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#223 - 🚀 How to write better notes (ft EMR guru Dr. Shama Patel)



Hello Friends 👋

In this Tech Tuesday episode of the Incubator podcast, Ben and Daphna engage in an enlightening conversation with Dr. Shama Patel, a neonatologist and clinical informaticist at Nationwide Children's Hospital. Dr. Patel sheds light on the pressing issues surrounding electronic medical record (EMR) systems and documentation practices in neonatology. She addresses the problem of "note bloat," where progress notes become excessively long and filled with redundant information, contributing to physician burnout and potential errors in patient care. Dr. Patel shares her innovative work in creating a more efficient and relevant patient review screen in Epic, tailored explicitly for neonatology, and discusses the development of a new progress note template aimed at reducing documentation burden while improving accuracy.

The conversation delves into the importance of having dedicated informaticists in each medical division to continuously improve EMR workflows. Dr. Patel envisions a future where all NICU progress notes follow a standardized format, enabling better communication and data analysis. She emphasizes that improving EMR systems is an ongoing process that requires cultural change within medical teams. The hosts and Dr. Patel explore the potential for standardized documentation practices across NICUs to enhance patient care and facilitate research, as well as the future possibilities for using AI in medical documentation. The episode concludes by highlighting the career opportunities in clinical informatics for young medical professionals and the potential for this work to significantly impact patient care, physician well-being, and medical research.


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Short Bio: Dr. Patel holds a dual appointment both in the Division of Neonatology and Clinical Informatics. Her goal is to combine her passion for the care of the smallest, most critically ill patients with her interests in technology and specifically the Electronic Medical Record to improve care delivery and provider satisfaction. Within informatics her focus is in applied clinical informatics, specifically workflow optimization and efficiency.


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Find the article mentioned in today's episode here:


Patel SY, Palma JP, Hoffman JM, Lehmann CU.J Perinatol. 2024 Jun;44(6):773-776. doi: 10.1038/s41372-024-01924-4. Epub 2024 Mar 7.PMID: 38454154 Free PMC article.


Learn more about the NeoMIND-AI EMR Subgroup here: www.neomindai.com

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The transcript of today's episode can be found below 👇


Ben Courchia MD (00:00.749)

Hello everybody, welcome back to the Incubator podcast. We are back today with another Tech Tuesday episode. We're continuing to call them Tech Tuesday even though they're airing on Wednesday now, but it's just the way things are. Daphna, how are you? How are you this morning?

 

Daphna Barbeau (00:14.798)

I'm doing well. I love Tech Tuesday because we always learn something new, something exciting. We make some connections in the community and stuff just grows. So I think that will happen today too.

 

Ben Courchia MD (00:26.893)

Yeah, we have the pleasure of having on with us, Dr. Sharma Patel. Sharma, good morning. How are you?

 

Shama Patel (00:31.258)

Good. I'm great. Thank you for having me. I'm having, I'm like starstruck, podcast struck to be here.

 

Ben Courchia MD (00:37.613)

We even though we did meet before, we got to meet each other during our visit that in Columbus, Ohio. And we're very happy to have you on the podcast for the people who are not familiar with who you are and what you do. You basically hold a dual appointment in the division of neonatology and clinical informatics at Nationwide Children's Hospital. And you have an interest in technology, specifically electronic medical record to improve care delivery and.

 

Daphna Barbeau (00:38.51)

That's nice of you.

 

Ben Courchia MD (01:06.349)

provider satisfaction, which is something that should stand out to anyone because usually that's no one has an interest in medical EMR. And so within informatics, you focus on applied clinical informatics, specifically workflow optimization and efficiency. You are the first author of a very interesting comment that paper that came out in the Journal of Perinatology not too long ago called Neonatal Informatics, Past, Present and Future. We will link that in the description below.

 

So thank you for making the time and talking to us about how to write better notes.

 

Shama Patel (01:40.41)

Thanks for being interested in this topic that most people never want to talk about.

