Your Functional Medicine EHR doesn’t do these.. (And its stealing your life)

Essential EHR requirements for functional medicine success. So, here’s the problem. I spent two hours charting a 1-hour visit. And it’s not because I’m slow. It’s because the system that I was using was built to build insurance, not to help people become healthy. So, that is the gap, which I hardly understand why I need to even mention it. It’s stealing your life. So, why should you listen to me? Well, I’m Dr. J and I built this system called Esprē Health and I have a long time in the emergency medicine department which as you well know it’s exciting to me it was incredibly fun but it was focused on a problem get that patient keep them alive till sunrise or fix the problem and what we uh turn and burn right hit the street but I found it wasn’t enough and I decided I’d want to do something a little bit more fulfilling And after getting involved with functional medicine, I thought, man, this is the holy grail. But the thing that was not known was that doing it well, it takes all that you have. You have to really think the whole time. You got to build a story. And what wound up happening was because of the electronic health record debacle, a lot of late nights, a lot of time missed with family, um, and a lot of the people who do functional medicine because the EHR is so poorly equipped to deal with functional medicine. Great for the ER, urgent care, and for a little primary care that does just sore throats and snotty noses, perfect. But there’s a lot of resentment out there. But what you’re going to learn is what an EHR should have always been, but really until Esprē has never been what needs to happen for functional medicine to really work? Well, in standard practice management, there’s just this complete disconnect with the root cause, And with getting that root cause, you’re asking to really get to know the patient well, to know their whole story. And that takes time unless you have a mechanism to do that. Unless your architecture is built differently. And um if it is the return of the excitement that functional medicine brought me um and maybe you’ve experienced this, maybe not functional medicine, but almost everybody who’s become a medical professional has had a moment where they thought, I got into medical school. This is going to be so great. Or I got my nurse practitioner certificate. I’m so excited. And then the EHR nightmare, Well, where does it come from? Well, EHRs were built in the early 2000s to ask one question. What’s the chief complaint? Assign an ICD code to it and then build the insurance company so that that always works. The billing always works. The billing always works. That was the thing. And that way, the people who decided to have EHRs all over the place were the insurance companies and the government, right? So, they wanted to be able to track that. That’s not what functional medicine’s about. Functional medicine is about the patient about knowing the story and why is the patient suffering and believe it or not the ICD code has almost nothing to do with it almost nothing right in the traditional model the chief complaint drives everything you have let’s say knee pain well when did it start what have you done ICD code billing end of story okay and then maybe you’ll put together a treatment plan if you’re an orthopedic surgeon you probably see him Otherwise, you make the referral. Oh, I’m sorry. Was I falling asleep? Functional medicine. Knee pain. Okay. Now, let’s ask the story. Ask about the story. Okay. Where could knee pain come from that’s not the knee itself, hormone imbalance, chronic infection, systemic inflammation, gut dysfunction. I mean, I could go on and on. So, you have to understand the whole story. sleep, stress, hormones, nutrition, toxins, um the timeline of the illness that does not fit into an ICD 10 box. It just doesn’t work right. Let me give you an example. During my ER years, this is real. A young lady comes in with really bad belly pain. And um the reason that they thought she had bad belly pain was because she had such severe constipation. So, everybody focused on that symptom. And you can imagine in the ER, that’s a really popular situation, right? Everybody’s standing outside of her bay going, “Oh my gosh, this kid has belly pain from constipation.” But I came in at the end of my or at the beginning of my shift at the end of another person’s shift. And um, they had waited hours because of that. You know how ER is with those kinds of things. Um, I walked in and the mom ripped me from head to toe. How dare you make us wait? And I said, I’ve just begun my shift this minute. Let me hear your story. I had some time. I wasn’t burned out at that point because I was on a 12 hour shift I just started. Horrible anxiety, depression, uh bad boyfriend situations, long-standing history of uh recurrent infections. There was no room in the ER for that story to develop. Understandably, that’s not what the ER is for, right? Um but her story told a completely different pattern of her problem than constipation. What an annoying kid and her crazy mom. Um so there was no place for that story. Of course she left the ER with a laxative. That was not my treatment plan. We actually followed her up and handled all of those other underlying issues. Not only did she stop having belly pain, but she became really well and became a really happy person. Her anxiety and depression resolved, right? Um, but right now the problem