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Building a new patient treatment center from the ground up is not an easy task, as Dr. Michael Krupa, the founder and CEO of TaraVista Behavioral Health Center, can attest. Prior to opening TaraVista in 2016, Dr. Krupa knew that a state-of-the-art facility would require a comprehensive healthcare IT support system. He also knew that clinical applications alone were insufficient, that a strong development partner was essential, and that affordability was a bedrock consideration in the system review process.

“Treating a behavioral health patient means treating the entire patient and all ailments, not just the mental component,” Krupa said. “I needed a platform that spoke to the unique needs of behavioral health and included traditional medical inputs in one place. As a standalone facility with Medicare patients, the selected system had to meet a number of regulatory requirements, and we were fortunate to find a platform that checked all the boxes.”

In this podcast, Dr. Krupa generously shares the educational and research process he and his staff went through to identify an optimal healthcare IT solution. Much of the insight he acquired through countless hours is available here to other behavioral health providers and administrators who may be considering a move from paper to digital technology or from a limited behavioral health application to a fully functional platform.

Thanks for listening.

FULL TRANSCRIPT

Tyler Kern: Hello and welcome to The Full Circle Healthcare podcast presented by Medsphere. I’m your host today, Tyler Kern and on today’s episode, we’re discussing how to improve clinical and business processes in behavioral health hospitals and we have an expert joining us who can speak to these types of things. His name is Dr. Michael Krupa and he’s the CEO and founder of Taravista Behavioral Health Center. Dr. Krupa, thank you so much for joining me today.

Dr. Krupa: Oh, good morning. I’m really happy to participate in this.

Tyler Kern: Well, I’m really excited to get the chance to talk to you and to get your insights here on the podcast today and so I want to start off at a high level as we talk about healthcare records and that sort of thing. So tell me how having a comprehensive EHR system has helped you care for your patients perhaps, especially during this pandemic. What are the benefits of having a fully functional system versus a behavioral health focused application?

Dr. Krupa: Well it is so interesting that you’re speaking to me. We’re speaking together about 10 to 12 weeks into this COVID pandemic and I have to say one of the absolute best implications of having made the selection for CareVue and for an electronic health record at all, is that the presence of COVID and the need for a number of my staff to be able to have the capacity to work remotely would just have not at all been possible were we not have had this multi-function capacity. So I can have social workers for example, coders, physicians, physicians assistants, APRN work remotely and in fact, we have a COVID plus unit for patients here at the hospital that we developed over the last two months and we can have providers sit external to a patient, use a video platform, have the full access to the electronic health record, be able to do their notes, be able to make orders, review lab values, do all of that in one common format that just would not have been possible were we on a paper record.

So if we can, I want to take you and take anybody listening to this podcast sort of back in time to the point where we selected Medsphere and CareVue and that is that I had this idea of starting a hospital from scratch. The hospital is called Taravista Behavioral Health Center. It’s located just outside Boston and one of the very first decisions I needed to make was would we use an electronic health record at all? And if so, which one would we select? And I knew that this would be one of the most important decisions that I made as we launched the hospital and both to do it at all, many places were still on paper at that time. About five years ago when I conceptualized Taravista and then which one? And I hope I’m able to take our listeners through both how we decided and what my experience has been of CareVue in particular.

Tyler Kern: Absolutely. Yeah, we will absolutely touch on that and kind of talk through that process as well, but before we get there, I wanted to ask just how behavioral health care differs from acute and how that might impact the choice of a healthcare IT platform. So when you were walking through that process you know, explain to the listener just a little bit about those differences between behavioral health care and acute.

Dr. Krupa: Yeah. That’s a great question and observation and in fact, as listeners will know, there are choices that can be made that are either electronic health records that started within the med surge world and upended behavioral health to it or pure plays as they’re called behavioral health companies that focus exclusively on behavioral health and sort of build it from that point of view outward… First of all, I was uneducated. So I needed to become educated about what it was that I needed. I needed outside expertise to help guide me in all sorts of ways and I needed a platform that… Or I evolved into knowing what I needed is a platform that spoke to the unique needs of behavioral health.

