Morgue Duty with National Coordinator for Health IT, Dr. Micky Tripathi

foreign [Music] [Applause] [Music] and we are excited to have you here today we're going we're talking about something a little bit different today than we have in the past talking about I.T Health I.T care it Healthcare I.T a wide-ranging conversation uh about um it's just every where it's going where it's been why it's been where it's been yeah going where it's going you basically like throw our guests some like things that we want and like tell him to make it happen yeah it's a little bit like Christmas morning and asking you know Sam's class for some things that we want uh and so and what this what it made me think about uh was actually the time that I spent as a super user for epic I remember that I do so I was like uh I did it as a fourth year med student and a little bit as an intern as well I'd like all my vacation time went towards right going to mostly the health the Henry Henry Ford Health System when they shout out to everybody at Henry Ford um when they went live with epic this was like 2013. this was pre-glock and so there may have been some people some listeners out there who interacted with you and did not know it I I got you know paid you know extra money obviously to like go and do this that's the only reason I did it because it was the worst job ever real bad uh because what I had to do was they they put me in like some area of the hospital so at Henry Ford I was mostly in emergency medicine and I just had to walk around and like help people like teach people how to use how to do like discharge summaries and and admission orders and all just put in anything all like make smart phrases all this stuff so and uh and you can imagine like Henry Ford's a big Health Center and so you can imagine people were stressed and and we were in emergency medicine yeah and learning how to use epic and so uh it was a high stress situation um and I do remember at one point during the week I was working with a cardiologist and I think it was a cardiologist uh and he was toward the end of his career you know uh and that that was it was the hardest for those individuals because they'd been on paper charts for their entire for like 30 plus years right and all of a sudden here the last few years of their career they had to like switch over to the most complicated thing in the world epic uh very very different um experience and that's your electronic health record system right so when you go to the doctor and the doctor is like typing into the computer they're typing like they're using epic or something like epic yeah there's lots of them out there but epic's one so that's the one we were on we were we were working on and um and so I'm working with this with this doctor and he's not saying anything and I'm like working at walking him through how to do like a I think it was a admission orders or something and um and as I'm sitting there like teaching him he just he stands up and he just walks away like he didn't say anything to me and I as as I didn't know what was going on so I just I you know I went on to do other things he actually didn't come back that day and uh and so toward the end of the week I like I asked someone about this guy I was like Hey I was helping this guy I haven't seen him since like what what was going on and they told me he retired foreign he decided that he would rather end his medical career then listen to me talk about discharge or admission orders for one more second that was it so that gives you a little little flavor about what the uh what the Epic super user job was like and so shout out to all the Epic super users you got a hard job uh but thank you do they still have those are people still doing that yeah people are still going live I mean I feel like I feel like everybody's on some kind of health record electronic record system at this point actually we learned 97 that's right we did learn that um and uh and so yeah that's still out there there's still doing it I don't know maybe International I don't know if it still happened in the U.S but yeah I remember what I remember from that time is as you coming home I've seen a lot of frustration about the triple clickers oh triple clicking yeah lots of truth I mean that's a like a lot of the job was just sitting there watching someone try to like do something right and and a lot a lot of you out there you love to click three times on things like consecutively it's my understanding and I Know It by by no means a computer expert is that there's never a situation where you need to click three times consecutively on one thing in fact it usually um creates more confusion than anything else that's right I was then weird things start to happen did you remember that yeah oh yeah I think I was having nightmares about Chipotle anyway let's get to our guest today so we have uh for our guest Dr Mickey tripathi and it's a fascinating guy he's uh the national coordinator for health information technology at the U.S

Department of Health and Human Services where he leads the formulation of the federal health I.T strategy this is like he's like the health I.T yeah he's the nation's Health I.T man yeah he's like

so if you have a question about like Health I.T fax him your suggestions this is this is the guy and it really was like it's just we had a fascinating conversation about all kinds of stuff I he answered all of my questions that I've had as a physician working in in healthcare in medicine and dealing with all these things so and he's a fun guy too he was a fun conversation he's got a good sense of humor I don't know what preconceived notions you all have about I.T people all right but it was it was a very gregarious wonderful individual not that it's not what you would expect he doesn't even like a basement that's right that's right he gave us some stories about that well let's get to it let's do it here is uh Dr Mickey tripathi yeah all right we are here with uh Dr tripathi Mickey tripathi how you doing Mickey I'm doing great yeah thanks for talking to you thanks for thanks for joining us today now I I gotta start um with a question how does someone become the world Authority on like electronic health I.T because it's not exactly something that a kindergartner will say that they want to do when they grow up like I I just like how did you get to into this field it's it's it's kind of fascinating to me yeah it's uh you're right I didn't uh you know pop out especially you know I'm old so uh you know back then it would have been you know amazing Vision to say electronic medical records that's where I want to be um so uh I was working for a consulting firm and we went out to uh Indianapolis to do some work um with the Reagan Street Institute out there I don't know if you know those folks but they've you know in Indianapolis it turns out is like a beacon of Health Information Technology unbeknownst to a lot of people really um yeah there was an Institute out there called the Reagan Street Institute and um founded by a