Navigating Healthcare – Patient Safety and Personal Healthcare Management

The Healthcare Huddle

 Delivering the Care Patients Want

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This week I am talking to Dr. Jay Mathur, Associate Regional Medical Director for Caremore Health Systems in Connecticut. A program that started 25 years ago in California and has now expanded to multiple states and has been in Connecticut for a little over a year. This is the medicine that we went to medical school to practice, the opportunity to deliver the care that patients and families want.

We know that the poor typically live alone and quite often socially isolated and their zip codes play a part in their health status but sometimes it can be their shopping experience and availability of food not just their zip code that is a key determinant of health. We talked about some of this in my interview with Dr. Won Chun from Carrot Health

Team Sport
The Healthcare Huddle

Listen in to hear how they select the hardest patients with the most complex diseases and chronic conditions as and learn the key elements in their success that are tied to the early morning huddle where everyone shares the upcoming day, tasks and resource allocation getting everyone on the same page. All I could think of was the scene from The Replacements and Shane Falco’s huddle:

Huddle Fight

They have a range of team members with their Clinical Partners as the glue that keeps everything together and others on the team including Social Workers, Psychiatrists, Case Managers and physicians playing a supporting role to each other

Glory Lasts forever

From a patient standpoint, it all starts with a detailed assessment and importantly introducing all the team members to the patient using a range of technology tools to facilitate and improve efficiency

Their Incremental steps to improvement include the huddle but listen in to hear what other incremental steps you may be missing that has added significantly to their team-based approach, coordination and success


Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next two weeks at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.


Listen along on HealthcareNowRadio or on SoundCloud

The Healthcare Huddle was originally published on Dr Nick – The Incrementalist

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Future Failure Guaranteed in Healthcare

 Medical School Candidate Selection

MedEd Books Education books
Are we are selecting the wrong candidates for medical school and not teaching them the skills they really need to be good doctors?

I’m a doctor first – anytime anyone asks me what I do the first words out of my mouth are “I’m a Doctor”, followed by a follow-up explanation of my role today outside of day to day clinical medicine and the laying on of hands-on patients.

Many years ago I decided to give up my daily medical practice and it was a difficult decision. While I loved taking care of patients, I’d been beaten up in a system that pushed me to my limits and I did not like what I felt and saw in myself as I existed in a sleep-deprived haze courtesy of a 152-hour working week aka a 1 in 2.

I believed that the healthcare system was creating barriers for doing what patients really needed. And too much of my time was taken up with things that didn’t really matter. By moving into the world of technology and focusing on medical technology development, I hoped to create new tools that would improve our ability to help patients in the ways that they wanted to be helped.

My emotions about this move were conflicted, and I sought out a colleague who had been a mentor to me and shared my decision and mixed emotions about that decision. His response bewildered me.

“That’s terrible,” he said. “You never should have been allowed into medical school.”

From his point of view, the fact that a doctor was leaving the profession was not a sign that anything about the healthcare system needed to change. It just meant that the selection process for medical students was wrong and I was a flawed candidate that never should have been allowed to study medicine.

That unwillingness to examine the status quo is not uncommon in the world of medicine, especially when it comes to medical education. The current curriculum has changed very little over the past century. While science has been updated, the basic structure of medical education hasn’t changed. The daily practice of medicine, however, has changed. And it has changed a lot. Medical education isn’t preparing new doctors for the challenges they will face, and many of the skills they will need are never addressed during the four years of medical school.

But there is an even bigger problem with the medical education system: acceptance into medical school isn’t based on characteristics that are important in medical practice. We have become very focused on academic perfection and MCAT scores, with little consideration for the personality traits that lead to highly effective and compassionate physicians. We get lucky with many people, who have the academic performance and the needed personality traits, but we also train people who are not inherently suited to the practice of medicine or who have what compassion they had entering the system crushed out of them with debilitating academic testing with multiple choice questions systems. And we exacerbate the problem with a system that encourages isolation with a monstrous amount of academic study and rote learning. To excel or even survive the rigors of the system you diminish social interactions and limit them to others who are stuck in the same academic sinkhole.

We are failing to train medical students in the skills and thinking habits that make good doctors.

