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Cheryl DeVita, senior search consultant at Cejka Search, Inc., in St. Louis, Mo., offers advice on evaluating contracts and hospitalist groups.

Cheryl DeVita, senior search consultant at Cejka Search, Inc., in St. Louis, Mo., offers advice on evaluating contracts and hospitalist groups.

Cheryl DeVita, senior search consultant at Cejka Search, Inc., in St. Louis, Mo., offers advice on evaluating contracts and hospitalist groups.

ROBERT COBEN, MD, Program director of the gastroenterology fellowship program at Thomas Jefferson University Hospital in Philadelphia, discusses GI bleeds and colon cancer.

ROBERT COBEN, MD, Program director of the gastroenterology fellowship program at Thomas Jefferson University Hospital in Philadelphia, discusses GI bleeds and colon cancer.

ROBERT COBEN, MD, Program director of the gastroenterology fellowship program at Thomas Jefferson University Hospital in Philadelphia, discusses GI bleeds and colon cancer.

(Reuters Health) - Not all U.S. stroke patients eligible for thrombolytic therapy actually receive it - and the odds of getting this therapy may depend on where they live, a large study finds.

Dr. James Burke of the University of Michigan and the VA Ann Arbor Health System and colleagues examined 844,241 hospital admissions for ischemic stroke from 2007 to 2010 among U.S. patients insured by Medicare.

They sorted patients into 3,436 different hospital service areas based on home postal code to assess regional variation in thrombolysis treatment rates.

Patients were 78 years old on average. About 57% were women, and most were white. The majority had hypertension and many also had diabetes, high cholesterol or arrhythmia.

Overall, just 3.9% of these patients received thrombolysis, the researchers report online June 2 in the journal Stroke. The treatment wasn't given at all in 20% of regions, and it was more likely to occur in places with higher population density.

In the 20 regions with the highest rates of thrombolysis, roughly 10% to 14% of patients received the treatment.

After accounting for the number of strokes in each region, the proportion of patients receiving thrombolysis ranged from 2.2% in the bottom fifth of regions to 5.9% in the top fifth.

Older patients, women and minorities were less likely to receive the treatment. Regions with the lowest proportion of college graduates also had a smaller percentage of people treated with thrombolysis.

Not every patient with stroke should receive thrombolysis. One study in Cincinnati estimated that about 6% of stroke patients would be eligible, but the new findings of higher rates in the highest-performing regions suggest that more patients could benefit if they could be transported more quickly to hospitals where thrombolysis is available, the authors say.

By boosting use of the treatment in regions where it's least likely to happen up to the level in places where the therapy is most common, researchers estimated that an additional 92,847 stroke patients might get thrombolysis, averting disability for 8,078 of them.

"Prompt recognition and reaction to warning signs and effective emergency service systems can minimize delays in pre-hospital dispatch, assessment and transport, and ultimately increase the number of stroke patients reaching the hospital and being prepared for thrombolytic therapy within the 4.5-hour time window," Dr. Maurizio Paciaroni, a stroke specialist at the University of Perugia in Italy who wasn't involved in the study, said by email.

"For a variety of reasons, only a minority of patients get to the hospital within the first couple hours of a stroke," Burke said by email. Patients might not recognize symptoms or call 911 soon enough, and even when they do seek help quickly they might not end up at a hospital that's equipped to provide thrombolysis, he added.

The best outcomes are for patients who receive thrombolysis within the first hour after the blood vessel becomes blocked, said Dr. Brian Silver, director of the Comprehensive Stroke Center at Rhode Island Hospital and researcher at Brown University.

"When patients don't receive this treatment, they are up to 50% less likely to have a better outcome," Silver, who wasn't involved with the study, said by email. "This means, for some, residual speech difficulties, paralysis, vision loss, cognitive impairment and depression."

Globally, 15 million people suffer strokes each year; five million of them die and another five million are left permanently disabled, according to the World Health Organization.

(Reuters Health) - Not all U.S. stroke patients eligible for thrombolytic therapy actually receive it - and the odds of getting this therapy may depend on where they live, a large study finds.

Dr. James Burke of the University of Michigan and the VA Ann Arbor Health System and colleagues examined 844,241 hospital admissions for ischemic stroke from 2007 to 2010 among U.S. patients insured by Medicare.

They sorted patients into 3,436 different hospital service areas based on home postal code to assess regional variation in thrombolysis treatment rates.

Patients were 78 years old on average. About 57% were women, and most were white. The majority had hypertension and many also had diabetes, high cholesterol or arrhythmia.

Overall, just 3.9% of these patients received thrombolysis, the researchers report online June 2 in the journal Stroke. The treatment wasn't given at all in 20% of regions, and it was more likely to occur in places with higher population density.

In the 20 regions with the highest rates of thrombolysis, roughly 10% to 14% of patients received the treatment.

After accounting for the number of strokes in each region, the proportion of patients receiving thrombolysis ranged from 2.2% in the bottom fifth of regions to 5.9% in the top fifth.

Older patients, women and minorities were less likely to receive the treatment. Regions with the lowest proportion of college graduates also had a smaller percentage of people treated with thrombolysis.

Not every patient with stroke should receive thrombolysis. One study in Cincinnati estimated that about 6% of stroke patients would be eligible, but the new findings of higher rates in the highest-performing regions suggest that more patients could benefit if they could be transported more quickly to hospitals where thrombolysis is available, the authors say.

By boosting use of the treatment in regions where it's least likely to happen up to the level in places where the therapy is most common, researchers estimated that an additional 92,847 stroke patients might get thrombolysis, averting disability for 8,078 of them.

