EPtalk by Dr. Jayne 5/6/21

I was intrigued by an article in the Journal of the American Medical Informatics Association (JAMIA) that looked at “Public vs. Physician Views of Liability for Artificial Intelligence in Health Care.” The authors found that although a majority of both physicians and the public believe that physicians should be liable for errors occurring during AI-assisted care, the public was more likely to do so (66% versus 57%). Compared to the public, physicians were more likely to believe that both vendors and healthcare organizations should be liable. In summarizing the background, the authors note that there are more than 60 AI-based algorithms and devices approved by the US Food and Drug Administration. Although they didn’t find significant differences across specialties, they only surveyed internal medicine physicians, oncologists, and radiologists. The number of physicians surveyed was also fairly small – 750 physicians were invited, but only 192 responded.

Another article, also in JAMIA, reported on interviews with medical scribes and how their work might reduce clinician burnout. I’ve got a fair amount of experience with scribes, from using them in practice to helping health systems set up scribe training programs. It was a fairly small study with only 32 interviews. The authors looked at different types of clinical tasks from documenting visit notes to tracking down clinical information. I liked the way they referred to clinicians delegating these tasks to their scribes as “outsourcing.” Especially if you have an EHR that makes finding information challenging, as many of us do, it’s a heck of a lot easier to ask your scribe “what was her blood pressure at the last visit?” versus having to dig for it yourself, especially if you’re on the high-volume hamster wheel where you’re asking patients questions and synthesizing information at the same time you are conducting your examination.

Unfortunately, some organizations don’t embrace scribes fully and leave it up to individual physicians to determine if they want or need a scribe, which usually means that the cost of hiring, training, and using the scribe falls entirely on the single physician. Practices that incorporate scribes as part of the overall infrastructure can see additional benefit, including being able to have appropriately-trained scribes help perform clinical tasks (such as rooming patients or helping handle phone calls) during any downtime where the physician may be doing work that isn’t best supported by a scribe. In my soon-to-be-departed clinical gig, it was also a plus that nearly all the scribes were doing a gap year between undergraduate studies and hopefully being admitted to medical school or a physician assistant program. Across the board, they are a highly motivated bunch who seem to genuinely want to learn about clinical care and the health system. Unfortunately, that meant that nearly the entire scribe workforce turns over every spring and summer, which is a challenge.

JAMIA hit the trifecta with an article on reducing EHR-related burnout through a “personalized efficiency program.” This is the kind of work I do as a consulting CMIO – helping organizations figure out not only how to technically optimize their EHR, but how to get providers to adopt time-saving workflows. There are a variety of strategies I like to use, so I was eager to hear what kind of offerings their efficiency program included. I felt validated in my approach – their individual coaching sessions included a focus on increasing EHR knowledge and maximizing user-level customization. In the study, a good number of providers participated in the optimization sessions, 87%. However, not all participants returned both the pre-survey and post-survey, so they weren’t included in the research sample.

This week’s Health IT Buzz blog focused on sunsetting the interoperability roadmap. It was a nice walk down memory lane, thinking back to 2015 when the roadmap was introduced and sparked plenty of comments before it was finalized. It made plenty of people nervous, especially the parts that talked about patients having expanded access to their records. Many of the milestones it laid out have been achieved. The last pandemic-filled year has been impactful on health IT and has accelerated numerous interoperability projects. Although the new developments are appreciated, let’s hope it doesn’t take a pandemic to continue moving organizations and the industry in the right direction.

As a big-time science nerd, I was excited to see that the team at Fermilab published an article that they have successfully achieved sustained, high-fidelity quantum teleportation. It’s a step closer to a quantum internet, which would revolutionize how we use and manage data. The research team — made up of folks from Fermilab, AT&T, Caltech, Harvard University, the University of Calgary, and the NASA Jet Propulsion Laboratory — plans to continue to upgrade its systems over the next several months to further refine its results.

May is Mental Health Awareness Month. The ongoing pandemic has certainly brought discussion of many mental health issues to the forefront. Among my patients, I’ve seen increases in depression, anxiety, and insomnia. Many people have their symptoms compounded by difficulty accessing both primary care and psychiatric services, and although I know the urgent care isn’t the best place to handle those issues, we can typically help connect patients with additional resources and supports. A good number of my colleagues have had their own mental health struggles during the past year. Due to the challenges with physicians having to report mental health treatment in many states, a number of them are untreated or undertreated, and that is a sad commentary on healthcare in the US and our willingness to understand that everyone is human.

I’m glad we are past the panic attack-inducing days of the early pandemic, when we didn’t know what we were dealing with or whether we would make it out the other side. There are a number of physicians and other clinicians who may be whole in body but not in spirit, and I hope the health system starts to look seriously at what needs to be done to help them heal. In the short term, I see a lot of them leaving medicine. I’m curious whether other countries that don’t have the same stressors are seeing the same outcomes. In the immortal words of U2, “we get to carry each other.” If you sense your colleagues are in need of help, do what you can to get them to a better place.

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