Recruit for compassion and intelligence, not academic perfection

The first step in getting this right is recruiting students who have more than academic skills. Perfection in academic performance is often accompanied by self-involvement verging on narcissism. To attain perfect grades in college, you have to have enormous discipline as well as intellectual ability. You also have to sacrifice time spent in other endeavors – experiences that might broaden your worldview and increase your sense of compassion. This intense focus on your own goals can create a sense that you are more important than others.

MedEd MedicalStudentID

I watch this first hand with my daughter, who makes me proud on a daily basis with her dedication and focus towards her goal – which she has had since the tender age of 5 – of getting into medical school and qualifying as a doctor. But every step towards medical school moves her inexorably away from the compassion and caring she has demonstrated on her journey thus far. Like her peers, she fears that if she doesn’t keep an intense focus on academics she will fail in her study of medicine. I know I want her as my physician but wonder if the obstacle course she must complete will change her beyond recognition.

Medical Education

 

Teach medical students skills, not just facts

Medical education is like drinking from a scientific fire hose. Few students retain more than about 50% of that data, and we neglect other skills that are more important. Doctors can instantly look up any medical fact they need so this attempted brain download of scientific detail isn’t necessary.

What isn’t taught is how to think about health, illness, and people. Medical students should be learning root-cause analysis and the ability to connect disparate pieces of data and understand the meaning. They need to learn data search skills, listening skills, problem-solving and how to be a continuous learner. They need to flex their compassion and objectivity muscles and learn the patience that will help them understand people who are different from themselves. And they need to learn leadership and how to work with others as in a team and as a team leader. These are the skills that are hard to acquire but are crucial to accurate diagnoses, more effective treatment decisions and effective management of chronic diseases.

The change is beginning

Medical schools are starting to respond to the need. In 2013, the American Medical Association gave $11 million in grants to medical schools that are developing flexible, competency-based pathways. They are making changes that will narrow the gap between how physicians are trained and how medicine is practiced. As of 2015, grants have been given to 32 medical schools, each with an innovative approach intended to prepare students for the real world of medical care. None of these programs are focused on the science of medicine, but rather the thinking, leadership and management skills needed to effectively use the science of medicine.

This is a great start, but there are 141 accredited medical schools in the U.S., and nearly 2,500 worldwide, many still using a curriculum developed more than a century ago. I hope the leaders of these schools are paying close attention to the innovations being tested under the AMA program. We all need them to do a better job of recruiting and training medical students who have the right stuff for the medical environment of this century, not the last.

Some Early Progress

The Dell UT Medical School which was funded in part with support from the Michael and Susan Dell Foundation and by a vote from local residents to increase their personal taxes to fund the development and ongoing management of this facility. They are trying a new funding model that gets rid of the conflict of interest that hamstrings many medical schools that are dependent on fee-for-service hospitals for revenue. The financial model will emphasize outcomes and cost-effective care overpayment for individual procedures and the medical school is taking a different approach to education while still encumbered by the need to meet the regulatory requirements to satisfy the medical education definitions and allow their students to compete on the current playing field for medical education the United States Medical Licensing System (USMLE) testing system

What do we need in Healthcare

More accurate diagnosis early in the disease process (12 million people annually are misdiagnosed, and about a quarter of those errors are life-threatening)

MedEd Costs

86% of healthcare spending in the U.S. was used to treat patients with one or more chronic conditions, and most of that goes for treating complications due to poor management.

Clinicians are under increasing stress and committing suicide at extraordinary rates (A systematic literature review of physician suicide shows that the suicide rate among physicians is 28 to 40 per 100,000, more than double that in the general population)

Incremental Steps to Improving Medical Education

  1. Let’s start by acknowledging the current system and trajectory is not matched to the requirements of our future doctors
  2. Find one element of the curriculum suited to a different method of teaching and change the approach. Match this with an approach to changing the testing methodology to match this more closely
  3. Enlist support to bring about change with the examining board, the clinical teachers and mentors and recently graduated doctors who can all provide relevant insights on the deficiencies of training in preparing for a medical career and what can and needs to be changed

 

Do you think I’m wrong – is our system well suited to the current requirements and just in need of some minor tuning? If I am right – what changes can we work on immediately to change the course and direction for the students now to bring about lasting improvements?

