Dr. Jayne at HIMSS 4/16/15

I’m home but still playing catch-up with my HIMSS experiencing. As I was triaging my inbox, I found a gem about a new patient engagement product. It wasn’t a great release and didn’t even mention the vendor showing it at HIMSS. Who sends dry press releases during HIMSS and doesn’t even mention the conference? I’m sure the visibility on this one was pretty low.

The highlight of my day Tuesday was running into a good friend while waiting for the show to open. His cup caught my eye and we had a nice catch-up until heading into the fray. The show floor was pretty busy. The creepiest booth was in the Interoperability Showcase, where one of the hospital displays had two people sitting in a hospital bed together. One was wearing a baseball cap and looked totally bored. The same display area also had a guy walking around in a hospital gown with a sign around his neck, pushing what looked like a vital signs monitor machine. Very strange.

I saw HIStalk sponsor signs at Sunquest and Santa Rosa as well as at Healthfinch, where I had a great demo from Debbie. Healthfinch is one of what feels like only a handful of products that actually makes physicians’ lives easier, so I salute them. I stopped by the Enovate booth to see if they had anything new – we use their pediatric computer carts and they’re super cute. I was hoping they’d have a new animal offering this year and they promised to send some literature.

Venturing back into the bowels of the hall to the HX360 area, there were quite a few empty booths. One of my colleagues joked about creating a fake wireframe and sitting at their booth just so we could have a rest. We did use their chairs while I caught up on email. My goal was to check out MediVu, who had emailed me about their startup. Although their message said they had “no fancy giveaways or fancy parties to invite you to,” they were warm and welcoming as I chatted with CEO Robert Baldwin about their product’s dynamic icons. They did offer me some mints in a test tube, so they passed the southern hospitality test as well. I like to follow startups – I’m still following one that I first saw at HIMSS in 2011. They haven’t made the big time, but they’re still at it.

McCormick Place failed the southern hospitality test, with overflowing trash cans and recycle bins. They also committed the “here’s a trash can but no corresponding recycle bin” faux pas, which makes me crazy. It’s not like they’ve never hosted a convention before, you know?

They did, however, have an actual working pay phone near the lower-level restrooms, so that’s something.

I spotted these shoes in the 900 aisle. Although they’re attractive, I think the gentleman she was talking to made a more responsible shoe choice.

I tried several times to connect with specific vendor reps as I roamed the aisles. My success rate was zero for three –people had stepped out of their booths and the response of those left behind was highly variable. IMO (Intelligent Medical Objects) gets the prize for best response. First they asked if I would like them to try to find the person or whether they could help me, then offered refreshments while they looked for him. The second two vendors will remain anonymous to protect the guilty – one didn’t bother to ask what I wanted, saying, “He’s out of the booth, but I can help you,” which wasn’t true since I was just there to see pictures of his new baby and catch up. The third just said, “I have no idea where he went, but it was a while ago” and left it at that. Vendors take note: you should have a plan for this because I bet it happens a lot. Other “booth teams behaving badly” included the guys from Intel, who were leaning on the door of the Medicomp booth and preventing people from getting in or out.

Humetrix had surfing rubber ducks at their booth.

I headed to the HIMSS Bistro in the afternoon to stalk the CMIO lunch. This sign on the sky bridge reminded me of the need to proofread. It looked like the CMIO group was having a great discussion, but I was a little disappointed by the small number of women at the table, one of whom was Lorre. She has promised to send me her notes from the discussion – I bet it was a good one and would have loved to attend if there was any way to stay anonymous.

Epic had their traditional quirky art. I really like this guy, though – I would totally buy him. Insight Enterprises had a life-sized “Operation” game in their booth, but I couldn’t get a picture of it because of the crowd around it. I visited with my good friends at RemitDATA for a few minutes. They helped talk me off the ledge after I was accosted by aggressive vendor reps on the way there. One was stepping into the aisle, randomly shoving literature at people in complete disregard to their “no thank you” or corresponding lack of interest in their product. Another actually grabbed my hand and tried to pull me into the booth. When I told a colleague about it, he also commented on the aggressive nature of some of the reps, saying, “It was like they were on an attack vector.”

After that, it was time to head back to the hotel and change for the evening’s parties. The bus to the hotel was much faster this time, but still with the same people rushing the front as soon as it stopped. I got ready quickly and the cute boots I brought sat unused as I knew I wasn’t going to make it through the night without serious pain. I cabbed it over to the New Media Meetup at Gino’s East with a friend. The Chicago-style pizza was the perfect way to fuel before a big list of events, but I was bummed that I didn’t have a paint pen to add my “Dr. Jayne was here” to the walls.

From there it was off to the “HIMSSandHers” networking event, sponsored by XX in Health and Edifecs. They generously donated $5 to Bright Pink for everyone who tweeted a pic from their event. Do you like my selfie? There were several other parties that night including Nordic and NextGen. I caught up some friends at the end at Tavern on Rush, where I was confused by the fact that they have a pair of sparkly Louboutin heels in a rotating Plexiglas box behind their bar. I’m sure there’s a story there.

By the end of the night, I was ready for a trip to the spa as this bakery display advertised, but alas there was still more HIMSS ahead of me. Next up: I’ll post my HIMSS wrap-up after the weekend.

Dr. Jayne at HIMSS 4/15/15

I’m way behind on my writing, mostly due to the overwhelming nature of the exhibit hall coupled with entirely too many social events. I had decided to walk to McCormick Place Monday morning but abandoned my quest after the first half mile due to the drizzle. I was joined on the bus by two women who joked about the window curtains, saying that if they were rock stars they’d close them and kick back. If they were rock stars they’d have couches and tables rather than the flimsy cup holder that turned my bottle of Diet Coke into an ankle-seeking missile.

They joined me in rolling our eyes at the people on the bus who jumped up and rushed the front as soon as the bus stopped. I’m not sure what happened to waiting until those in front of you exit, but that wasn’t the only bus ride where that happened. I had been trying to time my arrival to the opening of the exhibit hall, but was early since I decided to catch the shuttle at the Hilton. I picked up some breakfast and was nibbling a sandwich and juggling my stuff. I want to offer a profound thank you to the gentleman who gave me his chair and proved that manners still exist.

Shortly after that, I saw a tweet from Jessica Kahn that highlighted images of women at HIMSS with the hashtag #overit. Sex definitely still sells, as proved by a vendor event I attended that featured scantily-clad Go-Go dancers. I did overhear several attendees comment that they thought there were fewer “booth babes” than in previous years. The wildest thing I remember seeing was in 2011 when one vendor had contortionists on stage in their booth. As a clinician, it was fascinating, but still not appropriate.

I did make it to a couple of sessions, but none of them had anything earth shattering. Monday’s agenda was aggressive and included hitting several booths before making my way to play Quipstar at the Medicomp Systems booth. The amount of work that goes into putting together a full-scale working game show set is huge. Their backstage area hosts a variety of technology that keeps the game up and running. I’m not sure how many trucks it takes to haul it, but the infrastructure of their two-story booth is pretty impressive.

My performance as a contestant, however, was not impressive. Despite winning the double-points bonus question, I finished second and will be taking home six gallons of popcorn, which I’m sure my staff will enjoy. The real prize was their donation of $1,000 to Wings of Hope. Nominated for the 2011 Nobel Peace Prize, they set up field bases in developing nations. The bases help build clinics and schools, and establish air ambulance service for rural areas. As a non-sectarian, non-political organization, they can often work in areas that will not accept other charities. They also operate a Medical Relief and Air Transport Program in the US that flies children for medical treatment free of charge.

I returned to Quipstar later in the day to escort Jonathan Bush to the booth. He played for the St. Boniface Haiti Foundation against former ONC Deputy National Coordinator Jacob Reider. St. Boniface Haiti Foundation helps bring healthcare, education, and community development to the people of Haiti. The highlight of the round was seeing them take a selfie together. The contest was also full of entries for my “things I thought I’d never hear at HIMSS” list, but they were throwing them out too fast for me to jot them all down. Dr. Reider won the round, earning $300 cash which he added to the Medicomp donation to Engeye, which is dedicated to improving health and education in Uganda.

