EPtalk by Dr. Jayne 7/29/21

As I get ready for HIMSS, people always ask me what’s on my must-see list for the year. The Medicomp booth is always at the top because the people are friendly, the product is solid, and they always have the good carpet for giving your feet a break. I enjoyed their two-story booth in the past because it provided an interesting view of the HIMSS spectacle.

Notwithstanding the physical space, Medicomp has a couple of cool things to talk about this year. The first item is the new Holy Name EHR, built using Medicomp solutions and brought live in their emergency department in the middle of a pandemic. Having spent way too much time in the ED trenches, I’m eager to see what they came up with in their custom solution compared to the off-the-shelf products.

The second Medicomp item I want to learn more about is the plan for partnership with CPSI to integrate the Quippe Clinical Data Engine into the CPSI platforms. I’ve been a big fan of Quippe for a long time since it has the power to help the EHR surface important information at the point of care. One of my favorite features is its ability to tag different clinical findings across time, so physicians can easily see where a symptom appeared previously. CPSI is used in many community hospitals and integrating Quippe will add some bells and whistles that will help build on quality initiatives and make documentation more efficient. While academic centers and large integrated delivery networks get a lot of attention, community hospitals enjoy having nice toys, too. Hopefully the integration will go quickly and get some cool tools into the clinicians’ hands.

Social media is everywhere, and I always enjoy having new emojis to enhance my communications. The new @VaccineEmoji is gaining traction and will provide a welcome alternative to the much maligned bloody syringe. The new emoji is modeled on a Rosie the Riveter-esque arm with a bandage strategically located over the deltoid muscle. Designers hope it will help in public health messaging, although the emoji is still awaiting approval by web text organizations. The director-general of the World Health Organization even supported it on World Emoji Day, which I didn’t know until recently was a thing.

I participated in a telehealth roundtable this week and one of the hot topics was medical licensure for telehealth physicians. Those who practice telehealth exclusively often have a dozen or more licenses, which can be burdensome and costly to maintain. Some states participate in the Interstate Medical Licensure Compact, and while it streamlines the licensure process somewhat those licensed in participating states, physicians still have to obtain individual licenses. Telehealth advocates are lobbying for relief, including licensure reciprocity or potentially a federal-level license that would allow people to practice in any state.

I live on a state border. Back in the day, I could care for my technically out-of-state patients over the phone without concern. Now, however, that is considered telemedicine, and my choices were to either get another license or stop caring for those patients over phone and video. The license process was a pain, especially the part where they wanted me to submit my high school transcript – a data point which makes absolutely no sense for determining whether a physician is worthy of licensure. One would think the medical degree, board certification certificate, etc. would be enough. Still, I had a good laugh with my high school’s registrar who promised to find my transcript on microfiche. One approach being championed by the Alliance for Connected Health includes a Medical Excellence Zone, which would be a group of states that recognize each other’s licenses as long as the physician doesn’t create a physical office in the other states.

In addition to being an annoyance for border dwellers like me, it is also a barrier to very specialized or renowned physicians who want to provide second opinion services to patients without the inconvenience of travel or distance. A federal licensure approach would likely benefit these physicians most, although many states will resist. The precedent is there for physicians credentialed by the Department of Veterans’ Affairs for telehealth. I learned from another panelist about the Sports Medicine Licensure Clarity Act of 2018, which apparently allows team physicians to care for their athletes in any state where the athlete or team is playing, as long as they hold a valid license in at least one state. If it’s good enough for professional athletes, shouldn’t it be good enough for the rest of us?

Recent Illinois legislation HB 3308 establishes payment parity for numerous telehealth services through 2027. Audio-only telehealth and asynchronous telehealth services were expanded as well. The bill also prevents payers from requiring an in-person visit before telehealth services can be delivered and keeps them from requiring patients to provide a reason for requesting telehealth. It also protects patients who request in-person care by preventing payers from requiring virtual visits and protects providers by preventing insurers from mandating delivery of telehealth services.

Breakthrough COVID-19 is real, y’all, and it hit close to home as one of my fully-vaccinated family members added an undesirable diagnosis to his problem list. It’s heartbreaking to see people who did such a good job avoiding infection now being impacted, but the transmissibility of the delta variant is definitely in play in my community, as is the abject lack of masking. My former employer is seeing record-breaking numbers of patients, a sizable percentage of whom are unvaccinated and test positive, although the vaccinated positive patients are becoming more numerous.

Looking for testing options, both Walgreens and CVS were booked for days and he didn’t want to be exposed to other illnesses at urgent care, so I was able to get him scheduled at the local county health clinic. Drive-through appointments were abundant and I was able to go online at midnight to book an 8:30 a.m. appointment. The only negative of the county health process was the lack of practical medical advice provided to the patient – his only follow up was a link to his lab result that simply said “detected.” Not every patient is going to readily understand that it means positive or what to do next. Fortunately, I was able to provide isolation and self-care advice, so we’re hoping for a speedy recovery.

HIMSS21 will be requiring masks as well as vaccines, and I truly hope it doesn’t turn into a super spreader event. I’m waiting for my academic colleagues to get hit with travel bans again, so my planned catch-up opportunities may be dwindling.

What are your HIMSS21 plans? Is it time to throw in the towel? Leave a comment or email me.

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