Welcome to our 10th annual Top Hospitalists issue! The physicians profiled on the following pages were nominated by their colleagues and chosen by ACP Hospitalist's editorial board for their accomplishments in areas of hospitalist practice such as patient care, quality improvement, and medical education. Read on to learn about their achievements and innovations, and make a note to nominate any top docs you know next summer. Note: ACP Hospitalist's Top Hospitalists feature is not part of the ACP National Awards Program.
From surgery in Nigeria to hospital medicine in Tennessee
Benedict Aimua, MD, FACP
Medical school: University of Benin School of Medicine, Nigeria
Residency: New York Medical College at Metropolitan Hospital Center, New York City
Title: Attending hospitalist at Johnson City Medical Center in Johnson City, Tenn.; adjunct clinical professor of medicine at Lincoln Memorial University, Harrogate, Tenn.
Before he was a hospitalist in Tennessee, Benedict Aimua, MD, FACP, was a globe-trotting surgeon.
He graduated from medical school in 1990, then practiced surgery and family medicine in Nigeria until 1997, when he traveled to Dublin, Ireland, to complete a fellowship in general surgery with subspecialization in trauma at the Royal College of Surgeons.
After a brief stint studying laparoscopic surgery in Strasbourg, France, Dr. Aimua came to the U.S. in 2005 for his internal medicine residency training. He then moved to Johnson City in 2008 and has been practicing as a hospitalist ever since.
These days, Dr. Aimua focuses on internal medicine and no longer performs surgery. However, he takes care of central line placements and difficult catheterizations that the nurses are unable to do. “Sometimes they call on me instead of calling the general surgeons, and I just do them on my own,” he said. “It's actually very helpful. It saves a lot of time, and it saves the hospital some money instead of having to put in a consult for general surgeons.”
As the chair of the quality unit for IPC, a division of TeamHealth, in his region, Dr. Aimua has overseen improvements in many areas for Johnson City Medical Center. “When I came in here nine years ago, we were struggling with a lot of issues, including documentation, length of stay, case-mix index, relationships with the administration and also other staff members,” he said.
Dr. Aimua's first improvement was in the relationships among hospital administration and staff, which helped lead to improvements in other areas. For example, when his group began focusing on improving length of stay, the average stay was about seven days, whereas it's consistently been about half that amount over the past couple of years, he said, attributing the improvement to collaboration with case managers, discharge planners, and patient educators. In addition, Dr. Aimua helped increase the tertiary care center's case-mix index from 1.23 to about 1.56 by focusing on appropriate documentation for its complex patient population.
A new project aims to decrease the mortality of patients with delirium to 7% from the current 12% to 15%, he noted. “I know it's a very tall goal, but I think we should be able to do that because there are simple things that I've been noticing in the hospital that if we prevent a lot of those things, we should be able to get our mortality down,” he said, adding that another goal is reducing length of stay in this cohort from an average of seven to 12 days to about three to five days.
Beyond improving safety and quality, Dr. Aimua is also involved in education. He helped the hospital and IPC/TeamHealth start from scratch an academic program with clinical rotations by physician assistant (PA) students from Lincoln Memorial. The program is now in its fourth year, and Dr. Aimua gave the keynote address to graduating students at the school's white coat ceremony in 2016.
Creating the program has deepened the PA pool for the hospital, which has hired several recent graduates, he noted. “It's helped not just the hospital; it has helped the region a lot, from nothing to having about, as it is right now, 30 to 40 PA students to hire from on a yearly basis,” Dr. Aimua said. “A lot of them are local students, and a lot of them are students who were born and grew up here, and they are usually very happy to stay back in the region.”
Starting young in caring for the elderly
Gopi Astik, MD, ACP Member
Medical school: University of Missouri–Kansas City School of Medicine
Residency: University of Missouri–Kansas City School of Medicine
Title: Hospitalist, medical director of clinical documentation, and inpatient medical unit director at Northwestern Memorial Hospital; instructor of medicine at the Northwestern University Feinberg School of Medicine, Chicago
ACP Member Gopi Astik, MD, has known she would be a doctor since she was in third grade.
She saw her first patient at age 17, when she began a six-year medical program after high school. The program meant forgoing general education courses and summer breaks to learn about medicine year-round. “But for me, it was worth it because I knew I wanted to do this, and it just got me there faster,” said Dr. Astik.
