EPtalk by Dr. Jayne 5/4/17

A recent ONC blog post mentioned efforts to “demystify patient matching algorithms.” Patient matching continues to be challenging to many interoperability projects. The blog post makes the point that although matching is critical, there isn’t much transparency around how well current algorithms perform. There’s been a lot of debate about a universal patient identifier, and despite the restrictions around any federal initiatives to move towards such an identifier, many of us would like to see one move forward. Even if it’s voluntary, I’d rather take my chances with ID theft than risk misidentification. I’ve had recent issues with someone else’s data in my chart, so maybe that adds to my bias.

To aid in finding a solution for matching issues, ONC launched the Patient Matching Algorithm Challenge, which aims to develop new algorithms, benchmark the current state, and help organizations find common metrics. There will be six prize winners with a total payout of $75,000. There are several webinars upcoming and registration for the challenge opens next week, for those that are interested.

My pet peeve of the week is meetings that start late. I’ve been on multiple conference calls where I’ve heard phrases like, “Let’s just wait a few more minutes, there might have been some people with meetings before this who have not yet arrived.” It’s extremely disrespectful to those of us who adjusted our schedules to be on time, who get to sit there and wait. During several of the offending meetings, the latecomers never materialized, so it truly was a waste of time.

I’ve said it multiple times, but organizations that want to be high-performing need to look at how they schedule meetings and make adjustments if people are constantly late or double booked. Condemning people to daily runs of back-to-back meetings is not only inhumane, but non-productive. The best organizations I’ve worked in have policies in place to limit meetings to 25 or 55 minutes so that participants can transition to another meeting if needed. They also have active agenda management within their meetings to ensure that time is used well and that they don’t run over. I preach this constantly during my consulting engagements and can usually get my clients to make progress. Lately I’m involved in projects, though, where I’m just a small piece of the puzzle, so I’ve been feeling the pain of poorly managed meeting schedules.

US prescription drug spending continues to rise, potentially crossing the $600 billion mark in the next four years, according to a Reuters article. The annual increase of 4-7 percent is less than the 6-9 percent increase in spending growth that was originally forecast, partially due to fewer approvals of new medications and pharmaceutical companies facing pricing pressures. The piece mentions that “several drug makers have pledged to limit annual price hikes to under 10 percent.”

I understand price increases have to keep up with inflation and manufacturing costs, etc. but it seems most manufacturers are going to keep increasing prices as much as the market (and public opinion) will bear. I continue to cringe when I review patient medication lists during patient care shifts. It’s increasingly rare to see patients on fewer than 10 medications unless they are pediatric patients. I see people on the “latest and greatest” branded medications when generics are available that have virtually identical side effect and risk profiles.

It takes a lot of work and effort to have conversations with patients around whether switching from medication X to generic Y is a good idea and what the cost savings could be over the course of a lifetime of chronic treatment. Patients with low health literacy aren’t going to understand relative risk reductions and how a medication being 1-2 percent more or less effective is going to make a difference for them. Physicians often don’t have the time to have those conversations, either.

The best resources I’ve seen for these conversations are pharmacists who are embedded in the clinical practice, but we don’t see a lot of those in the workforce. We also need to get past the cultural idea that being on the latest and greatest medication is best. How many drugs have we seen that have serious issues that aren’t found until they are on the market for a year or two? More than I care to remember.

It’s also more of a challenge to have the conversations and interventions around lifestyle modification than it is to just give another medication, especially when physicians are being graded on their outcomes. I’d like to see insurers or pharmacy benefits managers providing these kinds of direct-to-patient interventions. They could keep a share of the savings from the lower-cost interventions to motivate them. Of course, it would cut into the overall profit margin, but it would be better from a societal standpoint because polypharmacy is a real issue. It’s easier though to push the work to the physicians and other front-line providers, who I guarantee aren’t getting payment increases that are hovering under 10 percent.

Lots of people were impacted this week by a Google Docs phishing scam. When I saw identical emails come through from almost a dozen unrelated people in the course of a few minutes, I knew something was up. It quickly made its way through several local school systems that use the Google Classroom applications, and from there to their parents and out into the community. It’s a good lesson for the younger set, that there are bad actors out there and they have to be suspicious.

The things that kids have to worry about in this day and age are sad, however. My local school district just announced a program starting in the fall where every middle school student will be issued a personal Chromebook for use at school and at home. Although it might keep family computers from being impacted by scams accepted by unsuspecting children, it increases the burden for tech support for the schools.

The rapid growth of technology is also a bit of an experiment on our society as a whole. Social media creates stress for adults and youth alike, and the social media-related suicides and bullying are truly tragic. I was fortunate to grow up in a location and as part of a generation that could run around the neighborhood until the street lights came on, and most of our worries were around flat tires on our bikes. Even in middle school, the pace of bullying was limited by the passing of folded pieces of notepaper and whispering in the hallways between classes, where now hundreds of people can be involved in negative interactions at the touch of a button. Add in the recent boom in murders, suicides, and assaults broadcast live for the world to watch and it makes you wonder where we’re headed. Maybe patient matching challenges aren’t such a big deal after all.

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