【英语生活】美国医院用大数据监测医生工作

Marnie Baker, a pediatrician at California's MemorialCare Health System, has an easy manner and ready smile. Now, though, her job is to be the bearer of a serious and, for some of her colleagues, unwelcome message.

She's the voice of a program that digitally tracks their performance, informs them when they don't measure up─and cajoles them to improve.

MemorialCare is part of a movement by hospitals around the U.S. to change how doctors practice by monitoring their progress toward goals, such as giving recommended mammograms. It isn't always an easy sell. At one clinic earlier this year, physicians grilled Dr. Baker, who is director of performance improvement at a MemorialCare-affiliated physician group.

Cardiologist Venkat Warren said he worried that 'some bean-counter will decide what performance is.' He wondered whether doctors would be pushed to avoid older and sicker patients who might drag down their numbers.

'If it isn't cost-cutting, what is it?' Dr. Warren asked.

'It's providing better value,' Dr. Baker responded.

Encounters like these are one result of the changes sweeping American health care. Technology is making it easier to monitor doctors' work as patients' details are compiled electronically instead of on paper charts. Software makers are selling new tools to crunch the data. Software called Crimson offered by the Advisory Board Co. ABCO +3.55% now includes information on more than a half-million doctors, up from fewer than 50,000 in 2009.

At the same time, more physicians are going to work for hospital systems, which are under pressure to hit quality goals and cut costs. Many are striking deals with insurers that pull them away from traditional 'fee-for-service' reimbursement, which pays for medical procedures individually.

Insurers─which themselves increasingly track physician results─are moving toward providing a set payment for the overall care of a patient. This system means that doctors who provide costlier-than-average care could break the budget.

The federal health law is speeding these trends. Under the law, hospital payments and penalties from the federal Medicare program will be linked to their performance on quality gauges, particularly rehospitalizations, which are costly. The law also created a new Medicare initiative for 'accountable care organizations,' providers that get extra rewards for efficiency and quality performance.

To succeed under the new health-care economics, hospital executives say, they must lean on doctors, who make nearly all the key decisions on what treatments, tests and drugs patients get. 'The last frontier is the physicians,' says Thomas Heleotis, vice president of clinical effectiveness at Monmouth Medical Center, part of New Jersey's seven-hospital Barnabas Health system.

A few years ago, he ordered up a list of the 20 physicians practicing at Monmouth who were costing the most money and sat down with each to go over their data. Several trimmed services like repeat lab tests and daily X-rays, he says, and those 20 are no longer among the costliest. Their patient-mortality and complication rates also improved, he says.

Some of this has been tried before, with mixed results. In the 1990s, hospitals bought up doctor groups, and insurers tried paying for care based on per-patient fees instead of charges for each service. Patients and doctors pushed back, and many of these initiatives failed financially. Tying doctors' pay to their performance isn't a new idea, either, and the effectiveness is debated.

What is different this time, some hospital executives argue, is that new technology enables closer, faster tracking of individual doctors, and the new insurance payments factor in quality goals. But partly because many of the efforts are new, broad results are scarce. The Advisory Board says that among hospitals using its software for three years, lengths of inpatient stays fell 2.9%, on average, and readmissions fell 4.5%.

Hospital executives nationwide say that many doctors, particularly younger ones, are receptive. But others feel second-guessed. 'The whole way you get trained is to be the decider, the captain of the ship,' says Michael Sills, a cardiologist and technology executive at Baylor Health Care System in Texas. Now someone will be 'monitoring their productivity, monitoring their costs. They're not going to like it one little bit.'

Leery of sparking doctor revolts, hospitals are delivering the feedback in sessions led by fellow physicians like Dr. Baker at MemorialCare, not outsiders. Executives refer to their efforts as 'aligning' with physicians, not telling them what to do.

MemorialCare, a six-hospital nonprofit based in Fountain Valley, Calif., is keeping detailed data on how the doctors at its affiliated medical group perform on many measures─including adolescent immunizations, mammograms and keeping down the blood-sugar levels of diabetes patients. The results are compiled, number-crunched and eventually used to help determine how much money doctors will earn.

To get doctors on board, Dr. Baker points out that the group's results will be made public as part of a statewide California initiative overseen by a nonprofit. She has also resorted to humor, including some poetry last fall at a physicians' meeting:

'So order those mammos and colonoscopies too / HPV vaccine will keep warts away from you!'

