Why "Afoundria"

SS Afoundria courtesy of shipspotting.com

SS Afoundria courtesy of shipspotting.com

We're asked quite often, why the name "Afoundria?" It means a lot to us and we wanted to share our story with everyone.

My grandfather was a sailor and shrimper in Alabama. He had a lot of amazing stories, one of which was that as a Merchant Marine he sailed around the world in the mid 1900s. He was amazed at crossing the International Date Line on his ship, the Afoundria, back when that was considered a giant accomplishment. In today's world it's tough to think people even notice as they relax on their jumbo jet or comfy cruise ship.

Besides being a vessel on which my grandfather served, the Afoundria had a very interesting history. During World War II it was temporarily renamed the USS Wayne; and afterwards back to Afoundria. The interesting - and perhaps strange - part is that the Afoundria didn't just sink, it sank twice. So why would we name a company after a ship, albeit with great family history, that sank twice? It's hard to sink twice! This is where family history crossed paths with the American healthcare industry.

When we started this company, the founders had dreams and goals of improving healthcare. As doctors, economists and technologists, we surveyed the landscape in healthcare and it needed a lot of improvements in technology. In fact, many people were calling the healthcare industry a train-wreck or a shipwreck. Pick your metaphor, but with shipwrecks you can either abandon them and let them rot away; or you can salvage them.

Our little group felt strongly that healthcare is worth salvaging - and it can be salvaged with like-minded individuals and companies working together. People are worth saving and helping. The nucleus of our belief is that patients and their providers should have technology that helps them and serves them, not the other way around.

So yes, against the advice of many we named our company after a ship that sank twice. But like the Nuestra Señora de Atocha (another great story), we believe that this ship can be salvaged. And with a lot of hard work and perseverance, the third time is also the charm. As I watch the waves from hurricane activity from my office as I write this today, I can say that we plan to stay afloat!

That's our story of the name Afoundria. Thanks for being a part of the story and working, advocating, sharing and doing whatever you can to improve healthcare.

Medicaid Meaningful Use

You could qualify for $21,250 per provider by the end of 2016.

It's possible, and you might want to look into it because you're going to be doing most of this stuff anyway in 2017.

The last year to start participating in the Medicaid Meaningful Use program is 2016, which is wrapping up quickly! Under this program, Eligible Professionals (EPs) can qualify for $63,750 in payments over 6 years, with a first year payment of $21,250 per provider (not group, PROVIDER). The purpose of this program is to incentivize EPs to adopt certified EHR technologies (CEHRT).

The requirements:

  • Eligible Providers must have a payor mix of 30% Medicaid patients over a 90-day period at some point in 2016
  • Eligible Providers must adopt a CEHRT certified EHR (this is where we can help!)

Our users primarily see patients in post-acute facilities, which is predominantly paid for by Medicare. However, many of these patients are dual eligibles where Medicare is the primary coverage for a patient, and Medicaid is a secondary payor. These patients count when calculating the payor mix, even if Medicare is the payor for the encounters.

If you enter the Medicaid MU Program, you must do so in 2016. You don't have to demonstrate Meaningful Use to receive the initial payment of $21,250 in 2016 and you don't have to continue to demonstrate Meaningful Use in following years. However, if you do, you will receive $8,500 per year per EP in your practice for the next five years.

THIS IS ICING ON THE CAKE!! With Medicare's new MACRA legislation (Medicare Access and CHIP Reauthorization Act) comes new payment structures, specifically MIPS (the Merit-based Incentive Payment System). MIPS is essentially a combination of PQRS (Physician Quality Reporting System), VPM (Value-based Payment Modifier) and Meaningful Use Stage 3. The big kicker here? Providers will be required to use Certified EHR Technology (the MU 3 part) and report on clinical data for patients (the PQRS part). Based on the data reported and the technology used, providers will have Medicare reimbursements adjusted with either a bonus or a reduction starting in 2019.