"Prompt recognition and reaction to warning signs and effective emergency service systems can minimize delays in pre-hospital dispatch, assessment and transport, and ultimately increase the number of stroke patients reaching the hospital and being prepared for thrombolytic therapy within the 4.5-hour time window," Dr. Maurizio Paciaroni, a stroke specialist at the University of Perugia in Italy who wasn't involved in the study, said by email.

"For a variety of reasons, only a minority of patients get to the hospital within the first couple hours of a stroke," Burke said by email. Patients might not recognize symptoms or call 911 soon enough, and even when they do seek help quickly they might not end up at a hospital that's equipped to provide thrombolysis, he added.

The best outcomes are for patients who receive thrombolysis within the first hour after the blood vessel becomes blocked, said Dr. Brian Silver, director of the Comprehensive Stroke Center at Rhode Island Hospital and researcher at Brown University.

"When patients don't receive this treatment, they are up to 50% less likely to have a better outcome," Silver, who wasn't involved with the study, said by email. "This means, for some, residual speech difficulties, paralysis, vision loss, cognitive impairment and depression."

Globally, 15 million people suffer strokes each year; five million of them die and another five million are left permanently disabled, according to the World Health Organization.

(Reuters Health) - Not all U.S. stroke patients eligible for thrombolytic therapy actually receive it - and the odds of getting this therapy may depend on where they live, a large study finds.

Dr. James Burke of the University of Michigan and the VA Ann Arbor Health System and colleagues examined 844,241 hospital admissions for ischemic stroke from 2007 to 2010 among U.S. patients insured by Medicare.

They sorted patients into 3,436 different hospital service areas based on home postal code to assess regional variation in thrombolysis treatment rates.

Patients were 78 years old on average. About 57% were women, and most were white. The majority had hypertension and many also had diabetes, high cholesterol or arrhythmia.

Overall, just 3.9% of these patients received thrombolysis, the researchers report online June 2 in the journal Stroke. The treatment wasn't given at all in 20% of regions, and it was more likely to occur in places with higher population density.

In the 20 regions with the highest rates of thrombolysis, roughly 10% to 14% of patients received the treatment.

After accounting for the number of strokes in each region, the proportion of patients receiving thrombolysis ranged from 2.2% in the bottom fifth of regions to 5.9% in the top fifth.

Older patients, women and minorities were less likely to receive the treatment. Regions with the lowest proportion of college graduates also had a smaller percentage of people treated with thrombolysis.

Not every patient with stroke should receive thrombolysis. One study in Cincinnati estimated that about 6% of stroke patients would be eligible, but the new findings of higher rates in the highest-performing regions suggest that more patients could benefit if they could be transported more quickly to hospitals where thrombolysis is available, the authors say.

By boosting use of the treatment in regions where it's least likely to happen up to the level in places where the therapy is most common, researchers estimated that an additional 92,847 stroke patients might get thrombolysis, averting disability for 8,078 of them.

"Prompt recognition and reaction to warning signs and effective emergency service systems can minimize delays in pre-hospital dispatch, assessment and transport, and ultimately increase the number of stroke patients reaching the hospital and being prepared for thrombolytic therapy within the 4.5-hour time window," Dr. Maurizio Paciaroni, a stroke specialist at the University of Perugia in Italy who wasn't involved in the study, said by email.

"For a variety of reasons, only a minority of patients get to the hospital within the first couple hours of a stroke," Burke said by email. Patients might not recognize symptoms or call 911 soon enough, and even when they do seek help quickly they might not end up at a hospital that's equipped to provide thrombolysis, he added.

The best outcomes are for patients who receive thrombolysis within the first hour after the blood vessel becomes blocked, said Dr. Brian Silver, director of the Comprehensive Stroke Center at Rhode Island Hospital and researcher at Brown University.

"When patients don't receive this treatment, they are up to 50% less likely to have a better outcome," Silver, who wasn't involved with the study, said by email. "This means, for some, residual speech difficulties, paralysis, vision loss, cognitive impairment and depression."

Globally, 15 million people suffer strokes each year; five million of them die and another five million are left permanently disabled, according to the World Health Organization.

John Pandolfino, MD, chief of gastroenterology and hepatology at Northwestern University’s Feinberg School of Medicine in Chicago, talks about best practices for colonoscopies and treating C. diff infections.

John Pandolfino, MD, chief of gastroenterology and hepatology at Northwestern University’s Feinberg School of Medicine in Chicago, talks about best practices for colonoscopies and treating C. diff infections.

John Pandolfino, MD, chief of gastroenterology and hepatology at Northwestern University’s Feinberg School of Medicine in Chicago, talks about best practices for colonoscopies and treating C. diff infections.

Excerpt of our interviews with Choosing Wisely, Lisa Shieh, MD, PhD, of Stanford University School of Medicine, discusses an example of a Choosing Wisely program.

Excerpt of our interviews with Choosing Wisely, Lisa Shieh, MD, PhD, of Stanford University School of Medicine, discusses an example of a Choosing Wisely program.

Excerpt of our interviews with Choosing Wisely, Lisa Shieh, MD, PhD, of Stanford University School of Medicine, discusses an example of a Choosing Wisely program.

Gregory Seymann, MD, discusses a Choosing Wisely program.

Gregory Seymann, MD, discusses a Choosing Wisely program.

Gregory Seymann, MD, discusses a Choosing Wisely program.

Clinical question: Can novel configured rapid response teams (RRTs) improve non-ICU cardiopulmonary arrest (CPA) and overall hospital mortality rate?