MemorialCare's chief executive, Barry Arbuckle, says he is trying to create an 'integrated health system' that operates efficiently and hits quality goals. Last year, MemorialCare said it would launch its own health plan focused on Medicaid recipients. He wants to craft deals with employers to care for their workers, and possibly offer individual plans.

Tracking doctors' performance is 'absolutely key' to this future, he says. Wide variation in practices among doctors is 'extraordinarily costly,' he says. 'Do we control physicians? We don't try to,' he says. 'We just try to use process and information to get them to that same point.'

MemorialCare's efforts are two-pronged. One initiative focuses on what happens inside the hospitals. The other effort deals largely with outpatient care provided by affiliated physicians. The latter includes the program Dr. Baker oversees at MemorialCare Medical Group, the physician group.

Asked to devise ways to introduce the Crimson system to physicians who work in MemorialCare hospitals, several doctors created and starred in a video. One skit, 'Dr. McClueless Gets Fired,' focuses on a doctor who ignores the Crimson data and loses his contract with an insurer. Meantime, 'Dr. Goodjob' wins praise for trimming unnecessary daily X-rays and reducing some patients' hospital stays.

Long stays and heavy use of services such as X-rays by inpatients can be costly to hospitals, which often aren't paid more for the extra days or additional tests even under traditional reimbursement policies.

At MemorialCare's flagship hospital, Long Beach Memorial Medical Center in Long Beach, Calif., Maged A. Tanios, an intensive-care specialist and a medical director whose job includes overseeing quality improvement, introduced Crimson in a meeting with doctors in 2011. For each physician, Crimson shows variables including complications, hospital readmissions and measures of cost. It uses yellow, green or red coloring to signal whether a doctor is performing about as well as peers, better or worse.

Gradually, Dr. Tanios and others cranked up the effort. Last spring, at regular meetings of the hospital's medical staff, they began sharing lists of doctors whose patients spent on average the most days in the hospital, as well as those who spent the fewest. Doctors were encouraged to learn how to check their own data.

Some doctors had to go through 'stages of acceptance,' he says. 'First is anger, 'Why is someone looking at my data?' Then denial, 'This is not my data!' Then acceptance.' In the end, he has seen some doctors' average patient stays go down after he discusses their results with them, he says.

MemorialCare says that, in general, the doctor-data efforts and other programs have helped reduce the average stay for adult patients to four days in 2012 from 4.2 days in 2011. MemorialCare also says that, between 2011 and 2012, it trimmed the average cost per admitted adult patient by $280, saving $13.8 million. It says it has improved on indicators of quality including patient readmissions, mortality and complications.

Mojtaba Sabahi, who practices at Long Beach Memorial, was warned by a pharmacist that data showed one member of his group of inpatient-care physicians was using Levaquin, an antibiotic, at a far higher rate than peers. MemorialCare guidelines generally recommend limiting use of the drug, largely on concerns about generating drug-resistant bacteria.

Dr. Sabahi says he shared the result with his colleague, and the doctor was receptive. MemorialCare says physicians are often willing to change if they believe they aren't performing as well as peers.

Later, Dr. Sabahi checked the data and confirmed his colleague had cut back on the drug. 'It completely changes the way we practice,' he says. While he says he himself appreciates the feedback, some physicians consider it 'punitive' and think 'the administration wants to make you practice their way.'

Dr. Baker oversees an initiative focused mostly on doctors who provide primary care. She got involved in quality improvement partly because of her work as a pediatrician, she says, which made her feel 'very passionate about child vaccination.'

One day last fall, Dr. Baker sat down with about a dozen primary-care doctors in the group's Irvine, Calif., clinic. She passed around a printout showing how each doctor, by name, was performing on 17 quality measures. The doctors' performance looked 'absolutely awesome,' she told them, with numbers generally in the top percentiles.

But on one measure, cervical-cancer screenings, the Irvine office's results were falling short. The reason: Some patients were getting pap smears more often than every third year, as recommended by the California program.

Doctors said that some patients resist if told that they are low risk and don't need annual exams. One doctor said she had hung a printout of cervical-cancer guidelines on the wall of an exam room to persuade patients they didn't need annual paps. Also, some of the tests were being ordered by gynecologists outside the group who were also seen by MemorialCare patients.