guy who was an industrialist who went to a hospital you know and um and was shocked by what he saw like he couldn't believe that you know that they were using better technology and dishwashers than they were using in the hospitals and so he created this institute um that I think both of you will probably attest to that being the case um and uh so he created this institute that worked on health information technology so anyway I was working for a consulting firm we went out there we did a bunch of market research and we kind of looked at it and said wow this could be you know like a really interesting business this is like in 2002 yeah that's what got me started in in this area and I I just like love areas where you mix science technology policy and business well you probably saw the the landscape of Health I.T and realized well there's some work to be done here yes it looks like it was a lifetime for the rest of my for the remaining part of my life yeah I mean because you you've been at I mean just the the change that you've seen over the last 20 plus years uh of uh you know going from paper records uh exclusively pretty much right um to just this this really rapid adoption of of electronic health records and different Health Care you know record systems and and so how how do you feel about the speed at which this has happened is it going fast enough is it is it too fast is it you know how are we doing just in general yeah you know my um my my clinician friends will kill me for saying this um but I think it's going at the right pace which is to say that you know if you if you um and I know I mean you you were on the front lines of you know living this right of this change so um actually I should ask the question back at you but you know just to give you the just for the context we um you know like in 2010 or 2005 whenever it was something like five percent of providers were using electronic health records and that was self-reported so that was also you know my brother-in-law's access database Microsoft Word with macros that's all electronic health records right and then we invested a ton of money through you know Federal incentives in the private sector to the point that we're now at the point where 97 of hospitals and like 85 percent of ambulatory providers using electronic health records so that's like a short probably 10 years you know and if you think about um the you know this is the like the most complex part of the biggest economy in the world flipping that from like pretty much zero percent adoption or five percent adoption to 97 adoption and 10 years that's a pretty remarkable achievement I think there really is and so what so was it the the subsidies you're talking about was that what really started driving it like what was the impetus to like really turn the lever and you know just really get it ramped up yeah so the the we had you know before the federal government so the federal government dollars were huge um and it was it turned out to be about 35 billion dollars in incentives um through Medicare and Medicaid um you hopefully got one of those checks you know like to make sure that you know that all all of the really Advanced Physicians got them but uh but you know before then the challenge was um that you know that there was like slow adoption of electronic health records but you know Healthcare you know as you know Healthcare is really complicated in our country right and so the Challenge from a technology perspective was that um it was kind of a prisoner's dilemma like you know doctors felt like well I don't want to why should I invest in this technology it's like forty thousand dollars a user or whatever but I get no benefit right you have no pricing power as a doctor it's not like you can say oh I'm gonna pass this on to my customers well you can't charge anymore you know and um and the health insurer isn't going to pay you anymore and the health insurers on the other side felt like well I don't want to provide you know the subsidy for the electronic health record because I can't prevent that doctor from using it on patients who aren't my members right so they felt like well you know I'm going to pay for the whole EHR but I'm only 10 or 15 of that patient of that doctor's panel and so you know therefore I can't capture all the benefits so we're like at this real stalemate that everyone felt like well it's good for society but not in my interest to do it um so then the federal government came along um in night in 2010 high tech and said well there's a public goods problem here and also Medicare and Medicaid have a really distinct you know kind of incentive to say wait a minute our providers are all across the country and it would be great for them to adopt electronic medical records because we believe that's good for Medicare and Medicaid and good for patients at large so how about if we provide the incentives and kind of share the cost and you know in a way it's not that different than business this is due every day if you think about you know right Ford and Toyota and Walmart they invest in their supply chains I know you I know you don't like to think of yourself as a part of the supply chain but that's all right Medicaid you're just supply chain I get it absolutely well you know it's I remember so I when I came into medicine so I started med school in uh 2008 and and so this was very and we had it was like a the hospital I was in which is a Dartmouth Hitchcock Medical Center um we had this uh hybrid system it was it was like the we had uh the some some of it was on the silhouette I don't even remember what it was called yeah I forgot what that was yeah yeah yeah yeah CIS some something I don't know anyway I'm not I don't know what it is someone out there is yelling at you yeah exactly it was it was this um but then but then we still should have left I missed that system but then we still we still did uh orders like on paper so it was this weird you know hybrid thing and then I was there when we made the the switch over to to Epic and that was that was a huge deal and would you call it epic it was it was it was an epic uh for some people call it an epic fail that we you know but that was you know it we we understood I think that the reason why we needed it you know for all the reasons just to make things more efficient and uh I mean in some ways more efficient but just the documentation uh more thorough and you could actually read the handwriting you I mean you could read the text you have to try to read Dr handwriting um but it was a huge challenge for a lot of the Physicians and it was there was a lot of stress around the go live and and switching over to that kind of system um and so you know I feel like we're at the point now though where everybody accepts that that's the best way to do things but we also now have all these different systems that still don't seem to talk to each other and in a lot of ways and that that seems like a big struggle right now as opposed to like actually getting people on board with electronic