One Click At a Time: Technology Empowered Family Medicine Podcast

Innovation is a word that is liberally used in technology spaces. Within family medicine circles, we believe that innovation is baked in to our self-perception. Bridging that gap is like leading a diplomatic mission. In a payment landscape where family medicine is the "upstream" problem to the "downstream solution," what is the innovative role of family medicine? In this episode, Kelly and Lalita break down the innovative origins of family medicine, and dissect the role that uncertainty and full-spectrum training have played in building creativity and systems thinking within family medicine. 1. Uncertainty in Medicine: Through Thick and Thin. The Nocturnists...

We're taking a break for the month of April, but we wanted to make sure that you still got excellent content. Last year, Change Healthcare, a subsidiary of UnitedHealthGroup, faced a ransomware attack by cybersecurity pirates that essentially took down the entire country's healthcare reimbursement structure. Last week, UnitedHealth apparently tried to recoup "loans" (read: not loans, read: early payments) in the midst of this debacle. This week we're reposting our chock-full-of-gossip episode (from last year) on the cybersecurity attack that targeted Change Healthcare. Kelly and Lalita go down the rabbit hole on consolidation, cyberattacks, and how family physicians need...

We're taking a break for the month of April, but we still want you to meet some of our incredible friends and colleagues! In September of 2024, we chatted with Chief Product Officer extrodinaire, Kalie Dove-Maguire. Take a listen! In this episode, Kelly and Lalita chat with a good friend of the podcast, Dr. Kalie Dove-Maguire. Kalie is an Emergency Medicine physician who is now the Chief Product Officer at Evidently, an AI-enabled chart review tool. Previously, Kalie was the Senior Director of Product at Carbon Health, where she oversaw the EHR and the rollout of AI-enabled ambient documentation. Kalie, Lalita...

We're taking a break for the month of April, so we thought we would repost some of our spicier takes! This episode was originally published July 16, 2024. "Value" based care is all the rage, but as two family docs interested in data and measurability, we're not so sure. VBC will likely increase the need for informaticists and good data queries, but are proxies dictated by payers really able to capture the value of primary care? Or is qualitative research a better way to measure the immeasurable?

In this week's episode, Kelly and Lalita speak with Dr. Marisha Burden, the division head of Hospital Medicine and a professor of medicine at the University of Colorado School of Medicine and the co-creator of the mobile platform, Gritty Work. She's an avid researcher, publisher, and thought leader on evidence-based work design and building thriving teams. With a remarkable broad research base and the curiosity to creatively address research questions on optimal teams, workplace improvements for healthcare workers, and most recently, administrative harm, Dr. Burden's mixed-methods research has the potential to impact health care design in more meaningful and financially...

Alternate title: Assessment BEFORE Plan In this episode, Lalita and Kelly speak with Esther Johnston, MD, family physician and an Assistant Professor at the University of Minnesota North Memorial Family Medicine Residency Program. She currently serves as the Director of the Global Engagement Network for Primary Health Care (GEN-PHC), a polycentric collaborative of primary care academicians that aims to facilitate the development of educational pathways, data, policies, and programs needed to support robust, fit-for-purpose primary health care systems through partnership and collaboration. The conversation ranges from decolonizing global health in a post-pandemic world to telehealth, broadband, and building family medicine...

Kelly and Lalita chat with Alex Butler, MD a pediatric chief resident at Boston Children’s Hospital and Boston Medical Center, and the co-founder and Chief Product Officer of River Records, an AI-powered documentation and data summarization platform. Alex received a medical degree and a Masters in Clinical Informatics from Columbia University. In this episode, the three discuss the phenomenon of a "noteless EHR," the interface goals of River Records, the influence of Dr. Lawrence Weed on clinical documentation, and how Alex has applied his interest in technology to streamlining processes as Chief Resident. A great episode for early career ph...

In this episode, Lalita and Kelly speak with Col. Brian Cahill, Chief of Soldier Primary Care and soon-to-be Chief Nursing Officer at Carl R. Darnall Army Medical Center in Fort Cavazos, Texas. As a colonel in the army with a 20-year career in clinical and administrative leadership roles, Brian discusses his journey from bedside nursing to completing a Masters degree in Clinical Informatics at Duke University to implementing MHS Genesis as CMIO at the Army Medical Center. He delves into the challenge of integrating new technologies in healthcare settings, the importance of a strong clinical background, and the role of...