One doctor, John Stasiewicz, raised a concern. Some diabetes patients needed closer care, but they avoid coming in for visits, limiting a doctor's ability to track their progress. Then, if the patient's blood sugar exceeds recommended levels, it counts as a strike against the physician in the data program. 'It's very frustrating,' he said.

Another doctor, Keith Lee, offered a solution. With some patients like this, he simply doesn't give them long-term prescriptions, forcing them to come in for checkups and new prescriptions. 'I cut them short, and then they get the message,' he said.

Generally, Dr. Baker says, doctors work to improve their results. As it ramped up its focus on the data efforts in recent years, the MemorialCare Medical Group has improved its performance on measures including giving people with asthma the right medications and adolescent immunizations, with data reported in 2012 showing 76% of patients getting recommended shots compared with 56% in 2010.

Still, she says, she runs into skepticism. That happened at a February meeting, where she introduced the program at a new MemorialCare clinic, located in a Long Beach, Calif, mini-mall.

With a half-dozen physicians gathered around a conference table, Dr. Baker showed a slide deck titled 'Performance Improvement 101.' In addition to the measures of clinical quality, she said, the California program tracks indicators of efficiency, or 'appropriate resource use.' Those include, among other things, prescribing of certain generic drugs and patients' frequency of visits to the emergency room.

'Why do you care about pay-for-performance?' she asked the doctors.

She showed a slide listing some reasons. Among them: It can mean extra insurance payments. Doctors' compensation is based partly on the results. And public reporting will mean their patients can see how well the medical group is doing.

And, 'Of course, the most important thing is patient care,' she said. Despite the data targets, she also told the doctors that their clinical judgment would trump the recommendations.

Some doctors fired back tough comments. 'I have a lot of reservations' about programs that tie payment to performance, said Dr. Warren, the cardiologist. He detailed his worry that the program could put pressure on doctors to avoid sicker patients in order to boost their numbers and pay.

Dr. Baker responded by saying that every doctor will have patients with difficult conditions who affect their results. 'Your peers have the same issues you do,' she said. 'These measures really do help us take better care of the patients.'

Dr. Warren wasn't persuaded. Regardless of data-tracking and financial incentives, 'I give very good care to my patients,' he said. 'One-on-one, clinical care.'

The director of the clinic, David Kim, chimed in. 'Well, you're an outlier,' he said. 'Every doctor says they provide good care to their patients,' but nationally, data show that patient outcomes are often bad. 'I understand your reservations, and many doctors have those reservations,' he added.

Dr. Kim, for his part, had another concern: whether too much was being put on the backs of the doctors. 'Physicians are going to feel that you're whipping them to do more, and they're going to burn out,' he worried.

Dr. Baker agreed there needed to be a 'lot of collaborative effort' and said the group was working to improve its procedures and add more staffers. 'All of this stuff needs to happen, and will happen,' she promised.

'You can't piecemeal it,' Dr. Kim warned. 'It can't be a little bit here, a little bit there.'

As the doctors began to drift back to work, Dr. Baker thanked them. 'My goal is to make a believer of Dr. Warren!' she said cheerfully.

Today, Dr. Warren says his February comments still represent 'the way I continue to feel at this time.' But Dr. Kim says the data program has been well-received overall at the clinic. He said he recently hired a new staffer, with another planned, to help doctors with tasks including tracking when patients are due for tests.

ANNA WILDE MATHEWS

Dan Krauss for The Wall Street Journal
马妮•贝克(Marnie Baker)是加州医院联盟MemorialCare Health System的儿科医生，为人随和，脸上总是挂着微笑。不过她现在的工作却是负责传递一种严肃的、某些同事不乐于听到的信息。

MemorialCare推出了一个利用数字手段跟踪医生绩效、在他们不合格的时候给予提醒、并诱使他们做出改进的项目，贝克成了这个项目的代言人。

美国各地医院正掀起一场通过监测医生的目标达成情况（比如推荐做乳腺检测）来改变医生诊疗方式的运动，MemorialCare也参与了这场运动。这一概念并非总是很容易就能让人接受。今年早些时候在一家诊所，贝克博士就受到医生们的盘问。（她是MemorialCare关联的一个医师联合执业团体的绩效改进负责人。）

心脏病医生文卡特•沃伦(Venkat Warren)说，他担心将会由“某个财会人员来决定医生的绩效”。他在想，医生们会不会被迫避开那些年龄更大、病情更重、有可能拉低其分数的病人。