Look let’s take a treatment plan for example, as one of those sort of core needs. There are several others, but start with the treatment plant. We really needed a kind of collaborative platform if you will, way that social workers, physicians, psychiatrists as well as medical physicians and many others can connect into this common platform… That’s not a typical thing. There’s not a treatment plant designed in the same way within the med surge environment that includes both medical inputs. You know, what are the lab values? What medical condition does this patient have that’s what we referred to as a comorbidities of diagnoses that include both behavioral health and physical health, diabetes, CPO, heart disease, other sorts of things that may play a role in a psychiatric sort of presentation? Substance abuse issues that have a medical sort of component. So we needed a platform.

We were seeking a platform that was going to have both behavioral health and traditional sort of medical inputs if you will, in one place and I needed to become educated about what was out there. We did examine pure play behavioral health platforms and had a number of reasons why we determined that was not the direction that we wanted to go and we’ve been satisfied with that. Just another piece to speak to about this is the regulatory environment. So behavioral health, we’re a standalone psychiatric facility and we needed a platform that would permit us to be compliant with various CMS centers for Medicare services. So those federal authorities, as well as our local department of mental health, we needed features that would speak to regulatory needs of those regulating bodies and the platform we selected ended up able to accomplish both of those needs. In other words, a regulatory need and a kind of practical team of people working together around a patient’s care and able to capture that within the medical record.

Tyler Kern: Right. And you know, you mentioned a little bit earlier that when you were going through this process of starting and opening Taravista, I think you said about five years ago. That makes it a relatively new facility. So talk me through some of the priorities that were in your mind as you were learning about healthcare IT systems and learning about what you needed in a healthcare IT system. So kind of talk me through those priorities and that decision making process that you went through that eventually led you to CareVue and Medsphere.

Dr. Krupa: Well as it turned out to be around a lot of things, so starting a hospital from scratch. I’d never done this before. The team that I brought together to do this had never done this before. It was a quite audacious kind of thing to take on. It required raising the money, it required finding a location that was going to work within Massachusetts and it required selecting just so many things that… I’m a clinical psychologist that I would never be typically involved in. I mean from food service and environmental services to again, something that’s… The clinical side of things and then ultimately in this case electronic health record and by the way, some other modules that are connected to it that were really important.

So I started out, as I say, needing a bit of an education about what it is that I should have embedded in such and they’re kind of two different, I call it broad categories of features that I really determined that I needed. I needed the clinical features. In other words, what is it that makes a doctors and nurses, social workers, and mental health counselors job sort of the easiest and captured information in an important way. So a whole set of clinical things which we’ll talk about, but I also had a set of business needs. I needed and learned and determined that I wanted things like revenue cycle, … How do you produce a bill from the services that you provide, how does the record get coded? There’s a whole medical coding process that goes on before a bill goes out the door, and I wanted it to be a system that already connected to an accounting package, which CareVue does and I also became educated about learning the total cost of the system.

So whatever initial outlay there is as well as what we’re going to be the maintenance costs and those are not always evident. I mean for example, one needs many more laptops. If you’re having an electronic health record, there has to be end user access via those laptops. There’s a WiFi system that has a different need when you’re talking about needing 24/7 access into the medical record. The servers, I mean, just sort of all sorts of implications when you’re on electronic health record platform versus a paper platform. So I needed advice about just what were those structural elements that should be built into it and then I needed advice about what would those all in costs likely be, because one does need a little bit more IT support, need more physical devices.

I have to contemplate what it will be like if users are working remotely, so secure means of virtual private networks of being able to get into this and have it basically as intrusion proof as possible. We’ve read a great deal about whether our system would ever be hacked. So that was another consideration that we needed to contemplate as we started and so I also focused as a part of my process of making determination of whether to use an electronic health record at all or not. I spoke with hospitals that were in the middle of implementing various systems. Ultimately I came to speak with hospitals that use Medsphere, but I started by interviewing CEOs and IT people and clinicians in other institutions that were in the midst of converting from paper to electronic health record and among the very first decisions I then made and feel fortunate that I made it actually as time has gone on, was to start right out with this electronic health record rather than building on a paper platform and then converting over and that decision had financial implications.

