When we write about EHR transitions these days, it is usually about a hospital system or large physician practice moving to Epic. That’s why it was interesting to interview executives from Sound Physicians’ telemedicine practice about what led them to work with CharmHealth in 2024 when their previous EHR vendor announced they were going out of business in nine months. 

Founded in 2001 and operating in over 400 hospitals, Sound Physicians provides outsourced clinical staff such as hospitalists, emergency room doctors, and critical care specialists. The practice also has a strong telemedicine business, led by Brian Carpenter, M.D. Its telemedicine service lines include a tele-hospitalist practice and post-acute care programs connected to accountable care organizations.

Joining Carpenter in our discussion was Dria McCluskey, R.N., M.S.N., senior vice president of innovation and technology, accountable care organization and telemedicine at Sound Physicians. Carpenter and McCluskey explained how they came to work with Pleasanton, Calif.-based CharmHealth because their previous tech vendors were not meeting their needs.

Healthcare Innovation: I understand that you had a tight timeline and had to find a new EHR vendor for your telemedicine service line. How did you begin? 

McCluskey: We looked at over 30 different vendors, and we narrowed it down to three finalists, and Charm was one of those. In our process we did a pretty extensive proof of concept, whereby we get our hands on the technology to really test it and find where the walls and the ceiling actually are compared to a marketing or sales pitch. The team at Charm was great about that. Their enterprise solution allows bigger clients like us to take advantage of some of their APIs, their development capabilities. So in that proof of concept we knew based on our experience with previous vendors and our service lines what we needed. We also knew what we wanted to retain control of, and Charm was this nice medium whereby they had the proper frame, the elements for the EMR, as well as telemedicine, but we knew we needed to configure it for our purposes, so we went through that proof of concept, identified all of those things, and came up with a plan, and we went live with them, and they were excellent.

HCI: Could you describe a few of the criteria that you had identified based on your experiences with previous vendors?

McCluskey: There were two major things we were looking for. No. 1, the telemedicine capabilities — that is our core service line, and what that really means is the ability to do secure messaging or chatting, to have phone calls, and to do videos as well. There are a lot of details that you want to make sure you have fluidity and can move across those mediums and not be restricted to one or the other. Charm’s platform allows for that. 

The second criteria is an actual EMR, which is what allows the documentation, billing, the closure of that encounter. We looked for both sides of that. 


HCI: What are some unique aspects of Sound Physicians’ telemedicine operations that led this process? 

McCluskey: There are two big pieces. No. 1, in our model we usually have present what is called a patient presenter. It is a third-party representative, usually a nurse, who is present during the telemedicine encounter, and who is in front of the patient with the device assisting, if you will, and speaking to our clinician, who's on the device, so it's almost like a three-way assessment and conversation, different from direct to consumer, where you have just the patient and doctor. With our new ACOs, we're expanding into the home, and some applications are just structured for direct to consumer, but we saw that Charm could do both. 

The second piece that's unique about Sound is that Dr. Carpenter has a whole pool of providers, and we have a very strategic way of assigning and distributing consults, making sure that our providers are productive. We’re being mindful and thoughtful of that, while also respecting the rules relative to licensing, privileging, and e-prescription. Every state has different rules, so you have to follow those, and we have our own way of doing that, so we wanted to retain control of that. We have our own software in house that we use that contains all the logic, and it's basically talking and interacting with Charm’s, so they work together to pull the full workflow off.

They had an API library that was pre-built and they could share that during the RFP. A lot of vendors today just don't have that or won't share that. They'll build them as needed for a cost, but these guys were ahead of the curve. They had their full API library — FHIR and non-FHIR. They had the pieces, and they were also willing, where needed, to do the custom development with us to close any gaps.

HCI: Dr. Carpenter, do you want to weigh in on that?

Carpenter: That multimodal communication piece is important. Charm’s simplicity in that is the beauty of it. It’s not overly engineered, it's not complicated. You can switch from one mode to the other. It is our experience with other vendors that they might have it, but it's clunky for the physician and/or the nurse. The user interface is very nice. Charm is an EHR that added telehealth capabilities to their platform, and as a virtual medical practice that up till now has provided facility-based care, we needed a true EMR that our physicians could use not only to document, but we needed a platform that we could modify as we needed to.

As we're working in the value-based care world, we know there are certain metrics that we have to meet. We have to document a certain way, and now we can build those documentation templates to meet those needs. One of them, for example, is depression screening. Simple enough, but the way that we can document it and capture that diagnosis, and bill directly through Charm is nice. Their platform also integrates very well with our RCM vendor to move information seamlessly without a lot of manual work on our side, so those are really important to us, 

HCI: Does Charm have AI tools like an ambient scribe or AI documentation features that are of interest to your team?

Carpenter: They do. They have an AI scribe. We're actually in the process of deploying that to our medical group now. They’re evolving the product. What I really like about theirs is it's embedded within the platform; it’s not an add-on where you have to go outside of the platform to turn it on. That makes it easier for everyone to use, and it works really well. They’re very thoughtful about their approach to these builds.

HCI: Is there a story about making the transition from your previous EHR vendor to the new system? Often we hear that that's a big lift for organizations to actually go through the transition process, but maybe with a physician group it's not as big of a deal as it is for a hospital system...

Carpenter: It was a big deal because we had a very, very tight deadline. Our previous vendor basically said we're not going to be around in nine months, so find somebody else. So I think just from the physician side, that gave me severe anxiety, but Charm made it easy for us. They worked with us. They knew we had a tight deadline. They reprioritized some of their own development work to be able to get us off the ground, and that was amazing. And really, it was hard to find a vendor that could execute on such a tight deadline, so the relationship side was critically important to us being successful in transition.

McCluskey: Yeah, I think it was nerve-wracking, to say the least when your vendor says we're going away in nine months. That’s why we did the RFP immediately, but Charm was great about it. I do think part of what made us successful is we at Sound do invest in partnership management, and that's part of what my team is responsible for. We did our best to make sure that we could be good partners to Charm and only lead with the things that we needed and to lead with mock-ups and examples. I was proud that we pulled it off on time. It was a great experience, and Charm was wonderful.

Carpenter: I will add that we were struggling with physician efficiency prior to the transition, meaning that the other technology was getting the job done, but it was hard for doctors to see a meaningful number of cases per month in a telemedicine world. We transitioned to Charm, and we saw that our physicians were able to see more patients per hour, and not feel stressed about seeing those more patients per hour. Their workflows were more efficient, they could multitask, whereas with many other technologies they couldn't. So the increased efficiency has helped our labor costs. We don't have to staff as many providers per shift, because they can see more patients in an effective way.

HCI: You have been with Charm for over a year. Are there some other things you’d like to build with them? 

Carpenter: As we expand our scope of practice, we're going to need to integrate more with other EMRs as we cover nursing homes on nights and weekends on behalf of our ACO medical groups. And we will continuing to evolve our use cases for AI, and think about the intake process, and having an AI agent help the nurse gather the information that they need.

McCluskey: Because we have ACOs, there are certain aspects of quality submission that your EMRs play a role in. So I think we're very excited to partner and take advantage of that, especially as we're expanding from two to four ACOs.

HCI: And CMS is moving to electronic clinical quality measures, right? 

McCluskey: Yes, next year. So we're starting that discussion with them to see what they'll be able to do for us as an ACO. Also, I have heard Charm envision how they can allow the physician to practice at the top of their license but remove all the unnecessary pieces from their workflow. So I'm very curious to stay tight with their development team to see where they stretch this EMR. Then as we expand our ACOs and widen the scope of the services, I am very excited and curious to step more closely into the direct-to-consumer aspect.