Jeffrey Hoffman, MD, began working at Columbus, Ohio-based Nationwide Children's Hospital 15 years ago as a pediatric emergency medicine physician. Committed to a lifetime of learning, Dr. Hoffman shifted his practice to informatics. In 2013, he became one of the first physicians in the county to earn board certification in clinical informatics.
Shortly after Dr. Hoffman was appointed to chief medical information officer of Nationwide Children's Hospital.
He also serves as chief of the division of clinical informatics and a clinical associate professor of pediatrics, family medicine and biomedical informatics at the Ohio State University, also in Columbus.
Here, Dr. Hoffman answers Becker's seven Corner Office questions.
Editor's Note: Responses were lightly edited for length and clarity.
Question: What is one thing that piqued your interest in healthcare?
Dr. Jeffrey Hoffman: I've always been fascinated by the workings of the human body, even when I was little. When I was four years old, I remember going to the library on weekends with my father. I would go to the kids' section and check out an anatomy book about the eye, ear or the digestive system. Although my interest in anatomy didn't initially put me on the path of thinking, "I want to be a doctor," I was fascinated by what happened inside our bodies at such an early age.
What really piqued my interest in a healthcare career was when I came down with appendicitis as a teenager. It was my first experience being admitted to a hospital, and I was a patient for almost a week. After getting past the first few days post-surgery and the discomfort involved, I found the entire environment interesting. I made a friend with another patient down the hall, and we would sneak out of our rooms and explore the hospital. It drove the nurses nuts. But that's when I thought, "Wow, this is a really cool place. I really like this stuff. Maybe this is a place I want to work." So that was my first inkling that I wanted to go into medicine. From there, I just followed the educational path.
Q: What do you enjoy most about Columbus?
JH: What I enjoy most about Columbus is the diversity. Out of all the cities in Ohio, Columbus is the most diverse, the most inclusive, the most tolerant. There are tons of different people and different cultures, which translates to different neighborhoods, different foods, different opportunities for entertainment and unique events. It's always fun to explore the unique cultures. I think having a university here sort of accentuates the diversity and helps draw a lot of big-name events to us, which I always find fun and enjoyable for myself and my family.
The second thing I love is that this town really embraces technology. We have a lot of big tech firms here, but businesses also know and assume that customers want to engage digitally. So, everybody is connected and networked. They're exploring smart highways, self-driving cars and distributing WiFi everywhere. So, from being in a technological side of the business and being a technophile myself, I find it exciting to live somewhere that really embraces all of that.
Q: If you could eliminate one of the healthcare industry's problems overnight, which would it be?
JH: I think the biggest problem and biggest stress on healthcare right now is physician burnout. The entire healthcare system rests, in many ways, on the backs of individual physicians providing care, making treatment decisions, using diagnostic services, using acute facilities and chronic care facilities. That is the foundation of healthcare. Physicians are also often the direct interface with the patients who choose those services. I am horrified to see the number of my colleagues who have left medicine, are considering leaving medicine or scaling back their work because they're overwhelmed.
Burnout comes from many different corners, but one that is top of mind for me is attributed to a shift in healthcare. In the past, the physician was the leader, the captain of the ship or the man or woman at the top of the hill. Everyone took direction from them, and they had a whole support apparatus to help them complete their work. As healthcare moved to a team-based approach, which is now pretty much the norm, the hierarchy flattened. What that did was push a lot of tasks onto the physician. In the past, the physician would often direct that task to another worker. Now, it seems to be expected to be done by the physician.
I think the use of EMRs have only accentuated that ability to push work onto physicians that they previously did not need to do. Whether or not the physicians are the right people to do the work is obviously a point of debate, but I think that in many ways this change has contributed to physician burnout. Physicians feel like they've become care coordinators, secretaries and case assistants. I think we need to find a way to reverse that and better distribute the workload so providers can get back to helping diagnose, manage, treat and care for their patients.
Q: With all the talk of burnout, how do you personally revitalize yourself?