Background: RRTs are primarily executed in hospital settings to avert non-ICU CPA through early detection and intervention. Prevailing evidence has not shown consistent clear benefit of RRTs in this regard.

Study design: A parallel-controlled, before-after design.

Setting: Two urban university hospitals with approximately 500 medical/surgical beds.

Synopsis: Researchers compared annual non-ICU CPA rates from two university hospitals with newly configured RRTs (implemented in November 2007) from July 2005 through June 2011 and found a decline in the incidence of non-ICU CPA to 1.1 from 2.7 per 1000 discharges (P<0.0001) while comparing pre- (2005/2006 to 2006/2007) to post- RRT implementation (2007-2011), respectively. Post-implementation, the overall hospital mortality dropped to 1.74% from 2.12% (P<0.001). With year-over-year, the RRT activation was found to be inversely related to Code Blue activations (r=-0.68, P<0.001), while the case mix index coefficients were still high.

The study lacks internal validation and may carry bias by including just one pre-implementation year (2006) data. It demonstrates that the rounding of unit manager (charge nurse) on “at risk” patients might avert decompensation; however, there was no determination of their decision-making process, with regard to RRT activation. No comparison was done with other RRT configurations.

Bottom line: Novel configured RRTs may improve non-ICU CPA and overall hospital mortality rate.

Citation: Davis DP, Aguilar SA, Graham PG, et al. A novel configuration of a traditional rapid response team decreases non-intensive care unit arrests and overall hospital mortality. J Hosp Med. 2015;10(6):352-357.

Clinical question: Can novel configured rapid response teams (RRTs) improve non-ICU cardiopulmonary arrest (CPA) and overall hospital mortality rate?

Background: RRTs are primarily executed in hospital settings to avert non-ICU CPA through early detection and intervention. Prevailing evidence has not shown consistent clear benefit of RRTs in this regard.

Study design: A parallel-controlled, before-after design.

Setting: Two urban university hospitals with approximately 500 medical/surgical beds.

Synopsis: Researchers compared annual non-ICU CPA rates from two university hospitals with newly configured RRTs (implemented in November 2007) from July 2005 through June 2011 and found a decline in the incidence of non-ICU CPA to 1.1 from 2.7 per 1000 discharges (P<0.0001) while comparing pre- (2005/2006 to 2006/2007) to post- RRT implementation (2007-2011), respectively. Post-implementation, the overall hospital mortality dropped to 1.74% from 2.12% (P<0.001). With year-over-year, the RRT activation was found to be inversely related to Code Blue activations (r=-0.68, P<0.001), while the case mix index coefficients were still high.

The study lacks internal validation and may carry bias by including just one pre-implementation year (2006) data. It demonstrates that the rounding of unit manager (charge nurse) on “at risk” patients might avert decompensation; however, there was no determination of their decision-making process, with regard to RRT activation. No comparison was done with other RRT configurations.

Bottom line: Novel configured RRTs may improve non-ICU CPA and overall hospital mortality rate.

Citation: Davis DP, Aguilar SA, Graham PG, et al. A novel configuration of a traditional rapid response team decreases non-intensive care unit arrests and overall hospital mortality. J Hosp Med. 2015;10(6):352-357.

Clinical question: Can novel configured rapid response teams (RRTs) improve non-ICU cardiopulmonary arrest (CPA) and overall hospital mortality rate?

Background: RRTs are primarily executed in hospital settings to avert non-ICU CPA through early detection and intervention. Prevailing evidence has not shown consistent clear benefit of RRTs in this regard.

Study design: A parallel-controlled, before-after design.

Setting: Two urban university hospitals with approximately 500 medical/surgical beds.

Synopsis: Researchers compared annual non-ICU CPA rates from two university hospitals with newly configured RRTs (implemented in November 2007) from July 2005 through June 2011 and found a decline in the incidence of non-ICU CPA to 1.1 from 2.7 per 1000 discharges (P<0.0001) while comparing pre- (2005/2006 to 2006/2007) to post- RRT implementation (2007-2011), respectively. Post-implementation, the overall hospital mortality dropped to 1.74% from 2.12% (P<0.001). With year-over-year, the RRT activation was found to be inversely related to Code Blue activations (r=-0.68, P<0.001), while the case mix index coefficients were still high.

The study lacks internal validation and may carry bias by including just one pre-implementation year (2006) data. It demonstrates that the rounding of unit manager (charge nurse) on “at risk” patients might avert decompensation; however, there was no determination of their decision-making process, with regard to RRT activation. No comparison was done with other RRT configurations.

Bottom line: Novel configured RRTs may improve non-ICU CPA and overall hospital mortality rate.

Citation: Davis DP, Aguilar SA, Graham PG, et al. A novel configuration of a traditional rapid response team decreases non-intensive care unit arrests and overall hospital mortality. J Hosp Med. 2015;10(6):352-357.

In this month's issue, our cover stories relay 11 things gastroenterologists think hospitalists should know about patients with gastroenterology disorders, and explore the intersection of post-acute care and hospital medicine. Elsewhere in this issue, we include tips for Choosing Wisely in HM, look at the hospitalist job search, and cover the latest in HM clinical literature.

[audio mp3="http://www.the-hospitalist.org/wp-content/uploads/2015/07/2015-July-Hospitalist-Highlights1.mp3"][/audio]

In this month's issue, our cover stories relay 11 things gastroenterologists think hospitalists should know about patients with gastroenterology disorders, and explore the intersection of post-acute care and hospital medicine. Elsewhere in this issue, we include tips for Choosing Wisely in HM, look at the hospitalist job search, and cover the latest in HM clinical literature.

