Healthie

So today, we’re chatting about Healthie and how it’s used at your company. Before we jump into that, could you give a brief overview of the company and your role there?

We are a network of primary care offices that subscribe to a membership medicine model, where membership fees are paid to cover non-covered services such as health coaching and wellness services. We have offices across the south through the mid-atlantic region. I’m responsible for all aspects of operations, technology and project management.

What was the core business need that drove you to look for a solution like Healthie?

As a practice, we’ve always had both the clinical part of primary care in addition to a wellness component. A few years ago, we increased our investment in wellness content for our members. We spent a lot of time building a large library of content and needed a platform to deliver that content to our members.

What key requirements did you have when evaluating solutions for this need?

The key requirements we had were the ability to create an online course catalog, as well as the ability for members to sign up for classes, some of which would be included in the membership fee, and some of which would be charged at an additional fee. We also needed a platform that could deliver the content through both the web and a smartphone application. Those were our core high-level requirements.

Did you look at any other vendors?

No; the physician who runs our wellness organization ran across Healthie, looked at it, and thought it checked the majority of the boxes. So we stopped there and decided to implement Healthie.

Did Healthie meet all of your requirements?

Some yes, some no. On the wellness platform side, they actually couldn’t deliver the course catalog requirement. We ended up building our course catalog inside of our website then integrating it with the individual courses in Healthie. They were able to deliver content and allow for the sign-up and delivery of classes; as well as schedule integration with our EMR.

What was the sales process and onboarding experience with Healthie like?

The sales process was pretty typical, but their licensing structure was rather unusual. They don’t charge an implementation fee; instead, they charge a fee based on how you integrate the system. For example, integrating with athenahealth might cost you $20,000 initially. That fee is charged annually, even though the bulk of the integration work is done upfront and the remainder is simply maintenance. The iPhone application may cost an additional $20,000 annually; the licensing fees are based on different chunks of functionality.

Within each license, they include a certain number of license pairs, which consist of an admin license and a provider license. Initially, they provide a specific number of these licenses. If you require additional licenses, you can only purchase them in pairs. If you have many physicians and few admins, you’ll have excess admin licenses, or vice versa. There is no pricing based on patient access or usage; it’s all based on specific functionalities and the number of providers you need to give access to. Overall, it’s a very unusual licensing structure that I personally haven’t come across before.

Can you give me some more details on how the initial vision was realized through Healthie and how it fits into your overall care model?

There are a couple of ways in which our patients can access the wellness content. Firstly, they can visit our website, browse the catalog (all outside of Healthie), and sign up for a class. When they click on a specific class, they are redirected to Healthie. In Healthie, if they already have a login, they can access the platform. We have pre-populated Healthie with all of our patient data, which is synced from athenahealth. The patient’s user ID is their email address, and that information is displayed on the page. Patients can then create or reset their passwords as needed to log in and access the content.

The other way patients can access the content is through internal referrals. When a physician refers a patient to a specific topic/course , they go through our coordinator, who then works with the patient to set up their Healthie account. The coordinator can then sign them up for the desired class, and the patient can log in to Healthie and access all the courses available. They can review any content, whether videos, PDFs, or any other format in which the content is delivered. All of this content is accessible within the Healthie portal.

What does the clinician administrative workflow look like? Are clinicians keeping track of patient usage of the courses, and do they access dashboard analytics?

Healthie itself doesn’t offer robust reporting capabilities or the ability to provision dashboards or reports for providers or administrative staff. As a workaround, we export data from Healthie into a SQL database. From there, we have various scripts that run against the data to generate dashboards.

What are the typical next steps from a clinical workflow perspective? What is the purpose of monitoring and tracking patient engagement with the courses?

It varies—once patients are in the wellness university, the health coach becomes the main point of contact. Each patient is assigned a health coach who stays informed about their progress and is tasked with following up with patients.

If a patient schedules a coaching visit with the health coach, the coach creates an appointment within Healthie, which creates a note that’s transferred to athenahealth, where a summary of the encounter with the health coach can be reviewed by the physician.