沃伦博士问道：“（其意义）如果不是削减成本，那是什么？”

贝克博士回答：“是带来更好的效益。”

这样的交锋，源自美国整个医疗卫生行业所发生的变化。随着病历的编制从纸质图表改为电子手段，科技使医生的工作更容易监测。软件开发商正在出售处理相关数据的新的工具。Advisory Board Co.提供的Crimson软件现在已包含50多万名医生的信息，而2009年时还不到五万。

与此同时，越来越多的医生将为医院联盟工作，而医院联盟有达成质量目标和削减成本的压力。很多医院联盟跟保险公司签署的协议都抛弃了“按服务收费”，即为单个医疗流程付费的报销模式。

保险公司自己也在越来越多地跟踪医生的成绩。它们正在逐步地转向为病人的全程治疗支付固定费用的模式。这种制度意味着，医生如果提供成本高于平均值的医疗服务，就有可能超支。

联邦卫生法加快了这些趋势。根据该法，联邦医疗保险(Medicare)计划对医院的偿付和惩罚将与医院的质量评估表现（特别是高成本的再入院治疗）挂钩。该法还在联邦医疗保险计划名下设立了一项针对“负责任医护机构”的新行动，为它们的效率和质量表现提供额外的奖赏。

医院管理层认为，为了在这种新的医疗经济学中取得成功，他们必须依靠医生，因为在采用哪种治疗方法、检测手段和药物的问题上，几乎所有关键决策都是由医生做出的。蒙茅斯医疗中心(Monmouth Medical Center)负责临床效率的副总裁托马斯•海力奥蒂斯(Thomas Heleotis)说：“医生是最后一个待开发的领域。”蒙茅斯医疗中心从属于新泽西州七家医院构成的医院联盟Barnabas Health。

几年前，海力奥蒂斯召集蒙茅斯20名成本最高的医生，与每一位医生单独坐下来一起梳理他们的数据。他说，好几位医生后来砍掉了重复检验、每天进行X光扫描等项目，如今这20位医生已经不再位于成本最高之列。他说，他们的病人死亡率和并发率评分也有改善。

这当中有些方法在以前也尝试过，结果有好有坏。20世纪90年代，医院收购医师联合执业团体，保险公司尝试按每个病人、而不是每项服务的费用来为医疗服务买单。此举遭到病人和医生的反对，很多这类行动在经济上归于失败。而将医生的报酬与其绩效挂钩也不是新概念，其有效性也是有争论的。

部分医院管理人员认为，这次不同的地方在于新技术的存在使得每一位医生的情况都能够得到更密切、更快捷的跟踪，而新的保险报销模式也考虑了质量目标。但由于很多此类措施是以前所没有的，加上其他一些原因，覆盖全面的结果甚为寥寥。Advisory Board说，在使用其软件达到三年的医院里面，病人住院时间平均下降了2.9%，再入院数量下降了4.5%。

全美各地的医院管理人员说，很多医生、特别是年轻医生对此乐于接受。但另一些医生则有一种被人指手划脚的感觉。得克萨斯州医院联盟Baylor Health Care System心脏病医生、技术主管迈克尔•西尔斯(Michael Sills)说：“整个受教育过程就是让医生成为决策者，成为船长。”而现在，将会有别人来“监控他们的效率，监控他们的成本，他们肯定不会喜欢”。

因担心引起医生的反感，医院在反馈监测结果的时候，都是让MemorialCare的贝克博士这样的医生、而非外部人士来主持座谈会。管理层说他们这些措施是与医生“结盟”，而不是对他们指手划脚。

MemorialCare是加州方廷瓦利(Fountain Valley)的一家非营利组织，共有六家医院。它保留着其关联医师联合执业团体的医生们在很多指标上的详细数据，如青少年免疫接种、乳腺癌检测、糖尿病人血糖水平的控制等。监测结果经过编制、运算，最终用来和其他因素一起确定医生能拿多少钱。

贝克博士指出，为了让医生参与这个项目，该医师联合执业团体的监测结果将作为一家非营利组织监督的一项涉及全加州的行动的一部分而公开。她还用上了幽默的方法，比如在去年秋季一次医生开会的时候她念了几句诗：

“那就把乳腺癌检查和结肠镜检查也做了吧/HPV疫苗会让你不长小瘤子！”

