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jbbuckybarnes · 4 years

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Professor Sugar - 3/7

Pairing: Student!Reader x Professor!Bucky Description: Like tons of other students you struggle with finances, but you can’t get any aid since your parents are filthy rich. The system doesn’t care that they broke off contact after you came out as bisexual. There is, however, someone else that cares. The prof of your class on PTSD and trauma. Professor Barnes. Warnings: Financial Instability, flirting with a teacher, feelings, mentions of PTSD and war, not beta read.

Professor Sugar Masterlist // Masterlist

After Office Hours

The week after you decided to visit him in his office hours to figure out where you lacked in your studies. The mission earning you a wiggling of brows from your roommate Samantha. „I think you struggle most with the medical part of these things. You‘re great at the psychological part and all the causes and symptoms. I just think your medical referencing could be a little better. Can‘t blame you, my course is for med students and psych students.“ He explained after reading through your study materials again and then your test. „Yay,“ You expressed monotone, „Wish I‘d get paid like that too, once I graduate.“ He smiled with a huff, „You remind me a lot of myself when I was in Junior year.“ „I hope that‘s a good thing, Bucky.“ You raised a brow with a playful smile. „A little bit of sass is always good.“ He chuckled and WOW...why was that so hot? There was a short silence when he put all your stuff back into a neat pile of papers. „So...how is the book?“ He asked interested with his attention fully on you. „Oh, it‘s really cool. I like it when I find out just how wrong stuff in movies is. The way they do shit and how much we don‘t know about is insane. They also did some horrible shit man. I‘m about 80% through.“ You smiled wide and he looked at you very content. „I‘m glad you like it. Would‘ve been shitty to spend $35 on something bad.“ He chuckled at you and almost looked cute. „Did that ever happen to you?“ You grinned and he nodded. „Have you ever seen psychology-based books? My god, half of them are absolute trash.“ He groaned and then laughed. „And what is the last good book you read?“ You dipped your head to the side. „Romance Novel. Forgot the name. The main character kinda has the same outlook on life that you have.“ He grinned. „What‘s that supposed to mean?“ You asked a little more playful again. „Been through shit, knows what she wants, works hard, asks for help, doesn‘t get played easily.“ He smirked at you and gosh were you attractive to him after this conversation. Where did that come from?

+Why was he suddenly so hot? You got a little flustered by the compliment. -He shouldn‘t, should not. +You would if you could. -Why did he now picture you leaned over his table naked? Shit! +You noticed him undressing you with his eyes. Why didn‘t it bother you? -The tension was so thick, cutting it with a knife would‘ve been easy.

„Why don‘t you start one of those study accounts. Heard there is money in that.“ He leaned back and changed the mood in the room. „My phone is from the last ice age and the good editing apps cost money.“ You shrugged. „Maybe just with your iPad notes for now?“ He shrugged and pointed at the pile of paper on the table. „Yeah...that might be an idea.“ You mumbled taking them and putting them back into your backpack.

You started studying for the course by rewriting notes in your Goodnotes app. Making them look nicer and organizing them in fun ways that made them easier to read and understand. You created that studying account like Bucky had suggested and started posting your notes on there, gaining a couple hundred followers in a short amount of time. He wasn‘t wrong, there was money in it as you found out with time. You realized your notes looked different to what most other study accounts posted but copied some of the stuff they were doing. Getting a hold of using an Instagram account in a business-manner wasn‘t as easy as you thought it would be. But at least it was fun and made you learn more and more so you could produce content. „Are you making new notes for Insta again?“ Sam peeked her head through your door. „Yup.“ You smiled over. „If you wanna borrow my phone for some nicer pictures you just need to ask.“ She grinned proudly. She had gotten a new phone from her parents at the end of the last semester. It was her whole pride in the midst of broke student life. „I‘ll keep it in mind. Are we watching Star Wars later?“ You looked back to your notes. „Baby Yoda doesn‘t like to wait.“ You both giggled as she closed the door.