Kelly and Lalita share their own backgrounds and how they got interested technology innovation. They also share the origin story of the podcast! Other hot takes on this week's episode include: - Do we actually want to work at the top of our license? - Sometimes fun solutions are better than efficient ones - Big picture thinking to change systems and identifying stakeholders

In this week's episode, Lalita and Kelly speak with Dr. Sara Pastoor, a DPC family physician at People-Centered Health and the Head of Primary Care Advancement at Elation Health. Sara shares her origin story of her instrumental role in shifting the military from AHLTA (the armed services EHR) to safer interfaces, all the way to Elation Health which emphasizes the importance of co-development between family physicians and design/engineering teams. She also shares some incredible leadership advice including: - learning how to flex the muscle of "no" - having strong clinical skills to have an influential seat at the table ...

Jordan Chanler-Berat, MD is an Emergency Medicine physician and the founder/CEO of POCUS Preceptor, a company that supports clinical learners to learn point-of-care ultrasound later in their careers. In addition to practicing at Baystate Health, Berkshire Health Systems, and Holyoke Medical Center and teaching at ultrasound at UMass Chan Medical School, Dr. Chanler-Berat spends time as a clinical advisor for Circucare, a novel wearable cardiac ultrasound biotechnology company. In this episode, Jordan, Kelly and Lalita talk about all things POCUS: including how to get training, use cases in primary care, the value of using the tools, an artificial intelligence...

Dr. Sarah Nosal, MD is the president-elect of the American Academy of Family Physicians and a practicing family physician in the Bronx. In this episode, Sarah shares her journey with Lalita and Kelly from her days programming a turtle in kindergarten to becoming the Vice President for Innovation & Optimization and Chief Medical Information Officer at The Institute for Family Health, a federally qualified health center in New York. Lalita, Kelly and Sarah talk about the importance of asking for what you want, designing "user error" to still be the correct outcome, and the importance of having excellent clinical skills to...

Travis Bias, DO, MPH, FAAFP, is a Family Medicine physician and Deputy Chief Medical Officer of Health Information Systems at Solventum, the healthcare business spin-off of 3M. Travis has had a varied career, including full time clinical medicine, peace corps work as a medical educator, and multiple roles within 3M. Kelly, Lalita and Travis talk about his experiences being the only family physician in a corporate setting, what the day to day entails, and how family physicians are perfectly situated for inter/multidisciplinary work in these environments. Other topics covered include: - balancing family life, a non-clinical corporate job, and...

We're back for 2025! In this episode, Lalita and Kelly speak with Elliott Wortham, a design and strategy consultant and the Director of Cove Studio in San Francisco, CA. Elliott helps us understand design principles for the family physician and how a fresh perspective is imperative to problem solving. Ultimately, each one of us can consider the unconsidered in our clinical environments to make it a better experience all around.

Thank you to all of our listeners for tuning in each week! In this episode, Kelly and Lalita reflect on an incredible year of doing 28 podcast episodes, and how these conversations have changed their perspective on technology in primary care, while impacting how they practice medicine on the ground. Kelly and Lalita highlight some of their favorite podcast moments and set intentions for the new year.

In the second to last episode of the season, Kelly and Lalita have a wonderful conversation with family physician, entrepreneur, and CEO of AskMeYourMD, Dr. Patricia Kelly Marsh. In this episode, Patricia shares with us how she is breaking the mold when it comes to telemedicine and payment models, and how the thing driving her through thick and thin is strong sense of confidence, faith, and believing in yourself at all costs. An inspiring and truly entertaining episode!

Dr. Robert Oh's career has spanned military service, residency education, and he now serves as the Chief Wellness Officer for the Veterans Affairs Health Care System in Palo Alto. An enthusiast for cutting edge medical innovations, Rob has used continuous glucose monitors since 2019 and advocates for their use in family medicine practices. In this episode, Kelly, Lalita and Rob discuss medical research, the challenges of applying statistics-based evidence based medicine to individual patients, and that the future of primary care will be patient-led. ** Opinions expressed are solely those of our own and do not express the views or opinions of...

