A decade or two after the majority of health systems took the EHR plunge, it’s still far from perfect, and the complaints still seem to pile up. But as those who have spent time in both the pre- and post-electronic worlds – and have the benefit of that experience – can attest, the benefits outweigh the challenges.
Remembering that, according to Jason Buchanan, MD, clinical informatics officer at Baylor College of Medicine, is critical. “There were many times when you’d be looking for a patient’s chart and couldn’t locate it. It was like flying blind.”
For leaders, the key is to ensure systems are usable, which means providing continuous education and support. During a recent interview, Buchanan talked about his approach to optimization, the power of listening, how medical school has evolved in recent years, and how he first got “hooked” on informatics.
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- Sending out surveys to providers and patients is a great way to gain feedback — as long as leaders clearly state “what they’re being used for and what’s the tentative plan.”
- By spending a half-day or even a few hours with providers, leaders can get “a bird’s eye view of a day in the life of a doctor or nurse, which offers a lot of insight into the organization as a whole.”
- One way in which medical schools are evolving? By providing more emphasis on the business side of medicine. “You have to have a feasible and sustainable framework” to successfully care for patients.
- Barriers between departments will always exist; leaders need to offer cross-training and ensure people have the freedom to say, ‘I don’t understand what you just said. Can you say it in a different way?”
Q&A with Jason Buchanan, Part 2 [Click here to view Part 1]
Gamble: You mentioned listening as an important part of leadership. Can you give some thoughts on the best ways to do that?
Buchanan: I think of listening in a few different ways. One is the traditional way where you send out surveys to your providers and patients. That’s the quickest and easiest way to do it. What’s important is to ask the right questions. You want them to be broad, but not overly broad, because you want to get actionable information from those surveys.
A lot of times when people see a survey in the inbox, they think, ‘oh great, another one.’ And so, you have to make sure that when you do those surveys, you clearly state what they’re being used for; what’s the tentative plan for these surveys.
For example, you might say, ‘we’re doing this survey to process the levels of burnout in the organization,’ and share a little bit about your plan to address it. By doing that, you’ll have increased compliance. That’s the first bucket of listening: sending out traditional surveys and collecting data.
What’s also important, especially among upper administration, is getting out on the floor with providers and patients. We know about the typical walkarounds where you have a dyad or triad that goes around to see what’s happening and chat with providers or patients.
Rounding to gain “insight into the organization”
But I think that in some of the really innovative places, folks in upper administration will spend a half-day or a quarter of day with providers, or with patients in the waiting room, so they can see what’s happening. They get a bird’s eye view of a day in the life of a doctor or nurse, which I think offers a lot of insight into the organization as a whole. When you combine that with surveys and other traditional means of getting data, that’s really a winning combination.
Gamble: It makes sense. Because if you’re just seeing a snapshot of someone’s day, you’re not getting the full picture.
Buchanan: People really appreciate it when leaders get out of their comfort zone and enter their space. I think it’s seen as more of a benefit than an intrusion.
Gamble: There’s a theme I’m seeing: people really need to feel heard — and they need to feel like things are happening with them, not to them.
Buchanan: Exactly. It shows that you care about them and that they matter.
Medical school’s evolution
Gamble: Let’s talk about your background. When did you go to medical school?
Buchanan: I’m originally from New York; I came to Houston in 1998 to attend Baylor College of Medicine. I got my MD in 2002 and did a residency in family medicine, which I completed in 2005.
“An integrated approach to teaching”
Gamble: I can imagine it has evolved quite a bit since then. Can you talk about how education and training has changed?
Buchanan: When I started at Baylor, it was one of the first few medical schools to focus more of the clinical aspect. Traditionally, it was two years of classroom and two years in the wards. At Baylor, it was one and a half years in the classroom and an extra six months of direct patient care as a medical student.
That’s one of the first trends I’ve started to see. Another is more of an integrated approach to teaching. In the past, anatomy, physiology, genetics, cardiology, etc. were taught in individual blocks. But in the last 5-10 years, we’re seeing more of an integration where the person or patient comes together as a whole. Now, anatomy, physiology, and others are wrapped into one, and you could see the various aspects of each of those disciplines during the preparatory coursework. That’s very important.
Focus on the business side
I’m also starting to see more focus on the business side of medicine. Of course, medicine is about taking great care of patients. But you have to have a feasible and sustainable framework financially to do that.
We’re also seeing more emphasis on nutrition in patient care. I consider diet and exercise basically to be medicine. Before, we had very little training around nutrition. Now it’s coming more into the fray, which is heartening to see, and determinants of health are being included in teaching. It’s critical because the care we provide in the clinic accounts for about 20 percent of what ails people. Having that focus on what’s going on at home and work is also very heartening to see.
“Get into each other’s spaces”
Gamble: That’s so important. You also want to see an evolution in IT training, so it’s happening in both worlds.
Buchanan: There’s a great focus on technology now. We talked about how medical training used to happen in siloes. The language is very different when you think about clinical medicine, IT, and the administration/business. When you get them together, oftentimes the lingo is different; people don’t quite understand it. And so, it’s important to do a lot of cross-training, get into each other’s spaces, and provide the freedom to say, ‘I don’t understand what you just said. Can you say it a different way?’
Or if you’re an IT or analytics team, instead of presenting raw data on a presentation screen, you might be better off with graphs and charts that everybody can understand. It’s keeping those things top of mind; that there are folks who don’t have your level of expertise in a particular realm. It’s making sure that when you do presentations or talk to folks, they understand what you’re saying and how it all fits together. That also is very heartening to see.
Fitting the puzzle pieces together
Gamble: What made you interested in pursuing informatics? What it something specific?
Buchanan: I’ve always liked science and technology. It’s almost archaic, but in those days, we didn’t even know how many patients were on our panels. And so, having the ability to see that there are 1,000 patients whose hemoglobin A1C is controlled is very powerful knowledge to work with as a provider. And you can take better care of your patients that way.
Again, it was pretty rudimentary at that time. Seeing the evolution happen so rapidly kind of sparked my mind about all of the different possibilities. Now we have AI and machine learning coming into the fray as well. You can see, over time, different parts of the puzzle start to fit together gradually. You can see what the future will look like if we stay on the present course.
Back to your question about informatics, for me it goes back to being a kid and playing with computers and science technology. That’s what got me into it. And then later, once I saw how much better things were with the EHR, in terms of having knowledge of the people I’m taking care of — that really sparked me.
One thing I really liked when we first got the EHR was being able to write prescriptions electronically. Back in the day, you used to have to handwrite prescriptions for each patient. If you see 20 patients a day, and they’re each taking a few medications, that’s a lot of writing. Being able to just refill one with a few clicks is a big time-saver. I got hooked that way.
Gamble: And it can make a huge difference in terms of safety as well.
Buchanan: Definitely. When you think about it, having clinical decision support systems built in can really help reduce medication errors. I can’t imagine how we would function without those backups in place. There really are some great points for EHRs.
Gamble: Agreed. It’s easy to get bogged down by the challenges, but it’s important to remember that some of the advancements are really going to make a tremendous difference.
Buchanan: That’s right. There’s some talk around using voice with EHRs to be able to have an ambient voice listening to encounters and having the information populate in your note. If we see that come into play, that’s going to help dramatically with the burden providers feel in terms of documentation.
Gamble: It’s been amazing. On a personal note, telehealth has been a game-changer, especially for parents during these past few years.
Buchanan: It has. Healthcare has traditionally been slow to change, but now we have evidence it can be quite nimble if it has to be. We essentially changed our entire model of patient care overnight because of the pandemic. And so, anything is possible.