 

Future Failure Guaranteed in Healthcare was originally published on Dr Nick – The Incrementalist

Speech and Medical Intelligence – Allowing Doctors to Focus on Patients Not Technology

I spent some time at Medicine 2.0 and participated on the panel Bridging the Digital Divide and will presented: Speech and Medical Intelligence – Allowing Doctors to Focus on Patients Not Technology

This is an exciting time for mobile devices and while we know there is a discrepancy in the accessibility of mobile technology (I’ll be participating on the panel Bridging the Patient Digital Divide) some of this divide in access can be linked to the complexity of this technology. With ubiquitous technology comes ubiquitous complexity – adn this is especially true for doctors who face challenging User Interfaces – captured here in this post: How Bad UX Killed Jenny. As doctors we feel we are loosing touch with the Art of Medicine

Which for many of us was the reason we started on the journey to being a healer. Physicians don’t go to medical school because they want to document and code clinical information. Doctors choose their path because of their compassion and desire to deliver care to patients in need. There are increasing physician frustrations with technology and their struggle to keep the focus on patients and not data entry.

Medicine is part science, part art. The relationship between physicians and patients is at the core of healing. This begins with hearing and understanding but is followed by focusing on the patient not the technology. I will be presenting our prototype “Florence” that combines artificial intelligence and speech recognition to offer innovative new speech technologies that help capture and understand not just what the clinician says but what they mean. With new tools that speech enabled systems we simplify access and empower clinicians to capture information and thoughts as they occur. Through the innovative use of natural language tools, context awareness and the generation of high-value clinically actionable medical information clinical systems become efficiently integrated into care delivery process offering the opportunity for doctors to return to the Art of Medicine and focus on the patient.

Here’s a video showing off Florence

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Dunkirk Spirit: How physicians support patients overcoming adversity

One in eight U.S. women will develop invasive breast cancer over the course of her lifetime.  In 2014 alone, an estimated 295,000 new cases of invasive breast cancer are expected to be diagnosed.  That’s approximately 808 cases per day.

That’s ~640 cases per day or a little over 1 case per hour (26 per day)1

But these statistics don’t matter.  Whether it’s one-in-eight or one-in-3 million, the impact of the illness is what matters—not the numbers.  It immediately becomes a reality to you.  We can never forget that healthcare is personal, something my colleague, Melissa Dirth, articulated beautifully in her recent post “When 1 in 8” was no longer just a statistic to me.”

As a physician, sharing unfavorable findings and test results is always a sobering moment, no matter how many times you’ve done it before.  We all struggle to find the right words, and look for ways to be supportive as you allow your patient to handle the shock that accompanies such news.  We all have different viewpoints and our perspective on the disease is colored by our own life experiences and the individual circumstances.

What never ceases to amaze me, however, is the strength of the human spirit.  Despite the hard road stretching before them, so many of our patients face breast cancer with what the British would term “Dunkirk Spirit,” that inner strength that helps patients and their families overcome tremendous adversity.

Dunkirk Spirit

It is, in my opinion, one of the reasons that make cancer sufferers and survivors such an important and compelling tableau of courage.

Unfortunately, one of the essential elements that quickly becomes lost in the morass of technology is the Art of Medicine, and our ability as doctors to spend the time focused on our patient and their relatives.  As clinicians, we intuitively know the statistics associated with the disease and can interpret them to understand the impact the diagnosis we have just communicated with the patient is likely to have, but there is so much more to providing care.  We don’t just treat the condition, the physical body—we are caregivers and healers, and we seek to help the whole patient.

Technology can help in healthcare, but it is not the goal nor should it ever be the focus.  Yet, in some cases, it has detracted from our ability to provide care and compassion.  To deliver on the promise of great healthcare we have to return to the Art of Medicine and enable, not disable, our clinicians with the technology we develop.

To learn more about the role technology plays in the Art of Medicine, read: “There’s no room in technology in end-of-life care decisions

 

This article originally appeared on WhatsNext: Healthcare

Getting Value from the EHR – Yes it is Possible

Posted in #hcr, #hcsm, Art of Medicine, EHR, EMR, Healthcare Technology, HealthIT, HIT, HITsm by drnic on July 18, 2014

I have the privilege of spending a lot of time on the road interacting with clinicians around the country (and world). I hear with too much frequency many doctors complaining about the Electronic Medical Record and how it fails to help them and in many cases makes their work harder. Some of this is a hangover from the past and the inadequate technology and in some cases hardware at the time In fact I’ve told this story a number of times that I can date to around 1995/6 and in this piece: Clinical documentation in the EHR