Later I stopped by the Dell booth to put together some cute headbands for Brooke’s Blossoms. They will go to pediatric cancer patients. We always like hearing about HIMSS events that benefit others, so if you have pictures or write-ups, feel free to share them. I wanted to hit several other booths, but was struggling mightily with the floor plan, mostly due to confusing booth numbering and crazily staggered aisles.

I left the exhibit hall early to get ready for HIStalkapalooza and was glad that I did since the bus ride to my hotel involved nearly 45 minutes of bumper-to-bumper traffic. Luckily the taxi to the House of Blues was much quicker. I had the opportunity to chat with my Secret Crush, David Dieterich, who was admiring my escort’s crushed velvet jacket. Although my crush initially bought my cover story, I’m pretty sure he figured out my secret identity.

The third floor at the House of Blues was the place to be for dinner, with minimal buffet and bar lines. I snagged a front row seat to enjoy the music while having dinner with a couple of friends. Although I couldn’t experience the sponsor opera boxes because I didn’t have a wristband, they looked cool. After dinner, it was time to grab some pecan pie and head to the dance floor for the HISsies.

As an avid baker, I enjoyed Judy Faulkner’s comments about liking to bake pies. She said she was reluctant to put the pie in Jonathan Bush’s face because it would be an insult to the pie. BTW, apple is her favorite. Once the HISsies were over and the pie was abused, Party on the Moon took the stage. They were even better than I remembered and I hope we can make them a permanent fixture. I overheard several hysterical comments throughout the night, including one attendee’s remark that the lead singer looked like the love child of Farzad Mostashari and Usher.

I admired many footwear choices, lamenting the fact that I just can’t do stilettos anymore. I wish I could have gotten a better picture of the red boots above — they were phenomenal. If the owner sees this, please send me a picture and description for my wish list. I could probably tolerate those for a couple of hours. Since I listened to my Shoe Advisor’s pronouncement that “wedges win every time,” I was able to stay on the dance floor until the bitter end, then hit two after-parties before collapsing at The Palmer House.

A reader shared a pic of the Athena Cloud Party, describing it as “insane.” I’m wondering if Jonathan Bush had any comments to make about HIStalkapalooza? I know there were plenty of other events Monday night – send your best pics and a description and I’ll run them next week.

Dr. Jayne at HIMSS 4/13/15

I made it to Chicago despite an extremely turbulent flight, opting to take an earlier route to Midway instead of O’Hare. The taxi queue was epic and made me long for the organization of Las Vegas. I did run into several friends in line, although none we headed to the same hotel. Although I’m usually annoyed when my taxi driver talks on the phone while driving, this one was lecturing his high school daughter on her GPA and the importance of getting into a good college, so I just relaxed and enjoyed the ride.

Besides catching up on new products and doing research, the main reason I come to HIMSS is to catch up with colleagues. It’s nice to be able to chat in person and the event brings so many people together. A friend who has missed the last couple of HIMSS conferences met me and we enjoyed the long walk to the convention center for registration. Other than a few sprinkles, the weather was gorgeous. The only thing that could have been better would be if Google Maps had not been providing walking directions that felt like we had been bar-hopping first.

While waiting outside the opening reception, I ran into a CMO friend that I hadn’t seen in several years and we talked about her new work with the VA system. Our employed specialty physicians provide a lot of care to veterans outside the VA clinics, so we talked about some strategies for making sure all the information is shared not only within the VA but with the community physicians who deliver increasing amounts of care for veterans.

The reception opened a bit early and there were plenty of bars and buffets set up. The band was named The Fat Babies and was playing to the backdrop of scenes from The Untouchables on the video screens above and behind them. I haven’t seen it in years and the younger Kevin Costner and Sean Connery reminded me that I’m not getting any younger either. I’ve officially been in healthcare IT for more than a decade. Had you asked me at the start whether I’d be doing it full time, I’d have thought you were crazy.

The reception brought some interesting characters my way. Since I was there early enough to grab a table, I made a good target for solo attendees looking for a place to set their drinks while they ate. People aren’t afraid to just introduce themselves and start talking, and my wing-man got to see me almost choke when one of the random people started talking to us about absolutely ridiculous things. Despite the titles on his badge, he had only a loose grasp of some of the key concepts in health IT, so we educated him on the Direct protocol and how physicians need to incorporate received data into patient charts – not just leave it in some email box. I had to leave my wing-man after the reception, but he promises to share many stories about other characters on our upcoming stroll through the exhibit hall.

After the reception, we headed towards the river with a stop at Rebar at Trump Tower. It has a beautiful view and apparently also was hosting a get together for Healthfinch, so we enjoyed seeing celebrities come and go. After a quick dinner we headed to the Divurgent/Experis reception at Roof on the Wit. I was traveling with a pack of party animals who decided to have a contest to see how many people each knew. The competition was stiff and I was quickly reminded that even though I’ve been around a while, I’m but a young pup when it comes to networking. I did run into Nordic’s Drew Madden who showed off what must be the year’s hot accessory – snazzy socks. He informed me that he brought a special pair of shoes for HIStalkapalooza.

On the way to catching my beauty rest, I happened upon the Aventura team at the Palmer House bar. I didn’t make it to the HIStalk sponsor reception (it’s a little tricky to do that and remain anonymous) but they promised a pair was waiting at their booth. I’m excited and think I’ll sport them at Quipstar rather than the sparkly numbers I brought.

EPtalk by Dr. Jayne 4/10/15

For those readers attending HIMSS who might want to check out my shoes, you can catch me at the Medicomp Booth (# 2318) on Monday afternoon. This year’s celebrity contestants include Jacob Reider, Lyle Berkowitz, and Ross Martin. Medicomp will again be making donations to our favorite charities and I’m honored to have been invited back. They offered bodyguards to protect my anonymity as well as a swanky backstage green room, which should make for a fun afternoon.

After I get my game show on, I’ll be heading over to the Meditech booth for the official launch of their Web Ambulatory product. Quite a few legacy vendors seem to be trying to embrace the cloud, so I’m eager to see their take on it. Plus they’ve promised champagne, although I wonder if they’ll be sneaking in the good stuff given the typical trade show restrictions on food and beverage service. I spent a fair amount of time sorting through press releases and booth invites today (nearly all of them via email) and can report that misspellings of HIMMS are leading HIPPA 3 to 2. I’m definitely not putting those organizations on the priority list.

I received the final instructions for the HIMSS Wellness Challenge. It will be measured in steps taken on Monday and Wednesday and in distance walked for Tuesday. Entrants must be present at the Connected Patient Learning Gallery to win – times are 5:30 for Monday and Tuesday and 3:30 for Wednesday. Those times border on my social schedule, so I think I’ll have to take a pass. If you decide to hang in there, the prizes are $300 gift cards.

Our leadership is hoping that CMS uses HIMSS as the prime time to release the rule making official a 90-day reporting period for 2015 Meaningful Use. Regardless of when it happens, I suspect that quite a few organizations will be planning to attest as late as possible so that they maximize their timeframe for upgrades and workflow changes they might need to be successful. We’re historically conservative and planned for full-year reporting, so our monthly status reports continue to be amusing reads as providers have decided they don’t need to be compliant just yet.

I had a brief trip in the Wayback Machine this week when our newly-acquired community hospital started including me on its email distribution list. Apparently they can’t convince their physicians to actually use electronic charting, so they’re going to pilot scanning hand-written progress notes starting next week. They reminded physicians to “change the dial on the charts to yellow which will alert the staff to scan the note.” It’s been so long since I actually used a paper chart, I had forgotten about the colored dials and sliders we used to let unit secretaries know we had written orders.