health records am I wrong and like seeing like that's that's still like a big problem that we have in this whole system no you're absolutely right and I think you know a part of that is just kind of the you know the nature of adoption like we got to get everyone from paper to electronic first and then start to think about what are the things that you know we want to build on top of that in you know interoperability being one of them we want the systems to be able to talk to each other and we want to be able to do things that are more than just like better billing and getting rid of file cabinets right I mean we can you know we we uh expect more out of the 35 billion dollar investment that we've made but I think it's appropriate actually to phase it we um in a prior organization that I um worked for um we implemented electronic health records among you know Community docs and you know and often onc and the whole program gets criticized for not doing interoperability from the beginning I guess you know I would argue that that was actually really appropriate to phase it because I remember I still remember one of the one of the Physicians who we brought live first so this is back in 2005 right really really and we brought you know him live his practice live it was a him brought him live on his on this on his EHR and we had a lab interface set up with the hospital and we turned it on and I wanted to be there for the ta-da moment to see the joy that would spread across his face right and the left and the laugh started coming in and it wasn't Joy it was terrible it was like stop it stop turn this on no no what is this and you know and I was like no no those are those are the labs that you can he's like I don't want them I'm not responding you know how can I be responsible for all those where are those coming from it's like no no those are the same Labs that you ordered they're just not coming in via fax they're coming in electronically but he was just like turn it off now it's like I'm having enough problems just dealing with the EHR that I document now you're bringing in all this other information so I think part of it is just that cultural thing you first got to get people settled um second is one early learning we had in implementing ehrs with all these docs is if you screw up they're getting paid then everything else stops right and everyone's always criticizing oh you know you just focused on a revenue cycle it's like well people need to get paid like the minute that the revenue cycle broke and all of a sudden cash flow stopped coming for two three four days the practice is like all right we're done here you know thank you so much for coming take all your computers and and you know we'll see you next decade but you know we need to get paid so that was the other thing is you gotta focus on Landing safe is kind of how I think of it it's like let's land everyone safe first and then we can move to the next thing the last thing on interoperability I think is that um is that you know standards change a lot like if we had you know because we were in the through this Federal program you were starting to implement ehrs like in 2012 like 2011 2012 and think about what technology was you know was like back then and you know we would basically have been like baking in AOL you know for all these systems and now we have much better ways of interoperating you know you think about the apps on your phone and all of that that's like restful apis and all this technical mumbo jumbo but a lot better standards now that are much more lightweight and that's what we're trying to push the industry toward is those lightweight standards so it made sense to wait because you know that things are going to change and if we don't have to make those decisions that early let's not make those decisions until later and let you know all the other parts of the technology develop are we still in the early stages of the achieving the interoperability yes or are we like like where on the Spectrum are we here are we anywhere close to what phase are we in um I would say you know we are we're not infants I think we're toddlers okay and you know the reason I say that is is we throw temper tantrums appropriately um but uh uh there is interoperability that's happening so there are networks now that that exist um The Connect up EHR systems and um there's one called Care Quality that exchanges like you know they do 50 million transactions a day um okay connecting up you know provider organizations on the back end and just to give you a sense you know the Swift global banking network does 41 million a day so you know so that's a lot of interoperability that's happening um the problems with it are the data is still highly variable in terms of quality so you may get you know like if it's not if it's coming from a different EHR system for example you may get it and it's still like uh you know that it didn't come together seamlessly I'm having to go into this other Tab and find it in the basement of the EHR and you know and and it's hard for me to read and you know I really just wanted to know if the patient was allergic to penicillin or something and I know I have to read through an 80-page electronic document to figure that out it's a lot easier just pick up the phone and you know so I think we have those challenges that now we are better and better at delivering the information back and forth you know more work to do for sure but better and better with that but the next level is well how do we make sure that the data is actually useful you know and then it's giving you the right information at the right time so that you can actually you know make better use of of that information and get through your day in more efficient ways than you're able to today that's that's sort of the next set of challenges and are we looking at like standardization as a part of that to you know make the data systems from each place be able to be more um you know easily compared with each other and and merge together or is maybe AI something that can help with not having to do that as much or what is that what does that look like exactly God we're only a few minutes in and AI came up oh man absolutely I knew we were going to get there um standards are certainly a part of it um because you know because that is a challenge and computers are you know really dumb in certain ways right well right before AI computers are really really dumb right so they they you know if like if if that lab came in and here you know in your in your lab it's you know sort of a blood panel in that hospital and this it's a CBC or something the computer's like oh those are two different things I have no idea what that is and so if you wanna if the data isn't standardized it makes it really hard for you know for you to be able to get it integrated in the right way into all the great higher level things you want to be able to do with it um right you know the hope is that with AI you have the ability to say we can actually learn and see that those four