Many years ago, an excited friend who worked for one of the electronic health record (EHR) vendors at that time — it was really more of a billing and patient tracking and management system than an EHR — was desperate to show me some of their latest applications. In particular, a new module they had developed to capture clinical data. My friend pulled out his laptop, fired up the application, selected a patient and proceeded to enter blood pressure (BP). Some 20-plus clicks later, he had entered a BP of 120/80. While he was excited, I was dumbfounded. When it comes to patient care, doctors didn’t have time for 20 clicks to record BP years ago and they definitely don’t have that luxury in today’s demanding medical environment.

There is still some of that going on and not enough focus on the User Interface design and turning the technology into a barrier – this is the focus of the Art of Medicine campaign we launched some weeks ago

This article on Government HealthIT Are electronic health records already too cluttered? highlights a rising problem and one I hear about frequently. This is not just a healthcare problem and it is the focus of the work by Edward Tufte an American statistician and professor emeritus of political science, statistics, and computer science at Yale University who is well known for his books on information design which are bets acquired by attending one of his frequent courses on data visualization Here is a recent overview of visualization on the iPhone

He has a section on healthcare but many of his principles apply

For Brian Jacobs the problem was even more acute working in a Pediatric ICU:

The ICU is a very toxic and tech-laden environment….because of that, it offers the opportunity to make a lot of mistakes

As he points out much of the cutter derives form the multiple notes entered into the EHR every day. “It’s not uncommon in teaching hospitals to have six to seven notes per day on one patient, by the time the attending physician, residents, consultants, other doctors and fellows check on the patient.” So they instituted a policy of One Note per day

Actually its

It’s actually one note per team per patient per day; one giant multi-contributor note. They still may be all writing their components, but it’s one note

With a template to hold the content generated each morning by the resident and then everyone contributing to that one note, adding and amending as necessary

So in addressing the issue clutter they also addressed usability and design turning the note into a living breathing document that is updated and maintained by the team that now takes care of patients But he addressed some other important issues – especially when it comes to quality of care and the quality of the medical note

Copy Forward is subject to some warranted scrutinyfrom a billing and audit standpoint. Much of the repetitive and “clutter” in the note comes form the copying forward of past information. But:

These notes should never be the same

And as part of that message they moved to an “End-of-day note” that was a fresh summary of the patient. Add to that an updated and well maintained Problem List and integration with the billing system to allow doctors to select their code for the work carried out that day and they moved to a valuable addition to the healthcare team in delivering quality healthcare with their EHR

EHRs are: more complete, legible, accessible and can be auto-populated and searched. They can provide diagnosis codes and they’re good for billing. On the other hand, they can sometimes lack quality information and are by far, too cluttered.

I said this back in 2003 (yikes!) – The Future of Technology is already here – Who’s on Board the train and who’s left at the station. I still believe it and understand that the technology does need to get better and be more integrated into the existing workflow

The next generation of health care technology is here, with visionaries and futurists pushing the envelope to enhance, create and generate the newest cutting edge in health care delivery. Advances in technology, like advances in medicine, are a shared entity that enhances life expectancy and the quality of life.

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Patients Prefer Electronic Documentation

This Survey: Do Patients Really Care if You Use Your EHR in the Exam Room? was very revealing. It turns out contrary to the perception that the intrusion of EMR’s in the office patients prefer electronic documentation to alternatives

Most Patients Don’t Mind Electronic Note-Taking During Exams

In each case, more than 80 percent of respondents indicated they would not be bothered. On a sliding scale, patients indicated the least concern for doctors using tablets during the exam.

What was more surprising was the push back by patients on having scribes

But worst of all – recording devices

Ultimately, over one-third of patients said they’d be bothered by doctors using tape recorders to assist in charting medical notes. Specifically, patients at the furthest end of the spectrum—those who chose “would bother me a lot”—were more prevalent when it came to tape recordings than with any other method of charting during an exam.

