How Abjayon helped transform Avance Care, a North Carolina (US) based Primary Healthcare provider, from being a tech-enabled company to now a tech-driven company by developing and delivering a next-gen virtual healthcare and patient engagement platform.
In mid-2019, Abjayon was hired by an Avance Care Health System, an innovative Primary Healthcare provider, to lead and implement its Digital Transformation strategy. Their plan was to offer Virtual Healthcare as the default option for the modality of care to all its patients, and to take healthcare closer to its patient by starting employer worksite and retail clinics. This initiative was based on the belief that virtual care will change the way healthcare is delivered, so the idea was to make virtual care the default source of care for the patients.
This was quite a challenge for it not only involved supporting different modalities of care but also a better way to understand patient’s healthcare needs and steer him / her to the right source of care. Additionally, as the business grew at a rapid pace and the new locations got added, a strong need to transition to the systems and infrastructure that were truly Enterprise-grade was being felt. A plan was required to be put in place to ramp up the infrastructure and the systems to support up to 50 locations, 250 providers and 300K patients over the next 5 years.
A plan was required to be put in place to ramp up the infrastructure and the systems to support up to 50 locations, 250 providers and 300K patients over the next 5 years.
The task on hand required the complete transformation from being a tech-enabled company to now a tech-driven company. For this, the team needed to make the Avance Care’s systems Enterprise grade and use technology to drive patient engagement and delivery of care and health outcomes.
The team needed to make the Avance Care’s systems Enterprise grade and use technology to drive patient engagement and delivery of care and health outcomes.
In order to roll the projects faster, an overall plan was put together and reviewed with the company’s Finance team and the CEO for their approval. Also, a standard vendor evaluation process was created to ensure there was no ambiguity in identifying the right partners and the contract negotiations.
Multiple projects were conceived, and project leads were assigned to own and drive them independently. Also, the projects were prioritized, and a roadmap was created for the rollouts.
Although the services were hired from external agencies, the management for all projects was kept in-house to control the quality and the timelines.
In order to manage the projects and support team collaboration, Atlassiani’s Confluence and JIRA were identified and implemented, and the access was granted to all teams.
A number of projects were then kicked-off and executed in each of the following areas over the 18 months.
Avance Care operates on the belief that primary care should be a patient default choice of care, and a good primary care system that takes care of patient’s physical and mental health and the nutrition is the key to improve patient’s quality of health.
So, even as the Telehealth was being considered as a new offering, it was imperative that the offering matched the same beliefs. This meant that the implemented Telehealth system would have the following key features:
- The delivered care was not episodic and was an extension to the primary care being given to the patient at the current location.
- The delivered care was holistic. It covered physical health, mental health and nutrition care.
- The delivered care was integrated into the current system. All clinical protocols and back office practices were to be followed.
The Health Pod was established as a new offering to provide “assisted telemedicine” service to the patients at the worksite. This was a unique offering that included an electronic health cart with diagnostic attachments, such as stethoscope, otoscope, ophthalmoscope, ECG etc., which could be remotely operated by a provider from one of the locations. The cart was housed in small fabricated 10’x10’sized pod that could be hosted in any employer or retail facility. The pod was designed to look and feel like a traditional exam room and manned by a trained medical assistant. A small lab area was included to allow the medical assistant to collect the lab samples if needed. The Health Pod can be used to service more than 80 patient conditions remotely.
For the regular Telehealth sessions, Zoomii’s Meeting Telehealth platform was selected because of its ease of use and support for the HIPAA standards.
Dieticians and Therapists were trained and given access to conduct Telehealth sessions for their patients.
Along with the introduction of new sources of care (Health Pod and Telehealth), the idea of a next generation patient engagement platform was conceived with 4 main objectives.
OBJECTIVES OF THE PATIENT ENGAGEMENT PLATFORM
- Provide patient next generation online experience
a. Collect patient’s health information (PHI) and suggest most optimal source of care
b. Help patient book make and modify appointments
c. Allow patient to fill up registration, health screening and consent forms
d. Upload insurance and contact details
e. Make payments online
f. Online check-in
- Orchestration of patient appointments, information and medical charts between telehealth, EHR and other platforms
- Patient messaging and chat (future)
- Patient self-service and online patient monitoring (future)
The platform was built as a web and native application and could be accessed by the patients from home or at the kiosk in front office area on the tablet PCs. It leverages Natural Language Processing (NLP) for the patient interaction and Artificial Intelligence (AI) for understanding the patient symptoms and identifying the optimal source of care. The application was successfully rolled out in January 2020.
