EPtalk by Dr. Jayne 12/30/21

Monday’s clinical adventures were full of patients who had been exposed to COVID-19 over the Christmas holiday. A good number of them tested positive on home tests and wanted to speak to a physician to request a laboratory order for a PCR test, because they didn’t believe the home test was accurate.

There’s a bunch of epidemiology calculations that can be done to explain this using pre-test probability, sensitivity, specificity, etc. but they all roll up to this. If you have symptoms and any test is positive, whether it’s a home test or not, you need to take it as fact and isolate yourself. The healthcare system is being crushed in my state and there aren’t enough tests for people to double test.

A couple of local physician offices turned off the phones Monday because so many staff members were out that they simply could not handle the volume and opted to triage everyone to their patient portal. I’m having some guilt about not seeing patients in person while my colleagues are being pummeled, but will do what I can to help from a telehealth standpoint.

Also on the telehealth front, both Ohio and New Jersey have new telehealth bills that were recently signed into law. Common themes include expanded access, preventing insurers from denying coverage, and granting payment parity between in-person and virtual care. The Ohio bill’s expansion provisions include allowing additional provider types to deliver virtual services including optometrists, pharmacists, physician assistants, and school psychologists. It also broadens the list of entities that can bill Medicaid for telehealth services.

Proponents don’t believe that the expansion and payment provisions will raise healthcare costs, as was argued in other states such as New Jersey earlier in the year. An initial telehealth bill was rejected there due to concerns about increased costs to taxpayers, but now the bill has been signed with the condition that the state department of health will study telehealth use and patient outcomes.

Telehealth advocacy group as well as patient advocacy groups are calling for reinstitution of so-called COVID-waivers for telehealth services, which were a key part of the initial pandemic response. On an individual basis, many states allowed any licensed provider to see patients regardless of whether they had a license in those specific states.

Even health systems that normally provide telehealth urgent care services are struggling, partly due to patients who have traveled for the holidays and now can’t get remote care from their “home” health system because they’re outside their normal state of residence. This is a great example of why the telehealth laws need to evolve. I’m confident that my personal physician can care for me virtually whether my body is in my house or sitting on the beach hundreds of miles away, even if my state doesn’t think so.

Also in telehealth news, the Department of Health and Human Services announced $35 million in American Rescue Plan funding to expand telehealth infrastructure and capacity for Title X family planning providers. Many of the Title X providers are part of the so-called health care safety net that provides care for low-income populations and other groups who might not otherwise receive care. The funds will be distributed as 60 one-time grants that will be given to active Title X program participants. Applications are open on Grants.gov through February 3.

I enjoyed a recent article on terms that make hospital executives cringe. I’d like to add my personal list of language elements I wish would go away: frictionless, the use of “solution” as a verb, ecosystem, the cloud, enablement, holistic, the Internet of Things, and anything prefixed with “smart.” They’re old and tired (and in the case of “working to solution something” just plain weird) and if we have all these brilliant minds in tech, certainly we can come up with something better.

I missed this story when Jenn sent it my way earlier in the month, but was happy to see it. It details the work of the Refugee Artisan Initiative, where newcomers to the US can receive skill training and experience with micro-businesses. The organization received a community investment grant from Swedish to cover creation of medical scrubs for its staff. The Initiative is making 500 sets of scrubs which will be custom sized for employees. My new clinical gig won’t allow me to wear scrubs, so after nearly two years of wearing them exclusively, I’m having to figure out what looks good under a white coat but won’t be bulky or aggravating.

Speaking of aggravating in the context of health tech, the team at the Consumer Electronics Show has spoken and has declined to approve my request for media credentials. The email simply said that my submitted credentials were inadequate and didn’t specify which of the two were problematic. I’m baffled because I submitted items that complied with their requirements and were of the same substance as last year (just more current, in keeping with their requirements). Lots of tech companies are backing out of the in-person show and switching to the digital edition, so we’ll have to see what the engagement level is for those who still plan to attend.

I’m still on the hunt for interesting health tech that can help engage patients and enjoyed reading about the Prevention circul+ Wellness Ring. The name is quite a mouthful and is partly due to the manufacturer’s co-branding with Prevention Magazine. The ring is bulkier than I’d like, but includes technology to measure blood oxygen levels, which is intriguing to any of us who are trying to manage COVID-positive patients in their homes. The team worked with clinicians at the VA and Kaiser to trial the technology and refine the design. It can now also record blood pressure and a single-lead electrocardiogram, with data captured in its associated app. FDA approval as a diagnostic medical device is still pending, but it’s something I’ll keep my eye on.

What kind of new devices would get your attention or hold your interest? Leave a comment or email me.

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