or five different things are or the things those different lab results that the computer thought were four or five different lab results are actually the same you know the same lab that was being done it just happened to be done by different Labs so a better ability to make sense of that information to turn data into information I think is what we want to be able to do yeah that would make a lot of sense especially with how many different electronic health records systems there are out there you know that that display things in different ways and yeah different organizations deeper you know I would argue and you can tell me you know you're being a clinician I'm just a fake doctor I'm one of those PhD doctors um but you're like a real doctor um is that you know that the that that I think it goes even you know it's deeper than the EHR it's that providers doctors themselves document differently and they want to document differently right you know so I often hear you know how come you didn't require that the EHR vendor do this or this and I was like well the minute I did that is the minute that you would tell us that we were you know a socializing medicine because we were forcing you into that template that came from Cerner or e-clinical works right you know and is that what you want and I you know I've helped doctors Implement any HRS and the first thing they do is they tell the software vendor you need to adjust the software to my way of documenting it yeah because yeah I document better than all those other guys and gals actually you know you got it pretty nailed though yeah yeah especially in your case or my my scribe documents better yeah let's be honest you're not documenting anything [Laughter] the as you've been talking I keep I keep thinking back to um to cprs the the VA health system which is which has been around since I don't know the 80s right it's a long time and and I just it's been a while since I've worked in the VA system but um that seemed to have the interoperability down pretty pretty remarkably at uh for how old it is and uh uh just being able to pull up all the records on your patient regardless of which VA they've been to in the country and do you feel like we've learned lessons from that was that like us a stepping off point for any of this or is that just a completely separate thing that um doesn't really inform our you know thought process on this at all I think it does I think I mean you you said um you had a key phrase in there which was you could bring all the information from the various va's so it's like you know they're all using the same software it was just you know sort of different instances of the software different databases under the same you know kind of basic technology and so that made it easier for them to be able to bring it together because it was you know basically the same technology but I think that there are a ton of lessons um yeah that you know that were learned and continue to be learned from the VA um because you know it kind of showed what the promise was it showed that if you could actually get these systems connect with each other here's kind of a vision of the future of you know what that can do for um you know more holistic view of the patient and for better quality I mean uh you know my mom it's funny my mom was a physician with the VA for like 35 years and my dad was in private practice and you know for a long time there was the kind of yeah private practices you know higher quality and that's where you know the highest quality and then the VA started being able to show data that demonstrated that hey we got this technology and we actually deliver pretty darn good quality it turns out and you know my mom was like wow look at the VA right who knew that yay actually delivers high quality um so I think there are a ton of lessons there and there continued to be tons of lessons I mean they're going through growing pains right now as they move to a commercial vendor but I think one of the challenges that they found with the Vista system is you know when it's customized it's really hard to keep up with that and once you you need to keep growing and building and if that's all custom development that ends up you know having a lot of overhead and a lot of weight on top so just for Kristen's uh um you know information the this Vista he's talking about that which is the the documentation system at the VA yeah basically it felt like a glorified uh Word document it's basically kind of like what it what it seemed like and but you could customize your own documentation pretty well I honestly when we moved over to Epic for the first time I was like happy to go back over to the VA and be able to like it just it seemed so simple at the time but but you know there's other issues with with that as well but um but yeah I mean it's you know it just you go to something like the the systems we have now and there there's you can see how it would be very overwhelming to someone like just dropping them into this um when they've you know been on uh just your paper records and writing I mean we still in our practice we have some paper charts still that we have like they're old now but we so we keep a few around [Laughter] but man I'm just so very occasionally like if someone's had LASIK or some eye surgery from like 20 years ago you know sometimes I'll go back and I'll look at that paper record the documentation my God it was uh it was it's it's hard to figure out what was going on uh and it's like it only made sense to the doctor themselves and so and my point about saying this is is that it I think I see one of the huge benefits of everything we've been talking about the interoperability and the way we're documenting now with our electronic health records is that in the end I think this is such a great thing uh for the patients and I think from the patient perspective it probably feels chaotic you know there's there's all yeah right it does but uh in the end I feel like it's it's we're moving in the right direction toward just being able to educate our patients a little bit better having them have access to some of their records just more more easily and and I don't know so could you speak on that a little bit on how you see where we're going really improving patient care and yeah like you know what relationship with patients is I would like to see and I don't know sorry to mention AI again but I feel like it might be helpful for this um you know he and I both have a somewhat complex medical histories right so I would like to see the ability like technology be able to come in and and you know do pattern recognition which is what it does so well right and be able to say you know this patient over their lifetime has had this this and this and you know just really quickly and easily be able to tell oh they have this you know complex condition or whatever that a lot of um you know human beings would miss so you know that would be delightful from a user perspective can I just like do you have a suggestion box that I can