It used to be that pediatrician John Tedeschi found his passion in caring for children -- being part of their families, enjoy babies. Now it's data that excites him and the power of it to improve care.
"I really latched onto that with something called population management care coordination," Tedeschi told me as part of our Leadership Agenda interview, which was published in Monday's Philadelphia Inquirer. "I love it. I think it’s the future."
Tedeschi, at 75, has built himself a great laboratory to practice this kind of medicine -- two related companies, Advocare LLC and Continuum Health Alliance LLC., both of which are collections of physicians and health practitioners, many of whom use a common electronic health record system devised by Tedeschi and his crew. It's that shared system that provides the data that excites Tedeschi.
"It always bothered me in my life time that you would have a specialist talking to you and nobody is coordinating the ideas of the specialist. Nobody is following up with – I ordered you medicine. Do you really take it. Did somebody order something up that is conflicting ? The population management [software] does this well. This piece of it, of measuring quality has become my obsession now," he said.
Tedeschi talked about what the doctors in his companies get when they click on to their in-office computers.
"At the end of every day, they see their business intelligence, they click onto their computer, they see what’s in the bank for them. They see how it's collected, where it came from, how many patients they saw – all that kind of business stuff, but now they are [also] seeing clinical intelligence."
Like what, I asked.
"You saw 10 diabetics and you didn’t order the appropriate testing. What is the follow-up? You have so many patients who didn’t get their colonoscopies. So many patients who didn’t get their mammograms, so many patients who didn’t have preventative visits.
"I have all this technology developed now so when you come [as a patient], into my office and I type your name in -- normally, the first thing that would appear is your chart. Not in our office. The first thing that appears is something called Gaps in Care. It’s very easy to read -- red, yellow, green -- of all the quality things you should be doing with your patient and what you haven’t done and what you did do and it’s paired to your diagnosis.
"If you are a well patient and you just need routine stuff, it tells you, `get your colonoscopy at 40.' If you are not a well patient and you have diabetes, [it asks] `Did you get your blood test? Did you have your skin examination? Did you get your eyes examined? – All the things that come with diabetes."
The system, in effect, nags the doctor, but the doctor can make the decisions.
Sounds like a lot of work, I comment.
"So, it’s a reminder and he doesn’t have to do anything. Guess what? He doesn’t have to do anything. The nurses and the care coordinators do all the follow-up on what he wants done," he said.
"Most doctors, 99.9 percent of them, just want to do a good job. They really want to be a good doctor. I find that to be universally true, but they are overwhelmed. They are overwhelmed with volume. They are overwhelmed with money. They are overwhelmed with the healthcare changes. They are overwhelmed with their lifestyle. They are overwhelmed with all the things that happen. They are totally overwhelmed.
"To leave it to the doctor to do all this – you can’t put that on top of them," he said. "Now you have these people who are their assistants who can help,who can help. They could be nurse practitioners, they could be social workers, whoever it is," he said. "The complexity of this is absolutely amazing and we are just at the tip. There is so much things we are going to learn."
In other words, the data leads to a human intervention -- a call from a practitioner. Tedeschi describes it as a "hug" from a doctor, something that shows the patient that someone cares.
Is this a period of innovation in medicine, I asked.
"Yes, but not scientific innovation, but clinical innovation, the innovation of delivering what’s right to the patients. It's almost like an operational innovation. The science of medicine keeps going great. We are doing things better but how to deliver that science is another story. A lot of this stuff you see is fostered by academic institutions – researchers, and thank God we have them, the movement toward genetics in our treatment, the whole movement toward predictive modeling, who are the patients who are at the higher risk to get sick. All that stuff is wonderful and is going to make a big difference in medicine, but the academicians can’t give you the operational problems.
"It’s easy to say, `you need a blood test every week,' but to get that blood test done every week is another story."
When I look at this interview, what strikes me the most is the passion Tedeschi has -- at the age of 75. It makes me ask myself, and maybe you should ask yourself, especially if you are older, especially if you are in the later years of your career, what new passion can rejuvenate? How can it happen for you? Is it something at work? Is it a different something? A new job?
What's the biggest mistake someone can make at work, I ask Tedeschi.
"Not loving what you do every day. I love what I do every day and I’m 75. I love the fact that I can do this."