As she completed her residency training, a chief resident year, and a fellowship in geriatric medicine at the same institution, some patients followed her from clinic to clinic. But while many geriatricians elect to do more outpatient work, Dr. Astik believed her skills were best suited for the inpatient setting. She found ease in the difficult aspects of hospital medicine. “I think I form relationships pretty quickly with people, so it's not hard for me to get to know someone that morning and then talk to them about their life and goals of care that afternoon,” she said.
The challenge can be letting go at discharge. “When they leave or when they start feeling better, it's hard as a hospitalist because you don't know if your patients are going to remember you . . . but receiving a card or verbal appreciation on a patient callback feels really good,” Dr. Astik said.
Her current research involves quality improvement of discharge metrics and clinical documentation. As Northwestern Memorial's only hospitalist who is fellowship-trained in geriatric medicine, Dr. Astik worked with a team of physicians, pharmacists, and nurses to target patients through an initiative that built upon the printed medication list at discharge to improve medication adherence among frequently readmitted heart failure patients.
Initially, fewer than 40% of these patients were taking their medications correctly, and a previous project had shown low literacy rates among patients was likely a large contributor. “We realized that just handing out paperwork wasn't going to work; it had to be active learning,” Dr. Astik said.
Instead of the standard printed medication list, patients participating in the pilot project received an easier-to-read list that was also saved in their electronic chart, as well as comprehensive education about the medications from pharmacists, who used terms like “water pill” if necessary to make sure that patients understood. “It made them realize that ‘I do need to take my diuretic in the morning because if I take it at night, I don't sleep well,’” said Dr. Astik.
Over the seven-month pilot, adherence increased to more than 60%, but the team is aiming for full adherence as it adds more interventions, such as multidisciplinary rounds and more patient education from ancillary staff, she said. “Ideally, we'd want to do it for more patients and for more conditions, but we really want to find the sweet spot with education and pharmacy assistance before we expand it to other diagnoses,” Dr. Astik said.
Improving experience locally and nationally
Marisha Burden, MD, FACP
Medical school: University of Oklahoma College of Medicine, Oklahoma City
Residency: University of Colorado, Denver
Title: Division head of hospital medicine and associate professor of medicine at the University of Colorado, Denver
Since her first job as a hospitalist in 2006 at Denver Health, Marisha Burden, MD, FACP, has followed up with her patients after discharge. “It's something I really believe in,” she said. “People who I'm concerned about, I'll reach out to or they'll get my office number, which goes directly to my email, so I get their messages in fairly real time.”
Dr. Burden now does much more to improve hospitalized patients' experiences, but it took her a while to figure out that she had the power to change the system on a larger scale. “The research and the work that we do in academic medical centers can really drive national changes or national thoughts, so that's probably the part that I've loved learning the most,” she said.
As a researcher, Dr. Burden's interests may seem variable—she's looked at topics from bacterial contamination on health care workers' uniforms to the gender differences in leadership, authorship, and speakership in hospital medicine—but she said there is a common thread: hospital systems improvement.
As chief of hospital medicine at Denver Health from 2011 to 2017, Dr. Burden expanded the group from about 15 to 50 hospitalists and advanced practice providers. Over the years, she's also increased the services offered, including working with leadership and her hospitalist team to offer a palliative care service, expand the services offered within the ACUTE Center for Eating Disorders, and reimagine how to care for patients with complex disposition needs. Another key focus for Dr. Burden was to facilitate and grow the academic efforts of the group in terms of research, quality improvement, and teaching initiatives.
At Denver Health, she founded and chaired the Inpatient Patient Experience Committee, composed of physicians, nurses, pharmacists, patient advocates, therapists, and dietitians, with the aim of improving patient experience. “To me, a key to a hospital system's success is how patients and families perceive the care that they received, and alongside that is also provider experience,” Dr. Burden said.
After experiencing a health care crisis with a family member, she said she realized how important bedside rounding actually is. “A lot of providers will state, ‘It takes a lot of time out of my day,’ and I think we sometimes need to put ourselves back into the shoes of the patient or the patient's family member and realize that maybe what we consider minor is actually all that person is waiting for that day,” said Dr. Burden.
