Leading the Curated Healthcare IT Life

Craig Joseph, MD
By: Craig Joseph, MD
Date: October 16, 2018

I’ve been thinking and reading a lot about curation recently. By curation I mean allowing experts to make decisions for those of us who are not experts. My first experience with curation happened four or five years ago. I walked into an optical store with my wife to look for some new frames. My vision is so poor that when I don’t have my prescription glasses on, I can’t really see much of anything at all. So, you can imagine how helpless I am when I take off my glasses to put on a pair of frames with no lenses. Sure, I can look at the mirror from an inch away and maybe have an opinion, but c’mon! That’s not very effective. Hence, I typically just put myself in the hands of my wife.

At this particular optical store, the manager who was helping me seemed very . . . opinionated. He asked about my style, and when I told him I didn’t have a style, he was ecstatic. My wife has a style. My kids even have styles. But me? Not so much. A minute or two later, I found that my wife and the store manager were talking about me as if I wasn’t even there. “Do you like these on him? No, not with that forehead. What about this pair? Too big for his face, and that color accentuates his pallor: no way!” At first, I was offended. What’s wrong with my forehead? And I am not pale. Ok, I’m not that pale. But I grew to appreciate the fact that some experts (at least one expert) was apparently going to make a decision that I wasn’t very good at making myself.

I’ve always chosen my own glasses. I never been particularly good at it, and I’ve not particularly cared about how frames affected people’s opinions of my forehead. It was sort of nice to have someone else make the decision for me. And when I started getting compliments about my glasses, well, that was just icing on the cake. The expert who curated my frame selection did a much better job at something that I didn’t care much about nor knew much about.

In a recent article in the Wall Street Journal, I read about a startup fashion company called Wardrobe.nyc. Here’s a snippet from the article:

Ordering through Wardrobe.nyc’s website is a rigid process – four or eight pieces, your sizes, boom. The only other choice the company offers is between black and white T-shirts. Want just one piece? Sorry. Want it in navy blue? Nope.

. . . Something about Wardrobe.nyc [is appealing]: its strictness and severity, its self-assuredness in a moment when most companies are telling customers they can have anything they want. Walking into a retail store in 2018 means getting hit by an avalanche of options – hundreds of patterns, colors, and sizes. Want to design your own sneakers? Car interior? iPhone case? No problem.

Wardrobe.nyc isn’t doing that. It’s saying: This is what’s important. We know what you need. (emphasis added)

How does this relate to the world of healthcare IT and electronic health records (EHRs)? I bet if you’re a practicing clinician who uses an EHR every day, you know where I’m going already. I’m making a plea for EHR curation. And a strict curation at that!

Doctors might say that they want the EHR to work for them. They want to tweak this color, and that font, and those order sets. They want it just so. But deep down, very deep in their psyches, they know. Oh, they realize that while they are experts in practicing medicine, they are most likely not experts in configuring the EHR. And they know that the EHR has lots of options for them to “personalize” the buttons and orders and documentation tools, but who can remember how to do it? And further, who can tell them which options really make a difference?

I’m telling you, dear reader: doctors want us IT folks to tell them how to use the EHR. They need us to tell them. Don’t ask many questions. Don’t ask any questions at all if you can get away with it. Just tell them. An example: how do you admit a patient?

  • Good answer: do this, then that, go here, check over there.
  • Bad answer: Well, it depends on the patient, doesn’t it? If you think the patient is going to just be observation, it’s somewhat faster to click over here because you don’t have to have the admission order, technically. And if the patient is going to the unit, it’s best to skip the problem list reconciliation because most of the time, you don’t really know what’s wrong with them anyway at the beginning. Did you say the patient was a kiddo? In that case . . .

Clinicians need someone to tell us how to do the things we need to do to care for the patient in front of us. And we will listen. But . . .

I failed to mention a key aspect of Wardrobe.nyc’s offering. Not only are choices virtually non-existent, but it’s sort of pricey. And by “sort of pricey” I mean: an eight-piece set of clothing costs $3,000. As the article notes, you can get eight similar pieces at the Gap for maybe $300. At Wardrobe.nyc, the founders have decades of experience in the fashion industry. They choose top-quality fabric; they determine every feature of the clothing; they have the clothes made in Italy. The quality is apparent and obvious.

In the healthcare IT world, if you’re not an expert in physician workflows, don’t curate for physicians. We’ll do what you tell us to do if and only if it becomes immediately obvious to us that you know more than we do. Am I saying that only a pediatric neurosurgeon can help configure and personalize the EHR for another pediatric neurosurgeon? No way. I’m saying that you better understand surgical workflows (pre-op, inter-op, PACU, SICU, floor) and you better be able to explain why a child isn’t just a short version of an adult. If you can do these things, you’re likely good to go.

Have you had someone curate part of your personal or professional life? Tell me how it worked out.

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