EPtalk by Dr. Jayne 10/5/17

This week is National Health IT week, with events being held across the country. The “points of engagement” for this year’s events include: supporting healthcare transformation; expanding access to high-quality care; increasing economic opportunity; and making communities healthier. I’m particularly fond of the point regarding healthcare transformation, as so much of my work revolves around helping healthcare organizations make sense of the changing delivery environment and payment models. Many organizations are transforming for the right reasons, such as patient and community health, and those efforts make me feel energized and that I’m doing valuable work.

However, I still see far too many organizations that are on the “stick” end of transformation, only changing because they feel they are being forced to. Many of these groups are fighting themselves as they move through the change, with the C-suite saying change is here while allowing some of their more vocal (and often more profitable) physicians and subspecialties to basically opt out. I watched one group mandate that primary care physicians enter all data through discrete template fields, while allowing their orthopedic surgeons to dictate because they were afraid the surgeons would leave the group. This kind of behavior doesn’t do much to engender collegiality or build professional rapport. The most successful groups I work with are transforming because they believe in their ability to deliver care more efficiently and effectively, but trying to spread that enthusiasm continues to be a challenge.

It feels like there is considerably less buzz around Health IT Week than there was even just a few years ago, let alone what it was like in the heyday of excitement around Meaningful Use. Even Google seemed a bit lackadaisical, with my “national health IT week 2017” search bringing up an article about the 2016 events as the fourth item in the search. Let’s face it, healthcare IT isn’t as sexy as it once was and there aren’t as many so-called rock stars out there doing the moving and shaking, but it’s something in which every single one of us is a stakeholder. Having gone through yet another round of medical adventures this week, I’m grateful to have care with physicians that continue to use technology to its fullest and who enable me to be a more educated and engaged patient.

Despite the relative lack of buzz, healthcare IT continues to be of interest to young physicians and those still in training who have decided that clinical medicine may not be right for them. Maybe it’s the rigors of the schedule, the stress of feeling responsible for so many outcomes, or lack of resilience to deal with the chaos that can be modern medical practice that are raising interest. I’ve been mentoring a young resident who is considering whether he should pursue a clinical informatics fellowship or give practice a try. It’s hard to watch a once-idealistic trainee talk about his level of burnout before he’s even made it out of training. Primary care salaries continue to lag behind other subspecialties and doing something other than going straight into the trenches has a certain appeal. He’d like to stay in our metropolitan area for family reasons, so I’m encouraging him to try some moonlighting shifts in the urgent care setting to see if that’s a better fit.

One of the reasons he’s so burned out is that his residency program hasn’t truly embraced the model of team-based care. The faculty physicians are still in the mold of doing things how they were trained, which means a lot of work rolls downhill to the trainees. They have to do all their own patient callbacks and aren’t allowed to leverage staff to manage routine patient requests or to do care management activities – everything must be done by the resident physicians. I don’t dispute that this gives them a lot of knowledge about managing patients, but it doesn’t teach them how to work effectively with other members of the care team or how to lead the care team. The residents don’t get assistance with chart prep or morning huddles, leaving them to try to address gaps in care as part of the routine office visit. Worst of all, when patient-facing work is delayed by other clinical rotation activities, the patients aren’t getting good care. I’m trying to help him arrange some elective work in a setting where he can see clinical transformation in play, along with a rotation with a clinical informaticist in the academic setting. He needs to see first-hand that healthcare IT isn’t all that glamorous either, and depending on where you wind up, you may not escape patient care.

I’m still waiting to see if all this talk about the shift to value-based care will increase primary care salaries, but I’m not holding my breath. I do have a number in mind for which I would hang up my frequent flyer card and go back to primary care, but it would also require some addressing of the details of physician autonomy and practice structure. The wait for a new patient appointment with a primary care physician in my community is upwards of two months if you have commercial insurance, three months for Medicare, and four to six months for Medicaid. When people complain about the potential for rationing in healthcare, they don’t understand that in all practicality, it’s already here. These issues are daunting to new physicians (and old alike) and aren’t doing much to increase enthusiasm among physicians in crisis.

I’m always on the lookout for new vendors and found one this week in the form of CampDoc. The product is positioned as an electronic health record system for camps and they’ve been doing some epidemiologic research looking at the camp population. In addition to injuries, heat-related illness, insect bites, and allergic reactions, camp physicians also have to contend with head lice, infectious diseases, and disaster preparedness. They’ve partnered with the University of Michigan to broaden their research, which has been presented at the American Academy of Pediatrics, the Society of Academic Emergency Medicine, and other groups. Upcoming studies will focus on head injuries and concussions during summer camp activities. Interested parties can visit their website or reach out to CampDoc for more information.

For all you IT road warriors out there, join me in saluting Southwest on their retirement of the Boeing 737-300 series planes. The last of the fleet without Wi-Fi or exit windows that open like a DeLorean vs. having to be thrown out, they officially ended service September 30. I was pleased to see that several will be turned into firefighting tankers and others are in the process of being brokered. I’ve spent many hours in its confines, usually on time. I’m looking forward to its replacement, the 737 MAX 8 ,which has enough range for destinations in South America and the South Pacific. If SWA ever heads to OGG or HNL, I’ll be cashing in my points faster than you can say humuhumunukunukuapua’a.

Email Dr. Jayne.