A Digital Health Checkup for the US – #1 in AI, Meh in Interoperability – An OECD Update

While health care has been slower than other industries to leverage digital transformation, COVID-19 accelerated change — revealing some key barriers blocking the potential for more fulsome transformation, the OECD explains in its latest version of Health At A Glance for 2023 with a detailed chapter on “digital health at a glance.”                   The OECD report assesses digital health maturity across 22 countries: in addition to the U.S., the report provides details digital health traits in (alphabetically) Australia, Austria, Belgium, Canada, Czech Republic, Denmark, Estonia, Finland, France, Germany, Ireland, Israel, Japan, Korea,


Most Medicare Patients Haven’t Accessed Their EHR Information (Yet)

The HITECH Act, part of the Stimulus Bill (officially, the 2009 American Recovery and Reinvestment Act, ARRA) invested $35 billion of U.S. taxpayer funds to incentivize health care providers (doctors and hospitals) to acquire and use electronic health record systems (EHRs). Most providers have taken advantage of these financial incentives, so that EHRs are now part of mainstream medical practice and workflow among providers. For patients, and particularly those enrolled in the government programs of Medicare and Medicaid, personal access to their personal data in EHRs has been largely elusive. While nearly 9 in 10 doctors and hospitals have offered these


Most Wired Hospitals Spending on Cybersecurity, Telehealth and Population Health

Investing information technology dollars in telehealth and mobile platforms, patient engagement, and cybersecurity are major focuses for leading IT-savvy hospitals in America, according to the 2016 Most Wired survey of healthcare organizations, released in July 2016 sponsored by Hospitals and Health Networks and Health Forum, a division of the American Hospitals Association. This survey, in its 18th year, has become an important benchmark measuring the adoption of information technology tools and services among American hospitals and health systems. The complete list of Most Wired hospitals for 2016 can be found here. The most popular telehealth services offered by the Most Wired hospitals are


Paper and Fax, Not EHRs or Portals, Are Popular for Health Data Sharing

Faxing in health care ranks higher in patient data information sharing than using secure email, online portals, health information exchange (HIE), or leveraging electronic health records. Welcome to the American healthcare system in 2016, as described in a market spotlight published by IDC, The Rocky Road to Information Sharing in the Health System. IDC’s survey research among healthcare providers forecasts the “rocky road” to information sharing. That rocky road is built for medical errors, duplication of services, greater healthcare costs, and continued health il-literacy for many patients. “The holy grail of interoperability — lower-cost, better-quality care with an improved experience for


“What If 1 Million Americans Asked for Medical Records on the Same Day?”

This was not a theoretical question Dr. Farzad Mostashari, former head of the Office of the National Coordinator of Health IT in the Department of Health and Human Services, asked yesterday at the closing keynote of Day 1 of the Patient Engagement Forum. Dr. Mostashari issued a challenged to the community of mischief-makers in health/tech patient advocacy: tell everyone you know to contact their doctors — by phone, email, patient portal, or in-person, on one designated day which he called a “Day of Action.” Health IT journalist Neil Versel (disclosure: also a long-time friend in the field) covered this news


People don’t know much about patient portals: Xerox’s 5th EHR study

The Field of Dreams works in nostalgic plotlines about baseball, but as I’ve pointed out since the advent of consumer-facing health technologies, there’s no Field of Dreams effect in health care when it comes to consumer health engagement. U.S. health consumers aren’t using the patient portals that health care providers have built as part of their efforts to bolster health engagement via EHRs and health IT, Xerox found in the company’s 5th annual survey on electronic health records. I spoke with Tamara St. Claire to discuss the implications of the consumer poll, which was conducted among 2,017 U.S. adults in


Practice Fusion joins the open health data community with Insight

Open data is a growing trend in health care. Analyzing data sets across lots and lots of people can help researchers identify medical cures, anticipate epidemics, and solve knotty problems where social and behavioral issues complicate clinical questions and solutions. Joining the open health data community is the health IT company Practice Fusion, which is sharing with the public aggregated data on some 81 million patients collected through over 100,000 active users every month recording patient data in the company’s cloud-based electronic health records system. Insight, the searchable database, is freely available to people, researchers, policymakers, and anyone who wants to look at top line


Privatizing health privacy in the US?