Dr. Burden is now division head for the division of hospital medicine at the University of Colorado, and one of her main research goals is determining the best model of inpatient care. “Does that mean geographically based teams? Does that mean rounding at the bedside? We have a lot of projects around that, which will be very important going forward because I don't think the answer is known that well at this point,” she said.
Encouraging physician development, from training into practice
Robert Chang, MD, ACP Member
Medical school: University of Michigan Medical School, Ann Arbor
Residency: University of Michigan Medical School, Ann Arbor
Title: Service chief of hospital medicine and associate chief medical informatics officer for adult inpatient hospitals at Michigan Medicine; associate professor of medicine at University of Michigan Medical School, Ann Arbor
After completing his medical training, ACP Member Robert Chang, MD, stayed at the same institution in various roles to fulfill his passion: nurturing other people.
As medical director and then service chief of the hospitalist division, he said he's overseen tremendous growth from eight to 100 faculty members in a competitive academic environment. “Growing people to be successful with that rapid expansion of our numbers and creating a culture of people that are committed, care, and will do the right thing every day is what I view as my biggest accomplishment,” said Dr. Chang.
He believes a key component of this success is his willingness to be an accountable member of the team and use personal vulnerability for the benefit of the group. “I'm not going to tell someone to do something that I'm not willing to do myself,” Dr. Chang said. “And in our hospitalist group, when someone called me on not doing what I was asking everyone else to do, that was a powerful culture-building moment where I could emphasize that ‘even I’ was not exempt.”
In his leadership role, Dr. Chang has also worked to identify areas of improvement and burnout among his physicians through a highly developed peer-evaluation process. This year, one key area was identified: negative faculty evaluations by learners.
“What we found was that our faculty had often provided a negative evaluation face-to-face, were often uncomfortable doing that, and the resident returned the favor when evaluating the faculty,” Dr. Chang explained. “The issue brought up questions about how our faculty assess all learners, not just those needing negative feedback.”
In a future session planned with the inpatient residency program director, “attending physicians will learn to give learners feedback frequently and clearly, with actionable recommended changes, which must then be reassessed and positively reinforced,” he said. “Just as important, you have to summarize the story that you've been telling with your feedback to them and say, ‘This is where I think you're at, this is what you're doing well, I think you could do this differently, and at our next summative evaluation, I want to see you achieve x by doing y.’”
Dr. Chang added that “Sometimes, you're going to get a negative evaluation no matter what you do. But if the learner was doing poorly in an area and did not receive any feedback and suddenly receives a negative evaluation, then the faculty will likely receive a negative evaluation, which is a failure on the teacher's part, not the student.”
In his role as associate chief medical informatics officer, he has two fundamental design principles: “Make the right thing easy, and make me do it once.” In 2014, when the hospital moved to a new electronic record system, Dr. Chang drove much of the inpatient design build, personally leading the training for the internal medicine faculty and residents while coordinating operations around the transition. “We had to make the best possible design [and] ensure that everyone knew how to use the new system, that all 50,000 orders in the old system were perfectly translated into the new system, and there was support everywhere for everyone once we came back up,” he said. “I knew we were successful when everyone walked in the next day and told us that everything was there and, more importantly, they could easily take great care for patients or get the help they needed.”
Overall, Dr. Chang said his passion for helping other people advance is what motivates him as a hospitalist and division leader. “How do you do something that's very hard, demands long hours from you, and you have to say ‘no’ a lot?” he said, laughing. “I think the reason is that the people you're serving deserve the best.”
Making clinical practice more efficient and rewarding
Rachel Cyrus, MD, ACP Member
Medical school: Rush Medical College, Chicago
Residency: University of Utah Health Sciences Center, Salt Lake City
Title: Clinical practice director for the division of hospital medicine at Northwestern Memorial Hospital, Chicago
As clinical practice director at Northwestern, ACP Member Rachel Cyrus, MD, is in charge of making day-to-day care as rewarding as possible for the hospitalist group.
With the goal of preventing burnout, she works to create an efficient service structure and manageable workload so that hospitalists can spend more time doing the parts of their job they enjoy most: talking with patients and thinking through clinical diagnoses. Several scheduling options allow for increased shift flexibility, and a set of 30 or so guidelines and policies specific to the hospital medicine group makes it easier for all of the hospitalists to work from the same page, Dr. Cyrus said.