After the next test about two weeks later you found an App Store card on your table with a little note. *Some people need to be self-made with a little help. -B* You smiled for a second before putting it away and listening to Bucky‘s presentation. PTSD in DID patients. After the lesson you went to him, realizing how weird it might look to others by now. You did it every time, but now that you had that little situation in his office, it became apparent that it could be interpreted wrong. „Bucky?“ „Yes?“ He smiled at you. „Can I ask you something a little more personal?“ You mumbled and had him nod back with attentive eyes. „Where do you take the money from to just give to me. It‘s not like professors make that much money.“ You asked straight forward. There was a short silence and a deep breath, „I was a prisoner of war with the army. That‘s why I started teaching about trauma. I just leave it out of my material since it‘s a depressing story. But that money I have is from the army paying me for the time I was a prisoner of war.“ His lips were a thin line. „God, I‘m sorry for asking.“ You were embarrassed. He grabbed your hand with both of his, „Don‘t be. Wouldn‘t be doing what I love otherwise.“

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kokomatcha · 6 years

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Vigilante!All Might x Reader snippet

Here’s a snippet of the first chapter of my Vigilante!All Might x reader AU. Again, it’s self indulgent, but I’m not sure if I’ll be focusing on this one, or my other ones, but this is the one that kind of just started flowing so I went with it. Again, I only have my iPad and touch keyboard, which gets very moody so sometimes it’s hard to type. I just wanted to post a sample of my writing so people know what I offer and not get too excited so they won’t get their hopes up because I haven’t even really posted anything and have people following me/liking my posts, but I guess I’m worried about being disappointing as a writer so here’s a sample for you to decide if you like my writing or not! Cheers!

*edit* whoops forgot a synopsis that might help!

You’re an ER nurse, quirkless, and on the verge of burnout.

At least, you thought you were quirkless until an opportunity arises that shows you were never quirkless, it’s just that you were never in a situation that utilized your quirk. All your childhood dreams of being a super hero with an amazing quirk were effectively dashed at a young age, but upon the horrifying truth of your quirk, you realize that it was better to let sleeping dogs lie and that being quirkless was not the worst thing in the world.

Now you’re mandatorily enlisted to support the supposed law enforcement that was meant to protect and serve civilians and the general population, but you find yourself entangled in the corruption. You’re only hope is a chance meeting with a strange man, and the infamous villain All Might. But is he really the villain that the media and government paints him out to be?

You repressed what would have been an obscenely large yawn, briefly raising the back of your hand to hover over your mouth, a strangled noise resulting in the back of your throat and the warmth of creeping tears welling up behind your eyelids that you blinked away before they threatened to spill over. You let your hand drop limply back to your side as you stepped out of the emergency room into the waiting room, or what you and your coworkers most commonly referred to as ‘The Pit,’ with a clipboard clutched to your chest.

It was packed with a variety of different potential patients, all of whom jerked their gaze to you the moment you entered, you’re stethoscope hung around your neck over you’re patterned scrubs (it was the only real choice you had to show your individuality so you’re damn right they were cute) marking you like a giant target out in an empty field. It never failed to make you feel like a piece of meat on display to a pack of wild animals. You could practically feel them humming with anxious energy as they all individually willed you to their direction, to be the lucky ticket holder to be able to walk through those double doors and have their emergency dealt with.

‘Sorry,’ you thought dully with no real sincerity as you walked past a few people before stopping at your intended target, ‘but the lucky contestant is—‘

“Hello,” you greet with a smile plastered onto your face, stretching the corners of your mouth turning it into more of a grimace than a genuine expression of greeting. It was a sort of instinctual mechanism you’ve developed over time in your career, all teeth and no tongue, a reminder of the harsh reality that the medical world cared less about actual medical practice and more about customer service (and money). However, you had plenty of time and situations to practice pulling off that award-winning smile of false assurance in even the most dire situations that could fool most.

For example, it had the intended effect on the young boy with a mess of wild dark green hair and freckles dotting over his small cheeks, still rounded with residual baby fat. His already impossibly large eyes widened as you now stood before him, a nervous smile returned in response to yours as he fidgeted with a tattered note book in his hands, something he clearly used to distract himself while waiting. Your smile softened a small bit out of genuine concern. He was probably a preteen, barely even twelve, but admittedly you found looks and age never coincided well in your line of work.

He seemed to sense your sincerity, his smiling becoming less stiff and his shoulders relaxing as the hands in his lap were no longer ringing the poor notebook to confetti.

Your gaze drifted over to the man at his side just in time to see him double over in a coughing fit. Without even batting an eye you grabbed a box of tissues sitting on top a table full of outdated magazines, as well as fished out one of the unused disposable mask from your scrub pocket. You held them out to the man as an offering, but he kept his gaze down and only glared at your proffered hand in response, opting to use a closed fist as his means of infection control.

