The Role of Technology in Coordinating Care, the Next Generation of Hospital Medicine, and the Future of Certification

What needs to be done to improve working conditions for hospitalists, and what role will technology play?

This is going to be a non-technical answer for a non-technical problem. In terms of the working conditions for hospitalists, one of the key things a hospital can do is provide a hospitalist room; a private place and an environment that is quiet so that hospitalists can access whatever kind of technology is going to be provided to them. Hospitalists are very mobile within that facility, going from nursing station to nursing station and sharing computers, and Internet access can be spotty or slow. So access to whatever type of technology they have can be limited or restricted because of that requirement. One of the key things a hospital can do is provide their hospitalists a specific space within the facility; when that happens, the morale of staff improves dramatically. In terms of working conditions for hospitalists and technology, one important step is to give each local hospital’s group autonomy to structure their own call and coverage systems, and the technology that each one provides allows them some type of ability to manage that call or coverage system and the patient handoffs electronically. I also believe it’s increasingly important that our hospitalists contact patients post-discharge to ensure that the care is done right, and in order to make that efficient and workable for your hospitalists, you want to develop some type of transition management software package that helps automate the contact of those patients. At IPC, we use the IPC Link to automatically develop surveys of the patients as they go home, and then the data is electronically sent to a call center that contacts each patient for our physicians. That helps reduce the workload on hospitalists post-discharge and ensures good followup on those patients.

Why is technology like IPC Link becoming more popular?

It’s a necessity. As you develop EHRs and EMRs, all of them require extra work on the part of your hospitalist. And so, doctors don’t willingly jump on them but actually perceive them as a detriment to their working conditions. You really have to look at it and understand that—as an employer of these hospitalists, or as someone who wants to get them to use these technologies—you really do have to provide incentives to them in some way, because they are not going to willingly jump onto the technology.

What steps need to be taken to make sure that the integration of acute, post-acute, and senior care—the “next generation of hospital medicine”—is implemented successfully?

I think a hospital employment of hospitalists is a detriment in itself to developing that next generation of hospitalist services. The acute care hospital is only one piece of the continuum today. Patients may start in a hospital, but they end up in a rehab hospital, they end up in a skilled nursing facility (SNFs), and then they may end up in assisted living. So, how do you ensure that the patient is moved through that system, or places of service, in a way in which the patient handoffs are safe, efficient, and cost effective? I believe you are going to see the most evolved hospitalist programs with integration between the so-called SNFs, the so-called hospitalists, and even the specialty hospitalists that exist now within these facilities. And with IPC, you are starting to see, as we announced a transaction in Tucson for example (www.hospitalist.com/mediacenter/releases/press-release-20090720.htm), acute care hospitalists and assisted living hospitalists. What we are going to need to make that really work is a technology that links all those providers together—so they all can see what happened to the patient in the facility before them and can pick up the patient most effectively—and at the same time communicates out to the primary care doctor what’s happened to their patient as they are being moved through the system. This is already incorporated into IPC link. I think the most evolved hospital systems will have electronic records that cross those barriers. Typically, what you have in most situations is a hospital owned by “x” entity and then skilled nursing facilities that may not be owned by that same entity. Therefore, an EHR does not integrate or crossover between these facilities. IPC link can be independent in terms of the facility allowing the providers to see everything happen to the patient across the continuum.

Do you feel, since hospital medicine has emerged dramatically over the past decade, that there is a need for hospitalist certification, or would it cause more problems than solutions?

I think that there’s an inevitability that it’s going to have some type of certification. There are going to be some issues and growing pains along with that, but I think it’s going to happen. We’re already seeing movement toward that. The problem that I worry about is that to be a hospitalist today, there are so many more jobs than there are potential doctors to fill them. Anything you place upon this that makes it harder to recruit and to staff—like a requirement of certification—is going to make it really hard to effectively staff these programs. I also don’t believe the industry itself has really defined the difference between what you are trained to do as an internist in the hospital and what I believe a true hospitalist is. And so, I’m still worried that they don’t know what the core competencies are or what they would test for or look for to give you that certification.