The Hospitalist

CLINICAL QUESTION: How does the clinical decompensation of a ward patient affect the likelihood of another patient’s decompensation?

Dr. Anstett is Hospital Medicine Fellow in Quality and Systems Leadership, Division of Hospital Medicine, University of Colorado School of Medicine, Aurora.

CLINICAL QUESTION: How does the clinical decompensation of a ward patient affect the likelihood of another patient’s decompensation?

Dr. Anstett is Hospital Medicine Fellow in Quality and Systems Leadership, Division of Hospital Medicine, University of Colorado School of Medicine, Aurora.

CLINICAL QUESTION: How does the clinical decompensation of a ward patient affect the likelihood of another patient’s decompensation?

Dr. Anstett is Hospital Medicine Fellow in Quality and Systems Leadership, Division of Hospital Medicine, University of Colorado School of Medicine, Aurora.

CLINICAL QUESTION: Can a single institution’s VTE prophylaxis program be scaled to increase prophylaxis and reduce HA-VTEs across multiple institutions?

Dr. Anstett is Hospital Medicine Fellow in Quality and Systems Leadership, Division of Hospital Medicine, University of Colorado School of Medicine, Aurora.

CLINICAL QUESTION: Can a single institution’s VTE prophylaxis program be scaled to increase prophylaxis and reduce HA-VTEs across multiple institutions?

Dr. Anstett is Hospital Medicine Fellow in Quality and Systems Leadership, Division of Hospital Medicine, University of Colorado School of Medicine, Aurora.

CLINICAL QUESTION: Can a single institution’s VTE prophylaxis program be scaled to increase prophylaxis and reduce HA-VTEs across multiple institutions?

Dr. Anstett is Hospital Medicine Fellow in Quality and Systems Leadership, Division of Hospital Medicine, University of Colorado School of Medicine, Aurora.

“Nocturnist years are like dog years. So really we’re celebrating you for 105 years of service!”

Shawn Lee, MD, a day shift hospitalist at Overlake Medical Center in Bellevue, Wash. (where I work), said this about our colleague, Arash Nadershahi, MD, on the occasion of his 15th anniversary as a nocturnist with our group. Every hospitalist group should be so lucky to have someone like Arash among them, whether working nights or days.

When Arash joined our group the job simply entailed turning on the pager at 9 p.m. and coming in to the hospital only when the need arose. Some nights meant only answering some “cross-cover” calls from home, while other nights started with one or more patients needing admission right at the start of the shift.

Configuring the nocturnist position

A full-time nocturnist in our group works ten 10-hour night shifts and two 6-hour evening shifts (5-11 p.m.) per month. I like to think this has contributed to longevity for our nocturnists. One left last year after working nights for 10 years, and another just started his 9th year in the group.

The three nocturnists can work any schedule they like as long as one of them is on duty each night. For more than 10 years they’ve worked 7 consecutive night shifts followed by 14 off (that is sometimes interrupted by an evening shift). To my way of thinking, though, they’re essentially devoting 9 days to the practice for every seven consecutive shifts. The days before they start their rotation and after they complete it are spent preparing/recovering by adjusting their sleep, so aren’t really days of R&R.

For this work their compensation is very similar to that of full-time day shift doctors. The idea is that their compensation premium for working nights comes in the form of less work rather than more money; they work fewer and shorter shifts than their daytime counterparts. And we discourage moonlighting during all those days off. We want to provide the conditions for a healthy lifestyle to offset night work.
 

The longest-tenured nocturnist?

At 15 years of full-time work as a nocturnist, Arash may be one of the longest-tenured doctors in this role nationally. (I would love to hear about others who’ve been at it longer.) I like to think that our “pay ’em the same and work ’em less” approach may be a meaningful contributor to his longevity in the role, but I’m convinced his personal attributes are also a big factor.

Dr. Nelson has had a career in clinical practice as a hospitalist starting in 1988. He is cofounder and past president of SHM, and principal in Nelson Flores Hospital Medicine Consultants. He is codirector for SHM’s practice management courses.

[email protected]

“Nocturnist years are like dog years. So really we’re celebrating you for 105 years of service!”

Shawn Lee, MD, a day shift hospitalist at Overlake Medical Center in Bellevue, Wash. (where I work), said this about our colleague, Arash Nadershahi, MD, on the occasion of his 15th anniversary as a nocturnist with our group. Every hospitalist group should be so lucky to have someone like Arash among them, whether working nights or days.

When Arash joined our group the job simply entailed turning on the pager at 9 p.m. and coming in to the hospital only when the need arose. Some nights meant only answering some “cross-cover” calls from home, while other nights started with one or more patients needing admission right at the start of the shift.

Configuring the nocturnist position

A full-time nocturnist in our group works ten 10-hour night shifts and two 6-hour evening shifts (5-11 p.m.) per month. I like to think this has contributed to longevity for our nocturnists. One left last year after working nights for 10 years, and another just started his 9th year in the group.

The three nocturnists can work any schedule they like as long as one of them is on duty each night. For more than 10 years they’ve worked 7 consecutive night shifts followed by 14 off (that is sometimes interrupted by an evening shift). To my way of thinking, though, they’re essentially devoting 9 days to the practice for every seven consecutive shifts. The days before they start their rotation and after they complete it are spent preparing/recovering by adjusting their sleep, so aren’t really days of R&R.

For this work their compensation is very similar to that of full-time day shift doctors. The idea is that their compensation premium for working nights comes in the form of less work rather than more money; they work fewer and shorter shifts than their daytime counterparts. And we discourage moonlighting during all those days off. We want to provide the conditions for a healthy lifestyle to offset night work.
 

The longest-tenured nocturnist?

At 15 years of full-time work as a nocturnist, Arash may be one of the longest-tenured doctors in this role nationally. (I would love to hear about others who’ve been at it longer.) I like to think that our “pay ’em the same and work ’em less” approach may be a meaningful contributor to his longevity in the role, but I’m convinced his personal attributes are also a big factor.

Dr. Nelson has had a career in clinical practice as a hospitalist starting in 1988. He is cofounder and past president of SHM, and principal in Nelson Flores Hospital Medicine Consultants. He is codirector for SHM’s practice management courses.

[email protected]

“Nocturnist years are like dog years. So really we’re celebrating you for 105 years of service!”

Shawn Lee, MD, a day shift hospitalist at Overlake Medical Center in Bellevue, Wash. (where I work), said this about our colleague, Arash Nadershahi, MD, on the occasion of his 15th anniversary as a nocturnist with our group. Every hospitalist group should be so lucky to have someone like Arash among them, whether working nights or days.