8 in 10 people in the U.S. believe that total privacy in the digital world is history, based on a survey from Accenture conducted online in March and April 2014 and published in the succinctly-titled report, Eighty Percent of Consumers Believe Total Data Privacy No Longer Exists. 84% of U.S. consumers say they’re aware what tracking personal behavior can enable – receiving customized offers and content that match one’s interests. At the same time, 63% of people in the U.S. also say they have a concern over tracking behavior. Only 14% of people in the U.S. believe there are adequate safeguards


4 in 5 doctors in America use an EHR, but most not ready for Stage 2

The number of physicians using electronic health record systems (EHRs) rose by 50% since 2010, from 51% to 78% of office-based doctors. That equates to about 4 in 5 U.S. physicians now using any EHR system. This growing adoption of EHRs is evident in the first chart, published in Use and Characteristics of Electronic Health Record Systems Among Office-based Physician Practices: United States, 2001-2013. This survey was published by the National Center for Health Statistics in the NCHS Data Brief Series in January 2014. (The NCHS is part of the Centers for Disease Control, aka the CDC). This growth rate hasn’t


Healing the Patient-Doctor Relationship with Health IT

A cadre of pioneering Americans has been meaningfully using personal health information technology (PHIT), largely outside of the U.S. health care system. These applications include self-tracking and wearable health technologies, mobile health apps, and digital medical tracking devices like glucometers that streamline tracking and recording blood glucose levels. In the meantime, only 21% of doctors surveyed by Accenture currently allow patients to have online access to their medical summary or patient chart – very basic components of the electronic health record. We know what’s primarily driving health providers’ adoption of health IT: namely, the HITECH Act’s provisions for incentives. But


Driving innovation in health through the use of open data: Health Datapalooza, Year 4

In the $3 trillion economy that is American health care, the role of information technology is central to transforming this huge piece of U.S. fiscal activity. This week convened the fourth annual Health Datapalooza (HDP) in Washington DC, with the underlying theme, “health engagement is the blockbuster drug of the 21st century” (quoting Leonard Kish). This meeting of over 2,000 registrants – huge growth from the first year’s 400 attendees — is organized by the Health Data Consortium (HDC) , whose CEO Dwayne Spradlin kicked off remarks on Day 2 of HDP4. He described the HDC, a public-private collaboration led


Do doctors want patients to have full access their own medical information? It depends.

Only one-third of U.S. physicians believe that patients should have “full access” to their electronic health records, according to Patient Access to Electronic Health Records What Does the Doctor Order?, a survey conducted by Accenture, released at HIMSS13 in March 2013. Two-thirds of doctors in the U.S. are open to patients having “limited access” to their EHRs. However, the extent to which doctors believe in full EHR access for patients depends on the type of health information contained in the record. Accenture surveyed 3,700 physicians in eight countries: Australia, Canada, England, France, Germany, Singapore, Spain and the United States, and found the doctors’


Bill Clinton’s public health, cost-bending message thrills health IT folks at HIMSS

In 2010, the folks who supported health care reform were massacred by the polls, Bill Clinton told a rapt audience of thousands at HIMSS13 yesterday. In 2012, the folks who were against health care reform were similarly rejected. President Clinton gave the keynote speech at the annual HIMSS conference on March 6, 2013, and by the spillover, standing-room-only crowd in the largest hall at the New Orleans Convention Center, Clinton was a rock star. Proof: with still nearly an hour to go before his 1 pm speech, the auditorium was already full with only a few seats left in the


Patients globally would embrace Jetsons-style health care…but will health providers?

Patients are getting comfortable with remote health care – that is, receiving care from a health provider at a distance via, say, telehealth or via a Skype-type of set-up. Furthermore, 70% of people globally saying they would trust an automated device to provide a diagnosis that would help them determine whether or note they needed to see a doctor. Based on the findings from Cisco‘s survey summarized in the Cisco Connected Customer Experience Report – Healthcare, published March 4, 2013, just-in-time for the annual 2013 HIMSS conference, a majority patients the world over are embracing health care delivered via communications


Americans #1 health care priority for the President: reduce costs

Reducing health care costs far outranks improving quality and safety, improving the public’s health, and upping the customer experience as Americans’ top priority for President Obama’s health care agenda, according to a post-election poll conducted by PwC’s Health Research Institute. In Warning signs for health industry, PwC’s analysis of the survey results, found that 7 in 10 Americans point to the high costs of health care as their top concern in President Obama’s second term for addressing health care issues. Where would cost savings come from if U.S. voters wielded the accountant’s scalpel? The voters have spoken, saying, Reduce payments