We'll dive into MIPS and what that means for your Post-Acute practice of medicine in another post. The point here is YOU'RE GOING TO HAVE TO BASICALLY MEET MEANINGFUL USE ANYWAY, so why not get paid for it?!

$8,500 over the next few years can do quite a bit. Not even half of that amount will pay for a full year of ChartPath ($250 per provider per month). You can use the other $5,500 and buy an old MG B, like Buzz did, or pay for professional ping pong skills and try to beat our in-house champion, Donovan, or use it to buy a Smart Car and start a home health business (we can help there too!). $8,500 won't even pay for licensing fees of most of our competitors.

We're always here to help our users. If you have any questions about this program or would like some help getting started, don't hesitate to reach out to us! Our team of experts, led by our CMIO, Dr. Charles Owen, are always on call for you. We believe in partnering with our users, not just providing technology. Our goal is to help you run a Perfect Practice!

And because Afoundria is currently undergoing the CEHRT certification process for ChartPath, our technologies will meet all your requirements to run a perfect practice (including those requirements set forth in the MU programs and future payment models).

You can call us directly at (888) 632-4659 or email Buzz, our Chief Product Officer, at buzz@afoundria.com or Jon, our CEO, at jon@afoundria.com.

Some funny bits about Medicaid MU:

  • Your entire group can qualify even if some of the providers only see 1 Medicaid patient in the 90 days. The group average must be 30% of patients on Medicaid, anyone in the group under 30% can be carried along with the other providers. So if you have 5 providers, and one only sees 5% Medicaid, but the rest see 40% Medicaid, and the overall group average is 30% or higher, then that is 5 checks for $21,500.
  • Nurse Practitioners ARE eligible under the Medicaid MU program (they were not under Medicare's MU program). Physician Assistants and non mid-level providers won't qualify, but they can be used to help an EP qualify.
  • Unlike Medicare's MU program, you don't have to continuously show Meaningful Use for years and years, you just have to report on the percentage of Medicaid covered patients over a 90 day period in 2016. The program was truly designed to simply incentivize the implementation of CEHRT (Certified EHR Technology) EHR systems in provider practices. The Medicare MU program was designed to incentivize achieving Meaningful Use (which means "Using" the CEHRT technology in a Meaningful manner).
  • There are no penalties for not meeting Meaningful Use (at least from this program... there are other penalties, lots of them, and we'll cover those in another post).
  • Medicare MU required providers to show Meaningful Use before receiving payment, Medicaid's MU program does not!

EHR Medications Usability

Adapted from Inspired EHRs

In post-acute care, we commonly see patients with 20 or more current medications. In many EHRs, this list of meds is displayed as a dense wall of text with no visual cues for quickly processing the large amount of complex data. Add a high case load and a few family conferences, and you'll be finishing your documentation late in the evening.
So what can we do to reduce the time and cognitive load so providers can quickly understand a lengthy patient medications list? Basic usability! And you don't even need to figure it out for yourself because there is already a free resource available: Inspired EHRs is a freely downloadable guide written to teach EHR product managers and software developers how to improve usability for clinicians. This eBook is brief and easy to read but also full of relevant usability examples and scenarios covering medications lists, e-prescribing, allergy lists, and drug alerts, and they also teach general usability principles in the last three chapters.

EHR usability: a better medications listChapter 2 focuses on medications, and we've put together an HTML/CSS demonstration of their Simple Medications List in Example 2.1. From the authors:

The simple list displays bare-bones basic information. It’s made to be read quickly, scanned at a glance. It’s easy to scan visually to see the name, strength, and dosing of the medication. The list is alphabetical, which makes it easy to search for and locate particular items.

With these example files, you can quickly implement your own version of the Simple Medications List. The code is MIT-licensed for free use, and you can download a zip file from GitHub. With free resources such as Inspired EHRs, there is no longer an excuse for EHR vendors to deliver crappy software. We are sharing our files to inspire other vendors to do the same.