When Arash joined our group the job simply entailed turning on the pager at 9 p.m. and coming in to the hospital only when the need arose. Some nights meant only answering some “cross-cover” calls from home, while other nights started with one or more patients needing admission right at the start of the shift.

Configuring the nocturnist position

A full-time nocturnist in our group works ten 10-hour night shifts and two 6-hour evening shifts (5-11 p.m.) per month. I like to think this has contributed to longevity for our nocturnists. One left last year after working nights for 10 years, and another just started his 9th year in the group.

The three nocturnists can work any schedule they like as long as one of them is on duty each night. For more than 10 years they’ve worked 7 consecutive night shifts followed by 14 off (that is sometimes interrupted by an evening shift). To my way of thinking, though, they’re essentially devoting 9 days to the practice for every seven consecutive shifts. The days before they start their rotation and after they complete it are spent preparing/recovering by adjusting their sleep, so aren’t really days of R&R.

For this work their compensation is very similar to that of full-time day shift doctors. The idea is that their compensation premium for working nights comes in the form of less work rather than more money; they work fewer and shorter shifts than their daytime counterparts. And we discourage moonlighting during all those days off. We want to provide the conditions for a healthy lifestyle to offset night work.
 

The longest-tenured nocturnist?

At 15 years of full-time work as a nocturnist, Arash may be one of the longest-tenured doctors in this role nationally. (I would love to hear about others who’ve been at it longer.) I like to think that our “pay ’em the same and work ’em less” approach may be a meaningful contributor to his longevity in the role, but I’m convinced his personal attributes are also a big factor.

Dr. Nelson has had a career in clinical practice as a hospitalist starting in 1988. He is cofounder and past president of SHM, and principal in Nelson Flores Hospital Medicine Consultants. He is codirector for SHM’s practice management courses.

[email protected]

CLINICAL QUESTION: Are alpha blockers efficacious in patients with ureteric stones?

CLINICAL QUESTION: Are alpha blockers efficacious in patients with ureteric stones?

CLINICAL QUESTION: Are alpha blockers efficacious in patients with ureteric stones?

CLINICAL QUESTION: How efficacious are interventions to reduce burnout in physicians?

BACKGROUND: Burnout is characterized by emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment. It is driven by workplace stressors and affects nearly half of physicians practicing in the U.S.

Dr. Ecker is the assistant director of education, Division of Hospital Medicine, University of Colorado School of Medicine, Aurora.

CLINICAL QUESTION: How efficacious are interventions to reduce burnout in physicians?

BACKGROUND: Burnout is characterized by emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment. It is driven by workplace stressors and affects nearly half of physicians practicing in the U.S.

Dr. Ecker is the assistant director of education, Division of Hospital Medicine, University of Colorado School of Medicine, Aurora.

CLINICAL QUESTION: How efficacious are interventions to reduce burnout in physicians?

BACKGROUND: Burnout is characterized by emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment. It is driven by workplace stressors and affects nearly half of physicians practicing in the U.S.

Dr. Ecker is the assistant director of education, Division of Hospital Medicine, University of Colorado School of Medicine, Aurora.

PARIS – Unwarranted prescriptions for proton pump inhibitors tripled the rate at which patients with atrial fibrillation needed hospitalization for a first episode of acute heart failure, in a retrospective study of 172 patients at a single center in Portugal.

About a third of the atrial fibrillation patients received a proton pump inhibitor (PPI) without a clear indication, and the PPI recipients developed heart failure at 2.9 times the rate as patients not on a PPI, a statistically significant difference, João B. Augusto, MD, reported at a meeting held by the Heart Failure Association of the European Society of Cardiology. Dr. Augusto believes that these patients largely had no need for PPI treatment, and the drug may have cut iron and vitamin B12 absorption by lowering gastric acid, resulting in deficiencies that produced anemia, and following that, heart failure, he suggested.

Mitchel L. Zoler/Frontline Medical News

PARIS – Unwarranted prescriptions for proton pump inhibitors tripled the rate at which patients with atrial fibrillation needed hospitalization for a first episode of acute heart failure, in a retrospective study of 172 patients at a single center in Portugal.

About a third of the atrial fibrillation patients received a proton pump inhibitor (PPI) without a clear indication, and the PPI recipients developed heart failure at 2.9 times the rate as patients not on a PPI, a statistically significant difference, João B. Augusto, MD, reported at a meeting held by the Heart Failure Association of the European Society of Cardiology. Dr. Augusto believes that these patients largely had no need for PPI treatment, and the drug may have cut iron and vitamin B12 absorption by lowering gastric acid, resulting in deficiencies that produced anemia, and following that, heart failure, he suggested.

Mitchel L. Zoler/Frontline Medical News

PARIS – Unwarranted prescriptions for proton pump inhibitors tripled the rate at which patients with atrial fibrillation needed hospitalization for a first episode of acute heart failure, in a retrospective study of 172 patients at a single center in Portugal.

About a third of the atrial fibrillation patients received a proton pump inhibitor (PPI) without a clear indication, and the PPI recipients developed heart failure at 2.9 times the rate as patients not on a PPI, a statistically significant difference, João B. Augusto, MD, reported at a meeting held by the Heart Failure Association of the European Society of Cardiology. Dr. Augusto believes that these patients largely had no need for PPI treatment, and the drug may have cut iron and vitamin B12 absorption by lowering gastric acid, resulting in deficiencies that produced anemia, and following that, heart failure, he suggested.

Mitchel L. Zoler/Frontline Medical News

Within hospital medicine, there has been a recent increase in programs that provide virtual or telehealth hospitalists, primarily to hospitals that are small, remote, and/or understaffed. According to a 2013 Cisco health care customer experience report, the number of telehealth consumers will likely markedly increase to at least 7 million by 2018.¹

Since telehospitalist programs are still relatively new, there are many questions about why and how they exist and how they are (and can be) funded. Questions also remain about some limitations of telehospitalist programs for both the “givers” and the “receivers” of the services. I tackle some of these questions in this article.

What is a telehospitalist?

What are the drivers of telehospitalist programs?

One primary driver of telehealth (and specifically telehospitalist) programs is an ongoing shortage of hospitalists, especially in remote areas and critical access hospitals where coverage issues are especially prominent at night and/or on weekends. In many hospitals, there is also a growing unwillingness on the part of physicians to be routinely on call at night. Although working on call used to be on par with being a physician, many younger-generation physicians are less willing to blur “work and life.” This increases the need for dedicated night coverage in many hospitals.

Another driver for some programs (especially at tertiary care medical centers) is a desire to more thoroughly assess patients prior to transfer to their respective centers (the alternative being a phone conversation with the transferring center about the patient’s status). There is also a growing desire to keep patients local if possible, which is usually better for the patient and the family and can decrease the total cost of their care.