[audio mp3="http://www.the-hospitalist.org/wp-content/uploads/2015/07/2015-July-Hospitalist-Highlights1.mp3"][/audio]

In this month's issue, our cover stories relay 11 things gastroenterologists think hospitalists should know about patients with gastroenterology disorders, and explore the intersection of post-acute care and hospital medicine. Elsewhere in this issue, we include tips for Choosing Wisely in HM, look at the hospitalist job search, and cover the latest in HM clinical literature.

[audio mp3="http://www.the-hospitalist.org/wp-content/uploads/2015/07/2015-July-Hospitalist-Highlights1.mp3"][/audio]

Clinical informatics has been growing significantly in this age of precision medicine, healthcare reform, and population health. Over the last decade, there have been great efforts focused on implementation and integration of electronic health records (EHRs). With the explosive use of mobile technologies, doctors can engage, educate, and empower their patients in ways that have never before been possible. An interconnected digital healthcare data network is slowly but steadily taking shape. We will eventually reach a new era in which clinicians can harness the power of information technology (IT) to receive, report, and analyze healthcare data in order to predict and prevent adverse health outcomes for individuals and populations.

However, there is still much left to be done—the current state of EHRs is not delivering its full potential. In fact, many providers would argue that EHRs have taken us steps backward in our quest to achieve higher efficiency, safety, and quality. As members of the Society of Hospital Medicine (SHM) IT Committee, we have heard the frustration of hospitalists at each of our IT interest group meetings and other forums. This frustration does not come from resistance to adopt or accept technology, but arises from the gap between where we currently are with health IT and where each of us knows we could and should be. For us to attain the full potential of health IT, providers with a clinical perspective must engage and lead in this area. We believe hospitalists are uniquely qualified and positioned to provide such leadership.

Understanding the great demand for specialized physician informatics experts, the American Board of Medical Specialties (ABMS) approved clinical informatics as a board-eligible subspecialty in 2011, and the first board exam was offered in October 2013. The board certification recognizes both the vital role of practicing informatics in healthcare and the sophisticated knowledge and skills it requires. Appropriately, the exam assesses not only knowledge of informatics, but also quality, safety, leadership, and change management. There is a narrow window of opportunity for hospitalists who are currently involved in health IT to become certified in clinical informatics during a grandfather period. Physicians can grandfather into board eligibility via the “practice pathway” through 2017 if they have been working in informatics professionally for at least 25% of their time during any three of the previous five years. Starting in 2018, only graduates of two-year Accreditation Council for Graduate Medical Education (ACGME)-accredited fellowships will be board eligible.

Hospitalists, given their broad understanding of hospital operations, their firsthand end-user experience of EHRs, the high percentage that come from the tech-savvy generation, and their flexible working schedule, are well-positioned to become physician leaders in this field. Recognizing the high value of these skills in hospitalists, the SHM IT Committee has made encouraging SHM members to become board certified in clinical informatics one of its priorities. In fact, we believe that hospital medicine could have more clinical informatics board-certified physicians than any other specialty. If you have been contributing to health IT projects over the last few years, you may already be qualified to sit for the board exam of clinical informatics.

Currently, there are fewer than 800 physicians board certified in clinical informatics, and there has been a high pass rate of about 90% for the board certification exam. We encourage every board-eligible hospitalist who has been practicing informatics to apply for the board exam. For more information, you may refer to the webpage created by the SHM IT committee and seek advice from SHM IT committee members from the HMX IT community forum.^1,2 The future potential of health IT is simply beyond imagination, and hospitalists can, and should, be the major driving force.

Cheng-Kai Kao, MD, assistant professor of medicine, medical director of informatics, University of Chicago

Kendall Rogers, MD, SFHM, associate professor of medicine, chief, division of hospital medicine, University of New Mexico

References

1. Society of Hospital Medicine. Are you a hospitalist frustrated with health IT? Become part of the solution. Accessed June 7, 2015.
2. Society of Hospital Medicine. HMX Healthcare Information Technology community forum. Accessed June 7, 2015.

Clinical informatics has been growing significantly in this age of precision medicine, healthcare reform, and population health. Over the last decade, there have been great efforts focused on implementation and integration of electronic health records (EHRs). With the explosive use of mobile technologies, doctors can engage, educate, and empower their patients in ways that have never before been possible. An interconnected digital healthcare data network is slowly but steadily taking shape. We will eventually reach a new era in which clinicians can harness the power of information technology (IT) to receive, report, and analyze healthcare data in order to predict and prevent adverse health outcomes for individuals and populations.

However, there is still much left to be done—the current state of EHRs is not delivering its full potential. In fact, many providers would argue that EHRs have taken us steps backward in our quest to achieve higher efficiency, safety, and quality. As members of the Society of Hospital Medicine (SHM) IT Committee, we have heard the frustration of hospitalists at each of our IT interest group meetings and other forums. This frustration does not come from resistance to adopt or accept technology, but arises from the gap between where we currently are with health IT and where each of us knows we could and should be. For us to attain the full potential of health IT, providers with a clinical perspective must engage and lead in this area. We believe hospitalists are uniquely qualified and positioned to provide such leadership.