 

Ben Courchia MD (01:47.181)

I think we are just interested because it's something that frustrates all of us. And so whenever someone is brave enough to tackle the issue, we have a lot of respect for them. So I just want to know maybe for the audience, how did you get into this realm? Because you are, after all, a neonatologist, just like all of us. So how did you tailor your path to become...

 

to play a significant role in informatics at your current institution.

 

Shama Patel (02:22.81)

Yeah, that's a great question. I think every applied clinical informaticist has sort of a similar origin story, and it all kind of goes back to efficiency. So I remember as a resident feeling like our EMR practices just felt really, really ineffective. Why am I documenting, and then a senior resident documents what feels like the same thing, and then the attending does something similar, and there just felt like there was a lot of information that was redundant, and nobody could.

 

answer why we're doing this. There was a sort of esoteric, well, we have to, by some overlords that nobody could point me to. Exactly. So that's what sparked my interest. And then I had an attending in residency mention that she had a fellow trainee at Stanford who was a neonatologist that was doing something with this EMR thing. And I went into the literature and I found John Palma's initial work.

 

Ben Courchia MD (02:59.221)

You

 

Daphna Barbeau (03:00.59)

That's the way it's always been done. Yeah.

 

Ben Courchia MD (03:17.133)

Mm -hmm.

 

Shama Patel (03:20.698)

John Palma of, you know, preemie Billy Rex fame now. And that was kind of how it all started. And when I was approaching fellowship opportunities, I wanted to pick a place where I could do both of these things. And so I ended up going to Riley Children's Hospital in Indianapolis where there is the Regan Streep Institute, which is sort of a pioneering institution in informatics. And I was able to get my MPH in public health informatics.

 

But I think most importantly, honestly, was the mentorship that I received from the chief medical informatics officer at, at now IU, Emily Weber, without her support and helping me understand that this was a career interest that I could build despite the naysayers is really the reason that I was able to ultimately achieve my goal, which was having a dual appointment in neonatology and informatics.

 

Ben Courchia MD (04:15.757)

That's great. And the first point you brought up, which is that when you start off as a fellow, as an attending, and you see the way we write notes and you're like, why are we doing this? The answer is usually, well, because this is the way young Padawan, this is how we've always done it. But the more practical answer I feel like is the one that we've all received, which is basically we've been writing notes forever on paper and with the advance of...

 

electronic medical record, we've tried to retrofit our written notes into a digital format. And I think this is where a lot of the pain points are coming from. Can you tell us a little bit about that and how this is an issue and maybe how do we liberate ourselves from these constraints?

 

Shama Patel (05:03.674)

Yeah, so as we all know that in medicine, particularly in pediatrics and neonatology, a lot of the work that we do is not based on concrete evidence, right? Because we don't really have a lot of other options besides to look to what we've done in the past and see that it works and continue. Unfortunately, I think documentation workflows and EMR workflows in neonatology suffer from the same problem. If you look in the literature, almost,

 

decades ago, now in 1992, there was a paper written on the implementation of Neo data, which was the first EMR and it was in neonatology. I think what's sad is their same conclusions about how we should be concise and only should copy forward relevant things and the historical record and the daily decision -making are separate. They figured that out 30 years ago. And yet 20 years ago Drummond wrote a paper about paperless NICUs and had similar conclusions.

 

And I think, again, as we're transitioning to vendor, huge enterprise level EMRs like the bigger names like Epic and Cerner, we're going to suffer from the same problem as we just duplicate our previous work. And so I think what is imperative in improving this is thinking about what are the new tools that exist and how do we achieve our goal? And I think the goal is how do we keep all relevant information about a patient easily accessible?

 

How do we make this a better communication tool for our colleagues? We don't have to keep every single piece of data about a patient in a progress note anymore. Before, that was the only way to keep everything at your fingertips. And so I think breaking some of those habits is really the hardest part, right? We all know, you know, the entire echo report is in the EMR. Like you don't have to paste it into your note. It still exists independent of being entirely in your note. And I really think,

 

Daphna Barbeau (06:50.894)

Mm -hmm.

