Q&A With New Reading Hospital CMO: Perspectives on Telemedicine, Patient Safety, and Burnout

Tower Health's flagship hospital promotes executive with cardiovascular and thoracic surgery background to top clinical leadership role.

The new chief medical officer of Reading Hospital is confident that the expansion of telemedicine services will continue after the coronavirus disease 2019 (COVID-19) pandemic passes.

Reading Hospital is the flagship hospital of West Reading, Pennsylvania–based Tower Health. Ron Nutting, MD, was appointed CMO of Reading Hospital in July. He succeeded Gregory Sorensen, MD, who had been serving in a dual role as CMO of Reading Hospital and Tower Health. Sorensen remains as the CMO of the eight-hospital health system.

Nutting, who is also serving as vice president for medical staff services at Tower Health, started his medical career as a cardiovascular and thoracic surgeon at Reading Hospital in 1992. He transitioned from clinical care to medical staff administration in 2013, when he became director of medical affairs at Reading Hospital.

Nutting shared his perspectives on telemedicine, patient safety, and other healthcare topics in a recent interview with HealthLeaders. The following is a lightly edited transcript of that conversation.

HealthLeaders: Telemedicine has experienced explosive growth during the coronavirus pandemic. Which telemedicine services has Reading Hospital adopted or expanded recently?

Nutting: Telemedicine areas where we have had success include outpatient screening—particularly individuals suspected of respiratory illnesses that could possibly be COVID-19. The telemedicine screening has allowed us to direct these patients to locations where they can be safely and effectively evaluated.

With telemedicine, we have also been in a better position to monitor our COVID-19 patients who have been staying at home. We have been doing remote monitoring utilizing pulse oximetry and screening questions. In the past, we have done telemonitoring of congestive heart failure and chronic obstructive pulmonary disease patients as part of our population health management strategy. The onset of the pandemic allowed us to amplify many of those activities.

We have done a lot of ongoing patient care with telemedicine—particularly for patients who need continued monitoring for chronic illnesses during the pandemic when they are concerned about coming in for office visits. For example, we have used telemedicine to monitor patients with diabetes and anticoagulation needs.

Perioperatively, we have been able to conduct pre-operative screening via electronic means to a larger extent than we have before. And we have taken advantage of being able to monitor our postoperative patients with telemedicine. This is an area of telemedicine that is likely to continue after the pandemic—it is a significant patient satisfier. If we have a patient who travels from the next county to undergo a surgical procedure, we can have a postoperative visit and our ability to evaluate a wound electronically can save the patient a car ride that can be uncomfortable. We can screen the patients to determine which ones we need to see in person.

Related: 4 Ways You Haven't Thought About Using Telehealth During the COVID-19 Pandemic

We have been able to set up virtual ICU care with our sister facilities. We are a hospital system with eight acute care hospitals, and several of the hospitals have adult ICUs that have relatively small critical care teams compared to Reading Hospital. We have been able to utilize Reading Hospital's ICU team to render virtual ICU monitoring to help several of our sister facilities with coverage of acutely ill patients. This has helped us standardize some protocols and to identify patients earlier in the phase of decompensation. 

Telemedicine has been available for many years; but, as a society, we had allowed the strategies around what was allowable for billing to prevent us from doing things that patients would prefer us to do remotely. It is nice to see this logjam open up, and I am very optimistic that many of these telemedicine advantages that have been gained will be maintained in the future.

HL: Since the publication of To Err Is Human two decades ago, where have healthcare organizations made the greatest strides in patient safety?

Nutting: This is an interesting issue, and it serves to highlight how complicated healthcare delivery is.

Unlike many manufacturing processes, healthcare is extraordinarily variable at the biologic level, both in terms of the individual variability of our patients and the wide array of maladies that they are presenting with that require us to discover the underlying ills and make an accurate diagnosis.

The strides that we have made in patient safety are around elements that reduce variability such as universal protocols like central line protocols, how we don gowns, and rituals for handwashing.

Medication safety is another area that stands out. This is one area where we have reaped some gains from information technology in terms of being able to track what medications we are giving patients in the inpatient environment and ensure we are giving medications safely through methods such as barcodes and multiple forms of identification.

We also have made progress in the engagement of patients and family members in care—they are participating at the level of decision-making and timeouts to verify that we are operating on the right site and performing the correct procedure.

Infection control through various bundles has also been a big win.

HL: How can health systems and hospitals help address physician burnout?

For physicians and clinicians of all stripes including allied health professionals and nurses, burnout is one of the big issues of our time.

Addressing burnout is not about making clinicians more resilient—it is about looking at the root causes of the burnout problem. Physicians feel overworked. Sometimes, they feel underappreciated. They are mourning the loss of autonomy. They feel they spend too much of their time on activities that are not aligned with their sense of purpose such as the impact of the electronic medical record.

When we look at the EMR, many of them are designed to limit the variability of care, but limiting variability of care drives a sense of loss of autonomy if the clinicians have not been involved in the process of standardizing care at the outset. There also are ways that clinicians must work through the EMR interface that are primary drivers of career dissatisfaction. Those drivers include the diminishing time of eye-to-eye contact with patients because of the distraction of needing to click fields in the EMR. Overall, interface optimization is going to be important in moving forward and reducing those distractions.

The inefficiencies of EMRs contribute to causing work hours beyond clinic time and into the evening for many medical professionals. As a result, there is diminished access to outside interests, which can cause hopelessness and a sense of depersonalization, which are hallmarks of burnout.

Related: Resilience is Not the Key to Addressing Physician Burnout, Researchers Find

Other clinical inefficiencies are created by nonclinical agents that are mandating requirements for data input from clinicians that may be important but really are not good uses of clinician time. Clinicians feel they are not creating value in the clinic because they are working more in the role of a clerk. This is related to requirements from government regulators, insurers, and health system management. My colleagues and I need to be careful about what we are asking clinicians to do.

The antidote to burnout is to engage physicians and enlarge their sense of joy in work by involving them in clinical redesign that leads to performance improvement through lean-process improvement efforts and lean management. That approach will allow clinicians to have a sense of autonomy and to make sure a greater fraction of their time is spent on higher-value activities such as interacting with patients.