There was a big preference to Electronic documentation at the point of care

They asked about reasons for dissatisfaction

Its not the technology that causes the dissatisfaction but in order of importance (for patients)

  • long wait times at the doctor’s office,
  • unfriendly staff
  • short duration of visits with the doctor
  • Trouble Scheduling Appointment

And coming in with a sliver of dissatisfaction at 5% “Doctor using a Computer in the exam room”

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Google Glass in Healthcare – Part 1 the Basic Facts

HIMSS was exciting and despite the HIS Talk HISies awarding Google Glass the most over rated technology:

I know I am biased as one of the lucky Google Glass Explorer as can be seen in this post from MedCity Watching for Wearables at #HIMSS14:

I think they are wrong and its not just Glass that will provide better more ready access to essential clinical data.

Not to say that the initial program like many launches have had their problems with early releases of technology not quite ready for prime time – remember the 1987 Apple Newton:

Even the omnipresent iPad struggled initially – most have probably forgotten the initial lukewarm reception of the iPad

had Apple talking about a price reduction.

Mat Honan (one on the same “Epic Hack”) wrote a piece about his early experiences “My Year with Google Glass” that highlighted some early acceptance challenges

  • Glass is socially awkward
  • People get angry at Glass
  • Wearing Glass separates you

and I would add Glass interrupts normal conversations and social behavior – but that is all now and like the mobile phone I believe it will be come a natural part of our technical fabric. Think back to 2007 and how pulling out a phone in a meeting was frowned upon – now it seems part of the fabric of many of the meetings I attend. But it was Mat’s commentary on the impact it had on his perception fo phones that really stuck out for me

Glass kind of made me hate my phone — or any phone. It made me realize how much they have captured our attention. Phones separate us from our lives in all sorts of ways. Here we are together, looking at little screens, interacting (at best) with people who aren’t here. Looking at our hands instead of each other. Documenting instead of experiencing.

Which resonates with me an the Art of Medicine campaign and the struggle clinicians have with focusing on the patient (To learn more, download the eGuide Art of Medicine in a digital world). As Dr. Edward C. Grendys, Jr. said in his article: There’s no room for technology in end-of-life care decisions:

From initial diagnosis through to surgical therapies, chemotherapy treatments and even end-of-life care, my job is to listen, assess and provide educated decisions that ultimately impact the health and wellness of another human being…. it’s my belief that when talking face-to-face with a patient about a care plan aimed at eradicating their body of a disease that threatens to take them away from their family, there’s no room for paper, computers and/or mobile devices. In these most intimate of conversations, the focus has always and must remain on the communication between the caregiver and the patient on the receiving end. That, in its purest essence, is what practicing the art of medicine is truly all about.

That’s not to say that Google Glass can solve this problem and in its current state and acceptance it might cause more challenges – but the potential is there to blend information access and capture into a physician patient interaction that remains all about the patient

Glass will provide improved access to essential clinical data to clinicians but as my friend Chuck Webster has pointed out on several occasions this is not just for clinicians. Patients are already accessing the internet in droves for clinical information, researching their conditions and that of their relatives and communities abound with resources and support for conditions from common to rare.

Before talking about some of the potential medical applications it is worth detailing the technology. Google Glass is basically a computer with 12Gb of memory attached to your head in the form of glasses. It has a heads up display with voice activation and has some apps that can be installed:

Facts

  • Google Glass is basically a computer attached to a pair of glasses
  • Google Glass has a display that is projected in front of the Right Eye that is a high resolution display equivalent of a 25 inch high definition screen from eight feet away
  • Google Glass has a camera that points forward and can take pictures (5MP) or video (720p) that is closely aligned with the view you see from your own eyes
  • Google Glass is voice activated using speech recognition to interact with the glass computer
  • Google Glass works best when connected to the internet
  • Google Glass Integrates with an Andorid Phone with a limited set of functions available for the iPhone
  • Google Glass has no built in illumination so pictures or video taken in dark conditions do not work well
  • The screen can be hard to see in bright light

There are many myths circulating:

Myths

  • If someone is wearing Google Glass they are recording me
    • False – The device is not set up to record continuously and will only record a video or photo based on an action by the wearer (either a spoken request
      • OK Glass, take a picture
      • or by pressing a button on the google glass device
  • Once Someone Has recorded something on Google Glass it is Publicly Posted
    • False – it requires an action on the part of the Glass owner to post the material to the internet otherwise it resides on the Google Glass device. It will be synchronized with the users Google+ account for automatic backup (much like photos are backed up from the iPhone to iCloud but like iCloud remain private to the user unless they elect to share them)
  • Google Glass is constantly capturing data and transmitting it to the Internet
    • False. Without an internet connection Google Glass simply stores any recorded information in the glass memory. And unless you have set it to record there is no data being captured
  • Google Glass tracks users and unsuspecting bystanders
    • False – Google Glass is not tracking or recording anything unless instructed to do so by the user