The state of health informatics: positive ROI, but a shortage of talent and comprehensive data

While most players in health care see potential ROI through investing in health informatics, there’s a supply-side problem in the market in two ways: a labor shortage of health IT talent, and a dearth of clean and comprehensive data needed for specific objectives. Even with sufficient budgets, health care providers, plans, and pharma companies say, these two limiting factors prevent fully realizing the promise of health data. Deloitte and AMIA polled health providers, plans and life science companies on the state of informatics in health care, the results of which are summarized in The 2012 Deloitte-AMIA Health Informatics Industry Maturity Survey.


Only 1 in 4 US Health Consumers Wants a Digital Record, Xerox Says

While 87% of U.S. adults are familiar with health providers converting paper medical records into digital records, only 26% — 1 in 4 — say they want their own medical records to go digital. This sobering statistic comes as hundreds of thousands of doctors and hospitals are migrating to electronic health records (EHRs), motivated by the U.S. government’s HITECH act which provides incentives for the adoption and so-called meaningful use of EHRs. To gauge U.S. consumers’ views on digital medical records, Xerox polled 2,147 U.S. adults ages 18 and via an online survey in May 2012. The chart illustrates several key


Said the EHR to the doctor, “you like me, you really like me!”

Over one-half of office-based physicians in the U.S. had adopted an electronic health record (EHR) in 2011. Among theese adopters, 85% were satisfied: 38% “very,” and 47% “somewhat.” Those are pretty good reviews considering so many came to EHRs based on the government’s HITECH incentive and not motivated purely out of intrinsic personal passion to adopt digital medical records systems. This update comes from the July 2012 Data Brief from the National Center for Health Statistic, Physician Adoption of Electronic Health Records Systems: United States. 2011. The report details survey findings from 5,232 office-based physicians who completed the mailed questionnaire in


Wellness Ignited! Edelman panel talks about how to build a health culture in the U.S.

Dr. Andrew Weil, the iconic guru of all-things-health, was joined by a panel of health stakeholders at this morning’s Edelman salon discussing Wellness Ignited – Now and Next. Representatives from the American Heart Association, Columbia University, Walgreens, Google, Harvard Business School, and urban media mavens Quincy Jones III and Shawn Ullman, who lead Feel Rich, a health media organization, were joined by Nancy Turett, Edelman’s Chief Strategist of Health & Society, in the mix. Each participant offered a statement about what they do related to health and wellness, encapsulating a trend identified by Jennifer Pfahler, EVP of Edelman. Trend 1: Integrative


HIMSS 2012 in retrospect – from patient engagement to Big Data. Viva Las Vegas or Tumbling Dice?

The record attendance at HIMSS12, in terms of both attendees (numbering some 38,000) and exhibitors, illustrated just how hot health information technology has become in the 20 years since I first began attending this meeting — when it was only a few thousand hospital computer geeks and materials managers picking up pocket protectors and calculators from vendors. At this year’s conference, the major concerns were when Stage 2 meaningful use details would be revealed. HIMSS communications leadership in the press room thought it would be Tuesday, then Wednesday. Finally, it was Thursday the 23rd of February when Farzad Mostashari, National Coordinator for Health IT at the Department


Glass half full, glass half empty: EHR use has doubled, but…

By Jane Sarasohn-Kahn on 21 February 2012 in Health care information technology, HITECH Act

With $3.1 billion awarded to doctors who are buying and learning how to use electronic health records (EHRs), Secretary of Health and Human Services Kathleeen Sebelius told a Kansas City community college that 41,000 doctors and 2,000 hospitals were on the road to meaningfully using the technology — double the number of EHR users in 2 years. That’s how “stimulating” the ARRA HITECH stimulus funds have been — a glass half-full interpretation of the data. A survey of health providers conducted by the American Hospital Association learned that the proportion of EHR-using providers grew from 16% to 35% between 2009


Connected Health: countries’ vary in their health IT connectedness, but US patients are ready, willing and welcoming EHRs