 

Shama Patel (06:57.658)

There are some cultural barriers we need to break to improve this process.

 

Daphna Barbeau (07:02.766)

Yeah, I had a question along that lines before we talk about some of the solutions that you are bringing to the forefront. I think we blame a lot on, and there are plenty of problems with the system and the fact that we use notes for billing. And so we have to do some of the billing compliance. I think hopefully you will come up with solutions that fix that problem. But we're part of the problem too, right? Like there are lots of things that healthcare professionals do to...

 

Cloud the Notes and Cloud the Medical Record, myself included. So I'm hoping you can tell us about some of those like note writing faux pas. You mentioned a few of them and I know I'll hear myself in most of these because I'm a extensive note writer. Ben's chuckling because he comes after me and he deletes my notes. So tell us what we've been, what are the don'ts of note writing?

 

Shama Patel (07:58.106)

So I think the term is note bloat, right? There's just a lot in the note that doesn't feel relevant. And I really think it comes down to not having a good understanding of what's expected of us. That's really the number one problem. I mean, how many times do you find yourself documenting something and you're not really sure who you're putting it in there for? If you think about the consumer of the note, is it a note to yourself in the future? Is it for the billers? Is it?

 

Daphna Barbeau (08:00.366)

Mmm.

 

Ben Courchia MD (08:18.413)

Mm -hmm.

 

Shama Patel (08:26.042)

because it just makes you uncomfortable that nobody wrote it down somewhere. Those aren't all always the best motivators. But I think having a clear understanding of which components are there and who they serve can help with some of that notebook. In the United States, I think we have some of the longest progress notes in the country. And I think some of the regulatory and billing burden is to blame. There is some...

 

stuff that's in there that we really can't get around. But much of it is self -imposed. How often do you come on and think, well, such and such a person likes their notes this way, so I'll just keep them like this? And I think some of that personal style preference is what we need to maybe move away from and come to accept some best practice standards so that no matter who's writing a note, you have a sense of how it's supposed to be built and what goes where.

 

And then maybe you won't have people, you know, deleting your entire note when they come on service.

 

Daphna Barbeau (09:23.79)

Noted.

 

Ben Courchia MD (09:26.349)

And in your commentary, you do mention this note bloat, and when compared to other countries that in the US, we have notes that are as much as four times longer than other progress notes. And I think that goes back to a lot of the things you're saying. And to that end, as you mentioned correctly, this plays a significant role in what we've identified as very high rates of physician and provider burnout.

 

Daphna Barbeau (09:30.67)

Mm -hmm.

 

Daphna Barbeau (09:37.582)

Mm -hmm.

 

Daphna Barbeau (09:52.718)

Mm -hmm.

 

Ben Courchia MD (09:53.741)

Can you tell us a little bit about how the two are connected?

 

Shama Patel (09:58.778)

Yeah, so as you guys know, I think in the last decade or so, we've really started to put a little bit of emphasis and focus on physician burnout and satisfaction. And I think that's why this is a great time to have this conversation about approaching progress note and documentation optimization, just like we do every other problem in healthcare. It may not touch a patient directly, but...

 

Our satisfaction with our jobs has a huge impact on the way that we're able to take care of our patients, which is why I think this is an important topic to get to now. Sorry, wait, remind me what the question was. I always like just get back on my snowbox.

 

Ben Courchia MD (10:36.269)

No, I was just making the link between our note bloats, the retrofitting of paper documentation into a digital EMR, and really how all these factors have compounded to actually be significant contributors to the source of burnout for many, many physicians who are on multiple surveys. I mean, it's not hard to go through PubMed and look for surveys on physician burnout and find out that EMR is often at the top of the list of sources of what is...

