7 questions with Dorsata CEO David Fairbrothers
Dorsata CEO David Fairbrothers worked for years to bring his “baby”—now a successful digital health company focused on maternity integrated with athenaOne—to market. But it was his recent experience as a first-time father through which he was able to experience firsthand the kind of impact that this technology, designed in partnership with the American College of Obstetrics and Gynecology, can have. Clinical decision support, intuitive navigation, and episode-of-care reporting inserted directly into the workflow means that Dorsata helps empower providers, promotes patient safety, eases administrative burden, and powers care-gap and outcomes reporting
Simply put, there aren’t enough Ob-Gyns in the country, maybe 40,000. There’s certainly less than that in the market who deliver babies. A typical ambulatory schedule is 7 a.m. to 5 p.m., but OBs work full clinical days and can also see five to six patients that night in labor and delivery. It’s incredibly demanding so we ask if there’s any way we can increase their productivity with good tools and good frameworks so they can still go home to their families in a space that already suffers from burnout and mental health issues.
The financial model is another challenge facing many Ob-Gyns across the country. Quite simply if you compare Ob-Gyn reimbursement rates to orthopedic surgeons for example, the disparity is significant, it’s disappointing. Compounding the issue is the fact that the opportunities for Ob-Gyns to participate in the upside that comes from high-quality and value-driven care are limited. Negative outcomes continue to increase healthcare system costs, and neonatal intensive care is obviously a strong source of cost pressure. The U.S. has a higher C-section rate than the rest of the developed world. Nearly half of births are insured by Medicaid, and (reimbursement) rates are a fraction of commercial rates — but obviously OB is not going to compromise on what they put into it from a quality standpoint.
The continued expansion of value-based care introduces many unknowns to providers but can be a compelling opportunity to reward the best providers.
We’re particularly focused on helping our clients succeed by providing intuitive tools, information, and strategies to deliver good outcomes and value. We think it’s important to make those three- to five-minute appointments as seamless as possible so that OB-Gyns can do what they do best. That’s building authentic and trusting relationships with their patients.
EHRs are largely phenomenal tools for running a practice—documenting the care that you are providing and for submitting a claim to insurance. What we thought was lacking was a user experience for providers based on the type of condition they were treating. We realized that medical intelligence and methodology was largely trapped in 20-page documents or on whiteboards in hospital conference rooms.
We endeavored to bring these standards of care out of PDFs to inform better care delivery, to improve outcomes for patients, and to improve the provider’s experience at the point of care. Our core thesis has never changed—we’re focused on how to make the tools doctors use more intelligent and on increasing their awareness of underlying clinical data and how it relates to the care the patient should receive. There was quite a bit of learning in our early days when we tried several specialties and settings before selecting obstetrics. In obstetrics there is wide guideline acceptance among physicians, which made the specialty a logical choice for clinical decision support innovation.
I see us as very complementary to athenaOne. Fundamentally, Dorsata goes back to a “paper chart” structure. Paper was this phenomenal tool that let you craft precisely what was best for a specific condition or patient. We wanted to have the ability to slide that back into the overall medical record so everything was very comprehensive and structured specifically for OB. Then connecting to athenaNet and athenaOne gives the abilities to manage the practice. It’s really the best of both worlds that has made us and users successful. We really want to create this ecosystem that’s focused on elegant workflows and reporting tools so physicians can easily identify patient care gaps and close them.
We want to do anything we can do to help grow our network, and our athenaOne collaboration is part of our growth strategy. The athena team really went out of their way to accommodate our API needs, endpoint to endpoint, to bring the ACOG Prenatal Record to market quickly. They were also instrumental in introducing us to athenaOne partners, who were early adopters and open to assimilating new tools at their practices.
We were really focused on establishing that partnership with providers at the point of care, understanding what was actually needed from both technology and product strategy to achieve a level of integration with the EHR that moved the needle for them. We aimed to achieve a level of integration that enabled practices to use the ACOG Prenatal Record as the OBs’ primary workflow for all appointments. We needed the ability to not require practices to change their underlying EHR and integrate within an existing system. athena provided an incredible area to test. The API program when we started this work was the most expansive. athena was a good partner, too, because we needed to be able to earn that presence and that trust in the exam room with providers.
When a practice invests in Dorsata, we have observed that provider experience improves and episodic costs fall. Unfortunately, the value the Dorsata technology creates for the health care system does not accrue to our Ob-Gyn provider customers, making some groups reluctant to invest in technology even though it is the right thing for the system. That said, we continue to see new payment models being introduced and tested across the country. Inevitably, we believe that most reimbursement in maternity will shift to fee-for-value, but it is a transformation that will not happen overnight. Therefore, providers must be ready for this shift and prepared with tools, information, and strategies.
Gosh, when I’m out with patients or providers, I hear stories constantly. One provider recently shared that a patient under his care needed a surgical consent form for a tubal ligation signed no less than 30 days before surgery. This patient was going to have a scheduled C-Section and could have the tubal ligation simultaneously. Thirty-four days before her C-Section, the consent form still hadn’t been signed. The physician would have had to have performed a second, separate surgery had a staff member not seen the recommendation that appeared on Dorsata’s care plan. Prompts like this are seamlessly integrated into the Dorsata/athenaOne workflow to make sure things like this don’t get missed. What gets us really excited is the ability to have our tools to assure every patient gets the right preventative care.
My first son was born in August (2019). Much to my wife’s chagrin, I treated our pregnancy much like a research opportunity to understand what my network providers go through with their patients. It was an eye-opening experience for me. There needs to be better interoperability of health care data and adherence to evidence-based guidelines. Our existing health care system places the entire onus for communication of critical information on the patient. It’s no surprise that each provider is effectively operating blindfolded with one hand tied behind her back. We have to do better.