EPtalk by Dr. Jayne 7/18/19

I took a little break from work and writing this week due to an unexpected illness in the family. As much as hospitals focus on their subspecialty capabilities, imaging, and technology, the one thing that stood out during our stay was the importance of compassion and high-quality nursing care. The care provided by both regular floor nurses and the hospice team contributed more to our patient and family experience than anything else the facility had to offer.

I’m glad we were at a community hospital with a patient-centric focus. The staff was kind enough to allow us to spill over into a conference room for take-out meals after the cafeteria closed and kept us fortified with drinks and snacks. I think we were the only hospice family on the nursing unit and it’s a fairly low-census time of the year for many facilities, but it was good to know they were looking out for ways to make us comfortable.

Being “the doctor in the family” puts you in a unique position. I was grateful that the nurses were willing to let me eyeball the orders so I could help put the rest of the family at ease about the plan of care. It was also an opportunity to think back on the patients in similar situations that I’ve cared for over the years and whether my efforts matched up to their families’ needs. Hospice care delivered in-hospital has come a long way from having the on-call intern make it up as they go along.

I appreciate the work done in the field to ensure patients have maximum comfort and that families have the support they need, especially when things don’t quite go as anticipated. I also appreciate the role of social media in the modern grief process. Although it’s easy to make fun of memes and the silliness we see out there, nothing beats being able to contact dozens of people quickly without having to call each one. Memories can be shared collectively rather than individually and overall it impacted positively on the experience.

Now I’m back home and back to the healthcare IT grindstone. A reader sent me this article about a skill for Amazon Alexa that allows patients in the UK to receive answers based on information vetted by the National Health Service. The NHS hopes this will reduce backlogs for patients who need advice on uncomplicated conditions. I spent some time learning about care in the NHS firsthand and enjoy the British commentary on issues. The author notes that “maybe, just maybe, this could also save some from going down an online rabbit hole into rubbish health forums.” I had forgotten how much I love the word “rubbish,” especially in that context, and will look for ways to use it going forward.

As expected, privacy and civil liberties groups are against it despite Amazon’s assurances that confidentiality will be maintained. The Health Service has set up a special division, NHSX, tasked with increasing the use of technologies, including electronic prescribing, artificial intelligence applications for radiology, and more. Clinicians want to make sure that research occurs to ensure the quality of the advice, and also that accessibility factors like cost are factored in for new approaches. My experience with Brits and healthcare is that they tend to be quite matter-of-fact and that is borne out in the comments on the piece: “Take paracetamol (basically Tylenol), and if you’re not better or dead in 48 hours, contact your doctor.”

New data has been added to the Physician Compare website reflecting data for the 2017 Quality Payment Program. We didn’t participate, so I don’t have any data, but a quick glance at several colleagues who did participate shows no data for them either. I’m not sure why they’re not displaying, but it adds to concerns about data validity and whether patients are really going to use the metrics to select their physicians. Most of the Medicare patients in my area select their primary care physicians based on who is accepting new patients and whether they can even get an appointment rather than being concerned about quality data that may or may not be accurate.

Speaking of data, here’s some that might be useful. Research presented at the American Diabetes Association annual meeting looked at whether individualized text messages sent to diabetic patients with recent emergency visits can improve glucose control, medication adherence, and ED utilization. The authors identified the ED as a place where high-risk patients can be engaged when they are in crisis and might be willing to make changes to improve their health. The goal is to use texting to bridge between the urgent issue and stable long-term care. The original intervention was one way and patients received two messages daily for six months. The control group received the same information in a pamphlet. The program has now been commercialized and a second module targeting family and caregiver supports is available. Although small at 166 patients, a study on that approach will be completed later this year.

The beginning of July marks the time when newly-minted physicians begin their careers as hospital interns. Internship and residency has changed quite a bit since I was in those trenches, mostly through the implementation of work hour reforms and the addition of dedicated days off, caps on admissions, and extra layers of supervision. A new study published in BMJ shows that “exposure of physicians to work hour reforms during their residency was not associated with statistically significant differences in 30-day mortality, 30-day readmissions, or inpatient spending.” The authors compared rates during 2000-2006 and 2007-2012 to reach their conclusions. The study looked at 485,000 admissions and compared outcomes for patients cared for by physicians in their first year of independent practice vs. patients cared for by physicians in their tenth year of independent practice during the same-year cohorts. The study is somewhat limited by its observational construction and limitation to internal medicine physicians, but it’s a good start.

For those of you in the EHR implementation trenches, how is your July going? Are the new house officers “getting it” or are you ready to pull your hair out? Leave a comment or email me.

Email Dr. Jayne.