Friday, August 28, 2015

Modernizing the Medical Office

I sold my practice, Bayside Medical Group, to Stanford two and a half years ago. It was time for me to sell, and Stanford has oodles of cash, which I thought would bode well for both staff and patients, and they are technology oriented, which I thought was necessary. What I couldn't avoid, and I knew I couldn't, was the fact that the buyer was a hospital, an academic hospital, a bureaucracy, a corporation. No way around it.

Today I picked up granddaughter Lola at Bayside after her last visit for shots before going to kindergarten. The visit went well, aside from the fact that her screaming over this one shot raised the dead over a significant area of Alameda, although the cri de coeur ceased immediately upon being offered princess stickers. While waiting for her, I visited with several of my younger former colleagues back in the clinicians' office. “How's it going?” I asked.

Well, actually, that's not what I said. What I said was, “How's it going with the electronic medical record?” They have had it for over a year now. My pediatric colleague said, “I hate it.” It takes her several hours more a day to do her work, and the number of patients she can see has decreased. (I had heard from another younger former colleague that because of this decreased productivity, many of the clinicians had had their salaries reduced this year.) The EMR program, called Epic, is a very unintuitive program, which is to say it's hard to figure out what is where and what you need to do to get done what you want to do. It is person vs. machine. My colleague said that she had hoped that as she became more familiar with it she would get faster and it would help her work. But she says she still feels at times like kicking it and putting a knife into it. And she said that if I wanted to hear more, I could ask the other colleague who was seeing Lola, who is a more outspoken sort. I passed.

I had delayed adopting an EMR for Bayside because I knew it would be hard and expensive, and that the investment would have a negative financial payoff. So I wisely put it off for someone else to suffer with it. If I had done it, it would have ruined my life.

Then I spotted a new phone in the office. “Is that a new phone system?” I asked a colleague from the Family Practice side.

“Yup,” she said.

“How is it?” I asked.

“It sucks,” she said.

Seems that in introducing the new system they reduced the number of lines into the office. After six rings – which should never ever happen – the Stanford operator down in Palo Alto picks up, takes a message, and then calls the message into the office. Takes time, but at least the message isn't missed. Other times, the patient records a message on the phone, and can ramble on and on and on, and then the message is forgotten and missed on this system, and if it is found, it takes forever to listen to.

This modern phone system also requires that if you are on a call and want to transfer it to someone else, you need to know the exact number of the station to transfer it to, you have to look that up, and then when you make that transfer you have no assurance that the person is actually sitting at the desk where you transferred it to. In an office office, they are usually at their desk; in a medical office, of course, not so. So what happens here now is, you transfer the call to the station you need the patient to reach, and then you run – literally run – down the hall yelling for that person to get to the desk and pick up the call.

I had heard from another colleague previously when I saw him for my own check up that the phone system was so bad he had lost patients, and had started giving out his personal cell phone number instead of the office number to many of his patients.

So the phone system sucks. But besides obvious consequence for patients and staff, on top of that, the Stanford administrators award (or don't award) clinical staff a bonus depending on the ratings given by patients to the office they work in. The administration this year declared they were not giving bonus to this office because of patients' negative rating. But if you looked at the patients' ratings, what they downgraded was not the clinicians, but the phone system! When this was pointed out to administration, they replied that , even though they were the ones responsible for a new phone system, the clinicians ought to be able to find a way to make a fix for each patient nonetheless.

I guess you could call that creative decentralization. Or you could call it absolute administrative bullshit. In any case, they eventually relented and the clinicians got their bonus.

My colleague said that on the positive side, things did seem to be getting better over the past six months, and administration is learning to listen, albeit reluctantly. She said there was just a learning curve on each side, on the administration side because they don't know outpatient medicine. I'm not sure what the learning curve is all about on the clinician side. Hard to tell.

Larger groups practicing medicine are inevitable. More capital is needed, more improvements, hopefully not just to cope with administrative, regulatory bullshit, and hopefully not just so that the larger groups can garner better insurance contracts. It's clear that to run a quality practice, a lot of effort and learning needs to be applied. In this practice and with this hospital system so far, I'd say there is far more heat than light, not heated anger, just needless friction as the necessary skilled minds don't appear to be at the table. I'm hoping it will happen eventually, I'm hoping that there is a lot of “team-building” going on, but when it comes down to it, what you are really looking for is intelligence and experience. I'm not on the inside so I don't know, but I'd say they are still looking for the proper components so far.

They are lucky that no one else in the community appears to be doing any better.

Budd Shenkin


  1. I have chronic renal disease and I'm at the doctor's office regularly. I've definitely been aware of the differences caused by modernizing record keeping in medicine. Still, I haven't had too many negative experiences as a patient.

    The one thing I have experienced is not receiving a response for numerous messages that were left for my primary care doctor and his staff. It was so angering that I stop seeing him, but upon reading this, I'm reconsidering. I think if a patient knows the phone systems suck, they're not likely to give up a good medical practitioner if they're having phone communication issues.

    Brendon Hudgins @ MedCare Pediatric

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