 

Daphna Barbeau (10:57.934)

Mm -hmm.

 

Daphna Barbeau (11:02.766)

Mm -hmm.

 

Ben Courchia MD (11:05.549)

is causing burnout for many of us. So I just wanted to, yeah, yeah. Yeah, go ahead.

 

Shama Patel (11:08.954)

So I'll share an unpopular opinion. Sorry. Yeah. So here's my unpopular opinion, that it's not really just the EMR. The EMR has kind of become a scapegoat for the way that our roles as physicians have changed. A lot of times people will say that they feel like they've been lowered to the level of a data entry technician or something like that. And my response to that always, though, is that your...

 

Daphna Barbeau (11:19.534)

Hmm.

 

Mm -hmm.

 

Shama Patel (11:33.754)

role is dictated by your behaviors and your interactions. So the way that the neonatologist interacts with the chart is inherently different than the way that, you know, like the unit clerk does. They're all equally vital and important roles in the care of the patient, but they're fundamentally different. Just like on rounds, we have a huge care team, right? There's so many allied health professionals that help us to take care of the patient.

 

but we still each have our own sort of scope and role. So I think in that same way, we sort of have to elevate our relationship with the EMR. And again, like I said, there is some truth to the regulatory and billing burden that we deal with. Some of this is real and it comes from outside of our day -to -day work with the EMR, but sometimes it's easy to point to that concrete thing as what's most responsible for your burnout.

 

Ben Courchia MD (12:08.045)

Mm -hmm.

 

Daphna Barbeau (12:25.038)

So you're saying I should value the work that I'm putting into the EMR. I like that. I think I can buy into that. And to your point, I think what some of us are recognizing, and hopefully you can tell us about the data about that, is that the way we do our notes now, actually they're quite prone to errors in the notes and miscommunication. And that puts, I think, us all at risk, especially our patients, for...

 

for medical errors. Can you speak a little bit about what's happening in the community in terms of the things that are incorrect in the medical record?

 

Shama Patel (13:04.826)

Yeah, absolutely. I think one of the things we don't place enough emphasis on is the nature of the progress note as really being like a legal document. The way that we casually write notes, I think in some ways is a little bit scary, right? Because if you're not reading every single line of a contractual document somewhere, we would never do that in any other portion of our lives. But...

 

We've become a little cavalier, I think, in medicine and the way that we write progress notes. And I think in the way we write them in neonatology feels particularly risky because sometimes, depending on the way that your notes are written, whether it's started by an APP and finished by the neonatologist or maybe started by a resident or primarily written by an attending, there are some times that information is presented in duplicate or triplicate. And that really just sets you up for a huge risk of presenting something that's in error.

 

And I think we also need to start relying more heavily on notes that are auto -populated, right? Things should come directly from where they were put into the EMR. There's really no reason for, I think one of my biggest pet peeves in neonatology is when, you know, like the nursing staff has to record like all the ABDs and then...

 

Whoever's rounding with you, like, writes all that on a piece of paper and then they like read it out loud to you and then like you write it down on your piece of paper and then you go and write that into a note. Like how many times has that data been transformed when really we should pull it directly from where it was? And the bigger question, exactly, a really dangerous and scary one, I think, if you put it wrong.

 

Daphna Barbeau (14:33.102)

It's like the telephone game, right? Dangerous, yeah. That's right. Very interesting.

 

Ben Courchia MD (14:41.965)

And so I want to maybe turn our attention to the work you are doing. Obviously, at your current institution, you are using Epic, which is one of the most prominent EMRs. But can you tell us a little bit, because the reason you're on is you are tackling these problems innovatively and successfully. Can you tell us a little bit what you have worked on to try to address these issues for your team at Nationwide?