Understanding the great demand for specialized physician informatics experts, the American Board of Medical Specialties (ABMS) approved clinical informatics as a board-eligible subspecialty in 2011, and the first board exam was offered in October 2013. The board certification recognizes both the vital role of practicing informatics in healthcare and the sophisticated knowledge and skills it requires. Appropriately, the exam assesses not only knowledge of informatics, but also quality, safety, leadership, and change management. There is a narrow window of opportunity for hospitalists who are currently involved in health IT to become certified in clinical informatics during a grandfather period. Physicians can grandfather into board eligibility via the “practice pathway” through 2017 if they have been working in informatics professionally for at least 25% of their time during any three of the previous five years. Starting in 2018, only graduates of two-year Accreditation Council for Graduate Medical Education (ACGME)-accredited fellowships will be board eligible.

Hospitalists, given their broad understanding of hospital operations, their firsthand end-user experience of EHRs, the high percentage that come from the tech-savvy generation, and their flexible working schedule, are well-positioned to become physician leaders in this field. Recognizing the high value of these skills in hospitalists, the SHM IT Committee has made encouraging SHM members to become board certified in clinical informatics one of its priorities. In fact, we believe that hospital medicine could have more clinical informatics board-certified physicians than any other specialty. If you have been contributing to health IT projects over the last few years, you may already be qualified to sit for the board exam of clinical informatics.

Currently, there are fewer than 800 physicians board certified in clinical informatics, and there has been a high pass rate of about 90% for the board certification exam. We encourage every board-eligible hospitalist who has been practicing informatics to apply for the board exam. For more information, you may refer to the webpage created by the SHM IT committee and seek advice from SHM IT committee members from the HMX IT community forum.^1,2 The future potential of health IT is simply beyond imagination, and hospitalists can, and should, be the major driving force.

Cheng-Kai Kao, MD, assistant professor of medicine, medical director of informatics, University of Chicago

Kendall Rogers, MD, SFHM, associate professor of medicine, chief, division of hospital medicine, University of New Mexico

References

1. Society of Hospital Medicine. Are you a hospitalist frustrated with health IT? Become part of the solution. Accessed June 7, 2015.
2. Society of Hospital Medicine. HMX Healthcare Information Technology community forum. Accessed June 7, 2015.

Clinical informatics has been growing significantly in this age of precision medicine, healthcare reform, and population health. Over the last decade, there have been great efforts focused on implementation and integration of electronic health records (EHRs). With the explosive use of mobile technologies, doctors can engage, educate, and empower their patients in ways that have never before been possible. An interconnected digital healthcare data network is slowly but steadily taking shape. We will eventually reach a new era in which clinicians can harness the power of information technology (IT) to receive, report, and analyze healthcare data in order to predict and prevent adverse health outcomes for individuals and populations.

However, there is still much left to be done—the current state of EHRs is not delivering its full potential. In fact, many providers would argue that EHRs have taken us steps backward in our quest to achieve higher efficiency, safety, and quality. As members of the Society of Hospital Medicine (SHM) IT Committee, we have heard the frustration of hospitalists at each of our IT interest group meetings and other forums. This frustration does not come from resistance to adopt or accept technology, but arises from the gap between where we currently are with health IT and where each of us knows we could and should be. For us to attain the full potential of health IT, providers with a clinical perspective must engage and lead in this area. We believe hospitalists are uniquely qualified and positioned to provide such leadership.

Understanding the great demand for specialized physician informatics experts, the American Board of Medical Specialties (ABMS) approved clinical informatics as a board-eligible subspecialty in 2011, and the first board exam was offered in October 2013. The board certification recognizes both the vital role of practicing informatics in healthcare and the sophisticated knowledge and skills it requires. Appropriately, the exam assesses not only knowledge of informatics, but also quality, safety, leadership, and change management. There is a narrow window of opportunity for hospitalists who are currently involved in health IT to become certified in clinical informatics during a grandfather period. Physicians can grandfather into board eligibility via the “practice pathway” through 2017 if they have been working in informatics professionally for at least 25% of their time during any three of the previous five years. Starting in 2018, only graduates of two-year Accreditation Council for Graduate Medical Education (ACGME)-accredited fellowships will be board eligible.

Hospitalists, given their broad understanding of hospital operations, their firsthand end-user experience of EHRs, the high percentage that come from the tech-savvy generation, and their flexible working schedule, are well-positioned to become physician leaders in this field. Recognizing the high value of these skills in hospitalists, the SHM IT Committee has made encouraging SHM members to become board certified in clinical informatics one of its priorities. In fact, we believe that hospital medicine could have more clinical informatics board-certified physicians than any other specialty. If you have been contributing to health IT projects over the last few years, you may already be qualified to sit for the board exam of clinical informatics.

Currently, there are fewer than 800 physicians board certified in clinical informatics, and there has been a high pass rate of about 90% for the board certification exam. We encourage every board-eligible hospitalist who has been practicing informatics to apply for the board exam. For more information, you may refer to the webpage created by the SHM IT committee and seek advice from SHM IT committee members from the HMX IT community forum.^1,2 The future potential of health IT is simply beyond imagination, and hospitalists can, and should, be the major driving force.

Cheng-Kai Kao, MD, assistant professor of medicine, medical director of informatics, University of Chicago

Kendall Rogers, MD, SFHM, associate professor of medicine, chief, division of hospital medicine, University of New Mexico

References

1. Society of Hospital Medicine. Are you a hospitalist frustrated with health IT? Become part of the solution. Accessed June 7, 2015.
2. Society of Hospital Medicine. HMX Healthcare Information Technology community forum. Accessed June 7, 2015.

Editor’s note: First in a two-part series on hospitalists as expert witnesses.