Dr. Katherine Davis is a family physician and educator with a background in health informatics. Dr. Davis was instrumental as residency faculty at Summa Health in Akron, Ohio and most recently took that experience to apply her expertise at scale at MDCalc. Kelly and Lalita chat with Katie about her experiences and how important it is for family medicine physicians to have a seat at the table in health technology.

Kelly and Lalita talk about data privacy and its impacts on patient/physician safety, and how regulating an implied right to privacy is important to prevent indiscriminate data sharing...while still being excited about interoperability! It's a mixed bag conversation!

Kelly and Lalita talk to Shawn Martin, CEO of the AAFP on a new collaboration with Rock Health, a digital health investment and consulting group. They talk about the intention and the vision behind the collaboration and about how family physicians can get a seat at the table. They also discuss how this collaboration can help family physicians better understand our current technological environment, support family medicine education, improve operational and clinical workflows, and help disruptors build better digital health tools for our diverse and unique family medicine practices. Be sure to fill out the AAFP x Rock Health survey...

In this episode, Kelly and Lalita chat with a good friend of the podcast, Dr. Kalie Dove-Maguire. Kalie is an Emergency Medicine physician who is now the Chief Product Officer at Evidently, an AI-enabled chart review tool. Previously, Kalie was the Senior Director of Product at Carbon Health, where she oversaw the EHR and the rollout of AI-enabled ambient documentation. Kalie, Lalita, and Kelly chat about career journeys, innovations in the future of health tech, and ground their conversations in the practical data and human connection.

In this episode Kelly interviews Lalita on her experience attending the Rock Health Summit in San Francisco, California. The Rock Health Summit "is a digital health conference that brings together diverse minds from technology, medicine, public health, and beyond for a day of inspired conversation and connection." Lalita shares the overall gist and gets into the specifics of some of the themes and products that she saw during the event. If you're interested in reviewing all of the speakers, you can check out the 2024 speakers here: https://www.rockhealthsummit.com/speakers2024

Kelly and Lalita welcome their very first guest! Matt Sakumoto is the Regional Chief Medical Informatics Officer at Sutter West Bay Medical Group in San Francisco, and health tech start-up consultant. He is a graduate of the UCSF Health Informatics Fellowship and an Internal Medicine Physician at a Virtual First Medical Practice at Sutter. In this episode Kelly, Lalita and Matt talk about using personas in clinical technology education, AI scribing, and Matt shares a Help Desk Ticket of the Week!

Episodes on tips and tricks to advocate for yourself to designers and leaders:

Assistant Secretary for Technology Policy. HTI-2 Proposed Rule Patient, Payer, Provider API Information Session https://www.youtube.com/watch?v=hn3Bn3_9l9M

Public Comment for ONC rule: https://www.federalregister.gov/documents/2024/08/05/2024-14975/health-data-technology-and-interoperability-patient-engagement-information-sharing-and-public-health

In this episode, Kelly shares her experience and takeaways from Epic's UGM! We discuss Epic's influence on the software space including: - Generative and Predictive AI - Whether we should start tackling downtime issues - Cybersecurity - Epic's international, interconnected influence - Change Management - Keeping up with change ...and more!

Alternate Title: Slime Mold Maps and Taco Seasoning In this excellent episode, Kelly and Lalita dive back into the discussion on Health IT legislation, this time starting with HITECH (Health Information Technology for Economic and Clinical Health Act) and moving through the 21st Century Cures Act. We discuss the role of Health IT regulation in developing the current landscape, and where we hope things go as we build out some of the aspirational goals of the Cures Act. Also, how do we swing the pendulum back towards the small practice?

References:

Institute of Medicine. Computer-Based Patient Record: An Essential Technology of Health Care. 1991. https://nap.nationalacademies.org/catalog/18459/computer-based-patient-record-an-essential-technology-for-health-care

Ambinder, EP. A History of the Shift Toward Full Computerization of Medicine. J Oncol Prac. 2005 Jul; 1(2): 54–56. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2793587/

George W Bush White House Archives. President Bush Strengthened America's Health Care System. https://georgewbush-whitehouse.archives.gov/infocus/bushrecord/factsheets/healthcare.html

Mennemeyer ST, Menachemi N, Rahurkar S, Ford EW. Impact of the HITECH Act on physicians’ adoption of electronic health records. J Am Med Inform Assoc., Volu...