Keeping an eye on hospitalists' workloads and the service structure is also key to increasing long-term physician retention at the hospital. “I think all hospital medicine groups struggle with that,” said Dr. Cyrus.
To this end, she and a colleague created a mentorship program to help physicians learn how they might develop their careers as hospitalists and which career paths are available. Hospitalists in their first or second years at Northwestern attend a series of six evening sessions throughout the year that explain how to move forward in different career paths at the institution.
“The original focus was to provide them with information on how they might get started on their career path when they find that they are settled into their new job and ready to take the next steps. . . . Then we also found that this became a forum for new hires to get to know each other and to share any stresses that they're having,” said Dr. Cyrus. So in addition to the didactic component, the program has implemented small-group mentoring and peer mentoring with a senior mentor facilitator, she said.
Dr. Cyrus has also supported clinical initiatives that help achieve her main goal of creating a fulfilling and sustainable hospitalist position. For example, adopting a localized unit system “improved communication a lot because your patients, for the most part, are all on one unit, and that's one social worker, one pharmacist, one group of nurses for your patients,” she said.
In addition, Dr. Cyrus oversaw the incorporation of advanced practice providers (APPs) into the service, which increased efficiency and teaching opportunities for physicians. “We found that they really helped with admissions, as far as doing a lot of the coordination and initial work that needs to be done when patients come into the hospital, and we've been able to increase the proportion of teaching services that we have,” she said.
In a recent service change, the group also added a nurse who is paired with the physician and APP team and whose tasks include educating patients and families, drafting discharge instructions, coordinating follow-up appointments, and arranging rides home, said Dr. Cyrus, adding that the extra support on the unit has helped with workflow. “One of the comments that physicians made is they can spend more time with the patients and circle back in the afternoon, because some of the administrative and educational load has been taken off of them,” she said.
Dr. Cyrus said that being a hospitalist is like having a private practice, except that the inpatient unit is the office where clinicians focus on improving quality of care. “The hospital is our home,” she said. “That's the neat thing that I think makes us unique: We have that ownership and investment in the way the hospital delivers care.”
Rebuilding a hospital after disaster
Michelle M. Guidry, MD
Medical school: State University of New York, Brooklyn
Residency: Tulane University School of Medicine, New Orleans
Title: Chief of hospital medicine at New Orleans VA Medical Center; assistant professor of medicine at Tulane University School of Medicine
Before Hurricane Katrina destroyed the New Orleans VA Medical Center in 2005, the center served nearly 40,000 veterans.
“Ever since that time, we've been trying to piece together interim services and then build this facility to give this back to them,” said Michelle M. Guidry, MD, who in the meantime had been taking care of hospitalized veterans at Tulane Medical Center through a partnership with the university.
After about seven years of construction, the new hospital opened to inpatients this year with 120 medicine/surgery beds, 20 acute psychiatric beds, and 60 community living center beds. In charge of getting the medicine/surgery units up and running, Dr. Guidry said that “No amount of residency or fellowship training could have ever prepared me for opening and activating a hospital. . . . It's really been an incredible experience.”
Her group is starting off with 14 hospitalists, who have been a crucial part of the design process, she said. “As systems experts, we're perfect for designing processes at our new hospital,” such as writing policies and procedures and planning out processes like admissions, transfers, discharges, Code Blues, rapid responses, and more, said Dr. Guidry. “We were the best ones to do that, and we made sure that we were engaged on the ground level for all those things.”
Hurricane Katrina proved a valuable teacher in terms of the new hospital's design. “We took all the lessons that we learned from Katrina and built them into the facility itself. For instance, our generators aren't on the first floor like they were before,” she said. The ED is now also on the second floor rather than the first, and if completely cut off from outside resources, the hospital now has backup power, water, and food to last many employees and patients for five to seven days, Dr. Guidry added.
The hospital also sought input from veterans before the architectural designs were in place, she said. “An example would be that because a lot of our veterans have problems with PTSD, we don't want them to be walking in corridors and turn a 90-degree corner and be surprised by somebody who's standing there,” Dr. Guidry said. “So they designed angles and turns such that one can see people coming before they're in close proximity.”
She is now in the process of building a hospitalist-run procedure service to be staffed by three trained proceduralists. “We felt it needed to be a smaller number of people who were doing them frequently. . . . Once we get that up and running, then we will have residents on the service and provide extra resident training and educational programs through Tulane. The trainees who are interested and work on the service will be able to earn a level of distinction within the area of procedures,” Dr. Guidry said.
