EPtalk by Dr. Jayne 12/16/21

The healthcare IT world seems to be going into hibernation for the winter. I don’t expect too many big news stories between here and HIMSS. I’ve started to see some buzz around the Consumer Electronics Show and plan to attend virtually if they ever approve my request for press credentials. I enjoyed the virtual approach last year, although some day I’d like to go in person – they say the atmosphere of the show is really something, although I’ll be interested to see what in-person attendees think of it this year compared to its pre-COVID-19 vibe.

There’s minimal buzz around HIMSS, but I’ve gotten a lot of questions about ViVE. Everyone loves an excuse to go to Miami Beach in March, but the price tag is steep and requesting media credentials would require me to reveal my true identity, so I guess I’ll have to take a pass.

Regardless of the lack of vendor or industry news, academic channels continue to put out good articles. I enjoyed this recent item in the Journal of the American Medical Informatics Association. Titled “Assessing the impact of the COVID-19 pandemic on clinician ambulatory electronic health record use,” it does just that, by looking at data from ambulatory care physicians in over 360 health systems in the US that use the Epic EHR. They looked at data from December 2019 to December 2020, capturing the full timeline of the onset of the pandemic. They used data for active use of the EHR, after-hours use, and messaging. I wasn’t surprised that they saw a decrease in EHR use at the beginning of the pandemic. However, utilization not only ramped back up to baseline but increased by July 2020. This was consistent for both in-office and after-hours use.

In-Basket messages increased, largely due to the category of patient messages, which grew to 157% of its pre-pandemic average. Most of my colleagues hate the inbox regardless of the EHR platform. It usually contains not only messages from patients but also refill requests, correspondence from other providers, requests for referrals, preauthorization paperwork, lab results, diagnostic study results, and reminders to complete documentation in a timely fashion.

Some organizations do well at allowing physicians to delegate a large amount of this work to appropriately trained staff members, which allows team-based handling of many patient messages, refill requests, and referral / authorization requests. However, others refuse to let anyone other than the physician do this work, which not only leads to burnout, but can delay care. The savviest organizations report on their inbox workload and monitor how much work is being done by which members of the staff and adjust coverage accordingly. I wish this approach would be more commonly adopted, but as long as physicians continue to do the work without pushing back, there’s not a significant incentive for those organizations to change.

I wrote recently about challenges faced by the US Food and Drug Administration’s Risk Evaluation and Mitigation Strategies (REMS) programs to help mitigate the risks of serious side effects with certain medications. I used the program for the drug Accutane as an example. Little did I know that the IPLEDGE program for Accutane and its generics would implode this week. A colleague wrote in response to a patient complaint about refill delays: “Since Monday, there has been a nationwide issue regarding IPLEDGE and the FDA’s system for controlling isotretinoin prescriptions. They decided to change several things with the system and use a new website without first ensuring the website actually works. It is *literally* a sh*tshow with the nationwide program being shut down, hold times more than six hours for their tech support, and no one able to renew their prescriptions. I would give the office a break as currently no dermatologist in the country can send isotretinoin prescriptions until the FDA fixes the website.”

Sounds like the FDA didn’t learn much from the clozapine website debacle. These are exactly the kind of technology nightmares that physician offices fear, and which can bring even a well-oiled refill process to a screeching halt. Unfortunately, there’s no mitigation for the losses and frustration caused by this type of systems failure for either the providers or the patients. There are enough experienced healthcare IT people out there who know how to plan a project and how to run a go live that this should not be happening. Sounds like there were gaps in end-user testing, help desk support, and a potential reversion plan. Now that this has happened twice, I’d be interested to hear from anyone with FDA connections on what they plan to do to keep it from happening again.

Despite the news we’ve heard in the past that chocolate is good for you, new information shows that boring old multivitamins are more likely to slow brain aging. Preliminary information from the COcoa Supplement and Multivitamin Outcomes Study for the Mind (COSMOS-Mind) showed that taking a multivitamin each day for three years was associated with a 60% slowing of cognitive aging, most notably in patients with pre-existing cardiovascular disease. The findings were presented at the 14th Clinical Trials on Alzheimer’s Disease conference. The impact of vitamin use peaked after two years then remained stable; the reported 60% slowing is equivalent to 1.8 years. I usually treat myself to some dark chocolate around the holidays, and despite the evidence, I won’t be changing that habit.

I was commiserating with a friend recently about the American Medical Association’s monopoly on Current Procedural Terminology codes. Most of the provider-side organizations I have worked with dread the AMA’s license process, which is challenging for smaller organizations that have a lot of part-time users. Some EHR vendors include AMA licensure in their own license fees, but others make you work directly with the AMA to arrange licenses. My friend must know someone with some good AMA connections, because he later sent me a picture of this AMA-branded cheese board set. I’m not sure what exactly it’s trying to convey, since it’s somewhat evocative of what you see in movies when the character who is going to torture someone opens a case with various knives and picks. From a cheese board standpoint, the recessed AMA logo looks like a great place to harbor bacteria.

The holidays always bring out some interesting corporate gifts, although lately I’ve seen more companies making donations on behalf of their workers rather than sending gifts. What’s the most unusual corporate gift you’ve seen? Leave a comment or email me.

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