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EPtalk by Dr. Jayne 12/8/16

December 8, 2016 News No Comments


The FDA is making available its data on adverse events stemming from foods, dietary supplements, and cosmetics. I found it interesting that the coded symptom data contains numerous British English spellings: hospitalisation; dyspnea; diarrhea; and pale faeces to name a few. Pretty unusual for a United States governmental agency. Repeat offenders included the full range of “5-Hour Energy” products; B-complex vitamins; cabbage; and a number of products with the name “cleanse” in their names, which is not surprising to this physician.

I attended a continuing education session this week. Although I learned a lot, it was the first time that I heard so many gambling metaphors in one place. I’m used to hearing sports phrases, but the gambling references were new to many of the attendees. I had the privilege of explaining what “table stakes” were to a newly-minted pediatrician, as well as the meaning of “double down.” I’m grateful to my former partner who once invited me to be part of a ladies’ poker night, which ended up being less about poker and more about wine and catching up. It’s always a good reminder for presenters to consider their audience before including figures of speech. There were also some Yiddish references and some regional slang, which, although entertaining, might have been confusing to some.


The reader mailbag brought quite a bit of correspondence this week. I always enjoy hearing from readers, even if it’s just a “thanks for writing” type comment. Being anonymous and doing most of my work solo while watching “Call the Midwife” can feel pretty lonely, so thanks for the feedback.

From Texas Tornado: “I enjoyed your recent mention on MU reporting. Would text analytics be helpful in this MU attestation scenario? I understand the push to do more discrete documentation, but what if you could report on structured and unstructured data combined? Does it really matter if the data is discrete or not as long as you can report on it?” That type of approach would certainly be appreciated by many clinicians who have been clicking their little hearts out over the last half decade. With most of the EHR-based quality reporting platforms I’ve seen, however, most documentation has to be discrete and in a fairly narrow workflow to “count” for quality measures. Ultimately, as natural language processing evolves, I think we will see more information being transformed to discrete data points; but I’d love to see some other approaches.

From Roaring Waters: “Thanks for your discussion of the need for clinical participation in IT projects. As a vendor selling to the acute care environment, I am always shocked at how often patient care workflow solutions are handed to an IT or non-clinical person to evaluate and determine how it will impact clinical workflow. I know people have been talking about end-users making user workflow decisions for decades, but for some reason these basics of project management are lost. Providers themselves are just as guilty, as I see them constantly passing these decisions off to a non-doc or non-clinical user to make decisions about their workflow and ultimately the patient care they deliver. It’s mind-boggling!” The providers that pass the buck for decision-making are often the first to complain when workflows or solutions don’t meet their needs. Another variation on this that I’ve seen lately is to pass the decision to a clinical representative who doesn’t actually practice or who doesn’t have any real buy-in to the clinical situation at the institution. I’ve been working with a group for nearly a year that has a CMO who constantly criticizes the EHR and demands a move to Epic, yet hasn’t shown up at a single executive briefing or strategy session where the EHR has been discussed. His comments are strictly hit and run via email and one-off conversations with the Board of Directors, which hasn’t learned to say no to his shenanigans. His peers are working hard for solutions and all he does is tear down their work, which is unfortunate.

From Science Guy: “Thank you for your comments about clinical staff having to take ownership of the quality reporting. Having worked in healthcare in both the payer and clinical side … there is a paradigm shift taking place that many clinicians have not come to grips with. That is that the payers are driving more and more of the clinical decisions based on outcome data and not clinical judgment. It is becoming increasingly difficult to practice medicine in a vacuum without using clinical information to justify decision making. Having worked at a University Medical Center, I saw this very plainly as the more experienced physicians struggled with this very topic and resented the IT staff for ‘creating additional hoops for them to jump through.’ I heard the statement more than once that ‘my time is too valuable for this … and my time is better spent healing patients than working on the computer.’ On the other side of the coin, there is a whole new generation of physicians coming out of school that are much more computer literate. They embrace using information from the health record to support their decision making. They realize this information could assist them with their clinical decisions, and all of this data was really just another clinical diagnostic tool to improve care. I guess my point is that like any other change, this current shift will cause a lot of frustration for a lot of staff, but it is certainly not going away. Hopefully many of the more experienced staff will be motivated to change as they see their younger peers embracing this technology and ultimately the patients will benefit from these changes. But hopefully, in the meantime, your information will help with the whole ‘shooting the messenger (the IT staff) mentality.’”

As a young physician working in clinical informatics for the first time, it took me longer than it should have to learn to stop shooting the messenger. Looking back, I realize I was working with a very inexperienced IT staff that had no idea how to work with physicians and didn’t understand how much havoc a poorly-run EHR project could have on a practice. I assumed that since the hospital had contractually agreed to provide me a paperless practice with a functional HER, that they would also provide staff that had the skills to deliver it. Some of the individuals involved in that debacle are now some of my information technology BFFs and we continue to learn a great deal from each other. Whether it was encountering chicken wire in the wall that was interfering with wireless connectivity or having providers install their own black-ops routers under their desks, it was kind of fun working in the early days (read “Wild Wild West”) of health IT.

Have you ever used poultry netting as a drywall patch? Email me.

Email Dr. Jayne.

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