On Monday, CMS opened the Dispute Period for Open Payments. Drug and medical device makers are required to report payments made to physicians and teaching hospitals and physicians have the opportunity to review the data for accuracy. The review period is open for 45 days. Although I have all the logins, I discovered reviewing the data isn’t as easy as it sounds. Physicians have to register for both the CMS Enterprise Portal and the Open Payments system. Enterprise Portal accounts are locked if there is no activity for 60 days and deactivate at 180 days. Based on other demands for our time, I doubt that too many physicians will be personally reviewing their data. Maybe CMS could try sending us our data using DIRECT addresses.

Earlier this week, Mr. H mentioned the ECRI Institute list of top patient safety concerns. Of course health IT-related issues are hot topics, but I was surprised to see managing patient violence as number three. Our hospital was on lockdown multiple times last fall and it’s always unsettling, but the high-profile events aren’t the ones I’m most worried about. I’ve been threatened several times by patient family members. I suspect some of our outlying physicians may have firearms at their offices despite our official ban.

What are you doing to keep your staff and patients safe? Email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 4/6/15

The run-up to HIMSS is typically packed with marketing, but this year has been incredibly slow. As I scanned the Monday Morning Update, this ad from First Databank caught my eye. I’m pretty sure no one in their right mind would electively join a Meaningful Use club (unless they had some sadomasochistic tendencies), but it was catchy and smart. In fact, so catchy and smart that I might borrow their “varsity” idea. We typically have a theme for each year’s major EHR upgrade and I’m liking the idea of awarding varsity letters to our next class of super users.

There are only four more postal days until I board the plane for Chicago, so if vendors were going to try to reach CMIOs by snail mail, they’d better already have their marketing pieces on the way. There are usually several pieces that arrive the week after HIMSS and I hope their senders at least got a bargain when they chose PR firms that wouldn’t get the message out on time. My administrative assistant is getting seriously depressed at the lack of entertaining pieces – usually he enjoys making fun of the poker chips and other items, but there hasn’t been anything interesting this year.

The weekend email did bring a heartfelt apology from Nordic President Drew Madden, who heard about my dis-invitation from their HIMSS event. It sounds like they’re still working on right-sizing given their venue and have been able to expand capacity. Being part of the HIStalk team, I certainly understand how crazy it can be to find your event turning into the hot ticket. If I can figure out how to re-RSVP and stay anonymous I’ll certainly give it a go. I appreciate the personal contact and his kind words.

Speaking of HIMSS events, I’ve finally locked in my wardrobe for HIStalkapalooza. I’m really a jeans and boots girl at heart, but do love dressing up. It looks like the Chicago weather is going to be fairly cooperative and I’ve got plenty of other casual-dressy events, so this year’s red carpet look is going to be decidedly formal. I was completely outdone by Lorre, last year so it’s time to catch up. I’m still waffling between two different pairs of stunning shoes and will be wearing them around the house this week in the hopes that I’ll be able to decide. There’s nothing that can make you feel classier than folding laundry in heels and pearls. Eat your heart out, June Cleaver.

There are very few people from my day job who will be attending HIMSS, so I have a long list of booths to try to visit. A friend of mine recently clued me in to Humetrix, which offers several different smartphone apps. Their iBlueButton offering allows patients to store, aggregate, and share personal health data. SOS QR allows patients to create a record of emergency health information and then generate a QR code that can be displayed on their phone’s lock screen. First responders or healthcare providers can use the code to access critical health information during an emergency. A premium version allows patients to send out SOS messages to their emergency contacts.

Although it seems like these would be good for older patients or those with complex health needs, for young active patients who might wind up with a concussion or sports injury, it’s a great idea as well. It took me all of three minutes to create my record and there’s a certain peace of mind knowing that if I get loopy during my next half marathon, someone might have access to better data than what I illegibly scribbled on the back of my race number bib. Humetrix announced their Tensio app at the Consumer Electronics Show and they’ll have it at HIMSS. I’m looking forward to seeing how they use HealthKit data to engage patients for disease management.

The annual HIStalk guide to HIMSS is out and lists sponsor booth numbers as well as blurbs about swag and other giveaways. Several sponsors are donating to charities if you stop by, so be sure to visit AirStrip, Divurgent, and Orion. The Guide is also a great way to plan your route for complimentary drinks and snacks (cocktails at Billian’s, coffee at First Databank, scones at MedData, smoothies at PatientKeeper, and of course candy at PerfectServe). HCS Health Care Software, Inc. is hosting “a night of baseball, beer, and burgers” near Wrigley Field – check out the Guide to see what else you might be missing.

What’s your HIMSS15 exhibit hall battle plan? Email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 4/2/15

I’ve been struggling to get through the Meaningful Use Stage 3 proposed rule, but finally reached the end. I’m not sure how much of it I’ve retained, although I did take good notes.

I also skimmed the certification document to get an idea of new things my vendors may be offering. A couple of them struck me as interesting additions: the family health history pedigree; expanded social, psychological, and behavioral data; and consolidated care plans. CIO John Halamka, MD and Micky Tripathi posted an excellent analysis last week that should be required reading for all hospital and software vendor executives.

My favorite section of their write-up (appropriately subtitled “The Ugly”) encapsulates my frustration as a primary care physician:

If a clinician has 12 minutes to see a patient, be empathetic, document the entire visit with sufficient granularity to justify an ICD-10 code, achieve 140 quality measures, never commit malpractice, and broadly communicate among the care team, it’s not clear how the provider has time to perform a “clinical information reconciliation” that includes not only medications and allergies, but also problem lists 80 percent of the time. Maybe we need to reduce patient volumes to 10 per day? Maybe we need more scribes or team-based care? And who is going to pay for all that increased effort in an era with declining reimbursements / payment reform?

Most of my primary care peers could deliver truly excellent care if I we only saw 10 patients per day. However, primary care physicians in my organization are expected to perform at a certain percentile based on MGMA data. The majority are seeing 30-35 patients daily, yet revenues are still declining. They’re also working longer hours with increased burnout. One of my favorite colleagues just “retired” from practice at the tender age of 48 and will be doing part-time urgent care instead.

I’m grateful to those who actually selected primary care residencies during the recent National Resident Matching Program process. Over 1,400 fourth-year US medical students selected family medicine and I salute them. To consciously choose this life given current market forces, you are either called to serve or you are a risk-taker. Fortunately, we can benefit from having more of both in the trenches. There were a total of 3,195 positions available and graduates of non-US medical schools will typically fill the remaining slots.

I mentioned last week that I had received some pre-HIMSS mailings with butchered addresses and titles. Not to be biased in reporting only questionable print media, I’ll share that this week I received three emails that fell into the category. When preparing mass communications, first make sure you’re selecting the right field for the last name. I guarantee my real name is not “Dr. O’Day,” so I didn’t read your piece. Second, “Dear Chief Nursing Executive” isn’t going to make CMIOs want to continue reading. Third, don’t call out my mostly-inactive consulting company as needing your services because my “organization is bustling and case managers are overwhelmed with ineffective ways of contacting and tracking patients.” Nothing like serving up an insult to an entity that doesn’t even have contact with patients.

While I’ve got my crankypants on, let’s talk about vendor events at HIMSS. On one end of the spectrum, we have sponsors like Divurgent who offered all HIStalk readers the opportunity to attend their HIMSS event.  On the opposite end, we have Nordic. Their event was advertised in a CHIME bulletin, but after an initial acceptance email, I received a follow up email stating I’m now declined “due to the lack of space and focus on our clients.” I guess the fact that I’m on the IT committee at one hospital who has been a client and on staff at another Epic hospital is moot. I’ll be reporting on other social events instead, but they might want to update their website since it says guests are welcome and suggests forwarding the invite to colleagues.

I always enjoy hearing about sponsors and their philanthropic efforts. NextGen announced its Eighth Annual NextGen Cares Golf Tournament to benefit the Jayne Foundation. The scholarship fund is in memory of former client Dr. John W. Jayne, but for obvious reasons, it caught my eye. Opportunities are available for both golfers and non-golfers, including a cocktail hour and silent auction.

