EPtalk by Dr. Jayne 12/2/21

Last May, the Office of the National Coordinator for Health Information Technology (ONC) launched its Health Interoperability Outcomes 2030 initiative with a goal of engaging the public around the future of interoperability. It received over 700 submissions of “Interoperability Outcome Statements” during the comment period and has created summary statements to reflect what the future should look like. Several of the summary statements resonated with me based on current projects and recent patient experiences:

• Individuals will be able to seek and receive care (e.g., telehealth, specialty) without needing to gather and provide their health information themselves.
• Individuals will no longer fill out paper forms for any healthcare encounter or process.
• Health professionals will be able to search for and access electronic health information within their workflow and have it presented in ways that intelligently synthesize relevant data.
• Reporting for public health, quality measurement, and safety will all be completed automatically and electronically.
• Duplicate diagnostic tests and procedures will be reduced.
• Health professionals will spend less time on administrative tasks and more time caring for their patients.

If you’re interested in some bedtime reading, individual submissions are also available. Some of the more high-profile submitters have their names listed and a few have videos. Repeat themes from the bulk of the comments include the desire to stop using fax machines, the desire to have end of life or advance directives universally available without being provided by the patient, and the need for a unique patient identifier to support interoperability.

In other government health news, the Centers for Medicare & Medicaid Services (CMS) announced this week that it is ending part of the Primary Care First innovation model, specifically the Seriously Ill Population component. The initiative targeted Medicare clinicians who provided care for high-need, seriously ill Medicare beneficiaries. The patients would be attributed to a specific clinician who would receive additional payments for coordinating and delivering care. CMS determined that the outreach methods planned to identify patients would most likely not result in a sufficient number of participants, making evaluation of the model impossible. The CMS Innovation Center plans to look for other ways to best serve these patients either through new models or enhancement of existing programs.

Zoom announced this week that it is accepting beta customers for its new integration with Cerner’s EHR. The integration will allow for EHR-based provider notifications when patients are in the virtual waiting room as well as sharing of test results during the Zoom meeting. There’s been a Zoom integration with Epic since the pre-COVID days. I wonder how many development hours it took for Cerner to play catch up?

Physicians who rapidly embraced telehealth visits last year have been struggling with lack of integration over the past year often resulting in clunky workarounds as well as patient and clinician frustration. When you look at smaller EHR vendors as well as some of the larger ones, the pace of integration has been slow. I know of quite a few physicians still using completely freestanding telehealth systems or just using conferencing software because their organization claims it doesn’t have the time or resources to work on existing integrations, not to mention the number of folks using systems where they haven’t been released yet. Even when organizations have homegrown solutions to provide integration, they’re still often clunky.

It’s not every day that we see an article about a good old HIPAA violation. HHS settled with five providers who violated the law’s Right of Access Rule, which states that providers have to give patients copies of their medical records in a timely fashion at a reasonable cost. As someone who used to enjoy reading her state’s Provider Discipline Newsletter, I wonder what these organizations did to receive such disparate penalties. Where one pain management clinic received a $32,000 fine and two years of monitoring, one internal medicine physician will pay a $100,000 penalty. A medical group settled for a $10,000 fine and performance of corrective actions. There has been a total of 25 actions since this particular enforcement started in September 2019. Based on the number of health systems I see behaving badly in this regard, I’m surprised there aren’t more actions.

I’m no stranger to wandering through the woods, so I was interested in this “News & Perspectives” piece in the Journal of the American Medical Association. In response to seeing patient take toxic but ineffective drugs during the pandemic, they applied to the US Food and Drug Administration (FDA) for approval to perform clinical trials using medicinal mushrooms and traditional Chinese herbs. The double-blind, placebo-controlled study (known as MACH-19) looks at treatment of mild to moderate COVID-19 with the agents and is ongoing at UCLA and UCSD. Recruitment has been challenging due to declining pandemic cases, however. Another trial is looking at whether medicinal mushrooms can be used alongside COVID-19 vaccines for better protection. The theory is that mushrooms can alter the behavior of immune cells. Unfortunately, robust science takes time, and results might not be available until well into 2022. Hopefully, the pandemic will be greatly reduced by then, but the findings could be helpful for other viral infections. If nothing else, the effort demonstrates the need to actually test proposed therapeutics, rather than encouraging patients to take unstudied drugs or those not meant for humans.

One of my clients offered to add me to their Grammarly subscription, so I thought I’d give it a try. With the various hats I’m wearing and roles I’m juggling, I can use all the help I can get a times. I like how it works with social media and various apps, not only highlighting any potential issues as they occur, but allowing one-click corrections. Apparently, it is impressed that I have a 12-week writing streak and today announced, “You’ve surely earned some ambrosia for your efforts.” I don’t know about ambrosia, but I’d settle for some dark chocolate.

What’s your favorite celebratory treat? Leave a comment or email me.

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