Dr. Eric Weidmann’s History of Embracing New Tech & Expanded Care Teams

Melanie Marcus: Today we’re going to experience healthcare from the perspective of a long-time primary care doctor. Our guest today is Dr. Eric Weidmann, and he’s kind of a rare breed, in my opinion.

He describes himself as a classic overachiever in math and science as a baseball-playing, do-gooder kid. There’s nothing rare about that, of course, for someone who goes on to become a doctor. But the rare thing was his approach to life and his life’s calling.

Dr. Weidmann had always wanted to contribute to the greater good—also not rare for a doctor—but he ended up doing so in two ways: one, in the primary care clinic, and two, in health technology. One role fed the other.

What truly fed him was being exactly where he needed to be: a doctor taking care of patients. A doctor who saw his patients become parents, then grandparents. A doctor who had the chance to jump into the inner circle of his patient’s lives at critical points and then see the results as he cared for multiple generations in the same three rooms of his clinic for over 30 years.

We’re talking about helping healthcare heal itself on the podcast this season, and Dr. Weidmann has been doing just that since the start of his career. And I’m excited for our audience to find out how.

So, a warm welcome to the show, Dr. Weidmann, and thanks to our audience for tuning in.

It's a pleasure to have you on the show today, Dr. Weidmann.

Eric Weidmann: Thanks. It's good to be here. Thanks for the invitation.

Marcus: We're talking about the evolving care team on today's episode, something you know quite a lot about as a family doctor for many years in Austin, Texas. Although I should say that patient care isn't the only thing you've done in healthcare, Dr. Weidmann, and I hope it's fair to assume that your viewpoint has also been shaped by your experience in business.

You've been a doctor treating patients and you've been deeply involved in health IT as a former chief medical officer. But before we dive into how all of that has shaped your perspective, I'd like to go back to when you were a young doctor working on one of the first electronic health record platforms, one of the first EHRs.

What was the promise of EHRs in the early days?

Weidmann: Well, thanks, Melanie. I appreciate the opportunity to think back to the good old days as they were, when we scribbled prescriptions incomprehensibly and had lots of phone calls with our pharmacy friends to clarify what we meant. Thinking back, I view that as kind of a desperate plea for help to clarify data systems and interchange of information.

The first systems I worked on were really just trying to get electronic prescribing up and running into a clean fax form, and then moving forward to using systems that helped organize data. So early on [the promise was] more clear records, quicker sorting, better organization for continuity and chronic care, which is what I spent my whole career doing. It was slow to evolve, but still, it has very much evolved.

Marcus: So how difficult was it to build that first EHR, that first implementation in your practice?

Weidmann: In a practical way, our first builds and our first attempts were really spinoffs of our billing systems. Because again, the data systems that had been legacy for all these years had been built basically on accounting and billing and reconciliations. The bigger challenge was putting meaningful clinical patient-provider data into what was [a] legacy billing machine. And so that was the difficult fit that we kind of slowly transitioned through in the 1990s.

Marcus: Right. Interesting. So, you started with the billing system and built an electronic health record from there. If you could have waved a magic wand to build the perfect EHR back then, what would it have looked like?

Weidmann: If we had really been able to rethink a whole system, magic wand—poof—build it from scratch for the entire machinery, we would have thought about more population health, group health, family units, community units, and how we can put those at the center of the machine that drives health information. Both to patients and back to systems, which is what we've been trying to recover this most recent decade.

Marcus: So let's go back a bit to your decision to study medicine. Tell us about how you got started.

Weidmann: You know, I was a classic do-gooder, overachiever, math and science kid who liked to play baseball. And so when the baseball career doesn't look very shiny, you start looking at other ways to make a living and contribute. The thing that kind of morphed me toward medicine was this idea that med school was a big challenge [with] math and science built into it. But yet it had very much people involved in community. And so that was something I wanted to make sure I naturally anchored. The rhythm of my day, my week, my year into people, relationships and community. I saw a lot of my colleagues—I have an electrical engineering degree from UT Austin—and that undergraduate degree would naturally kind of shove me toward not the community and people and relationships, unless I wanted to do team management, sales and things like that. And I wanted to stay with more the meat of relationships. And so medicine seemed to be the natural path to that.

