Rewriting EHR Processes Using Comms APIsRewriting EHR Processes Using Comms APIs

Startup Skywriter MD provides real-time virtual electronic health record assistance using the Kandy communications platform from Genband.

If you were planning to launch a company today, would you really put in a PBX?

That's the question Paul Pluschkell, founder of Genband's cloud-based communications development platform, Kandy, says he likes to ask when he sits down to discuss communications needs with large enterprises. Given that we're living in a "world today of apps and services," as he put it in a recent phone interview, the answer, we presume, is "No, you wouldn't."

The availability of cloud communications services and easy-to-use communications APIs makes the on-premises PBX installation nonsensical for many new companies. Skywriter MD, a three-month-old company that provides virtual scribe services for physicians, serves as a case in point, said Pluschkell, who also is executive vice president of strategy and cloud services for Genband.

Skywriter MD is using the Kandy communications platform to provide physicians with real-time assistance aimed at offloading the time-consuming process of electronic health record (EHR) management, Pluschkell said. Intrigued by this new business model for physician practices, I got Skywriter MD's Roger Rue, co-founder and senior vice president of technology, on the phone to learn more.

You can think of Skywriter MD as somewhat of a HIPAA-compliant and secure contact center staffed by dedicated teams of "medical scribes," Rue said. Each physicians practice selects medical-savvy Skywriter team members suited to its requirements, including expertise with whatever particular EHR on which the practice has standardized. Prior to, during, or even following a patient visit, a physician launches a real-time communications session and hands off EHR responsibilities to a Skywriter assistant. "We basically take over and do all the consult notes and all the documentation, and fill in the drop-down boxes and prescriptions, leaving the physician to focus on seeing the patient rather than managing the electronic health record," Rue said.

"We are not a transcription service, although we do provide transcription services. What we really do is provide all of the EHR documentation in real-time," he said.

The Skywriters and physicians connect and collaborate via WebRTC-initiated browser sessions, Rue said. During these live sessions, the Skywriters support any and all EHR-related activities, doing things like documenting a physician's assessment and treatment plan and entering diagnostic and prescription information. The Skywriter and physician can converse in real-time, via voice or chat channels, and share screens, he added.

Physicians, mind you, are required to inform patients of this virtual presence, and Skywriter MD abides by HIPAA stipulations to assure private, secure communications. And, should physicians want to speak with patients privately, they do have a mute option available to them, Rue noted.

Skywriter MD sees the Kandy platform and WebRTC as critical enablers of its virtual EHR assistance service, Rue said. Among the other communications options it vetted, he said, only Genband could meet the company's stringent requirements for robust audio quality, scalability, and seamless integration with the components and applications comprising the service.

The one thing that really stood out about Genband and Kandy was simplicity of integration, especially in tying in with call recording technology, Rue said. Skywriter MD is using what Rue called a "tried-and-true public safety-type recording solution" for which integrations into traditional PBXs are readily available but not so for WebRTC connections. "Some folks just couldn't put that together, and certainly not in our timelines."

The value proposition for physicians is that they can see more patients, and provide more focused care during a visit. "And then at the end of the day, because we do all the EHR workflows in real time, they can go home at night. They don't have to stick around the office to complete their documentation," Rue said. In addition, Skywriter MD only hires qualified people who have medical backgrounds, then provides training to assure the EHR workflows are handled correctly. This, he added, should reduce errors and resulting delays in the reimbursement process.

In a press release issued late last month, Skywriter MD customer Panorama Orthopedics & Spine Center said its preliminary results show physicians are seeing a "significant decrease" in the amount of time spent on EHR documentation, and a subsequent increase in patient focus. "We pride ourselves as being on the cutting edge of technology, but we realize the challenges that EMRs have created as well. We have finally found a partner that is helping us preserve both our ability to practice personalized medicine, as well as to capture high quality and structured electronic data," Bharat Desai, an orthopedic surgeon with the practice, said in an official statement.

Skywriter MD is largely funded by physicians, a fact Rue said the company considers a testament to the need for its services and its focus on giving time back to physicians. He declined to comment on the number of physicians currently using its cloud-based virtual EHR assistance services, but cited aggressive growth plans.

Beyond an interest in saving time and increasing patient focus, physicians who want to use Skywriter MD services need "nothing more than enough bandwidth for a good video conference call," Rue said. "Our solution takes about 300 KBps per session to run really seamlessly and effectively, so how much that bandwidth is depends on how many sessions a practice does in a given day," he added. "But we'll assist with figuring that out, too."

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