For the rest of the year, the hospitalist group will staff both the inpatient service at Tulane and the new VA hospital, she said. “Then, as things build up over here, we'll wind down at Tulane,” Dr. Guidry said.
During her encounters with veterans, she said the sacrifices they and their families have made are always on her mind. “It's really good work to be able to take care of them. . . . They're so happy to finally have their home back,” Dr. Guidry said.
Reaching out to other cultures at home and abroad
Cheng-Kai Kao, MD, FACP
Medical school: National Taiwan University College of Medicine, Taipei
Residency: Albert Einstein Medical Center, Philadelphia
Title: Assistant professor of medicine, associate chief medical information officer, and medical director of international patient services at the University of Chicago
When Cheng-Kai Kao, MD, FACP, first left Taiwan for his residency, he didn't know that he'd end up helping people just like himself.
As a bilingual physician with knowledge of medical systems of countries outside the U.S., his position as University of Chicago's medical director of international patient services was “a natural fit,” he said. But the responsibilities aren't restricted to international patients, since Chicago is a big city with large ethnic communities who speak Chinese, Spanish, Polish, Korean, and other languages, said Dr. Kao.
“Whenever the non-English-speaking patients come to the hospital, there are always language, cultural, and sometimes religious barriers,” he said. For example, some patients may need space to worship several times a day, while some cultures have much less individualized decision-making processes in medicine, said Dr. Kao. “Very often, you see a patient cannot make a medical decision because he needs approval from his father or grandparents. That is very different than the patient-centered care model in the U.S., and people may not fully understand the differences, so our office is dedicated to breaking down all these barriers,” he said.
In addition, Dr. Kao recently started practicing at an outpatient clinic for non-English-speaking patients. “I feel this helps me understand both worlds and look at the process of health care delivery as a whole, because there's no such thing like ‘The patients are out of our hospital and we don't need to worry about them anymore,’” he said.
Dr. Kao's work in the office of international programs goes beyond clinical services. This year, he will visit China as part of the institution's knowledge transfer service, in which clinical leaders provide advice to overseas medical organizations on such areas as building new medical centers, managing hospital operations, and setting up different types of clinical services, he said. “There have been many requests from Asian and Middle Eastern countries. For example, countries like China have ongoing health care reform, and they need our expertise,” said Dr. Kao.
As associate chief medical information officer, Dr. Kao spends much of his time on multiple clinical informatics initiatives. For example, he leads an ongoing electronic health record optimization initiative, which aims to increase usability, reduce screen time, and minimize alert fatigue for inpatient clinicians. He also directs other informatics projects to prevent adverse drug events from QT-prolonging medications and decrease incidence of insulin-related hypoglycemia.
Dr. Kao is currently working on a large initiative to innovate the discharge process, with the goal of reducing length of stay. “Informatics is all about enhancing care quality, improving patient safety, and strengthening relationships between the providers and the patients,” he said.
Dr. Kao also teaches biomedical informatics courses in the medical school and the master's program at the University of Chicago. “When I give a speech about informatics, what I've always said is health IT is the foundation of a modern medical center. In the U.S. now, we pretty much operate almost everything leveraging health IT tools,” he said, adding that he always tries to spread his appreciation for informatics internationally. When traveling abroad, “I just keep telling people that and see how they pick up. I expect it's still going to take a few more years until people can realize the full potentials of IT in health care,” Dr. Kao said.
Promoting understanding across religions and specialties
Naseema B. Merchant, MD, FACP
Medical school: Aga Khan University School of Medicine, Pakistan
Residency: University of Illinois at Chicago
Title: Academic hospitalist and pulmonologist at VA Connecticut Healthcare System, West Haven, Conn.; assistant professor of medicine at Yale University School of Medicine, New Haven, Conn.
After Sept. 11, Naseema B. Merchant, MD, FACP, found patient interactions often became stressful, with her Pakistani heritage and Muslim faith leading to questions.
In her third year as an attending, she recalled taking care of an elderly patient. “His daughter called me up and said, ‘I know where you trained; I looked you up on Healthgrades. How many patients like my dad have you seen?’” Dr. Merchant said. “I remember feeling stressed and taken aback at that comment.”
