EPtalk by Dr. Jayne 1/29/15

The physician lounge was buzzing this morning with discussion of HHS secretary Sylvia Burwell’s newly-announced goals for the Medicare program. The plan is to move 90 percent of Medicare fee-for-service (FFS) payments to a quality-based system by 2018 and to move 50 percent of FFS payments into “value-based alternative payment models” on the same timetable.

Although we’re pretty far along with the quality-based payments, we’re nowhere near that far with alternative models (such as ACOs). When you consider the number of providers who have failed to join (or dropped out of) ACO programs, that’s a pretty audacious goal. The general tone among my colleagues is this: they’re supportive of quality, but would like to see other institutions (especially the Medicare and Medicaid bureaucracies and Healthcare.gov) held to the same standards.

I didn’t watch the State of the Union Address to hear about the President’s “Precision Medicine Initiative” but have been asked a couple of times what I think about it. Although it is very sexy, precision medicine is also very expensive. I surfed around for some quote from the Address and the Initiative purports “to give all of us access to the personalized information we need to keep ourselves and our families healthier.” It reminds me a little of end users who refuse to use the EHR because it doesn’t have one sexy feature or another. I have to talk them into using it to get the benefits it actually has rather than worry about what it doesn’t have. We need to figure out how to better encourage patients to take advantage of the general (but very effective as well as inexpensive) medicine advice we already have: eat less, move more, make healthy choices. Alas, daily exercise and delayed gratification aren’t as exciting as the idea that technology will fix all that ails us.

As a CMIO, I spend a fair amount of time listening to what physicians don’t like about our software. It’s always interesting when we perform an upgrade, and while some users like it, others consider it a “downgrade.” Sometimes the complaining is justified, but it always feels more acute when it’s a problem with the EHR rather than consumer software. I was interested to see a software firm other than Microsoft or Yahoo make a blunder recently. Intuit is under fire for realigning the features of its popular TurboTax product. Since I’ve already spent a couple of hours this week preparing all my documentation, I’m glad I saw this letter to customers that explained that the version many of us have used for years will no longer meet our needs. They’re trying to make it up to users with a $25 rebate. That’s about 50 percent of the purchase price of the version in question. Extrapolate it for what we pay for medical software and that could get interesting for a vendor who wanted to make good on a dodgy software release.

Speaking of vendors, I have a couple of physician friends who work in the vendor space. If you’ve ever wondered why they’re not spending all their time creating usable new features that physicians need and want, take a look at the test procedures they have to follow in order to get the product certified. If you’ve never seen them, let’s just say they make CMS billing regulations look like a pre-K reader.

Researchers at the University of Pennsylvania have harnessed Twitter to predict rates of coronary heart disease. Analyzing the content of tweets by county, “they found that expressions of negative emotions such as anger, stress, and fatigue in a county’s tweets were associated with higher heart disease risk.” Although there is no expectation of privacy when using Twitter, I couldn’t help but think about the documentation needed to do this kind of human studies research. Maybe Twitter should add something about it to their terms of service.

Another interesting twist on their work is the comment by one researcher that, “You’ll never get the psychological richness that comes with the infinite variables of what language people choose to use.” This is exactly what EHR-using physicians have been saying for years – that it’s impossible to get the “flavor” of the patient’s story through checkboxes and templates. I’m looking forward to the day when I can go back to dictating my notes and letting voice recognition and natural language processing do the heavy lifting of turning it into something appropriate for coding, billing, and interoperability.

The research team has experience with linguistic analysis, showing it can be as effective as questionnaires in assessing personality characteristics. I hope they’re not looking at my tweets, because given their recent infrequent nature, they would likely determine that I’ve become reclusive.

What does your Twitter history say about your personality? Email me.

Email Dr. Jayne.