So who is using this technology, where are they using it and how are they using it in Healthcare. This articlecovered some of the early concepts and featured a short list of potential applications

  • Video sharing and storage: Physicians could record medical visits and store them for future reference or share the footage with other doctors.
  • A diagnostic reference: If Glass is integrated with an electronic medical record (EMR), it could provide a real-time feed of the patient’s vital signs.
  • A textbook alternative: Rather than referring to a medical textbook, physicians can perform a search on the fly with their Google Glass.
  • Emergency room/war zone care: As storied venture capitalist Marc Andreessen proposed in a recent interview, consider ”dealing with wounded patients and right there in their field of vision, if they’re trying to do any kind of procedure, they’ll have step-by-step instructions walking them through it.” In a trauma situation, doctors need to keep their hands free.
  • Helping medical students learn: As suggested by one blogger, a surgeon might live stream a live — and potentially rare — surgery to residents and students.
  • Preventing medical errors: With an electronic medical record integration, a nurse can scan the medication to confirm whether it’s the correct drug dose and right patient

In its simplest form just transmitting images in real time can offer some advantages for diagnosis – in Rhode Island they are planning on implementing Google Glass for the ED doctors to obtain real time consults with dermatologists.

And this from Kareo showing a patient education application that records the physician patient interaction and then makes it available afterwards for additional review:

In this case featured in the ER doctors use Google Glass and QR codes to identify patients which featured Dr. John Halamka, CIO of Beth Israel Deaconess Medical Center which he talked about in his blog detailing their experience (oddly the articletalking about this refers to text that appears to have been changed or taken down):

When a clinician walks into an emergency department room, he or she looks at [a] bar code (a QR or Quick Response code) placed on the wall. Google Glass immediately recognizes the room and then the ED Dashboard sends information about the patient in that room to the glasses, appearing in the clinician’s field of vision. The clinician can speak with the patient, examine the patient, and perform procedures while seeing problems, vital signs, lab results and other data.

And this concept by the way was top of everyone’s wish list that I talked to in my unofficial survey of engaged and interested observers of my own pair. I’ll paraphrase

If I could get it to recognize someone and provide me with their name when I meet them that would be fantastic!

But it is in urgent care where there is so much potential:

This recent piece on Healium featured in the Seattle King5 News Station: Seattle Doctor testing Google Glass for Surgery in the ER (click on the link if the video does not show below to see it in action)

“If I want to look at for example radiology I can double tap ‘radiology…There’s his chest x-ray, it just popped up, oh he’s got a middle lobe pneumonia”

Part 2 will cover medical applications and how Google Glass technology can be applied in a busy clinical setting

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The Art of Medicine CIO Breakfast – What Needs to Change to Get Doctors Back to the Patient?

Medicine is part science…. Part art.

The relationship between physicians and patients is at the core of healing. This begins with hearing and understanding. We want to reimagine healthcare—where physicians can get back to the art of medicine and were delighted to be joined by panelists:

Dr. Mark Kelemen, Senior Vice President, CMIO, University of Maryland Medical System Dr. Charles H. Bell, Vice President, Advanced Clinical Applications, Hospital Corporation of America (HCA) Stuart James, CIO, Sutter Health Dr. Andrew Watson, CMIO, University of Pittsburgh Medical Center (UPMC) (@arwmd)

The panel was moderated by our very own Dr. Paul Weygandt, Vice President, Physician Services, Nuance Keith Belton, Senior Director, Clinical Documentation Solutions Marketing, Nuance

and attended by some 50 attendees with varying backgrounds and perspectives

The underlying question:

How do return the focus to the patient. How can physicians navigate the changes and challenges of today’s complex healthcare environment while doing what matters most to them – listening and caring for patients?

The panel discussion addresses current physician frustrations with technology and what needs to change to keep them focused on patients and not data entry. It was clear that the physician’s voice and medical decision making is what matters most in practicing the art of medicine and how do physicians and patients both benefit?

