Q&A: AristaMD's Cofinas on bringing specialists, patients together

Visiting a specialist can be difficult for both patients and practicing physicians. Workflows can be interrupted, logistics can prove difficult and waiting for results can be stressful.

“Partnering with primary care physicians and providers as they are making decisions on referrals has grown into a two-step process to making more efficient decisions," said Rebecca Cofinas, AristaMD CEO, a digital health company focused on the specialty referral process.

In early January, AristaMD announced a partnership with San Mateo Medical Center (SMMC), a hospital and clinic system with more than 70,000 patients, to develop a customized set of clinical checklists and eConsult capabilities to be implemented at up to six SMMC sites.

In an exclusive interview with Clinical Innovation & Technology, Cofinas dives deeper into the technology behind AristaMD to discuss working with clinicians and bringing patients and specialists together.

Clincal Innovation & Technology: Can you give a summary of how the specialty referral process will work within SMCC’s 800 healthcare providers?

Cofinas: We’ve taken lot of effort in planning in making sure we are not disrupting the clinician’s primary workflow when they make a referral. The first step is that the referring provider will order a referral as usual with an electronic medical record (EMR), then the AristaMD platform kicks in. We help triage that referral against one of our clinical workup checklists where we help resolve the issues in the moment or suggest the right diagnostics and testing to be done. The clinical workup checklist covers about 80 percent of reasons for all referrals, from primary care to specialist. The second part is an eConsult platform, including the electronic exchange between primary care and specialist. In this exchange, the specialist can look at your information and provide a consultation back to the providers, which may solve the issue and doesn’t necessitate a visit to the specialist. The process is much more efficient and cost effective than a referral. What we do when a patient does see a specialist is we send the information back to the primary care physicians. This “closed loop” involves all parties in the care process.

Do you think some physicians may reject this "extra work," just as some have done in response to electronic health records (EHRs)?

We have worked on making this seamless for the provider. We haven’t added any extra work and it takes only 30 seconds or a minute to complete the clinical workup checklist. We are actually saving time because we are searching through the EHR to pull in the right diagnostics and tests. This way, the primary care providers don’t need to pick up the phone and call a specialist to get their opinion or look at other guidelines. On the back end, it can take a long time to receive information, so we have automated this so the eConsult will be answered in 24 hours or less. The information is automatically sent back to the primary care physicians and sent into the EHR. By keeping the practicing physician in mind, this process is quick and effective.

For rural patients, has there been any development into telemedicine?

While we do not offer telemedicine, we are partnering with other companies to add that capability if the client wishes. We saw a gap in the support between specialist and primary care provider. Around the country, there are shortages of specialists, so it could take months for patients to see a specialist. With our form of telemedicine, which is using technology and healthcare information to facilitate the care between primary care and specialists, we find it possible to treat a large percentage of patients. We are able to resolve 55 percent of all questions through clinical guidelines.

Do you think there is a chance that this system could make it much more difficult to see a specialist? 

In healthcare, the focus is on the three major stakeholders: the patient, providers and the payor. Currently, you have to look at the state of patients trying to get in to see specialists. In many cases, especially with a market that is underserved, it is hard to access specialist care. It can take weeks to months for a patient to see the specialist in person. Our solution gives access to specialists in under 24 hours, the average being five hours. It allows for patients to have a specialist weigh in on care planning. The No. 1 reason why we have clients around the country is the desire to increase access to specialist care.

Can you give our readers any tips on how to improve interoperability?

I think that is starts with end-users and how they work. I came from the provider world. I have over 25 years on the provider side, and I think trying to navigate the many different technologies that don’t speak to each other makes it difficult. Our insight would be that it really helps to understand the workflow of your clinicians, understand what they are doing during the day and understand what they need. Then you can use technology that fits.