EPtalk by Dr. Jayne 4/2/20

Monday was Doctors’ Day. I had pretty much forgotten until I looked in my non-work email account and saw this greeting from Cerner. Specifically, it was from their Jamboree Team that supported us at the World Scout Jamboree last summer in West Virginia. It was a nice reminder of better times, when I was able to watch 40,000 people from around the world work together and get to know each other.

Our current situation is a reminder of just how global we really are. Since that Cerner team is used to supporting an international clientele, I wonder if any of them will be deployed to support the Cerner Millennium implementation at London’s 4,000-bed Nightingale Hospital?

This is going to be a rough year (or two) for doctors. I’m glad to see that professional organizations are stepping up. Whether it’s statements about the rights of healthcare providers to wear their own personal protective equipment if their employers cannot provide it or extensions for continuing education requirements, it’s appreciated. I have several friends in private practice who have taken out personal lines of credit to try to pay their staff members and who are forgoing their own salaries indefinitely. I suspect this might be the death knell for many independent practices, depending on how solvent they were prior to the crisis.

Vice President Mike Pence sent a letter to hospital administrators this week requesting that they report data in connection with coronavirus testing along with data on bed capacity. The data is to be reported in a de-identified fashion to ensure patient privacy. In a nod to 1990, all data is to be reported based on a spreadsheet, which is due every day at 5 p.m. ET for the period ending the previous midnight. Hospitals will be submitting this critical data to a FEMA email address. Since everyone likes a redundant process, hospitals must also report daily data to the National Healthcare Safety Network’s COVID-19 module, which went live March 27.

Unbelievable, but in cybersecurity news, hackers have targeted the World Health Organization in the midst of this crisis. Tactics include creating a fake website that poses as a WHO email login portal to try to obtain passwords. Hackers had previously tried to spoof the WHO in an attempt to get money and private details from unsuspecting users. I hope what goes around comes around for these scoundrels.

A great piece in Kaiser Health News last week illustrates what it’s really like to be in an ambulatory setting and trying to confront COVID-19. This mimics what I’m hearing across the country. Although some organizations have stopped routine visits, others are forging ahead at full speed. Practices that can are pushing telehealth, but safety net organizations and others that are unable to limit in-person visits are having to rapidly redesign processes.

There are challenges in making sure exam rooms are clean in between patients. My own practice had to do an air handling study to figure out how long it would take to circulate the air out of our largest exam rooms should a high-risk patient be treated in them.

Many practices are doing “at the door” screening and triage, which often takes the form of a clipboard. Others are turning to novel solutions using chatbots and algorithm-based screeners.

Although adaptations are being made for telehealth payments, the article notes that some states are slow to get to speed with transitioning their Medicaid programs to a new payment model. It also notes the phenomenon of patients who “misrepresented their COVID-19 risks in order to get past screening.” We’re experiencing that in our environment as well, with patients desperate to be seen. Unfortunately, we have little to offer those we genuinely suspect of having the illness since care is largely supportive. Patients have latched onto media coverage of unapproved drugs and are requesting them. I’d love to be able to put a sign on the door that says simply, “No, you cannot have a Z-pack.”

From Other Duties as Assigned: “Re: from the front lines. I spent two shifts this week as a screener for all employees, clinicians, patients, family, and vendors. I’m usually a tech guy. It was a bit harrowing. In my state, we are hard pressed to maintain our PPE supplies and are repurposing surgical units to COVID. Our revenue will drop by 40% if this continues up the curve.” The writer wanted to remain anonymous, which is not difficult since this scenario is playing out at hospitals across the country. Kudos for stepping out of your comfort zone and giving it your all. Fighting this pandemic is definitely a team sport, whether you are supporting interfaces or enforcing the use of hand sanitizer at the door.

Lots of companies are throwing out cool COVID-related dashboards, showing various things such as hospital bed capacity (Definitive Healthcare) and effectiveness at social distancing (Unacast). Some of them are pretty fascinating, but it’s easy to go down the rabbit hole of interesting data and fail to do actual work. I’m limiting my COVID-related web surfing in an effort to actually remain productive.

I’m normally not a huge fan of Eric Topol, but I did enjoy his recent piece on how the “US Betrays Healthcare Workers in Coronavirus Disaster.” I think “betrayal” is the word that many healthcare workers are feeling right now, whether you’re a physician, nurse, therapist, tech, dietary worker, housekeeper, facilities engineer, security staffer, transporter, phlebotomist, or just about any role in the healthcare ecosystem. Many of us have spent our careers in service to others, but are having difficulty coping with the fact that when the going gets tough, our employers abandon us with salary cuts and furloughs. Their ultra-lean “just in time” inventories have left millions of workers without the basic protections of a safe workplace as defined by the Occupational Safety and Health Administration.

My clinical employer is still working hard to get us PPE, but it’s an uphill battle. A shipment of 500 gowns doesn’t do much for an organization that executes over 1,500 patient visits a day. We still don’t have company-supplied N95 masks, but we do have lab goggles for everyone. I’m eternally grateful to friends and family that dug through their basements or hit stores that were rumored to have legitimate masks, because I’m now covered with a set of masks I can rotate as I work. We’ll see how they hold up since they’re supposed to be single use and I’ll be wearing them up to 14 hours a day, but at least I have them, and the generosity of my support system allowed me to provide a few to colleagues as well.

Tonight’s dinner table conversation included such topics as “remember when we used to go out to eat” and “who wants to call the elders to make sure they’re actually at home,” along with something from a college math class that I’m sure I knew once upon a time. I’ve mostly adapted from my lack of travel, although the occasional tiny bottle of hotel shampoo brightens my mood. I have thousands of dollars in airline credits just waiting until the skies are safe again, so I’m making my post-2020 bucket list.

A friend sent me this photo, allegedly from a restaurant in Ohio. I’m not sure what all is going on with this concoction, but I do want to experience it in the future. If you know where I can find it, leave a comment or email me.

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