And then med school at UT Southwestern Medical Center in Dallas was another decision point of “how do I stay closer to the ground of the community?” And that's a family medicine or a general medicine kind of practice that I kind of gravitated to because of the same point. I wanted to be able to apply things that seem challenging to learn, keep up with and manage, but stay firmly rooted with the people in my community.

That's how it works out. Staying in the same three rooms, taking care of several generations of patients for 35 years was exactly what I wanted.

As I did that, it's a really silly thing, but in the early ‘90s, the fax machine actually hit medicine and it was not welcome. This new technology of a facsimile on thermal paper that was not very long lasting, not very clear. And was it truly secure or was it not?

And I just shook my head in shame that my peers in industry could not embrace something as remedial as a fax machine in 1990. So that actually jumped me into looking around and seeing how I could up the game and up the bar.

And it seems silly, but that thought of, “We need to deploy technology, we're drowning here.” I was entering a practice that had been around since 1968. And the files and paper charts—same in my residency—it was all so disorganized, so hodgepodge, so difficult to deliver organized care or do any sort of patient recall. You'd ask physicians, “What's your vaccination rate?” And they'd say, “Oh, it's perfect.” And you actually pull the charts and do it. And it was 18%.

It was just so hard to get data. You'd have to apply a couple of full-time employees for two weeks to get one topic analyzed. So crunching the data tracking and what I think of as the multi-sorting capacity. If I wanted to eventually look at tracking a condition—blood pressure, say—versus various medications to be able to slice and dice it spreadsheet-wise made all the sense to me. So moving toward that was really the vision that I took in the early ‘90s. And indeed, it took a decade to see that come about, but it happened.

Marcus: You're in primary care at the South Austin Medical Clinic. What over the years have you loved about being a family practitioner?

Weidmann: The fabric of being what I think of as intimately involved in people's lives as they struggle to take care of themselves, their kids, their parents, their plans, and getting the chance to jump into those inner circles of importance and decision making and follow-up that gives one insight into not just the people I'm working with, the patients and my coworkers, but the results of my efforts.

One of the silly things I thought of early on in medicine was, in my pre-medicine, high school/college days, I did a whole lot of construction and kind of building things. And there was a satisfaction of seeing the results of what you did. And the longitudinal care model where you're involved with people and you see the results of what you do—whether those are positive or negative results, whether they're equivocal—is an important piece of what I think keeps a person grounded in their work choices. So [it’s] the fabric of being intimate with people's lives and families and the ability to be there for them over many, many years to see the fruits and foibles of those labors.

Marcus: What are the challenges? What are the things that you've found along the way that are just plain unresolved?

Weidmann: There's some major challenges in both the financial aspects of healthcare in all of the world, but for sure in the United States. And so I think people have a lot of angst over where cost and revenue for healthcare workers and outcomes can settle into a sustainable marketplace.

So the ecosystem of healthcare finding a stable resonance amongst all the different factions. And oh my goodness, we are so far from a stable flow in the entire ecosystem [and] that is a major issue. And so what you hear is people pulling and pushing. We see insurance rates at crisis levels, but yet we see various insurance companies doing reasonably well in their stock and management.

So, from the standpoint of healthcare providers, what we see is a major push toward somewhat of a more moderate-income potential for people. They feel squeezed or they feel desperate to resolve education debts. We see a spreading of the workforce into various other dimensions, creating a larger base of healthcare providers to help take care of the population. So that's all good, but it's all a big challenge in flux right now.

Marcus: You've had a front row seat to the digital transformation. Can you talk about how that plays into some of the challenges that you're talking about?

Weidmann: That front row seat has been a bumpy ride. I can attest that various facets of it have been hugely successful. We've literally in a decade taken a paper-based system to basically an 80% electronic system in that first decade of meaningful use. And that is huge. That is a rapid transformation of the infrastructure by which process happens.

The thing that didn't happen through that time was a lot of concerted guidance to help improve the interoperability and the population health in that first decade of iterations. So again, we digitized a lot of stuff and a lot stayed siloed and digitized and useful in pockets, but not as useful as we would have liked. So that's the biggest pitfall of how this had played out through the ‘90s and into the 2000s. So we all knew at that time, there would likely be some large entity that helps coalesce and guide. And the federal government has not been that entity in a major way. They've given parameters, but it's been loose enough or burdensome enough that it really hasn't broken down the competitive commercialization that fragments our data systems.

