancements and adoption can complement the patient-provider relationship.
Kuzniak frequently travels back and forth to his home state of Tennessee, where he trained as a resident at Vanderbilt University before joining a private practice in Georgia three years ago, which has since been bought by nonprofit Piedmont Hospital, where his day job is general surgery.
As an entrepreneur, he’s based in Nashville, Tenn. His startups include eClinic Healthcare, a Healthbox award-wining communications tool in the pilot stage for established patient-provider relationships.
He’s experienced academic, private and employed healthcare from the provider side. Ten years ago he teamed up with software engineers and business developers and widened his purview even more. We asked him what he’s learned.
Q: What motivated you to become a businessman as well as a surgeon?
A: During my residency at Vanderbilt I was looking at how our health IT system worked and I felt that our electronic medical record (EMR) system was built around IT information, but I didn’t practice on IT, I practiced on patients.
I got together with a colleague and we whiteboarded some things during nights and weekends. We came up with an idea to take information that was clinically relevant and put it together in a way that made sense clinically. That’s not the way it is set up in a standard EMR or healthcare IT system. Over the years this idea turned into a company called CredenceHealth which grew and was acquired by Xerox in 2011. We are now rebranded as Midas+ Live.
Q: How did the divide between healthcare and IT affect you as a provider?
A: If you’re dealing with an electronic record from any vendor, data from IT is siloed with like data. Laboratory results are siloed with other laboratory results. If it’s a vital sign, like a nurse documenting the color of a wound or the state of a patient’s appearance, that’s going to be in clinical documentation. If it’s a radiology result, that’s going to be with all the other radiology results.
What we saw was you had to click through all these different silos to go get the results you need.
If somebody has pneumonia they’re probably going to have an elevated white blood cell count, which is a clinical result, a chest X-ray, which is a radiology result, and abnormal vital signs, increased respiratory rate oxygen requirements or a fever. All those things are in different silos in the EMR so you’d have to click through and find all that information. How can we aggregate all that data, which are related around a diagnosis, not around what type of data they are? That’s what CredenceHealth built algorithms to do.
What you’re starting to see now is algorithmic evaluations built in, different sorts of alerts or notifications built around that. I think the trend is bringing information to the provider so they can use it, instead of waiting for the provider to come looking for it.
I certainly see a trend in that direction, but the major IT providers are all what I would describe as large cruise ships, so they don’t make transitions very quickly.
Q: You’ve said the patient-provider relationship is your big focus now. Why?
A: Twenty years ago nobody was really on the Internet, so it hasn’t been that long since we started to discover the online world. Ten years ago people were on the Internet but not managing their health there. Now what you’re seeing is patients have access to their medical charts.
You’re certainly seeing technology connect the patient and provider. There are new means of communication, which used to be just a phone call. Now you’re having non-traditional messaging between patient and provider, looking at data and management of that patient. Within my chart, you can send a message to the patient about their results.
One of the entire points of the Patient Protection and Affordable Care Act ,in my opinion, is shared responsibility between the patient, provider, payer, employer and government. Everybody is responsible. One of the key tenets is that the patients need to be advocates for their own healthcare, not passengers in their own health. They should be active. One of the first steps is providing access to information.
Nobody’s going to care more about you than you. When I talk to patients I tell them: “I don’t make decisions for you, I give you all the information and help you make the decision, because ultimately your healthcare is your decision, not my decision.” I think patients respond to that.
Q: What specific tech innovations do you advocate?
A: I’m a healthcare entrepreneur and one of my startups, eClinic Healthcare, is in a pilot stage. It’s a communications tool for established patient provider-relationships. Barriers to healthcare access have spawned a whole new industry of “minute clinics” or urgent care centers.
This is occurring because it’s an access issue; people can’t get in to see their primary care doctor, and they don’t want to go to the ER to wait eight hours in a room full of sick people. The solution of “doc-in-a-box” clinics actually fragments the system. It brings in another provider, another set of questions, another opportunity for confusion.
We use a software-based tool with HIPAA compliant text messaging and emailing. Patients can take a picture of their wound, send it to their doctor and ask whether or not they should come in or go to the ER. It also has the ability to do online or virtual visits in a mobile fashion, on a desktop, iPad or smartphone.
It uses technology to create communication between established relationships. The goal is: Let’s not fragment the system, let’s not send you to a different provider because you want better access. Let’s provide a tool that’s convenient for the patient’s lifestyle.
Q: Why is maintaining connection between provider and patient so important to you as a surgeon?
A: Say I’m on call tonight and a patient who a partner operated on calls me, and a patient who I operated on calls me. I know everything about the one I operated on, [but] I may not know that [my partner’s] patient is on immunosuppressive medications for rheumatoid arthritis, which affects wound healing.
There are things that you know from an existing relationship. As good as we become at handoffs, there are things your provider is going to know from experience that another provider is not going to know.
My stress level is a lot lower when I get a call from a patient of mine.
Q: The cost of healthcare is another big issue these days. How does tech come into play there?
A: The low-hanging fruit is how can we match cost and acuity.
We don’t need to handle a viral respiratory infection in the ER — that’s the lowest acuity and the highest cost point, but that happens because we have a problem with access.
The good thing about the mini-clinics is that they have done that work of matching cost and acuity. You can match the need of that patient to the cost by having essentially a triage service.
But these clinics have rents and furniture, staff who are there whether patients are or not. How can we provide patients meaningful interactions and engagement in a low-cost setting?
That’s where virtual appointments come in.
I would step out on a limb and say that within five to seven years we’ll see 30 percent of bricks-and-mortar office visits move to an online space. The best solution is to maintain the integrity of that existing relationship and not fragment it.
In the past, there was a hardware issue, but we’ve overcome that. Now we just need to overcome the software barrier and tradition barrier.
Q: What wisdom have you gained in your transition from medicine to business?
A: I want to be able to take it from the boardroom to the bedside. Let me answer with an anecdote.
Patient care is often in its own box, documentation is in its own box, and then the financial aspect is in its own box. When we started CredenceHealth, we had a surgeon, a guy in business development, a guy who worked for a midsize hospital system, and a guy who built software.
It took the four of us about a year before we could speak the same language. What I learned is to speak different languages. I can speak business development, IT and clinical. That’s what’s helped me be successful: Being able to integrate the different boxes. We were bright, motivated individuals, and it took us a year to speak the same language.