Another catalyst to telehospitalist program growth is the growing cultural comfort level with two-way video interactions, such as Skype and FaceTime. Since videoconferencing has permeated most of our professional and personal lives, telehealth seems familiar and comfortable for both providers and patients. In a recent consumer survey, three out of every four consumers responded that they are very comfortable communicating with providers via technology, as opposed to seeing them in person.¹

Another driver for some programs is financial. Depending on the way the program is structured, it can be not only financially feasible but financially beneficial, especially if the program can consolidate coverage across multiple sites (more on this later).

One other driver for some health care systems is the need to cover areas with on-site nurse practitioners and physician assistants. Using a telehospitalist makes it easier to get appropriate and required oversight for this coverage model across time and space.

What are the advantages of being a telehospitalist?

Some of the career advantages of being a telehospitalist include the shift flexibility and convenience. This work allows a hospitalist to serve a shift from anywhere in the world and from the convenience of their home. Some telehospitalists can easily work local night shifts when they live many time zones away (and therefore, don’t actually have to work a night shift). Many programs are designed to have a single hospitalist cover many hospitals over a wide geography, which would be logistically impossible to do in person. This is especially appealing for multihospital systems that cannot afford to have a hospitalist on site at each location.

The earning potential can also be appealing, depending on the number of shifts a hospitalist is willing to work.

What are the limitations of being a telehospitalist?

There are limits to what a telehospitalist can perform, many of which depend on the manner in which the program and the technology are arranged. Telehealth can vary from a cart-based videoconferencing system that is transported into a patient’s room to an independent robot that travels throughout sites. The primary limitation is the need to rely on someone in the patient’s room to act as virtual hands. This usually falls to the bedside nurse and requires a good working relationship and patience on their part. The bedside nurses have to “buy into” the program in advance and may need to have scripting for how to explain the process to the patients.

Another major challenge is interacting with different electronic health record systems. Becoming agile with a single EHR is challenging enough, but maneuvering several of them in a single shift can be extremely trying. Telehospitalists can also be challenged by technology glitches or failures that need troubleshooting both on their end and on-site. Although these problems are rare, there will always be a concern that the patient will not get his or her needs met if the technology fails.

How does the financing work?

Although this is a rapidly changing landscape, telehospitalists are not currently able to generate much revenue from professional billing. Unlike in-person visits, Medicare will not reimburse professional fees for telehospitalist visits. Although each payer is unique, most other (nonMedicare) payers are also not willing to reimburse for televisits. This may change in the future, however, as Medicare does pay for virtual specialty services such as telestroke. In addition, many states have enacted telemedicine parity laws, which require private payers to pay for all health care services equally, regardless of modality (audio, video, or in person).

For now, the financial case for employing telehospitalists for most programs has to be made using benfits other than the generation of professional fees. For telehospitalist programs that can cover several sites, the cost is substantially less than employing individual on-site hospitalists to do low-volume work. Telehospitalist programs are also, likely, less costly than is locum tenens staffing. For programs that evaluate the need for transfers, a case can be made that keeping a patient in a smaller, low-cost venue, rather than transferring them to a larger, higher-cost venue, can also reduce overall cost for a health care system.

What about licensing and credentialing?

Telehospitalists can be hindered by the need to have a license in several states and to be credentialed in several systems. This can be cumbersome, time-consuming, and expensive. To ease the multistate licensing burden, the Interstate Medical Licensure Compact has been established.² This is an accelerated licensure process for eligible physicians that improves license portability across states. There are currently 18 states that participate, and the number continues to increase.

For credentialing, most hospitals require initial credentialing and full recredentialing every 2 years. Maintaining credentials at several sites can be extremely time consuming. To ease this burden, some hospitals with telehealth programs have adopted “credentialing by proxy,” which means that one hospital will accept the credentialing process of another facility.

What next?

In summary, there has been and will likely continue to be explosive growth of telehospitalist programs and providers for all the reasons outlined above. Although some barriers to efficient and effective practice do exist, many of those barriers are being overcome quite rapidly. I expect this growth to continue for the betterment of hospitalists, our patients, and the systems in which we work. For a more in-depth look into telemedicine in hospital medicine, view a report created by a work group of SHM's Practice Management Committee.

Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at [email protected].

References

1.Cisco. (2013 March 4). Cisco Study Reveals 74 Percent of Consumers Open to Virtual Doctor Visit. Cisco: The Network. Retrieved from https://newsroom.cisco.com/press-release-content?type=webcontent&articleId=1148539.

2. Interstate Medical Licensure Compact Commission. (2017). Interstate Medical Licensure Compact. Retrieved from http://www.licenseportability.org/index.html.

Within hospital medicine, there has been a recent increase in programs that provide virtual or telehealth hospitalists, primarily to hospitals that are small, remote, and/or understaffed. According to a 2013 Cisco health care customer experience report, the number of telehealth consumers will likely markedly increase to at least 7 million by 2018.¹

Since telehospitalist programs are still relatively new, there are many questions about why and how they exist and how they are (and can be) funded. Questions also remain about some limitations of telehospitalist programs for both the “givers” and the “receivers” of the services. I tackle some of these questions in this article.

What is a telehospitalist?

What are the drivers of telehospitalist programs?

One primary driver of telehealth (and specifically telehospitalist) programs is an ongoing shortage of hospitalists, especially in remote areas and critical access hospitals where coverage issues are especially prominent at night and/or on weekends. In many hospitals, there is also a growing unwillingness on the part of physicians to be routinely on call at night. Although working on call used to be on par with being a physician, many younger-generation physicians are less willing to blur “work and life.” This increases the need for dedicated night coverage in many hospitals.

Another driver for some programs (especially at tertiary care medical centers) is a desire to more thoroughly assess patients prior to transfer to their respective centers (the alternative being a phone conversation with the transferring center about the patient’s status). There is also a growing desire to keep patients local if possible, which is usually better for the patient and the family and can decrease the total cost of their care.

Another catalyst to telehospitalist program growth is the growing cultural comfort level with two-way video interactions, such as Skype and FaceTime. Since videoconferencing has permeated most of our professional and personal lives, telehealth seems familiar and comfortable for both providers and patients. In a recent consumer survey, three out of every four consumers responded that they are very comfortable communicating with providers via technology, as opposed to seeing them in person.¹

Another driver for some programs is financial. Depending on the way the program is structured, it can be not only financially feasible but financially beneficial, especially if the program can consolidate coverage across multiple sites (more on this later).

One other driver for some health care systems is the need to cover areas with on-site nurse practitioners and physician assistants. Using a telehospitalist makes it easier to get appropriate and required oversight for this coverage model across time and space.

