EPtalk by Dr. Jayne 6/4/15

Pharmaceutical companies are major users of direct-to-consumer advertising. Although we see a lot of EHR vendors advertising in medical journals and at conferences, I haven’t seen a lot of direct mailings to non-administrative physicians. This week at my clinical office, I received a direct-to-physician mailing from Imprivata regarding electronic prescribing of controlled substances (EPCS). It was actually a nice piece – educational with respect to Meaningful Use requirements and the current status of EPCS.

Rather than relying on MU-related scare tactics, it appealed to the concepts of streamlining physician workflow and reducing prescription fraud and abuse. Enclosures explained the DEA ruling in detail and laid out strategies for planning a successful implementation. They did, of course, market their solution, but it was tastefully done. I also appreciated the fact that the entire packet was devoid of flashy marketing distractions. Maybe I’m getting more boring with age, but it’s nice to see something straightforward.

Health Datapalooza took place this week in Washington, DC. The agenda listed sessions on personalized medicine, patient-reported outcomes as quality indicators, data privacy and security, and advancing technology. I’d be interested in hearing from readers who attended. What were the best sessions? Anything earth-shaking?

The May-June issue of the Journal of the American Board of Family Medicine surprised me with a special issue including multiple healthcare IT articles. One reviewed existing studies on physician use of scribes, concluding that scribes may improve clinician satisfaction and productivity. The researchers were only able to find five studies done between 2000 and 2014, so the validity of the results is limited. Another discussed the notion that “primary care researchers are uniquely positioned to inform the evidence-based design and use of technology.” It suggests leveraging existing research programs and methodologies from human factors engineering, which sounds like a great idea. A third examined how physicians use previous visit notes to prepare for an upcoming visit, suggesting that the note output of EHRs needs an overhaul to reduce cognitive load.

A friend shared Atul Gawande’s recent piece titled “Overkill,” which discusses continued recommendations for unnecessary tests and treatments. These not only drive up the cost of healthcare, but can lead to additional testing, which often leads to a spiral of waste. It also leads to overdiagnosis, which creates stress for patients and can also lead to additional unnecessary treatment. Theoretically our EHR systems should help us avoid these pitfalls through the use of clinical decision support and better availability of patient data at the point of care. However, until we spend time educating the populace that there are risks to “doing too much,” we won’t be able to take action on the information before us.

Gawande cites specific examples, stating, “We’ve tripled the number of thyroid cancers we detect and remove in the United States, but we haven’t reduced the death rate at all.” It’s not just the United States facing this issue – South Korea is seeing similar problems. I often hear patients talking about the nation having the most advanced technology in the world and the best procedures, so it’s challenging to help them understand that often less is indeed more.

We’re putting steps in place to encourage physicians to proceed thoughtfully and avoid unnecessary expenditures, but I haven’t seen the level of national programming needed to bring patients around to this new way of thinking. Choosing Wisely presents evidence-based lists of tests and procedures to reconsider, but I don’t see them being used on the front lines of care. Patients often don’t want to rely on a physician’s education and clinical judgment; they want hard proof and this leads to testing. The relentless pursuit of higher patient satisfaction scores doesn’t make it easy to say no to patients, either.

It will be interesting to see how the healthcare landscape shifts over the next five to 10 years. Billions of dollars in Meaningful Use funds haven’t shifted the needle as much as we’d hoped, so it might be time to try new strategies.

How can we make the most of the next decade? Email me.

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