 

Shama Patel (15:07.962)

Yeah, so there's really not a lot of literature that exists in the data about best practices around documentation generation. I think we have to look to some of our sort of semi -adjacent fields in informatics. Like there are people that have entire degrees in human computer interaction, in developing user interfaces that work well for the work that we're trying to do. And so I think we need to lean heavily on that to support us in improving these workflows. So one of the things that we're doing at Nationwide and

 

Ben Courchia MD (15:35.373)

Mm -hmm.

 

Shama Patel (15:37.658)

Hopefully we'll be deploying this new progress note in about two to three weeks. But we have, by we, I mean, I made a new patient review screen for the neonatologist that holds precisely the information we need to see about patients. There are a few really key pieces of neonatal information that for whatever reason are not coming standardly in build for neonatology yet. Like the percentage PO.

 

Daphna Barbeau (15:47.534)

Mm.

 

Shama Patel (16:02.874)

No one should ever be calculating a percentage PO for a neonatal patient. That doesn't seem like a good use of the care team's time, right? Any time, any cognitive effort spent on computation to me is wasted effort that's not moving the patient forward. So I've tried to develop an attending review screen that captures the high points of what we want to know and keeps it front and center.

 

Daphna Barbeau (16:03.214)

Mm. Mm -hmm.

 

Ben Courchia MD (16:10.797)

Mm -hmm.

 

Ben Courchia MD (16:27.213)

Mm -hmm.

 

Shama Patel (16:27.258)

hoping that that might reduce the amount that people feel that the progress note has to hold that information. So if the last chest x -ray or if the last head ultrasound is just one click away and you can visually see it when you're writing your note, maybe people won't feel like they have to write that down in the note at the same time. There are a few pieces of the progress note where I'm trying to leverage the power of EPIC to reduce some of this.

 

billing burden. Like for example, a query that we get on our end often is why is a patient on caffeine? Like we all know that our patients are on caffeine for literally one reason. It's always the same reason every single time. So I've made it now so that if a patient has caffeine ordered on their medication list, the note automatically writes, continue caffeine for apnea of prematurity. And those two things are linked. So when the caffeine order gets discontinued, the note will update and remove that. So trying to think of different sort of like,

 

Ben Courchia MD (17:05.421)

Mm -hmm.

 

Shama Patel (17:23.002)

You know, like the low hanging fruit of the way that we care for our patients that might decrease some of the query burden on us.

 

Daphna Barbeau (17:31.822)

And I think it's interesting exactly what you're saying. Like if another neonatologist picked up the chart, they'd know exactly those things, but the computer system doesn't. And it sounds like you're teaching it, which is really cool. Go ahead.

 

Shama Patel (17:45.882)

Yeah, no, exactly. I think it's really difficult to develop workflows that work for each specialty, right? Because only a neonatologist knows exactly what we need from the EMR. So expecting an analyst to be able to build us exactly what we need is kind of impossible, which is why I think informaticists are so valuable that can wear both hats, that can sort of work in that liaison role. And like we talked about when we met, I think every large division probably needs their own informaticists.

 

Daphna Barbeau (17:51.31)

Mm -hmm.

 

Daphna Barbeau (17:55.182)

Right.

 

Shama Patel (18:13.466)

But really we should develop some best practice standards that we can share in the community. So everyone's not redoing the same work. There are people that are going to listen to this podcast that are going to say, I've been doing this work at my institution for years and years. Every place that has a neonatologist kind of interested in this field has probably custom built that PO percentage calculator. That shouldn't be the case, right? Like we should have one person make it and we should be able to share it universally, which is our hope going forward.

 

Daphna Barbeau (18:24.814)

Mm -hmm.

 

Ben Courchia MD (18:42.253)

And.

 

Daphna Barbeau (18:42.286)

I have, sorry, one more question about the note flow because this really impressed me also when we spoke previously that it's not just about writing the note, but with your note template, this could potentially really help with rounding on the patient. Tell us a little bit more about that.

