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Curbside Consult with Dr. Jayne 11/29/21

November 29, 2021 Dr. Jayne 2 Comments

The holidays are often a time for families to catch up and share recent happenings. Especially in the ongoing COVID-19 era, there is often a lot of catching up to do if people haven’t been seeing each other as recently as they did in the past, and if they haven’t been keeping up by other means. Although most of my older relatives are on social media (including one who has a Facebook account for each device she owns, because our attempts to explain how accounts work have not been well received), others spent the time catching up on their grandkids’ exploits. I always find it interesting to see how people in the same age bracket embrace technology differently.

In the early days of Facebook, I had avoided joining because I was super busy with a multi-hospital EHR conversion project and didn’t need one more thing to suck up excess time. I remember the night I finally signed up, sitting in a hotel room in the middle of nowhere during a hospital site visit. When it searched my contacts to try to find “friends,” the first person that came up was my then 88-year-old grandmother. It turns out that was the best way for her to see pictures of my cousin’s children, since they lived across the country. Even though she used a computer for little else, she saw the value in trying something new. She was also the kind of lady who spent part of her retirement auditing classes at the community college so she could learn new things, so I think that had a lot to do with it.

Fast forward to this year, and one of our relatives is struggling with a new iPhone that her son bought for her, seemingly without talking to her about it. She had been an Android user for years but her base model phone was low on memory and speed. Since she was on her son’s plan, he volunteered to help her pick out a new device, but it turned into him buying her what she thought she needed versus what she actually needed. Now she’s stuck with an expensive phone she doesn’t like, and the family dynamics make her not want to speak up about getting something else. The grandkids worked with her to do basic things such as connecting her phone to her house’s wi-fi network and doing some minor adjustments to voice-to-text settings, but I suspect she’s still going to struggle with it.

Most of my relatives don’t really understand what I do since I “gave up being a doctor,” so of course there were some conversations about that. I’ve given up on explaining how you can still be a doctor and not necessarily see patients. In the interests of simplifying the explanation, I’ve tried to explain that what I do is kind of like being a medical school professor who helps a resident learn a new surgical technique or a better way to treat a patient, and that sometimes I also work to help create the tools that doctors use to do their jobs. They still don’t get it, but that’s OK. I’m still the one they come to with all their medical questions, even in disciplines I know absolutely nothing about, so I guess I’m still a doctor after all.

There were of course the usual conversations about everyone’s chronic health conditions and the woes of choosing the wrong Medicare secondary policy. Since I’m working on a project that involves heavy use of a health system’s patient portal, I tried to get some information about whether and how my relatives might be using the ones they have access to. Use was all over the map, partly due to limitations in what their providers allow patients to access and partly due to lack of knowledge. It seemed like using it to send messages to the doctor was the most common, followed by prescription requests. No one was using it to read their visit notes, and none of them were aware of the ability to grant proxy access to a family member or caregiver.

The latter would be great for the other members of the family that are doing a lot of caretaking, so I hope they’re able to set this up in the near future. I’m not sure I would push them to read their visit notes since they would probably become aggravated by any inaccuracies or jargon. I recently had a visit at a large academic health system and there were at least five small errors in my note. I’m not going to get excited about it because it doesn’t change the treatment plan but I’m sure they would be less sympathetic if they saw something like that in their notes.

As with any technology, it takes time for adoption to occur, and I see wide variation in how different health systems are encouraging people to use their patient portals as well as in the support that they provide to users. Those that understand how much a well-configured patient portal can help office efficiency promote it more and are willing to spend more resources on development and configuration. Those that instead view it as something they have to provide and don’t want to cultivate likely have a lower return on investment as well as a less-fulfilling patient experience. This phenomenon shouldn’t be a surprise to anyone who has worked in healthcare IT, but I think sometimes people forget it as they’re planning projects.

Since I’m working on a project that assumes heavy use on the part of both patient and provider, I’m trying to learn everything I can about what works and what doesn’t work so I can help create the best solution for my client. In addition to talking to other CMIOs who have maximally leveraged their solutions, I’m taking some classes to really learn the details about what the system I’m working with can and can’t do. I’m working with some great analysts, but there’s always a chance they missed something or didn’t think about it in a way that a physician would, and my client is supportive of the approach.

In talking with a friend who does some clinical informatics work for his university, his institution restricts him from attending vendor classes. I think that’s absurd, especially if he planned to use his own continuing education funds to cover the cost of training. I get that they don’t want random people going to classes and demanding that they make changes that are problematic, but there’s a thing called “discussion” when people have ideas, and preventing staff from learning isn’t a good look for those in higher education. It’s also not a great recipe for stakeholder engagement, but I’ve known that his employer hasn’t cared about that for a very long time, so I’m not surprised.

I hope readers were able to at least get some down time this weekend, and that all the games of “refrigerator Tetris” were successful. What was the best thing you did over the holiday? Leave a comment or email me.

Email Dr. Jayne.

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Currently there are "2 comments" on this Article:

  1. “I’m still the one they come to with all their medical questions, even in disciplines I know absolutely nothing about, so I guess I’m still a doctor after all.”

    Even better–you are a FAMILY doctor!

  2. I have 3 roles with portal.
    1. Software vendor – we provide support for our EMR independent ambulatory practice clients. We help them see the benefits to their workflow efficiencies and help them customize their portals and train them to proficiency. We also help them support their patients. When they can’t help the patient, they have the patient call us and we provide remote on-demand support.to help them get connected and function in their chart.
    2. Patient – I have multiple patient portals in 2 states. I’ve granted permission to all my providers to my MyChart for all that are on Epic. Many of the providers in my current state are still not using portals, this is a huge challenge as I’m used to self-serve when I need something from my chart. We switched to Kaiser in 2020, they too have a version of Epic, so they can see my prior Epic charts within theirs.This is incredibly helpful as i have multiple chronic conditions.
    3. I’m a full time caretaker of my 86 yo mother. I manage her portal accounts, I could not function without them!

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