JH: I'm insatiably curious. There is one quote by Albert Einstein that says, "I have no special talent. I am only passionately curious." I have an insatiable curiosity about things well beyond what I do every day. So, I love to learn. The way I revitalize myself is by learning. Luckily, nowadays it's easy because we can access so much information online. For me, I love to learn about history, culture, politics and religion, and always keep myself up-to-date on the latest news. It's usually information that I'll never put into practice at my job, but it makes me feel like I'm connected to a larger whole, and that helps rejuvenate me to focus on the daily task at hand.
Q: What is your greatest talent or skill outside of the C-suite?
JH: With some humility, I'll say creativity. My first love was writing, ever since I could pick up a pencil and knew the alphabet. I loved to write. I was an avid writer, creative writer. I wrote short stories, plays and all kinds of things. I'm not published anywhere, but I loved creating things and building things. I love being able to point to something and say, "I made that," or "I helped make that."
One of the coolest things I've ever built was a computer simulator for a microbiology class in medical school. Back when I was in medical school, the project was very manual. It involved a simulation of a patient that had an illness that you had to diagnose and manage. The project required analyzing fake specimens, diagnosing the infection in the fake patient and checking to see if you were right. Overnight, a nurse would "check" on your patient and provide additional notes on how the patient was reacting. The project was very manual and required a lot of effort and time to create the simulation and complete the physician and nurse notes.
So, at that point, I got support from one of the faculty to write the project as a computer-based simulation that would streamline this project for the professors and students. I was able to create the simulator so students could access it from a computer, use the program to complete the patient's history, order the lab tests, specimen identification tests and medications from the pharmacy. Then, at night the computer simulator would automatically churn notes, and the next day a student could come in and have a detailed report of what the nurse said, how the patient was holding up and if the patient felt better or worse. From there the student could go in and modify the treatment for the fake patient.
What I didn't realize at the time I had built this was that I wound up writing an EMR and a physician order entry system without realizing it. The program was not only a simulator, but a tool where you could write notes, put in orders, see results and communicate with these imaginary nurses.
Q: What is one piece of advice that you remember most clearly?
JH: My clinical background is pediatric emergency medicine, which I practiced for more than 20 years. Early on in my fellowship, during a busy emergency room shift, I had a patient who had some interesting complaints and I didn't know what to do. It was sort of outside my experience at the time.
My attending physician asked me what I thought the patient was suffering from and to come up with a plan of action. I really didn't know, and I was flustered because I thought maybe it was something I should know. However, during that shift, the attending physician stopped me and said, "You know, you don't have to know everything. The job of being a good physician is not to have everything stuffed in your head. The secret to being a good physician, is knowing when you need rely on outside research and quickly knowing how to find what you need to know."
Essentially, he told me I needed to focus on how to quickly and reliably find what you need to know, whether it's a resource, a reference, an individual, a person to talk to, a consultant or a colleague. So that was something that I've carried with me throughout my career. Not knowing everything and needing to look something up is not a weakness. It's a sign that you are doing the best job possible.
Q: What do you consider your greatest achievement so far at Nationwide Children's?
JH: As CMIO, I have a lot of responsibility in terms of the health IT systems that we provide for providers, patients and families. However, I am also responsible for a group of colleagues in the domain of clinical informatics. They're folks that have chosen the same field and career path I have. But, when I first started in informatics at the hospital, we didn't have a specific place in the organization for those in the medical specialty. Everybody who worked in informatics was in their own clinical area. A general pediatrician here, an emergency medicine doc there, a neurologist over there.
A couple years ago, I decided we really needed to be legitimized as informatic specialists. We needed to say, "Yes, this is a discipline. This is a field of medicine that adds value to the organization and has a future as a career in and of itself." So, I worked hard, alongside my CMO, to establish a division of clinical informatics at the hospital, where all the informaticists could be appointed. It provides both an organizational structure, but also a clinical, academic and scholarly home for us.
So now, this division of clinical informatics spans shoulder-to-shoulder with all the traditional medical disciplines like cardiology and endocrinology. The five of us in the specialty have a seat at the table. After establishing a clinical informatics division, we now have the ability to hire staff and promote people's careers. Most recently, we were able to establish an accredited fellowship training program to further grow the field of clinical informatics.