Curbside Consult with Dr. Jayne 2/2/26

I’ve been doing a bit more clinical work lately because of how the flu season has played out in my community. Rates of Influenza A have been rising over the last several weeks, but we were cautiously optimistic when we started to see a small decline in flu-like symptoms.

However, the flu season decided to deliver a classic one-two punch, because influenza B is now on the rise. Looking at the statistics, this year’s flu season is one of the worst in the last decade as far as hospitalizations for pediatric patients. Our local hospitals are swamped. Hospitals are boarding patients in the emergency department for a prolonged times because they lack staffed beds elsewhere in the hospital. With float pools exhausted, nurses are being reassigned to units that are outside of their core area of expertise.

Hospitals can be full of overly rigid policies and procedures, so I was surprised to learn that one of my colleagues was hired by a local hospital and fast-tracked through their credentialing process in under two weeks. Although it’s great to see that when there’s a will there’s a way, it raises the question of why hospitals can take up to 120 days to credential providers under normal processes.

Putting on my process improvement hat, I wonder whether the process contains steps that are less critical than assumed, and perhaps those steps are skipped during fast-track credentialing. Alternatively, pieces of the process might be able to be expedited at an additional cost that hospitals are not usually willing to pay.

Either way, I was glad to see her get back into the trenches quickly. Having a physician on the sidelines when they are willing and able to work is a loss to community’s patients.

For those of us that work for multiple care delivery organizations or who work infrequently, a fair amount of anxiety can be created when you decide to pick up a shift. When you’re a PRN or as-needed staffer, you are theoretically supposed to keep up with changes to the organization’s policies and procedures. You are also expected to be aware of any changes that have been made within the electronic health record or other tools.

An organization that I work with makes this easier for clinicians. They have a high level of maturity around their EHR governance processes and it’s rare for them to deliver updates more than once a month unless something has gone wrong. Their documentation is great. I typically store all of their update emails in a folder and read through them before I go back on shift so that the changes are fresh in my mind. I arrived at this process after trying a “read as you go” approach that wasn’t as productive.

Another facility where I’ve worked at makes a hash of this with a far less robust process. Instead of sending a single monthly email with release notes that follow a standard format, every builder who is working on a change creates their own messaging without any overarching review. Sometimes the descriptions of changes and fixes are vague, making it challenging to figure out whether they will affect everyone or if they even apply to your department.

For this facility, I still store everything in a folder and refresh my knowledge before reporting. Regardless of how well I try to read and comprehend, the first hour or two of my shift feels like being in a carnival fun house, with all kinds of surprises popping out at you.

One of my favorite organizations to cover is a direct primary care practice. The practice is not a Covered Entity under HIPAA and doesn’t do any third-party billing, their EHR is remarkably simple, and updates to the system are few and far between. The platform they use is remarkably patient-centric. Documentation is a breeze since you’re focused on documenting the clinical encounter rather than meeting billing and documentation guidelines.

The practice has templated the visit notes to have three areas of focus. The “Short Term” section is like a traditional SOAP note and captures issues that are addressed during the encounter. This might occur in person, by phone, or via video visit. A “Patient Progress” section captures the bigger picture of chronic or recurrent conditions.

I like the patient progress nomenclature. It feels more positive than the traditional problem list even though it’s doing the same thing in capturing whether a given issue is improving, worsening, or remaining stable. That section also includes tools to help visualize and close care gaps, monitor preventive services, and track procedures or orders that are due in the next month, quarter, or year.

I can still go to traditional problem list or past medical history or social history sections in the chart. But it’s nice to have things pulled directly into the note where you can see them and understand how they might connect with today’s issues without having to click around.

The last section is simply called “Horizon.” It’s a bit of a catch-all for everything that doesn’t fit into the other two sections, but it includes information that helps the clinician chart a broad course with the patient.

Rather than just having demographic and family history information, it graphically illustrates the patient’s support system. It includes information on their cultural beliefs and practices as well as their general preferences in care. You can go here to figure out whether the patient is motivated to make lifestyle choices or prefers medications to address issues. It’s also where you can see notes on their living will and healthcare directives as well as the nature of any end-of-life care discussions.

Patient portal messages are blissfully absent in this practice. Patients use a secure texting platform to communicate directly with the physician or their coverage. Those interactions are added to the chart at the end of the conversation.

It’s elegant in its simplicity, but it works, primarily because the physician has a smaller patient panel than most insurance-based practices in the area.

I always get whiplash when I go from covering this practice to working in a setting where I’m incentivized to see as many patients as quickly as possible. Still, it reminds me of what it must have been like to be an old-timey physician who really got to know their patients.

For those of you who work with different care delivery organizations, what are some of the most striking differences you see? Leave a comment or email me.

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