A Pediatric EHR Workflow System: 10 Questions For Barry Hayut, Xcite Health

Just in time for the American Academy of Pediatrics National Conference in San Diego, here is one of my increasingly infamous 10 question in-the-weeds interviews! This time about a remarkable pediatric EHR workflow system (also used by other primary care specialists). It used to be named EncounterPRO, under which name it won the first three ambulatory EHR HIMSS Davies Awards. This EHR workflow system is now called XciteEHR and my interview is with Barry Hayut, of Xcite Health. By the way, Xcite is hosting a free webinar, featuring me! I’ll talk about the difference between traditional EHRs and EHR workflow systems on November 5th at 12 Noon EST.

As a side note, this is a special interview for me because I was involved with the early design and implementation of this particular pediatric EHR workflow system. I expect many AAP attendees may remember EncounterPRO (originally developed by JMJ Technologies) and will find this interview of special interest. Creating and customizing EHR workflows for our customers, when I was EncounterPRO CMIO, really drove home the importance of true workflow technology at the point of care. Some of the older posts on this blog, EHR Workflow Management Systems, were about EncounterPRO.

  1. How did you end up in the pediatric EHR workflow system business?
  2. Could you discuss Meaningful Use 2 and why it’s important to be MU2 certified?
  3. Do you also sell a Practice Management system?
  4. What’s the difference between EHR workflow systems and mere EHR systems?
  5. Would you share your workflow, writer, editor, publicist analogy?
  6. What does a true EHR workflow system *do* for physicians?
  7. Would you show us the XciteEHR Office View and explain its functions?
  8. What physician specialty practice areas does the XciteEHR cover?
  9. How will you educate the world about true EHR workflow systems?
  10. Thoughts, Barry? About EHRs, workflow, and physician happiness?

By the way, Barry, congratulations on making the XciteEHR is a Complete MU2-certified EHR! You must be mighty proud of your certificate!

Starting Saturday, I’ll be updating and tweeting answers to the above questions on the AAP conference hashtag #AAP14. Stay tuned!

1. Barry, could you tell us a bit about how you ended up in the business of selling the award winning pediatric and primary care XciteEHR workflow system?

I was the CEO of a company that owned and managed multiple radiology outpatient centers. We experienced first-hand the needs of the physicians, office staff and patients for software that enhances productivity.

When we saw the EncounterPRO EHR’s superior workflow engine, Office View, and configurability, we decided to adapt it and integrate it with our Practice Management system and patient portal for seamless integration, productivity and ease of use.

2. In choosing an EHR for a physician practice, can you discuss Meaningful Use 2 and why it’s so important to be MU2 certified?

As you mentioned, XciteEHR is indeed Meaningful Use Stage 2 certified. Thank you.

Meaningful Use 2 is a set of very ambitious standards implemented by the Office of the National Coordinator for Health Information Technology, designed to create robust digital clinical records, track Meaningful Use metrics and Clinical Quality Measures, increase interoperability among various vendors, create uniform standards for reporting data to health agencies, and create standards for the secure communication of electronic health data to patients. Certification of an EHR is tied to incentive payments from the government to physicians with Medicare and Medicaid patients and eventually is expected to be the standard imposed by health insurance companies for all physicians.

3. Do you also sell a Practice Management system? (Scheduling, Billing, Accounts Receivable, etc.)

Yes, Xcite Health also has an integrated cloud-based Practice Management System with the EHR. It has scheduling, registration, billing, revenue cycle management, provider credentialing and vaccine inventory management. All of the billing codes such as CPT codes, ICD-9 codes, and in the near future, ICD-10 codes, flow seamlessly into the practice management system from the EHR so, as the physician finishes charting the patient encounter, the billing information is finished and sent to the payers, as well.

4. Talk to me about what it means to be an EHR workflow system, in contrast to a mere EHR system.

Let me first explain what we mean by workflow. As the leader in this area it is important that I explain how this ‘changes things forever’—for many physician practices!

If you feel that, as a physician, you are constantly giving instructions to your staff—and always following up to ensure things have been done—then XciteEHR is for you.

If you feel that you are being asked to change the way you practice medicine to adapt to the strictures of your EHR software, then XciteEHR is for you.

Or, if you feel that you should not take a productivity hit when you implement an EHR and feel instead that your productivity should improve and finish charting as the exam is done, then the XciteEHR is for you

This is what truly sets us apart.

5. I love your workflow system / writer, editor, publicist analogy! Could you please share?

Our EHR workflows drive action, ensure consistency, and increase visibility by connecting your people with relevant tasks and information. It helps you rapidly transform your practice—with applications that connect the right people to the right information and the right work.

Other systems may claim to be “workflow systems.” However, a TRUE workflow system has 3 components—much like an author who needs three things to be successful. An author needs a writer—himself, an editor, and a publicist.

