Collaborating and engaging in the post-EHR era – A visit to the @dermdoc

Jeff (@dermdoc) and Jackie, at your service – View on

When you want to learn about medical practice in the era of online social collaboration, social media, in the post-EHR world of a connected, integrated, member-centered health system, where do you go? Easy answer, Jeff Benabio, MD, aka @dermdoc

Luckily for me and a lot of others, Jeff is part of our health system. He and I have known each other since I began working at Kaiser Permanente in 2008, and he’s been a physician member of the Southern California Permanente Medical Group for 7 years now. However, I have never shadowed him, until now. I came to see him and his colleagues with member of our digital workforce capabilities team, who are designing next-generation collaboration and information tools for our 180,000+ workforce. To help people use technology to collaborate, you must first watch them collaborate, and also luckily for all of us, this is a team that takes advantage of the fact that we work in a system that finances AND delivers the care by going to see it in action.

Jeff works at Kaiser Permanente La Mesa Medical Offices in La Mesa, California, which I didn’t realize until I arrived that is famous in my world for another reason – it is a world leader in using natural energy. Take a look at the parking garage – it’s covered with solar panels, which provide 75% of its annual energy. This medical office exemplifies “To heal, you must first do no harm.”

As his twitter handle implies, Jeff’s a dermatologist, a specialist working alongside primary care physicians to integrate skin care, technology, teaching, learning, service, and engagement, all at once. He’s pioneering work in teledermatology that allows him and his colleagues to facilitate the care of the 400,000 510,000 people that Kaiser Permanente San Diego (@KPSanDiego) serves. He asks his patients to follow him on twitter. He posts QR codes of helpful information resources for his patients to scan and learn more, all in the flow of a busy practice that includes biopsies, cancer removals, and full body skin exams.

I may enjoy being a family physician, but I am also deeply impressed at the dermatologist’s ability to examine complex skin patterns quickly and make judgements quickly. As Jeff explained to me, he and his colleagues like doing this, and they are leveraging technology to the fullest to be there for patients who may be (a) in his office (b) in the office of a peer in primary care (c) at home (d) on their way to or from any of the previous places. What I observed is that they do it with a bit of excitement, as we noticed when members of the team are pulled in to watch how service is given with these new tools. 

Jeff and his team also do more than dermatology. Kaiser Permanente is the home of complete care, which includes advanced tools that guide clinical staff here to counsel on preventive interventions, including colorectal cancer screening, and the famous exercise as a vital sign. The system is smart enough to know how often these questions are asked of patients and decides when the answers need to be refreshed.

It’s worth repeating – in this dermatologist’s office, medical assistants are as comfortable coaching people about FIT kits (to screen for colon cancer) as they are about skin biopsies. 

What we’re seeing as this team and medical group push the boundaries of what technology can do for members is that they’re doing the same for their own colleagues. The challenge in the post-EHR era, that I think most health systems are not experiencing yet (and my not for several years) is to keep teams and groups who provide the care, up to date on their skills, communicating with each other, moving ahead together. My own semi-foolproof shadowing system involving two shadowers and one practice team started to break down a little because the team is so sync, it was hard to keep up. This type of actualization achieved in the delivery of care makes for a great learning environment about the future. And why wouldn’t it be, this is @dermdoc we are talking about here.

Thanks again to the members, staff, and physicians at La Mesa Medical Offices. We’re sticking around for one more day, this time I’ll be seeing primary care in action.

Ted Eytan, MD