Curbside Consult with Dr. Jayne 2/23/15

I’m leaning heavily towards staying with my current employer as we move to a single platform for all our hospitals and practices, but lots of people keep sending opportunities my way. Today a juicy CMIO position came across my desk. It’s in a great location and with a well-known health system that I’ve had some dealings with previously.

It looked pretty exciting until I got to the part about the heavy inpatient focus and complete disregard for those of us who have come up through the ambulatory ranks. I started to move it to my recycle pile until something caught my eye. They’re looking for someone “politically savvy with a high tolerance for ambiguity… who can put all the pieces together and deliver on time and on budget.”

I’ve got a lot of experience delivering the undeliverable and creating successes despite some of the people I work with. Usually hard work and pixie dust are involved, but we never admit it. My general rule of thumb is that organizations are typically 30-50 percent more dysfunctional than they admit, so I’m wondering what that looks like when they’re already warning candidates about ambiguity and the need to be able to patch things up to get a project out the door. They also mention frequent interruptions and constantly changing priorities. I’m not rushing to submit my CV.

Another prospective position (thanks to the reader who sent me an opportunity in a warm climate) looks like it’s much more up my alley. The nine responsibilities bulleted in the job description are things I’ve been doing for years. I’m less sure, however, about the tenth one – supervising and assigning projects to physician informaticists on the CMIO’s team. Sometimes it feels like I’m lucky to get an administrative assistant to support me, so the idea of multiple physicians helping deliver value from healthcare IT is awfully tempting. They’re also looking for someone either board certified in clinical informatics or with a masters degree in the field, so that tells me they value the education and training that many of us can bring to the table.

In the mean time, I’m still waiting to find out how my health system is going to handle the clinical leadership structure for the EHR consolidation project. I don’t have a lot of time to dwell on it, however, since we’re preparing more than a dozen practices to seek recognition as Patient-Centered Medical Homes.

The first time I went through the process was on paper. Although there are certain aspects of the requirements that are significantly easier with an EHR in place, there are still elements that are much simpler in the paper world. Some of our practice managers have actually laughed out loud when I ask them to use a simple three-ring binder for some of the requirements. Although I’m obviously a fan of technology, sometimes a manual process is quicker, easier, and doesn’t require anyone from IT to give it a blessing.

I’d estimate that three-quarters of our practices are ready, with stable processes and solid physician buy-in. The other few still need some work. We’re likely to urge the others to move forward while we continue to tweak workflows in those that aren’t quite ready. They also need some refinement in staff roles and responsibilities. We’re finally helping our administrators understand that PCMH is not a technology project so much as an operational initiative. I want to try to get as many of our joint operational and technical projects completed before the transition to the new system begins in earnest.

I’m also staying occupied looking for interesting ways to use some of my accumulated vacation time. As of January 1, our health system has gone to a “use it or lose it” philosophy and has capped the vacation hours we can have on the books. I’m dangerously close to the limit and certainly don’t want to leave any hours on the table. I’m planning a wilderness adventure for July, and if I don’t get eaten by a bear, I’m looking for a trip in the fall that will provide not only some R&R but some continuing education hours. I also hope to take some long weekends once the weather gets nice. The new policy should make for some interesting resource challenges as everyone tries to lower their balances.

What’s your plan for R&R in 2015? Email me.

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