What are the advantages of being a telehospitalist?

Some of the career advantages of being a telehospitalist include the shift flexibility and convenience. This work allows a hospitalist to serve a shift from anywhere in the world and from the convenience of their home. Some telehospitalists can easily work local night shifts when they live many time zones away (and therefore, don’t actually have to work a night shift). Many programs are designed to have a single hospitalist cover many hospitals over a wide geography, which would be logistically impossible to do in person. This is especially appealing for multihospital systems that cannot afford to have a hospitalist on site at each location.

The earning potential can also be appealing, depending on the number of shifts a hospitalist is willing to work.

What are the limitations of being a telehospitalist?

There are limits to what a telehospitalist can perform, many of which depend on the manner in which the program and the technology are arranged. Telehealth can vary from a cart-based videoconferencing system that is transported into a patient’s room to an independent robot that travels throughout sites. The primary limitation is the need to rely on someone in the patient’s room to act as virtual hands. This usually falls to the bedside nurse and requires a good working relationship and patience on their part. The bedside nurses have to “buy into” the program in advance and may need to have scripting for how to explain the process to the patients.

Another major challenge is interacting with different electronic health record systems. Becoming agile with a single EHR is challenging enough, but maneuvering several of them in a single shift can be extremely trying. Telehospitalists can also be challenged by technology glitches or failures that need troubleshooting both on their end and on-site. Although these problems are rare, there will always be a concern that the patient will not get his or her needs met if the technology fails.

How does the financing work?

Although this is a rapidly changing landscape, telehospitalists are not currently able to generate much revenue from professional billing. Unlike in-person visits, Medicare will not reimburse professional fees for telehospitalist visits. Although each payer is unique, most other (nonMedicare) payers are also not willing to reimburse for televisits. This may change in the future, however, as Medicare does pay for virtual specialty services such as telestroke. In addition, many states have enacted telemedicine parity laws, which require private payers to pay for all health care services equally, regardless of modality (audio, video, or in person).

For now, the financial case for employing telehospitalists for most programs has to be made using benfits other than the generation of professional fees. For telehospitalist programs that can cover several sites, the cost is substantially less than employing individual on-site hospitalists to do low-volume work. Telehospitalist programs are also, likely, less costly than is locum tenens staffing. For programs that evaluate the need for transfers, a case can be made that keeping a patient in a smaller, low-cost venue, rather than transferring them to a larger, higher-cost venue, can also reduce overall cost for a health care system.

What about licensing and credentialing?

Telehospitalists can be hindered by the need to have a license in several states and to be credentialed in several systems. This can be cumbersome, time-consuming, and expensive. To ease the multistate licensing burden, the Interstate Medical Licensure Compact has been established.² This is an accelerated licensure process for eligible physicians that improves license portability across states. There are currently 18 states that participate, and the number continues to increase.

For credentialing, most hospitals require initial credentialing and full recredentialing every 2 years. Maintaining credentials at several sites can be extremely time consuming. To ease this burden, some hospitals with telehealth programs have adopted “credentialing by proxy,” which means that one hospital will accept the credentialing process of another facility.

What next?

In summary, there has been and will likely continue to be explosive growth of telehospitalist programs and providers for all the reasons outlined above. Although some barriers to efficient and effective practice do exist, many of those barriers are being overcome quite rapidly. I expect this growth to continue for the betterment of hospitalists, our patients, and the systems in which we work. For a more in-depth look into telemedicine in hospital medicine, view a report created by a work group of SHM's Practice Management Committee.

Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at [email protected].

References

1.Cisco. (2013 March 4). Cisco Study Reveals 74 Percent of Consumers Open to Virtual Doctor Visit. Cisco: The Network. Retrieved from https://newsroom.cisco.com/press-release-content?type=webcontent&articleId=1148539.

2. Interstate Medical Licensure Compact Commission. (2017). Interstate Medical Licensure Compact. Retrieved from http://www.licenseportability.org/index.html.

Within hospital medicine, there has been a recent increase in programs that provide virtual or telehealth hospitalists, primarily to hospitals that are small, remote, and/or understaffed. According to a 2013 Cisco health care customer experience report, the number of telehealth consumers will likely markedly increase to at least 7 million by 2018.¹

Since telehospitalist programs are still relatively new, there are many questions about why and how they exist and how they are (and can be) funded. Questions also remain about some limitations of telehospitalist programs for both the “givers” and the “receivers” of the services. I tackle some of these questions in this article.

What is a telehospitalist?

What are the drivers of telehospitalist programs?

One primary driver of telehealth (and specifically telehospitalist) programs is an ongoing shortage of hospitalists, especially in remote areas and critical access hospitals where coverage issues are especially prominent at night and/or on weekends. In many hospitals, there is also a growing unwillingness on the part of physicians to be routinely on call at night. Although working on call used to be on par with being a physician, many younger-generation physicians are less willing to blur “work and life.” This increases the need for dedicated night coverage in many hospitals.

Another driver for some programs (especially at tertiary care medical centers) is a desire to more thoroughly assess patients prior to transfer to their respective centers (the alternative being a phone conversation with the transferring center about the patient’s status). There is also a growing desire to keep patients local if possible, which is usually better for the patient and the family and can decrease the total cost of their care.

Another catalyst to telehospitalist program growth is the growing cultural comfort level with two-way video interactions, such as Skype and FaceTime. Since videoconferencing has permeated most of our professional and personal lives, telehealth seems familiar and comfortable for both providers and patients. In a recent consumer survey, three out of every four consumers responded that they are very comfortable communicating with providers via technology, as opposed to seeing them in person.¹

Another driver for some programs is financial. Depending on the way the program is structured, it can be not only financially feasible but financially beneficial, especially if the program can consolidate coverage across multiple sites (more on this later).

One other driver for some health care systems is the need to cover areas with on-site nurse practitioners and physician assistants. Using a telehospitalist makes it easier to get appropriate and required oversight for this coverage model across time and space.

What are the advantages of being a telehospitalist?

Some of the career advantages of being a telehospitalist include the shift flexibility and convenience. This work allows a hospitalist to serve a shift from anywhere in the world and from the convenience of their home. Some telehospitalists can easily work local night shifts when they live many time zones away (and therefore, don’t actually have to work a night shift). Many programs are designed to have a single hospitalist cover many hospitals over a wide geography, which would be logistically impossible to do in person. This is especially appealing for multihospital systems that cannot afford to have a hospitalist on site at each location.

The earning potential can also be appealing, depending on the number of shifts a hospitalist is willing to work.

What are the limitations of being a telehospitalist?

