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Dr. Jayne Goes to AMIA–Tuesday

November 18, 2015 Dr. Jayne 6 Comments

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Another busy day at AMIA today. I started the morning with a panel, “Looking Back and Moving Forward: A Review of Public Health Informatics.” Neither of these disciplines is something I do in my daily work, but I’ve always been interested in public health, so I thought I’d check it out.

I admit that global health is entirely outside my comfort zone, but was interested in learning more. I appreciated that the presenters spelled out how the articles and events were selected for review as well as their admission that they slides weren’t quite ready to share with the world yet. I’ve been hunting for presentation slides all week without much luck. They shared a URL link to a Google drive, but said it may be a few days before everything is available. I’m looking forward to getting them.

Presenter Brian Dixon shared a couple of interesting vignettes:

  • In one study looking at provider prompts for immunizations, there was no difference between the control and the intervention. The clinical decision support intervention didn’t use data from the immunization information system, only from the local EHR. The authors believe this may be part of the problem. I was surprised that there was no difference, but that’s why we do research.
  • Another study looked at direct to consumer portals for self-testing regarding sexually transmitted infections. Essentially patients could go online anonymously and request a testing kit, which was to be mailed to the lab. They could receive their results securely, and if they tested positive, receive a prescription via eRx or telephone. They didn’t have to actually present to a healthcare provider. Out of the thousands of patients eligible, only a few hundred followed through. I would have thought the uptake would be higher since testing in the privacy of one’s home is less embarrassing than going to the office.
  • Another study looking at healthcare-acquired infections concluded that most research is done in academic medical centers or the VA, institutions with “considerable financial resources” and technical skills not widely available. Dixon noted that although people in those settings likely feel they never have enough resources, they’re relatively wealthy compared to some public health settings.
  • The Biosense surveillance system was rebranded this year to the National Syndromic Surveillance Program and moved to the cloud. The goal is to have it be more about disease surveillance and less about bioterrorism detection, but how well that is achieved remains to be seen.
  • Public health applications aren’t just about MU anymore. This year there was a rise in use of mobile solutions, patient portals, and social media. The research base for public health informatics is increasing.

The presentation shifted to global health informatics with presenter Jamie Pina, who explained that typically these are resource-constrained environments and are defined as “low- and middle-income countries” based on the World Bank definitions. Often there is external or donor funding, such as philanthropies or other countries. There is generally a weak market for global health informatics products, so organizations typically use open source or homegrown tools. There were many articles on mHealth and telehealth found in their review.

There are data quality challenges and other limitations, including the fact that traditional medicine doesn’t fall into the same paradigm or concepts that we have in what we consider modern medicine. One study from Bangladesh looked at linking local traditional medicine practitioners with trained physicians through a call center. Another study found (no surprise here) “cultural misalignment between IT and healthcare providers” in Botswana. At least something is consistent globally. Other notable facts: 80 percent of users in rural Africa are computer illiterate or beginners, but more than 95 percent have a positive attitude towards computers. He did also mention the end of the current Ebola crisis as a notable event that solidified the need for attention to global health issues. Programs are starting to focus on implementing the lessons learned from that crisis.

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There was also some buzz today about changes to the clinical pathway for board certification in Clinical Informatics. I had a couple of people ask me if I heard anything, but I admit I didn’t. Hopefully someone in the know will see this and provide an update if there really is going to be a change.

I’m going to save writing about my favorite presentation of the day until the slides are available. Some of the ideas put forth are just too good not to share. Of note, today’s multitasking included some impressive knitting by one attendee who was using nearly microscopic needles. I never figured out what she was making, but it was fun to watch.

I ducked out for lunch at the Ferry Building Marketplace with the always-entertaining Matthew Holt. He had just returned from a whirlwind trip including Japan, Finland, the UK, Seattle, and finally San Francisco. There were many stories of lost baggage and adventures including the most polite people in the universe (Japan) and time in the sauna (Finland). Our conversation ranged all over the place and included startups, conferences, HIMSS preparations, and the exorbitant cost of Epic projects. My adventures are not nearly so interesting, but he humored me in listening to stories about my current practice situation (which I dearly love) and my ongoing consulting road show. Next stop, Des Moines!

I hustled back to the conference and caught a panel on “Needs of the Digital Native: Adolescents and Access to PHRs.” It was one of the more compelling panels I attended, with speaker Pam Charney talking about her own experience as a parent of a child with medically complex issues. In her state, patients can’t have access to personal health records or patient portals after age 13 to when they turn 18, which created a lot of complexity due to the loss of online scheduling, secure messaging, and test results. Rather than being able to manage her daughter’s health online, she became trapped in an ongoing maze of phone calls, faxes, and lost test results.