with the EHR world is it’s pushing everybody into being kind of an urgent doctor, kind of sort of like an ER and that’s not really good. So, the standard EHR is designed like that about symptom suppression, treat them and treat them, right? Functional medicine, I need to know the story. And when I walked in on that girl’s mom and she ripped me, um, I sensed her frustration. I flared a little tiny bit for a second, but I’ve learned over the years, just quietly take it until the person talks themselves out. It usually takes about 60 seconds. And then I’m like, tell me the story. And once I got the story, it really made an impression on me that that person, that young, and she’s actually a very beautiful young woman is suffering because the system doesn’t really take into account what are the whole picture elements. What are the 150 data points that you’re going to need to actually make a really impactful decision for her and really engage in her care? And if the EHR only revolves around the chief complaint, I’ve got news for you. If you want to do a great job, whether you love integrative medicine, functional medicine, if you’re a naturopath, I don’t care what your profession is. If you want to do a great job for patients and you’re focused on the chief complaint only and you have an EHR that only does that, you’re using the wrong tool. That’s all. Let me tell you what happens when you try to put this all together and really do big picture care, right? I call it the fragmentation tax, right? Most practices have or many practices have paper intake, right? They’ve got a form you fill out and they put it on a clipboard, hand it to you with a pen. Um, and that’s their intake and they do that. Um, and that gets put aside right now. They have an EHR which is a glorified word processor for charting. Their lab intake comes and the lab pays for it for free. So they use that um and they order and that’s a separate and they print those things and they put them aside in another thing. And they have a faxing system and they have a comm system with texting and none of them communicate with each other, right? So, you have everything everywhere. My personal story before a spree and this is one of the reasons that I think a spree is so powerful, so valuable, um, you’ve seen the long legal pads. They’re not eight and a half, 111, they’re eight and a half by long, whatever that distance is, but they’re long, so you can put all that stuff down, right? So, I would sit down with a patient and I would go through that. And if I was having a good day, I would take down everything. Um, and the next page and then the next page. And that would be the information that I would have besides all of their records stacked up somewhere. And then possibly elements of their story that I would write down included with that. Right? So, these things are separate. Um, in that process, she also filled out that big stack, that 15-page questionnaire. And in there somewhere, she had mentioned that she’d had an allergy to antibiotics of some kind. I think it was sephilosporin. And that she had an IV and she had a little bit of a reaction. And it was buried. And I have all this to do. I have many pages of my notes and I have all of her documents. And that was the only time it was mentioned. And um because of that and because I am conscientious about patient care and well trained I asked her um by the way before we start this IV do you have any antibiotics? And she said oh yeah I wrote it down. It’s like oops I didn’t though, you did the work to fill out this whole form uh I didn’t I didn’t notice it in the 15 pages. How could I possibly have missed it? You know everybody would miss it right or many people would miss it. But I did ask. I think that’s the value of our training. you you ask the question again what is critical right but there’s so many things that you don’t consider as critical because it doesn’t fit in that ICD10 box that you miss right so I learned she was allergic and because of that a potentially very dangerous situation was avoided in a spree on one page you look at that one page you have a graphic of her entire narrative you have her allergies and alerts you have the chief complaint and the history of chief complaint everything on one page including the diagnostic the prescriptions everything on one page clearly clearly written total difference. You’d never miss it. And then you could still use your excellent professional training and ask the question again. Of course, always ask. She might not have written it down and you wouldn’t know, right? But when you have fragmentation like that, you have the legal pad and you have that 15-page questionnaire and you have all of her documents, which by the way, if you’ve done functional medicine for a while, a lot of patients are going to bring you in a stack. And unless you have an inordinate amount of time and incredible concentration, that’s not going to be super valuable to you. You have all this fragmentation, you don’t have that with a system like a spree. You don’t lose information. You don’t do duplicate work and you don’t miss patterns because all those things, they’re integrated together so that everything’s graphically displayed so you see a pattern instantly. And the great thing is, not only does it make you not a burned out maniac, but the risk of making a mistake that’s going to have a significant impact drops. What’s sort of money for? It’s not infinite, but it’s close. It’s so much your risk is so