Have a charitable event and want to get the word out? Email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 3/30/15

I mentioned that we are having budget meetings this week. One of the hot topics is how we’re going to manage office space and various leases as we reorganize to consolidate onto a single vendor platform. The health system’s goal is to move everyone under the IT umbrella, so we’ll need more space at the mother ship.

We’ll also have to figure out what to do with existing office space leases at our regional campuses and how to transition people from one location to another in a timely fashion. Certain functions such as desktop support and provisioning will continue to be somewhat regional, so there’s going to be some delicate negotiating while we figure out which spaces to keep and which to let go.

I hadn’t given much thought to the new space they’ll be outfitting for the project. The last time I was involved in a significant office move was seven or eight years ago and we were going into a largely completed space. The biggest thing we had to decide was which staffers would be placed into which rows of cubes.

Late last week, I had the dubious pleasure of attending a half-day session to discuss design and construction of the upcoming office build-outs. Given some of the complaints we’ve gotten about the open office design at some of our newer facilities, I thought the topic might be contentious, but I had no idea just how much.

One faction came to the meeting armed with copies of a recent article in The New Yorker called “The Open-Office Trap.” It details the perils of the open office, citing examples of reduced productivity and higher levels of employee stress. Reports have also chronicled higher use of sick days and reduced cognitive performance. One study from Cornell University found that workers exposed to typical open-office noise had higher levels of the stress hormones that are typically associated with the fight-or-flight response. Another from Finland looked at whether younger employees did better with the open office platform and concluded that although they might seem to, there are trade-offs.

As we started the meeting, another attendee hastily emailed links to the Washington Post piece on the topic. The author mentions employees who have difficulty with the transition the open office paradigm and laments the lack of huddle rooms to be used when private conversations are required.

I know that the first time I had to transition from a private office to a cube, I had a hard time adapting. As a newly-minted medical director, I was given a “supercube,” which was essentially double sized with a small table for meetings. It was on a main thoroughfare in cubeland however, which seemed to invite people to plop around the table for impromptu conversations.

I was often interrupted with requests to borrow my chairs or by people just saying hello on the way to the bathroom, icemaker, elevator, or coffee pot. It was also difficult to have confidential conversations about physician behavior, especially since we didn’t have enough smaller meeting rooms. This led me to hide out in a poorly-lighted and recently-vacated office in the basement near hospital engineering, at least until that space was reassigned. The experience definitely strengthened my support for allowing staff to work from home.

Halfway through today’s already-rowdy meeting, another colleague emailed around a piece entitled “Open-Plan Workspaces Are the Work of Satan.” The meeting quickly spiraled out of control after that since it’s hard to take Formica samples and color swatches seriously after someone has invoked the Prince of Darkness. The design and construction team had brought along an intern and I’m sure she found the meeting to be highly educational, just not in the way it was originally intended.

I’m just glad I kept a low enough profile to avoid being volunteered for the subcommittee that will meet again to “continue the dialogue.” I’ve spent the last two months fretting about the future of my team and of my own career and it didn’t even occur to me that serious choices needed to be made on whether we want an aquatic color scheme or one that is desert-inspired or how many “rolling-wall” whiteboards we might need to order. I’m glad there are people that care and are thinking about these things, but at this point it feels frivolous.

The positions for our new clinical project were posted last week. It’s hard to watch my highly-qualified staff fret over whether they’ll be chosen. They’ve heard that they have to take a personality test and that there may be a preference for younger workers without “bad habits” gleaned from working with other vendors and systems.

I’m not part of the hiring decisions at all, but I certainly hope we don’t shoot ourselves in the foot by throwing away all the non-software knowledge we have amassed regarding how to effectively serve our physicians and their practices. In the mean time, I’ll have to amuse myself by running the betting pool on aquatic vs. desert color schemes.

What do you think about open offices? Email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 3/26/15

I read with interest Mr. H’s summary of Chicago’s April weather over the last several years. One of my friends was in Chicago this week and posted pics of snow. Right now I’m still planning a ball gown for this year’s Histalkapalooza, so I’m crossing my fingers against rain, snow, sleet, hail, and slush. I do have an opera length coat at the ready, but I am not looking forward to figuring out how to pack it all. The fact that I’m thinking about HIMSS planning right now underscores the fact that I’m procrastinating the continued reading of the Meaningful Use Stage 3 documents that were released last Friday.

I’ve only received a couple of pre-meeting mailers, but there have been a couple of ads in healthcare IT publications that caught my eye. Sponsor ChartMaxx is giving away some Chicago pizzeria gift baskets in their “Grab a Slice of the Windy City” promotion. Winners could receive a gift basket and pizzas delivered to their home – sign me up for that one. The two mailers I did receive both mentioned Apple Watches, but I’m not an iPhone girl, so they didn’t engage me. Additionally, one had my title wrong and another botched the address. It never ceases to amaze me when a mail merge goes awry or that people don’t proof things before they go out.

Speaking of proofreading, I wonder if 1-800-Contacts realizes that their most recent mailing provides a possible time-travel option for customers? Although it was mailed earlier this month, it invited me to place an order through January 2013. I guess it’s not just conference marketers who can’t get it straight, but I’m wondering if I can call and see if they’ll honor their 2013 pricing.

Procrastinating on the Meaningful Use documents also means catching up on journals this week. I’ve been doing a better job of keeping the pile on my entryway table to a minimum, but still am not current. A blurb about using Fitbit devices to predict recovery from back surgery caught my eye, however. Researchers at Northwestern University, New York University, and the University of California-San Francisco are looking at patient activity four weeks prior to a procedure and six months after. Preliminary data shows that patients not only reach their pre-procedure activity level after about a month, but continue to increase to levels that weren’t possible prior to surgery. Although they’re only looking at a subset of spine surgery procedures, I like the idea of capturing that data to model real-world results.

I’m glad I went through the journal pile because nestled in the back pages of American Family Physician was a “Patient Oriented Evidence that Matters” (POEM) segment answering the question of whether computerized decision support systems linked to EHRs improve patient outcomes. The ‘not really’ response cites a recent meta-analysis and I’m glad I read the original article. It was a little less pessimistic than the “bottom line” summary provided in the POEM. I printed a couple of copies of the actual paper to keep on my desk because I’m sure someone will bring the summary in next week as support for why we should not have an EHR. I’ll be ready when they do because at this point EHRs are not going away, but I do love a good medical literature spitting match.

Going back to January in the stack, I also found reference to an editorial in the Annals of Family Medicine that talks about allowing medical students to use EHRs so that they’ll be ready for later phases of training such as residency. Our students get a lot of experience with EHRs in our academic hospitals, but very little when they’re on their community-based rotations. The barriers cited by our sponsoring physicians include licensing issues with EHR vendors, lack of dedicated training for students, inability to separate student documentation from rendering physician documentation, and the transient nature of clinical rotations. Most of these were echoed in the editorial, which also mentions the need for students to learn how to manage populations using registries and other analytic components of EHRs.

I’ll be interested to see how the current generation of medical school and residency grads use EHRs after completing their training. In many parts of the country, we’re to the point where students may not even be exposed to paper charts. In my area, even our community free clinics are using EHRs. I’d love to do a study of new physician interactions with patients in an EHR-enabled exam room vs. physicians who transitioned from paper charts.

Got grant money? Email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 3/23/15

Just when I was excited that spring had finally sprung, our friends at CMS and ONC have dumped a load of snow on my proverbial daffodils by releasing the Meaningful Use Stage 3 proposed rule along with the 2015 Edition Health IT Certification Criteria. Although it proposes to “simply the meaningful use program,” I find it hard to believe that the 301-page rule and corresponding 431-page certification criteria can be viewed as simple. As an example, there is a four-and-a-half page glossary of acronyms near the beginning.