It was more expensive in the beginning to start with an electronic health record than it would have been to start with paper, but I observed how many of my colleagues out in the behavioral health world were struggling with doing an implementation that started from paper and so I took the risk if you will, of saying we’re going to start this way. I also felt like if we were going to be a state of the art hospital and we really are in many ways, our physical plant is spectacular, our usability of the space for patients and visitors and staff is extraordinary. It’d be hard to claim being a state of the art hospital and not be on a state of the art electronic health record platform and so that, that was another variable I guess, that went into my thinking.

Tyler Kern: Yeah, I think it’s really interesting the way that you talked through those variables and trying to understand all of the various costs associated and understanding the implications of starting with paper and then moving to an electronic healthcare record system and so you know, having that context I think is really important because it is important to balance all of those factors I suppose, both the functionality but also the cost associated and having that full picture of information. I think really led you to your final destination and where you ended up with this decision and that to me is a really interesting process that you went through.

Dr. Krupa: Yeah, thanks. And I think we may come back to it in a moment, but again as we started this podcast, we each made reference to the fact that we’re meeting, we’re talking today about 8, 10 weeks into this COVID pandemic and I guess, it comes back to mind for me again that if we were on paper, we just could not have had providers working remotely for example. We could not have coders who never had to step foot inside the building at all, but can review the electronic health record from a coding perspective totally remotely, and have the bill therefore ready to go out to our various payers in a much quicker fashion and their lives… The providers lives certainly were influenced by COVID and having this capacity to work remotely, but a coder is able to be within our electronic health record and work remotely. They work remotely before COVID, they continue to do it through this and it was just one of those unanticipated impacts for me that I hadn’t really thought through or been as aware of how positive that would be over time as it turned out to be.

Tyler Kern: Yeah. Absolutely. And you’re taking me exactly where I wanted to go next and that’s just talking about, how you have found the CareVue system to work with so far. So you’re talking a lot about the functionality and what it’s allowed you to do. So explain a little bit more in depth how the CareVue system has been to work with for you and how met your needs so far.

Dr. Krupa: Yeah. So let me talk if I can about kind of two different directions. So one is just the technical pieces of what this system permits us to do. It permits physicians and others to be able to review the record from the moment the patient is first evaluated even over the phone. I mean, we get all of our referrals just so listeners aware, they come from emergency rooms. So we have virtually no one who’s walking up to our front door or very few people even calling in advance for an admission and it just means that we’re hearing a clinical picture of a patient before they even step foot in the building from the emergency room. So that attending physician, that initial nurse doing a nursing assessment of the patient is able to see what that initial presentation was of a patient directly within the health record.

So that’s really helpful. They’re able to do order entry as it’s referred for ordering the first set of medications that a patient is going to be taking. They’re able to order labs. They’re able to… By the way this integrates with our automated pharmacy system…The listeners will know there are several that are out there and we need to say their names, but they’re automated dispensary sort of systems and inventory control that really are just absolutely terrific and super state of the art with delivered medications, and CareVue integrates with each of those systems making the upkeep very efficient. I mentioned before the treatment planning capacity. So in this age of COVID where we don’t want people meeting in a closed space together in person, we want them to be able to sit in their offices when necessary or just be on their laptop even with a patient.

They’re able to do that by going into CareVue with multiple users in it at the same time, able to see that electronic health record, make their notes, do a very sensitive thing to do and again, kind of comparing that to paper that is just not be possible. As is the case for other behavioral health facilities, we have what are referred to PAs, Physician Assistants. We have other medical doctors whose role and function is really on the medical side. Physical symptoms side of things, as opposed to they’re direct psychiatric or substance abuse care. Each of those users can tap into the system and both review the record in any way they want and then make their own notes and then finally, at the moment of discharge, we have discharged summaries created within the system, able to be printed out in paper.

A med list, by the way, doing med reconciliation of a patient’s medications. Able to have a final nursing meeting with a patient that reviews each the pieces here. So the next level of care you’re going to go to, remind you about the medications you’re on. Able to have that printed out and available for a patient and their family as they leave the institution. Able to have our utilization review experts who are folks who have to review the chart for talking with insurers. They’re able to go in and look at the record and extract from it the things that they need and then I guess I’d just say lastly, back to that regulatory thing.

