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The CHCF Blog

Transforming the Waiting Room: Digitizing Our Paper-Based Health Care System

Imagine a waiting room with no paper forms to fill out, where the health information is tailored for your needs.

Seamless Medical Systems (since renamed GetWellNetwork) uses iPads to provide patient registration, digital patient health education, and ongoing patient communications customized to individual health needs. The CHCF Health Innovation Fund partnered with Seamless after hearing from community health center leaders across California that they wanted to improve the patient appointment check-in experience and make the registration process more efficient. Digital tools present an ideal opportunity to improve medical practices, and they are prevalent in systems that serve mostly insured patients, but to a great extent these technologies have yet to be embraced by those who care for low-income communities in California.

The CHCF Health Innovation Fund supports health care technology companies that are trying to improve quality of care, lower costs, and improve access to care in the safety net. I talked with Seamless CEO David Perez about his company and about the progress and challenges in modernizing health care delivery.

Q: You have had a long career in the internet industry, launching companies and raising capital with a particular focus on the Latino market. What drew you to pursue opportunities in the health care safety-net setting?

A: I grew up in a medical family. My mother was a nurse who grew up in New Jersey, and my dad was a surgeon who emigrated from Bolivia in the 1950s. Many of my dad's patients were low-income Latino immigrants who sought him out because he spoke their language and always cared for people regardless of their ability to pay. As an entrepreneur, I started Seamless because I wanted to do something that would have a meaningful impact on a large number of people, and to honor my father's legacy.

David Perez

The idea for Seamless came to me at my own doctor's office while filling out paperwork and noticing the other patients waiting in the lobby reading outdated magazines and old newspapers. Wouldn't it be great if there were a way to fill these forms out digitally and access digital content about topics that matter to our health — everything from information on diabetes to the flu? I didn't want this kind of technology to be available only to wealthy clinics and their wealthy patients. I wanted to make sure underserved populations and the clinics that see those patients also had access to this innovative technology.

Q: Information-sharing platforms have transformed everything from sales transactions to photo sharing. How far along is health care in integrating information-sharing platforms into medical practices and the patient experience?

A: There are two million health care providers in the country, and there are 9,600 FQHCs [Federally Qualified Health Centers — clinics reimbursed by Medicaid and Medicare that care for underserved populations]. Yet less than 2% of all medical practices are using a platform like Seamless. Our nearly 190,000 clients have seen an average 80% reduction in registration time, a 20% increase in staff productivity, and savings from eliminating paper materials. A survey we conducted with patients using Seamless showed that 99% of patients found it easy to use and preferable to paper. The market potential for a product like Seamless is $4 billion. We believe that in five or eight years there will be a 60% penetration of products like Seamless in the market. The adoption of technological innovation increases over time, even in health care, where things happen a lot slower than in other industries.

Q: Seamless didn't initially serve the low-income/FQHC market. How did you adapt the product for those in the safety net?

A: Even before focusing on the safety net, Seamless was built to work in diverse settings. The platform is multilingual. With one touch, users can choose English, Spanish, Vietnamese, or Mandarin Chinese. It's a compassionate intake process because the questions on Seamless are easy to comprehend by a broad range of literacy levels. Most questions can be answered with a few finger taps and minimal typing. Recognizing the needs of the patient and making the forms easy to use allowed us to remove the intimidation factor some people feel when they are given a stack of paper forms. There is a lot of information in our MyHealth digital magazine that Medicaid users and patients in other safety-net programs may find useful, including information about asthma, diabetes, the flu, cancer screenings, and content about public health programs and services for the underserved. The goal is to help improve basic health literacy among all our readers. We have also leveraged our experience with serving retail clinics and integrating Seamless with their electronic medical records (EMR) platform, which happens to be the same platform used by many FQHC providers. And part of what helped prepare Seamless for this market was working with retail clinics. There is a fair amount of overlap between retail clinic clientele and Medicaid users.

Seamless tablet

Q: How has replacing paper with iPads transformed the medical practice for frontline staff, nurses, doctors, and administrators?

A: A clinic in New Mexico saved 80 person-hours of data entry after using Seamless for a month. Another clinic came back to us after only one week and said, "We don't even know how to use paper anymore!" Replacing paper with an iPad eliminates the use of thousands of sheets of paper and reduces one's carbon footprint. It also eliminates time-consuming, paper-related tasks such as data entry, scanning documents, shredding paper, and managing paper files. These efficiencies allow practices to focus on providing customer service and clinical care, as opposed to paperwork.

The greatest challenge to expanding innovations like Seamless is time. Medical practices are all very busy, and it's difficult to get enough of their attention to discuss how Seamless can make their practice or clinic more efficient.

Q: How does Seamless improve not only data collection but also the overall patient experience? What exactly does it change for patients?

A: For all patients the platform saves time, eliminates repetitive questions, and gets directly to patient needs based on their previous responses, so it's about using a device that's responsive to their own health profile.

I've personally visited clinics where Seamless is in use and have asked patients in the waiting room what they think. One woman shared that she wished all her doctors had Seamless. During another visit I saw an elderly woman react negatively to having to use an iPad, claiming she did not know how to use computers. After a short explanation from the receptionist at the office, she was able to complete the process very quickly and even told the staff there she wanted an iPad for herself! When we started building Seamless, we took into account all literacy levels and wanted to be accessible even to 80-year-olds who had not used a digital device.

Q: How is paperless administration changing health care delivery from the provider's perspective?

A: Especially in the case of FQHC providers that serve very diverse populations, staff members don't always speak English as their first language. Seamless makes it easier for them to gather complete and accurate information from patients and to reduce the stress of discussing confusing forms. The forms are then uploaded to the EMR automatically. More complete information supports clinical care and revenue cycle management. Some clinics have let us know that their patients think of them as being on the leading edge of technology because of Seamless. Their patients spread the word and recommend the clinic to friends and family.

Q: What other areas do you see in health care that look like opportunities to reinvent care for better patient outcomes in care, choice, control?

A: Health care needs a lot of innovation in chronic care management and health care literacy. These issues are separate but also related in many ways. The challenges in these areas exist for all populations, but particularly for the underserved.

Learn more about the CHCF Health Innovation Fund.