drop that into or because you just did okay good exactly um I think I think we're getting there I think we're really getting there and we're really you know sort of at the cusp of that kind of capability and what the reason I say that is um you know you need at least two things for that one is is you need the interoperability because you know Dartmouth Hitchcock let's say only knows so much about me and in order to be able to you know really in a complete way do what you're described driving you know you want to be able to have well I need as much information as possible before I can you know sort of turn the algorithm loose and then be able to you know get the most accurate type of view of you as an entire person um so first off you need interoperability and that has to be higher quality data so as we were describing before you know if it's a dropability with dirty data well great now I'm applying my algorithms what am I going to get am I going to get potable water out of oil prices on raw sewage I don't know but uh yes that's the first thing and then the second is is the algorithms of cells you know how do we bring those to bear in a way that um that they're easy to use that they're understandable and that they're safe I mean uh you know the um the you know I'd love you know both of your views on this I mean we're just at the you know just at the at the beginning here of this revolution um with chat GPT and everything making these tools really really easy to use and almost dangerously easy to use because you can just start right just using them and um and a couple of the challenges with this I mean I've heard from providers who get concerned about algorithms because the Black Box nature of them you know they kind of feel like well I could take the whatever results are coming out of this that no one can explain to me where it got those results that said that your risk is high or I could use my clinical judgment which I actually know something about so until you can explain to me what the Black Box does I'm going to use my clinical judgment um but hopefully as those get better and better you know I'll have greater comfort with them but we need some guard rails around them I think just so you know people feel a greater sense of safety as well because you can make decisions that you know that are dangerous um uh you know in in certain cases right that's why I kind of maybe I shouldn't scoff but I kind of scoff at the this whole idea of you know replacing people in healthcare with with AI uh and and you know you get on social media you'll see people that are playing around with it and like show how it's just it's not there it's not even close really with being able to replicate the thought process of a healthcare professional taking care of people and right yeah past the mle yeah because we all know that that's that's uh you know the highest quality evidence yes first for someone being a doctor right it also doesn't get the fact that like it's still people putting their data in you know and writing the algorithms and you know you can't really completely extricate humans from the technology right yeah right so yeah I think I mean I think that's a great point that uh you know that and and it's so early you know like who knows where you know where this is headed um that you know that right now it's kind of well is it automation meaning well get rid of doctors it'll all be you know computers doing it or is it you know something that is really a part of you know human-assisted right you know sort of care right that you know the tool in a toolbox yeah and and that you know and I could see a point um where you know as a patient I may actually want to know well I'd love to know that you know you as a dermatologist that you actually used some AI in the background to Screen through you know two million patients before making a judgment on one of that mole actually is cancerous or not but you know I also would take comfort in the fact that you're making the final decision um so there may be a little bit of a demand kind of thing too where patients you know want to know actually that you're using the tools that you know the people have a sense can actually help you and right but also that you're in control and that the humanism you know is sort of in the loop there I think the other thing getting back to your point about you know wanting to be able to have you know sort of what's the dream here um is we're doing a lot to make information available to patients so that patients can have the ability to take an app and up with their choice download the records onto their onto their iPhone we'll talk about some of the concerns with that in a second but yeah but the you know but the idea is that you ought to be able to take your records and maybe it's in five different places take those records into five different places maybe bring in you know other information that only you know like your Fitbit information or whatever sleep app you're using or whatever else and you're over the counter you know uh you know purchase data and your food data and you can imagine Services developing that say we can take all of that information and give you you know information about your wellness and you know advice and I'm sure nothing will go wrong with any of that but um yeah no insurance right that's the opportunity for you to be able to do those things that you know your healthcare provider isn't going to do because that's not the way we think of Health Care in the U.S you know Healthcare is in the US is when you get sick then I show up at the doctor I show up at the hospital and they use whatever medical information they have and that's what they do to make you not sick anymore versus a view of wait a minute we're on this continuous journey of different degrees of you know kind of Wellness all of us are temporarily healthy at points of our lives and your ability to have more and more information that Services can develop around and provide you with information that guides you through that entire entire patient Journey that's you know that's kind of what we want to be able to enable right yeah and I think patients are always going to look for information and try to figure out their own things right they're doing that right now with Google I mean you can't just like take that out of the equation because that's not human nature humans are going to be curious about this thing that's causing them a problem and they're going to do what they can do to figure that out so Building Technology that enables them to do that in accurate and safe ways instead of who knows what ways that lead to who knows what misinformation yeah I think would be beneficial yeah I think that's one of the challenges is that a lot of medical information can be dangerous without context right and that's why you talk with your doctor about about uh you know your health issues and and you know so I I know you know there's been a lot of conversation lately in the past year or so about uh you know having your medical