MemorialCare的首席执行长巴里•阿巴克尔(Barry Arbuckle)说，他想构建一套能够有效运行并达到质量目标的“整合医疗体系”。MemorialCare去年表示将推出它自己的专注于联邦医疗补助计划(Medicaid)受益者的医保方案。阿巴克尔想跟用人单位达成协议，由MemorialCare照料其员工，不排除提供一对一的方案。

他说，跟踪医生的绩效对于这样的计划“绝对关键”。他说，医生工作方式千差万别会带来“特别高昂”的成本。他说：“我们是要控制医生吗？我们不是要控制医生，我们只想利用流程和信息让他们到达同一个点上来。”

MemorialCare双管齐下。一项行动专注于医院内部，另一项行动主要是关注其关联医师联合执业团体的医生提供的门诊服务。后者包括贝克博士在MemorialCare关联医师联合执业团体MemorialCare Medical Group负责的那个项目。

院方请几位医生设计一些办法来向MemorialCare旗下医院的医生介绍Crimson系统。这几位医生制作了一段视频并出演了其中的角色。其中一则短剧名叫“无能医生被炒鱿鱼”(Dr. McClueless Gets Fired)，说的是一位医生忽略Crimson的数据，丢掉了一家保险公司的合同。与此同时，“干得好医生”(Dr. Goodjob)因为砍掉了多余的X光检测并减少了部分病人的住院时间，获得了赞扬。

长时间住院以及让住院病人大量接受X光检测等服务，可能会给医院造成高昂的成本。即便是按照传统的报销政策，很多时候医院也不会因为多余的住院时间和检测项目而获得额外的资金。

马吉德•A.塔尼奥斯(Maged A. Tanios)是MemorialCare的旗舰医院、加州长滩(Long Beach) Long Beach Memorial Medical Center的重症监护专员和医疗总监，其职责包括监督质量改进，他在2011年和医生们开会，介绍了Crimson系统。Crimson显示出每一位医生的并发率、返院率和成本指标等参数。它用黄色、绿色和红色分别代表某个医生的表现等于、高于和低于同业。

慢慢地，塔尼奥斯博士和其他医生一起加快了这场行动的节奏。去年春季，在同医院的医护人员召开例行会议的时候，他们开始分享病人住院时间最长以及病人住院时间最短的医生名单。院方鼓励医生学习怎样查看自己的数据。

塔尼奥斯博士说，有些医生需要经历多个阶段才会接受。“先是愤怒，‘为什么有人在看我的数据？’然后是不承认，‘这不是我的数据！’然后才是接受。”他说，在跟一些医生讨论他们的成绩之后，最后他看到这些医生的病人住院时间平均值出现了下降。

MemorialCare表示，从总体上看，这些监测医生数据的措施和其他一些项目已经帮助医院将成年病人平均住院时间从2011年的4.2天降为2012年的四天。MemorialCare还表示，从2011年到2012年，每位成年入院病人的平均成本减少了280美元，一共省下了1,380万美元。它表示，病人返院率、死亡率和并发率等质量指标都有所改善。

一位药剂师提醒在Long Beach Memorial执业的穆杰塔巴•萨巴希(Mojtaba Sabahi)说，数据显示他带领的住院病人护理团队的一名成员使用抗生素左氧氟沙星的频率远高于其他医生。MemorialCare的指导原则总体上建议限制这一药物的使用，主要是因为担心会产生抗药性细菌。

萨巴希博士说，他把这一监测结果与这位同事分享，对方也能够接受。MemorialCare说，如果医生认为自己的表现不及同事，他们常常是愿意做出改变的。

后来萨巴希博士又复查了数据，证实他的这位同事已经减少了左氧氟沙星的使用。他说：“它彻底改变了我们的工作方式。”虽然他表示自己很重视这种反馈，但有些医生认为它“是为了惩罚人”，认为“管理层想让你按他们的方式给人看病”。

贝克博士负责监管的一项行动主要关注的是提供初级保健护理的医生。她说，她参与质量改善的一部分原因在于她是一名儿科医生，“热衷于儿童的疫苗接种工作”。

去年秋季的一天，贝克博士跟十来位初级保健护理医生座谈，他们来自MemorialCare联合执业团体在加州欧文(Irvine)的诊所。她散发了一份打印件，上面指名道姓地显示出每一位医生在17项质量指标上的表现。她对医生们说，他们的表现“非常厉害”，数字成绩总体上都处在靠前的水平。

