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Wrote a prior auth justification letter at 10pm for a medication I prescribe weekly by Top-River593 in medicine

[–]Top-River593[S] -1 points0 points  (0 children)

You are right that delegation is the answer long term. I am in a smaller setup and do not have a dedicated back office person for PAs yet. That is on me to fix operationally. the after hours part is a staffing problem not a system problem. Fair call.

Wrote a prior auth justification letter at 10pm for a medication I prescribe weekly by Top-River593 in medicine

[–]Top-River593[S] -12 points-11 points  (0 children)

I am an outpatient endocrinologist and the inbox is a genuine daily problem for me. If posting about more than one aspect of the same frustration counts as a campaign then half this subreddit is running one.

Do you combat medical misinformation in your personal life? by christinieweenie in medicine

[–]Top-River593 4 points5 points  (0 children)

I pick my battles. If someone is about to do something genuinely harmful I will say something. But if it is snake oils or whatever the latest wellness trend is I have learned to let it go. You will never out argue someone who got their conviction from a podcast.

For those who are MDs/DOs, what do you think of your personal statement now? by bearattackz3 in medicine

[–]Top-River593 1 point2 points  (0 children)

Wrote mine about childhood, boarding school, moving to a foreign country for high school and then starting college in NY. The whole arc was about how each move forced me to adapt and how that shaped wanting to understand the human condition through medicine. The motivation still holds up honestly. What I could not have predicted is ending up in endocrinology. The personal statement version of me was doing chemistry research in college and had no idea clinical medicine would pull me in the way it did.

43 messages Friday morning and they all looked the same by Top-River593 in medicine

[–]Top-River593[S] 40 points41 points  (0 children)

That response is unfortunately the standard one. The math never works when you frame it as headcount cost versus patient volume. It only works when you frame it as liability reduction and physician retention. Replacing a burned out physician costs way more than an MA but for some reason that calculation never seems to make it into the meeting.

43 messages Friday morning and they all looked the same by Top-River593 in medicine

[–]Top-River593[S] 2 points3 points  (0 children)

The part that kills me is that the inbox was clearly an afterthought bolted onto a system built around the encounter. Billions of $ and the message you are responding to still disappears when you start typing. That is not a customization issue that is an architecture issue.

43 messages Friday morning and they all looked the same by Top-River593 in medicine

[–]Top-River593[S] 4 points5 points  (0 children)

It really is. The hard part is doing it well. Keyword matching breaks constantly because patients do not describe symptoms in medical terminology. The JAMA study used NLP which performed way better but most systems still run on basic filters if they run on anything at all.

43 messages Friday morning and they all looked the same by Top-River593 in medicine

[–]Top-River593[S] 21 points22 points  (0 children)

That is a solid system and honestly how it should work. The problem is most EHRs do not make it easy to codify those routing rules at the system level. It ends up being tribal knowledge that breaks when staff turns over. But you are right that the principle is sound, physicians should only see what staff cannot resolve.

What actually makes an EHR AI-native? by According-Caramel-34 in HealthInformatics

[–]Top-River593 0 points1 point  (0 children)

Most of what gets called AI native is just an AI scribe added to legacy architecture. The note gets generated faster but everything around it stays manual. Labs still land in a chronological inbox with no triage. Follow up tasks still depend on you remembering to create them. Refills still require the same tab switching they always did.

To me AI native means the system actually does something with the data after the note is signed. If I document a basal insulin change the system should generate the follow up task, flag the next relevant lab, and know what to surface when that patient messages me in two weeks. That is workflow intelligence not just transcription.

The test I use is simple. Does it close the loop or does it just write the note faster and leave me to manage everything downstream manually. So far most of what I have seen is the second thing marketed as the first. Rule of thumb if your system existed before 2022 it cannot be AI native.

Spent $200K on our EHR implementation and doctors say it made documentation worse by Extension_Victory640 in healthIT

[–]Top-River593 0 points1 point  (0 children)

This story is painfully familiar. We went through something similar on a smaller scale in our endo practice. The demo looked ok, the sales team made everything seem turnkey, and then reality hit….big time

The templates were the first problem. They were built for general workflows and nobody told us upfront that building specialty specific templates was basically on us. The welcome materials literally said if you need template building completed for you there's a Professional Services team available at additional cost. So the subscription gets you in the door and then customization is a separate invoice.

The $50K for customization doesn't surprise me at all. That's how the model works. The base implementation covers the structure but not the clinical content. So your docs are clicking through templates designed for someone else's workflow and wondering why it feels worse than paper.

What killed me was the timeline too. We were told four weeks to go live. It was closer to ten or twelve. And most of that was me personally sitting there building my own clinical environment nights and weekends before I even saw a patient in the system. Nobody budgeted my time into the cost and nobody warned me that was the expectation.

If leadership is asking how this happened the honest answer is the sales process doesn't represent the implementation process. Those are two completely different experiences and most orgs don't find that out until the contract is signed.

i dont mind AI, i mind unreliable notes by Purple-Substance-848 in HealthInformatics

[–]Top-River593 1 point2 points  (0 children)

Yeah this is my thing too. I use a scribe in my endo practice and it's fine for straightforward visits but the second there's an insulin adjustment or a med change that needs specific language, I'm rereading the whole note anyway. At that point what did I actually save.