much lower because you only have human capability, right? So when you’re going to be dealing with so many issues, you really want to have your system, the architecture of your system do as much heavy lifting as possible. Okay? hidden costs. So you have your gut systems over symptoms over here. You have your lab values over here. You have your timeline god knows where. Um guess who has to synthesize all of this. I have to cram that in my head. Somehow I have to get these 15 pages and cram that in my head and I have to get these three pages of scribbly notes and I have to integrate all that. Oh my gosh. um the drain on your brain as you do that kind of work. You may have heard me say that the thing that really drove me to build Espre was a headache. And I mean I really had a headache at the end of every day. At 3 or 4 I would just get this headache from having to think so hard all day. So all of what Espre can create and all of what this doesn’t um is unification of the data. It puts it all together and that is not a luxury. It is the building block, the foundation of excellent care. So this over here, this 15page questionnaire,It’s an interview problem. A comprehensive functional medicine intake minimum 100 usually 200 data points as you develop it out. You have to collect symptoms, timeline, triggers, family history, previous treatments, lifestyle, all the things that you know about, right? In reality, insurance coding requires you to say that you spent the time to do that, but this long 15-page questionnaire qualifies and typically that’s not really a critical thing to do to be reimbursed. So, that gets pushed aside. Not so with Esprē. All of those data points are collected, interpreted by the artificial intelligence, presented as a suggestion like, hey, you might want to look at these. This is what rises to the top. It takes zero time the presentation from that point on that there’s your time 30, 60 seconds to go all right here’s a deeper questions then you spend some time doing that deeper questioning this over here you don’t get reimbursed for any of that time that you do on top of the minimum right as Esprēprovides so much data so much information so well interpreted that it’s easy to do a great job thinking cannot be a loss leader in excellent medicine, That can’t ever work. And it drives me insane that the history in the care of the patient has been minimized now. So, it’s like, well, history is not that important. Get some really good imaging and a great lab. And that’s nothing more cost effective and takes you to the root of the problem than an excellent history. And if you can automate that like we have with theEsprē, you’re golden. Why would you possibly think that doing a computerized online survey would work better? Well, actually the data shows that patients are more honest with the computer. when you ask many patients about their bowel habits, they really are not forthcoming. They don’t want to tell you, but they don’t care about the computer. They’re not in a hurry. They have all the stuff at their house. They’ve got their whole cabinet full of their supplements and full of their prescriptions and all of those records that they need. So, they can go back and forth and make a very complete job of it, which they can never do sitting your way. It’ll never happen. And when you’re working with paper, I don’t know if you’ve ever seen um sticky notes all over the side of a desk and computer, and I used to see it, much less these days. We still use them once in a while, but it’s not an everyday pile, right? Details get skipped and transcription errors and all of that. So what most providers do really for this to work is they shorten their intake so that they get just a little tiny piece of the story enough to get the chief complaint and they miss the larger story and then they lose the opportunity to help the patient actually get well and actually build their health rather than just stop them from you know progressing in their disease. So your system should capture the full story without requiring you to become um a data entry clerk or as I called it the data sherpa. It ain’t no fun being a data sherpa. So the way that you can be sure that your data is good and the way that it’s free works is that validated questionnaires have a bunch of really great questions that will direct you to the very highly likely outcome. Um, most practitioners and systems, they use a review of systems and they pretty much put it together and guess. But when you use a validated tool, you know that you’re getting a high likelihood of the diagnosis. Espre uses dozens of validated questionnaires. The questions are derived from them, integrated, and presented to the patient. The patient answers the questions. They’re put through a validated system, and then the answers you get are highly likely to be true. You’re not guessing, right? A structured interview, which is really good, keeps you on target. I know you’ve worked with enough patients when um, it’s hard to keep a lot of patients on track, you know. So, how are you in terms of your headache history? Oh, my grandma had them for years and every time she drank whiskey all night, the next day. Okay, good. Let’s get back to So, you can save a lot of time, right? And you can screen areas that the patient wouldn’t necessarily be able to relate to in a one-on-one conversation. They don’t want to talk about depression and anxiety necessarily. They want to talk about their hormones. But if you