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EPtalk by Dr. Jayne 11/19/20

November 19, 2020 Dr. Jayne 6 Comments

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Although telehealth has certainly been helpful for many organizations trying to boost patient access during the COVID pandemic, a recently study shows that it was not fully able to offset the loss in available patient care slots. Overall, telehealth was able to help organizations recoup about 40% of the decline in ambulatory office visits. Not surprisingly, patients from low-income ZIP codes and racial / ethnic minorities were less likely to use telehealth services than those from more affluent areas.

The study looked at more than 6 million private payer claims, but there’s still a gap in understanding visits for patients with public payer coverage (Medicare, Medicaid) as well as those telehealth visits that may have occurred but not been billed since providers were struggling to understand how to get paid for telehealth.

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Office visits were most dramatically affected, but vaccine administration, mammograms, colonoscopies, and HbA1c tests were also reduced significantly.

I have to admit that I was part of that mammogram cohort and didn’t end up getting my semi-annual imaging until August. The facility where I usually have my mammogram didn’t bother to send me a reminder that I was overdue or let me know when they had resumed services, so it was completely on me as a patient to make sure I caught up. Good thing I did before COVID spiked and services were limited again.

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Sometimes the titles of articles say it all, and this piece in JAMIA definitely caught my attention: “Unveiling the silent threat among us: leveraging health information technology in the search for asymptomatic COVID19 healthcare workers.” The article reviews the National Institutes of Health Clinical Center’s approach to rolling out an Asymptomatic Staff Testing System. The Center is the 200-bed hospital arm of the NIH that delivers patient care and research support. Due to the type of research being performed, over 60% of the patients admitted are immune compromised either from an underlying health condition or an experimental treatment. This underscores the need to deliver continuous surveillance of healthcare workers and prompt identification of those who may be positive for COVID-19.

One of the program’s goals was to deliver weekly testing for eligible healthcare workers. They used existing EHR and other systems to identify workers and allow them to self-schedule their testing appointments. Automation was prevalent throughout the process, including check-in, specimen tracking, and laboratory interfaces. As the process was designed, they “identified the difficulty in following the organization’s formal software development process under the time requirements” and mitigated this by using existing systems where possible. The whole process from task identification to early adoption was only four weeks, which would be a near impossibility for many healthcare organizations.

To determine how successful they were, the team looked not only at the primary outcome of identifying infected workers, but also surveyed the healthcare worker customers on the process as well as the facility process owners. I wish I saw more organizations follow this approach with a 360-degree evaluation where they pay attention to all the feedback, not just internal customers such as infection control departments or human resources. One of the findings was a need to ensure that patients / workers set up accounts on the patient portal, which is a common challenge among healthcare organizations.

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I always get a kick out of articles that cover poor password management habits, and this year’s list shows that the more things change, the more they stay the same. Review of data from hacking forums and the dark web revealed that the most commonly used passwords in the US include “password” and “123456.” The latter (and the multiple variations similar to it) shows that it’s not just users behaving badly, but vendors who should have logic behind their password requirements that would disallow such sequential numbers. Humorous options in the top 20 include superman, iloveyou, football, and letmein.

Although some vendors may be complicit, the other side of this coin is the vendors or entities that make ridiculously complicated password requirements or rules for frequent changes. These approaches have been shown in some studies to actually increase security risk, as users may be more likely to write passwords down.

One of my clients falls into this bucket. They make you change your password every 30 days, and the requirements include upper case, lower case, numbers, symbols, and a length of at least 10 characters. Maybe their goal is to push people to use randomly generated passwords coupled with a password manager, but that’s not always practical when using shared workstations. Regardless, I wasted half an hour of their tech’s time this morning (and a billable 30 minutes of my time) dealing with an expired password after I missed the prompt to change it.

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Big thanks to the gals in my life who sent a couple of recent care packages. Jenn knows my love for putting my feet up with a good book and surprised me with the world’s softest socks, along with energizing foot lotion and an Amazon gift card, which I promptly swapped for a new read. There were also some addictive gummy bears, but I’ve had to tuck them in my snack drawer lest I eat the whole bag. My favorite revenue cycle informant, Bianca Biller, sent the famous “Bionic Apple” from Merb’s Candies in St. Louis. Let me tell you, this thing is a Granny Smith apple covered with the smoothest caramel you’ve ever seen and rolled in chopped pecans. Did I mention it was the size of a softball? It made an excellent lunch while I enjoyed a webinar presented by some of my favorite folks.

For your friends and colleagues at the tip of the clinical spear, the next few months are likely going to be some of the worst times they’ve ever experienced professionally. I’m thankful for my friends and their support. Hopefully my newly energized feet will give me a bounce as I head back to the trenches tomorrow.

What are the best pick-me-ups you’ve ever received? Leave a comment or email me.

Email Dr. Jayne.



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Currently there are "6 comments" on this Article:

  1. Not a pick me up, but when I was in college, I was an IT intern for a local grocery store chain. The new network admin decided to expire passwords every 30 days, and one of my favorite users was having trouble remembering her password. I suggested she set it to the then-equivalent of “November_2020!” – problem solved.

    • I have a particular hatred for passwords and there is a special place in hell for those who define the password requirements.

      Why?

      Most systems I work with are handled by Single Sign On — except for the dozen or so that aren’t.
      Most systems have various degrees of complexity — which means I can’t reuse one password for them all — I get it, that is supposed to be a good thing, but hey, now I have to remember which password goes with which system. Either paper or a OneNote…
      Most systems have different expiration policies, meaning that you will almost certainly be out of synch at some point even for those passwords that you can reuse in multiple systems.
      And frankly, there are systems that I do want to be more careful of and not reuse either username or password — paper or my phone
      And, I don’t trust password managers

      Then, there are systems that know who I am, know that I am logged in, but want to revalidate my supposedly SSO credentials multiple times a day at nearly 60 characters a whack (user+Pwd). I won’t name names but its initials are Office365! Am I a bit bitter about passwords? You betchya!

      By the way, the most frequently used list of passwords and password patterns are readily available with a simple google search. They are worth looking at, because there are people who use those lists.

  2. “I have to admit that I was part of that mammogram cohort and didn’t end up getting my semi-annual imaging until August. The facility where I usually have my mammogram didn’t bother to send me a reminder that I was overdue or let me know when they had resumed services, so it was completely on me as a patient to make sure I caught up. ”

    The pizza place I frequent didn’t tell me when they reopened. Neither did my gym, my dentist, the wine shop. When did our personal health become the responsibility of our doctors?

    • My gym, and my dentist, and the wine shop send me updates and reminders all the time (Beaujolais Nouveau anyone?). And so does my PCP’s healthcare organization…

    • Since I’m enrolled in their high risk program after a referral from their staff geneticist, they agreed to send reminders as well as handling all the precertifications and insurance issues since I’m not even officially old enough for screening yet and coverage is a battle. They dropped the ball.

      And like Eddie, I did get regular updates on resumption of services from my YMCA branch, my favorite quilt store, my dentist, my library, my primary physician, and more.

      • Apologies for how rudely that came across. I do still question why our health is the responsibility of our doctors, but if that office agreed a reminder service was something they would offer on your behalf, then they absolutely needed to live up to that agreement.







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