 We know from surveys that

  • 36% of physicians say that EHRs interfere with face-to-face communication during patient care
  • 80% of physicians say “patient relationships” are the most satisfying part of practicing medicine
  • 28% of an average ER physician’s time is spent directly with patients
  • and from a recent HIMSS session interesting Patients prefer doctors to have an EHR
This is about the changing face of healthcare – it’s not just about technology. It’s about how we envision healthcare. How do we explain to providers that this isn’t about technology – this is about a new world order coming to healthcare

Posting every patients Magnesium level multiple times in a note is not good clinical care #artofmedicine #himss14

One of our panelists asked the audience:

How many Docs would go to facility with no #EMR and used paper – no hands went up

We do see value in Health Information Technology
 

One of the overriding concerns was the need for cultural change. The office or hospital based physician system is struggling to meet the patient needs today. They want to have the right nurse or physician there for them at the right time and indeed at the right place with telemedicine. It’s about cloud-based/consumer-based healthcare.

More consumer-friendly healthcare

We need to get back to that local physician practice – with technology in the middle as a supporting actor but not the main event

Technology cannot be an impediment to taking care of patients
 

Many physicians are in this field because we are trying to drive change but are struggling with the existing system that fail them. When I see a patient I have to review 10 systems, carry out at least 4 major systems examinations before I can submit a claim that properly reflects the care I delivered:

 I am not taking care of the patient I am taking care of a computer

Dr Andrew Watson told the story of a patient under his care with a terrible antibiotic resistant infection that a patient developed in hospital and he was now under constant supervision adn intensive therapy. But as he said – he never needed to come into hospital – he could have been treated at home. Poignant reminder that Telemedicine is not just about reducing cost – it can be better for the patient and offer better results.

Dr Bell is waiting for the MIDI (musical instrument digital interface) moment so that he can plug into the medical record and go.

As a musician he remembers the implementation of the MIDI interface in the early 1980’s that allowed music manufacturers to create one standard that was royalty free and widely adopted for the benefit of the user musicians and the vendors. He wants that in healthcare – so do I.

Until we change the mandate on clinicians to document 8 of 10 systems to be fairly compensated for the care given  

And importantly the concept of Bring Your Own Device (BYOD) is bringing functional tools into the healthcare setting and will/is revolutionize the care being delivered. As one panelist put it:

my iPad never complains, is always there, has the latest information and access to latest medical updates
 

To summarize:

  • We need strategies for bringing the focus back to the physician-patient interaction and removing impediments to that relationship
  • Healthcare organizations should be and are encouraging/valuing physician professionalism
  • This is about the changing face of healthcare – it’s not about technology. It’s about how we envision healthcare. How do we explain to providers that this isn’t about technology – this is about a new world order coming to healthcare

Come join the conversation at The Art of Medicine or come to the panel session Thursday, March 27, 2014, 9:00 – 11:00 am EST at the W Hotel,100 Stuart Street, Boston, 02116

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Art of Medicine at #HIMSS14

Posted in Art of Medicine, Healthcare Information by drnic on March 6, 2014

The new Art of Medicine campaign is focused on getting physicians back to their original roots – the reason we all stepped over the threshold of medical education and into an honorable profession to serve our community. Its all about the patient but changes in the healthcare system and in particular changes with technology have taken the focus away from our patients and onto the technology in our office. Recent study conducted by Northwestern University highlighted the distraction physicians feel away form their patients by the EMR

As Steve Schiff, MD a practicing cardiologists puts it

As far back as I can remember, there was never a time when I didn’t want to be a physician. It’s a choice in which there is no equivocation: either you want to be a doctor or you don’t.

The campaign includes an e-Guide: The Art of Medicine in A Digital World replete with thoughts, suggestions and concepts to manage the digital world while remaining focused on the most important person in the examination room – the patient. The release was covered in this piece by HIT Consultant and referenced the panel taking place next month in Boston. Many of the thoughts and ideas were captured in the Top 38 lessons from Digital Health CEO’s from Rock Health. I picked a few choice quotes that capture the spirit and intent of the Art of Medicine for me:

“Healthcare is yet to be transformed by technology.” – Joshua Kushner “You need a degree of foolishness to cause disruptive change in healthcare. Dare to dream.” – Vinod Khosla “If you’re going to re-invent healthcare you have to start from scratch.” – Vinod Khosla “The key to good product is invisibility for the user.” “Partnership is going to be absolutely key to taking healthcare to the next transition in evolution.” – Sue Siegel

The campaign kicked off this week with this resource page – The Art of Medicine and a short video highlighting the challenges and opportunites

There will be much discussion at HIMSS14 around the topic and we are looking forward to hosting the panel on Thursday, March 27, 2014, 9:00-11:00 a.m. at Boston’s W Hotel. You can find out more and/or register here or come by our booth 3765 at HIMSS14.