 

Shama Patel (19:00.41)

Yeah, absolutely. I really think that best practice for progress note generation and signature is as at the time that you make the decision, right? If you round on a patient at eight o 'clock in the morning that's critically ill, that's on the oscillator, we all know that if you don't get to signing it until three or four o 'clock, that could be a completely different patient, right? So in order for notes to be helpful, they have to be timely and accurate and up to date. And that means signing them when you make the decision. That's only possible if you have a...

 

workflow that's optimized for you to do that. So you need a patient summary screen that you can look at in real time. You need to be able to pull up the note right beside it in real time, and you need to have shortcuts that allow you to document quickly. So all of those pieces have to be in place in order for this sort of ideal state to function effectively for people.

 

Ben Courchia MD (19:48.105)

So what's in?

 

Daphna Barbeau (19:49.358)

So it sounds like what you're saying is we could round off of the note and sign it before moving on to the next patient.

 

Shama Patel (19:56.474)

Yeah, and I think even just moving away from this idea of rounding off of the note, right? Because historically all we had was a note. So if you have a patient review screen that has all the information you need, the note really only has to hold your clinical decision -making for the day, like your thoughts. There's really no reason that you can't do that in real time because you're having those conversations and making those decisions in real time. And yes, there are some patients who are complex, right? You go back to the office and you want to like chat with your friends to see what to do.

 

But a vast majority of our patients, I think it's possible.

 

Ben Courchia MD (20:28.461)

Mm -hmm. And so what's interesting is that I want to go back to what you described because I think some of these may be lost on some of our audience members who are listening to this for the first time. You are creating a new dashboard. So this window in Epic where you have all these different pieces of information and you are basically tailoring the data to our clinical practice. Like you said, instead of having fully catheter days, which is something that in adult medicine,

 

is something they use all the time. But in Neonatology, we don't really have a great use for that information because we rarely put in follies on every baby and so on. You have designed these data points to be more relevant to our practice, like how much percent PO and so on and so forth. And what I see from this is that by creating this dashboard, number one, you're alleviating one of the concerns you mentioned prior, which is I don't feel the need...

 

Shama Patel (21:05.402)

Exactly.

 

Ben Courchia MD (21:24.653)

to put this in my note because someone has to write this down somewhere in the chart. But you then have this feeling like, well, it is in the chart already because that's where I saw the information to begin with. And then from there, you're building a new progress note template that will pull on this information, relieve the burden on the clinician to transcribe data from the record to a piece of paper back to the record and so on and so forth. And really,

 

allowing us to focus solely on what is the thought process and what are you doing today for this patient.

 

Shama Patel (22:01.242)

Yeah, exactly.

 

Ben Courchia MD (22:03.469)

The question everybody is then asking right now in the car is, how do I get my hands on this template and this new build? Is this something that you... Obviously, there's a lot of... It's not a first take type of thing. I'm assuming you're doing these builds and you're rolling them out slowly to your team, getting feedback, making improvements, and slowly breaking it down in different releases like, we're going to try this new template today and then we're going to add this and so on and so forth. So...

 

How long have you been working on this? And when do you see yourself having reached a state of semi -completion where you say, well, we're in a good place right now where it's pretty fully functional note.

 

Shama Patel (22:45.338)

Yeah, so we're hopefully going to go live, like I mentioned in the next few weeks. And one of the things I've emphasized to all of my colleagues is that this is an iterative process that lasts forever. The note is never going to be done. You know, our patient populations change. Like if we had made templates 15 years ago, they wouldn't even account for some of our tiny babies we take care of now, right? And so really, like I said, I've mentioned so many times, it's really about shifting the culture. It's not as much about the technology piece. Like the template,

 

Daphna Barbeau (23:04.622)

Mm -hmm.

 

Shama Patel (23:14.97)

is the easy part. Really anybody can make a template. It's about coming to a consensus. I do think the tech piece is the smallest piece. I think it's the cultural acceptance within a group, agreeing together that you want to standardize some of the work that you're doing. And then like I said, just appreciating that this can change. We're so used to the EMR being

 

Ben Courchia MD (23:19.533)

I don't know about that.