tests and results available to your to available to you immediately right as soon as it's coming in you're welcome and is that that's you did you do that that I'm I know this is controversial but I am a big fan of that so thank you no and I I think uh it's it's interesting to hear different perspectives on it because you know there are a lot of people I know a lot of Physicians who feel like this is a dangerous thing and that um uh you know without the right context it can it can lead to a lot of anxiety a lot of other issues but maybe the technology can help provide some of that context right you know right that's missing yeah exactly that's where I was I was going next is that I I think the the solution isn't to just not do it because that's not right it's patronizing too exactly people can't handle their own information people should there it's their information it's their own body it's the things happening inside their own body and so they need to have that information uh but we have to just be able to also give that other context or be able to let them not set them up to to not understand stand what they're seeing right I don't know I don't know I don't know how to make that can you fix that can you do that we're working on some of these things so you know so the uh come on Mickey let's go what's taking so long um the uh you know I think we're in this weird transition on that which is you know we're not gonna be able to sort of engineer all the you know the perfect solution before doing it I mean you know my experience is it's not until you actually do it that people start to realize oh wait a minute we need to have some more context around some of the stuff like as you're pointing out better education to patients and have that push to them but until we said you need to make the results available that's when people start paying attention and saying oh okay yeah we need to be able to do that and right now it's really clue G and you know my my daughter is a physician and she talks about situations in the hospital where you know she's a pediatrician where they you know literally race down to the um waiting room to make sure that they're able to talk to the patient before the patient's parents before something shows up on the app that they you know want to make sure that the patients the parents have an understanding so you know right now it's all like men manual and we're trying to you know sort of figure it out a little bit ad hoc but the idea is that the technologies will rapidly develop to provide context um as well as provide capabilities that are more calibrated to individual patient preferences because I think that there's a whole spectrum that the current system just never really you know sort of addressed which is and what I mean by that is the current system was every hospital physician made kind of arbitrary decisions about well we're going to wait a week before giving you these results we're going to wait a week and a half and that meant that all the people who you know who actually really wanted the information right away were just left out you had no choice you couldn't get it and what we're you know the reason to do it the other way is to say you know what we should make it available but if they're you know if if there are patients who say I would rather you wait a week then by all means you know our our regulations say that's totally fine now the technology hasn't totally caught up you know some vendors have developed that capability to allow you as a patient to literally come into the portal say I would like to wait a week before any results or I'd like to wait before you know wait for my provider to call me first and what we need is for you know for the supply side to kind of now meet that demand um but otherwise I think it just wouldn't happen unless we you know sort of said you know what let's make the results available to you know to everyone and then let's everyone adjust to that and we also don't think about the other side of it you know for every one of those anxiety-ridden uh you know sort of situations where you know someone got the result before they were able to talk to the provider I mean you know I have people on my staff from one you know one our head of policy who wrote A Blog about this so I'm not sharing anything that you wouldn't feel comfortable sharing where she found out she got breast cancer on the portal and she felt like that was actually a positive experience because she could collect her emotions she could do a bunch of Google searching she could talk to friends who are Physicians so by the time she talked to her physician she felt much more poised and better prepared to actually have you know the conversation she wanted to have um that's why I'm a fan of having access to that information is I you know I don't know I want to be able to do just that of you know get my head wrapped around it otherwise you go into or at least I do go into the doctor's office and they give you this information and then you're just kind of like in shock and you don't hear anything else that they say for the rest of the appointment and you know I don't know I think it's a good thing I and it's hard it's hard for for Physicians to put ourselves in that mindset because we know too much about medicine like we we know all these things so it's hard for us to think okay from even when even when a physician's been a patient like it's hard it's hard to think okay what if I didn't have any medical background knowledge whatsoever like what would I want here and um because a lot of it's just being able to empathize with other people but it's hard to do that when you just we already have the information and you know you remember we remember how anxiety provoking those days are in between you know the waiting days of I noticed something and I have to wait for my appointment to see whether it's anything harmful or I got this test but I have to wait for days or a week to get the results and those waiting days are just excruciating yeah what I do know is that nobody's I don't think people should have to wait just because of their doctors and ophthalmologist who doesn't work on the weekends like like come on as an exception to the rule right you know another really interesting point that our you know this is just you know a function of our medical system which as we know isn't as responsive to patients as we'd like it to be um there's a patient advocate who we worked with who points out that you know for all the conversation about the trauma of a patient getting a result before they talk to the provider you know think about the financial side like our Health Care system has no problem delivering you know a 17 000 surprise Bill to a patient and thinking about you know what kind of trauma does that count you know does that cause right I would argue that in a lot of cases that's a lot more trauma but that's imposing on individuals than oh yeah what kind of trauma does it cause to not know when you want to know right you know that is like what I was just getting I mean It's Tricky no you're right you're right I mean you don't have to tell me twice yeah the the insurance company is causing more trauma than anything on Earth so yeah for the most part I'd be a bit of an exaggeration but anyway anyway let's take a little let's take a little break but you cool off for a second oh you mentioned you mentioned health insurance all right uh yeah let's take a little break and we'll be right back with uh Mickey tripathi all right hey Kristen have I ever told you about Demodex afraid a little eyelid might oh gosh no don't do that oh I'm just saying if you've ever had red itchy irritated eyes it could be Demodex blepharitis you might have some little friends on your eyelids they're not quite this big well that's comforting to find out more though you can go to eyelidcheck.com that's