We’re able to have extractions from the medical record done remotely by a third parties that do required reporting to various places including CMS, all within this platform that’s electronic. That lets these many different team members both from a medical point of view, as well as the regulatory point of view come in, and billing, be able to each use this same platform to come in, which kind of goes back to the beginning of my selection process. That was what I came to know, I really wanted. I did not want all of these to be existing in separate non-speaking pieces of which I’ve learned is one of the challenges of electronic health records.

Tyler Kern: Right. Absolutely. We’re talking to Dr. Michael Krupa, CEO and founder of the Taravista Behavioral Health Center. Doctor, one of the things that we’ve seen a lot in healthcare IT media is that there is frustration on the part of providers with the extra time that many systems require to enter patient data. Is that something that you have noticed and then has that been your experience and if so, how do you view the use of an electronic health record system in providing care?

Dr. Krupa: It’s a great and important question, including in particular the greatest number of people who may come to use this or any other system for that matter is going to be converting from paper to an electronic health record, right? That’s the biggest hurdle to sort of get over and I have a few observations about it. So first of all, anyone who comes to Taravista, any provider, they already know, this is one of the requirements of the work. They have to be comfortable with what it means to now be using a computer and entering data in that way and as you can imagine, there are generational differences.

I mean, these differences don’t travel only with age, but you could imagine anybody who’s 20, 30, 40 years old, they’ve been used to using a laptop, a device of some sort from inception. From when they were toddlers practically, and people who are my age and a little bit older than that, we may or may not have come to be that. Particularly as a practitioner, it may or may not have been part of… Certainly it wasn’t part of our early practice history and so variant degrees is likely sort of come along over time. So it certainly is important that people… It’s funny the most important skill is being able to type and you know, those folks who are really facile with typing quickly find that it really doesn’t present much of a barrier at all and those folks who haven’t really used… You know, not as facile with using computers generally, they of course are going to have more of a struggle.

By the way, this platform does integrate with some of the third party voice recognition software and we do have practitioners who found that to be a helpful aid and it’s worked terrifically with that. So those folks who want that kind of aid to entering notes have found it to be helpful, but I think it’s… I think that the most important piece to kind of call out here is this recognition together that a paper chart with different handwriting and the struggle that any of us go through of reading something from a typed page versus trying to decipher the handwriting of a physicians, nurses, everybody in that chart.

Dr. Krupa: I mean, it nearly goes without saying, but it’s important to call out just how much of an improvement in care, a probability of reducing errors, of being able to read off those medications from what’s a typewritten page versus somebody’s handwritten notes, extraordinarily different, very different for regulators coming in and reviewing a chart to make sure it’s compliant. If they have to fight through reading the poor handwriting of any member of the care team versus being able to see that as a typewritten page, it’s just enormously and obviously more helpful. Who of us wants to read handwriting that varies in its style and its legibility versus being able to read a printed page that’s typewritten. That’s just enormously, enormously important and it has a certainty of reducing the probability of errors.

Tyler Kern: Right. No, that absolutely makes sense and you know, God help the person that tries to read my handwriting at any point and so I absolutely understand the argument there and I think that what you’re saying makes a lot of sense, because if you take the time on the front end to type it out and reduce errors on the back end, reduce time spent trying to decipher handwriting on that side then in the end that balances out and really makes it worthwhile to make sure that the records are accurate and that people are able to easily read and communicate what they’re seeing in charts and so I think that, that makes a lot of sense just in terms of how it improves operations overall.

Dr. Krupa: I would say it’s absolutely true and… To the question that you’ve posed about just to take more time, I’m actually not certain because I haven’t done the time studies to look at the overall time. If you measure only, can you sit and write a handwritten note versus sitting and typing it. It certainly is possible that there’s a greater ease and that it goes faster by just sort of scribbling out a note, but really the notion of time has to include these other pieces, where do you go in the chart? Where do you go to look for the meds as they were written out? How much time does it take to decipher that handwriting versus something that’s typewritten? So if you were to do the kind of analytics of looking at a total time, I’m not certain that electronic health record does add any time or create the need for more of it and I will say this with absolute certainty and that is that.