It was clear who your patient was as the scent of copper assaulted your senses, and it was fairly obvious how your shift would play out if this would be your first patient.

Wonderful, you thought without any trace of humor as you placed the mask and box of tissue on the table and waited patiently for his coughing fit to subside.

The boy seemed to jump to his feet, hovering over the clearly emancipated form of the man hunched over in his seat. His eyes were heavy with dark shadows, cheekbones and chin sharply defined from his sunken cheeks, his teeth bared and stained with blood as he struggled to control his coughing fit. Your assessment was running through your head, assumptions already swimming to the surface of your mind as you surveyed him from head to toe.

Loose, ill-fitting clothing hung from his skeletal frame, decorated with an array of damage and stains from long term use. His skin stretched thin over bony prominence in his joints, including the nape of his neck and down his spine that you managed to catch a glimpse of while he was hunched over. He wore a long sleeved black shirt with khaki colored cargo pants, cinched together with a belt around his thin waist with a large, gaudy looking belt buckle. His blond hair was unkempt, probably dry and fragile from poor nutritional intake, sticking up in all directions aside from two distinctive locks that flopped about his face during his coughing fit.

Drug user? Addict? With his long sleeves you couldn’t tell if there was any injection sites. Hemoptysis indicated something with the respiratory system or maybe digestive system? Obviously lung issues were present. Pneumonia? Cancer? Definitely need to start IV fluids—

“—fine.”

You must have been lost in your thoughts because the man was now standing and you had to take a step back, your eyes widening as you took in his full height. His posture was poor, but god, he still towered over you. He was clearly well over six feet, maybe seven? Now that he was standing, you almost flinched at how obviously malnourished this man appeared to be. The shirt he wore was three sizes too large and hung very loosely around his neck, giving you glimpse of his clavicles protruding sharply above his chest.

But his eyes were still what unnerved you the most.

You realize that the sound of his voice, a deep rich baritone that you hardly expected to come out of such a fragile looking man, was what pulled you from your reverie. He had been brushing off the young boy when he waved the tissues out to him almost frantically.

You realized you must have been staring, frozen in place from his gaze, but the moment he turned to address the boy at his side, you seemed to regain your senses, feeling a bit shaken. You really didn’t think you’ve ever met someone with an eye color that was such a shockingly bright shade of blue.

Slightly intimidated by his height, you regained your composure as you put on your best assertive, yet friendly customer service voice.

“If you could please follow me? I’ll guide you to your room and then we can triage you, Mr—?”

You already knew his supposed name (from the shoddily attempted paperwork that was scribbled in by the boy at his side. You highly doubted this man would have bothered to even look at the paperwork given his current attitude) but you trailed off, giving him a chance to fill in the blanks to try and build rapport in the short amount of time you would have to assess him. However, judging by his posture and resistance to the offer of even a small tissue, you could already tell how smoothly this interaction would go.

He scowls in response, those shockingly bright blue eyes contrasting sharply with the dark shadows overcasting his gaze, piercing you from their depths.

Right.

“Alright, Himawari-san, if you and your son would just follow me,” you motioned them towards the silver double doors.

The expression on the man’s face was absolutely priceless and you thanked the higher powers above you to help turn your day around, because this reaction alone was definitely enough to help you handle whatever would be thrown your way the rest of the day.

You really should have known better than to jinx yourself like that.

“My name’s not... He’s not—“ the man didn’t seem to know where to begin, his protests flying at the same time as the boy spoke, but a coughing fit overtook the rest of his response before he could finish.

“I-I’m not his son!” The boy supplied quickly, flustered as a dark hue spread across his cheeks, his freckles even more prominent in his embarrassment.

You felt a little bad for teasing. You knew this was obviously not the man’s name, and it was probably a struggle for this boy to find a suitable name to use in the interim. In addition to the ridiculous (yet ironically, strangely fitting) name chosen, you knew this could not be the man’s son. But it did put into question why this boy was trying so hard to help some stranger who didn’t even seem to want to give him the time of day, let alone his own name.

You’ve been surprised before, but this time your assumptions were correct and you were more than entertained by the results.

