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Existing medical documentation, particularly EHRs, needs to support physicians - not stymie them - as the industry transitions to value-based care.

What to do when your EHR derails productivity and value-based care 

Three initiatives are changing the momentum for behavioral health and chronic care reimbursement. 

Behavioral Health Gains Momentum in Reimbursement

In the past few decades, healthcare has focused on money as a metric of practice success. Yes, we can only have a comfortable livelihood with money. Still, some areas of life are far more important than the girth of your investment portfolio or the size of your bank account. This blog will focus on ten areas, perhaps even more important than money.

Physicians often see their primary role as financial providers for their families. Such a focus rationalizes making sacrifices for the sake of our work and our careers. We also justify placing work before family as we are taught the virtues of a strong work ethic; I remember growing up that the advice was to study hard and you can go to college. Study harder, and you can go to medical school. Graduate from medical school and work 60-80 hours a week, and you will make a lot of money. If you make lots of money, you will be happy. Unfortunately, that is not a roadmap to happiness.

Your significant other, your parents, and your children should come first. They are much more important than seeing one more patient or doing one more operation. I recall Rabbi Harold Kushner's advice: "I never saw a man on his death bed who said, 'I should have spent one more day at the office.' But said, 'I wish I would have spent more time with my family.'" You must make time for your family and place the highest priority on spending quality time with your family.

Physicians are often too busy climbing the ladder of success and may need more time for their friends. We live in a consumer-oriented society where so much is disposable. Don't fall into the trap of allowing your friends to be disposable. If you have friends you can turn to in a time of need who will listen and be there for you, that is more important than money. My take-home message is to take time to invest in your friendships, both old and new.

As doctors, we are surrounded by stress. We have a sedentary occupation, don't have a regular exercise program, and are frequently sleep-deprived. Being caught up in our careers and working long hours may lead to neglecting our health. Too many physicians don't find time to get an annual examination by a colleague or fail to participate in screening tests like mammograms, PSA testing, and regular colonoscopies.

Investing time with your children is one of your best investments. Understanding how to relate and communicate with children will make you more fulfilled. Also, if you can communicate effectively with children, it may enhance your relationships with your patients.

Our children are our future. We need to care about children if we don't have any. We need to be aware of the danger of social media and how it can impact and pollute the minds of our children and our patients' children.

I know that the rigors of managing a medical practice can be daunting. We often struggle to balance the demands of a medical practice and raising our children. We all benefit when we find ways to be more efficient in our practices, stay home for dinner, and spend more time with our children. When your children are grown, they won't recall that you worked harder to buy them an iPhone. However, they will appreciate your involvement with their school, friends, sports, and how you treated your significant other. Suppose you need motivation to spend time with your children. In that case, I recommend you listen to the words of Harry Chapin's "Cats in the Cradle," you will go outside and play ball or build a LEGO project with your child. 

Robert Frost said, "Good walls make good neighbors." However, your neighbors can be a source of friendship, happiness, and comfort. Please don't write off your neighbors because they aren't the same age, ethnicity, or at the same rung on the social ladder as you. Part of our connection with the world comes from where we live. Our neighbors are an essential piece of that connection. You never know when you might need to borrow a cup of sugar!

As a physician, we can interact with many others from all walks of life. There are people with more material wealth than I have and many more with much less. I have noticed how many people focus on the material objects they need to improve rather than appreciate what they have. Unfortunately, our culture emphasizes what we don't have and what others have instead of enjoying what we do have. Consider making a list of what you do have and reviewing that list regularly.

As physicians, we live and die by our reputations. We may spend years creating and polishing our reputations. What takes years to develop can be wiped out by an unhappy patient with just a few clicks on a review site or a lawsuit that implies that we were negligent in our care of a patient. As those around us chase more fame, money, power, and worldly things, they often devalue or underinvest in relationships, such as their friends, family, and others who made it possible for us to succeed. Look at your review sites and see what others say about you. If it is less than five stars, then make every effort to repair your personal as well as your professional reputation.

Physicians need always to be learning. Using the same skills you learned when you graduated from medical school or completed your training will make you antiquated. We must continually invest in ourselves by participating in continuing education. There are many opportunities to continue learning inside and outside the medical profession. There are courses, lectures, and programs available on the internet on a 24\7 basis. There are colleges in many communities that allow students to audit classes. I have participated in the 

, which make available hundreds of lectures by leading college professors on topics from astronomy to zoology. You can download the 20–30-minute lectures accompanied by a guidebook that accompanies lectures. There is no reason not to continue learning for your entire career and beyond.

