TRENCHWORK
TRENCHWORK · Start here

Start here.

Three steps, about 16 minutes. The first explains the problem. The second shows the judgment I bring to it. The third lets you test an idea yourself.

  1. 01Understand the workload
    The 27-hour day

    The math that breaks the job, and why nobody in it is lazy.

    4 min read
    Read it →drag the panel →
  2. 02Explore responsible AI
    I let an AI draft my notes. Here's the line I won't let it cross.

    Where I let a machine help with the work, and the line it does not cross.

    7 min read
    Read it →
  3. 03Try a simulation
    Panel Weather

    One year, two worlds, the same invented patients. Flip the switches and watch what changes.

    Interactive · about 5 min · simulated, not measured
    Open it →or plan one visit →

Then these four.

  1. 04Value-based care, explained without a single buzzwordDoctrine: how the system works7 min read
  2. 05The inbox is the second clinicDoctrine: how the system works5 min read
  3. 06Red tape, itemizedDoctrine: how the system works6 min read
  4. 07Data doesn't add hours. It aims them.The Lab: try the ideas5 min read

Then see who is writing and what I am building, or everything in the Lab.

If you are a patient

If you are in training

Then Chapter 6: Hematology, the carrier and the clot →
Words I use

Plain English for the words that come up most.

Attribution
The plan's decision about which doctor a patient belongs to. It is not always the doctor the patient would name.
Care gap
Something a patient is due for and hasn't had yet: a screening, a test, a vaccine. A gap is not a box. It is a person who didn't get something. The Gap Closer →
Closing the loop
Making sure an order ends in a result someone acted on. Ordered is not done. Filed is not finished.
Fee-for-service
Getting paid per visit, per test, per procedure. More things, more money, whether or not the patient is better for them.
Information blocking
Making health information harder to get, use, or share than it should be. Federal rules ban it, with a short list of exceptions. The Access Map →
The inbox
Everything that reaches the doctor between visits: results, refills, messages, forms. A second clinic with no schedule. Sixty Seconds in the Inbox →
Interoperability
A long word for a simple idea: records that move between clinics, hospitals, and plans on their own, so nobody has to fax them.
MEAT
Monitor, Evaluate, Assess, Treat. The test an auditor uses to decide whether a note actually supports a diagnosis. MEAT, when an auditor walks in →
Panel
The patients one doctor is responsible for, whether they come in or not. Researchers often model it at 2,500 adults. The 27-Hour Day →
Peer-to-peer
A phone call where the doctor makes the case to the plan's reviewer, who may not practice the same specialty.
Prior authorization
Permission from the insurance plan before a test or treatment is covered. One request, often many steps. The Prior Auth Maze →
Quality measure
A rule for counting whether care happened. It says who counts, what counts as done, and by when.
Recapture
Writing down, again this year, a condition the patient still has, with the evidence beside it. Risk scores start over every January.
Risk score
A number that estimates how sick a patient is, built from the conditions documented that year. Plans use it to set the budget for that patient's care. The Gap Closer →
Team-based care
Nurses, medical assistants, pharmacists, and coaches doing the work they can finish, so the doctor does the work only a doctor can.
Value-based care
Getting paid to keep patients well, instead of for each thing done to them. Value-based care, explained →