So, fast forward, what we see is what we expected. Some major players surfacing as the survivors that help assimilate and organize. And indeed, the name up behind your head, Surescripts, is one of those major survivors that has been tremendously successful at creating a relatively nonproprietary clearinghouse of a lot of data that many, many systems have been able to tap, utilize, and up the game for patient and population care. Now, we see others doing this regionally. We see the specter now, literally in this year, of the qualified health information networks, the QHINs, upping that game another level of data interoperability. So, on the tech side, on the data crunching side, on the data sharing side, that's the rocky path that has brought us to a hopefulness for this next five years. Now, the other part of this is, the data does not get patients interlaced with providers and populations and communities healthier. The data gives the opportunity for the players in the ecosystem to do a more efficient and more comprehensively effective job.

Marcus: There is a shortage of primary care and there are a set of other care providers who are pulling in and, at least not taking on the primary care physician's full job, but taking some of that burden off.

So what has been your approach to collaborating with other members of a care team in your practice?

Weidmann: Well, you know, lessons from the past. I don't even recall when it was, maybe 1998, pharmacies started delivering vaccines. Seasonal vaccines, particularly. So, flu vaccine, basically. And the medical community was a little bit apprehensive about what that meant. And quite frankly, some of the pharmacists said, “I don't know that I really want to be giving vaccines.”

And so there was this reorganization that happened over a few years. And now it's like, “Oh, thank goodness. Somebody else is helping give all these vaccines.” And the providers basically count on it and offload a lot of that routine and seasonal surge in workload to pharmacies, to vaccine clinics, to other folks.

Now, as we look at spreading the primary care base to some protocol-based nonphysicians, to other resources, to people who have independent practice rights in different states, nurse practitioners, physician assistants, nurse midwives, pharmacists. And then comes physical therapists and occupational therapists and speech therapists. And then comes, prosthetics rehabilitation people. Again, the ecosystem of healthcare delivery.

Marcus: Do you have a story from your practice where that expanded care team really, really helped?

Weidmann: Let me lean on one that is potentially scary and divisive, but very intimate, And that is nurse midwives. A whole lot of good work in the teams of nurse midwives that practiced around Austin, Texas. And I recall meeting one of my patients to have urgent consult when things did not go well at home. So again, the vast majority of these three midwives that I knew pretty well, the work went beautifully. Home deliveries, wholesome environments, healthy mom, healthy baby, all great. And the need for the backup expedited by the relationships with a critical care OB-GYN and a neonatal intensive care unit facility. Again, when it was needed. Then pulling that trigger and having it not be, “Oh my goodness, you shouldn't be doing what you do.” But, “Oh my goodness, patient is in need, infant is in need, mobilize and address.” And so that is kind of this concept of one of the aspects that actually has been going on for a long, long, long time. My whole life. Doulas in the southern U.S. and along the Latino/Mexican culture border. The nurse midwives that practice in or out of OB-GYN groups. But they have backup. And so that is one of the examples that I would come up with.

The other that I would come up with is we have a very innovative, very dedicated pediatrician who opened literally a zero-pay clinic on a shoestring basis in Austin. And deployed two nurse practitioners that she had worked with at one of the hospital PICUs. And they deliver what's needed from donations and stock of their own pharmacy to whoever shows up. And, again, the majority of the work is provided by the nurse practitioners with the physician stepping in for some of the more complicated or the reality check support. And that has really expanded that kind of gap care for pediatrics in half of Austin.

Marcus: If you could snap your fingers and put the perfect care team together for your practice, what would be the elements of it and how would it all play out for patients?

Weidmann: The diversification of access points is something that is not agile to most of the people who play in the healthcare domain. “What does the guy mean by that?” Let me explain.

I have friends, colleagues, employees over the years that just cannot do a telemedicine visit. They don't do it well. They don't like it. They feel like it's beneath them or it's just not agile. I have people that would never think of doing a home visit or see patients in a long-term care facility or do hospital rounds. I have employees who have been great at strategizing and managing alternatives and alternative resource and reaching out into the community.