All of our practitioners, once they get acclimated to really this or any electronic record, the frictional costs of that time within the chart gets to be fewer. I mean, we have practitioners that come in that are not comfortable with electronic health records in the beginning. Our IT person has to spend a lot more time educating them. There’s certainly provider variability, some people will pick it up right away and need very little further attention and others who just need more time, over a bit of time and I don’t mean over years.

Over a matter weeks, people acclimate to what the interface looks like, about how to use it, about how to make certain saves in certain places, et cetera. And uniformly, their comfort with the electronic health record grows and I would dare to say that should be a rare practitioner once acclimated would ever think that it would be better to go back to paper and pencil. It sort of hard to imagine that anyone would advocate going backwards once they found their way.

Tyler Kern: Right. So doctor, do you feel like the revenue cycle management component of CareVue has improved facility revenue over what it would be on paper with a different type of solution?

Dr. Krupa: Yeah, it’s a great question and as you heard in the beginning of my contemplating, which platform to use. I really knew enough to know that I really wanted the revenue cycle of patient registration. A place where you enter the authorization for care, all of that business to be integrated… Electronic health record, to be integrated with our accounting platform and CareVue and Medsphere brought that to us. It was one of our selection needs. So I can’t speak to what it would have been like were we not to have used this platform, right? As you heard, we’ve decided right from the beginning, we were going to use an electronic health record and the corresponding pieces inside like the revenue cycle.

With RCM, we can do these analytics of looking at for example, how many in-house patients do we have where we choose not to draw the bill until they are actually discharged. We’re able to see how many charts are sitting there ready to go for billing, but are awaiting the coding piece, right? We can track that bit of what that time is. We can track the time when the bill actually went out to the insured, went through a clearing house and was noted to be received, and then when do we get the money actually in-house and the electronic health record and the corresponding revenue cycle piece.

Once it’s out the door, it’s a clean claim. That now is something we need to manage directly with the insurance company, but what this product does do and any of them should do is let one look into those analytics and also reduce that time that the chart sits in a queue, if you will and the bill sits in the queue unable to be produced because the coding isn’t done, right. That process it’s necessary for any healthcare institutions to do, which is that you review the chart for what are the proper codes, the billing codes to be used to send a bill out and by having electronic health record, we’re able to manage that, measure it, watch it. We can look over the shoulder of the coder if you will, and see how many charts are waiting to be coded and really importantly, we reduce that time.

I mean, we produce coded charts within our institution with a matter of hours today. So it’s no longer than one or two days that a patient is discharged and the chart is waiting to be coded and again, that’s enabled by an external coder, that’s a big deal all by itself. They’re able to sit at home, sit wherever they want to be and view the record as an electronic version. When you think about the alternative we would have had to either have him sit here in the institution in medical records, pouring through a bunch of paper to organize the chart. First of all, that’s a notorious way you can… Important things to do with the medical records.

You know, make sure that each of the tasks, that each of the indicators of care have to review all of those and then add in paper away that the codes are noted and then get that bill out the door. That now has been reduced to be somebody sitting in front of a computer screen with the full record in front of them and able to attach the appropriate codes before all the chart goes out the door. That’s a really important part of that revenue cycle, that’s controllable by an institution to be as short as possible, and therefore to result in both appropriate, emphasize appropriate reimbursement, not under, nor over what it’s supposed to be and as expeditious as possible for those variables that we control within the institution.

Tyler Kern: You know, you mentioned, talking a little bit more about the support that you’ve received from Medsphere as a partner and working together. I was wondering if you could just go into a little bit more detail about how that support has worked for you and just kind of explain a little bit more about partnering alongside Medsphere and what that has looked like.

Dr. Krupa: Yeah. So that is probably the most important ingredient in selecting any or it’s among the most. It’s sort of hard to pair it out with… If the basis of the product didn’t work sufficiently, then it doesn’t matter how much good service it has, it wouldn’t be able to make up for it. So you really need to have both pieces, but in our case as a startup, I really emphasized, that’s an enormous challenge for us and anybody who kind of walks along with us to come into this journey of being a startup and I mean, I’m thinking back to the days when Medsphere provided their experts to train us in the use of the electronic health record and again, I mean both the medical side of it, right. It required all of our staff to be trained in how to use it, but it also, these things like revenue cycle, right?