e-y-e-l-i-dcheck.com to find out more information about Demodex blepharitis don't freak out get checked out okay [Music] all right we are back with uh Mickey Dr Mickey tripathi and we uh so I I want to just uh have you talk a little bit about your own background because we've talked a lot about you know your experience the awesome things that you're doing in it most of which I probably don't understand and I never will be able to understand them but um you have a this isn't your first foray into the medical world uh I understand your your parents are both Physicians is that right yep and uh and you had a couple interesting jobs growing up in the medical world yeah I did so I was a uh an orderly as we called them back then do they still use that term you don't hear that word anymore I don't even honestly what exactly I I think of an orderly as like in the movies where like you have someone pushing a bed around like that was like Hey you personally I never even made that connection literal standpoint I am ordering and you are the orderly yeah exactly that must be it well I was definitely taking orders that's for sure work yeah it was kind of the equivalent of like the nurse's aid right you're one step up from the volunteer like nurses aid I don't even know if they use that term anymore but um it was sort of the male equivalent of a nurses you know I wore all white um and uh and so I worked Summers as an orderly in the in the community hospital um a job that I'm sure I know never would have gotten without you know my father's having you know had lots of connections with the hospital but amazingly we you know I was like 16 and 17 years old when I was doing this they had us doing stuff that you know that I don't think they allow or I used to do today like I was doing uh Foley catheters um on men for those for those who don't know what a Foley catheter is it's you know when you well you get a tube up your urethra up into the bladder so and it's you know that's that's that's that's the medical field of seeing it yep so you were doing that as a 17 year old you were a 17 year old I was doing that I was doing you know the pre-surgical enemas you know waking someone up at four in the morning and saying you know good morning cheers have you ever considered that your um whoever it was that was supervising you just really did not like you that's that's fun now that I think about it maybe it's not maybe um yeah so we were doing that so I was doing that and then I also was uh I was in charge of morgue dude well not in charge of but I did more Duty that's what the orderways would do is if someone died we were responsible for going up to the patient's room um you know um uh wrapping them up um you know obviously being as respectful um as uh as we could with the uh with um the process but you know wrapping them up and putting them on the gurney and bringing them down to the morgue and um that was fine during the day but you know one summer I did the graveyard shift and it turns out there's only one orderly in the hospital with a graveyard shift and we would hang around the ER all day but then you know a call would come for morgue Duty and that would mean that I would have to go and um and deal with that um and that wasn't fun because it maybe you can tell me why are all morgues in the basement like yeah why do you want to be a really scary traumatizing experience possible yeah because probably I'm sure it's dark down there and and yeah there's no windows there's no windows pipes clanking and yeah that's probably it it's probably probably because it's below ground and so you get to save a little bit on refrigeration yeah I guess I I don't know yeah yeah so but do those experiences uh they didn't make you want to run yeah yeah so we had this whole thing where you know of course that you know the it turns out that a lot of the more duty calls were in the cancer Wing which was a different building from where the ER was and so when you get the more call and I was in the ER to have to go down to the basement go through the tunnels which are as you can imagine from a you know 1920s era coming Community Hospital you know Doom incandescent lights yeah place you know at about you know one third of the frequency that you would expect and Clinton pipes because it's all steam skeletons yeah and so you have to go into the Morgan you have to get the gurney so it's like going in and like getting the grinning and then racing over to the you know to that cancer wing and then you have to bring it back and they always told us you know go in and you walk it all the way in and there'll be other gurneys with bodies there and you put it in order you know next to that and they were like two doors you have to go in so you open the first door and then of course it was like a vestibule and then in order to get to the second door you have to go all the way in and that means the first door is closing behind you right so yeah yeah so so I'd go in with sometimes go to the body claustrophobia open the first door and this is you know it's it's the middle of the night so there's no one there like you're the only one there you know open the door kind of go in and I am you know I am very embarrassed to admit it but I will admit it here on this public show that I would open the second door and I would hear that first door click and my heart would start creeping up through my throat and I would just gently wish the patient well and push the gurney in and turn around and race out the door as fast as my 17 year old legs could take me um it was it was a pretty scary experience to this day I mean I didn't see it but every single time I just had this Vision in my mind of one of them like sitting up yeah as I was going and I did not want to see that if that was going to happen yeah oh my gosh pathology was not in your future or being a mortician yeah that wouldn't have worked yeah and I imagine you weren't uh uh you know doing any documentation in an electronic health record at that no the orderlies didn't do any documentation of anything I mean I assume someone has no record of even be there patient had a fully catheter put in but no Runner asked me to document anything so and how