EPtalk by Dr. Jayne 10/8/20

I’ve helped numerous organizations with EHR system selection over the years, so I’m always skeptical when vendors or others report outcomes that can only be described as too good to be true. I always feel vindicated when I get to the bottom or an article and find some tidbit that I might have otherwise missed if I skimmed.

Such was the case with a recent write-up about FastMed Urgent Care implementing Epic. Although FastMed may technically be the first independent urgent care operator to take Epic live, they partnered with HonorHealth in Arizona. It’s unclear what level of partnership is present – is it a joint venture, a resource sharing agreement, or some kind of licensing deal?

The write-up morphs from a report about FastMed into a write-up about a July KLAS report where vendors were rated on their COVID responses. It goes on to quote an anonymous Epic client who says that the efficiency gained using Epic has allowed them to go from seeing 300-400 patients daily to about 1,000. If you weren’t reading carefully, you might think this was about FastMed.

It caught my eye because for an urgent care to make that dramatic leap in volumes, it would require changes in many more systems beyond the EHR, such as staffing, facilities, supply chain, and more. When actually considering information like that, it’s also important to understand the timeframe for that kind of ramp up. It’s unclear why they even included the KLAS report in the piece, but just another example of the sloppy writing that’s out there and why prospects and customers need to remain vigilant.

From Dancing Queen: “Re: resigned employees. I sat on a 1:1 call earlier this week, waiting for someone who ultimately no-showed. There was no response to outreach on Slack or email, and no out-of-office message. Turns out he gave notice around Labor Day and his last day was almost a week ago. This was a C-suite person with an administrative assistant. Why would anyone think it’s OK to leave meetings on the calendar and not notify anyone of his departure?” Unfortunately, not caring about the time of other people seems to be the new normal. I personally experience no-shows all the time, as well as people who arrive late with no notification and no apology. One company I work with has a serious issue with people just ignoring emails. Especially in the world of virtual officing, people need to revisit the ideas of common courtesy and respectful behaviors. I understand companies not doing blast notifications when people leave, but there’s no excuse for not putting on an out-of-office message that directs people to someone who is assuming responsibility for that person’s work. In one past life, we would see a little “x” in the Outlook directory in front of people who had left, but that doesn’t help if you’re an external stakeholder, vendor, or consultant.

Telehealth has become a key part of the care team for many patients and providers, but organizations are still struggling with patient acceptance and technology glitches. Some patients seem to be more receptive than others, for example, those who had difficulty traveling to see a distant specialist or those who have difficulty taking time away from work for appointments. Others may not have the technology needed to do a visit well or may be uncomfortable discussing certain issues at home versus in the privacy of the physician’s exam room.

Now that the initial pandemic-driven pressures for telehealth services have slowed, organizations are starting to rethink their strategies. Maybe they have outgrown the quick and dirty solutions they initially deployed, or maybe they’ve realized that the vendor they chose didn’t offer all the features they need to be successful.

Organizations that are trying to move beyond the urgent care and immediate care constructs are looking for more robust technology that includes elements like remote monitoring or enhanced triage abilities that help streamline the physician portion of the visit. One consistent request I’ve heard in talking with CMIO friends is the ability to have multi-party conversations, such as with the patient and children or caregivers who may be remote not only due to distance, but due to potential quarantine or isolation. Having everyone virtually on the same page can cut down on the post-visit interactions that providers sometimes have to conduct to make sure everyone has the same information.

Others are looking for solutions that will allow multiple providers, such as a multidisciplinary care team, to see the patient at once. These integrated teams are often used for pediatric patients with complex medical problems that require follow up from a variety of subspecialists, to avoid having families travel multiple times to tertiary care centers. This is also important for patients who need translation and interpretation services.

EHR integration is also an ask, especially for those that implemented lightweight, standalone systems. Providers don’t like having to use multiple systems and screens to access data and document while they’re seeing the patient. It will be interesting to see what the provider-based telehealth market does over the next year, as well as how things turn out for direct-to-consumer applications.

Since no one hangs out in the actual physician lounge anymore (thanks, COVID), we’ve moved to virtual forums to try to stay connected. I’m part of multiple physician and provider groups that are trying to keep each other updated on not only COVID-related happenings, but other healthcare issues, while trying to bolster our communal morale. One of the hottest topics recently has been the future availability of a vaccine for the novel coronavirus and speculation on how complicated the process will be for its distribution. We’ve been collectively pleased that vaccine manufacturers seem to be holding the line against political pressures for a premature release and that CEOs have frankly contradicted the White House’s claim that manufacturers were pushing back against FDA guidelines.

Manufacturers have plenty of skin in the game and can’t afford to rush a vaccine to market only to have it go wrong in the field. We’ve all seen those examples of drugs released without adequate testing (Vioxx, anyone?) that have come back to haunt patients, providers, and manufacturers alike. As a front-line provider, the decision to take an available vaccine is not insignificant. FiveThirtyEight put together some thoughts from vaccine professionals on how we might know when a vaccine can be trusted. Here are the best nuggets:

• Don’t get your vaccine advice from politicians or pharmaceutical companies.
• Trust independent scientists and medical professionals.
• Look at information from FDA reviews.
• Be skeptical of anything released before year-end.
• Trust experts who are straightforward about the limitations of potential vaccines.

No one wants to get back to normal more than the healthcare providers who are in the trenches dealing with COVID and its fallout. Everyone is tired in a thousand different ways. Our hope is that people will learn to wear masks properly and consistently, that people will be vaccinated when a safe and effective one is approved and available, and that everyone will show patience and grace while all this is going on.

What’s the best example of grace under pressure you’ve seen during the pandemic? Leave a comment or email me.

Email Dr. Jayne.