The billing people. The in check and billing people had to be trained and our building actually was not completed quite on time for when we already retained Medsphere. So we needed to do training in this remote site set up by a test environment. An environment where we had no patients, we had no real records, we had none of that and we had to be training folks for the use of it and they were enormously flexible both about the timing, the place. I still have in my head, this image of setting all these computers up in a row in a big conference room and our users sitting there and being trained by the folks at Medsphere and it had to be all about make believe patients and intakes, et cetera. Because we didn’t have any such on board and we needed to be ready with our first admission, which came up four years ago, this coming November. Those first admissions to arrive it had to actually work, right. Have all the pieces actually sort of work.

So Medsphere was terrific and in advance of that, of setting up all the systems, of being with us. They were here with us as we admitted our first patients to make certain that all of this was working properly and then really importantly, they’ve been with us as we together… And I’m sure we’ve helped Medsphere too, as we’ve added various features and help them provide features that we really need. So we’ve worked together on that treatment planning process that I may a little bit of mentioned too earlier.

We’re working with Medsphere right now on a more efficient way for us to build what are referred to as part B the physician, the professional billing part of care within the behavioral health system. We want to have that same platform usable for doing that part, the billing, and they’re working closely with us to develop that. So they’ve been helpful to us in how this was priced. They recognize with us that we were a startup, so we wanted the pricing of it to reflect our having no revenue to begin with and then ultimately getting up to where we’re now, which is a full scale hospital and they just were enormously flexible with us in doing that and it’s just been such an important part of our launch here.

Tyler Kern: Right. Absolutely. So you mentioned that the pharmacy aspect earlier, and I wanted to take us back there real quick, because I understand that Taravista is a beta test site for Medsphere’s new pharmacy module. So how has Medsphere been as a development partner? How have you worked together in that way? And do you feel like you’ve had input and influence with regard to application development and things along those lines?

Dr. Krupa: Yeah. So the answer to each of those questions is yes. So with pharmacy med reconciliation, this process of reconciling what are the meds that a patient presents with an emergency room? Where do they get their medications? Verify what those are at the front end, and then also on the back end, right. What are the pharmaceuticals that someone’s being discharged with? And as I said earlier, we use… Most places I think now are using it if they don’t, they certainly will be.

You know, the two most prominent companies are Pyxis or Omnicell. We happen to have chosen Omnicell, but these electronic methods of medication management and an order entry physicians. All of those modules work with Medsphere. I actually can’t reconstruct in time how many were all set up before they ever joined us, but I know that it’s been a pretty seamless process of making sure that each of those speak together and they’ve worked terrifically and they needed to be… I think what any system like this to be quote state of the art needs to have that sort of integration, which this does.

Tyler Kern: Absolutely. So what do you see moving forward? I know you mentioned a little bit earlier, just how when it comes to support and working with Medsphere some of the ways that you’re building towards the future, but kind of talk about how you picture that partnership between Taravista and CareVue, really working together and moving forward, and how can Medsphere continue to evolve as your business grows and as things continue to progress.

Dr. Krupa: Yeah. So one of the areas that I set out as one of my aspirational goals for Taravista as a whole was patient participation in their own care. So one of the pieces that is sort of I don’t know, been notoriously there for all of healthcare is that the electronic health record is viewed and has been used as something that principally has served the needs of the providers. Right? You have a social worker, a doctor, a nurse who are able to collaborate and have put to the medical record what they’re thinking is, what interventions they made.

You know, this medicine, this lab, et cetera, but with patients pretty removed from it, right. Patients not directly… I mean, they have a voice about what happens, but not necessarily seeing it, not seeing what exists within that health record. So my hope is that we will and do it with Medsphere, but we’ll evolve into ways to sort of solve this issue of how can we have patients tie in, have access to the record in a way that could be helpful for them as they move on to other levels of care and not have it be such a mysterious record I guess, of what their care that they typically just don’t have much access to and it isn’t that they can’t, they’re able to request it.

