Getting Better

Dr. Mok's Notes - September 2006

The Children’s Hospital recently changed its tagline. “It's All Better” more accurately reflects our fundamental commitment to continuous quality and service improvement.

On describing change, the ancient philosopher Heraclitis said, “Everything is in constant flux and movement…Therefore, we cannot step twice into the same river.”  For many physicians who have practiced pediatrics for a long time, I think most of us would agree that children’s healthcare has changed immensely, generally for the better. However, there is mounting evidence that not all is well with the job satisfaction of primary care clinicians. A barometer of this satisfaction is the percentage of medical school graduates who choose primary care for post graduate training.  Between 1998 and 2006 there has been a 10% drop in the number of U.S. medical school graduates filling pediatric residency positions, and a 50% drop in family medicine residency positions. 

Two recent editorials in the New England Journal of Medicine ask “Will Primary Care Survive?” and “Is Primary Care the Best Job in Medicine?” The problem seems to be system related.  More demand for health maintenance care, acute care and chronic care coordination for a highly mobile population, more of whom are uninsured, without a system in place that recognizes and rewards the essential importance of primary care for the country as a whole and the innovation required to provide high quality care and service in a rapidly changing environment.  Some days it might seem quite attractive to just jump in the river and float away.

The long term answer to this dilemma will require creative energies from many sectors of our society.  The short term question is: “What can The Children's Hospital do to make things better for you and your patients?”  Here are three examples of issues we are working on.

Communication of Clinical Data

The Children's Hospital has invested considerable energy and resources in a comprehensive, integrated electronic medical record (EMR) for both ambulatory and inpatient care.  Those of us who have practiced in recent years with an EMR have come to appreciate the potential this tool has for communication of clinical data.  Without losing the personal touch of phone contact when appropriate, the EMR allows rapid transfer of precise information among clinicians and patients.  Over the next several weeks, we will be conducting a feasibility study to better understand the use of electronic medical records in pediatric practices in the metro area.  Based upon requests from pediatric practices interested in a system for their offices, we are exploring the possibility of potentially supporting EPIC for this purpose.  The proposed application would have implications for clinical information access and clinical workflow applications for affiliated physician practices.

Practice Management Series

A new feature of the The Children's Hospital Practice Update magazine offers helpful information on solving the many challenges of running an efficient and effective practice.  New ideas to organize data in your practice, manage requests for forms, handle employee issues, participate in quality and service improvement projects, and keep up with reimbursement changes will be among the topics covered.  In addition there will be suggestions on streamlining patient education, measuring satisfaction levels, and using new ways to improve communication with the families in your practice.  Another promising source of help in this area will be the American Academy of Pediatrics online Practice Management site due to start this Fall.  It will be free for AAP members and can be found at www.aap.org.

Scheduling of Complex Patients

The last thing that parents of a child with multiple medical problems need is hassle in making several appointments at The Children's Hospital during the same visit.  To facilitate scheduling of complex patients the appointment center has designated Mariana Baron as a specialist in arranging three or more appointments at the hospital. She is familiar with gathering the critical information from your office on what needs to get accomplished for these patients during their visit, including special lab or imaging studies, and she can alert the various specialists ahead of time that the patient has a busy schedule to keep. She can accommodate Spanish and English speaking families and can provide places to stay near the hospital if they are coming from out of town. 

Please let us know what needs to get better at The Children's Hospital.  We will work on it until it does.