Your patient was less than amused by the way he gruffly passed his sleeve over his mouth to wipe away the remnants of blood dripping down his chin and shot a dark look at both you and the boy, who flinched in response.

“Alright, my apologies,” you attempted to placate the man as you directed him in the direction of the emergency room. Surprisingly, he let you lead him by the elbow with no resistance, though a glower was still present on his face. You heard movement from behind you and saw the young boy was getting ready to follow. You paused before turning to the boy with an apologetic look.

“I’m sorry, but if you’re not family and he doesn’t consent to your presence, I think you’ll have to go home,” you told the boy, a twisting in your chest at the drop in his expression. “But thank you for your assistance. You’re very kind.”

“O-oh, you... you don’t have to thank me, I just... uh,” the boy stuttered, flustered by your praise, gaze darting to his shoes as he fiddled with the straps of his backpack. “I-I understand. But, um... c-could you update me later? Just... just so I know he’s okay?”

His voice sounded so hopeful and you felt your heart sink. Due to legality, you couldn’t very well volunteer any information to anyone that wasn’t approved by the patient unless they were incoherent or had some sort of power of attorney, and even then it could be complicated. Especially if your patient was a stubborn gentlemen who refused to even give you said basic and pertinent information.

The dour man was already at the emergency room entrance and was looking at you impatiently, ready to get this experience over with. Quickly you grabbed the boy’s hands and offered your pen as you gestured to his notebook.

“Tell you, what, kiddo. Write your name and number on a piece of paper and I’ll give it to Sunshine over there so he can call you and update you himself?”

The young boy beamed at the suggestion and hurriedly scribbled down the information before ripping out the piece of paper and handing it to you excitedly before giving you and your patient an enthusiastic wave. Turning and stumbling out of the waiting room, he waved once more from outside as the doors closed, effectively cutting him off from sight.

You carefully folded the piece of paper and placed it in your scrub pocket before turning to your patient. If possible, his expression had darkened significantly with his hands clenched into fists at his side, most likely at the promise you had forced upon him.

“Ah, sorry. Did you prefer to give me your real name after all?”

As expected, your only response was a glare with those unnerving, piercing blue eyes.

You tilted your head and walked over to him before pushing open the doors, gesturing with a flourish to keep the doors open for him as you smiled widely. For once, it was genuine and this seemed to catch the man off guard, his expression relaxing from its furrowed brow to that of wary confusion.

“Himawari-san it is then! Shall we?” You gave an exaggerated bow, attracting the attention of your coworkers and patients alike who began to giggle at the display, amused by your antics.

The scowl back in full force, your patient shoving open the doors roughly, probably hoping they would slam in your face or on one of your limbs after he passed through. You couldn’t hold back your sigh, catching the doors so that they would swing gently closed behind you.

If looks could kill, you’d probably be dead a thousand times over.

Thank you for taking the time to read and I hope you enjoyed it! I take a while to write tho given my situation with my iPad also I have an old man back with no desk or chair so I hunch over to write which can be tiring, haha.

Also I decided to keep the Japanese honorifics to keep things uniform for later because I’ll probably use things like ‘-kun’ ‘-chan’ and such and it’s kind of hard to find English equivalents for them so I hope that won’t be a huge issue to some. Also, Himawari means sunflower which is, of course, a little jab at how the Vigilante!All Might in my fic is kind of grouchy compared to use usual sunflowery authentic self, but he’ll become warmer, if I ever get around to it!

And of course sorry for grammar and spelling errors, but other than that thank you for taking the time to read! Have a wonderful day!

#All Might x Reader #Yagi Toshinori x Reader #AU Vigilante!All Might #BnHA #All Might #Yagi Toshinori #kokofic #self-indulgent fic #Boku no Hero Academia

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kristinsimmons · 6 years

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In Search of Intra-Aero-Bili-ty

By MATTHEW HOLT

Another one of my favorites, although this one is much more recent than those published so far–dating back to only March 2015. It was the written version of a talk I gave in September 2014 following the birth of my son Aero on August 26, 2014. So if we are discussing birthdays (and re-posting classics as, yes, it’s still THCB’s 15th birthday week!) we might as well have one that is literally about the confluence of a birthday and the state of health IT, health business, care for the underserved and much more!

Today is the kick-off of the vendor-fest that is HIMSS. Late last week on THCB, ONC director Karen De Salvo and Policy lead Jodi Daniel slammed the EMR vendors for putting up barriers to interoperability. Last year I had my own experience with that topic and I thought it would be timely to write it up.