Of course we provide their record any time they want it, but I could imagine there being a sort of evolution where it’s easier and the sort of interface and the opportunities become easier for patients to kind of be more at the table of looking at and understanding why this medicine, why this… And I don’t quite have articulated fully what that looks like, but I could imagine that that’d be one of the pieces that sort of evolves not just with Medsphere, but for all, any one of these electronic health records and a greater participation of patients being able to see it, have access to it, et cetera. It’s brought with it challenges as you can imagine. It is protected information we need to be certain that it’s not breached, right. It’d be catastrophic if somebody’s electronic health record is breached in some way. So it’s not as if it’s an easy thing to solve, but I could imagine that that will be one of the things that evolves over time.

Tyler Kern: So Dr. Krupa, I want to give you the opportunity here just to summarize your experience with Medsphere and the CareVue system and also just, to talk a little bit about anything that we haven’t discussed up to this point on the podcast. So just in closing if you could summarize your experience and also mention anything that we failed to mention on the podcast so far.

Dr. Krupa: Sure. Well, I guess in summary, I needed to make a really mission critical choice very early on before the building construction had even been underway about whether to use an electronic health record or not and if so, which one to use, and as I said earlier, I did make this determination that to be a state of the art facility, we really needed to use an electronic health record. I didn’t speak much about it, but we vetted 10, I think we ultimately had 10 companies that we’d use a third party to go out and solicit bids from and descriptions of what their products were. We narrowed that down to be three or four that came in and did in person presentations and really importantly, I reached out to facilities that have used every one of these to learn about their experience of implementing it. What was the team like? What was the product like?, et cetera. And I didn’t really emphasize this earlier, but I really wanted something that was very good value for the dollar pay.

There’s great variation in what the costs of electronic health records are. People may know that CareVue evolved out of a system called Vista within the VA. By the way, I didn’t make mention this earlier, but it was a practitioner who had been in the VA and said, are you aware of a Vista? It’s a good system. I used it when I did my training and I wasn’t aware at the time. It was part of how I found my way to Medsphere and CareVue. It’s open source software. It’s been developed basically originally on… You know, what? All of us tax payers within the VA system and possibly that means it may be the oldest most long existing electronic health record that exists in the US because of that history back in the VA. So I chose something that would have good value. I was less focused on the fanciness of the interface and that doesn’t mean that it’s a bad interface at all, but it just means that I was really focused on what had the greatest functionality and what was a good value.

A good product for the dollar that we spent and then I just would emphasize again, this sense of partnership that electronic health record of whether you buy it and now we’re converting over from paper or in my case, starting from scratch really need a lot of hand holding from the company that you select and we found people who are interpersonally terrifically skilled, and just did a great interface. They had obviously just complete depth of experience with what the product is. They know every bit of how those… The kind of computer interface works and they’ve been readily available. They’re instantly available actually. As you know, an electronic health record has to be available 24/7.

It has to be here at which it has been when the power went out and we went on a generator, it is something that must be available all the time and it certainly has been. So I just emphasized my own experience has been very positive in that way and perhaps lastly, they’ve been a good partner to work with to develop new pieces, new functionality that we really have found that we need over time. So I just have been terrifically happy, I’ve urged colleagues, not all of them have taken my advice, but I urge colleagues to move over to an electronic health record as quickly as possible if they’re not on it already and to certainly give this company a good look because I’ve been just so happy with them.

Tyler Kern: Well Dr. Krupa, this has been a really fun and informative and educational conversation and I’ve really appreciated your time and diving into these topics with us and telling us a little bit more about how this has been beneficial for your business there at Taravista, and also just been a huge booster of revenue and convenience and that sort of thing and so this has been a fantastic conversation today and so I thank you so much for your time and for joining us here on The Full Circle Healthcare podcast by Medsphere.

Dr. Krupa: Well, thank you so much. It’s been very enjoyable experience.

Tyler Kern: Everybody. Thank you for listening to this episode of Full Circle Healthcare. For more podcasts just like it, make sure to head to a The Full Circle Healthcare podcast on either Apple podcasts or Spotify. Make sure you hit subscribe and you can go back and listen to previous episodes and get future episodes right there on your mobile devices. We’ll be back soon with more episodes, but until then, I’ve been your host today. Tyler Kern. Stay safe.