Joyce Lee ’17, North Shore-LIJ Health System

Joyce-LeeFor three days over Reading Period, I shadowed Dr. Mitchell Adler ’73, who is Chief Medical Information Officer of the Medical Group at the North Shore-LIJ Health System. In the beginning, I was very excited to meet him for my Princeternship, but I wasn’t too sure what to expect because I had never shadowed anyone before. However, Dr. Adler and his colleagues welcomed me warmly from my very first day and gave me a fantastic experience. In these three days, I definitely became more comfortable and knowledgeable about what work in the health care field can look like.

On my first day, I followed Dr. Adler straight into a meeting involving outpatient care, medical practice and performance evaluation. Although the meeting was long, I was fascinated by how the doctors in the room, each representing one section of the health system like a hospital or a specialty, addressed problems that they face in medical practice and suggested solutions that they might be able implement to address these problems. The way the meeting was conducted made me appreciate how distinct hospitals and specialties come together – discussing, presenting, and sharing ideas and information – to ultimately function as one health system.

I spent the rest of the day observing and shadowing Dr. Adler as he attended important logistical meetings, interviewed applicants for executive positions, and oversaw the operations of the teams that managed electronic health records. I learned about the electronic system that was being implemented and updated at various hospitals to streamline and facilitate medical care. What really impressed me was the scope of these electronic health records: as North Shore-LIJ is a massive health system that includes many hospitals, clinics, and other health facilities, these records were being used and integrated on a very large scale to ensure that patients received the best care possible.

We ended the first day with a dinner with one of the residents that Dr. Adler oversees. The resident specializes in internal medicine at one of the North Shore-LIJ hospitals, and I really enjoyed our dinner discussion because it gave me a glimpse of medicine in the clinical setting. I learned about the basic hospital command structure, the different medical specialties such as cardiology or pediatrics, and the process medical students go through to become board-certified physicians. Most of all, the discussion made me excited and prepared for our visit to the clinic the next day, where Dr. Adler oversees medical residents.

The second day began with a logistics Joyce Leemeeting about how the new features of the electronic system would rollout and operate and to smooth over any foreseeable problems or glitches in the system. With the amount of people there, I could tell that this system took a lot of effort and work behind the scenes from hospital and health system administrative officers and executives to implement, and it made me appreciate the attention to detail that was given. In particular, it was interesting to see how the presentation melded into a discussion of questions and concerns from each of the departments represented before the new features officially came into use.

After a yummy lunch, we headed to the internal medicine floor of the clinic, where physicians provide outpatient care for a variety of medical conditions. The residents would leave the physician room to greet and see the patients, come back with reports of the patients’ concerns, and talk with Dr. Adler or another mentoring physician to diagnose and address those concerns. I watched the electronic health records, which I had learned so much about in the past few meetings, being used live as the interns looked up patients’ basic information and previous visits, inserted diagnoses and prescriptions, and updated patients’ information. The interns even used e-calculators, which evaluated medical indicators like heart risk when different factors like BMI and age were entered. It made me realize the valuable role technology plays in medicine today, where doctors use electronic records and electronic tools to aid them in providing better care to their patients.

The third and final day, I shadowed Dr. Adler during several meetings and conference calls where he addressed the implementation of the electronic health records and set agendas for the next few weeks to meet certain rollout and implementation deadlines. In between meetings, we discussed the current health care system and model, and Dr. Adler introduced me to several medical and health care policy articles, including those in the magazine Health Affairs, which focuses on a topic each issue and provides introductory profiles and different perspectives on that topic. I learned about different aspects of health care ranging from health insurance plans put in place by the government, to the economic implications of hospital systems, to, in particular, the roles physicians play in a health care system and the expectations placed on them by the system.

All in all, my Princeternship was a really amazing experience. Throughout the three days, I shadowed t, observed, and learned a lot. I feel that I went from having limited knowledge of the health care system to having a more comprehensive understanding of what it means to be a doctor. Although I’m still unsure about my plans for the future, this Princeternship makes me want to gain more insight into the health care field and perhaps to even pursue a medical profession after college. I’d like to sincerely thank Dr. Adler for giving me this opportunity to explore the health professions and my goals for the future!

Divya Seshadri ’16, North Shore-LIJ Health System

Divya-SeshadriThe first day of my Princeternship was right after the North Shore-LIJ Health System upgraded its electronic health record system. An electronic health record (EHR) is a systematic collection of data over a large range of potential fields for the patients in a particular system. Some fields include: medical history, medication and allergies, immunization, and social history. The HITECH Act, a part of the American Recovery and Reinvestment Act of 2009, introduced incentives in the form of bonuses for physicians who switched from traditional paper-based records to EHR as well as penalties in the form of decreased reimbursements for those who do not by 2015. In addition to using EHR, physicians must fulfill “Meaningful Use” criteria and certain other measures before qualifying for rewards.

My Princeternship host, Dr. Mitchell Adler ’73,  is the Chief Medical Informatics Officer for the ambulatory network of the North Shore-LIJ Health System. His role is to oversee the administration of the EHR system in this network by working with physicians to set up an electronic health record for their patients and ensuring smooth transitions when changes occur in the technology or policy. In my time shadowing him, I attended an ethics meeting, as well as several meetings to discuss the status of the software implementation and meetings with health care providers to help them switch to an EHR system. I also spent some time shadowing Dr. Adler at the clinic.

On my first day, I accompanied my host as he attended meetings revolving around the implementation of EHR. Some physicians and nurses found that with the upgrade, they had to change the workflows in their practices to accommodate certain changes. Dr. Adler also met with the group managing the IT end of the EHR implementation in order to ensure a smooth transition. Other meetings Dr. Adler attended were focused on making the EHR software more compatible with a medical field’s particular needs. For instance, we met with pediatric oncologists and learned that in order to transition fully to EHR, the software would have to support various treatment flowcharts and road-maps that are used in this field.

I attended another meeting on my second day which was different in subject from the previous meetings. The pediatric department was in the process of switching to EHR, so Dr. Adler, an attorney, and several members of the health system met to discuss the issue of confidentiality in adolescent medical records. According to New York state law, from the ages 12-18 a child is given the autonomy to keep certain treatments or medications confidential from his or her parents although the child is their dependent. This raises potential issues, and with a new health record format, it would be important to ensure that this information is protected. The meeting was centered on the issues of who should have access to this confidential information and how to protect the information from falling into the wrong hands.

On my last day at the Princeternship, my host and I spent the first half of the day in meetings and the second half at the clinic. In the morning, Dr. Adler held a Physician Advisory Group meeting in order to receive feedback from and discuss changes with physicians. Afterwards, we attended a data governance meeting that was focused on developing higher level data management and collection guidelines. Part of Dr. Adler’s responsibilities is to spend time at a clinic where residents see patients. After the residents see each of their patients, they discuss the case with Dr. Adler, who advises the residents and co-signs their reports. While at the clinic, Dr. Adler can also observe the EHR in use and answer questions that users may have.

My three days with Dr. Adler were valuable in exposing me to health care administration and the intersection of health care and IT. As Dr. Adler was previously a primary care physician, I had a chance to understand more about both clinical work and his current role as a CMIO. I would recommend this Princeternship to anyone who is interested in learning about health care and EHR, as Dr. Adler is knowledgeable about many intersecting fields such as medicine, IT, and public health policy. I would like to thank Dr. Adler for making this such a meaningful experience.