Dimple Khona
1. You have quite a few letters after your name in addition to MD and FAAP, and we’d like to know more about them. First, what is IFMCP?
Institute of Functional Medicine Certified Practitioner--after completing Completion of Applying Functional Medicine in Clinical Practice (AFMCP) course and all six individual Functional Medicine Advanced Practice Modules (APMs): GI, Environmental Health, Immune, Hormone, Cardiometabolic, and Bioenergetics--this takes roughly two years to complete as there are conferences to attend for each module. Case Report: Passing score on one case report submitted using the IFM Case Report Template. IFMCP Written Exam: Passing score on the written examination. Candidates may not take the IFMCP written exam until all coursework has been completed, and the Case Report has been presented and passed.
2. You also completed a rigorous fellowship in Integrative Medicine from the University of Arizona and are now an ABOIM diplomate—tell us more about this degree and how it helps you as a pediatric hospitalist?
I completed a 2 year fellowship and then sat for the ABOIM board exam to become certified. I do Integrative Medicine consults inpatient, provide education to both inpatient and outpatient providers on topics that are relevant to their practice. I participate in Wellness Committee work and Our integrative Medicine steering committee work. Integrative Medicine (IM) is healing-oriented medicine that takes account of the whole person, including all aspects of lifestyle. It emphasizes the therapeutic relationship between practitioner and patient, is informed by evidence, and makes use of all appropriate therapies.
Defining Principles of Integrative Medicine from UAZIM website:
1. Patient and practitioner are partners in the healing process.
2. All factors that influence health, wellness, and disease are taken into consideration, including mind, spirit, and community, as well as the body.
3. Appropriate use of both conventional and alternative methods (that are evidenced based) facilitates the body's innate healing response.
4. Effective interventions that are natural and less invasive should be used whenever possible.
5. Integrative medicine neither rejects conventional medicine nor accepts alternative therapies uncritically.
6. Good medicine is based in good science. It is inquiry-driven and open to new paradigms.
7. Alongside the concept of treatment, the broader concepts of health promotion and the prevention of illness are paramount.
8. Practitioners of integrative medicine should exemplify its principles and commit themselves to self-exploration and self-development.
3. And you have your Master of Business Administration from University of California, Irvine Paul Merage School of Business. What different perspective does it give you working in medicine?
As I am in administration, it helps with the cross talk between C suite and understanding of finance, budgets and the overall health of operations for PHM.
4. Previously you were the Regional Pediatric Electronic Health Systems Domain Lead and also trained physicians in using the electronic health records system. If you could develop your dream EHR, what are some of the features it would have?
I like that we use EPIC and we have modified it to it our needs and regularly meet to make adjustments. So as far as that I am happy with it. I would like it if it were easier to pull data from our EHR to help us better manage what we do in our day to day work.
5. As a volunteer with the general pediatrics pilot content development team, you help to develop question sets for the Maintenance of Certification Exam. What makes a good test question?
This is a very complicated discussion but a good question tests the knowledge that needs to be shown for proficiency in pediatric medicine with regards to blueprint created by national experts of what a general pediatrician should know. What are your thoughts about the MOC exam? It’s no longer an exam--it’s a series of questions delivered on a quarterly basis with some readings--this is much better than the old way of having to take a 4 hour exam at a testing center--this does require more from an exam developer because you must provide literature references and rationales, but it’s better for the learner and test taker because you learn as you go.
6. Since you work for Kaiser Permanente, we have to ask about the Neonatal Sepsis Calculator. Do you observe infants born to inadequately treated GBS+ mothers with a low sepsis calculator score for 36-48 hours or discharge at 24 hours if parents ask?
I don't work for KP. I am a Partner at SCPMG (Southern California Medical Group), so I must first make that distinction. The Sepsis calculator was developed by TPMG in northern California (a completely separate medical group and corporation not a partnership). Kaiser Permanente is actually a contractual partnership for exclusive care of Kaiser Heathplan Members--there are separate medical groups (Permanente part of the KP) in northern, southern cal, hawaii, northwest, georgia, midatlantic. We in Southern California have been doing early discharges at a number of our facilities prior to this calculator (based on internal data), some routinely discharge at less than 24 hours but with regard to low sepsis score, many are discharging at 24 hours. We rarely, outside of C-Section babies, keep babies beyond 36 hours and our discharges are typically closer to 24 hours in general. And in what time frame do you have them follow up with their PCP? 1-2 days in newborn clinic (newborn clinic is run by pediatricians who are PCPs, and some locations use PNPs) PCP follow up occurs at 2 weeks. All this being said we are a group that delivers babies at 13 hospitals in southern California, and there is local variation at each center.
7. Jack Percelay often ends his list-serve commentary with the phrase “that’s just my 2 pennies.” What are your two cents?
Our post COVID world will look quite different depending where you practice and how you practice. Telemedicine is going to be a growing part of all practices everywhere and this will create capacity in many departments and prevent unnecessary admissions or trips to the ED--I suspect our volumes may never get back to pre covid levels and they should not--why admit someone who doesn't need to be hospitalized. We are using telemedicine in our emergency rooms where we do not have in-house PHM docs even prior to COVID, and I suspect this will be a growing part of our routine work and will expand into our clinics and even the patient's home. That’s my two cents worth--we need to expand our repertoire of work we offer as the typical drivers of how we pay for things (outside of KP)--ie get paid if you put someone in the hospital will no longer be enough to sustain a lot of programs.
