On the Cusp

Tempus anceps est 

Today, we are still adjusting to our national pandemic. It feels as though we are on the cusp of something. But is it the edge of something brilliant and transformative or the brink of a precipitous fall that is forever crippling? While the economic and human toll is already high, I am hopeful that we are on the cusp of some great innovations and seismic lasting changes to our culture and society. This will mark a generation.

In conversations with colleagues, friends, clients, partners, and family, I find that our collective experiences are similar. We have moments of fear and frustration. We get lost in good moments with family. We forget the world as we sit around the dinner table and share a good meal. At times, we still feel helpless. At the same time, we’ve also been inspired with a desire to be part of a solution that helps others and makes our world better. 

Despite initial apathy and denial when COVID-19 came to our shores, fear and the omen of calamity rapidly grew. For several days I was sucked down a vortex of negative thinking. In rapid succession, it felt like worsening news came in ever faster waves. Finally, I snapped out of the trance. I decided that I personally wanted to push back and be part of a solution. I wanted Sophrona, the company I lead, to be part of a solution. I don’t know what changed in me. Was it a particular conversation with a friend, a divine inspiration, or something different in the news? It was enough to change my mental course. It created a mental goal so actions could follow.

Don’t get me wrong, I continue to have concerns for what is happening around me. I don’t want to get sick. I see neighbors who are out of work and wondering how to pay bills. I have brave family members and friends who go to the hospital daily to fight on the front lines of this pandemic. Yet, the goal to be part of the solution and the call to action is energizing and I work with pleasure and intensity. It feels like our team understands we are doing something important. 

Reframing with Startup Mentality

Despite Sophrona being 17 years old, it feels like we are again in an exciting startup mode. I read recently that some of the largest startups and solutions were forged during the financial crisis in 2008. It is possible to achieve extraordinary growth while rethinking how we do things to build greater opportunity for engagement.

So much has happened, so fast, but terminal velocity has been reached; the unsettling acceleration we’ve experienced over the past few weeks seems to have subsided. The wobble is gone - what is left is speed and direction. We are going to help our clients communicate with and care for their patients even while most of the country is under lockdown. We have ideas, big ideas.

The State of Ophthalmology – Being Part of the Solution

Only a short time ago, in a matter of days, in a series of jolts, ophthalmology practices around the United States went from recommending sick patients reschedule and stay at home, to rescheduling most patients altogether, to finally closing their doors to all but emergencies. Today, most practices operate with a skeleton crew to answer phones, open the door for the few patients who must be seen, and use one doctor who is on duty for that day.

Doctors and administrators alike face the stultifying realty that revenue streams have come to a grinding halt and are being forced to make very difficult decisions.

Leading a patient communications technology company used by thousands of ophthalmologists around the country means we have a role to play in helping doctors effectively and efficiently get their message out to patients – even as that message changes daily. This gives Sophrona something to do right away.

At the same time, we want to be able to help our clients beyond the current crisis. We want something that will help now, that will also help them transition back to normal in the mid-term and long-term.  We formed an internal task force with the focus of providing just such solutions. 

But we didn’t come at this blind. Our roots helped. 

Telehealth isn’t new to Sophrona.

In 2006, we were very early providers of telehealth by offering e-visits within our Patient Portal. We learned a lot from this experience. Ultimately, doctors were not interested in offering this type of service to patients when an in-office visit paid more and would often provide the patient with higher quality care. 

Sophrona shelved the functionality even while it was periodically revisited. The conclusion remained the same. Ophthalmologists needed to lay eyes on the patient. telehealth wouldn’t work in eye care. Clients didn’t want it – not yet. We had to wait.

Now, in a world of stay-at-home orders, lockdowns and closed offices, a recalibration has taken place. Doctors who closed their offices have no revenue, but plenty of time on their hands. They are willing to consider new ways of seeing patients. Patients still need care. Doctors are willing to explore other ways of providing care perhaps without having to lay eyes on the patient. The government wants patients to receive care while staying at home and has relaxed restrictions on how doctors can bill for different forms of telehealth.

One healthcare IT vendor after another has made an announcement about its telehealth offering. At Sophrona, we know ophthalmology is different from primary care. We paused and formed a telehealth Task Force consisting of clients, doctors, and IT managers in ophthalmology. Our goal is to really understand what business case there is for an eye doctor to do a video visit or an e-visit with a patient that provides real value. In discussion after discussion, we acknowledged that there are several cases where a video visit may work well. We agreed that a video visit might often not be the ideal way to deliver care but is preferable to no delivery of care and no payment. 

I compare this to the shortage of masks we hear about which doctors and nurses are now being asked to reuse. In the old world, two months ago, the idea of mask reuse would have been anathema, but today it sure beats not having one. You make do with what you have.

The output of our internal review is that we believe there are use cases for video visits in ophthalmology. These will work and we are equipping our clients with a telehealth workflow that incorporates the scheduling, conducting, and billing of video visits. Just as importantly, however, we also believe that doctors who do video visits will learn. They will test their preconceptions. They will make surprise discoveries about how telehealth unlocks value and creates new opportunities. 

Expected obstacles will be validated. Vendors will learn.  Together, we will adapt.

Taking Action

So what does doing something mean? What does being part of the solution mean for Sophrona?

• It means we are doing some incredibly rapid development and building new things. 
• We are spending a lot of time listening to clients and reminding them how to use the tools they already have to be even more effective with patient communication. 
• We are guiding clients on how to orchestrate all the tools we provide to deliver a comprehensive patient communication response to an evolving situation.

Right now, our clients are spending a lot of time rescheduling patients with minimal staffing.  Their staffing models have changed. Their doctors are physically not in the office.

• Our online scheduling tools provide ways to get patients scheduled and rescheduled with minimal or no staff involvement.  
• Secure messaging allows staff to respond to patient triage or prescription questions with time-shifting – during the limited hours staff is present.  e-visits can be conducted via Secure Messaging and submitted for billing.
• Video visits can take the place of certain appointments. Patients get the care they need. Doctors can bill for it. 
• Finally, our various announcement message tools and emails allow clients to get new messages out quickly to patients quickly and securely.

The curve is shifting.

We have been forced to do more with less, but the result is an entirely fresh outlook. I see more families walking together outside, more people content with what health and food they have, more gratitude for heroes on the front lines, more patients getting care without being forced out of their way into a clinic or medical office.

We are on the edge of something that may fundamentally change how healthcare is delivered in our country. We will find new ways of delivering care at a distance. We will clear immediate obstacles and redefine boundaries. We are on the cusp.