EPtalk by Dr. Jayne 8/19/21

HIMSS sent out its HIMSS Digital survey this week in an attempt to gather attendee feedback. The questions were predictable around whether the conference met expectations, whether the content was unique or valuable, if it was thought-provoking, and whether attendees can use what they learned in their organizations. Some of the areas they asked about I hadn’t heard of or seen promoted on any of the Digital communications, so I hope someone got something out of them.

I also received the “Important HIMSS21 Health & Safety” Update email, notifying attendees of several attendees who tested positive either on the way out of town or upon arriving home. If there really were only three cases that would be outstanding, but I suspect there might be quite a few mildly symptomatic or asymptomatic people out there. Judging from the people I’m seeing for testing (thanks to a touring musical act who shall remain nameless but did require testing or vaccination to attend the show) there are quite a few asymptomatic positives out there. My community’s transmission rate is rather high at the moment, so I’m not at all suspicious that they are false-positive results.

Desk jockeys, take heart: a new study in the American Journal of Physiology Endocrinology and Metabolism looks at the concept of “interrupted sitting” as a way to help mitigate negative impacts of sedentary work. Although the study was small with only 16 adults, it showed promising results. For 10 hours daily, participants were prompted to get up every 30 minutes. The active group had fewer extreme blood sugar values, suggesting that even small amounts of intermittent activity can be beneficial. I’ve been working on a big EHR build lately and often feel like I’m strapped to my desk, so I’m making it a point to try to get up regularly even if it’s just to walk to the kitchen to put more ice in my water glass or to drop a journal in my recycle bin.

I have to say that I’m really enjoying working on the build project. It’s different from what I usually do, and I am working with an outstanding team who gets it as far as understanding what clinicians want and need from their EHR. Several of them have clinical roots, so it’s not surprising that they know what needs to get done. Unfortunately, it’s a short-term gig and all good things will eventually come to an end, but it will have been fun while it lasted.

On the flip side, I established a micro practice earlier this year after leaving my urgent care job. It’s a way to have a place to hang my shingle so I don’t run afoul of the regulatory and licensure folks in my state. It’s also a way to experiment with new technologies and see how they play out in actual patient care. I’m test driving an EHR right now that can only be described as atrocious. It reminds me of some of the first systems I used in the late 90s, which were a cross between FileMaker Pro and an electronic prescription pad. For what I’m doing, I don’t need a certified system, but I certainly miss things like CPOE and clinical decision support that I think the majority of clinicians take for granted.

Two journal articles caught my eye this week. The first, in the Journal of the American Board of Family Medicine, reinforced the idea that perhaps breakfast is the most important meal of the day after all. Researchers analyzed existing mortality data from the NHANES 1999-2002 data sets, looking at overall mortality, cardiovascular mortality, and fiber intake. Nearly 83% were identified as breakfast eaters, and on the whole, they were older, had lower body mass index, and ate more calories and fiber daily than non-breakfast eaters. The study certainly doesn’t show causation, but the association of breakfast eating (especially when individuals consume more than 25g of fiber daily) with lower mortality rates seems solid.

The second article, also found in the Journal of the American Board of Family Medicine, looked at the practice of incorporating patient narratives in the medical record. It caught my eye because it took place in the Netherlands. One of my outdoorsy gal pals hails from that part of the world and is always sharing stories about how life is different in her home country. According to the article, the Netherlands is the home of the world’s oldest practice-based research network and contains over 300,000 patient-years of data gathered from 2.2 million encounters documented between 2005 and 2019. During the registration process, the practices gathered contextual information such as country of birth, level of education, family history, and trauma history and added it to the EHR.

Looking at data from early in the COVID-19 pandemic, they analyzed patient-reported reasons for encounters and found that episodes of pneumonia most often started with a complaint of cough. When documentation showed both cough and fever, the incidence of pneumonia was even higher. Cough with concomitant pulmonary disease was also a strong predictor of pneumonia, as was low socioeconomic status. Throughout my journey in the EHR world, people frequently minimize the need to have structured data in chief complaint and history of present illness fields. This just goes to show that maybe that data might be usefully mined after all.

I’m pool-sitting this week and have definitely enjoyed some quality time in a lounge chair in between long stretches of conference calls. I haven’t yet been bold enough to take a call from the pool deck, but looking at what’s on the agenda for the rest of the week, I just might. Any noises that might make it onto calls can’t be worse than what I’ve been hearing lately, as my remote colleagues seem to have become increasingly more casual. One co-worker has had a toddler on almost every call for the last few months, which makes me wonder how much work he’s getting done unless he’s cramming it all in while his son is asleep.

Do you think remote workers have become more casual during the pandemic? Leave a comment or email me.

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