“I know many physicians are already maxed out. Technology can make that worse. As soon as you introduce what will be perceived as new obstacles to moving from A to Z, all they’re going to think is, “I can’t do what I need to do. I’m exhausted and I’m behind. And now you’re introducing seemingly arbitrary expectations and steps with new tech, and you’re just sitting there with your arms crossed, shaking your head at me?” That further exacerbates this feeling of a loss of autonomy, a feeling that you’re not appreciated, a feeling that there’s no respect for efforts. Look at all of the accepted definitions of burnout, and it makes it worse.

But I’m not here to burn you out. I’m here to say that your voice is valuable, and there are very real ways to positively influence the strategy, adoption, and ongoing maintenance for technology you depend on as a physician.”

Rodrigo Martínez is an otolaryngologist and health care executive.

He shares his story and discusses his KevinMD article, “Here’s a crazy thought: Make technology work for doctors.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow.

Today on the show, we have Rodrigo Martínez. He’s an otolaryngologist and a health care executive. He wrote the KevinMD article “Here’s a crazy thought: Make technology work for doctors.” Rodrigo, welcome to the show.

Rodrigo Martínez: Thank you very much, Kevin. Thrilled to be here.

Kevin Pho: We’ll get to the article in a little bit, but first off, can you share your story and journey to where you are today?

Rodrigo Martínez: Yes, absolutely. I think, like many of us who have found careers adjacent to traditional clinical medicine, it’s been one of a lot of introspection and observation, as well as, ultimately, yielding to our inner curiosity. I went about chasing a dream to become an otolaryngologist, and then I wanted to be a facial plastic surgeon, and I did that for a few years. But along the way, I was discovering how cool technology was, first as a resident, when suddenly I didn’t have to go in to read all the X-rays. It was so convenient to do stuff from home, to be able to guide some of the junior residents from home, and to make calls without having to go in to see films. Then the organization, the health system there, Stony Brook, started to move towards Cerner, and I got interested in that.

Then I focused on what I wanted to do clinically and went down that path. But after a few years, I was really thinking that I missed those real, big, macro-level challenges. I think in medicine we are trained to typically treat one patient at a time, and I really missed the kind of thinking that’s involved in solving really big-picture challenges. I decided that I wanted to do more of that, and I made a very abrupt career change and decided to jump into consulting.

I remember, in the mid-2000s, using LinkedIn for the first time as a way of reaching out to people. Around then, there weren’t a lot of people who had left full-time practice, so a lot of it was just trying to network and find people who had done it. Ultimately, I made my way initially to McKesson, and then I was recruited to move to D.C. in 2010. I joined a company called Clinovations, which was really focused on incorporating physicians, in particular, in the important conversations that needed to happen prior to and during EHR implementations. We did a lot of work there, everything from system selection all the way through to go-live support and optimization thereafter. So I got a lot of exposure to a lot of different types of projects, especially ones geared around process improvement at the intersection of clinical workflows and electronic health records.

I rode that wave for a while. We were acquired in 2015 by the Advisory Board, and then the Advisory Board was in turn acquired by Optum in 2018. I left Optum shortly thereafter and joined a startup based out of Seattle called TransformativeMed. The co-founder there had created MPages inside of Cerner, and they had a great business creating very physician-specific and specialty-specific views inside of Cerner. Then I was invited to come join PerfectServe. I joined 10 months ago and have entered the world of digital health care communications, stepping away from the EHR and looking a lot more at a broader definition of the care team, now inclusive of the patient and the family. It’s been, for me, a very educational journey along the way, but I’ve loved being able to look at the future and what’s coming next and helping organizations prepare for that. So, a lot of fun.

Kevin Pho: Making that transition from otolaryngology to all the roles that you do in a non-clinical setting, has it been what you expected?

Rodrigo Martínez: I think that it has been. I understood that in making that transition, I was going to have to make a choice. I think a critical moment for me was with the CEO of Clinovations at the time, a guy named Trenor Williams. He had made a similar decision; he had worked at Deloitte Consulting. He sat me down one day and said, “Rodrigo, as you make this transition, I’m going to provide you a choice of two paths. Number one, you could go and become a subject matter expert. You will top out very quickly,” he said. “Or I can teach you how to do traditional consulting, but you’re going to have to start at the bottom. It may open up many more doors, but it’s going to be much more difficult.” Being a glutton for punishment and a bit of a masochist, I said, “Yeah, sure, why not? I’ll start all over again.”

