Shadowing A Physician: A first-person perspective

In our last post, we examined the importance of empathy in understanding physicians’ needs and building a product they actually want to use. This week, Elation Health engineer Phill Tornroth (at right) gives us a first-person account of shadowing a physician—a core component of our hiring process—and how the experience influenced his approach to building a clinical first platform for physicians.

The morning of October 18, 2010 was a busy one for me. I took a train to downtown San Diego to board a San Francisco-bound flight, landed at around 8am, downed half a cup of coffee and by 9am was standing in a Walnut Creek doctor’s office watching Elation Health’s first physician administer a patient’s physical exam.

The product was still just a prototype, and Dr. Dennis Fong (father of Elation co-founders Kyna and Conan Fong) was its only active user. He’d explained to his patients that I was there to observe him using the system in the hopes of improving the experience for physicians and, by proxy, their care.

I was terrified. I’d worked in healthcare IT for years, but even when I worked at startups I’d been three or four steps removed from the patients and even the clinician users. Being at the point of care, watching someone’s grandfather discuss his current prescriptions with his longtime primary care provider was revolutionarily human to me—and incredibly intimidating. Add to that the pressure that I didn’t have the job yet; this was one of the final stages of my job interview.

The patients I met all seemed much more comfortable with my presence than I was. I expected to be sort of invisible, my eyes glued to the screen, watching Dr. Fong interact with the system. Instead, most of the visit involved him interacting directly with the patient. During the visit, he darted in and out of the EHR to jot notes or pull up lab results. The system, while still rough around the edges, allowed him to multi-task quickly and accurately. It was easy to see how a system ill-equipped to handle the complexity of a physician’s day-to-day activities could lead to chaos at the point of care. I realized that perhaps even greater than the system’s opportunity to improve the physician’s care for the patient was its opportunity to interfere with it. This thing’s number one job, I noted, is to get out of the way.

In the back office, Dr. Fong would review his notes from the visit and expand on them, filling out details and referencing reports he’d reviewed in the EMR. He pointed out things he thought were flawed—and there were lots of them. At one point I remember asking him if he thought it was a good product, and if it helped him provide better care. His answer was a fast “no”—but he also conceded that in its prototype state it was already better than everything else he’d tried. He was a notoriously hard sell, though: he stubbornly refused to believe that any EHR could meet his needs. Kyna and Conan started Elation Health to prove him wrong.

As I processed the experience that evening, I found the lack of abstraction really refreshing. I’d gotten a good first-hand look at how tightly the system we’d build would weave itself into daily care for so many patients, and the potential impact that even very small changes might have, for better or worse. Once I was invited to join the Elation Health team, it was clear that respect for that impact would be central to building a tool that worked for physicians.

Elation’s core operational challenge is to innovate at a pace that’s on par with the products we as consumers use every day, without betraying the trust of our users by delivering changes that aren’t thoughtful and stable. The pace at which new ideas bubble up, ship out, and land on our phones or in our browsers is staggering. Meanwhile, it’s widely acknowledged that healthcare technology is well behind the curve. We think it’s suffocating under layers of abstraction from the end users in the form of huge teams, enterprise sales cycles, infrequent release updates, and the sort of institutionalized apathy that grows in such environments.

We want to go much faster, and stay much closer to our users. In thinking and experimenting with ways to do that we’ve come to value keeping a relatively small team, remaining organizationally flat, and making empathy the most important trait that we hire for.

We’ve found that reactions from shadowing one of our physicians have been an incredibly valuable tool for helping potential hires understand what we do, and for us to understand how they think about building things. If the idea of building a product that impacts the care of thousands of patients and their physicians every day is something that sounds both terrifying and exhilarating to you, we’re hiring. Visit careers to learn more.