Having sat through the first two parts of the trilogy, I know Hollywood would have helped me out by breaking the third installment into two full-length features. Alas, we aren’t that lucky with federal regulations and we’re squeezing it into three parts, much like Shakespeare’s Henry VI. I really did try to get through it, but I think the last five or so years of reading so many regulations have shortened by attention span. I hoped if I delayed into the weekend that Mr. H would read it and provide a pithy digest, but it seems he’s thrown in the towel as well.

Glancing through, they do note that, “Stage 3 of meaningful use is expected to be the final stage” which brings a sigh of relief. However, starting in 2018, all providers would report on the same Stage 3 definition of MU regardless of prior participation. Everyone would be on the same playing field regardless of their start date, which certainly does make things simpler. It makes it nearly impossible, however, for those who have not yet started to play the game.

I liked the proposal on page 15 to remove “topped out” measures, which they believe are “no longer useful in gauging performance, in order to reduce the reporting burden on providers for measures already achieving widespread adoption.” Sorry for the easy “A” grades, folks, you’re going to have to continue to work for it. There will, however, continue to be four categories of exceptions:

• Lack of Internet access or barriers to IT infrastructure
• Time-limited exception for newly practicing EPs or new hospitals
• Unforeseen circumstances such as natural disasters
• Exceptions for EPs with limited interaction with patients or lack of control over EHR availability for those of us practicing at multiple locations

The estimated federal cost to continue the incentive programs between 2017 and 2020 is approximately $3.7 billion. They do mention that “we do not estimate total costs and benefits to the provider industry” because those would be difficult to estimate. We all know that our EHRs cost far more than the $44,000 we might be receiving through Meaningful Use. Additionally, I’m not sure what the neck and back pain that some of us experience after hours at the computer might be worth if we asked for compensation. That’s not to mention the anxiety of dealing with all the virtual I’s that have to be dotted and T’s that have to be crossed to receive the incentive payment and/or avoid a penalty.

Pages 20-23 give a nice overview of the regulatory history and if you’re interested in the definitions they start on page 24. I admit, though, that my concentration started flagging around page 30 and I decided to call it a night. The 60+ patients I saw earlier in the day (will flu season never end?) started to catch up with me as did the glass of Simi cab. I’m going to have to work my way through it over the course of the next week, but I’m still crossing my fingers that the Cliffs Notes version will come out soon.

I feel for the vendors that have to read both the proposed rule and the certification requirement documents to be ready for clients who are going to start asking how vendors plan to handle the requirements before anyone has barely had a chance to digest them. Not to mention, this is still just a proposed rule and subject to public comment and potential revision. Although we don’t expect too many changes based on the historical track record, there still might be a few. I always enjoy reading some of the public comments and I’m sure those will be good for discussion in a few weeks.

I’m still a relative youngster in the medical trenches, but reading the proposed rule did make me nostalgic for the so-called good old days that I barely got to experience in practice. I was already nostalgic after a patient encounter earlier this week, when I had the privilege of caring for one of my medical school professors. He retired the year my class graduated and happened to need care while visiting his grandchildren in my city. When I saw the name come up on my census, I couldn’t help but think of my teacher. I’m sure I was beaming when I walked into the exam room and realized it was indeed him. I’m just thankful his issue didn’t involve his specialty of head and neck so I didn’t feel like I was on the hot seat again.

I do miss the continuity of traditional family medicine, so it was nice to make that kind of connection with a patient. I can’t help but think that my class gave him more than a little heartburn and might have contributed at least a little to his retirement decision back in the day. Luckily his problem was minor, but I have to say that seeing him made not only my day but possibly also my week and my month. I went into medicine to connect with people, but I feel that connection is being lost as the healthcare system evolves. After a bright spot like that, sitting and reading government regulations just makes me sad.

I’m sure lots of other CMIOs, medical directors, and informatics pros will be digesting the regulations this weekend. I’m going to finish unwinding and get ready for a big week of budget meetings and discussion about the further evolution of my team.

I asked last week how others unwind after a long day. Several respondents cited wine or other adult beverages, but an equal number mentioned physical activity as a stress reliever. Swimming, cycling, and horseback riding also made the list. As long as the snow stays away I’ll be out in the garden, marveling at the tender shoots and the promise of things to come. For tonight, however, I’m going to close my eyes and count not sheep, but pages in the Federal Register.

Are you ready for MU3? Email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 3/19/15

It was good to get away from my day job last week. I spent my days off seeing patients and intentionally not checking my hospital email account. I’m aggravated at how things are going with our upcoming EHR migration and how my team is being treated, so I thought unplugging would be therapeutic.

Initially we were told that our team would be transitioned to the new project and placed in similar job roles. Our ambulatory group continues to acquire new practices and a small team would remain to continue implementing at those sites as well as to support existing sites. We communicated this to the team and they were comfortable with the approach.

About a month ago, the plan changed. Leadership decided that they want to structure the team more consistent with what the vendor recommends. Now we’re looking for a fairly large number of project managers and plan to hire a completely new training team.

I’m reading between the lines and thinking that perhaps they don’t want people with experience because they’re worried about preconceived notions of how an implementation should look. New trainers will certainly be easier to mold to a new paradigm, but I have serious concerns about throwing away as much cumulative experience as our team has. In addition to being solid trainers, they understand our physician base and how our offices run. The offices trust them and see them as advocates.

Before I left for vacation, our leadership informed the staff of this new plan and essentially told people to get their resumes in order. If they want to move to the new project, they will need to apply for the project manager positions. Most of my team members thrive on the front lines and on working directly with users. If they had wanted to be project managers, there have been quite a few opportunities during the last couple of years. On the other hand, they don’t want to be stuck turning the lights out on a dying project and risk being let go at the end.

Because of flip-flopping by the leadership, the team is nervous and scared. At this point, I don’t know what to tell them. I’m still in limbo regarding my own position. I’ve seen at least half a dozen variations on the proposed clinical leadership structure and none of the positions have jumped out at me as being a good fit for my particular skill set. Like the team, I’ve been told to get my resume in order. Once the positions are posted, I can apply along with the rest of the CMIOs that are being consolidated.

We’ll have three days for internal candidates to apply before the positions are posted externally. It goes without saying that they’re going to hire a new system-wide CMIO who has experience with our new vendor, so at least we’re not all fighting each other for the top job. Postings are supposed to go up next week, but they’ve already been delayed several times, so I’ll be surprised if they are there before HIMSS. Once I see what is available, I’ll make my final decision on whether I’m going to stay or fly the coop.

Most people find uncertainty to be disconcerting. For me, it’s been somewhat liberating because I’ve given up on trying to figure it out. This might be the first time in my life that I haven’t had a plan. I’m starting to understand how my colleagues that fly by the seat of their pants feel every day.

After my week off, I came back to work much more relaxed and ready to see what the next curveball might be. We’ll see how long that lasts, based on the craziness that we’re thrown on a daily basis.

In the mean time, there’s always room for pastry therapy. In honor of St. Patrick’s day I made some outstanding cupcakes that a friend had suggested I make. I just may have found my new favorite buttercream frosting recipe. Slainte!

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 3/16/15

I wrote last week about my new urgent care job. This week I worked a bumper crop of shifts to try to immerse myself in the new policies, procedures, and workflows.

From a clinical standpoint, it’s been terrific. The support team is top notch. I have the option to use a scribe, but I haven’t yet taken advantage of it.

Today was the second-busiest shift that my location had ever seen. I thought I kept my head above water despite having some really ill patients. I had several patients needing procedures or multiple diagnostic tests, so at times we were a little backed up.

I was so busy I barely had time to eyeball my phone. I headed home to put my feet up and was surprised to find multiple emails from patients waiting for me. Apparently my new employer subscribes to an online rating service that allows patients to submit feedback in an attempt to mitigate any negative feedback that might be otherwise posted to online rating sites.

