At both our Semiannual Medical Staff Meeting in November, and at a special meeting of Deputy Chiefs and Members-At-Large on Dec. 12, we were able to move around, mingle and, more importantly, receive what I believe was some straight talk from our leadership. (While listening, we even got to hold on to the food, including the always popular jumbo shrimp, and we didn’t have to abandon or chug our drinks enroute to a stiff auditorium chair).
Of course not every question or issue has a neatly packaged solution. That’s the price we pay for dealing with tough questions. But at both meetings, we learned a lot about physician access, clinical office space, the electronic medical record transition, and the sweeping transformation of our medical center’s physical plant and footprint during the next decade. I walked away from both meetings with about as much understanding of the hospital-driven realities of my work life as I might expect in this fast changing world.
I asked all of the representatives at the deputy chiefs’ meeting to report back to their constituents. You should receive detailed service-specific information, so I’ll just provide a brief overview of our discussions with CEO Martha Marsh; Jerry Shefren, vice president, clinics/ambulatory care; our chief quality/medical information officer, Kevin Tabb; and our Chief of Staff Larry Shuer. (Both I and president-elect Bryan Bohman were “on stage” as well).
Physician Access
Martha Marsh kicked off the evening with reassurances that a resolution passed by the Hospital Board in 2004 is alive and well and affirms that access by community physicians to our hospital will continue after 2008. That’s when a contract between Stanford and the city requiring such access will expire. Besides needing to give “our patients choice and diversity,” the reality is that Stanford can’t retain its MediCal contract without open access, Martha explained. And there are no plans to give up MediCal access. The take home message: Stanford Hospital has, wants and needs a diverse staff.
Of course open access isn’t boundless. Many of us realize that in radiology, to cite one example, the hospital has an in-house group contract that sometimes prevents qualified practitioners from reading their own X-rays. But as Martha points out, at the end of the day, the public, medical staff and hospital will benefit from a health care and marketing strategy that broadens participation and creates a level playing field among practitioners.
Jerry Shefren noted that the hospital is looking for ways to strengthen the primary care base, “which for a number of reasons is declining here. The economics of primary care haven’t worked well for a long time,” and solutions are similarly long-range and complex, he explained.
New facilities
Martha reminded us why her job is so complicated as she described how SHC must predict institutional needs not just for the next few years, but also for the decades after the new hospital is built in time to meet a 2013 state-mandated deadline for a seismic retrofit. As announced in November, the new hospital will provide 600 beds, all with private rooms. Planning calls for 25 percent of beds to be in ICUs to serve what is surely expected to be an increasingly acute inpatient population. [See December’s Medical Staff Update for more details on the hospital construction]:
http://med.stanford.edu/shs/update/archives/DEC%202006/construction.htm
Larry Shuer asked Martha if high acuity care is conducive to private rooms, and Martha insisted that the need for privacy and patient amenities make single rooms mandatory in a modern and future environment. She said a line-of-sight floor plan, glass/curtain barriers and other design elements allow for close scrutiny by nurses while simultaneously providing the private environment patients demand.
Community offices
Jerry Shefren explained that while the 1101 Welch Road office building will be razed to accommodate the new hospital wing, SHC is committed to providing replacement office space for community physicians — currently major tenants at 1101. Not only did Martha and Jerry promise sufficient replacement office space at Hoover Pavilion before 1101 is brought down, but half the space at a planned 200,000 square-foot office building near Hoover Pavilion will be reserved for community physicians as part of the hospital reconstruction effort. You are seeing this in writing here, folks.
Electronic records
Kevin Tabb told us that medical centers that have successfully implemented a transition to electronic medical records have done so with the active involvement of — not just the knowledge of — the medical staff. Here at Stanford, physicians are actively involved in the design of the system, including seven physicians serving as half-time consultants to the project. Currently on board are internist Topher Sharp and thoracic surgery medicine chief Richard Whyte.
But the ball is in all of our courts, since we will all be required to take 12 to 16 hours of mandatory training before we have the requisite skills to log on and use this highly functional tool. Training will be offered on a schedule convenient to physicians — including evenings and weekends — and will occur just prior to our need to use the system after it “goes live” in 2008. While Epic will replace Carecast on a single day, physician documentation into Epic will be phased in by service in the first couple of months after the “go live.” Those enhancements we already have in Carecast will move immediately to Epic.
An Epic endorsement
Will our new relationship with an electronic medical record be a burden? Not according to Michael Trollope, a more than 30-year veteran gastroentestinal surgeon at Palo Alto Medical Foundation, where Epic has been in place during this century. Here, unsolicited is what Mike told the Deputy Chiefs on Dec. 12:
“Everybody is worried about the downside. ‘Oh my God I’ve got to have training, what am I going to do?’ The reality is, though, that this [Epic] is so great, [you will ask], ‘How can I complete my [training] hours so I can get online?’ All of you doubters in the audience will be ecstatic when you have this [Epic] available. …All the notes, all of the reports, everything you need is instantly available. Immediately. There’s no sending people around tracking stuff down. It’s all right there in front of you. It’s wonderful.”
Mike has invited our medical staff to see the “wonders” of Epic, and Kevin is organizing a field trip for interested medical staff members to both PAMC and to a hospital, probably in the East, where Epic now provides full functionality. If any of you are interested, please email me. Expenses will be paid by the hospital with two requirements on your part: participants must attend the PAMC demonstration before heading East, and then they must share what they’ve learned on both field trips with colleagues.
Harvey Young, a Medical Board member-at-large and community gastroenterologist, asked whether Epic and a new Internet dictation system, Spheris, will be available to physicians in their own practices. Not immediately, but hospital administration is amenable to offering the benefits of Spheris as a vendor service for non-Stanford patients once the system is fully stabilized a few months after its launch, now slated for April. [For more on see Spheris].
Adjunct association
In response to a question, I asked Diana Adams, deputy chief from psychiatry, to come up with what it would take on the medical staff side to promote a Medical Center-wide association of Adjunct Clinical Faculty. Diana has proposed such an organization modeled on the successful psychiatry ACF association.
Deputy duties
And my successor as your president in 2007, Bryan Bohman, has proposed a bylaws change, now well along in the committee approval process, that would designate responsibilities to deputy chiefs. Under the proposed amendments deputy chiefs would be responsible along with chiefs of service for monitoring the professional and administrative activities within each service. Sue Sorensen, the deputy chief for medicine, recommended that deputy chiefs should be ex officio on the quality assurance and improvement committees of their own service. As Bryan noted, we are all being held more accountable for our practices (see vice president’s column last month), and along with accountability comes responsibility for active leadership and participation.
These remarks are only an outline, of course, but we have many channels, including this publication, to let you know what’s going on. Meanwhile, if you have questions, contact your chief of service, me [kgarman@stanford.edu], vice president Bryan Bohman, [bdbohman@yahoo.com], or your deputy chief of service listed [see list].