Recently, you have found yourself pondering whether you want to be an expert witness for the prosecution on behalf of one of your patients or for the defense on behalf of one of your fellow colleagues. You enjoy tackling confrontational questions head on, are intellectually curious, and are articulate both orally and in writing. You like to look at complex fact patterns and simplify them, and “Law and Order” is your favorite television show. But, seriously, are you ready to be an expert witness?

The expert witness plays an essential role in determining medical negligence under the United States system of jurisprudence. Generally, expert witnesses are asked to testify regarding the standards of care relevant to the given case, identify any deviations from those standards, and render an opinion as to whether those breaches are the most likely cause of the injury. Without the expert’s explanation of the range of acceptable treatments within the standard of care and interpretation of medical facts, juries would not have the technical expertise needed to determine whether or not malpractice occurred.

This article, the first in a two-part series on hospitalists as expert witnesses, addresses the nuts and bolts of serving as an expert witness, including the role of the expert witness, time commitments, compensation, privacy or lack thereof, and the ever-present internal struggle about whether or not to choose to participate actively in our legal system.

Hospitalists who have developed a niche in a small area of expertise in which they can dominate a certain market, or those who have developed a national reputation, can charge a significant amount of money depending on their area of expertise.

The Role of the Expert Witness

First, let’s take a small step back, as the hospitalist’s role as an expert witness is largely dependent on how the expert witness is going to be used by the attorney. An expert witness is someone who has been qualified as an authority to assist others—namely, the attorneys, judge, and jury—in understanding complicated technical subjects that are beyond the understanding of the average lay person.

Thus, attorneys retain expert witnesses for a whole host of reasons, including:

• Evaluating their client’s claim initially to determine if the patient has a valid claim;
• Writing an expert report to be used for settlement, mediation, arbitration, or as an exhibit to a motion for summary judgment;
• Consulting with the attorney in order to form an opinion in the case, which will be used to shape the prosecution or defense, including in a response to the complaint, in discovery, or at trial (“Confidential, Non-testifying Consultant Only Expert”); or
• Testifying at a deposition and/or in court at trial (“Disclosed, Nothing the Expert Touches is Confidential, Testifying Expert”).

The first thing you need to do, therefore, is make sure your role and the scope of your area of expertise are clearly defined and that you are comfortable performing the tasks that are described in more detail below in a timely manner. As you will soon learn, testifying under oath can be a grueling experience.

Time Commitment

Is it worth the time commitment? Here, again, a lot depends on not only the expert witness’s role but also where in the course of the litigation the expert is brought on board the trial team. Is it ninety days before trial, before the lawsuit has even been filed, or somewhere in between? Have court deadlines already been issued that require the rescheduling of patient obligations?

Assuming you have been brought onboard as an expert before the complaint has been filed, you should expect to encounter the following noninclusive time constraints:

• Preparing litigation budgets and bills;
• Preparing a current curriculum vitae;
• Reviewing the entire file of paper;
• Assisting in drafting or responding to the complaint;
• Assisting in drafting and/or responding to discovery;
• Preparing an expert report;
• Preparing a rebuttal expert report;
• Preparing for your deposition;
• Attending your deposition;
• Assisting in the deposition of the other side’s expert witness;
• Assisting in preparing for trial;
• Preparing to take the stand at trial;
• Attending trial; and/or
• Assisting in identifying or responding to any post-trial appealable issues.

Although you should be compensated for each of these tasks, these tasks take away time you could be engaging in patient care.

Compensation

It should be a no brainer, but make sure you get paid. The expert witness business is built upon reputation, integrity, credibility, and expertise. Consequently, hospitalists who have developed a niche in a small area of expertise in which they can dominate a certain market, or those who have developed a national reputation, can charge a significant amount of money depending on their area of expertise. In the absence of substantial experience, expert witness rates are dependent on the location of the case, the dollar amount at stake, and the novelty of the legal disputes at issue.

You should immediately request a written agreement that states exactly who is responsible for paying your bills, when those bills will be paid, and, in addition to your hourly rate and what services that rate covers, the specific out-of-pocket expenses that will be paid, including those that are needed to cover postage, copies, travel, lodging, and any other incidentals.

Privacy, or Lack Thereof

Thanks to the Internet, unless a protective order is in place, and even that is likely to be narrowly tailored, opposing counsels can easily pull copies of all of your past deposition and trial transcripts, divorce records, past curriculum vitae, and articles you may have written in medical school or in practice. They can also use the Internet to identify who you usually testify for, whether your testimony has ever been refused by the judge, where you live, and even whether you own any property.

In essence, any and all public dirt on your private life can be extracted and used as fodder at the next trial. Are you prepared to become an overnight public figure?

The Internal Struggle

Finally, there is no question that the decision of whether to serve as an expert witness in a malpractice case is one of the most difficult, yet most important, nonpatient care decisions a physician can make. Expert testimony is essential to medical malpractice litigation, however. Many hospitalists may find themselves balancing their duty to patients who should have access to the courts and fair compensation from injuries caused by physicians who are impaired or who deviated from the standard of care against the professional and social pressure not to testify against colleagues and not to participate in a legal system that many hospitalists feel victimizes members of their profession.

The legal system, nonetheless, relies on competent medical expertise that is just and fair and relies on medical professionals to provide that expertise. Are you ready for the challenge? If you are, the second article in this two-part series will serve as a primer for your expert report, deposition, and testimony at trial.

Steven Harris is a nationally recognized healthcare attorney and a member of the law firm McDonald Hopkins LLC in Chicago. Write to him at [email protected].

Editor’s note: First in a two-part series on hospitalists as expert witnesses.