 

Daphna Barbeau (23:20.046)

I don't know if everybody can make a template. Let's back that up a second.

 

Shama Patel (23:43.098)

a really ineffective part of our workflow and something that can't evolve and change, understanding that it can change and it can be better, but that it involves sort of like active effort on our end, right? Like no one wants to think about making the notes better at the end of the day. We're so busy and we have so much to do. The last thing you're thinking about is like, what could I change in this template to be less annoying? Unless you're Ben, I guess, maybe you do that all the time.

 

Ben Courchia MD (23:47.565)

Mm -hmm.

 

Ben Courchia MD (24:05.773)

Yeah.

 

Daphna Barbeau (24:08.59)

He does.

 

Ben Courchia MD (24:09.645)

Something that we've talked about many times where you're so busy thinking about the day -to -day that you cannot even lift your eyes forward to say, how can we make the future better? When you say that you're going to go live, does that mean that for us in Florida, for example, we could get access to this template from our version of Epic, or is this going to stay internal to nationwide and eventually be made publicly available? What does the release schedule look like?

 

Shama Patel (24:17.626)

Yes!

 

Daphna Barbeau (24:18.734)

Next, yeah.

 

Ben Courchia MD (24:38.733)

What do you intend to do with these new developments?

 

Shama Patel (24:42.618)

Yeah. So we'll go live internally at Nationwide. So Epic actually has the ability that if you're an Epic client, you can go into their sort of like shared community space and you can get what other people are using. One of the issues though, is that sort of the way that things are plugged in on the backend, they may not plug in correctly at the institution that's using it. So for example, the percentage PO calculation, like the, like, like the, the flow sheet where the...

 

numbers live might be different where it's going, but that's something that an analyst should easily be able to fix and sort of like plug things into the right part. I love this topic more than anything else. So if people reach out to me, like I'm happy to try to, try to, you know.

 

Ben Courchia MD (25:13.261)

Mm -hmm.

 

Ben Courchia MD (25:20.717)

Mm -hmm.

 

Ben Courchia MD (25:28.109)

Careful what you wish for.

 

Daphna Barbeau (25:28.814)

Careful, yeah, that's right.

 

Shama Patel (25:30.81)

I'm happy to serve as a guide in working on this. And you know what? I don't have all the answers. I just have big ideas. And I'm hoping that if we can all talk about it together, we come to a shared solution. My like pie in the sky vision is that every NICU baby's progress note, no matter where they're admitted, looks identical. Like, wouldn't that be amazing if we could, you know, talk about our patients in the same way? And I don't know if we're going to have a chance to talk about this, but really this is...

 

Ben Courchia MD (25:49.325)

All right.

 

Absolutely.

 

Shama Patel (25:58.458)

This is the basic work we have to do to be able to really harness the power of technology that exists today. Until we do this.

 

Ben Courchia MD (26:04.301)

And yeah, and so when you talk about this community space on the backend of Epic, like will people have access to some of the templates you're developing through that?

 

Shama Patel (26:15.29)

I think so. Let me double check how that all works before I definitively say, but Epic has something called the user web and they have these community libraries which allow you to access other organizations that are on Epic. I think it gives you access to everything, but I'll double check how it can be shared.

 

Ben Courchia MD (26:17.869)

Absolutely.

 

Ben Courchia MD (26:25.869)

Mm -hmm.

 

Ben Courchia MD (26:32.333)

And my last question for you today actually touches on that point, which is that in your article, you do mention how there's a necessity within each division to identify a champion, someone who will take this on. And I feel like as you're describing the process, you can clearly see that it's not like an app on your iPhone. You just download it and that's it. There's going to be some tweaking that needs to happen to really make it tailor -made to your workflow. And can you tell us a little bit about...

 

about then how important it is to have that person who's going to say, yes, I'm dedicated to taking this on, just like you are.