How electronically connnected and communicative are nations’ health information infrastructures? Accenture has answered that question in its report, Making the Case for Connected Health. Accenture built a “connected health maturity index,” analyzing a nation’s level of health information exchange among users along with their level of health IT adoption among specialists and primary care doctors. Adoption was defined across four HIT functions: administrative tools, electronic patient notes, electronic alerts/reminders, and computerized decision support systems. Health information exchange was defined across seven connectivity dimensions: electronic communications, e-notifications, e-referrals, e-access to clinical data about patients who see a different provider, e-prescribing, and


iPads and health care – health IT managers slow down physicians’ clinical adoption

Doctors are using iPads in huge numbers for personal life project management. 80% of doctors are excited about using them in clinical practice. But when it comes to clinical applications, don’t confuse physicians’ desire for mobility with their current use of iPads in everyday practice. What’s surprising is the “why” behind that phenomenon. It’s not a lack of desire; to a large extent, it’s a hospital-based system that’s not listening to physician demand for seamless mobility that fits with real-life workflow. This was the light-bulb-over-the-head finding of Gregg Malkary of Spyglass Consulting. Gregg recently complete 100 in-depth interviews with switched-on doctors to


The state of health IT in America: thinking about the Bipartisan Policy Center report on health IT

There are few issue areas within the Beltway of Washington, DC, that have enjoyed more support across the political aisle than health care information technology. In 2004, George Bush asserted that every American would/should have an electronic medical record by 2014. Since then, Democrats and Republicans alike have supported the broad concept of wiring the U.S. health information infrastructure. With the injection of ARRA stimulus funds earmarked in the HITECH Act to promote health providers’ adoption of electronic health records, we’re now on the road to Americans getting access to their health information electronically. It won’t be all or even


On the road to retail health: healthcareDIY and primary care, everywhere

At the ConvUrgent Care Symposium in Orlando, attendees from the worlds of clinics, ambulatory care, hospital beds, pharmacies, medical devices, life sciences, health information, health IT, health plans, academic medical centers and professional medical societies came together to share and learn about the morphing landscape of retail health. The topline message: primary care is everywhere, and based on the response to my keynote talk this morning, every stakeholder segment gets it. My mantra, courtesy of the U.S. Surgeon General Regina Benjamin: don’t look at health in isolation, that is, where the doctor and hospital are. Health happens wherever the person


Top 15 Hospitals are very wired

Congrats to the 2012 Top 15 Health Systems as crowned by Thomson Reuters today, shown in the chart. They are segmented by size, with large systems (>$1.5 bn), medium ($750mm – $1.5 bn), and small (<$750 mm). No matter their size, though, across the segments, these best hospitals share several traits: They demonstrate better patient outcomes in terms of better survival rates and fewer complications Better long-term outcomes They adopt evidence-based medicine They have better patient safety track records Their patients leave hospital sooner, which could result in the fact that Patients are more satisfied than consumers at other hospitals (with higher HCAHPS scores). To


US doctors less sanguine about the benefits of health IT

To doctors working in eight countries around the globe, the biggest benefit of health IT is better access to quality data for clinical access, followed by reducing medical errors, improving coordination of care across care settings, and improving cross-organizational workflow. However, except for the issue of health IT’s potential to improve cross-organizational working processes, American doctors have lower expectations about these benefits than their peers who work in the 7 other nations polled in a global study from Accenture‘s Eight-Country Survey of Doctors Shows Agreement on Top Healthcare Information Technology Benefits, But a Generational Divide Exists. Accenture polled over 3,700 doctors working in


Health IT in 2012: a dynamic sector in the context of a fiscally-challenged health system

2012 will be a dynamic year for health information technology (health IT) in the U.S., which I outline in my annual health IT forecast in iHealthBeat, the online publication on technology and health care published by the California HealthCare Foundation. The full forecast can be found here. The key headlines for you Reader’s Digest abridged fans are that: The Health IT sector will continue to grow jobs in the ongoing Great Depression, particularly in key competencies in data security, analytics, integration, and EHR implementation. There will be more data breaches, and consumers will be justifiably concerned about data security. Government will more consistently


More U.S. health citizens embrace digital personal health information: the topline of Manhattan Research’s Cybercitizen Health survey