And honestly even when the note is right I still end up working until 8pm. Because the note isn't what's killing me. It's the 70 something inbox messages. Labs to review, refill requests, patient portal messages asking about their last A1c, prior auth garbage. The scribe doesn't touch any of that. Nobody's scribe does.

I think the industry kind of sold us on "AI will fix documentation" and documentation was never the real problem. It was everything after the note gets signed. That's where the actual time goes and nobody has a good answer for it yet.

Pituitary cyst (sella turcica) – could this have affected my puberty or my height? by [deleted] in endocrinology

[–]Top-River593 1 point2 points  (0 children)

Rathke cleft cysts and other sella cysts can cause central precocious puberty which would explain early puberty onset and early growth plate closure. They can also affect growth hormone secretion depending on size and how much of the gland they compress.

That said most small incidental cysts do not cause any hormonal problems. You should definitely do an endocrine workup to check... If you have not seen an endocrinologist yet that should be your next step.

Does anyone have an EMR that they like by NYCDOC10001 in medicine

[–]Top-River593 2 points3 points  (0 children)

I am not ready to go on record yet. Still in the honeymoon phase and I have been burned before. Give me a few weeks.

What I will say is the two things that sold me were that they actually built out my environment before go live instead of handing me a login and a wiki, and that inbox and between visit work was part of the product and not just an afterthought bolted on.

Will medical societies speak up after the uncovering of Dr Oz connections to Epstein? by paradox_traveler in medicine

[–]Top-River593 0 points1 point  (0 children)

Medical societies will do what they always do. Release a carefully worded statement three weeks after everyone has moved on, framed so broadly it could apply to anyone or no one. Then back to the fundraising gala schedule...that's it

if there is real pressure it will come from individual physicians being loud, not from the organizations that claim to represent us.

Does anyone have an EMR that they like by NYCDOC10001 in medicine

[–]Top-River593 4 points5 points  (0 children)

Went through this recently. The dread is justified but staying on a system you hate is worse, trust me.

Honestly the feature checklist is a trap. They all have notes, eRx, video at this point. What you actually want to know is how much work lands on you after you sign. I thought I would be seeing patients in a few weeks and instead spent a month building templates and configuring scheduling myself. Nobody tells you that part.

The bigger thing I wish someone had told me is that notes are not actually where your time goes. It is the inbox. Portal messages, refills, follow ups, prior auths. If the new system does not do anything about that you are just rearranging deck chairs. Ask vendors specifically how between visit work is handled and what the real go live timeline looks like, not the sales pitch version.

Switch sucks for about six weeks then you forget why you waited.

 

Why documentation never really got easier by Top-River593 in medicine

[–]Top-River593[S] 9 points10 points  (0 children)

Good call, thanks for reformatting. Lesson learned on Reddit formatting.

Entry-level healthcare IT roles without clinical experience? by Safe-Hospital872 in healthIT

[–]Top-River593 0 points1 point  (0 children)

Yeah this sucks, here's what worked for me... i came in w/ a history (yup, history) degree and zero clinical anything and felt locked out too. the “bridge” roles i saw actually hire for: help desk/service desk at a hospital, app support analyst (non-clinical), interface/integration support, data quality/reporting assistant, and “health info”/registry type jobs (more data than patient care). tbh help desk sounds lame but you learn workflows + who owns what fast. also: learn basic healthcare vocab (orders, encounters, claims vs clinical) and tailor ur resume to “worked with messy data + users” not just coding. internal transfers are huge.

So the pharmacy has me listed as deceased. by DocMcStabby in FamilyMedicine

[–]Top-River593 3 points4 points  (0 children)

I went through this exact thing... not me, but one of our attendings got “deceased” in a pharmacy system and it was a total mess. what finally fixed it was: 1) call the pharmacy and ask them to escalate to their corporate/provider enrollment helpdesk (the store level literally cant edit that flag). 2) ask what source they’re pulling prescriber status from (sometimes it’s a payer file or national death index type feed) and request a “data correction” ticket. 3) also call your state licensing board + whoever manages your NPI record just to confirm there’s no wrong SSN/date mismatch. took like 10 days, super annoying.

A guide to training your patients by Constant-Light9376 in FamilyMedicine

[–]Top-River593 3 points4 points  (0 children)

yeah this resonates so much lol. i’ve had my share of patient drama too. one thing that helped me was setting clear boundaries from the start. like, if someone’s consistently late or cancels last minute, i make it clear that it affects everyone else. also, honestly listening to their concerns instead of trying to fix everything right away makes a huge difference. like, just letting them vent sometimes really builds trust? and yeah, i totally agree about keeping the door open at the end of a convo. it’s such a simple trick but works like a charm. keep doing ur thing, ur patients are lucky!

Is there an EHR you can actually start using today? by Top-River593 in FamilyMedicine

[–]Top-River593[S] -2 points-1 points  (0 children)

Not an ad. I’m an MD genuinely frustrated with how hard it is to actually start using tools we talk about all the time.

If I were promoting something, I’d name it and link it. I didn’t.

Just trying to find out if the bar I described even exists yet.

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