In this episode of Tell Me Where IT Hurts, host Jay Anders, MD welcomes Michael Blackman, MD, chief medical officer of Greenway Health––another physician who made the transition into healthcare IT––for a discussion of the challenges of surrounding patient information.
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But first, Dr. Anders shares an anecdote from the recent HIMSS22 conference, where he ran into a former colleague, another MD who is now in healthcare IT, who asked how he was enjoying his work. Dr. Anders told him that he has his dream job––applying his medical knowledge and making a difference in the world of medicine.
“But do you miss your patients?” his friend asked.
Pausing for a moment, Dr. Anders responded, “Yeah, I do.”
“Then why do you do it?”
Dr. Anders explained that when he was treating patients, he would see upwards of 6,000 each year. But in his current role, he can not only make a difference in more patients’ lives, but can also make it better for physicians.
Practicing Medicine on a Macro Level
Like Dr. Anders, Dr. Blackman made the transition from practicing medicine to applying his expertise to the advancement of healthcare IT. Prior to joining Greenway, he was the medical director of population health for Allscripts and was chief medical officer for McKesson’s Enterprise information systems division. Earlier, he was an early leader in development of electronic prescribing.
Back when he was practicing medicine, the hospital he was working for was deploying in an EHR. The implementation raised some issues that he thought didn’t make sense from a clinical standpoint. His attention to this level of detail and a background in IT consulting led to his appointment to the hospital’s steering committee and the vendor advisory board, where he spent the next seven-plus years.
When an opportunity arose to move to the vendor side, he saw it as a chance to help create a system that clinicians would like to use. Today, he views his role as ‘practicing medicine at the macro level,’ where he can affect a larger number of patients––far more than if he were seeing them one at a time.
Dr. Anders asks about Dr. Blackman’s approach to incorporating clinicians’ input into the EHR process. Dr. Blackman emphasizes the need to focus on what clinicians are trying to do, and why, rather than focusing on technical aspects, or the “how” it gets done.
The Future of Care Delivery
Dr. Anders raises the pandemic’s influence on healthcare delivery, and what Dr. Blackman thinks this means for virtual care going forward. Dr. Blackman notes that the pandemic served as an accelerator for services such as telehealth, which isn’t new but gained acceptance and momentum over the past two years.
One of the biggest drivers for telehealth, he claims, was the change in reimbursement that allowed providers to get paid for the services. Now that patients recognize the advantage of virtual care, its usage should continue climbing. But there needs to be recognition by both patients and clinicians as to when virtual care is (and is not) appropriate. Many in-person visits can be calls, and other times there’s a need to be seen. And as far as EHRs are concerned, both agree that telehealth and virtual care don’t really impact the clinician’s use or how they interact with the system.
Going forward, Dr. Blackman sees the regulatory environment of healthcare continuing, but says it would be helpful if the pace were more predictable. With patients increasingly involved in their care, portals should play a more prominent role in the care continuum. But how do we encourage active use of portals? Dr. Blackman believes they should be more than an access point for test results or paying bills, and should be go-to sources of information for patients.
Dr. Anders asks how Greenway is working to address these issues and to make the entire experience more positive and productive for both patients and clinicians. Greenway’s focus is on helping providers be successful by making systems that are easy to use, that are simple to operate, and that make sense and provide value to users. “We want to empower patients … give them the information that they need to be actively involved with their care.” And if the company does these things well, they will help create healthier communities.
He points out that the goal is not to encourage the provision of more healthcare, but to improve outcomes with better decision support and reference material––and making that vital information readily accessible to providers at the point of care. Ensuring the consistent reliability of that information is the challenge. The EHR must be as essential and reliable as the water and electricity in the building.
Interoperability Challenges and Working Toward a Common Goal
Dr. Anders points out that with the advent of the 21st Century Cures Act and TEFCA, we’re about to ‘turn on the spigot’ for a tremendous amount of system-to-system sharing of medical information. So, how is Greenway going to help their providers get to that relevant information when they need it?
Dr. Blackman notes that while interoperability has been a goal for a long time, we still need to help bring appropriate information to the fore, because there’s simply more medical knowledge out there than one person can know. This situation is compounded with complicated patients. Greenway is working with partners like Medicomp to help point out that relevant information so providers can make more informed decisions based on all pieces of the puzzle.
Dr. Anders recalls the days of working with 4- or 5-inch multi-volume patient charts, and the challenge of discerning essential information. Dr. Blackman notes that when everything was on paper, you couldn’t know everything in the chart, and nobody expected you to. Now, with it all on the computer, he says, there’s a sense that you must be aware of it. That is why we need to surface the relevant information, and then make it easy for someone to find what they are looking for.
Dr. Anders shares that one of his goals is to be a part of an EHR system that allows a clinician simply to practice medicine––meet with the patient, ask the questions they need to ask, document what they need to document, and then let all the quality measures, HCC coding, and the 2020 guidelines for E/M coding happen behind the scenes. Dr. Blackman takes that concept one step further by asking how we can automate as much as possible and present the clinician with gaps in care to make the most of every patient interaction––regardless of who is treating the patient.
Waving the health IT magic wand
Dr. Anders wraps the episode with his signature closing question: “If you could fix one thing in healthcare IT, what would it be?”
“If I had to pick one, it would be interoperability, but truthfully, I think there are a few things that we can do that really have a greater impact on day-to-day practice. And, so if I had to pick one, I would take a good swipe at medication management, because certainly in the outpatient space, that’s one of the most dangerous things that we do––really improve the way the communication between pharmacies and practices around medications, e-prescribing to make that more seamless than it is today.”