EPtalk by Dr. Jayne 9/22/16

The Epic UGM was held this week and I was pleased to receive an invitation to LogicStream Health’s “Taste & Toast” event. Hosted at the Frank Lloyd Wright-designed Monona Terrace and lead by a certified sommelier, it sounded like a great event. I wasn’t able to make it to UGM this year due to conflicting priorities, but wanted to give them a particular mention for offering free Uber services upon request. The risk of driving under the influence is definitely reduced when you don’t drive yourself.

A recent study published in Annals of Internal Medicine looks at whether hospital employment of physicians improves the quality of hospital care. The study looked at readmission rates, mortality, length of stay, and patient satisfaction at hospitals between 2003 and 2012. There were 800 hospitals that had moved to a more employed physician model vs. 2,000 that had not. The authors noted no association between the presence of employed physicians and most of the scores, although there was a slight change in pneumonia readmissions. The study looked only at Medicare beneficiaries aged 65 and older, so it’s not clear how the data would apply to other populations. It also didn’t look at government-run facilities.

Another study that caught my eye this week looked at “The Effect of Wearable Technology Combined With Lifestyle Intervention on Long-term Weight Loss.” The authors compared a “technology-enhanced weight loss intervention” to standard behavioral modification techniques, looking at nearly 500 participants between 2010 and 2012. Everyone was treated with initial diet and counseling. At the six-month point, participants were split into a group who self-monitored and a group that used a wearable device. Weight was tracked every six months for a total of two years. Researchers also looked at fitness, physical activity, dietary intake, and body composition.

Nearly 75 percent of participants completed the study. Although both groups improved in fitness, activity, diet, and body composition, young adults with a body mass index (BMI) between 25 and 40 lost less weight if they were in the wearable group. Based on technology-related fitness behaviors I observe in the workplace, there’s a chance participants focused more on the technology than on their actions or personal responsibility. There’s also the chance that as they saw the activities racking up, they felt it was OK to eat a bit more since they were being active. The bottom line is that we still have a lot to learn about the effectiveness of technology interventions in solving complex health problems such as obesity.

If anyone questions the challenges facing healthcare, they only have to look as far as the recent FDA decision approving the drug eteplirsen. The FDA’s own advisory panel voted against recommending approval for the drug, based on a clinical trial that only involved 12 patients and didn’t have adequate placebo control. Critics accuse the FDA of setting a dangerous precedent for approving drugs based on patient and pharmaceutical company lobbying rather than on science. The FDA will require the manufacturer to conduct trials to confirm the clinical benefit, and depending on the outcomes may opt to withdraw approval of the drug.

In preparation for the October 1 update for ICD-10 codes, CMS is alerting providers to resources such as the 2017 ICD-10-CM and ICD-10-PCS code sets. I know a lot of providers that fail to understand that these need to be updated each year or are content to let their office staff or EHR vendor figure it out. Not having the correct codes installed after the cutoff can result in denied claims and a ton of extra work, so it’s worth a minute to make sure your practice has a plan.

AMIA is seeking submissions for the iHealth 2017 meeting. The event is focused a bit more towards the application of clinical informatics as opposed to research, and participants are encouraged to submit programs, pilots, and innovations in health informatics. Submissions are open through October 18 and this year’s conference topics are grouped under:

• Analytics and the Learning Health System
• Clinical Informatics
• Interoperability and Informatics Infrastructure
• Health Policy and Payment Reform

AMIA also announced that they’ll be offering licensed childcare during the AMIA 2016 Annual Symposium to be held November 12-16 in Chicago. The Women in AMIA task force led the efforts to make this a reality. Cerner and Epic were listed as sponsors on the email announcement.

I see several physicians at the local academic medical center. All of them are of the “once a year” variety, so I don’t expect a lot of communication from them. I had no recent appointments and nothing scheduled, so I was surprised to start receiving communications about my upcoming surgical appointment along with patient questionnaires and more. I called the help desk to figure out what was going on and they said they could see no appointments for me in the system, yet the messages kept on coming. Apparently I’m having a consultation for spinal surgery for my ongoing pain management problems, or at least that’s what the system thinks is going on.

I fully understand glitchy computer systems that do seemingly unexplainable things, but I’ve run into some attitude from help desk staffers that act like they don’t believe I’m actually seeing what I’m seeing. I’ve offered to forward the emails back to them along with screenshots of the portal, but they don’t seem keen on using that to troubleshoot. In this era of medical identify theft and big data, patients have the absolute right to have their documentation be correct and telling them to “just ignore the information if it doesn’t apply” is not the right answer.

Have you had success in correcting erroneous online records? Email me.

Email Dr. Jayne.