Meet CHA Primary Care Physician Robert Janett

08/24/2020
Pictured is Robert Janett, MD.

A patient with complex health issues, including diabetes, called his primary care team at Cambridge Health Alliance (CHA) in early April amidst the height of the COVID-19 pandemic in Massachusetts. "During the prolonged isolation, Mr. Daniels [not his real name] was experiencing shortness of breath," said Robert Janett, MD, a primary care physician at CHA Cambridge Family Health.

The patient thought that his shortness of breath must have been caused by a COVID-19 infection and he was referred to CHA's Respiratory Clinic in Somerville. At the clinic, he tested negative for COVID-19 and became frustrated not knowing what was wrong. Dr. Janett set up a televisit to get to the bottom of the issue. "We thought the whole situation through from the beginning to the current state and I listened carefully to what he was experiencing," said Dr. Janett. "It was clear that his shortness of breath was significant." Mr. Daniels, on the advice of Dr. Janett, went to the Emergency Department (ED) at CHA Everett Hospital.

Upon arrival at the ED, it was quickly determined that Mr. Daniels was experiencing heart failure with blockages of the coronary arteries. He was rushed to a tertiary care hospital where he received stents and other procedures to relieve the blockages. Today, his condition has improved greatly. "Our personal connection and insisting that we take the time to sit together (virtually) to think his condition through made the difference, leading us in the right direction," said Dr. Janett. Trust and building deep relationships with patients based on respectful dialogue is at the heart of CHA's approach to care according to Dr. Janett.

Dr. Janett joined CHA in 1980 and was one of the first chief residents in CHA's Internal Medicine Residency Program. Since then, he has served thousands of patients at Cambridge Family Health in Inman Square (Cambridge, Mass.). He is fluent in Portuguese and Spanish has a multi-ethnic patient population.

Outside of his role at CHA, Dr. Janett served as the medical director of the Mt. Auburn Cambridge Independent Practice Association for more than 25 years and played a key role in the development of the Accountable Care Model (ACO) in Massachusetts. Dr. Janett was also part of the founding team of Network Health, a provider-sponsored health plan, and later served as medical director, chief medical officer, and senior policy advisor.

Transition to Telemedicine During COVID-19

"Within days, we went from a service that was delivering 100% in-person care to providing 85% to 90% telemedicine in response to the COVID-19 surge," said Dr. Janett. "We were learning on the fly and relying heavily on new technologies." Two things were essential to CHA's transition to telemedicine so rapidly: trust and technology. CHA has made a longstanding commitment to patient-centered care and has invested in a robust electronic medical record (EPIC) which made it easier to provide virtual care for patients.

Many of the staff in primary care were redeployed to the hospital units, testing tents, and the ICUs. "We had primary care physicians who suddenly became hospitalists and nurses who were redeployed to the ICU, the acute care units, and elsewhere," said Dr. Janett. "Everyone stepped out of their comfort zone into essential roles that the pandemic required."

Comfort Care Units

Dr. Janett soon became responsible for standing up Comfort Care units at CHA Cambridge and CHA Everett Hospital to provide palliative care to patients with COVID-19. "We trained primary care, pediatric, OBGYN, IT, and cardiovascular testing nurses on how to deliver this critical end of life care," said Dr. Janett. "Medical assistants from all over CHA also joined the Comfort Care units." The team at the Comfort Care units quickly learned the principles of palliative care and stepped into a difficult environment caring compassionately for patients and helping connect them to their families.

This group of nearly sixty people received CHA's CIRCLE Award (the organization's high-level employee recognition award) for their service to the community. One family member of a patient wrote, "I felt like the tender care given was comforting at a time when I couldn't be there for her myself."

For Dr. Janett, one of the most pressing challenges of the pandemic has been social isolation. "You spend your whole life as a social person and you reach old age and you are suddenly in isolation," said Dr. Janett. "Social isolation is one of the cruelest consequences of the pandemic, particularly for the elderly."

Outside of his role serving patients in Cambridge and Somerville, Dr. Janett maintains a strong presence internationally and is focused on collaborating with providers in Latin America and Asia on health systems improvement projects. He partnered with a team that was instrumental in implementing primary care models in Brazil's private health system, one of which named their first primary care unit after him. He also served as an advisor to Brazil's Ministry of Health. Today, he is engaged in teaching and mentoring students in Brazil and in sharing the CHA COVID-19 preparedness protocols with Brazilian and other global health leaders.

CHA developed a robust community-based approach to manage COVID-19. Learn how this innovative model works and how CHA was able to keep thousands of patients out of the hospital.

"What keeps me excited, interested, and motivated are deep relationships with patients and colleagues," said Dr. Janett. "At CHA we produce innovative models of care and we are then privileged to share what we have learned with other organizations to benefit patients in low- and middle-income countries."

Cambridge Health Alliance

Contributed By: Cambridge Health Alliance

Cambridge Health Alliance is an academic community health care system committed to serving all members of our communities. We have expertise in primary care, mental health and substance abuse, and caring for diverse and complex populations. CHA patients receive high quality care in convenient neighborhood locations, and have seamless access to advanced care through CHA’s affiliation with Beth Israel Deaconess Medical Center. With over 140,000 patients in Cambridge, Somerville Everett and Boston’s Metro North, CHA is working hard to offer the integrated services its communities need now, and in the future.