But it was, for me, a huge eye-opener. There were a lot of things that I had wanted to learn and understand. I had been toying with, “Should I go to business school? Is that what one does?” But I found that by engaging in a lot of these projects and paying a lot of attention to the way my colleagues worked, particularly those who were much younger than me who had been in traditional consulting roles, and understanding how they tackled problems, how they organized themselves, how they organized for meetings, and how they created PowerPoints, I was just constantly noticing how different everything was and opening myself up to be willing to learn and to move away from expecting to be the smartest person in the room.

I think that was, for me, one of the most difficult things. In medicine, you rarely jump into something blind, and you rarely feel comfortable going in and winging it. We are trained to understand everything and anticipate every potential problem, and it is a very different mindset in the consulting world. It’s a much more collaborative approach to doing things, and a lot of that appealed to me. I’ve been thrilled with the way it’s turned out, the people I’ve met, and the types of things that I’ve learned. So I think in those regards, it’s actually really exceeded my expectations.

Kevin Pho: All right. Let’s talk about the KevinMD article that you wrote, titled “Here’s a crazy thought: Make technology work for doctors.” Now, for those who get a chance to read your article, just walk my audience through it and share the story of why you decided to write it.

Rodrigo Martínez: Sure. I think that the initial draw to the world of electronic health records was the fact that physicians didn’t seem to be part of the conversation. That was the first thing. As I entered the process and was exposed to the process as a resident, it just seemed that administrators were making decisions, IT was making decisions, and then things were just being delivered. I anticipated that that was going to be a recipe for disaster, and I was just drawn to wanting to step in there.

In the article, I was really drawing upon lessons that I’ve learned, not only as someone who was involved in the strategic thinking that happened before implementations, but as somebody who really focused on the importance of engaging physicians ahead of time. I really just talk a little bit about the history of EHR implementations and the amount of money that has been spent, and how, still to this day, when you look and think about topics like burnout, the EHR is still playing a huge role in that.

I think very often the concept of EHR is still, at least for the generation of folks who went through the transition, a dirty word. I think a lot of people have PTSD from that transition, and that’s something that some of the younger members of our audience may not actually appreciate. But I think any kind of huge transition like that can be potentially traumatic. So I was just thinking, OK, what are some basic pointers that I can provide to people so that they don’t have to feel that everything’s just being done to them, but that they can actually get involved?

Kevin Pho: Now, I want to go into those pointers and tips, but I just want to ask you: You’ve been on the industry side of this. What’s the reason that they don’t include more practicing physicians into that technology adoption process, whether it’s an EHR or another product?

Rodrigo Martínez: I think one of the main things that’s tricky in medicine is that the end users are very often not the buyers. I think that’s important, and very different from our experience in the consumer world, right? The companies, places like Apple, the people who make all of the applications that we are so used to in the commercial world, those are being sold to us or given away for free to us. This is something that’s very, very different when you’re implementing something like an EHR or communication systems. There’s a hope that you are introducing these into standardized processes and workflows, but because we are still in a state of transition, that is not necessarily the case.

Maybe organizations have been able to require the use of the electronic health record, but there’s still a ton of variability, not only in workflows, but also in expectations that have been set by the people who are ultimately buying this. I think that there’s a huge underinvestment in making sure that the workflows work. Oftentimes they’re buying it and they are implementing it, and people just expect that it’s going to be so intuitive and useful that people will just figure it out. But I think a lot of people just continue to struggle, and they often don’t know what help is available, or if there’s even any help available.

Kevin Pho: Let’s talk about some of those tips that you mentioned to help ease and facilitate the transition of technology adoption into clinical staff. What are some of those tips?

Rodrigo Martínez: Let’s say you’re a brand-new doc at a brand-new organization. I think one of the most fundamental things that you should do, and this is on one extreme: Let’s say I am not interested in knowing about computers, nor am I interested in getting involved. I’d say to that person, at the very least, find out who the resource is, or what resources are available to you, to make sure that you know, number one, what software is available and, number two, how you can use it to its maximum. Focus on your workflow, because at the end of the day, that’s what’s going to make or break you. The more complex and irritating it becomes, the sooner you’re going to just fry yourself.

But I think, at the very basic, just understand: Is there someone, some kind of a physician liaison or somebody from an informatics team, who can help? Then you can also talk to your partners and any colleagues that you have working there. These can be other physicians, or it could be nurses or other people who have had experience with that application or those applications, and get some tips and tricks from them. Many times, there’s the ability to share templates, to share documentation practices, and order sets. Make your life easy. Don’t try to reinvent the wheel or start absolutely from scratch. A lot of these EHRs, when used well and designed and configured well, can really, really speed up a lot of your day. So just because you open up the screen and you don’t recognize anything doesn’t mean that it has to stay that way. I think investing a little bit of time up front is going to save you a ton of time in the end. That’s what I would say, and that’s one of the things I talk about there in the article, at least for people who just want to make the minimum investment.