are your Foley uh inserting skills these days do you think I'm out of practice let's just say yeah thankfully so thankfully so yeah yeah did you because because I know your father was a was a was a Surgeon General Surgeons all right he was you know back back then um I I don't think people do this now but he was both a family doc and a general surgeon so he was like the old Marcus Welby type doc so he was you know he had a solo practice his whole career and he would you know see all generations of the family but then when you needed your appendix take out taken out you know he would refer you to the hospital he would go into the hospital he'd do the surgery he would do rounds every day he would do house calls I mean he did you know kind of the whole thing that's the classic like yeah yeah it's I'm sure it was difficult as well but I feel like it's got some pros that were missing these days you know of like one person who knows a lot of things about each patient and this gets back I guess to to what we were saying before about trying to make the technology catch up to that to be able to kind of pull together all the information over a lifetime I don't know I like that aspect of it anyway but not the aspect where those docs were like working like 120 hours nope that was no good right I mean he was on call like by you know growing up I remember him I remember many times you know watching Red Sox games watching Bruins games there's dad's call and you know he'd get up and be like I'm off to the hospital we'll see you right it was a it was a different model but um but there was a lot of there was a lot of high touch yeah exactly that's a good way to put it what he didn't know though and uh you know I'd asked him once I started getting into electronic medical records and he was surprised too that I was involved so you know what's the point of these things you know I deliver high quality and I was like I you know that I know you do um but you know so just for example you know you see what you have 2 000 patients roughly probably right and how many of those are diabetics and how many of those would you say are well controlled and it's like well statistically I like how I have no idea you know and that was the point right for every individual I could name every individual one and what he's doing with each one but like as an office and as a practice he didn't really have a good population Health view because he didn't have the tools to do that and you know I think that's a part of the point that's a good we need to find a way to get both you know to get that high-touch personal experience and also to have the kind of bird's eye view that the data can provide the chat Bots are going to give you the personal experience that's the thing right that's that that's uh AI is going to get us there you just well you know a future where you you walk into a room and and you just start talking and then it's just it all gets captured and it's there and uh you don't even have to walk into the room you can just do it through your phone from your home there you go practice medicine from your home that's right yeah well not everybody surgery every now and then like Ophthalmology that didn't work very well look at my eye isn't that enough yeah I still have nightmares I'm trying trying to do like on the fly at the height of the pandemic when everything was shut down trying to do uh Telly tella Ophthalmology uh it just it works better for certain Specialties these patients are patients who have difficulty seeing they have difficulty seeing and and that's a very good by definition yes and so giving them instructions on how to you know go to a website and operate put a put a little password code in there yeah they had it's challenging right yeah all right well I have so so Mickey sometimes what we'll do is I'll have like a just like an elaborate game or something to play but honestly I just have one question for you one question that I think is probably on the mines of all of the medical professionals who are listening to this episode right now is there anything that will actually kill the fax machine yeah or are is this just an immortal being it's the Cockroach of the technology world all right is this are we like 200 years from now are we will we still be using can we just like spin a few minutes here talking about the fax machine and how it's still a thing right now yeah um I you know I think the United States this is probably a really good one um there is certain Beauty in the fax machine it's very very flexible right you can scribble anything and just send it it doesn't care about standards or anything like that you know um but uh yeah I think um that is an ongoing source of frustration um there have been you know sort of you know but I think one of my predecessors had to kill the facts or ask the facts the facts I think it was like CMS had you know sort of a thing on ask the facts and we've been you know talking about that for years when I was working in Indianapolis um and we launched this health information exchange Network across the city to just to deliver lab results to all the docs um via like a you know a portal and one of the things we ended up having to do was you know I ended up you know going to all the different hospital CEOs and saying the only way for this to work is for you to literally tell all the docs you're not going to fax them their lab results anymore like you just have to shut it off and we had to have all of them agree because there were so many docs who wanted who still wanted to get the faxes right it's like well you're never gonna move them off of that unless all of you agree because you're all competing with each other as well it's like well we have to get everyone to agree to shut off the faxes and that's the only way that we can move it forward but obviously it's you know it's a big country it's really hard to like yeah turn off yeah I think um you know funny my daughter is uh she's a third year resident and she you know she's been in multiple systems with like epic and Cerner and I was asking her how that's going and she's like those are fine she's like they're not you know it's like it's all the older dogs who have a problem you know it's like epic certain I don't care you know you know the training is fine the systems work fine the thing that she couldn't figure out was one day they told her fax this to a community dog and she was like literally like what what exactly do you mean by that just like oh take this paper and shove it into that machine it's like you got to be kidding me someone used to show me how to use that thing well the explanations that I've been given about why the facts is still around is because it's it's it's uh safe people say it's it's HIPAA compliant which I take issue with because you have something that's just printing to some un random Place how is that it is monitoring it who's gonna see it it's actually yeah in many many ways it's not safer I

2023-07-07 18:51

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