Curbside Consult with Dr. Jayne 2/13/23

I went to a birthday party Sunday night, which of course overlapped with the Super Bowl, turning it into an impromptu Super Bowl party. It has been years since I’ve actually seen the game played since usually I volunteered to work Super Bowl Sunday because it’s a historically mellow day in the emergency department and urgent care arenas. People would typically only come in if they were truly sick, which meant a fair amount of downtime, the deployment of numerous Crock Pots, food that you could cook in a microwave or toaster oven, and plenty of camaraderie.

The worst place I ever worked on Super Bowl Sunday was labor and delivery. That is primarily because no one came in during the pre-game or the game itself, but waited at home as long as humanly possible before coming in. Once the final scores were tallied, people started arriving in droves and every bed was full, with babies arriving quickly. One year we even had to deploy a team to the parking lot to assist a patient who didn’t quite make it.

It was nice to be able to hang out with family and friends, although I did have to manage a patient callback in the middle of it due to some pharmacy-related shenanigans. The after-hours exchange was flustered and I wasn’t sure about waiting for the usual process to work, but I was happy to give them a ring. My family hasn’t seen me on call in years, so they were wondering what could possibly be going on.

The planned menu was all about the birthday person. By halftime, I was wishing that I had some taco dip, smoked queso, or Buffalo chicken wings. Certain foods just go with football, at least from my past, so maybe I’ll have to make up for it with this week’s meal planning.

I haven’t seen some of my extended family in some time, and it’s always interesting to try to explain to them what exactly it is that I do as a CMIO and how I can still be a physician if I’m no longer working in the emergency department. Usually I explain that I help manage all the clinical systems behind the scenes, including the patient portal and the software that the physicians use when they write their notes, order labs and tests, or send medications to the pharmacy.

Even with advanced age, many family members are used to communicating with their physicians through a patient portal or following their lab results on their phones. It has been fun to watch some of them become more active participants in their healthcare, although there is always the one relative that takes everything they hear from their doctor as gospel and refuses to question anything, even when the only doctor in the family says they might want to ask some questions based on some concerning prescribing patterns.

Some days are more difficult than others, such as when you have to explain to clinicians that although they have great ideas about workflows, they are not always possible. Especially when you are using a certified EHR, certain things, including workflows that are deeply connected to coding, billing, and other regulatory requirements, just can’t be changed. I’m a fan of giving my users choices, though. If you’re not happy with your current state, here are two potential future states that we can actually accommodate based on the EHR and regulatory guidance, so  which do you prefer? Often they end up preferring the current state, especially when it has been designed by board-certified clinical informaticists who have observed thousands of patient care encounters and who have worked in numerous EHR and documentation systems. 

Other difficult days happen when end users are raging against third-party requirements, but blaming it on the EHR. Sometimes these third parties have created the requirements because they are good for patient safety, and I’m not likely to budge on those. For example, when a physician doesn’t believe that they should have to associated a diagnosis with a prescription. I can certainly empathize with those two extra clicks, but as a primary care physician, I think it’s important that patients know what condition they are taking a medication to treat.

Additionally, when you work for a healthcare organization that has decided that this is a good thing and has created a policy and procedure around it, there’s not much I can do for you as an informaticist other than teach you the most efficient workflows and show you how you can use your clinical support staff to help you make some of these associations as they prep patients for their visits.

I’m always shocked by physicians who don’t know where their grievances should be directed. For example, if they don’t like the clinical policy and procedure, they need to take that up with their department chair or the chief medical officer, not the CMIO or a member of the clinical informatics team. I think sometimes we wind up at the tip of the proverbial spear because we are actually in the clinics interacting with people on a regular basis, which might not be the case with a CMO or a department chair, especially in a geographically diverse organization.

The best days are when someone proactively reaches out to you to let you know that they think a feature that you have recently deployed is cool. I remember vividly the technology that I deployed that generated the first non-hate email from a physician. That was more than a decade ago, and those emails are few and far between.

At my current institution, we were recently early adopters of a solution that I think is pretty darned revolutionary, and most of my physicians don’t have any idea how cool it really is compared to other commercially available options. It’s leaps and bounds better for our patients, has multilingual support, and uses data already in the EHR to drive a better user experience. However, because it has a purpose that some of our providers don’t think is necessary, it’s not getting the love it deserves. We’ll see if more users start to engage with it as they develop a greater understanding of what it can do, and I’ll still hold out at least a little hope that some clinician eventually says thank you.

Valentine’s Day is coming up on Tuesday, so consider showing a little love to your favorite clinical informaticist. If you don’t want to impress them with a witty card, conversation hearts, or an edible treat, consider thanking them for trying to make your user experience the best that their budget and staffing allows.

Email Dr. Jayne.