On the flip side, there are some people who are fascinated and love the technology. I would say find out if there’s an informatics division or group within the organization. If you have a CMIO or you have a CIO, understand them and get to know them. You will start to have insight into what’s around the corner and what some of the big-picture strategies are. I think it can be tricky understanding that, as we have moved to a much more patient-centric approach to care delivery, suddenly a lot of the decisions that we may think are convenient for us, or that we want to make just for ourselves, our group, or our specialties, can have downstream consequences that we may not think about. So I think understanding the big picture can be very, very valuable.

Kevin Pho: We’re talking to Rodrigo Martínez. He’s an otolaryngologist and health care executive. He wrote the KevinMD article “Here’s a crazy thought: Make technology work for doctors.” Rodrigo, I think that clinicians complaining about electronic health records and new technology has been going on for years now, and I think there’s always going to be a little bit of a gap between what clinicians expect from the proverbial front lines of medicine and what they’re getting. But over your years in this industry, are you seeing that gap narrow between practicing clinicians and what they’re getting from industry?

Rodrigo Martínez: Yes, I think it’s narrowing. I think people are listening. I do think that there is a certain amount that technology can do, but there’s a huge part that has to do with human behavior, right? The whole change management component of it. Some organizations manage it better than others. There’s a lot that you end up having to just understand: What is truly a technical problem? What is actually just a policy that’s suddenly being enforced that wasn’t enforced before, and the EHRs just suddenly make it very easy to enforce? And other things are: I may just be using a different workflow that worked well in one environment and is not going to work here. So I think opening yourself up to understanding what’s going on and what the ultimate intentions are can be valuable. You’re not always going to agree with it, but I think that technology is improving.

One of the things that I think maybe hinders how quickly the changes happen is the fact that there’s always a shiny new ball. If we think about it, a lot of electronic health record implementations really focused initially on physician order entry, and then they started to move to documentation, and really this was all in the inpatient environment. Then people started to make more aggressive moves into the ambulatory space. Well, on the one hand, you could say, “Well, OK, so we’ve moved. Does that mean that we’ve finished over here?” Well, the reality is no. We’ve just moved from the anticipation, the sale of a new concept, and the implementation, but then you have to work it and grow it, and those are really these optimization phases that truly are going to happen forever.

But in the meantime, what’s exciting, what gets talked about, is what’s tip of the spear, the really innovative stuff. So now you have everybody having seemingly moved past inpatient care and ambulatory care, and now everybody’s focusing on the virtual patient and the virtual experience. Now, suddenly, there’s a lot of interest in remote patient monitoring and artificial intelligence and how we are going to apply that. I think a lot of people, clinicians in particular, are left wondering, “Wait a second, what about the EHR? It’s still not doing what I needed it to do.”

It can be hard, because industry is going to be chasing new money. At the end of the day, when a lot of these things are driven by those dollars and cents, there’s not as much money in the moves to make modifications and these smaller, nuanced adaptations, number one. Number two, it’s often felt that it’s now the domain of the health system or the practice to fine-tune it. So in the meantime, the attention has moved to what’s new and exciting, and lots of money is being spent there, so there’s often that gap. Certainly, the initial excitement over inpatient EHRs has faded, and now people are trying to work in a lot of other capabilities, but it can seem like we’re not done yet.

Kevin Pho: Sure. And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Rodrigo Martínez: I think at the end of the day, it’s all about workflows and incentives. I think it’s understanding how you work and what you want to accomplish, and then working backwards from there to figure out, OK, what are the tools that I need to make this happen? I think it’s understanding, at the very minimum, if you are a physician who’s jumped into a new practice or a new health system, get to know who your resources are, whether they are colleagues or whether they are resources offered by the organization, and then certainly find those people and buy them lunch. And if you’re really into the innovation and the technology and want to meet other players, get to know your CIO and your CMIO. Vendors are often going to be stopping by, and seek out those opportunities. They really do value the input. So I think it’s for us as physicians to seize the day and make things work for us and for our colleagues.

Kevin Pho: Rodrigo, thank you so much for sharing your time and insight. Thanks again for being on the show.

Rodrigo Martínez: My pleasure, Kevin. Thanks for having me.