With a true workflow system:

  • YOU are the author, deciding how you practice medicine, and the XciteEHR was built to allow you to author the fine details of how workflow works in your office.
  • You need an editor to perfect and optimize the way you work and on-the-fly workflow editing tools allow your practice to fine-tune your office workflow.
  • And then you need a publicist – to PUBLICIZE this information to your whole staff—so they know ‘when and how’ to do their work – thereby meeting your expectations!

These three components: an engine, an editor, and a publicist, to provide visibility, are critical to having a blockbuster success when you implement an EHR.

XciteEHR is an easy-to-use tool built on top of a workflow engine that maximizes your success; it makes your team more efficient, your life easier, and your practice more profitable!

6. OK, that’s a true EHR workflow system *is*; what does a true EHR workflow system *do*?

Simultaneous processes take place as physicians and staff naturally and seamlessly interact with the program.

As an example, when physicians order vaccines from inside the exam room, the system simultaneously displays the tasks involved in completing the order on the office view screen prompting the appropriate staff members to respond wherever they may be.

While the physicians are finishing in the exam room, the nurses are already preparing to give vaccines. Not only that, the system is automatically queuing up the desired authorization forms and education materials as workplan steps. Before physicians walk out of the exam room, nurses can be ready to complete the necessary paperwork and administer the shots. Precious minutes are shaved off of the time that the exam room is occupied. Patients spend less time in the waiting room and less time in the exam room. The efficiencies yield happier patients and higher revenues.

There is no other system that has this sort of workflow. Because of this simultaneous processing, we are able to improve overall efficiency—and make the workday fly by—and end on time!

7. I know that the most visually striking feature of the XciteEHR is the Office View. Could you show us a screenshot (with de-identified data, of course!) and explain what we’re seeing—and its benefits?

The office view screen is what really sets us apart and is the heart of the office workflow.


The first thing you’ll notice on the office view screen is that it’s tailored to each individual office, with the exam rooms shown on the screen.

Also, each user or role is assigned a color for his or her task bars. For example, this doctor is assigned green and knows immediately that he/she has a patient waiting in room (4).

Each task is time-stamped in real time, so the user knows exactly how long the patient has been waiting for that particular task to be completed.

On the left taskbar, you’ll see that the patient has been waiting in the room for 9 minutes. And, on the right taskbar, it shows that the patient has been waiting on the physician to perform an exam for 3 minutes.

In reality, this prompts the physician to go and see the next patient, or to perform the next urgent task. The patient in room 8 is waiting on the nurse to give a vaccination. This is what I mean by simultaneous tasking—allowing for increased efficiency and a smoother work day and far, far greater coordination and patient satisfaction!

8. What physician practice areas does the XciteEHR cover?

We currently market to and are exceptional in the primary care areas of Pediatrics, Family Practice, Internal Medicine and Obstetrics/Gynecology. However, our workflow engine could be adapted to any medical specialty.

[CW: I'd like to interject here. The ability to customize workflow is critical for multi-specialty pediatric practices. See my Why Specialists Need Speciality-Specific EMRs That Understand More Than Their Specialty.]

9. I think it’s fantastic to see the kind of physician’s practice clinical workflow technology that the XciteEHR represents stepping into the health IT limelight, especially now that there’s health IT social media. How are you planning on educating the world about this type of award-winning EHR workflow technology?

We want to teach physicians to demand true workflow management technology from their EHR vendor. There is no excuse for lost productivity when a medical practice adopts an EHR. With true workflow management technology, a practice should see an increase in productivity in the first three to six months of use, not a decrease. Physicians do not know what to demand because they do not understand the efficiencies that a true workflow system can deliver to them.

We are going to conduct a series of webinars and marketing campaigns to educate physicians about how to make the EHR system to work for them and NOT how the physicians and their staff must conform to the EHR system.

10. Last thoughts, Barrry?

Unfortunately the term workflow has been too commoditized. It seems that if you can string together a serious of computerized actions you can call it workflow.

In many of the other systems, the physicians are choosing from menus, templates and options to figure out next steps. Each practice role player is on his/her own with their tasks, as if everybody is on their own island.

Since getting involved in this field way back in the late 90’s, I have looked at every EHR out there. What is now the XciteEHR, looks and works completely differently from every other type of EHR on the market.

In the XciteEHR once configured by the physician the way she/he likes to practice medicine, the workflow engine will present the right task screens, based on the action taken by the physician, to all relevant practice role players simultaneously and can be viewed and tracked on the Office View screen.

The XciteEHR is built on a strong history and experience of having been in the market for over 20 years—but its features currently surpass every other EHR on the market today—exponentially surpassing all others in one area. Happiness.

I believe that true EHR workflow, customizable to specialty and user needs and preferences, is the single most important key to dramatically increasing physician happiness (yes, happiness) to use an EHR.

[CW: Excellent, Barry! Thank you for working to improve healthcare workflow with information technology! In fact, I even have a special badge I give to the folks in the white hats, the cavalry, as it were, rushing to the aid of physicians ensnared in workflow-oblivious IT systems! See below...]

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