There are limits to what a telehospitalist can perform, many of which depend on the manner in which the program and the technology are arranged. Telehealth can vary from a cart-based videoconferencing system that is transported into a patient’s room to an independent robot that travels throughout sites. The primary limitation is the need to rely on someone in the patient’s room to act as virtual hands. This usually falls to the bedside nurse and requires a good working relationship and patience on their part. The bedside nurses have to “buy into” the program in advance and may need to have scripting for how to explain the process to the patients.

Another major challenge is interacting with different electronic health record systems. Becoming agile with a single EHR is challenging enough, but maneuvering several of them in a single shift can be extremely trying. Telehospitalists can also be challenged by technology glitches or failures that need troubleshooting both on their end and on-site. Although these problems are rare, there will always be a concern that the patient will not get his or her needs met if the technology fails.

How does the financing work?

Although this is a rapidly changing landscape, telehospitalists are not currently able to generate much revenue from professional billing. Unlike in-person visits, Medicare will not reimburse professional fees for telehospitalist visits. Although each payer is unique, most other (nonMedicare) payers are also not willing to reimburse for televisits. This may change in the future, however, as Medicare does pay for virtual specialty services such as telestroke. In addition, many states have enacted telemedicine parity laws, which require private payers to pay for all health care services equally, regardless of modality (audio, video, or in person).

For now, the financial case for employing telehospitalists for most programs has to be made using benfits other than the generation of professional fees. For telehospitalist programs that can cover several sites, the cost is substantially less than employing individual on-site hospitalists to do low-volume work. Telehospitalist programs are also, likely, less costly than is locum tenens staffing. For programs that evaluate the need for transfers, a case can be made that keeping a patient in a smaller, low-cost venue, rather than transferring them to a larger, higher-cost venue, can also reduce overall cost for a health care system.

What about licensing and credentialing?

Telehospitalists can be hindered by the need to have a license in several states and to be credentialed in several systems. This can be cumbersome, time-consuming, and expensive. To ease the multistate licensing burden, the Interstate Medical Licensure Compact has been established.² This is an accelerated licensure process for eligible physicians that improves license portability across states. There are currently 18 states that participate, and the number continues to increase.

For credentialing, most hospitals require initial credentialing and full recredentialing every 2 years. Maintaining credentials at several sites can be extremely time consuming. To ease this burden, some hospitals with telehealth programs have adopted “credentialing by proxy,” which means that one hospital will accept the credentialing process of another facility.

What next?

In summary, there has been and will likely continue to be explosive growth of telehospitalist programs and providers for all the reasons outlined above. Although some barriers to efficient and effective practice do exist, many of those barriers are being overcome quite rapidly. I expect this growth to continue for the betterment of hospitalists, our patients, and the systems in which we work. For a more in-depth look into telemedicine in hospital medicine, view a report created by a work group of SHM's Practice Management Committee.

Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at [email protected].

References

1.Cisco. (2013 March 4). Cisco Study Reveals 74 Percent of Consumers Open to Virtual Doctor Visit. Cisco: The Network. Retrieved from https://newsroom.cisco.com/press-release-content?type=webcontent&articleId=1148539.

2. Interstate Medical Licensure Compact Commission. (2017). Interstate Medical Licensure Compact. Retrieved from http://www.licenseportability.org/index.html.

LAS VEGAS – Masih Shinwa, MD, stood beside a half-circle of judges at SHM’s annual Research, Innovations, and Clinical Vignettes poster competition and argued why his entry, already a finalist, should win.

To think, his work, “Please ‘THINK’ Before You Order: A Multidisciplinary Approach to Decreasing Overutilization of Daily Labs,” was borne simply of a group of medical students who incredulously said that they were amazed patients would be woken up in the night for tests.

LAS VEGAS – Masih Shinwa, MD, stood beside a half-circle of judges at SHM’s annual Research, Innovations, and Clinical Vignettes poster competition and argued why his entry, already a finalist, should win.

To think, his work, “Please ‘THINK’ Before You Order: A Multidisciplinary Approach to Decreasing Overutilization of Daily Labs,” was borne simply of a group of medical students who incredulously said that they were amazed patients would be woken up in the night for tests.

LAS VEGAS – Masih Shinwa, MD, stood beside a half-circle of judges at SHM’s annual Research, Innovations, and Clinical Vignettes poster competition and argued why his entry, already a finalist, should win.

To think, his work, “Please ‘THINK’ Before You Order: A Multidisciplinary Approach to Decreasing Overutilization of Daily Labs,” was borne simply of a group of medical students who incredulously said that they were amazed patients would be woken up in the night for tests.

LAS VEGAS – In the view of academic hospitalist Alfred Burger, MD, SFHM, portability was long a dirty word in HM circles. But not anymore.

“My good friends in law and business do this all the time,” said Dr. Burger, associate program director of the internal medicine residency program at Mount Sinai Beth Israel in New York. “You’re not going to make partner in city X, but they’ve got an opening to be partner in city Y if you go there and perform for a year. People up and leave coasts, people up and leave states, people have up and left the country. ... Doctors are starting to view it the same way.”

The lessons of career development were a focal point of HM17, particularly for younger physicians who could take advantage of the Early-Career Hospitalists mini-track. But Dr. Burger said that those strategies of upward mobility can apply whether someone is chasing their first job or their fifth.

First, identify one’s strengths and play to those. Then identify the skills you don’t have or don’t excel at, and address those deficiencies.

“How can you acquire the skills to put yourself in the best position to move up, if you wish to develop your career as a leader?” Dr. Burger said. “If you wish to be the best clinician, you still need to stay on top of the game. Things like coming to SHM, staying on top of the content. That’s important.”

Another skill set is self-advocacy.

“Be your own champion,” said Brian Markoff, MD, SFHM, chief of hospital medicine at Mount Sinai St. Luke’s in New York. “Many of us are very good at this and many of us are terrible at this. You may fall somewhere in between, but you do have to be your own champion.”

Dr. Burger said that he understands that there is a fine line between too much self-promotion and too little. But he urged hospitalists at all career points to take responsibility for marketing themselves.

“Nobody is going to invest in your career unless you yourself invest in it,” he added. “You have to put it as a priority, and not in a selfish way, but in a way [that,] if you wish to move forward and move up, you’ve got to put the time in. It’s not a natural assumption anymore that, if you are the best and brightest of a group of doctors, you will just be chosen to lead.”

In a similar vein, networking is a major boon to career development that can be a double-edged scalpel.

“Having a great ‘social game’ is important, but if all you bring to the table is a social game, you’ll find yourself out of a job just as quickly as you found that job,” Dr. Burger said. “Meaning, you might be able to get it based on that, but you’re not going to be able to sustain it. At the same time, being highly accomplished and having no social graces is also a killer. So, you need to be sort of strong in both areas.”

