EPtalk by Dr. Jayne 7/15/21

So many health systems placed everything on hold during the pandemic, so I was excited to hear about a health system not only taking something live but building it themselves. Holy Name Medical Center’s emergency department went live on its homegrown EHR, powered by Medicomp’s Quippe solution. I’ve had the opportunity to test drive the Quippe Clinical Data Engine multiple times in recent years and it really is an impressive solution, so I can’t wait to see how Holy Name implemented it. It will be on display at HIMSS21 in the Medicomp booth and I’m looking forward to kicking the tires. Kudos to this team for the implementation even in the face of a pandemic.

Telehealth is here to stay, and I enjoyed reading a Medscape piece on “What should I wear to see my doctor?” Telehealth has changed the paradigm for care delivery at the same time that life in general has become more casual. I still balk at the idea that my telehealth employer wants us to wear white coats, since there’s no purpose to it other than having it shout, “hey, I’m a doctor.” The article shares a couple of anecdotes about multitasking patients, one who tried to do a medical visit while multitasking on a work Zoom meeting and another where the patient was cooking a meal during the visit. Those are certainly extreme examples, but there are many more where virtual visits have clued us into situations in the patient’s environment that we wouldn’t have known if they presented for in-person care.

There are also some pretty amazing stories about physicians being too casual for patient care, including one telehealth physician who lacked a shirt during a consultation. Another provider was written up by his network for drinking beer and eating chicken wings (both visible to the patient) during a behavioral health therapy session. I’m guessing he wasn’t trying to document real-time, because the grease load on anyone’s computer keyboard wouldn’t be desirable.

I personally use my telehealth patient care days as excuses to dress up, to bring out those chunky necklaces that I normally wouldn’t wear in person for fear of toddlers grabbing onto them or the dangly earrings that typically remained in the drawer for the same reason. I still don’t wear sassy shoes, though, mostly because I’ve become entirely too accustomed to living in the Kino sandals that have been my constant companion since the first time I visited Key West. That will all change in a couple of weeks, though, as I get ready for HIMSS.

HIMSS released the details of its COVID-19 vaccine verification process. All attendees, exhibitors, and staff will have to provide proof of vaccination through one of three processes: Clear Health Pass Validation, Safe Expo Vaccine Concierge Validation, or Safe Expo On-Site Validation. I decided to try the Clear Health Pass option and the experience was less than stellar. Once I clicked on the HIMSS-provided link in my email, I had to enter my phone number so I could receive a link via SMS to download an app. After waiting 10 minutes for it to install, I restarted the process, which started over in the download phase despite having been in the installation cycle previously. After another 40 MB of downloading, there was another three minutes of installation, after which I was asked to enter a code that I didn’t have. I guessed at HIMSS and HIMSS21 and the latter was successful.

From there, I went through multiple terms of use screens and consents, which I know the vast majority of users don’t or won’t read. From there I had to scan both sides of my driver’s license and then take a picture of myself, which rivals my passport for hideousness due to the app’s smile detection feature which forces you to basically frown. From there, I had to go through another selfie process, which converted my picture to a line drawing and seemed tricky to try to fit my face into its weird oval frame.

The next step was adding my vaccination information, for which I had to go through another consent then an electronic authorization to release data to Clear. From there I was instructed to log into MyChart and went through another disclaimer, followed by four panels of information regarding consent and release. Finally, I was asked to give permission to the HumanAPI app to release every scrap of data in MyChart, including allergies, the name of my physicians, demographics, documents, health goals, implants, lab results, medications, problems, orders, procedures, immunizations, vitals, appointments, clinical notes, encounters, referrals, smoking status, and OB/GYN status. It asked to allow sharing for the next 90 days.

I denied permission and went back to the option to submit a photograph of my vaccine card and to key in the vaccine information and dates. After less than 30 seconds, I received my validation, and I didn’t have to share a boatload of PHI to do it. The overall process took 26 minutes, which was way too long, and I imaginethat  if I had actually read all the consents and disclaimers, it would have been close to an hour. I’m sure everyone involved (except the patient/consumer) is making at least a little money on the sale of the personal data that thousands of people will release without thinking too much about it. Just say no to the API, folks.

Amazon Care has asked major health payers to cover its services on par with other in-network care options. Reported targets include Aetna, Premera Blue Cross, and Blue Cross Blue Shield of Massachusetts. Amazon Care was originally piloted with Amazon’s Seattle-area employees, but the company has tried to expand the product since March of this year, not only nationwide to Amazon staff, but also to other employers. Based on the challenges with getting coverage for telehealth, let alone some of the asynchronous services the platform purports to offer, it will be interested to see how long it takes for the big payers to bring the service into the fold let alone provide payment parity.

A recent article in JAMA Network Open looks at the ability of wearables such as Fitbit and Apple Watch to identify the long-term effects of COVID-19 infections. The data is from the Digital Engagement and Tracking for Early Control and Treatment trial (DETECT) which was led by researchers at the Scripps Research Translational Institute. More than 37,000 people enrolled in the study, which ran from March 2020 to January 2021. Subjects used the MyDataHelps research app to report symptoms and COVID-19 test results and shared data from their devices. Researchers concluded that when they looked at wearable data and symptom data together, they could detect COVID-19 cases more accurately than looking at symptom data alone.

A follow-up trial looked at Fitbit users with fever, cough, body aches, and COVID-19 test data. It found pronounced changes in COVID-19 positive patients compared to others. Symptoms included increased sleep, decreased walking, and higher resting heart rates. On average, the COVID-19 positive patients took 79 days for their resting heart rates to normalize compared to four days in the non-COVID-19 group. Definitely food for thought for all those who are still refusing vaccination and especially for those who think that COVID-19 is a hoax.

COVID-19 is on the rise in my area in a big way, and my former colleagues are being slammed. My former partner had 38 people on the wait list at urgent care this morning. Of those patients, 15 were COVID-19 positive. The most tragic story of the day was a family who came in for testing after seeing pictures of their COVID-positive cousin in the ICU on social media after they were all together for a July 4 event. The cousin didn’t even call family to notify them, just posted on social media. It sounds like they were beside themselves and I’m sure the positive results didn’t help things.

Speaking of social media, I’ve written before about some of the lesser talked-about aspects of social media, such as its role in the grieving process and how strange it feels for “memories” to pop up that might not be happy ones. I definitely had some strong emotions at the memory that popped up for me today, which was a picture of my mask-damaged face during a lengthy shift in the emergency department. It was a stark reminder of all that we’ve been through in the past year.

It also gave me pause because we’re still not learning the lessons we need to learn to deal as effectively with this pandemic as we need to. Many of us who read the medical literature and have close relationships with researchers understand that we’re literally one “variant of concern” away from being back at square one with this virus. There’s a constant sense of waiting for the other shoe to drop, and for some of us, I’m not sure we’ll ever be able to feel the sense of relief that we had in a pre-COVID world.

A close friend of mine is a counselor and executive coach who works predominantly with physicians. He agrees that there are thousands of us who meet the diagnosis criteria for post-traumatic stress disorder but who have not addressed it with employers or sought treatment, and in reviewing the criteria during our discussion I’m betting a lot of clinicians don’t know they have it. I’m curious to know if employers are doing any specific outreach to help manage these pandemic-driven symptoms in the workforce, or to know more about the experiences of those who may have reached out for help.

What’s your experience with pandemic-driven PTSD? Leave a comment or email me.

Email Dr. Jayne.