I want to put this essay in the context of my day job as co-chairman of Health 2.0, where I look at and showcase new technologies in health. We have a three part definition for what we call Health 2.0. First, they must be adaptable technologies in health care, where one technology plugs into another easily using accessible APIs without a lot of rework and data moves between them. Second, we think a lot about the user experience, and over eight years we’ve been seeing tools with better and better user experiences–especially on the phone, iPad, and other screens. Finally, we think about using data to drive decisions and using data from all those devices to change and help us make decisions.

This is the Cal Pacific Medical Center up in San Francisco. The purple arrow on the left points to the door of the emergency entrance.

Cal Pacific is at the end of that big red arrow on the next photo. On that map there’s also a blue line which is my effort to add some social commentary. To the top left of that blue line in San Francisco is where the rich people live, and on the bottom right is where the poor people live. Cal Pacific is right in the middle of the rich side of town, and it’s where San Francisco’s yuppies go to have their babies. Last year, on August 26, 2014 at about 1 am to be precise, I drove into this entrance rather fast. My wife was next to me and within an hour, we were upstairs and out came Aero. He’s named Aero because his big sister was reading a book about Frankie the Frog who wanted to fly and he was very aerodynamic. So when said, “What should we call your little brother?” She said, “I want to call him Aerodynamic.” We said, “OK, if he comes out fast we’ll call him the aerodynamic flying baby.” So he’s called Aero for short.

Thus began the Quest for Intra-Aero-Bili-ty –a title I hope will grow on you. The Bili part will become obvious in a paragraph or two.

Something had changed since we had been at Cal Pacific three years earlier for the birth of Coco, our first child.

If you look carefully at the top of Amanda’s head, there’s now a computer system. Like most big provider systems, Sutter–Cal Pacific’s parent company–has installed Epic and it’s in every room or on a COW (cart on wheels). Essentially we have spent the last few years putting EMRs in all hospitals. This is the result of the $24+ billion the US taxpayer (well, the Chinese taxpayer to be more accurate) has spent since the 2010 rollout of the HITECH act.While we were there all the nurses, all the doctors, everyone, were busy putting information in the computer system. Now they weren’t universally happy. Many of them were complaining about having to use Epic, about having to fill out a lot of dropdown menus, and several times the Imprivata auto-login tool didn’t work, so they had to re-login. In fact, one nurse told me,“The problem with this hospital is we always put in the cheapest system.” I said, “I don’t think you quite understand how Epic’s pricing works.”

Anyway, after two days, the pediatrician signed us out and we went home. While the clinicians may have been moaning, I was happy because Coco, the big sister in this picture, is already in the Epic System, and I want my kids lifetime medical records available.

Coco’s pediatrician is at the Bayview Children’s Health Center, also part of Sutter, which was set up by a great, increasingly famous pediatrician called Nadine Burke, who gave a wonderful TEDMED talk last year. Nadine and her espousing of the issues raised in the ACEs study is on the jacket I often wear at conferences painted by Regina Holliday. The Children’s Health Center is in the poorer part of town and we’re one of the few families to go there who have good insurance. But because it’s part of Sutter like Cal Pacific it’s on the Epic system, and after some agitation on my part I got to see Coco’s records using the MyHealthOnline portal.

I actually get to see a good part of Coco’s records. You can see really detailed information. For example, let’s say, you were a mother who left your baby in the care of her dad on the bed when the baby had just learned to crawl. Using this system you can actually see the the radiology report from the X-Rays she had after she fell off the bed and hit her head on the floor. It doesn’t happen to have a corresponding note about what you said to the dad who’d gone back to sleep and let the baby crawl off the bed. So if you’re keen on making sure your kid’s lifetime medical information is available to them–as you should be–this is a good way to start.

So a couple of days later, we want to have that first post-pediatric visit and I call the BayView Childrens Health Center and get their answering service. I say ”Can we have an appointment?” They say, “Sorry. It’s the week before Labor Day, we’re off,” and I go, “Why are they off?” I realized, of course like the rest of San Francisco they’re all at Burning Man.