However, there isn’t currently an effective way to relay information from purely independent training or courses, such as video courses, back to the physician on a patient-by-patient basis. Physicians do receive monthly reports from the SQL database, which provide information on how many patients within their panel are engaging with the wellness university. However, unless there is a visit with the health coach, Healthie doesn’t have a mechanism to directly feed this information back to the physician.

How effective has the platform been in empowering this aspect of your operations?

The initial implementation phase took almost a year to complete. The integration with athenahealth posed some challenges. It seemed as though we may have been one of the first few integrations or possibly one of the only ones with our specific requirements. Since our organization spans multiple locations, states, and tax IDs, the integration process was complex. As a result, it took longer than anticipated to get it up and running smoothly.

What is the extent of the integration with athenahealth?

When we initially contracted with Healthie, our requirements included a two-way scheduling integration and a one-way transfer of clinical information from Healthie to athenahealth. This would allow Healthie encounter data to be pushed into athenahealth and for demographics to come from athenahealth to Healthie. We didn’t want to push demographic changes back into athenahealth due to our workflow considerations.

Initially, we also wanted to provide single sign-on for the patient portal, but we realized that athenahealth wouldn’t offer this functionality and removed it from the licensing agreement.

The high-level vision was to enable health coaches to work entirely within Healthie. While they do work within Healthie to a certain extent, the majority of chart data resides in athenahealth, so they still have to access athenahealth to review that data. However, in terms of patient interaction, the goal was for health coaches to primarily operate within Healthie, where they could access their schedule, see patients, create encounters, document the necessary information, and sign off on the encounter, after which the information would be pushed to athenahealth as a clinical document. This clinical document is then routed to the physician for review, after which it can be closed in the system.

How has Healthie worked out for you in terms of meeting your needs and expectations?

Healthie meets the basic requirements, but there are some areas where it falls short. For example, the workflow for patients can be cumbersome. They have to navigate between the application and their email to access the system, which is not streamlined. For example, when they sign up for a webinar, they need to go into their email to claim their seat rather than reserving it directly within Healthie. Healthie does the basics in terms of delivering the content and provisioning the classes, but the user experience is clumsy.

What other feedback have you received from patients about their experience with the platform?

In general, the feedback we’ve received indicates that the platform is not intuitive and can feel disjointed at times. Patients have expressed difficulties in finding the specific content they need within the platform because the catalog of courses is not housed within the platform itself. If they want to access a new course, they have to exit the portal, visit the website to browse the catalog, sign up for the desired class, and then navigate back to the platform to access the class. The process is just very clumsy from a user experience perspective.

From the administrative and physician perspective, what would you say are the key strengths and weaknesses of the platform in terms of clinical usage?

The physicians in our context are the health coaches; they’re really the only ones who interact with it. Their requirements are very basic, so for the most part, it meets those needs. They can schedule classes, and the platform performs real-time checks to avoid double bookings. They can also document their encounters, and that process is straightforward because there’s no need for complex macros or intricate encounter plans. From a documentation perspective, it fulfills their requirements adequately. However, they’re not doing any of the truly clinical work in Healthie – they’re not taking vitals or anything like that.

What were the main reasons behind your decision to move away from Healthie? What core problem area drove that decision?

There are a couple of factors that led to the decision to move away from Healthie. Firstly, Healthie’s strategic direction has shifted over the past three years. Initially, they were focused on supporting wellness, but now they’re moving towards becoming an EMR, and that’s simply not what our organization needs.

We also have specific requirements for delivering content, which Healthie may not be able to fulfill as they evolve into an EMR platform. Our priority is to provide an exceptional user experience for our patients, and that’s just not consistent with the direction Healthie is taking.

We encountered several challenges with Healthie’s login process. We found that we’re unable to customize it to meet our specific needs and streamline the experience for our users. The lack of clear instructions has also led to difficulties and frustration for our customers. One specific issue we have with the login process is the inability to customize the “Package Purchase” screens, which has a negative impact on the user experience.

We’ve also experienced problems with unscheduled and unannounced product upgrades during business hours, which have caused errors and problems for both us and our users on multiple occasions. Additionally, changes in privileges that occur with these upgrades are often not communicated to us. When we raised our concerns about this, we were simply told that Healthie is following industry best practices. While new features can be disruptive when introduced without notice, our main concern lies with the bugs that are often introduced with these updates.