Institute of Functional Medicine Certified Practitioner--after completing Completion of Applying Functional Medicine in Clinical Practice (AFMCP) course and all six individual Functional Medicine Advanced Practice Modules (APMs): GI, Environmental Health, Immune, Hormone, Cardiometabolic, and Bioenergetics--this takes roughly two years to complete as there are conferences to attend for each module. Case Report: Passing score on one case report submitted using the IFM Case Report Template. IFMCP Written Exam: Passing score on the written examination. Candidates may not take the IFMCP written exam until all coursework has been completed, and the Case Report has been presented and passed.
2. You also completed a rigorous fellowship in Integrative Medicine from the University of Arizona and are now an ABOIM diplomate—tell us more about this degree and how it helps you as a pediatric hospitalist?
I completed a 2 year fellowship and then sat for the ABOIM board exam to become certified. I do Integrative Medicine consults inpatient, provide education to both inpatient and outpatient providers on topics that are relevant to their practice. I participate in Wellness Committee work and Our integrative Medicine steering committee work. Integrative Medicine (IM) is healing-oriented medicine that takes account of the whole person, including all aspects of lifestyle. It emphasizes the therapeutic relationship between practitioner and patient, is informed by evidence, and makes use of all appropriate therapies.
Defining Principles of Integrative Medicine from UAZIM website:
1. Patient and practitioner are partners in the healing process.
2. All factors that influence health, wellness, and disease are taken into consideration, including mind, spirit, and community, as well as the body.
3. Appropriate use of both conventional and alternative methods (that are evidenced based) facilitates the body's innate healing response.
4. Effective interventions that are natural and less invasive should be used whenever possible.
5. Integrative medicine neither rejects conventional medicine nor accepts alternative therapies uncritically.
6. Good medicine is based in good science. It is inquiry-driven and open to new paradigms.
7. Alongside the concept of treatment, the broader concepts of health promotion and the prevention of illness are paramount.
8. Practitioners of integrative medicine should exemplify its principles and commit themselves to self-exploration and self-development.
3. And you have your Master of Business Administration from University of California, Irvine Paul Merage School of Business. What different perspective does it give you working in medicine?
As I am in administration, it helps with the cross talk between C suite and understanding of finance, budgets and the overall health of operations for PHM.
4. Previously you were the Regional Pediatric Electronic Health Systems Domain Lead and also trained physicians in using the electronic health records system. If you could develop your dream EHR, what are some of the features it would have?
I like that we use EPIC and we have modified it to it our needs and regularly meet to make adjustments. So as far as that I am happy with it. I would like it if it were easier to pull data from our EHR to help us better manage what we do in our day to day work.
5. As a volunteer with the general pediatrics pilot content development team, you help to develop question sets for the Maintenance of Certification Exam. What makes a good test question?
This is a very complicated discussion but a good question tests the knowledge that needs to be shown for proficiency in pediatric medicine with regards to blueprint created by national experts of what a general pediatrician should know. What are your thoughts about the MOC exam? It’s no longer an exam--it’s a series of questions delivered on a quarterly basis with some readings--this is much better than the old way of having to take a 4 hour exam at a testing center--this does require more from an exam developer because you must provide literature references and rationales, but it’s better for the learner and test taker because you learn as you go.
6. Since you work for Kaiser Permanente, we have to ask about the Neonatal Sepsis Calculator. Do you observe infants born to inadequately treated GBS+ mothers with a low sepsis calculator score for 36-48 hours or discharge at 24 hours if parents ask?
I don't work for KP. I am a Partner at SCPMG (Southern California Medical Group), so I must first make that distinction. The Sepsis calculator was developed by TPMG in northern California (a completely separate medical group and corporation not a partnership). Kaiser Permanente is actually a contractual partnership for exclusive care of Kaiser Heathplan Members--there are separate medical groups (Permanente part of the KP) in northern, southern cal, hawaii, northwest, georgia, midatlantic. We in Southern California have been doing early discharges at a number of our facilities prior to this calculator (based on internal data), some routinely discharge at less than 24 hours but with regard to low sepsis score, many are discharging at 24 hours. We rarely, outside of C-Section babies, keep babies beyond 36 hours and our discharges are typically closer to 24 hours in general. And in what time frame do you have them follow up with their PCP? 1-2 days in newborn clinic (newborn clinic is run by pediatricians who are PCPs, and some locations use PNPs) PCP follow up occurs at 2 weeks. All this being said we are a group that delivers babies at 13 hospitals in southern California, and there is local variation at each center.
7. Jack Percelay often ends his list-serve commentary with the phrase “that’s just my 2 pennies.” What are your two cents?
Our post COVID world will look quite different depending where you practice and how you practice. Telemedicine is going to be a growing part of all practices everywhere and this will create capacity in many departments and prevent unnecessary admissions or trips to the ED--I suspect our volumes may never get back to pre covid levels and they should not--why admit someone who doesn't need to be hospitalized. We are using telemedicine in our emergency rooms where we do not have in-house PHM docs even prior to COVID, and I suspect this will be a growing part of our routine work and will expand into our clinics and even the patient's home. That’s my two cents worth--we need to expand our repertoire of work we offer as the typical drivers of how we pay for things (outside of KP)--ie get paid if you put someone in the hospital will no longer be enough to sustain a lot of programs.