Many of the meeting’s opportunities for tips on professional development are personal, but HM group leaders have to consider developing the careers of their employees. One of the main planks of that is physician engagement, said Flora Kisuule, MD, MPH, SFHM, of Johns Hopkins University, Baltimore.

“I don’t believe your institution or your organization can go anywhere if your employees are not engaged or if the people you work with are not engaged,” she said, adding that disengaged employees “are actively working against you. You don’t want that. You can’t go in any direction when there are people rowing in the opposite direction. At best, you stay in one place. At worst, you can end up losing ground.”

Hospitalist Christie Masters, MD, MBA, MHA, who practices at UCLA, disclosed during a session that she also runs a wellness coaching firm. She added that a focus on personal wellness and well-being is its own form of career development. It works in tandem with engagement, morale, and professional growth.

“If you’re only focusing on wellness and you don’t have hospitalists or a group that’s engaged or with high morale, they’re going to burnout or they’re going to leave,” Dr. Masters said. “And nobody wants that for their group. So, if we surround ourselves with people who feel well and feel whole, that’s going to have intangible benefits ... that affect the bottom line.”

LAS VEGAS – In the view of academic hospitalist Alfred Burger, MD, SFHM, portability was long a dirty word in HM circles. But not anymore.

“My good friends in law and business do this all the time,” said Dr. Burger, associate program director of the internal medicine residency program at Mount Sinai Beth Israel in New York. “You’re not going to make partner in city X, but they’ve got an opening to be partner in city Y if you go there and perform for a year. People up and leave coasts, people up and leave states, people have up and left the country. ... Doctors are starting to view it the same way.”

The lessons of career development were a focal point of HM17, particularly for younger physicians who could take advantage of the Early-Career Hospitalists mini-track. But Dr. Burger said that those strategies of upward mobility can apply whether someone is chasing their first job or their fifth.

First, identify one’s strengths and play to those. Then identify the skills you don’t have or don’t excel at, and address those deficiencies.

“How can you acquire the skills to put yourself in the best position to move up, if you wish to develop your career as a leader?” Dr. Burger said. “If you wish to be the best clinician, you still need to stay on top of the game. Things like coming to SHM, staying on top of the content. That’s important.”

Another skill set is self-advocacy.

“Be your own champion,” said Brian Markoff, MD, SFHM, chief of hospital medicine at Mount Sinai St. Luke’s in New York. “Many of us are very good at this and many of us are terrible at this. You may fall somewhere in between, but you do have to be your own champion.”

Dr. Burger said that he understands that there is a fine line between too much self-promotion and too little. But he urged hospitalists at all career points to take responsibility for marketing themselves.

“Nobody is going to invest in your career unless you yourself invest in it,” he added. “You have to put it as a priority, and not in a selfish way, but in a way [that,] if you wish to move forward and move up, you’ve got to put the time in. It’s not a natural assumption anymore that, if you are the best and brightest of a group of doctors, you will just be chosen to lead.”

In a similar vein, networking is a major boon to career development that can be a double-edged scalpel.

“Having a great ‘social game’ is important, but if all you bring to the table is a social game, you’ll find yourself out of a job just as quickly as you found that job,” Dr. Burger said. “Meaning, you might be able to get it based on that, but you’re not going to be able to sustain it. At the same time, being highly accomplished and having no social graces is also a killer. So, you need to be sort of strong in both areas.”

Many of the meeting’s opportunities for tips on professional development are personal, but HM group leaders have to consider developing the careers of their employees. One of the main planks of that is physician engagement, said Flora Kisuule, MD, MPH, SFHM, of Johns Hopkins University, Baltimore.

“I don’t believe your institution or your organization can go anywhere if your employees are not engaged or if the people you work with are not engaged,” she said, adding that disengaged employees “are actively working against you. You don’t want that. You can’t go in any direction when there are people rowing in the opposite direction. At best, you stay in one place. At worst, you can end up losing ground.”

Hospitalist Christie Masters, MD, MBA, MHA, who practices at UCLA, disclosed during a session that she also runs a wellness coaching firm. She added that a focus on personal wellness and well-being is its own form of career development. It works in tandem with engagement, morale, and professional growth.

“If you’re only focusing on wellness and you don’t have hospitalists or a group that’s engaged or with high morale, they’re going to burnout or they’re going to leave,” Dr. Masters said. “And nobody wants that for their group. So, if we surround ourselves with people who feel well and feel whole, that’s going to have intangible benefits ... that affect the bottom line.”

LAS VEGAS – In the view of academic hospitalist Alfred Burger, MD, SFHM, portability was long a dirty word in HM circles. But not anymore.

“My good friends in law and business do this all the time,” said Dr. Burger, associate program director of the internal medicine residency program at Mount Sinai Beth Israel in New York. “You’re not going to make partner in city X, but they’ve got an opening to be partner in city Y if you go there and perform for a year. People up and leave coasts, people up and leave states, people have up and left the country. ... Doctors are starting to view it the same way.”

The lessons of career development were a focal point of HM17, particularly for younger physicians who could take advantage of the Early-Career Hospitalists mini-track. But Dr. Burger said that those strategies of upward mobility can apply whether someone is chasing their first job or their fifth.

First, identify one’s strengths and play to those. Then identify the skills you don’t have or don’t excel at, and address those deficiencies.

“How can you acquire the skills to put yourself in the best position to move up, if you wish to develop your career as a leader?” Dr. Burger said. “If you wish to be the best clinician, you still need to stay on top of the game. Things like coming to SHM, staying on top of the content. That’s important.”

Another skill set is self-advocacy.

“Be your own champion,” said Brian Markoff, MD, SFHM, chief of hospital medicine at Mount Sinai St. Luke’s in New York. “Many of us are very good at this and many of us are terrible at this. You may fall somewhere in between, but you do have to be your own champion.”

Dr. Burger said that he understands that there is a fine line between too much self-promotion and too little. But he urged hospitalists at all career points to take responsibility for marketing themselves.

“Nobody is going to invest in your career unless you yourself invest in it,” he added. “You have to put it as a priority, and not in a selfish way, but in a way [that,] if you wish to move forward and move up, you’ve got to put the time in. It’s not a natural assumption anymore that, if you are the best and brightest of a group of doctors, you will just be chosen to lead.”

In a similar vein, networking is a major boon to career development that can be a double-edged scalpel.

