Giving time back to our doctors and nurses to deliver patient care
We are a nation with the highest per capita healthcare spend in the world, 2 times that of comparable wealthy nations.
There are myriad reasons such as significantly higher prices, over-utilization of expensive services (i.e. MRI, CT scans) and the highest prevalence of obesity (whopping 70.1%), but today I want to focus on one that’s largely invisible to the general public: clinician administrative workload and burnout. The administrative costs of care across planning, regulating and managing of health systems and services account for 8% of total US healthcare cost vs. 1–3% in comparable wealthy nations. The negative impact goes far beyond just cost. Nearly 50% of physicians feel burned out, the worst hitting frontline (internal medicine, family medicine, ob/gyn) and critical care specialties (ER).
Burned out clinicians mean decreased quality of care, a negative ripple effect on the rest of the staff, turnover, or in the most tragic cases, suicide. It costs a staggering $800,000 to $1.3 million to replace a doctor.
One of the biggest culprits is the electronic medical record (EHR), the all-in-one email, CRM, billing and compliance tool of the healthcare industry. If you think you spend way too much time in email, get this: doctors spend 2 hours clicking and typing away for every 1 hour of direct patient care delivered. A recent survey of family physicians showed on average 4.5 hours during work and 1.5 hours after work spent in EHRs. A simple flu shot requires 32 clicks to get documented!
I’m super excited to announce our funding of Canvas Medical along with fantastic co-investors iSeed Ventures, Village Global and prominent healthcare technology angels to solve this exact problem; I led the $3 million financing and joined the board. I met Andrew and Julian a year ago in SF. Andrew is an incredible product-driven CEO who has been working on this problem for years: first as a data scientist at Practice Fusion, then striking out on his own to build a new EHR from the ground up when he realized it couldn’t be solved through an incumbent system. He built the first version of the product and sold the first pilot customer all on his own. Julian then joined from Center for Medicare and Medicaid (CMS), where he reported directly to the Director of Innovation. From all my references and interactions with Julian, he’s the kind of rare subject matter expert who can also execute day to day, having built the Pioneer and Next Generation ACO models then helped program participants succeed.
The team launched product this quarter and has multiple primary care groups running their practice fully on Canvas already. In addition to the need for reducing administrative cost and easing clinician burden, now is the time as our healthcare system continues to shift from fee-for-service (billing for every rendered service, leading to over-utilization) towards value-based care (reimbursement based on actual clinical outcomes, leading to cheaper and better care). With continued bipartisan support, Medicare is moving toward having 50% of payments tied to non-fee-for-service models by the end of the year, with private payers following. To harvest those reimbursement dollars, practices need to gather medical records and submit proof on the various quality metrics they are measured on. Canvas makes the relevant data aggregation and submission a breeze: the key is to automatically categorize and structure medical record data as clinicians enter them.
The product is called Canvas because physicians start recording a new patient encounter on a blank page, and as they start typing, the constantly improving algorithm pulls from historical patient data to predict what you’re documenting next. It’s like Google auto-complete on steroids. In turn, you’re spending 1/3 the time in completing a record and importantly, every clinical and admin piece of data entered from diagnostics to procedures, patient demographics to billing events, becomes fully structured and searchable. You can then easily analyze your patient data for better (and automated) tracking of disease progression, prediction of potential risk or adverse events, avoidance of redundant or unnecessary services, more accurate billing submissions, to eventually large-scale population health studies that uncover the waste and opportunities in our broken healthcare system. Flatiron Health, which just sold to Roche for $1.9 billion for the treasure trove of oncology medical records they had, bought an oncology EHR company to build up that dataset. I strongly believe there’s tremendous value in organizing medical record data from the get-go, both in reducing workload and improving accuracy in care delivery and reimbursement day-to-day, as well as building up high-value, longitudinal healthcare data.
Despite it being challenging prying physicians away from their busy days to consider a new EHR (even when it’s supposed to help shave hours off their day), it’s been exciting watching the team turn on lightbulbs in clinicians’ minds with their memorable outbound sales campaigns, elegant product demo and clear subject matter expertise. Short of payroll and malpractice, EHR and the related IT costs that Canvas replaces are the biggest expense items for clinicians, accounting for up to 10% or more of their annual reimbursements. A three-physician primary care practice can earn $1–2 million and spend $100,000+ annually. You’d be hard-pressed to find another vertical with that kind of economics where the end user is the buyer. The Canvas team can not only replace existing EHRs for less but significantly save clinicians’ time so they can see more patients and improve accuracy in their billings, resulting in increased revenue. I am excited to go on this journey with Andrew, Julian and the rest of the Canvas Medical team in helping doctors and nurses take back their administrative time and instead, focus on delivering patient care.