About 10 years ago, she joined a group of Christian and Muslim women who met up for regular discussions on topics of mutual interest. “We realized that there's more common amongst human beings and amongst faith communities than what is not common,” said Dr. Merchant, a pulmonologist who also trained in critical care.
She went on to join another interfaith group of Jewish and Muslim members, who would meet regularly for brunch hosted either at a Jewish or Muslim home. “We all opened our doors to people we did not know initially, shared a meal, and . . . it took us three years of just meeting and breaking bread together before we were able to start discussing some really tough questions that make us all uncomfortable,” said Dr. Merchant. She said she's comfortable asking and answering more questions after spending five years with the group, which plans to travel to Israel on an educational tour in April 2018.
Dr. Merchant's interfaith journey has affected how she cares for patients and how she responds to pushback like the kind she received from the elderly patient's daughter. “Now it's easy because I know that when people are uncomfortable with a situation, it is simply because of the unknown; it is not because they are necessarily carrying an ill feeling,” she said. “They are afraid, and if given the opportunity, I would like to understand and address concerns from patients. I can take a step back and invite people to help me understand their perspective.”
Dr. Merchant, who received the ACP Laureate Award in 2015 from the Connecticut Chapter, has also been serving as the chair of the chapter's diversity committee for about 10 years and chair of its annual meeting planning committee for about four years.
In 2016, she and the diversity committee co-chair organized the chapter's first annual visa event, where residents and fellows who were in the country on a visa were invited to partake in a free counseling session with a lawyer. “We had almost 70 residents, and the lawyer gave them details on what to do if you want to stay on and want to apply for permanent residency,” Dr. Merchant said.
As part of her efforts to include diverse groups of physicians and trainees at the chapter's annual meeting, which is attended by a few hundred people each year, she and her team launched a networking breakfast for women in any stage of their medical careers. A panel of women shares its range of expertise with attendees, who sit around tables with people they don't know and discuss pertinent topics, such as work-life balance, compensation, and academic promotion. “The women were so engaged, we had to literally tell people it's time for them to move on to the next session because this session is coming to an end,” Dr. Merchant said. “It really provided people a forum and a safe space to network and exchange ideas on various issues.”
At the VA, Dr. Merchant is the site director for the internal medicine clerkship, chair of the patient safety committee, lead mentor for the quality and patient safety chief resident, and co-director for the newly organized distinction pathway in quality and physician leadership for Yale medicine residents. She is involved in multiple quality and safety improvement projects in addition to her responsibilities as a clinician educator for internal medicine residents and medical students.
As part of a project designed to improve the sense of teamwork between clinicians, Dr. Merchant created a shadowing program where third-year medical students shadow an inpatient nurse for some time and observe his or her workflow to develop a better understanding of the nurse's role. In the future, she and her team would like to engage nurses in shadowing physicians, as well.
The initiative is salient in that it combines her interests of increasing understanding between people who have different experiences but are members of the same team. “The idea is really putting all of us in each other's shoes to help us understand our workflows, develop mutual respect, and improve communication and teamwork,” Dr. Merchant said.
Using technology to engage patients
Sima Pendharkar, MD, MPH, FACP
Medical school: University of North Carolina at Chapel Hill
Residency: Duke University Medical Center internal medicine/pediatrics program, Durham, N.C.
Title: Chief of hospital medicine at Brooklyn Hospital, New York City
In 2012, at her first job as a hospitalist in the technology hub of San Francisco, Sima Pendharkar, MD, MPH, FACP, started noticing opportunities to improve the communication of health information to patients.
“That's when I started feeling some frustrations in the day-to-day of my job. There was a huge deficit in the way that things were done and the lack of communication to patients,” she said. “That's when I put my prior experiences together and said, ‘Hey, it doesn't have to be like this. It can be better.’”
The same passion for communication had fueled Dr. Pendharkar's grassroots advocacy work as an AmeriCorps Volunteer in Service to America after college, when she went door to door providing health information in low-income neighborhoods in Texas. “That's when I made this connection, that you really can make a larger impact on people when people are engaged and understand the consequences of their choices on their health,” she said.
During residency, Dr. Pendharkar, who is also a painter and visual artist, started drawing sketches for patients to explain medical concepts. One patient with diabetes, after learning about the impacts the disease has on the body through the sketches, was motivated to come off her diabetes medications and lost 60 pounds, she said. “I continue to see that when you communicate health information with people, it really changes their lives,” Dr. Pendharkar said.