“56 million U.S. Consumers Access Medical Information from Electronic Health Records,” asserted Manhattan Research’s press release of October 12, 2011. This statistic, fresh out of the firm’s 2011 Cybercitizen Health survey, is among several stunning numbers that demonstrate a growing trend: U.S. health citizens’ embrace of their personal health information in digital formats, via electronic channels. To kick the tires on the survey a bit, I spent time on the phone with the “3 M’s” of Manhattan Research — Meredith Ressi, President; Monique Levy, VP of Research; and, Maureen Malloy, Senior Healthcare Analyst who can recite the survey data backwards and forwards. Together,


ePrescribing continues to challenge physicians – but can be a link for patient engagement

  About 1.3 million people in the U.S. experience a medication error each year, which are preventable events that may cause or lead to inappropriate medication use or harm a patient, any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. Two very common causes of medication errors are illegible handwriting by prescribers and misplaced decimal points on prescription forms. Twenty percent of adverse drug events lead to life-threatening circumstances, according to The Leapfrog Group.  The costs of medication errors has been


Consumer engagement with health IT isn’t about technology

Today’s kickoff of the National eHealth Collaborative‘s Consumer Consortium on eHealth convened the most diverse workgroup of over 70 stakeholders with various lenses on consumers and health, rarely seen at similar meetings, as Lygeia Ricciardi (@lygeia) of the Office of the National Coordiantor for Health IT (ONC) in the Department of Health and Human Services, observed. However, although representing every conceivable segment of health consumer stakeholders, from seniors (AARP)  and physicians (MGMA) to people with disabilities (AAPD), women (National Partnership for Women and Families) and people who fall through the health safety net (the National Health IT Collaborative for the Underserved), there was concurrence


There’s hard ROI for physician groups that fully implement electronic health records

About one-half of physician practices used an electronic health record (EHR) as of late 2010, with 36% of groups still storing health records in paper charts. While 1 in 2 physician groups in the U.S. have implemented electronic health records, they confess that they haven’t yet optimized their use. Only 16% of medical groups have implemented EHRs and believe their practices have optimized their EHRs. But optimization has its rewards: over 1 in 3 groups that have had sufficient time to fully implement their EHRs report decreased practice operating costs. Furthermore, 41% of these fully-operational EHR environments have seen physician productivity increase. With the subtitle, “snapshot of


One-half of consumers want electronic access to doctors – including online medical records

Most U.S. health consumers would be keen to take advantage of alternative communications for their health care encounters. Of these 6 in 10 people, 72% would like nurse helplines, 60% email, and 1 in 3 would use a private online forum for their health. However, only 1 in 10 would use some form of social media for interacting with their providers, such as Facebook or Twitter, were it available to them in February 2011. Capstrat surveyed U.S. adults to learn about their perceptions and interactions with the health system. At least one-half of health consumers would use electronically-accessible applications offered by


How an EHR can help manage population health

There’s a lot of chatter about Meaningful Use in the context of electronic health records adoption; if you Googled the term today you’d find millions of references to the concept. The Centers for Medicare and Medicaid Services (CMS)’s website offers three main components of Meaningful Use as specified in The American Recovery and Reinvestment Act of 2009: – The use of a certified EHR in a meaningful manner, such as e-prescribing – The use of certified EHR technology for electronic exchange of health information to improve quality of health care – The use of certified EHR technology to submit clinical quality and other


Patients like health IT and digital data, balancing privacy concerns

Patients like the idea of advanced health IT, while continuing to be concerned about the safety and security of their personal health data. Dell polled patients and hospital executives on their opinions of health reform, technology, and other health care topics, reported out in The Dell Executive & Patient Survey. Overwhelming majorities of consumers are inerested in: Electronic access to information about a hospital to help determine which hospital to visit (81%) Electronic prescription processing (76%) Making it possible for EHRs to be shared between physicians, hospitals, and ancillary providers (74%) Providing more information electronically such as follow-up care post-discharge (73%)


Will providers be ready for patient-centricity in health IT?