So what would it look like? It would look like a network of people in a geographic location that have agility for the different touch points: online, in-person, critical care, long-term care, social needs, mental health needs. And whether those have what level of advanced degrees or not is more of a legal title and an authority and a licensure than it really is a practical matter. One of the examples I give you is when I work with nurse or medical assistants through the 40 years that I've done that. One of the most empowering experiences is if they've managed and raised children. Male, female, whatever gender. I don't care, but if they've been around young sibs, babysitting, raising kids, had assessments, caregiving. That empowers them to do healthcare very much.

Now, there's another one that we are just getting to, and this is where our larger healthcare systems may actually have some value added much to my chagrin. And that is, somebody looking at data analytics and subpopulations. And again, we're just up to having the clinical ways to track and look and forecast those here in this last 5, 8, 10 years or so, depending on how big a data set and how stable your population is. So the data analytics [are] saying, “You know, we have a pocket of people in this part of our territory that have not been accessing healthcare and are underserved with both vaccinations and acute care, and they're missing work, and their kids are not making it to school.” That kind of data analytics gives the focus for community engagement.

Marcus: We think about this a lot right now as a candidate QHIN. We're trying to figure out, like, what information does a pharmacy really need, for example.

Weidmann: This is not a popular opinion amongst my health care provider friends, but I actually accept and value the role of medical liability in my attorney colleagues, my malpractice attorneys, because that keeps people—developers, companies, providers—a little more cautious. Does it slow development? Does it create redundancies? Yes, it does. But these are important topics for people and their families and their communities. And so, yeah, I respect that. And it is not easy. I err—in our software development over the years—in exposing more information at the risk of overwhelming the workforce. Because the more information is empowering for people who can at least see and either be alerted by it or confused enough that they look for support and help. So again, that exception handling is an important piece of this for the public wellbeing.

Marcus: This season we're asking our guests how they think we can best help healthcare heal itself. So, Dr. Weidmann, feel free to answer these questions however you'd like. You can zero in on something specific or zoom out at the big picture or both. But healthcare's hurting—what’s your diagnosis for what’s wrong with it?

Weidmann: I see our healthcare ecosystem as being ill with what I would refer to as “fragmented narcissism.” The narcissism of each piece being self-loving and self-sustaining at the expense of other pieces is the natural build. So, the diagnosis is to have the different fragments feel and empathize more with others, which means we need more community building and community interplay amongst the ecosystem players. So, does that mean everybody works for guerrilla system A? No, it doesn't, because that now makes a “we-them.” It's [more about] people being involved in the healthcare of their community and seeing the results and failures of those different players’ actions.

So, transparency is the prescription. I think transparency is a very important thing, and I've been a promoter of that all along in how people use [an] EHR, in how they share results, in how they articulate things. I think transparency breeds a little bit more interplay and empathy and understanding.

Marcus: Transparency breeds community. And transparency in community is your prescription for healing this fragmented narcissism as you explained it.

Thank you so much for a wonderful discussion. It was really, really insightful to hear straight from the primary care office and your experiences both in practice and in health IT. So, thanks so much for today.

Weidmann: You're so welcome.

I want to leave you with one of those growing moments I had. I was standing in the ER as a resident with a chief trauma surgeon attending. A wonderful cornerstone of the Central Texas medical team for 45, 50 years that he practiced. And I was retracting a gunshot wound chest on one side and he was working on arterial bleeds on the other and he was saying how he really understood that people needed to know and promote public health and understand how to take care proactively. But he needed somebody here to tie off bleeders with him.

So, I thought to myself, yes, there are different skill sets in the entire thing, in the entire ecosystem. And so that was one of those epiphanies of, “thank you for at least acknowledging what I'll spend a lot of my time doing. And thank you for having me here and teaching me to tie off bleeders and manage major trauma.”

It is a rarity sometimes in medical training now, being exposed to many, many layers of the healthcare ecosystem.

Marcus: Thanks again so much. We really appreciate it.

Weidmann: Appreciate it. Melanie. It's been a delight talking with you. I appreciate it. And thank you for the opportunity to be here.