Now, as CEO and founder of Valeet Healthcare, her own health IT company, she is working to streamline diagnosis by using data analytics, machine learning, and artificial intelligence to process and synthesize information “so that doctors can focus on the important piece, which is interacting with the patient and making those connections,” she said.
The software platform is currently freestanding, although there are plans to integrate the technology into the electronic health records (EHR), Dr. Pendharkar said. “The current EHR is like a silo and stores data, but it's not actionable information,” she said. “We want to take that information and put it in the hands of patients so that they own their information and so that they can take action on the data and have better health.”
Although many physicians might grimace at the word “technology” in an era of EHR-related growing pains, it is the means rather than the goal, Dr. Pendharkar noted. “Right now, in the current state of medicine, people spend so much time on paperwork and really tedious things that can be automated and should not be done by people,” she said. “Once you have technology that takes care of processes, it frees up time for physicians to really spend time and focus on the doctor-patient relationship. This is one of the most exciting times, I think, to be in health care.”
Starting a new hospitalist group
Rachel E. Thompson, MD, MPH, FACP
Medical school: University of Washington School of Medicine (UWSM), Seattle
Residency: UWSM Seattle-Boise Primary Care Pathway
Title: Chief of the hospital medicine section at the University of Nebraska Medical Center, Omaha; associate professor of medicine and medical director for clinical care transitions at Nebraska Medicine
Being the inaugural chief of hospital medicine might seem daunting, but Rachel E. Thompson, MD, MPH, FACP, drew upon her academic experience to methodologically grow her new team.
When she came to the University of Nebraska at the end of 2015, multiple clinical groups came under one umbrella. The new hospital medicine group initially had 23 physicians and seven advanced practice providers, but Dr. Thompson oversaw rapid growth in the last year and a half. The section now has 44 physicians and 17 advanced practice providers.
Joining a new institution meant that it was first necessary to learn about the individual team members, she said. “I started understanding what made it work, what were individuals' interests, strengths, concerns, where do we have opportunities,” said Dr. Thompson. “And in my first few months, I just met with everyone one on one. After that, I feel that I was able to maintain those relationships in a way that as I lead, I can consider the individuals that make up our team.”
Then, she took the concept even further, running a retreat for the group's hospitalists and advanced practice providers with the goal of pulling the team together into one cohesive unit. “We talked about what we were good at, rallied around setting team goals and starting the creation of a team vision, and solidified what our core values were as a team,” which are engagement, accountability, compassion, and enjoyment, said Dr. Thompson. “It's a time to relax away from the busy clinical scene and reflect.”
The team has now gone on a second retreat to outline a second set of values and goals and assess its performance. From this a committee-based structure emerged, where work groups take charge of certain improvement initiatives at the hospital. So far, the group has designated four committees, which are responsible for outcomes, curricula, wellness and scheduling, and documentation.
The committees' work has already begun. For example, Dr. Thompson said the outcomes committee tackled a transfer triaging issue, “which got the attention of the hospital to the point that we have actually now built a triage service, which is going to grow in the next year and a half for the hospital.”
Before coming to the University of Nebraska, Dr. Thompson spent more than a decade as an attending at the University of Washington. Early on, she developed and refined her knowledge and skills in the perioperative care of medically complex patients, an area of focus that continues to align her clinical practice, teaching, and research.
In particular, Dr. Thompson's work on perioperative glycemic control has been recognized. In 2014, she partnered with the Washington State Hospital Association to publish a statewide best practices guideline on perioperative glycemic control. Dr. Thompson also served as clinical content advisor for the public health campaign Strong for Surgery, which integrates preoperative checklists into inpatient care and was adopted by the American College of Surgeons in 2017.
Most recently, she combined her research interests and passion for education by developing and overseeing two research-training programs at the University of Nebraska. The Hospital Medicine Summer Research Student program trains students in basic clinical research, while the Hospital Medicine Scholars program is a track for new faculty members who want to develop careers in clinical research.
Dr. Thompson said clinician engagement is a core component of innovation and improving patient care. “People want to do this work and want to make things better, so one of the wonderful things about our team is that everybody's in there doing something, helping to make things grow and move forward,” she said.