I’m all for patient engagement and receiving feedback, but I wish I would have been warned. Although the email came from the rating service, it’s unclear whether patients can see my email address. Regardless, I would have set up a separate account to handle the traffic.

Even more unclear is what I am supposed to do about feedback that might be negative. At one time we had multiple very ill patients in the office and had even called EMS to transfer one to the hospital. I wasn’t surprised that one of my feedback submissions was about having a long wait. I called for backup when I felt it getting bad (we have flex staff that can swing over from our other locations) but it took time for the float to arrive and pitch in.

Our practice management system tracks all the different times in the patient cycle, from door to doctor to discharge and everything in between. I’m sure my numbers looked pretty bad at multiple times today, but the numbers don’t reflect acuity or case mix. They don’t give you the true picture of what might be going on.

I’m comfortable being rated on the timeliness of my care when I’m in a practice setting with scheduled appointments. I pride myself in running on time and I do well keeping up as long as the appointment slots are on a pretty standard schedule. If you want to grade me on that, I’m game.

However, being graded on being too slow is uncomfortable when you’re in a walk-in setting. It’s not uncommon to have a half dozen patients walk in right after one another. Maybe having multiple patients at the same time who should have really been in a hospital emergency department isn’t that common, but it was my reality.

Thinking through the day, I know I saw patients as quickly as I could, giving the best care possible. My team worked extremely well together, and although people’s lunch breaks were delayed and they were working hard, it felt good. One of the nurses was celebrating her 40th birthday and a member of the management team came to the office with treats. She also brought my official monogrammed scrubs, which made me feel even more like a member of the team.

Although the patients were served faster than they would have been at my hospital’s ED — not to mention that their primary physicians were unable to serve them at all — we didn’t meet their expectations.

I was facile enough with the EHR to run without elbow support, even figuring out a couple of shortcuts. For some reason, my favorite medications are all duplicated, though. With the mad rush we had, there wasn’t time to look at it or resolve it, so prescribing medications is much slower than I’d like it to be. I did get quite a few favorites built on the fly and picked up some tips from the staff at the end of the shift as things slowed down.

I’m waiting to hear back from the owner about what they want me to do with any feedback that wasn’t five stars. In the mean time, I’ve got a new Gmail account ready to receive patient comments rather than having it sent to my personal account. Since I’m only working a couple of shifts a month, I hope the follow-up they expect from me is minimal.

I’m also waiting to hear about their ICD-10 training plan. I’m hoping to get them to hire me to do their training when the time comes. I’ll definitely have the skill set and it might be good for them to be able to have one of their in-house physicians deliver it rather than having to contract it out.

In the mean time, I’m unwinding with a nice glass of wine and recharging before I head into the CMIO trenches tomorrow.

How do you unwind after a long day? Email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 3/12/15

I mentioned in Monday’s Curbside Consult that I took some time off from my day job this week to immerse myself in the routine at my new moonlighting gig. I also used some of the time yesterday to finish my tax return. As I went to put my documentation in the file cabinet, I realized that the drawer was full and I should probably spend some time dealing with some non-hospital document retention.

At work, we’re rabid about document retention. We keep everything exactly as long as required by laws or regulations, and then it’s off to the physical or virtual shredder. There’s a certain liability in keeping things longer than you need to, and as a risk-averse organization, we don’t want to shoulder any more liability than required. I definitely had files at home that were well past the need for retention, so I started culling through them. The amount of document detritus that can accumulate over a physician’s career is pretty impressive.

In addition to the usual household paperwork such as tax documentation, financial paperwork, mortgage paperwork, and important receipts, physicians have a host of other documents to manage. If you’re lucky enough to work for the same employer for most of your career it might not be too bad, but for those of us that have worked for several groups, the paper carnage can be impressive.

I’m not even talking about patient records or office-related information – just the personal ones. There are medical liability insurance documents, payer credentialing documents, hospital privilege documents, employment contracts, CME documentation, licenses, and DEA and state narcotics documents. There are college and medical transcripts, records of licensing exams, diplomas (and their certified translations if you went to a Latin-loving med school like I did), board certification documents, and now maintenance of certification documentation.

The pile was impressive. For conventional financial documents, there are retention standards. Some of the professional documents need to be kept for even longer, especially if they relate to liability insurance. I’m not going to rely on a former employer to prove that I had liability coverage if a claim occurs at the end of the statute of limitations. With the prevalence of identity theft, I’m not going to get rid of some of my original documents that relate to licensing or board certification. I was, however, able to weed out quite a bit of documentation and reduce the pile. Now that it’s more organized I should scan it all, but that’s a project for another day.

After I made it through the “official” file drawers, I turned to some of the documents I had kept for more personal reasons. It was a reverse chronological tour through what it takes to become a doctor. I started with student loan payoff documents and worked my way back through the application to defer payment during residency and the heart-stopping promissory notes I originally signed as a 22-year-old. I distinctly remember the day I signed the first one – if nothing motivates you to not wash out of medical school, it’s the possibility that you could have upwards of $200K in debt with no way to repay it.

The tour down memory lane also included rejection letters from a handful of medical schools and acceptance letters from others, as well as my original Association of American Medical Colleges application packet. Back in the days of the typewriter, I had filled it out by hand first and then typed it up. Both copies were there and it was funny to think about doing business without the now-familiar fillable PDF or online form. Reading the essay made me smile – it was a good reminder of youthful optimism, untarnished by E&M coding regulations, fear of litigation, or Meaningful Use.

One might ask why I still had all that. Although I do probably tend to be overly sentimental, I think it is more due to the realities of rushing from college to medical school to residency to solo practice without a break. The boxes just moved from one tiny student apartment to another and then to a house. With the crazy hours we work, as long as you have space to keep it, there’s little motivation to spend your free time sorting it all out. It got me thinking about the volume of electronic documents I might have, where space is not a limitation.

For good or bad, my hospital has a fairly liberal retention policy for email. A CMIO buddy of mine works at a hospital where all emails delete after three months and they have limited archive space allotted, so he’s constantly having to either save emails to other file formats or risk deletion. I try not to keep email too long but there’s never time to sit down and clean it out. I realized I hadn’t purged my archive folder in what looked like about two years. I spent a couple of hours deleting tens of thousands of emails. In that history were both the mundane and the heroic. I looked back fondly on standing up the region’s first HIE, but with the bittersweet sense that it is now defunct.

Those electronic missives tell the story of hundreds of thousands of hours of work. Not only by the IT teams, but also by the clinicians and other end users that did the work alongside us, whether enthusiastically or reluctantly. I know the emails needed to go and it was somewhat cathartic to watch those massive chunks of data disappear from my folders. On the other hand, it made me miss the simpler days when our main goal was to do the right thing by our patients rather than checking boxes and counting measures.

I enjoyed being reminded of colleagues who have moved on to bigger and better things as well as some pretty crazy stories. The hail storm that struck during one of our EHR design sessions, totaling cars. The analyst who ran our first EHR upgrade and slept at the office all night in a folding lawn chair while the rest of us went to our vendor’s user group meeting (bad plan, by the way). The vendor rep who got food poisoning during a site visit and still called in to our meetings while lying on the hotel bathroom floor (that’s dedication). Team-building tricycle races, cosmic bowling, and mini golf. And the software developer who put up with my newbie questions and helped me bring a feature live that no one else seemed to care about but that made a huge difference for our users.

Those are not exactly the stories you memorialize in a scrapbook but I’m grateful for the memories and to everyone who has helped me along the way. We may not always have Paris, but we’ll have the EHR.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 3/9/15

I mentioned last week that I’ve been gearing up to start a new urgent care position. Unless you have been on the provider side of things, it may be difficult to understand all the moving pieces that go with a physician starting a new job.

It’s not just about adding them to the EHR and making sure they have logins. There are countless steps before you can even consider that. In addition to passing the normal steps in the hiring process (interview, reference checks, background check, drug test, pre-employment physical, etc.) there are applications for medical liability insurance and credentialing applications for all the different insurance payers. We also have to update our licenses and DEA registrations, not to mention state narcotics board certificates, hospital privileges, and more.

