Firefly's Blueprint for Reimagining Technology

by Jeff Greenberg

Published June 6, 2019

A laptop showing a virtual care moment between a patient and provider.

One of the most obvious differences between Firefly Health and traditional health care providers is our emphasis on digital technology. People use our app to sign up, schedule visits, send us messages, conduct video visits, and track their health goals. And that list is growing every day. For us, technology is not just a means to an end — it is core to how we care for people. In fact, a major reason why we started Firefly was a fundamental belief in the power of technology to enhance relationships and connections between people and their care team, and a realization that traditional health care systems were failing to harness this potential.

For us, technology is not just a means to an end—it is core to how we care for people.

Prior to starting Firefly, I held several leadership positions at an academic medical center in Boston. I was fortunate to be able to lead several important and often innovative programs. In each one, however, we were often stymied when we tried to access data and apply technology. In one, we convinced physicians across many specialties to design performance measures relevant to their work, but then struggled mightily to extract the data needed to implement them. Another program enabled physicians to develop novel pathways to standardize — and learn from — the care they delivered. Yet we relied on paper collection forms, because the electronic health record (EHR) could not embed pathways at the point of care. For one of our more successful projects, we worked with par8o, a great Boston tech start-up, to build a highly effective and well-adopted referral platform. But this was discarded a year later because it would have been too difficult to integrate it with the EHR.

These challenges are common and they are not an accident. EHRs are big, complicated, and expensive enterprise platforms. A major reason for their existence is to help with revenue collection; they do, after all, need to justify their high cost (big systems can spend over $1B just to implement a new EHR). But this focus on revenue has major consequences. It means these platforms are built around visits to the doctor or hospital — because visits are what generate bills. It means there is a big focus on documenting visits, and ensuring all the right information is included in the right place to justify a charge. That’s their job and they do it well — albeit at a cost to clinician productivity.

...we needed our systems to focus on three key concepts—convenient communication, smart task management, and automation.

As we built Firefly to transform care from intermittent, reactive, and transactional encounters to proactive, ongoing engagement — decoupled from face-to-face visits — it was clear that EHRs were not up to the task. We didn’t need a platform that put documentation, billing, and record-keeping at the center of care. Rather, we needed our systems to focus on three key concepts — convenient communication, smart task management, and automation. All three have transformed other industries but are barely visible in health care.

1. Convenient communication

First, we needed a system to enable seamless, flexible, and often asynchronous communication with our patients. Our goal was to make health care convenient by avoiding unnecessary in-person visits — so secure video chat was a must. But we also wanted to keep in touch with our patients between visits (and often instead of them), so we needed a messaging service that would make it super easy to converse with us — think text messaging, but secure enough for very personal information. And when patients did need to see us, they should easily be able to book visits without calling us (and dealing with the dreaded phone tree). Putting this together, it was clear we needed a mobile app to enable video visits, secure messaging, and easy scheduling.

2. Smart Task Management

The second core feature we knew we needed was smart task management. At Firefly, a key mantra is no dropped balls. How can we avoid dropping balls even as we build larger patient panels and bigger teams of doctors, nurse practitioners, health guides, and behavioral health specialists? The answer was to build Lucian — our intelligent relationship management system. Lucian enables Firefly clinicians to work with patients to develop personalized care plans, consisting of tasks grouped around a key goal or condition. Instead of hoping the patient remembers to schedule a colonoscopy for cancer screening, we can quickly create a task for the patient, coupled to scheduled reminders in the app. And we can create a task for the care team to make sure it gets done. Gone are the days of forward-dated emails (which I did at my old institution, even with a billion dollar EHR) or just hoping that if we don’t hear from a patient, everything must be OK. Lucian allows big teams to care for thousands of patients over months and years, with the confidence that the right care will be delivered on time.

Gone are the days of...just hoping that if we don’t hear from a patient, everything must be OK.

3. Automation & Intelligence

The third leg of the stool is automation and intelligence. The potential impact of intelligent, dynamic clinical pathways and protocols is immense — but yet to be realized in health care delivery. EHRs offer ‘decision support’ reminders, but their impact is limited by not being integrated into workflows, and not updating quickly enough. Lucian gives us a platform to build smart pathways and protocols directly into our workflows to help our clinicians deliver the highest quality care, to every patient. And it’s a double whammy: automation saves time for patients and clinicians while also ensuring that the best care is delivered consistently.

Lucian gives us a platform to build smart pathways and protocols directly into our workflows to help our clinicians deliver the highest quality care, to every patient.

Put all this together, and Firefly’s tech platform is transformative. In-app messaging replaces phone trees, muzak, or just giving up. Easy video visits replace stress, traffic and missing work to make appointments. Smart task management replaces hopes and prayers and uncertainty about what comes next and who does it. Clinical teams armed with evidence-based protocols replace harried, burnt-out doctors struggling to keep up with all the latest guidelines. And data from all of these tools enables us to get better and better at what we do — delivering the highest quality care with our patients.

Experience Firefly Health for yourself and let us know what you think!