Recently, you have found yourself pondering whether you want to be an expert witness for the prosecution on behalf of one of your patients or for the defense on behalf of one of your fellow colleagues. You enjoy tackling confrontational questions head on, are intellectually curious, and are articulate both orally and in writing. You like to look at complex fact patterns and simplify them, and “Law and Order” is your favorite television show. But, seriously, are you ready to be an expert witness?

The expert witness plays an essential role in determining medical negligence under the United States system of jurisprudence. Generally, expert witnesses are asked to testify regarding the standards of care relevant to the given case, identify any deviations from those standards, and render an opinion as to whether those breaches are the most likely cause of the injury. Without the expert’s explanation of the range of acceptable treatments within the standard of care and interpretation of medical facts, juries would not have the technical expertise needed to determine whether or not malpractice occurred.

This article, the first in a two-part series on hospitalists as expert witnesses, addresses the nuts and bolts of serving as an expert witness, including the role of the expert witness, time commitments, compensation, privacy or lack thereof, and the ever-present internal struggle about whether or not to choose to participate actively in our legal system.

Hospitalists who have developed a niche in a small area of expertise in which they can dominate a certain market, or those who have developed a national reputation, can charge a significant amount of money depending on their area of expertise.

The Role of the Expert Witness

First, let’s take a small step back, as the hospitalist’s role as an expert witness is largely dependent on how the expert witness is going to be used by the attorney. An expert witness is someone who has been qualified as an authority to assist others—namely, the attorneys, judge, and jury—in understanding complicated technical subjects that are beyond the understanding of the average lay person.

Thus, attorneys retain expert witnesses for a whole host of reasons, including:

• Evaluating their client’s claim initially to determine if the patient has a valid claim;
• Writing an expert report to be used for settlement, mediation, arbitration, or as an exhibit to a motion for summary judgment;
• Consulting with the attorney in order to form an opinion in the case, which will be used to shape the prosecution or defense, including in a response to the complaint, in discovery, or at trial (“Confidential, Non-testifying Consultant Only Expert”); or
• Testifying at a deposition and/or in court at trial (“Disclosed, Nothing the Expert Touches is Confidential, Testifying Expert”).

The first thing you need to do, therefore, is make sure your role and the scope of your area of expertise are clearly defined and that you are comfortable performing the tasks that are described in more detail below in a timely manner. As you will soon learn, testifying under oath can be a grueling experience.

Time Commitment

Is it worth the time commitment? Here, again, a lot depends on not only the expert witness’s role but also where in the course of the litigation the expert is brought on board the trial team. Is it ninety days before trial, before the lawsuit has even been filed, or somewhere in between? Have court deadlines already been issued that require the rescheduling of patient obligations?

Assuming you have been brought onboard as an expert before the complaint has been filed, you should expect to encounter the following noninclusive time constraints:

• Preparing litigation budgets and bills;
• Preparing a current curriculum vitae;
• Reviewing the entire file of paper;
• Assisting in drafting or responding to the complaint;
• Assisting in drafting and/or responding to discovery;
• Preparing an expert report;
• Preparing a rebuttal expert report;
• Preparing for your deposition;
• Attending your deposition;
• Assisting in the deposition of the other side’s expert witness;
• Assisting in preparing for trial;
• Preparing to take the stand at trial;
• Attending trial; and/or
• Assisting in identifying or responding to any post-trial appealable issues.

Although you should be compensated for each of these tasks, these tasks take away time you could be engaging in patient care.

Compensation

It should be a no brainer, but make sure you get paid. The expert witness business is built upon reputation, integrity, credibility, and expertise. Consequently, hospitalists who have developed a niche in a small area of expertise in which they can dominate a certain market, or those who have developed a national reputation, can charge a significant amount of money depending on their area of expertise. In the absence of substantial experience, expert witness rates are dependent on the location of the case, the dollar amount at stake, and the novelty of the legal disputes at issue.

You should immediately request a written agreement that states exactly who is responsible for paying your bills, when those bills will be paid, and, in addition to your hourly rate and what services that rate covers, the specific out-of-pocket expenses that will be paid, including those that are needed to cover postage, copies, travel, lodging, and any other incidentals.

Privacy, or Lack Thereof

Thanks to the Internet, unless a protective order is in place, and even that is likely to be narrowly tailored, opposing counsels can easily pull copies of all of your past deposition and trial transcripts, divorce records, past curriculum vitae, and articles you may have written in medical school or in practice. They can also use the Internet to identify who you usually testify for, whether your testimony has ever been refused by the judge, where you live, and even whether you own any property.

In essence, any and all public dirt on your private life can be extracted and used as fodder at the next trial. Are you prepared to become an overnight public figure?

The Internal Struggle

Finally, there is no question that the decision of whether to serve as an expert witness in a malpractice case is one of the most difficult, yet most important, nonpatient care decisions a physician can make. Expert testimony is essential to medical malpractice litigation, however. Many hospitalists may find themselves balancing their duty to patients who should have access to the courts and fair compensation from injuries caused by physicians who are impaired or who deviated from the standard of care against the professional and social pressure not to testify against colleagues and not to participate in a legal system that many hospitalists feel victimizes members of their profession.

The legal system, nonetheless, relies on competent medical expertise that is just and fair and relies on medical professionals to provide that expertise. Are you ready for the challenge? If you are, the second article in this two-part series will serve as a primer for your expert report, deposition, and testimony at trial.

Steven Harris is a nationally recognized healthcare attorney and a member of the law firm McDonald Hopkins LLC in Chicago. Write to him at [email protected].

Editor’s note: First in a two-part series on hospitalists as expert witnesses.

