EPtalk by Dr. Jayne 11/4/21

I was at my local academic medical center for a meeting a couple of weeks ago and noticed that they have new policies in place regarding wearing scrubs outside the hospital. Apparently they’ve selected a new and distinctive color for the scrubs that are worn to the operating rooms, and if you’re caught trying to wear them out of the building, you’re subject to disciplinary action and possible termination. They already have scrub “vending machines” that prohibit you from taking scrubs home since they’re linked to your ID badge and you’re limited on how many sets can be issued to you. Wearing scrubs from the outside world into the operating suite isn’t ideal, so it makes sense not to let them go to the outside world in the first place.

Still, they don’t have any restrictions on what shoes can be worn in or out of the hospital, which given some recent news, might be a good idea. Shoe soles were swabbed for the presence of C. difficile bacteria, which is the most common healthcare-associated infection in the US. The results were presented at the Infectious Disease Week 2021 annual meeting and showed that shoe soles had a high rate of contamination and were similar to floor samples taken in either private homes or healthcare facilities. The researchers propose that when patients who are at risk for getting C. difficile infection are placed on high-risk antibiotics, that they may need additional education about cleaning floors and removing shoes before entering the home. Sometimes public health informatics isn’t considered sexy, but if you’ve ever encountered a patient with C. difficile diarrhea, you would likely support any research that would help reduce its presence in the world.

The AHIMA Foundation recently released a study on the “Understanding, Access and Use of Health Information in America.” In short, more than three-quarters of patients in the US don’t leave their physician’s office on a positive note. The study notes disconnects between the information that physicians think they are sharing and what patients understand. The findings are similar among caregivers who share concerns about their loved ones’ ability to process information they’ve been presented.

One of the data points I found most interesting was that more than 20% of patients don’t feel comfortable asking their physician certain questions. That points to the difficulty in building patient-physician trust and open communication. I was reading this in the context of a recent conversation with a medical school professor, who noted that at times his trainees were so uncomfortable with certain topics in class forums where patients were present that they asked if they could present their questions to the patients anonymously.

Other interesting tidbits:

• Seventeen percent of patients report not having an opportunity to ask questions at all during a visit.
• Ninety percent of patients search for health information on the internet, and 80% are confident that information is credible.
• More than half of patients report that they rarely access their medical records to review health information.

The latter bullet point indicates that we have a long way to go as far as the patient side of the information blocking equation is concerned. I certainly don’t see any public health organizations that have the resources to educate patients on the benefits of interacting with their own records, and although hospitals and health systems are promoting the use of patient portals as a convenience, I don’t see a lot of campaigns around how important it is to actually review your records. I’ve found multiple errors in my own charts (one of which was potentially life-altering), so I always review my after-visit summaries, but then again, I’m a physician who is also a data junkie which is a status shared by a relatively small number of patients.

Administrative simplification is a hot topic among my friends who are part of the revenue cycle side of healthcare informatics. The US spends a ridiculous amount of money on healthcare administration and a recent editorial in the Journal of the American Medical Association notes that administrative simplification has the potential to remove a quarter-trillion dollars from our healthcare expenditures in the near future. In 2019, $950 billion was spent on administrative functions within the US healthcare system, despite efforts to introduce technology as a way to streamline functions. In our non-system system, administrative staff outnumber physicians and nurses 2:1 with more than a million administrative roles being added in the last two decades.

The authors propose that 28% of annual administrative spending could be cut without impacts to quality or access. Many of the targeted areas are not healthcare related: general administration, human resources, non-clinical TI, sales, marketing, and finance. The second largest group of targets is financial, including revenue cycle management, prior authorization, and claims processing. Further down the list are the actual healthcare interventions, such as convincing payers they should standardize processes and clinical requirements for prior authorization. The authors propose that for many of the changes, financial incentives would be needed to overcome organizational inertia.

I’ve been in some recent training classes with international physicians, and it’s been interesting to hear their questions about phenomena that are particular to the US health system. In many countries, there’s no concept of different billing codes for different types of visits. In some countries, primary care physicians are mandatory, and in others, the concept doesn’t exist. I’ve enjoyed learning first-hand what things might look like in another part of the world and I hope that some day we could reach the levels of commitment to public health and universal coverage that I’ve been hearing about. In the mean time, we’ll have to keep playing Whac-A-Mole with crisis after crisis in the US healthcare system and see if it can recover before it breaks.

If you’re part of a payer/provider organization, I’d be interested to hear what administrative simplification looks like from your perspective. Is the grass already greener on your side of the street, or are you smiling like the Mona Lisa because there are secrets you can’t talk about? Let’s hear some ideas for how to solve these issues and free up money for other worthy projects. Have ideas? Leave a comment or email me.

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