The answering service finds me another pediatrician, also in the Sutter System. We got an appointment. It’s now Friday and we visit the new office and my wife Amanda of course fills out the clipboard. We go in to meet the pediatrician and 4 day old Aero gets checked out and there’s a bit of a problem involving this machine, the spectrometer. What it does is test the baby’s bilirubin level, which is a proxy for jaundice. Most babies get jaundice, which is related to the liver taking time to start functioning. They usually get over it when they start drinking and pooping, but in rare cases, jaundice can be very, very serious. If the bilirubin level gets too high, the liver function closes down and really bad things like kernicterus or mental retardation can happen. So you want to be very careful with babies and their bilirubin level.

The spectrometer test on his forehead says 15.9. That’s not a good number. The pediatrician digs out her iPhone and tries to download an app called BiliTool. She can’t download it but I’ve got my Android phone. I get connection to the BilliTool website app and plug in the 15.9, plug in the age of the infant, and it recommends that a follow-up is required within 48 hours. Note that neither the EMR, the spectrometer nor the app talked to each other. The data created digitally in the spectrometer was hand typed into the EMR, and then hand typed again into the analysis tool. On the way out, we get given a printout of our Epic record which we’re supposed to take to the new appointment.

So we need that appointment and of course, because it’s a Friday in 48 hours it’s Sunday, and this pediatrician is closed and my regular one is at Burning Man. So what did we do? Well, the good news is that there’s a Pediatric Weekend and Evening Referral Center in San Francisco so we call to make an appointment there. On Sunday morning, we go over. There’s Amanda filling in the clipboard at the new appointment on the Sunday morning. I’m thinking it’s ok because they have the Epic System there too and they must be connected because it’s in the same building (the red arrow in the picture above) which we just checked out of four days before. But instead, after we fill out the clipboard we go into an exam room and the computer screen is somewhat suspiciously backed up against the wall.

Now the referral clinic pediatrician comes in carrying a pen and a blank piece of paper. She starts saying, “Okay. Now tell me about the kid. Why are you here. When was he born? What was his bilirubin level?” Of course we’ve left that paper printout that we were given at home. I say “Well, I’m a bit concerned because the bilirubin level was 15.9, and Amanda stops me and says, no it was 14.9.” That’s actually a big difference. We apparently can’t look it up and the whole time that computer stays against the wall, and the pediatrician is writing it down on paper.

All right. She says, “What you need to do because you don’t know the real number is to is get a blood draw. Don’t worry. Go down the street to the other facility of Cal Pacific which is just a few blocks away”. So we go down the street into this facility and I’m holding the referral slip she just gave me. I see that the lab is on the second floor. As we walk past the front desk, they said, “Do you want to register?” I said, “No, we have a referral to the lab.” We walked up to the lab. The lab of course says, “You haven’t registered.” So I then have to go back downstairs and register again. Some guy takes my name and then hands me another clipboard.

I write up the information. He gives me some stickers with barcodes on them and I get back upstairs. The baby gets his blood drawn. The tech put the stickers on the bottles and then later that night, the great news is that the pediatrician calls and says, “I got the test back. It’s back down in the 14 range. and not going up. It’s pretty good, but you need to go and see your doctor as soon as you can in next couple of days to check out the bilirubin level again.”

So we’ve had demographic data not transferring between sites, clinical data not transferring from diagnostic machines into the record, and lab tests not triggering analysis automatically. All in one provider system with the same EMR.

But overall it’s going to be fine because now we’re going to be back into the Sutter system with our regular doctor, the same one that Coco has. We’re heading over there on Weds morning (I sort of bullied them into an appointment, as they were trying to put me off for another week). On the way there, I stopped for coffee at this place called Specialty’s which has these amazing, amazing cookies. When you go there, you can run your credit card through the iPad and it will show you what you bought last time and also it will suggest what you might buy now. You order your food, it emails you a receipt and you tell it which pager you picked up and it’ll actually tell you when your food is ready and to come up to the counter–which is the first time a Specialty’s employee needs to talk to you, to hand you the bag. All that for a $3 cookie and a $4 cup of coffee. By the way the cookies are worth the $3, even if they are creating more work for cardiologists in the future.