Recently, you have found yourself pondering whether you want to be an expert witness for the prosecution on behalf of one of your patients or for the defense on behalf of one of your fellow colleagues. You enjoy tackling confrontational questions head on, are intellectually curious, and are articulate both orally and in writing. You like to look at complex fact patterns and simplify them, and “Law and Order” is your favorite television show. But, seriously, are you ready to be an expert witness?

The expert witness plays an essential role in determining medical negligence under the United States system of jurisprudence. Generally, expert witnesses are asked to testify regarding the standards of care relevant to the given case, identify any deviations from those standards, and render an opinion as to whether those breaches are the most likely cause of the injury. Without the expert’s explanation of the range of acceptable treatments within the standard of care and interpretation of medical facts, juries would not have the technical expertise needed to determine whether or not malpractice occurred.

This article, the first in a two-part series on hospitalists as expert witnesses, addresses the nuts and bolts of serving as an expert witness, including the role of the expert witness, time commitments, compensation, privacy or lack thereof, and the ever-present internal struggle about whether or not to choose to participate actively in our legal system.

Hospitalists who have developed a niche in a small area of expertise in which they can dominate a certain market, or those who have developed a national reputation, can charge a significant amount of money depending on their area of expertise.

The Role of the Expert Witness

First, let’s take a small step back, as the hospitalist’s role as an expert witness is largely dependent on how the expert witness is going to be used by the attorney. An expert witness is someone who has been qualified as an authority to assist others—namely, the attorneys, judge, and jury—in understanding complicated technical subjects that are beyond the understanding of the average lay person.

Thus, attorneys retain expert witnesses for a whole host of reasons, including:

• Evaluating their client’s claim initially to determine if the patient has a valid claim;
• Writing an expert report to be used for settlement, mediation, arbitration, or as an exhibit to a motion for summary judgment;
• Consulting with the attorney in order to form an opinion in the case, which will be used to shape the prosecution or defense, including in a response to the complaint, in discovery, or at trial (“Confidential, Non-testifying Consultant Only Expert”); or
• Testifying at a deposition and/or in court at trial (“Disclosed, Nothing the Expert Touches is Confidential, Testifying Expert”).

The first thing you need to do, therefore, is make sure your role and the scope of your area of expertise are clearly defined and that you are comfortable performing the tasks that are described in more detail below in a timely manner. As you will soon learn, testifying under oath can be a grueling experience.

Time Commitment

Is it worth the time commitment? Here, again, a lot depends on not only the expert witness’s role but also where in the course of the litigation the expert is brought on board the trial team. Is it ninety days before trial, before the lawsuit has even been filed, or somewhere in between? Have court deadlines already been issued that require the rescheduling of patient obligations?

Assuming you have been brought onboard as an expert before the complaint has been filed, you should expect to encounter the following noninclusive time constraints:

• Preparing litigation budgets and bills;
• Preparing a current curriculum vitae;
• Reviewing the entire file of paper;
• Assisting in drafting or responding to the complaint;
• Assisting in drafting and/or responding to discovery;
• Preparing an expert report;
• Preparing a rebuttal expert report;
• Preparing for your deposition;
• Attending your deposition;
• Assisting in the deposition of the other side’s expert witness;
• Assisting in preparing for trial;
• Preparing to take the stand at trial;
• Attending trial; and/or
• Assisting in identifying or responding to any post-trial appealable issues.

Although you should be compensated for each of these tasks, these tasks take away time you could be engaging in patient care.

Compensation

It should be a no brainer, but make sure you get paid. The expert witness business is built upon reputation, integrity, credibility, and expertise. Consequently, hospitalists who have developed a niche in a small area of expertise in which they can dominate a certain market, or those who have developed a national reputation, can charge a significant amount of money depending on their area of expertise. In the absence of substantial experience, expert witness rates are dependent on the location of the case, the dollar amount at stake, and the novelty of the legal disputes at issue.

You should immediately request a written agreement that states exactly who is responsible for paying your bills, when those bills will be paid, and, in addition to your hourly rate and what services that rate covers, the specific out-of-pocket expenses that will be paid, including those that are needed to cover postage, copies, travel, lodging, and any other incidentals.

Privacy, or Lack Thereof

Thanks to the Internet, unless a protective order is in place, and even that is likely to be narrowly tailored, opposing counsels can easily pull copies of all of your past deposition and trial transcripts, divorce records, past curriculum vitae, and articles you may have written in medical school or in practice. They can also use the Internet to identify who you usually testify for, whether your testimony has ever been refused by the judge, where you live, and even whether you own any property.

In essence, any and all public dirt on your private life can be extracted and used as fodder at the next trial. Are you prepared to become an overnight public figure?

The Internal Struggle

Finally, there is no question that the decision of whether to serve as an expert witness in a malpractice case is one of the most difficult, yet most important, nonpatient care decisions a physician can make. Expert testimony is essential to medical malpractice litigation, however. Many hospitalists may find themselves balancing their duty to patients who should have access to the courts and fair compensation from injuries caused by physicians who are impaired or who deviated from the standard of care against the professional and social pressure not to testify against colleagues and not to participate in a legal system that many hospitalists feel victimizes members of their profession.

The legal system, nonetheless, relies on competent medical expertise that is just and fair and relies on medical professionals to provide that expertise. Are you ready for the challenge? If you are, the second article in this two-part series will serve as a primer for your expert report, deposition, and testimony at trial.

Steven Harris is a nationally recognized healthcare attorney and a member of the law firm McDonald Hopkins LLC in Chicago. Write to him at [email protected].