EPtalk by Dr. Jayne 4/29/21

The big news around the virtual physician lounge this week is the decline in COVID-19 vaccination rates. President Biden is pushing for small businesses to make use of tax credits to support paid time off for employees seeking vaccination.

At this point, anything we can do to incentivize people to become vaccinated is welcome. The more the virus continues to spread, the more it can mutate, which counters the progress we’ve made. Some employers understand this. Supermarket chain Kroger has offered cash incentive payments for employee vaccinations, as has hospital Houston Methodist and several health systems. Some decry this as coercion, but the reality is that someone won’t get a vaccine if they really don’t want one, based on a $100 cash payment. The incentives are also rewarding those who do the right thing, as additional vaccinations help strengthen the workforce and reduce burden on co-workers.

I remember when I received my first vaccine, we thought it would really be something if we got a million doses in arms. That would really be an indicator of safety and effectiveness. Now that we’re at the 200 million dose point, it’s clear that the risks of the vaccines are minimal. Even with the questions around the Johnson & Johnson vaccine and the potential for increased blood clots, these vaccines are remarkably safe and effective. Based on what I’ve seen with the COVID-19 illness in my patients, the vaccine is much more desirable. On the home front, I’m just waiting on a couple of second doses within my family, and then I’ll really be able to breathe a sigh of relief. It’s been a long year, for sure.

Healthcare workers have been at the tip of the spear, not only fighting the pandemic, but also dealing with increasing numbers of unstable patients and sometimes public hostility. The Journal of the American Medical Association published a recent article on “Navigating Attacks Against Health Care Workers in the COVID-19 Era.” Initially, health workers were on the receiving end of discrimination as well as violence. Several colleagues were asked not to attend church or told that their children couldn’t participate in activities because they were potentially in contact with COVID-19 patients. There are also social media attacks – I’ve experienced them personally, although what I’ve encountered has been on the mild side compared to that experienced by others.

During my career, I’ve experienced patients ranging from “creepy stalker” to verbally abusive to downright threatening. Fortunately, the only physical threats have occurred within the hospital emergency department, so I had security staff at the ready. Still, there’s always that worry that a disgruntled patient or drug seeker will be waiting for you at the end of your shift. Hospitals and larger facilities may have security staff that can help mitigate this risk, but for healthcare workers in small practices or isolated environments, we’re pretty much left with the buddy system to help keep each other safe.

Uber sent me an email this week, inviting me to schedule my COVID-19 vaccine at a nearby Walgreens through the Uber app, while also being able to book a ride. Of course there were caveats about vaccine availability and whether Uber Reserve service is available in my area, but it’s still a good option for people who might not otherwise be able to get a vaccine scheduled. In my area right now, there is an overwhelming surplus of vaccines and a lot of hesitancy, so anything that gets people to think about the process is okay in my book.

I was excited to hear that Meditech is integrating genomics into its EHR. If you are an EHR vendor thinking about incorporating it, there are some serious options not only for documenting the data for how they enable clinicians to use it. The most basic need is to be able to document specific genes that patients have in a discrete fashion so that they can be used by clinical decision support algorithms. That’s critical for those genes associated with diseases where the mere presence of the gene changes the need for preventive screenings or management. Systems need to be able to track what type of genes are present, whether they are sex linked or not, and whether patients have a single copy or two copies of a given mutation. They also need to be flexible enough to manage new discoveries, such as when a gene is found to have a new level of clinical importance.

For its Expanse Genomics solution, Meditech is partnering with First Databank. To be honest, I didn’t know how far First Databank had gotten into the world of genomics. I always enjoy stopping by the FDB booth at HIMSS and remember vaguely hearing about them moving into pharmacogenomics. Certainly, some specialties are going to be more drawn to the value of integrating genomics than others. Many of my primary care colleagues are concerned about being able to keep up with the basics of making sure all their patients are receiving preventive screenings and that diagnoses are managed optimally, let alone being able to manage the impact of genomics on precision medicine.

I was particularly excited to hear about the Expanse solution being able to import genomic data and integrate it into the patient record in what sounds like a discrete fashion. My own recent genomic results are sitting in a PDF within the chart and aren’t even accessible to me as a patient through the patient portal. My physician was supposed to mail me a copy (snail mail – shocking, I know) but the results never arrived, so they did send me a PDF version. Good thing, since when I look in the patient portal, it just says “see outside report.” If my physician’s EHR can’t even display the results, there’s no way it can use them to tell me how often I should get a colonoscopy or how my risk changes depending on what is found during the procedure.

It will be interesting to see how long it takes other EHR vendors to get on board with a similar solution, as well as how long it will take existing Meditech clients to embrace the new content.

How is your system currently handling genomics? Leave a comment or email me.

Email Dr. Jayne.