But we’re not that close to this customer service nirvana in health care. We next get to the Bayview Childrens’ Health Center, which is part of Sutter Health (and where Nadine Burke’s new Center for Youth Wellness is). We go upstairs and as it’s Aero’s first visit, Amanda fills in yet another clipboard. Then we go down the hall to the exam room and I took a good look at the computer. If you get right up close at that top left red arrow, it doesn’t say Epic, it says NextGen. On the bottom right arrow, it says South of Market Healthcare. Now I’m a little bit suspicious about this. Where are those records from the rest of Sutter? Well none of the data from Epic from that recent activity is in this NextGen System because the clinic was not off at Burning Man, they were taking a week off to move. It’s no longer part of the Sutter system, it’s now affiliated with a Federally Qualified Health Care Center called the South Market Health Care.

Aero has been discharged from inpatient, had two outpatient visits, and the spectrometer tests and a lab test. This information is on a random printout and in his parents’ head. So I get out Aero’s Epic printout and I literally held it up to the screen and took a photo. That’s the state of the art in Intr-Aero-Bili-Ty.

But of course, Aero still needs his bilirubin taken. He gets his test taken using the spectrometer and the good news is that it’s heading down below 12 and he’s getting better.

But then it has to be put in the machine. And now we see the actual real user experience.

The nurse having taken the test tired in vain to get the pointing part of the cursor placed in the correct part of the screen. She has to fill that data in manually because the spectrometer doesn’t talk to the record. Eventually she was able to click it in there but only just and it took her a long while.

So in terms of usability and the user interface, we’re not quite there yet. But this is state of play, almost state of the art in 2014, eight years after we started doing Health 2.0.

Now, our doctor comes in. Dr. Zea Malawa, who is a wonderful pediatrician, dedicated to her patients in one of the poorest parts of the Bay Area. She of course has learned Epic and she’s complaining about having to move to NextGen–in fact she was the only clinician I met who said she liked Epic!

Like her nurse she was having trouble with the mouse. I said, “Sometimes you can put it on your skin, it works better there.” Don’t forget as a nation, we spent about $500,000 putting her through residency and we spent $24 billion putting in electronic medical records. And the result is that a brilliant young pediatrician is holding the mouse on her hand to try and make her data entry work.

But of course, this change didn’t happen in a vacuum. Then I said to Dr Malawa, “Why did you move?” “Well, we’re in the Sutter System but we’re a very badly off clinic. Most of our patients have Medi-Cal and we don’t receive a lot of money. It’s a better deal for the organization because if we’re in the Federally Qualified Health Center, we get Federal funding as oppose to Sutter having to subsidize us”. I said, “But I thought Sutter was a big rich system which was interested in subsidizing care for the poor.” She said, “Well you know, I think they’ve already got their deal.”

Then I remembered this hole in the ground that I took a photo of which happened to be next to one of Amanda’s ultrasound appointments. This hole is going to be become the new Cathedral Hill Cal Pacific Medical Center in San Francisco. There was a big political battle about getting this new building approved and Sutter made a lot of promises about things it was doing for the disadvantaged areas of San Francisco in return for permission to build the new hospital. There were questions about to whether those commitments were going to be kept. Now they’ve got the deal through and perhaps because of that the BayView’s Children’s Health Center had to move. At Health 2.0 we ask, “how are we covering the underserved and are we doing it with the same systems?” Honestly, in terms of computer systems right now, we’re not.

Aero and Coco now have records in two separate but equal computer systems, and as far as I can tell not only do they not talk to each other, but there is no way I as the patient can see into the NextGen system.

So, what’s my conclusion? We talk a lot about data coming from the data utility layer and the health interface layer with all its devices creating more data. I can really taste it. Every year at Health 2.0 and of course in my day-to-day life at work, I see so much health technology that should make these problems obsolete

But when I see it from the point of view of patient, we’re just not there yet. It was only in 2015 that Sutter added the ability to download (rather than just view) Coco’s record. And we’re not even to the point where there is a Blue Button in Coco’s record as a symbol that it can be easily downloaded. Kaiser, the VA and many other systems have rolled it out and there you can not only view the record but download it and put it into other applications.

But many are not there yet and I don’t know when Aero’s record at the BayView Child Health Center is going to be downloadable. So right now I can’t download or even see the the record in which all his well baby visits and immunizations are actually being recorded. I know it’s a thankless task but all of us need to be pushing for that data availability.

Because in that one patient’s case Intra-Aero-Bili-ty is pretty damn important.

In Search of Intra-Aero-Bili-ty published first on https://wittooth.tumblr.com/

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