About two weeks ago, I spent most of the day shadowing Family Practice Physician Steve Golden at his main office in Cohasset, MA. This was a follow-up to the discussion some of us had at a Harvard Pilgrim Physicians Association meeting about six weeks ago in which several folks suggested I needed to get out more.

It was a very interesting day, and from it, I’d offer the following thoughts.  First of all, Steve loves his patients, and they love him.  No surprise there.  But what was quite interesting to me was the rapport they have with one another.  He speaks, they listen, they speak, he listens.  Sounds simple enough, right — but when you’re talking to the mom of a brand new baby, and she’s working with the child while you’re talking to her and she’s talking to you, it takes a special kind of connection to communicate.  In this particular case, they were talking about some pretty complicated stuff, and neither one missed a beat.  And I learned that sunlight, in moderation of course, is good for a newborn baby’s skin color.

I also got a pretty good sense about the complexity of managing a business and managing a patient panel at the same time.  Steve has to switch from what are we doing about installing our clinical information system to what are we going to do about Mrs. Jones’ medication to what’s happening with Mr. Smith’s chest pains and back again over and over and over.  This is quite a juggling act, but he seems completely at ease with it.  And part of the reason for that is the connectivity between the docs, the nurse practitioners (NPs), and the practice management staff.  They’ve clearly worked together for quite a while, and can finish each other’s thoughts and sentences.  This saves a lot of time and prevents mistakes.

Their office is also in the process of implementing an electronic medical record, and I got some sense about how complex that can be.  For example, if the record is being implemented over time, then for some period of time, some of the information is in paper records, and relies on paper processes, and in others, it’s all online.  This means some of the information a physician or NP seeing a patient is looking for is either available online, or in the paper record, but it’s not obvious which is where.  And for the time being, all the billing is still being done with paper, so even as the practice adds to its electronic medical record files, it’s still using paper-based systems and paper coding to get paid.

And this interim process, given the enormity of moving all of the office activity off of paper and into the digital age is going to take a while.  In some ways, this helped me understand why a lot of practices and providers are nervous about going “electronic.”  It’s a slow process, requires a lot of new learning, and does create, during the interim, significant challenges around managing, finding and updating clinical information.

All in all, an illuminating day.  And yes, I did spend some time in the billing and referral authorization departments — and got the good, the bad and the ugly about  what that part of the operation, does, too.

Posted by Charlie Baker in Care Management, Health and Wellness