“Having a great ‘social game’ is important, but if all you bring to the table is a social game, you’ll find yourself out of a job just as quickly as you found that job,” Dr. Burger said. “Meaning, you might be able to get it based on that, but you’re not going to be able to sustain it. At the same time, being highly accomplished and having no social graces is also a killer. So, you need to be sort of strong in both areas.”

Many of the meeting’s opportunities for tips on professional development are personal, but HM group leaders have to consider developing the careers of their employees. One of the main planks of that is physician engagement, said Flora Kisuule, MD, MPH, SFHM, of Johns Hopkins University, Baltimore.

“I don’t believe your institution or your organization can go anywhere if your employees are not engaged or if the people you work with are not engaged,” she said, adding that disengaged employees “are actively working against you. You don’t want that. You can’t go in any direction when there are people rowing in the opposite direction. At best, you stay in one place. At worst, you can end up losing ground.”

Hospitalist Christie Masters, MD, MBA, MHA, who practices at UCLA, disclosed during a session that she also runs a wellness coaching firm. She added that a focus on personal wellness and well-being is its own form of career development. It works in tandem with engagement, morale, and professional growth.

“If you’re only focusing on wellness and you don’t have hospitalists or a group that’s engaged or with high morale, they’re going to burnout or they’re going to leave,” Dr. Masters said. “And nobody wants that for their group. So, if we surround ourselves with people who feel well and feel whole, that’s going to have intangible benefits ... that affect the bottom line.”

LAS VEGAS – Ronald Schaefer, MD, a hospitalist with Hawaii Pacific Health who also works on creating digital templates for his hospital, can’t input hemoglobin A1c levels from three different labs into his electronic medical records (EMR) system the same way.

Hospitalist George Dimitriou, MD, FHM, who splits his time at Allegheny Health Network in Pittsburgh between clinical work and medical informatics, worries there are so many fields in his EMR that physicians can get distracted.

Yevgeniy “Eugene” Gitelman, MD, a clinical informatics manager at the Perelman School of Medicine at University of Pennsylvania Health in Philadelphia, wonders how good any systems can be with the privacy concerns related to HIPAA.

This was the nexus of IT and HM17, a time when hospitalists said they are stymied and frustrated by continuing issues of interoperability, functionality, and access. The meeting highlighted new smartphone and tablet applications, as well as medical devices available to hospitalists, but tech-focused physicians say the biggest issue remains the day-to-day workings of EMR.

“If you build something really good, people will use it. If you build something that makes their documentation process a lot easier and a lot faster and a lot better, they’ll use it,” said Dr. Schaefer. “The tools aren’t there yet. I don’t think the technology is mature enough.”

If the tech hasn’t yet come of full age, the concerns surely have. SHM unveiled a white paper at HM17 that codified hospitalists’ worries about the current state of IT. The report, “Hospitalist Perspectives on Electronic Medical Records,” found that “a staggering” 85% of providers said they spend more time interacting with their inpatient EMR than their actual inpatients.

Rupesh Prasad, MD, MPH, SFHM, chair of SHM’s Health IT Committee, says the report is meant to foster discussion about the issues surrounding EMRs. The data points, generated from 462 respondents, are stark. Just 40% said they were happy with their EMR. Some 52% would change vendors if they could. One-quarter of respondents would revert to using paper if given the option.

“By sharing these results, we hope to raise awareness of the unacceptable performance of existing systems,” the report states. “This continues to contribute to our slower than desired improvement in quality and safety, as well as increasing provider frustration. We strongly believe that we need a renewed focus on initial goals of technology adoption in health care.”

Dr. Prasad said that he hopes hospitalists heed that call to action and use the report in discussions with various stakeholders, including vendors, public policy officials, and their own bosses.

“We want to give hospitalists ammunition to go back to their systems and talk to their administrators to see if they can influence [it],” he said.

Dr. Prasad is pleased that the society is sensitive to the issues surrounding technology. He encourages hospitalists to actively participate in HMX, SHM’s online portal to discuss health IT issues and crowd-source potential solutions. Patrick Vulgamore, MPH, SHM’s director of governance and practice management, said the society is formulating a potential special-interest working group to further seek to solve problems.

Hospitalists were also urged to apply for American Board of Medical Specialties (ABMS) certification in clinical informatics. Physicians can grandfather into eligibility via the “practice pathway” through the end of the year, if they’ve been working in informatics professionally for at least 25% of their time during any three of the previous five years. Next year, only graduates of two-year Accreditation Council for Graduate Medical Education–accredited fellowships will be board eligible.

“As end users of technology, we understand the problems better than anybody else,” Dr. Prasad said. “Obviously, the next step would be try to solve the problems. And what better way then to get involved and become experts in what you do?”

While much of the meeting’s tech talk was frustration, both former National Coordinator for Health IT Karen DeSalvo, MD, MPH, MSc, and HM Dean Robert Wachter, MD, MHM, forecast a future when artificial intelligence and intuitive computers work alongside physicians. Imagine the user-friendliness of Apple’s Siri or Google’s Alexa married to the existing functionalities provided by firms such as Epic or Cerner.

But that’s years away, and hospitalists like Dr. Dimitriou want help now.

“The speed of medicine, the speed of what’s happening in real time, is still faster than what our electronic tools seem to be able to keep up with,” he said. “There are encouraging signs that we’ve definitely moved in the right direction. We’ve come a long way ... but again, the speed at which things are moving? We aren’t keeping up. We’ve got to do more.”

LAS VEGAS – Ronald Schaefer, MD, a hospitalist with Hawaii Pacific Health who also works on creating digital templates for his hospital, can’t input hemoglobin A1c levels from three different labs into his electronic medical records (EMR) system the same way.

Hospitalist George Dimitriou, MD, FHM, who splits his time at Allegheny Health Network in Pittsburgh between clinical work and medical informatics, worries there are so many fields in his EMR that physicians can get distracted.

Yevgeniy “Eugene” Gitelman, MD, a clinical informatics manager at the Perelman School of Medicine at University of Pennsylvania Health in Philadelphia, wonders how good any systems can be with the privacy concerns related to HIPAA.

This was the nexus of IT and HM17, a time when hospitalists said they are stymied and frustrated by continuing issues of interoperability, functionality, and access. The meeting highlighted new smartphone and tablet applications, as well as medical devices available to hospitalists, but tech-focused physicians say the biggest issue remains the day-to-day workings of EMR.

“If you build something really good, people will use it. If you build something that makes their documentation process a lot easier and a lot faster and a lot better, they’ll use it,” said Dr. Schaefer. “The tools aren’t there yet. I don’t think the technology is mature enough.”

If the tech hasn’t yet come of full age, the concerns surely have. SHM unveiled a white paper at HM17 that codified hospitalists’ worries about the current state of IT. The report, “Hospitalist Perspectives on Electronic Medical Records,” found that “a staggering” 85% of providers said they spend more time interacting with their inpatient EMR than their actual inpatients.