Also check out:

Dr. Jeff Belden EHR Usability Evangelist

SHARPC Usability Research

EMRs are Wasting Physician Time

Like all early stage entrepreneurial organizations, Afoundria is seeking to sharpen its focus and refine its message. This is important both in terms of looking inward, i.e. what should be the top priority for everyone in your organization as they do their jobs, and from the perspective of painting a clear picture to customers and prospects regarding what you do and how you intend to do it.

This fundamental tenet of sound business was brought clearly into focus for me recently when I read a news article, Physicians feel EMRs 'waste' too much time, study finds, and the referenced research brief in JAMA describing a study surveying doctors on the effects of EHRs on their time budgeting and allocation.

I was profoundly disappointed in the findings.


The majority of physicians spend significantly more time performing the critical functions of recording notes, accessing past historical information, and reading notes of other practitioners when using EHRs than they did before implementing these electronic systems. A randomly selected group of providers estimated that these functions collectively took on average 48 minutes longer using EMRs.

Sitting here today, I can additionally reflect on my experience of last night when for the first time, I used one of the "premier" Hospital Information Systems to care for patients in a busy emergency department. Although I certainly hope to improve with practice, my productivity was literally cut in half! Despite increasing our physician staffing significantly, our wait times ballooned and a number of patients left without treatment, frustrated with the wait.


What would you have your doctor or your loved ones' doctors spend their time doing? Should they be sitting attentively in front of you, fully engaged in the meaningful discourse that is the essence of good medical practice? Or should they be staring intently at a computer screen trying to record or receive information from an electronic tool?

Don't get me wrong. I got started in electronic health records more than 25 years ago based on a conviction that information technology was the key to improving care. My disappointment with the state we are in, as reflected in both the formal study and my personal experience, does not change my fundamental belief in the power of technology. We simply have not done it right.

Afoundria intends to do it right. We will start and end each day, each task, each interaction with peers, partners, and prospects with a commitment to make the recording, updating, sharing, and distribution of health records serve the provider. By giving them technology and applications that improve their efficiency and their effectiveness, we will give them back the 48 minutes to share more time and more meaningful time with patients and families.

We are early in this process. There is a large mountain to climb to achieve the "Holy Grail" - an electronic health record that allows health care practitioners to deliver better care and a better care experience for patients and providers. But don't doubt for a minute that we will get there.

The PALTC Health Information Technology Blog Series

I spend a great deal of my waking life thinking about electronic health records - I even dream about health technology. You're probably thinking I need to get a life - right? But I won’t make any excuses for this. I am convinced that if we are going to improve the health and well-being of our population; health information technology, and specifically electronic records, are a critical component of our strategy. There are two important caveats, however. First, electronic records are necessary but not sufficient to achieve our goals. Second, current iterations of EHRs are woefully inadequate to the task.

Over the next couple of months I, and the team here at Afoundria, intend to expand on this theme. We will ask, and propose answers, to the question “How can electronic health records be improved and expanded in order to more capably contribute to the achievement of “triple-aim” improvements in health care; better care, a better care experience and more cost-effective care?" In what ways are current products up to the task, and where do they fall short? What can be done to revise and refine technology supporting better health care? How can one tell when a proposed solution really meets the needs of patient, providers, and payers?

In anticipation of the upcoming discussions, I would like for you to read, or re-read, my previous post on the "5-C" demands of Charting. A quick reminder; the 5 “C’s” of Charting are Communication, Care, Coding, Compliance, and Clinical Research. This framework will be used to establish a rubric for measuring the adequacy (and understanding the inadequacies) of clinical information tools and applications and help us develop and deploy technology supporting more efficient, more effective, and more satisfying care processes.

We have already explored the Meaningful Use program and its contribution to more effective health information technology and will be diving deeper into this topic and others to discuss how health IT can help your clinical practice.