Since I’ve done a fair amount of locum tenens work, I was lucky to have all the required documentation already organized and scanned. The practice’s onboarding coordinator was excited about that, as was the medical liability carrier. Rumor has it that my onboarding process was one of the most streamlined they’ve had. I suppose that’s the benefit of having been on the employer side – I’ve seen what happens when a new physician stalls in filling out the paperwork and I didn’t want to be “that doctor.” It can literally take months to get everything ready to go if there’s a lot of back and forth with the documentation.

Based on the initial progress, they were convinced things would come together quickly and scheduled me for some shifts. They use staff management software that not only proactively asks me for my schedule requests, but also makes sure recipients acknowledge their receipt of the final schedules.

I started my EHR training last week while waiting for the above dominoes to fall into place. The online training was engaging, but I didn’t get very far due to the length of the modules and competing priorities on my schedule. Luckily I had completed the EHR overview, so I crossed my fingers and headed to my first day of work.

With as long as EHRs have been around, practices expect new physicians to be able to hit the ground running. Even if physicians haven’t had an EHR in the office, most of us have used electronic records in the hospital to at least some degree. Even if we’re not writing our notes on a computer, we may be doing CPOE or reviewing nursing documentation.

The practice arranged for one of their in-house trainers to stay with me during my shift. I was fortunate that she is not only a trainer, but also one of the most skilled medical assistants in the practice. She was able to teach me about office workflow and how the staff handles various situations in addition to making sure I wasn’t missing key EHR documentation.

I was honest and told her that I hadn’t completed all the training. Apparently getting through any at all was a big plus compared to other physicians she had trained. She said that most physicians don’t bother to do the self-directed learning until they work their first shift and realize they’re unprepared.

I guess that’s one way to figure out whether an EHR is truly intuitive or not, but I’m glad I didn’t take any chances. The EHR wasn’t as smooth as it had looked during the training, which was no surprise because trainers by design are skilled at making things look easy.

Most systems perform differently in the heat of battle than they do in the rarified air of the training room. This wasn’t the first time I’ve been trained on the job in an ER or urgent care – most of the time when you are a fill-in physician, that’s how things happen. Physicians who are paid hourly aren’t willing to donate their time for training and employers aren’t likely to want to pay for training time.

This system wasn’t any different from others I had used in that the first four or five patient notes were acutely painful as I tried to develop muscle memory and a feel for the different variations in the layout for the different patient complaints. Although there was another physician in the office, he was there only to back me up if I got too far behind. The organization prides itself on short wait times and immediate care and he was there to maintain standards while I got my feet wet.

By the end of the shift, I was feeling pretty good, but I’m nowhere close to the productivity I know I’ll have after two or three days in the office. Since I’ve spent the last year documenting most of my work using a paper-based template system, I was happy to be back in the EHR world. I’ll take some extra clicking any day in exchange for allergy and interaction checking, medication refill history, and clinical decision support. The e-prescribing system acted a little quirky, but I’m guessing it’s due to the fact that I’m enrolled on multiple vendor systems. Hopefully a couple of phone calls will sort that out.

At the busiest part of the day, I had 8-10 incomplete charts with a full count of patients in the exam rooms. Things slowly got easier, but I still had a pile of half-finished charts when we accepted our last patient for the night. While she received some IV medication, I was able to complete the rest of my documentation so that I could walk out the door right behind the patient. That’s always a good feeling and I know the staff appreciated the effort so they could get home as well.

Although the practice allows me to complete my charts from home, I’ve never liked that approach. I had to do that during my first EHR implementation and it was too easy to forget patient details and miss documentation. Processing refill requests and reviewing lab results is one thing, but trying to do visit note hours after the fact has never worked for me. I’m taking the immersion approach and working three shifts this week, so hopefully by the weekend I’ll be where I need to be to feel like I’m pulling my weight. It’s a heck of a way to spend a week of vacation, that’s for sure.

How long does it take your new physicians to get up to speed? Email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 3/5/15

As a CMIO, I’ve spent most of my time working for hospitals and health systems. The bulk of my experience has been in with face-to-face using a “train the trainer” model. Our in-house trainers learned from the vendor’s trainers; our trainers in turn deliver the training curriculum to end users.

As healthcare has evolved, many organizations have wanted to get away from traditional classroom training, whether due to facility, logistic, or cost issues. Having users participate in at least some kind of online or self-directed learning prior to in-person training is highly desirable.

We created this kind of training at my organization last year and it’s been fairly successful. I haven’t really been able to judge it as objectively as I’d like, however, because I already have a deep knowledge of our system and had been previously trained in the old methodology. I’m glad that my employer allows me to moonlight at other facilities.

I mentioned last month that I was going to start at a new site. Since I’m clearly a health IT geek at heart, I was actually excited to receive the email today with my password to their learning management system.

It’s clearly a vendor-driven system – my new employer didn’t go out and code this on its own. It’s branded with the vendor name and the graphics are fresh and inviting. Maybe I was looking for a reason to procrastinate, but it made me want to put aside the HL-7 specs I was reading and dive right into training. I think I was most excited about experiencing what online training might be like in a situation where I wasn’t involved with designing or maintaining it.

The system was ridiculously easy to navigate, with both a traditional navigation bar and a more graphical representation. That made me smile since I spent a lot of time arguing with some of our developers about the need for “old school” navigation when we configured our system. People have different learning styles – some are abstract thinkers and others concrete – and often seem to do better with one approach over the other. I’m more of a traditional girl, so I dove right in with the top-down navigation.

The introduction was handled with a video presentation. What struck me first was that it had background music. I haven’t seen that much in the training content I’ve used previously, but it was somewhat spa-like and unobtrusive, so I decided I liked it, although it kind of made me want to get up and light some scented candles to match the mood. Once I completed the introduction, it released me to view the courses in which I had been enrolled.

Many organizations assume providers don’t care about the practice management aspects of the system, so I was excited to see that I had been enrolled for training on the billing system as well as the clinical system. Knowing my background, they may want to revoke my enrollment in the EHR Configuration section but I am looking forward to seeing how things work with a new and different vendor.

Once I moved into the provider training, I was glad to see that it had option for both video/spoken content as well as turning off the audio and just reading. Putting myself in a typical physician’s shoes, I found it to be a little heavy on the technical jargon as it discussed virtualization and thin-client delivery. I don’t know that I need to be told that 100 million users have experienced “the promise of proven application compatibility” that is Citrix XenApp, but you can bet I’m going to use that factoid in our next office trivia contest.

I’ve spent most of my career using enterprise-class EHRs that attempt to support every specialty under the sun. This is the first time I’ve used a specialty-specific EHR. I have to admit it’s significantly different than my past experiences.

There were other exciting non-specialty features as well. In contrast to the system in place at our hospital, patients can pre-register and check in online. Instead of jumping right to the physician part, the module then walked me through the basics flow of a visit, including what the front desk staff would see and do. Not at the level where I could perform the tasks, but just to give me an idea of the features. I often think that physicians would be more forgiving of a lengthy check-in process if they understood what really went on in the front office.

This will also be the first time I’ve used an EHR that is optimized to run on an iPad. Although it looks cool, it was kind of jarring to keep looking at a screen in portrait layout rather than the landscape layout we’re all so used to. As I went through the initial training session, I saw a couple of things that raised my EHR developer hackles: inconsistent use of color and blood pressure fields where systolic and diastolic were combined are examples I noted. I know I’m more discerning than the average user, but I had thought vendors were well past those entry-level design flaws.

I have to admit, though, I drooled a bit when I saw how the system handles approximate dates. My primary vendor has struggled with this for quite some time. Maybe the way my new EHR is handling it isn’t glamorous, but it gets the job done much better than I’ve seen other vendors do it. Unfortunately, that was just a teaser during the EHR overview, and I’m going to have to wait to dig into it a little more. Each module shows the length of time allotted and most look like they’re 20-25 minutes. Since my eyelids were already drooping from a long day at the office followed by yet more snow shoveling, I decided to call it a night.