can ask those questions, you can see how much connection there is. They maybe not understand how immunity or inflammation or gut would relate. But we know they do. Heart and cancer risk those things. So the result is that before you enter the room, the patients functional patterns where they’re suffering functionally, they’re already identified. Your priorities are very visible. And with Esprē, you’re given the opportunity to put recommendations in there that are the result of your clinical experience. And there’s also opportunity to use other people’s. So what you basically get is refinement of your history at a level that you can’t possibly do on your own. Incredible clarification and the opportunity to make decisions that are fueled by this massive trove of history that has been interpreted, developed and presented to you so that your decisions are going to be very very accurate. So instead of spending 45 minutes or an hour discovering the basics like do you digest your food, you can move past all of that and get down to questions like have you been tested for uh celiac disease? So you move from discovery to refinement. If you’re manually searching through pages of notes for pay for patterns for your patients, you’re doing the software’s job. You don’t have to do that, right? Finally, if you’re doing a collaborative involvement with the patient, you’re doing a much higher level of work than you are doing it when you’re reading through their symptom list and saying, “Oh, this is what I think it must be.” And then making the decisions. Most providers, they’ll get that. Then they’ll sit behind their back to their patient and that’s just it’s not only rude but it’s a terrible way to create relationship and build trust. Most software wasn’t designed to be viewed by a patient. So I can’t understand why they might want to not show their word processor. So patients never see the process. Our approach on the other hand is to use a large screen TV in every room. Open notes, the long ago developed plan, but we’ve developed it to the point where it’s really very beautiful. And open notes are not necessarily quite as good if you don’t have a graphic artist who’s doing your system. And we have graphic artists and they’re beautiful. Um, so the patient sees your documentation and labs and your treatment plan and your prescriptions. Um, so the patients see all that and I tell patients, they say, “Hey, I really appreciate correction. So if I say something that’s not correct, correct me and then we’ll put it in your record. Right now patients are engaged. They totally trust you. Patients say it to me all the time. I feel a little pressure. It’s like whatever you say, doc, I trust you. Let’s work on this together. I want to have really truly shared decision-making. I don’t want you to just take my word for it. Let me show you. So patients will watch you actually. We use E-Scribe of course and we’ll put the prescription and say that’s right, that one. Oh yeah, that’s it. and this pharmacy and say, “Oh, no, no, no. I’m gonna be at my mother-in-law’s this weekend.” And that’s over in, you know, about an hour away from the pharmacy. And you can correct it immediately on the fly. So, you don’t get a phone call and you don’t have a problem with the pharmacy calling you or the patient calling and saying, “Oh, we need you to change everything.” Which is, you know, nobody enjoys that, right? So, how about having an employee with you all the time who corrects your errors and that’s your patient if you really engage them properly? I mean, why not? You have to learn a little bit of boundary how you can help the patient understand it’s like, okay, that’s enough. Good. That was helpful. That’s good. Um but it tremendously improves your communication and dramatically strengthens the relationship. They know exactly what you’re doing. So that kind of transparency builds trust faster than any kind of marketing. You can send them all sorts of pictures of you at the beach with your kids or in the middle of a procedure. But don’t let fear of switching an EMR stop you. we can migrate your data. The learning curve is short.it doesn’t need to disrupt your practice. Within a week you can be up and running. And um don’t be afraid. The learning curve is a few days. Really within a day or two you’ll experience the benefits especially because of the questionnaire the way that it works. No more midnight charting. Um no more partial care for the patient. No more fighting your software but which by the way you pay for it should help you right? So your real risk is not switching. You figure the cost of staying is 10, 20, 30 hours a week frustrating your family wondering where you went being burned out. So, when you’re actually going to do a demo, ask them to show you functional medicine timelines and specialty labs and supplement protocols and how do you handle communication and what does open notes mean? We can answer all those questions really well. We will. if they can’t answer, you’re probably not wanting to use that system. Functional medicine requires a comprehensive intake, unified data, automated screening, and patient collaboration, which is amazing. You want to know the root cause in your workflow and your EHR should support all of them and not fight you. So, I hope I’ve made my point. If this was helpful, subscribe and check out the next video. Consider building a practice that restores health instead of chasing symptoms. I think you’ll be really happy you did.