Speaker Fabienne Bourgeois has it a little easier in Massachusetts, where there can be graduated changes in access for adolescents. They initially had a parental consent requirement for portal access, but dropped it after a large number of obviously forged consent forms were returned. She provided an excellent discussion on the various needs of flagging data by category (HIV diagnoses and labs) vs. by patient or provider tagging. Catherine Arnott Smith noted that there have been only 13 studies on PHR use in adolescents and young adults since 1991, which is pretty thin. She gave an excellent discussion of academic accommodations for young adults after they leave the K-12 education system. These patients go from a system where their family is involved in advocating for them to one where they have to advocate for themselves, often without a full understanding of their medical history.

Consider the scenario of a child who turns 18 while away at college and whose parents no longer have access to health information. He or she is expected to manage on his or her own, and if there hasn’t been enough education or transition prior, it can be disastrous. Apparently the process for seeking academic accommodations resembles that for Social Security Disability. Having helped patients through the latter, I can’t imagine trying to manage the reams of data required while adjusting to life as a college freshman. Healthcare entities are often not helpful because they send reams of patient notes and data which may not be relevant or useful to the college in determining a valid disability requiring accommodation. My favorite comment of the day was from an audience member who highlighted the need for “a curated record vs. a raw sewage record.”

There were additional questions and comments on the fact that EHR data is much like the proverbial “permanent record” many of us feared in school – that it persists and can follow adolescents into adulthood, potentially creating difficulties when behavioral health diagnoses may be present. Attendee Adam Davis stated, “EHR is forever, but paper dies.” It’s definitely something to think about in the digital age.

On the fashion and social front, I’m happy to report that overall, bowties are leading standard neckties by a factor of six to one, although I feel I should give double credit to the attendee who paired his traditional tie with a snappy vest. After hitting another panel and a corporate member focus group, I headed out to dinner with some industry movers and shakers. On the way back I breezed by the Dance Party social event, which had several attendees cutting a rug and others continuing to network. By this time, though, my toes were tired and my brain was lagging, so I decided to call it a night.

Tune in tomorrow when I’ll cover the rest of Tuesday’s sessions and wrap up my overall thoughts of the conference.

Email Dr. Jayne.

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Currently there are "6 comments" on this Article:

  1. Dr. Jane – re: “exorbitant cost of Epic projects.” I think that is folk lore much like “gag clauses.” It would be great for that to be backed by “evidence based research.” In other words:

    – Exorbitant compared to what (ex: pre-EHR costs, Cerner versus MEDITECH versus Epic versus ?, ERP implementations in other industries)
    – The number of normalized total cost of ownership studies reviewed including the scope (ex: EHR, revenue cycle, all ancillaries), organization scale, organization strategy, organization profit status, organization services, number of integrations, approach to normalization of costs, go-live approach (ex: big-bang, incremental) and the like
    – Success rate of various vendors which will require a definition of success

    I’ve seen Cerner, MEDITECH and Epic. Epic takes a bad rap from my experience for requiring clients to be ‘eyes wide open’ to costs up-front. The cost differences at times are material to some organizations and to others they are not. I find Epic requires that clients focus on a critical few initiatives and dedicate resources to provide the best opportunity for success. That has been ‘best practice’ since the Big-8 dinosaurs roamed the planet. Other vendors do not do this. Pluses and minuses exist for all vendors and their approaches. There is no pat answer or ‘rule of thumb.’ There is urban legend and there is use of the frontal lobe. I vote for the latter.

  2. Just_the_facts you are mis-informed. Most Epic sites are shocked to see how much more they have to spend on the back-end to support the Epic platform. And that is fact…

  3. TPD! – Becker’s lists the publicly reported costs. They do not attempt to normalize. You would not likely be able to tell if someone added devices, updated their physical facility, upgraded their data center or any other facts about what was included, what was bought with capital dollars, or the like. It is a series of data points.

  4. Just_the_facts: I agree with you that it’s difficult to breakdown the costs but since I know Epic from the development aspect of healthcare solutions it shows that each institution is implementing Epic with their needs in mind. Epic offers numerous configurations of their software and also has partners in their ecosystem which adds costs.

  5. Lacy Underall, you are lying. Note: this statement has just as much validity as your assertion above, devoid of any factual information.







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