“The science of medicine goes nowhere if you leave the human element out of the equation. Curing our patients starts with listening to them.”

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Are Physicians the Cure to Healthcare’s Bugs?

Posted in Art of Medicine by drnic on March 5, 2014

This post originally appeared on HIT Consultant

During a recent and troubling discussion with a physician friend, he described to me a new ailment he’s been experiencing: waking up in the morning, and not looking forward to going to work.  The reality is that he is not alone.  It’s no secret that physicians across the country, regardless of their specialty or location, are reaching their limit for juggling new requirements, technology upgrades,  and policy changes, all while trying to deliver personalized, quality care to their patients.  As a result, busy physicians are, quite understandably feeling pressured and pulled away from direct patient care and critical clinical-decision making, and, at the end of the day, that is what matters most to patients and physicians alike.   It is easy to imagine the impact overloaded and dissatisfied physicians could have on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, and how these regulatory pressures and so many new healthcare technologies could be linked to the decline of the “art of medicine.”  But are we, in fact, misdiagnosing the problem?

A recent study from Johns Hopkins University found that internal medicine interns are lacking proper bedside etiquette, which is not only essential to providing quality care, it directly impacts medical outcomes and patient satisfaction scores.  Focusing on five key elements of proper patient-physician decorum, researchers tracked whether or not hospital interns:

  1. Introduced themselves, 
  2. Explained their role in the patient’s care,
  3. Touched the patient,
  4. Asked open-ended questions, or
  5. Sat down with the patient during the visit.  

Results revealed that interns touched their patients (either during a physical exam, handshake or gentle, supportive touch) 65 percent of the time and asked open-ended questions 75 percent of the time, but introduced themselves only 40 percent of the time, explained their role merely 37 percent of the time, and actually sat down during only nine percent of the visits.  Such results are disconcerting, at best, and reveal a more pressing truth: These basic and critical communication deficiencies that are essential to providing holistic patient care are not being taught.

The study exposes the reality that the shift away from patient focus and the “art of medicine” isn’t just stemming from increased physician workloads caused by new policies and changing technologies.  It is infiltrating our profession through a change in training, as well.  While we have reduced junior doctors’ work hours for safety reasons, we have not adjusted the overall length of training they receive.  Medical students, our future physicians, are not receiving the holistic education that helps them balance keen scientific skills with compassionate delivery.

But, as they say, “knowledge is power,” and now that we are starting to pinpoint conditions that are tearing at our profession, we can start to heal them.  We can’t expect our medical interns to know how to handle difficult and emotional situations unless we show them.  We need to teach them how to engage with patients, earn their trust, really listen and understand them.  They need to be able to view what their patients say through both a  lens of science and medicine, as well as  a  lens of compassion and caring, in order to help them get and stay well.

And what of the technology challenges that are driving wedges between patients and physicians?  While there is no denying that much of health information technology is putting pressure on physicians and forcing them to adapt to new methodologies, these challenges are a necessary to revolutionizing patient care.  They are, in essence, the basis of growth and the very nature of science.  If it weren’t for boldly trying new approaches, we might still be relying on leeches and blood-letting to cure melancholia.   Just as we can’t expect a patient with heart disease to know intrinsically to maintain a low-sodium diet, we can’t expect the healthcare industry to know how to fix everything unless we speak up and advocate for change (especially with the other loud voices of insurers and politicians speaking on “our behalf”).

We must be mindful that as physicians, it is our sworn duty to defend the practice of delivering the best care to our patients from anything that threatens to impinge on that quality.  We need to stay engaged and be responsive; and that also means we need to assist with diagnosing major technology pain points and identify when something isn’t working.  We have the rare opportunity to shape the future of healthcare infused with technology and I, for one, want to be part of developing a solution that helps the next generation of physicians offer that comforting touch as they deliver an even greater level of care to their patients.

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