The United States has the most robust economy on earth and the highest per capita income of any country. However, if you measure infant mortality, gun violence, divorce, or suicide, we are at the bottom of the OECD. We do well in some areas but have more than our fair share of problems.

More important than money is to be part of the solution rather than part of the problem. There are many causes worthy of your voluntary time or donations. Examples include Big Brothers and Sisters, Mothers Against Drunk Driving (MADD), and Habitat for Humanity, which helps build affordable housing.

I have appreciated the advice to take your profession seriously rather than yourself. Physician burnout has reached epidemic proportions. Many doctors spend too much time and energy chasing money and worldly things and end up sad and disappointed. My father once advised me, "Neil, as you climb the ladder of success, be sure when you reach the top of the ladder that your ladder is not facing the wrong wall." This advice helps me ensure I have priorities beyond being financially successful. It is imperative to pull back, look for humor that can be found everywhere, and make it possible to laugh at yourself occasionally.

Bottom Line: Money is not the only metric of success. Other areas are as necessary or even more important than money. Don't chase the dollar sign, as you may end up with a full bank account but no friends and, even worse, estranged from your significant other and your children. Take a moment to look at these ten areas of non-monetary achievement. You will be happier, more content, and likely find more enjoyment from your medical practice.

Some areas of life are far more important than the girth of your investment portfolio or the size of your bank account.

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10  things more important than money

Rapid advancements in artificial intelligence—sometimes known as augmented intelligence, to reflect that AI-powered tools supplement human intelligence, but do not displace it—have inspired many to feel cautiously optimistic about AI’s potential to assist healthcare professionals.

Administrative lifts first, diagnostic help to follow

Some healthcare institutions have been quick to implement tools that 

streamline scheduling and reduce wait times

 for cancer patients. There are also AI-powered applications that 

. In terms of text generation, applications for clinical documentation have come a long way: A number of medical groups have embarked on the use of 

, through which the clinical note is ready and available, as soon as the visit has ended, for the provider to edit. However, attempts to use generative AI to compose messages to patients have produced 

In the more daunting arena of patient-facing care, healthcare systems are building on the success of clinical decision support in areas like 

. Image analysis is one area where healthcare systems are already deploying AI tools—sometimes for diagnosis, and sometimes for 

—with further deployment of other patient-facing applications expected.

Determining responsibility—and liability

While the developers of AI-based applications charge ahead, clinicians and healthcare institutions must temper their optimism with caution—and with questions regarding who will be responsible when a patient is harmed. How can medical professionals and organizations take steps to protect patient safety? How can they shield themselves from responsibility for aspects of healthcare technology that belong with developers, not doctors?

It can take years for answers to wend their way through the courts. Yet clinicians and healthcare organizations have to make decisions now, during “

the awkward adolescence of software-related liability

Asking three key questions can help decision makers guard their doors against risk and liability.

 Will the technology application be granted any power to take autonomous action, or will the application report a pattern or concern to a human who takes an action? If the application can take action, what are the stakes?

Self-driving cars in San Francisco have driven into construction sites, obstructed first responders, and otherwise caused headaches, if not hazards.

This experience demonstrates how AI lacks what is commonly called common sense. Therefore, when we say “artificial intelligence,” for now, we mostly mean 

, through which machine learning and deep learning give humans the means to make better decisions. AI-powered clinical decision support tools may flag certain patterns for clinician attention, but we still need and want 

clinicians to investigate and validate AI recommendations

 does not mean that the human remembers the loop is there. For a variety of reasons, including the many ways in which technologies thread themselves through clinical practice, and the prediction that increased throughput expectations could consume any time clinicians have to investigate AI recommendations, 

: “[I]t is perilous to assume that clinician vigilance is an acceptable safeguard against AI faults.”

Clinicians must have sufficient bandwidth to maintain vigilance, and workflow design must support and encourage that vigilance.

 At some point, it could be considered negligence not to use certain new technologies. For the application under consideration, how does the current standard of care accommodate human intelligence vs. human intelligence augmented by technology?

While the developers of AI-based applications charge ahead, clinicians and healthcare institutions must temper their optimism with caution.

Charles Hutchinson

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