Curbside Consult with Dr. Jayne 2/22/15

I’ve mentioned a couple of times about having issues in the office recently, where our cloud-based EHR is down. A reader asks: “Please explain to me as an IT physician expert why your cloud EMR was ‘down again.’ Mission-critical systems should have backups. I also believed that bigger organizations should have more resources (like you) to prevent/remediate these events. Please tell your readers why this is happening and what procedures your organization has in place to prevent this?”

We actually went down again while I was seeing patients last week, although it only lasted for a few minutes. I’m happy to tell my story.

In my current clinical situation, I’m more representative of the “average Joe” (or Jayne) physician than an IT physician expert. Like many other physicians in practice, I am employed. Although I used to own my own practice, that was more than a decade ago and the demands of running the business took all the joy out of medicine, sending me into employed practice in the first place.

That was the position I was in when I became a CMIO – homegrown by my hospital/health system to take the reins as we moved into the EHR world, long before Meaningful Use was even thought of.

From a physician informatics consultant perspective, I live and breathe downtime strategy. Clients hire me to engineer their downtime strategies and ensure that being down is something they never have to encounter. Whether it’s the threat of utility providers with backhoes or a natural disaster, I’m all over it.

The downtime solutions I helped engineer when I was a CMIO were initially ridiculed by the IT department as overkill, but they proved themselves time and again as we encountered a variety of unstable situations. Car crash into the data center, knocking out power? Check. Flood in the backup data center? Check. IT guy pulls the Halon fire suppression system on accident, shutting down the building for half a day? Check. Network switch down? Check. Vendor fries your database with a bad upgrade? Check. We had it covered and I learned a great deal along the way.

However, when I go into the office now, I put on my physician hat. My employer knows full well what I do the rest of the time, and although we are a good-sized independent physician group, we don’t have the level of dedicated informatics or IT resources that a hospital-owned group or academic medical center might have. We sometimes run on paper-thin margins as we deal with shifting reimbursement schemes and a rising balance of patient pay accounts.

The bottom line is that that our management (like many other private practices) are not able (or perhaps willing) to pony up to have a full-time or even part-time expert deal with the situation.

That scenario is exactly why I went into consulting in the first place. I started my consulting practice on the side while I was still a CMIO, working with practices that might be on the smallish (or cheapish) side but that still wanted expert advice. Practices who may not feel like they can afford ongoing expert assistance, but might be willing to hire someone to come in, do an evaluation, and give them advice. But despite dire warnings and imperatives, clients don’t always take my advice and sometimes simply cannot afford to do so.

Eventually my consulting practice grew to where I also handle large hospitals and health systems, especially ones with more than their share of challenges. I left the hospital-based world some time ago and hung out my consulting shingle full time.

I had several locum tenens and urgent care-type assignments before settling in at my current practice. In my employment as “staff physician,” I am somewhat blinded to what our owners are doing with regard to the EHR vendor and the ongoing issues. I do receive direct emails from the vendor when the system goes down, and they’re “all customer” type bulletins, so I know that our outages aren’t due to local connectivity issues.

The level of redundancy our vendor may have is a black box to me as an end user. Although I have made suggestions about improving the downtime documentation tools and having regular drills, as an end user employee, dealing with the vendor is not my responsibility. (As a CMIO, I’d have had a vendor exec on a plane and hundreds of thousands of dollars of maintenance credits by now, had we had these issues.)

I’m not excusing the actions of my employer, but just sharing how it is in my world as an employed physician. They know what I do. They know I’m available if they want my opinion. Otherwise, my role is to care for patients and let management do the managing.

I will be visiting the vendor’s booth at HIMSS and asking a lot of pointed questions, but I won’t be doing anything to jeopardize my employment. A practice that lets me work a relatively limited schedule and is flexible with the demands of my consulting practice is rare. One that actually performs (from a clinical standpoint) at the level of my current employer is even more so. Despite the recent failures of our EHR, it does generate mounds of quality data that put us in the top decile for many benchmarks. Patients are voting with their feet as well, allowing the group to continue to grow.

You can bet that things would be different if I held a leadership or ownership position. But much like many other physicians across the country, I don’t. I am subject to the decisions of my employer. Maybe someday they’ll reach a place where they have dedicated informatics resources, but until then, I’m going to put my stethoscope around my neck and see patients.

How do you feel about being an employed physician? Email me.

Email Dr. Jayne.