A lot of team building, a little software builds success in the post-EHR health system – Shadowing at RTMC, @KPNorthwest

The best time to almost pass-out is when you are shadowing a group of emergency room physicians and Emergency Medical Technicians – this was my condition after a long flight from Washington, DC, and maybe an inattention to hydration on my way to shadow the physicians at the Regional Telephonic Medical Center (RTMC) for KP Northwest, in Portland. Rahul Rastogi, MD, my host did a wonderful job preventing the faint….

I came to see him and his team at the suggestion of my colleague Ann Kempski, who is the Director of Policy and Government Relations for The Permanente Federation who met Rahul recently when he was in DC. She suggests innovative enthusiastic physician leaders to me, and I go to shadow them…works out very well for both of us :).

The RTMC is at the site of the former Bess Kaiser Hospital, which is now the US Headquarters for Adidas. The Wikipedia page says:

The former location is now occupied by Adidas America Headquarters, Salomon North America Inc‎., and several physicians.

These are them, and they serve a lot of other patients, nurses, and physicians throughout the State.

The RTMC has been around for about 3 years and provides a special service for patients who are in transition to and from the ER, potential transition, and between inpatient facilities, wherever they may be, at home, in the outpatient medical office, in a Kaiser Permanente hospital, or in a community hospital.  They are a  service that includes 24/7 physician access, which means that they can do everything from adjust medications to coordinate physician-physician transfers and get testing and admissions started to safe patients time.

This knowledge and experience may be years ahead compared to places who are just installing EHRs now and may believe that they will achieve full coordination via electronic documentation and electronic messaging. I could see clearly in this experience how the human connection, enabled by the technology, makes a huge difference – recognizing that as they have here is allowing them to take coordination of care to a whole new level.

I saw cases in real time, where unnecessary ER visits were prevented.

I saw cases in real time, where necessary ER visits were facilitated – the physicians here have the ability to “arrive” a person in the ER’s electronic system before they are physically there, speeding admission and care. They will also call ahead to speak to the ER physician on duty, and hospitalists so they are prepped as well.

If a visit is not needed that evening, the physicians here can book an appointment with a person’s personal physician the next day AND order any needed tests in the morning so that by the time the patient sees their physician, results are in hand.

Just as in outpatient care, recruiting a team with the right skills

When I was in Colorado recently, I learned about successful physicians learning to recruit nurses, and medical assistants to be more successful. It’s kind of the opposite here – physicians are being recruited to work in teams with the 24/7 advise nurses. Opposite in terms of who’s being recruited to join what team, same in terms of people understanding what their skills are and seeking complementary skills. An advice RN, for example, can’t adjust medication doses up and down temporarily to stabilize a patient, and sometimes this can save an unnecessary ER visit.

Standardizing the way the EHR is used for maximum benefit

Since this team sees the impact, directly, of well coordinated care during transitions, they are also influencing the way the EHR is built and used. Rahul and his team have streamlined nursing protocols to make the documentation of advice phone calls easy to follow in the system. Same goes for discharge summaries – they now have a standard format that allows personal physicians in the outpatient setting to know what issues are important and need to be followed up on.

It was great to see how this health system has leveraged the interconnectivity of a comprehensive electronic health record to build and improve relationships among clinical staff to make the human handoff as precise as the electronic one. This seems to be a recurring theme I am seeing in the post-EHR era. Now that the electronics are in and working, the focus is on teamwork. It’s a great lesson learned in a learning organization.

With great thanks to Rahul Rastogi, MD and the integrated team of Support Agents, Care Coordinators, Case Managers, Nurses, and Physicians who let me see what they do, and maybe also saved me from not seeing what they do….


Hi Ted, I'm glad you're feeling better and didn't play a "mystery shopper" role by accident!

I love this line: "Now that the electronics are in and working, the focus is on teamwork." It's my observation that it's true not only for EHRs in the clinical setting, but for internet access in the consumer setting. We're past the stage of adoption being the news. We're now seeing what happens when a majority has the tools to connect with information and each other. Very cool.

Ha ha, so true, Susannah!

And always great to see you relate your work to what is happening at the level of people getting and providing care with technology. Awesome validation that this is the right work happening, I will pass it onto the team at RTMC!

"physicians are being recruited to work in teams with the 24/7 advise nurses" — Having staff who answer calls say who/what's needed…now that's user-centered design!

You really need to stop jetting across the country for the day, amigo 🙂

Ted Eytan, MD