I never thought I’d change the way I practice medicine.  But I recently enrolled as a provider in the Improved Care Now (ICN) collaborative network and I’m already working differently.

ICN is an alliance of gastroenterologists and patients working in a new model of pediatric inflammatory bowel disease care based on the analysis of thousands of doctor–patient visits as well as the latest studies and treatments.  Doctors and patients apply this information, experiences are tracked in an open registry, the results are then shared and refined to improve care.  I can see what I’m doing well and where I’m falling short relative to other clinics and pediatric gastroenterologists.

ICN is under the direction of Dr. Richard Colletti of the University of Vermont.  ICN is supported by the Chronic Collaborative Care Network (C3N), the brainchild of Cincinnati Children’s qualitymeisters, Peter Margolis and Michael Seid.  I flew to Cincinnati earlier this week to catch up on C3N and what appears to be a first step into medicine’s future.  More on the specifics later.  But suffice it to say that I’m stoked about where this is all headed.

A couple of thoughts after enrolling my first few patients:

I treat differently when I’m being watched. While I’m comfortable with the care I’ve offered in the past, knowing that what my care is under review changes how I see and do things.

My care is reflected in team performance.  And how I care for my panel of children with crohn’s disease and ulcerative colitis reflects on the public’s view of Texas Children’s Hospital.  A marginal remission rate, incomplete data and the failure to keep a close eye on 6-MP levels will reflect poorly on me and my team.

I have begun to perform pre-visit planning.  When I know one of my kids with IBD is on the schedule, I carefully review the chart and pull the necessary information for the registry. While I do this to save face-to-face time with my families, it has forced me to read and review old biopsy results and imaging studies. This offers a fresh and thorough picture of my patient.

I’m thinking about population management.  By the fall I will begin reviewing my patient panel as a group. On a monthly basis I can review a list of every patient on 6-MP and the date of their last levels. I can query my patients not in remission to see if anyone’s slipping through the cracks – a patient on prednisone, for example, who failed to return for follow up.

The parents see what’s happening.  They see the process in action and clearly understand that they’re part of something that’s going to move the chains forward, for them and the next child with IBD.

So was I doing it so wrong before?  I like to think that I’ll be doing things better.  This process of patient maintenance offers a new way to look after kids who have lots going on.

It’s interesting to watch myself evolve in this process.  I’ll chime in occasionally with my progress and thoughts.