Mentioned in Today's Episode:

Grimes, William. Dr. Lawrence Weed, Pioneer in Recording Patient Data, Dies at 93. The New York Times. June 2017. https://www.nytimes.com/2017/06/21/science/obituary-lawrence-weed-dead-patient-information.html

Newman David, MD, Dhanda Shan, MD. Taming the Problem List. Family Practice Management. May/June 2023.
https://www.aafp.org/pubs/fpm/issues/2023/0500/problem-list.html

Dr. Glaucomflecken. The Epic Problem List. YouTube. Jul 20 2024. https://www.youtube.com/watch?v=LDJvS8Iz4a8

In this episode, Kelly and Lalita focus on the backbone of VBC: Metrics! As data nerds and yet, somehow luddites, they discuss current news (CrowdStrike debacles), HEDIS measures, and putting patients at the center of everything. They also pose a question to the listener: what should we actually be measuring (and how) to get a good sense of health and successful outcomes?

"Value" based care is all the rage, but as two family docs interested in data and measurability, we're not so sure. VBC will likely increase the need for informaticists and good data queries, but are proxies dictated by payers really able to capture the value of primary care? Or is qualitative research a better way to measure the immeasurable?

This week, Kelly and Lalita discuss implementing clinical decision support in an EHR, using the 5 rights of Clinical Decision Support to guide their conversation. They also have some good advice for anyone who is interesting informatics leadership!

In this episode Kelly and Lalita imagine what a month long downtime might feel like (a la Ascension's hospital system) and have 7 major highlights for thoughtful (and actually helpful) downtime implementation.

Family physicians often don't know how to communicate with designers and engineers in the user centered creative process. Giving good feedback is key, so how do we do it? What are some principles to utilize and how can we be more effective in developing our own tools?

In this episode Kelly and Lalita discuss what makes a "good" patient portal experience? What elements are necessary? Focusing mostly on scheduling and messaging, Kelly and Lalita share stories highlighting the physical and technological constraints to practicing medicine and how standardization might mean losing the individual experience in order to achieve more individualized care.

Asynchronous care in health tech is all the rage these days. Kelly and Lalita talk about use cases and also the biggest limitations to dreaming of successful implementation: reimbursement and human capital. Take a listen!

Kelly and Lalita talk about the purpose of data collection in the exam room, how trust is imperative in data collection and share their philosophies on the importance of data safety, necessity and stewardship

In this episode, Kelly and Lalita discuss how the EHR creates additional constraints on physical space design in the clinical setting and talk about various ways to use data and information while in the exam room.

Whittaker, Zack. "As the Change Healthcare outage drags on, fears grow that patient data could spill online." TechCrunch., 9 March 2024. https://techcrunch.com/2024/03/09/change-healthcare-fears-data-breach-ransomware/Whittaker, Zack. "UnitedHealth confirms ransomware gang behind Change Healthcare hack amid ongoing pharmacy outages." TechCrunch., 29 February 2024.  https://techcrunch.com/2024/02/29/unitedhealth-change-healthcare-ransomware-alphv-blackcat-pharmacy-outages/Pierce, Alisa. "CMS Announces Flexibilities Following Cyberattack." Texas Medical Association. 8 March 2024. https://www.texmed.org/Template.aspx?id=63784.Whittaker, Zack. "Ransomware attack blamed for Change Healthcare outage stalling US prescriptions." TechCrunch. 26 February 2024. https://techcrunch.com/2024/02/26/ransomware-attack-change-healthcare-prescription-pharmacy-outages/Diamond, Dan. "Medicare announces emergency funds for doctors affected by Change Healthcare hack." The Washington Post. 9 March 2024. https://www.washingtonpost.com/h...

In this Episode, Kelly and Lalita discuss optimizing pre-visit planning through EHRs, why schedule simplicity matters for longevity of care and preventing provider burnout, what NOT to do, and how any conversation with health tech HAS to include data protection, privacy, and patient information safety discussions (a la Change Health).

Kelly and Lalita get a little off topic from onboarding with too many car analogies. We talk about what people need to learn about EHRs, how to do shared documentation, and how artificial intelligence, narrative medicine, storytelling, and patient centeredness has impacted our own medical documentation. We also touch on EHR standardization (is it possible?) and we get into a conversation about pre-visit-planning including the use of point-of-care testing, patient entered surveys, and a unique helpdesk ticket of the week!