 

Shama Patel (27:03.77)

Yeah, I think having a dedicated informaticist is really key because these are all things like we mentioned, they need maintenance, right? If we build it once and we never improve upon it, we're kind of stuck in the same situation. And I think that is maybe why we're living in the space that we are now. But we spend so much of our time and effort learning about different ways to serve our patients well. But the thing that we do all day long, we have no support or guidance surrounding. We spent all day in the EMR, but...

 

Ben Courchia MD (27:19.597)

Mm -hmm.

 

Shama Patel (27:32.506)

How many hours have we spent learning best practice or having someone give us feedback on the way that we use it? Like almost never. So I think we have to start thinking about this as sort of like a procedural competence and supporting it in the same way that we would anything else.

 

Daphna Barbeau (27:45.422)

Mmm.

 

Daphna Barbeau (27:49.294)

Well, I think you brought up so many good points that say, we don't have access to your note yet or your unit that doesn't have Epic. You don't just have to throw your hands up. You can say like, we can work together as a team and come up with something that works for us, at least for now until we have something that's globally available. I think that's so valuable. And.

 

I think you touched on another interesting point that I think, especially for young people, young trainees, early career, that there are a lot of career opportunities here. This is just the beginning. I'm hoping you can speak a little bit to how if we had the same templates and we had the same dashboards, like what else can we do? What does research look like? How does this change what we can do?

 

poll from the EMR as well.

 

Shama Patel (28:44.41)

Yeah. So people are always like, why are you so obsessed with the notes? Like I'm really not obsessed with the notes, right? It's sort of a means to an end. So if you think about it this way, like if, cause people are like, well, AI is just going to write my notes. Like, yeah, you know what? It probably will. But if we don't provide the appropriate guidance for how that's going to happen, the notes will look just as bad when that happens. Establishment of a standard allows for us to build something that makes sense for us and works for us.

 

Ben Courchia MD (28:47.849)

Hehehe.

 

Daphna Barbeau (28:57.902)

Hmm.

 

Daphna Barbeau (29:05.71)

Mm -hmm.

 

Shama Patel (29:12.73)

before we have something in kind of coming in and telling us what to do. In terms of sort of career opportunities, technology is not going to go away from the work that we do. It's only going to become a bigger part of what we do. And the more as physicians we take ownership of that part of our jobs, of understanding the technology, the better we'll be able to serve our patients. So instead of technology kind of happening to us,

 

We can be at the forefront of this. We can be at the table making decisions because when you become an informaticist, you can kind of speak the tech lingo. Like you understand the backend of how things work. You can think of more creative solutions because you understand your clinical workflow and you understand the technical limitations. I think there is a world of opportunity out there. Once the notes make more sense. I'm so excited to see what we could learn from.

 

the AI and the technology that exists, right? If we all agree that the subjective portion of the note holds X, Y, and Z, maybe three or four days before a baby gets neck or sepsis, we're all describing the same thing. Right now, the way that our notes are written, it's impossible to do that. I can't even figure out what happened to a patient sometimes, let alone any other nuanced conclusion about a large scale of patients.

 

Ben Courchia MD (30:20.077)

Mm -hmm.

 

Daphna Barbeau (30:25.166)

Mm -hmm.

 

Ben Courchia MD (30:31.869)

That's so true. I think that's a great point for us to conclude this interview. We're going to, I mean, at your own risk and perils, we're going to put a way for our audience to contact you in case they're interested in learning more or contributing to the work you're doing. I think you are at the forefront of something very important that has a lot of important ramification for both patient care, physician well -being, efficiency, research that I think it's all very exciting.

 

Thank you, Shama, for taking the time today to share your passion with us and tell us about the work you're doing. This was very informative.

 

Shama Patel (31:08.57)

Thanks guys, it was so awesome chatting with you.

 

Ben Courchia MD (31:11.853)

Thank you.

 

Daphna Barbeau (31:11.982)

twice.

 


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