Today was (almost) the last straw. If you've read this column before, you've listened to my diatribes about the insanity of the forms we are required to fill out, the wasted efforts, the missed opportunities, the duplicative care. This one today takes the cake. Going through my mail this morning, trying to clean up the work on my desk before I head off for a (hopefully) few days of jury duty, ...

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A sleeping dragon awakes. At our weekly health policy colloquium recently, the presenter described plans for our organization to form its own accountable care organization, or ACO. The idea behind an ACO is to find patients who get the majority of their primary care within our system, and then "attribute" their health care and all of its attendant costs to that system, making the providers ultimately responsible for providing both high-quality and ...

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It seems like every few days we get a message in the in-basket of our electronic health record (EHR) about a new type of message that we will be receiving in our in-basket. They call these messages "system notices." OK, maybe that's an exaggeration, maybe not every few days, but the different types of in-baskets and all the information we are bombarded with is getting out of control. As users of electronic ...

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Want to know why residents dont chose primary care? Read this. I just got a taste of improved access, and I gotta tell you, it sapped my energy. It reminds me of the old standup comic one-liner, "I just flew in from Vegas, and boy, are my arms tired." Today was the department of medicine housestaff picnic (pretty much a guarantee to cause the weather to change from clear skies to rain), and so ...

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Why do doctors still use pagers? I was on call last night. Don't get me wrong, this is not as bad as it sounds. With over 20 partners sharing evening call, and residents getting the calls first, we do not have it bad at all. And certainly nothing like my obstetrician friends, who seem to go in every time they are on call for labor and delivery and then ...

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One hundred forty-nine messages. This is what I return to on my first day back from vacation. Many of them were marked with a little red arrow, indicating a high-priority phone message. Recharging with a little time off is a darn good thing, something we all need, and something which has been shown to help all of us be better at what we do. All of us, no matter what our jobs are. ...

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Just the other day I received a somewhat anxious-sounding phone message from a patient of mine, approximately 72 hours after her office visit with me, and about 24 hours after I had already gone over all of her lab results from the visit with her. She sounded quite distressed, and said she'd received a message from someone, but could not really understand what they were saying. She said she was finally ...

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The state stopped by to see us the other day. Wow, that sounds ominous. No, really, I mean it felt like the entire Empire State: multiple people from multiple offices of New York state government, department of health, office of compliance this, oversight that, all with a vested interest in how things have been going (i.e., how we have been spending their money) in our patient-centered medical home resident pilot program. A few ...

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Actionable items. Today I decided to take a look at one of the dashboards that the information technology (IT) department built for our electronic health record, to help us a look at our patients enrolled in the multiple registries of diseases and conditions we are following for the patient-centered medical home. I booted up the program, and with just a couple of clicks of the mouse the program began running, checking with ...

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My morning practice session started out with a few patients arriving early, so I was able to get a jump on the day, and it looked like I was going to actually be running on time. As I was walking from one exam room to the other, my administrator came down the hallway, grabbed my arm and said, "Can I have you for a minute?" It seems that a group of systems ...

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