Another area of difficulty we encountered is with schedule-syncing, which is often blamed on the athenahealth API interface. We’ve experienced periodic problems that have not been tracked down and resolved, such as failed appointment check-ins and issues with syncing between Healthie and athena.

In addition to these general challenges, there are specific features and functionalities of Healthie that we have had to work around. For example, we found that group privileges are transitory, meaning that attributes associated with a group disappear when a user changes groups. This has caused issues with features being turned off or lost when users switch between groups.

Another issue we encountered is with notification emails for the internal team. When creating a course package, the notifications are sent to us as the creators rather than the patient’s assigned healthcare provider or the healthcare provider assigned for a particular course. This has caused confusion and is not ideal for our workflow.

Other features that have caused difficulties include package links that never expire, limited reporting capabilities, a lack of location awareness/functionality for offices and in-person appointments and events, the need to manually reserve seats for group appointments due to the transitory nature of group assignments, a lack of accessible audit-logging to track actions such as scheduling or canceling appointments, and the inability to prevent duplicate course registrations or package purchases.

Fundamentally, we wanted a single portal that would seamlessly integrate clinical data and wellness data, which we realized would not be possible with Healthie. We want more flexibility in delivering classes without users having to switch between different platforms. Reliable integration has also been a concern; we’ve experienced issues where the integration would unexpectedly break, causing us to redo our work.

We believe that Healthie needs time to develop into a more robust enterprise software platform, but we aren’t able to invest the time and effort into waiting for that to happen.

How do you plan on replacing Healthie and ensuring that your patients continue to have a similar experience with your wellness university?

We will be using a platform called Fold Health to replace Healthie in delivering our wellness university. Fold will also integrate seamlessly with our core EHR system; the integration between Fold and athenahealth feels more native compared to the integration with Healthie. Fold has a strong engineering team that originated from Praxify, which was the product that eventually became athenaOne. Their core engineering team effectively came out of athenahealth. Our plan moving forward is to continue utilizing our core EHR system, athenahealth, and leverage Fold to deliver additional extensions to enhance the patient experience.

Fold will power the patient portal and overall patient experience. Patients will interact with Fold to sign up for classes, take classes, access content, and have video visits. All of these functionalities will be consolidated within the Fold platform. The health coaches will transition from Healthie to Fold to do their documentation, and they’ll primarily utilize the features and tools within the Fold platform.

While the documentation by health coaches will now be done in Fold, the documentation will be held in athenahealth. However, with Fold integrated on top of athenahealth, accessing that data within athenahealth will be more seamless and native.

Is there anything else you’d like to note about the user experience?

No; I understand that Healthie is going through some changes, and I don’t want to criticize them. Our decision to transition away from Healthie is primarily due to a misalignment between our goals and their current direction as an organization. I think Healthie needs a bit more time to mature into an enterprise-level organization; our interactions with them have been lacking in some respects, whether it’s attention to detail, turnaround time, and sense of urgency when addressing issues.

Can you provide a high-level overview of your experience with Healthie’s account management and support teams?

It used to be better; Healthie’s account management team has experienced turnover, which has affected their level of service. Thankfully, our account manager has been with them for a while, which has been good, but it seems that everything hinges on one key technical person, which creates a bottleneck. When issues arise, it can be difficult to get them resolved in a timely manner.

Looking back, do you believe that moving forward with Healthie was the right decision?

It’s difficult for me to answer that because we were initially drawn into the relationship with Healthie without fully exploring other products on the market. Looking back, I would have conducted more thorough due diligence.

Do you have any advice for organizations that are considering procuring a similar solution, specifically something that is adjacent to their EHR, to enhance their care coordination efforts?

My advice would be to invest time upfront in clearly defining your requirements. It’s crucial to ensure strong alignment not only with the current capabilities of the product but also with its future roadmap.

Do you have any specific recommendations for the Healthie team in terms of areas where they should focus their attention?

I would suggest that Healthie be more open to actively listening to their customers.