The first Health Pod was commissioned at the company’s own corporate office in December 2019 and opened to its entire staff.
This effort has come to rescue during the ongoing pandemic as nearly 50% appointments were shifted online in matter of weeks. This has helped not only the patients to get the care but also the business to sustain itself.
This effort has come to rescue during the ongoing pandemic as nearly 50% appointments were shifted online in matter of weeks.
Safety, Security and Compliance
Patient and business data security is of prime focus at any healthcare organization. While the IT security systems – firewall, antivirus, domain security etc. – already existed, the goal now was to make the systems and processes truly “enterprise-grade”.
During the last 18 months, all internal systems and applications were integrated with Oktaiii (single sign-on and IAM) and Microsoftiv Active Directory.
All users were segregated into access groups and the permission levels were defined as per their roles in the organization. For the mobile users, the mobile management platform was implemented, and all mobile devices were registered. All external accounts were protected with multi-factor authentication using Yubikeys and Okta.
In order to enhance the security of the infrastructure (cloud and on-premise), platforms and applications, Tenablev’s Nessus was selected and implemented to discover and scan all assets for the vulnerabilities. For the intrusion detection and SIEM monitoring, services of Arctic Wolfvi were hired and implemented for the round the clock surveillance. Penetration testing was contracted to an external agency to conduct periodic penetration testing on all IT assets. The role of Security Manager was defined and formalized to oversee all IT asset deployment, maintenance and monitoring processes.
For the email security, Proofpointvii’s Essentials system was implemented. IT policies were strengthened and reviewed in the light of ever-increasing security threats and trainings were conducted for the corporate teams. As a result, thousands of phishing attempts and malware attacks were thwarted.
HIPAA and SRA audit were conducted to assess the vulnerabilities and the non-conformities were addressed immediately.
For the back-office systems, Avance Care has always relied on best-of-breed common-off-the-shelf (COTS) solutions. However, with the growing business size, some of these systems had to be upgraded to the “enterprise-grade”.
Oracleviii’s NetSuite was identified as the ERP platform of choice. GL, expense management, procurement, financial reporting systems were implemented to replace Quick Book Enterprise. The next step is to evaluate its Contract and Customer Relationship Management (CRM) capabilities before implementing them.
EHR system, from eClinicalWorksix, was upgraded to the latest release levels. A test instance was established in-house to test the configuration changes and integrations with Carin.
The decentralized location-based phone exchanges were replaced with a Unified Communication Platform in the Cloud from 8x8x. The new system allows us to roll out new locations in a matter of minutes instead of couple of weeks’ time the old system used to take. The new IP-based phone system was rolled out in phases to the corporate users and the new locations. The system supports centralized management of communication systems, integrated phone, messaging and conferencing features and the call center features. The new phone system brings guaranteed uptime to our patients, enhancing our call quality. The next step is to leverage this platform to centralize the phone desks at the locations to a back-office location.
A new portal was created for the HR team to communicate and share company mission, objectives, updates, policies and procedures, event news etc.
Corporate executives and operation management teams rely heavily on data reported from EHR, Financial and HR system for measuring quality of patient care, provider efficiency, operational efficiencies, revenue, billing collections etc.
The system previously had 70+ monthly reports that were generated with manual effort from a dedicated report. The process was manual, error prone, clunky, had no data security checks.
During the project, the entire ETL process was automated to be executed daily, and those 70 reports were combined into 3 sets of online dashboards using Microsoft Power BI for Executive, Corporate and Operations teams. The row-level security rules were implemented so that users could see only the data they were allowed.
This new system has greatly enhanced the data driven decision making process. Also, with the data refreshed every day, the users do not have to wait for a month to see their data.
With the plan to expand to 50 locations, the biggest challenge was the ability to manage the IT assets distributed at the locations and support the clinical staff efficiently. The goal was to do it with higher support quality levels, without growing the team significantly.
The remote monitoring and management system (RMMS) Automate from ConnectWisexi was implemented to discover, monitor and manage all IT assets remotely.
This immediately brought down the need for the support technicians to travel to the sites to support the users and provided the much-needed real time monitoring mechanism. The system was integrated with the incident tracking system to report and manage the possible glitches.
As a result, two support technicians manage more than 450 users across 15 locations and the corporate location, with the backlog ticket count of less than 25 on most days.
These projects concluded the first and the critical phase of digital transformation. The second phase of this transformation journey is in full steam at this time, with telemedicine, remote patient monitoring programs, patient communication, CRM, contract and budgeting implementation and centralized customer contact center implementations are in the pipeline.