In October 2012, Stage 2 of the HITECH Act’s meaningful use begins. That means that providers, both hospitals and physicians, who adopt electronic medical records systems and are looking to receive a financial incentive from the ARRA stimulus funds, must meet criteria defined as “meaningful use” (MU). Stage 2 will feature standards for providers to communicate health information to patients, based on the draft set of criteria issued by the U.S. Department of Health and Human Services. Will providers be ready to put patients in the center of the EMR? PricewaterhouseCoopers assesses the complex answer to this question in their report,


The health IT talent shortage could slow HIT adoption in U.S. health care

For hospital CIOs, 2011 and 2012 are all about achieving meaningful use, focusing on clinical systems, safe-keeping health information, and staying financially healthy as an organization.  These insights are brought to you by the 22nd Annual HIMSS Leadership Survey, sponsored by Citrix. This survey has become the most important snapshot of health CIOs’ priorities looking ahead. This year’s survey results, unveiled week at HIMSS 2011 in Orlando, held some important findings. While achieving meaningful use is the top IT priority for the next two years (with 81% of organizations believing they’ll quality for MU in 2011 or 2012), clinical systems implementation and


Robert Reich connects the dots between the macroeconomy, angst, politics and health care costs

“I’m not a class warrior. I’m a class worrier,” Robert Reich told a standing-room only crowd of thousands of health IT geeks as he delivered the first keynote address of the annual meeting of HIMSS, the Healthcare Information Management and Systems Society. This year’s crowd will have reached about 31,000 people interested in health information technology’s transformative role in health care. The 31K represents an 18% increase in attendance from last year’s crowd. The HIMSS economy is strong. Robert Reich warns, however, that the U.S. macroeconomy is far from healthy…and health care costs will be a long-term threat to the


Personal health records: will doctors connect?

What doctors are most likely to use patients’ personal electronic health records? Fewer than 1 in 2 are willing to. Those who most likely would include Hispanic physicians, doctors who practice in rural areas, those employed in hospitals, and surgeons. As part of the HITECH Act included in the American Recovery and Reinvestment Act (ARRA) 0f 2009, U.S. physicians have the opportunity to receive a portion of the $20.8 billion carved out as incentive payments to those who adopt and “meaningfully use” electronic health records (EHRs). Many EHRs include portals which allow patients to access a slice of their personal health information.


Doctors and the public support health IT in America, the Markle survey confirms

The majority of both doctors and people in the U.S. support sharing information to improve health care in the U.S. by reducing medical errors, cutting avoidable costs, better coordinating patient care, measuring progress on improving quality and safety, and improving public health priorities such as heart disease and obesity. What’s also clear is that both the public isn’t very familiar with the details of the HITECH Act which provides incentives for their doctors to adopt electronic health records. While 64% of doctors are familiar with the incentive program, only 14% of the public is. The Markle Foundation conducted parallel surveys to measure the public’s and doctors’ views


Don’t underestimate the costs of adopting health IT

Mature users of electronic health records bear many scars and learnings, having been through the first several rungs of the health information technology (HIT) adoption ladder. A few of these lessons for HIT adoption success… Implementing EMRs is a strategic and not just an IT-department initiative. HIT adoption requires top-down commitment and engagement. It takes longer and costs more than the planners of systems expect. During transition to an EMR, hospitals see an 80% “spike” (increase) in IT operating expenses — directly impacting the hospital’s overall operating budget as much as 200 basis points or more. There is evidence that those spikes


Health IT makes work easier for most doctors in small practices

By Jane Sarasohn-Kahn on 12 January 2011 in Health care information technology, HITECH Act, Physicians

While 41% of small physician practices – defined as those with 9 or fewer physicians – are doing ‘worse’ than last year, doctors are generally enthused by new technology, based on Practice Fusion‘s 2011 State of the Small Practice survey. The key challenges facing doctors in small practices are the costs of operations and administrative burdens (cited by 31% of small practice physicians) and insurance reimbursement delays and payments, noted by 1 in 4 doctors in small settings. 59% of doctors in small practices said that new technology such as electronic health records (EHRs), websites and smartphones have “made things easier” for


Rent, Buy or Wait? A post-mortem of HIMSS ’10

It’s been a year since the American Recovery and Reinvestment Act and the HITECH Act got the president’s signature. Since then, there have been countless meetings of standards-setters, CIO experts and medical informatics pros, all opining on the meaning of “meaningful use,” the criteria for certifying electronic health records and the vision for a Nationwide Health Information Network. As they asked in “Seasons of Love” from Rent, “525,600 minutes…how do you measure a year?” The chorus’s response: “In cups of coffee, in inches, in miles, in laughter, in strife.” And 525,000 journeys to plan. That’s about the number of physicians