Rupesh Prasad, MD, MPH, SFHM, chair of SHM’s Health IT Committee, says the report is meant to foster discussion about the issues surrounding EMRs. The data points, generated from 462 respondents, are stark. Just 40% said they were happy with their EMR. Some 52% would change vendors if they could. One-quarter of respondents would revert to using paper if given the option.

“By sharing these results, we hope to raise awareness of the unacceptable performance of existing systems,” the report states. “This continues to contribute to our slower than desired improvement in quality and safety, as well as increasing provider frustration. We strongly believe that we need a renewed focus on initial goals of technology adoption in health care.”

Dr. Prasad said that he hopes hospitalists heed that call to action and use the report in discussions with various stakeholders, including vendors, public policy officials, and their own bosses.

“We want to give hospitalists ammunition to go back to their systems and talk to their administrators to see if they can influence [it],” he said.

Dr. Prasad is pleased that the society is sensitive to the issues surrounding technology. He encourages hospitalists to actively participate in HMX, SHM’s online portal to discuss health IT issues and crowd-source potential solutions. Patrick Vulgamore, MPH, SHM’s director of governance and practice management, said the society is formulating a potential special-interest working group to further seek to solve problems.

Hospitalists were also urged to apply for American Board of Medical Specialties (ABMS) certification in clinical informatics. Physicians can grandfather into eligibility via the “practice pathway” through the end of the year, if they’ve been working in informatics professionally for at least 25% of their time during any three of the previous five years. Next year, only graduates of two-year Accreditation Council for Graduate Medical Education–accredited fellowships will be board eligible.

“As end users of technology, we understand the problems better than anybody else,” Dr. Prasad said. “Obviously, the next step would be try to solve the problems. And what better way then to get involved and become experts in what you do?”

While much of the meeting’s tech talk was frustration, both former National Coordinator for Health IT Karen DeSalvo, MD, MPH, MSc, and HM Dean Robert Wachter, MD, MHM, forecast a future when artificial intelligence and intuitive computers work alongside physicians. Imagine the user-friendliness of Apple’s Siri or Google’s Alexa married to the existing functionalities provided by firms such as Epic or Cerner.

But that’s years away, and hospitalists like Dr. Dimitriou want help now.

“The speed of medicine, the speed of what’s happening in real time, is still faster than what our electronic tools seem to be able to keep up with,” he said. “There are encouraging signs that we’ve definitely moved in the right direction. We’ve come a long way ... but again, the speed at which things are moving? We aren’t keeping up. We’ve got to do more.”

LAS VEGAS – Ronald Schaefer, MD, a hospitalist with Hawaii Pacific Health who also works on creating digital templates for his hospital, can’t input hemoglobin A1c levels from three different labs into his electronic medical records (EMR) system the same way.

Hospitalist George Dimitriou, MD, FHM, who splits his time at Allegheny Health Network in Pittsburgh between clinical work and medical informatics, worries there are so many fields in his EMR that physicians can get distracted.

Yevgeniy “Eugene” Gitelman, MD, a clinical informatics manager at the Perelman School of Medicine at University of Pennsylvania Health in Philadelphia, wonders how good any systems can be with the privacy concerns related to HIPAA.

This was the nexus of IT and HM17, a time when hospitalists said they are stymied and frustrated by continuing issues of interoperability, functionality, and access. The meeting highlighted new smartphone and tablet applications, as well as medical devices available to hospitalists, but tech-focused physicians say the biggest issue remains the day-to-day workings of EMR.

“If you build something really good, people will use it. If you build something that makes their documentation process a lot easier and a lot faster and a lot better, they’ll use it,” said Dr. Schaefer. “The tools aren’t there yet. I don’t think the technology is mature enough.”

If the tech hasn’t yet come of full age, the concerns surely have. SHM unveiled a white paper at HM17 that codified hospitalists’ worries about the current state of IT. The report, “Hospitalist Perspectives on Electronic Medical Records,” found that “a staggering” 85% of providers said they spend more time interacting with their inpatient EMR than their actual inpatients.

Rupesh Prasad, MD, MPH, SFHM, chair of SHM’s Health IT Committee, says the report is meant to foster discussion about the issues surrounding EMRs. The data points, generated from 462 respondents, are stark. Just 40% said they were happy with their EMR. Some 52% would change vendors if they could. One-quarter of respondents would revert to using paper if given the option.

“By sharing these results, we hope to raise awareness of the unacceptable performance of existing systems,” the report states. “This continues to contribute to our slower than desired improvement in quality and safety, as well as increasing provider frustration. We strongly believe that we need a renewed focus on initial goals of technology adoption in health care.”

Dr. Prasad said that he hopes hospitalists heed that call to action and use the report in discussions with various stakeholders, including vendors, public policy officials, and their own bosses.

“We want to give hospitalists ammunition to go back to their systems and talk to their administrators to see if they can influence [it],” he said.

Dr. Prasad is pleased that the society is sensitive to the issues surrounding technology. He encourages hospitalists to actively participate in HMX, SHM’s online portal to discuss health IT issues and crowd-source potential solutions. Patrick Vulgamore, MPH, SHM’s director of governance and practice management, said the society is formulating a potential special-interest working group to further seek to solve problems.

Hospitalists were also urged to apply for American Board of Medical Specialties (ABMS) certification in clinical informatics. Physicians can grandfather into eligibility via the “practice pathway” through the end of the year, if they’ve been working in informatics professionally for at least 25% of their time during any three of the previous five years. Next year, only graduates of two-year Accreditation Council for Graduate Medical Education–accredited fellowships will be board eligible.

“As end users of technology, we understand the problems better than anybody else,” Dr. Prasad said. “Obviously, the next step would be try to solve the problems. And what better way then to get involved and become experts in what you do?”

While much of the meeting’s tech talk was frustration, both former National Coordinator for Health IT Karen DeSalvo, MD, MPH, MSc, and HM Dean Robert Wachter, MD, MHM, forecast a future when artificial intelligence and intuitive computers work alongside physicians. Imagine the user-friendliness of Apple’s Siri or Google’s Alexa married to the existing functionalities provided by firms such as Epic or Cerner.

But that’s years away, and hospitalists like Dr. Dimitriou want help now.

“The speed of medicine, the speed of what’s happening in real time, is still faster than what our electronic tools seem to be able to keep up with,” he said. “There are encouraging signs that we’ve definitely moved in the right direction. We’ve come a long way ... but again, the speed at which things are moving? We aren’t keeping up. We’ve got to do more.”