Do you have a passion for online training? When is the last time your CMIO learned a new EHR? Email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 3/2/15

I received an email from ONC on Thursday that they were extending the deadline for nominations to the HIMSS Interoperability Showcase, citing “feedback that organizations needed more time to submit nominations for participation.” From the time the email arrived, that’s a whopping three business days until the deadline. It made me wonder exactly why the deadline was extended and what their current applicant pool looks like. If they were delaying because they didn’t have many applicants, then they hardly gave much of a window for organizations that weren’t already prepared. Was the announcement a way to raise awareness about the Showcase rather than being designed truly to solicit participants?

Perhaps organizations didn’t apply because they didn’t want to spend $8,000 to participate. That’s just for the kiosk at the Showcase, which includes a monitor, keyboard, mouse, power, and Internet connectivity as well as two exhibitor badges. Travel, meals, and lodging will be on top of that. We’re doing some cool things with interoperability at my health system, but they’re not about to spend upwards of $12K for developers to go show it off at HIMSS.

Whatever the reason, I can’t help but think about the ongoing list of government initiatives that have to be delayed, extended, or otherwise modified because they don’t seem to be achieving the desired results. Being a process improvement person, I’m always looking for the root cause when outcomes are not achieved or when projects run off the rails. Recently, we’ve had delays in ICD-10, Meaningful Use, and Healthcare.gov. Some of us, however, remember delays in the implementation of the 5010 claim standard and those of us deep in the weeds know about dozens of lesser-known parts of HIPAA and other omnibus legislation that are virtually unimplementable.

In medicine, we have a doctrine about ordering laboratory and diagnostic tests: don’t order it if it’s not going to change your plan for the patient. I do a lot of work with reporting from our EHR data and we have a similar dictum: don’t run the report if you’re not equipped to act on it. You’d think there would be a similar mantra about not making rules that people can’t actually follow, but that doesn’t seem to be a factor for those happily engaged in rulemaking. Only in healthcare do we come up with creatures like the “Two Midnight” rule and other similar nonsense.

My extended family is always asking about some of the wacky things that go on, such as provider-based billing, which allows hospital-owned practices to charge both a professional fee and a facility fee for outpatient visits. I’ve become as expert at explaining the Medicare Part D “donut hole” as I am at teaching patients to use a home blood glucose monitor. In trying to find some method to the madness, I stumbled on an article that attempts to explain why healthcare regulation is so complex. The first paragraph opens with a perfect summary: “Health care professionals may feel that they spend more time complying with the rules that direct their work than actually doing the work itself.”

The author contends that “regulation arises largely from a set of confrontations between opposing interests that created the system.” I agree that there are clashing agendas and learned that first hand as a young physician when the hospital’s chief of staff wanted to know why he wasn’t getting my referrals. It felt more than a little like a shakedown. He wasn’t aware that I sent nearly all of my referrals in his specialty to one of his partners, so at least his practice was seeing volume if he wasn’t personally. It didn’t matter, though, since it was apparently all about his ego. These conflicting agendas are ongoing, and “Doctored: The Disillusionment of an American Physician” talks about one physician’s struggle.

Although there are certainly turf wars at play, the regulatory soup includes rulemaking at so many levels that it’s nearly impossible to keep track of what needs to be done. I have to follow the rules of multiple hospital medical staff organizations, two state licensing boards, two specialty certification boards, one professional society, dozens of payers, the city, the county, the state, and the federal government. These rules (and non-rules that often have the force of law) sometimes conflict each other and often fail to make sense.

Several times in the last few decades, studies have looked at everything a primary care physician should be doing for his or her patients and how long that would take. An article in the Washington Post summarized the most recent data from the Annals of Family Medicine, which found that for a typical panel of 2,300 patients, the physician would have to spend nearly 22 hours a day to provide all the recommended care. That’s just delivering the care itself – it doesn’t factor in the time needed to comply with everything else a physician does such as arguing with payers, managing staff, dealing with regulations, worrying about compliance with programs, and trying to stay current with medical knowledge.

That’s what we’re dealing with in the ambulatory setting. Hospitals and health systems deal with many more rules and countless regulatory bodies. Similarly their IT departments are trying to keep the systems up and running, prevent breaches, avoid breaking something that’s required for Meaningful Use, and so on. It’s no surprise that people are not coming out of the woodwork to sign up for the Interoperability Showcase.

What regulations keep you hamster wheel spinning? Email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 2/26/15

I literally had almost 100 people forward me news articles about the CMS announcement pushing the Medicare Meaningful Use attestation and PQRS reporting deadlines to March 20. Although no specific reason was announced, possibilities include winter weather emergencies, the fear (or reality) of attestation site glitches, the complexity of preparing reports and audit documentation, and lack of vendor readiness as possibilities. Buried below the fold of several articles was the fact that this does not impact the Medicaid Incentive Program, so I hope those practices realize they’re still on the hook for the original deadline.

The hideous cold and repeated snows pounding a good chunk of the country have put a cramp in the style of many fitness enthusiasts. Although I once had a serious dislike of treadmills in general, I’m glad that I finally got one at home at least to be able to get some miles in despite the cold. I might have been more fond of treadmills sooner had I known about iFit, which allows compatible fitness equipment to automatically deliver uphills and downhills to match real-world routes while showing pictures from Google street view.

I’ve now run through Ireland, Paris, Norway, and my own neighborhood and definitely like it better than the standard programs on the treadmills at the gym. Once people’s New Year’s resolutions start failing, used equipment will start popping up for sale and I’m glad I have something to talk about with patients who think walking on a treadmill is boring. I also found a National Geographic “Everest” video workout on the site and although it bested me the first time, I’ll be back for more. Having the ability to track and quantify my efforts to stay in shape has been a benefit for me, although I draw the line at sharing every workout to Facebook.

A reader who has picked up on my running habit shared these high-tech socks from Sensoria that use sensors and conductive fibers to gather information about a runner’s speed, distance, steps, and how their feet strike the ground. They debuted at the recent Consumer Electronics Show and are from the same people who brought us shirts and running bras to sync with heart rate monitors. A magnetic anklet communicates with Android and Apple devices to provide real-time feedback. I’m not sure I want my socks to coach me and they aren’t cheap, so I think I’m going to take a pass this time. I do enjoy reading about wellness-related tech, so keep sending your finds.

I do some volunteering at a local school and they asked me to speak at an upcoming career day. When I get requests like that, I always have to ask whether they want me to talk about my “doctor job” or my “computer job” or both. When I decided to become a family physician, I never imagined myself on the cutting edge so I was happy to come across this piece on physician informaticists to help explain exactly what it is that I do all day. Apparently UCLA is thinking outside the box and is making their informaticists available for consultation with other Epic customers. It looks like a win-win situation to me – in addition to assisting other organizations, their team can also bring back successful approaches from other sites.

NCQA is offering the opportunity for the public to provide feedback on proposed change to 2016 HEDIS measures. There are a handful of proposed new measures and changes to several existing ones, so plan to get your comments in before the March 18 deadline.

Speaking of deadlines, Friday is the cutoff for HIMSS hotel changes. I’m mixing it up this year and staying somewhere swanky with a couple of my gal pals since I was able to get ridiculously cheap airfare. Although registration for HIStalkapalooza is closed, I know Mr. H is poring over the guest list and I’m looking forward to seeing many of you there (anonymously, of course). The event is one of the most fun parts of being on the HIStalk team, although I am feeling the pressure when it comes to finding a pair of outstanding shoes. Maybe Sensoria should make an insert to gather data on what happens to the feet of fashionable ladies and gents out for a night on the town.

Have you put together your HIMSS wardrobe plan yet? Email me.

Email Dr. Jayne.

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.

Email Dr. Jayne.