但在宫颈癌筛查这个指标上，欧文诊所的成绩却落后于人。原因在于，某些病人接受宫颈抹片检查的次数过于频繁，高于前述涉及全加州的那个项目所建议的三年一次的频度。

医生们说，如果跟病人说她们的患癌风险低，不需要每年检查，有些病人就会有抵触。一位医生说，她在一间检查室的 上挂出宫颈癌指南的打印件，劝说病人不要每年都做检查。另外，有一部分检查是MemorialCare联合执业团体之外的妇科医生在诊疗MemorialCare的病人时要求做的。

医生约翰•斯塔西维茨(John Stasiewicz)提出了一个问题。有些糖尿病人需要做更加仔细的护理，但他们不想到诊所来，使医生难以跟踪他们的进展。那么，如果病人的血糖超过建议水平，在数据化项目里就会对医生构成不利。他说：“这很令人懊恼。”

另一位医生凯斯•李(Keith Lee)提出了一个解决办法。对于这样的病人，他根本就不给他们开长期药方，逼迫他们前来做检查、拿新药方。他说：“我把药方时间缩短，然后他们就知道我是什么意思了。”

贝克博士说，从总体上讲，医生们都会努力提高成绩。在近几年日益注重数据化行动的过程中，MemorialCare Medical Group在多个指标上的表现都有提高，如恰当治疗哮喘病人、青少年接种等。2012年的数据显示76%的病人打了建议注射的疫苗，而2010年的比例是56%。

但她说自己也遭到过怀疑。事情发生在今年2月份的一次会议上。当时她在MemorialCare位于加州长滩一处沿街商业区的新诊所介绍了这个项目。

五六位医生坐在会议桌周围，贝克博士放了一组名为“绩效改善入门”(Performance Improvement 101)的幻灯片。她说，除了衡量临床质量的指标外，加州这个项目还跟踪衡量效率（或曰“资源的合理使用”）的指标，包括某些非专利药品的开具、病人前往急诊室的频率等。

她问各位医生：“你们为什么要关心薪酬与绩效挂钩的模式呢？”

她打出一张幻灯片，列出了一些原因。其中包括：它可能意味着保险公司会给予更多报销；监测结果是确定医生报酬的部分依据；而公开的报道将使病人能够看到联合执业团体的表现有多好。

她说：“最重要的当然是对病人的诊疗。”虽然有数据化的目标，她也跟各位医生说，他们的临床判断将优先于推荐诊疗方法。

有些医生用硬话反击。前面提到过的心脏病医生沃伦说，对于将薪酬与绩效挂钩的项目，“我有很多保留意见”。他细述了自己的担忧：这个计划可能会迫使医生避开病情更重的病人，以提高自己的绩效数字和薪酬。

贝克博士回应说，每位医生都会有病情复杂、影响其成绩的病人。她说：“你的同行和你面对着同样的问题。这些指标真的有助于我们更好地治疗病人。”

沃伦博士没有被说服。他说，虽然有数字上的跟踪和金钱上的激励，“我对自己的病人都是给予非常好的诊疗，一对一的临床诊疗”。

诊所所长戴维•金(David Kim)在一旁插话了。他说：“好吧，你与众不同。每一位医生都说他们为病人提供良好的诊疗”，但在全国范围内，数据显示病人的诊疗结果常常很糟糕。他还说：“我理解你的保留意见，很多医生也有这些保留意见。”

金博士也有自己的担忧：这样做是不是给医生增加了太多的负担？他说：“医生会觉得你在鞭打他们，要他们做更多的事情，他们会累坏的。”

贝克博士也认为需要做“很多配套工作”，并表示MemorialCare联合执业团体正在着手改进流程、增加人手。她肯定地说：“这一切都需要做，而且肯定会做。”

金博士提醒说：“不能零零碎碎地搞。不能这儿一丁点，那儿一丁点。”

医生们开始回去工作，贝克博士对他们表示感谢。她乐观地说：“我的目标是让沃伦医生相信这个计划！”

今天，沃伦博士表示他在2月份说的话依然代表着“我此时此刻依然有的感受”。但金博士说，数据化计划总体上受到了整个诊所的欢迎。他说，最近他聘请了一位新员工（计划还要再聘一位）来帮助医生完成一些琐碎的差事，如跟踪病人何时该做体检等。

ANNA WILDE MATHEWS

（本文版权归道琼斯公司所有，未经许可不得翻译或转载。）