EPtalk by Dr. Jayne 1/20/22

I’m getting ready for HIMSS in earnest, beginning to schedule meetings and the much-anticipated booth crawls with some of my BFFs. It’s always good to have a support team to help you spot eye-catching products, interesting giveaways, and of course the finest footwear.

Several people have asked me what I think will happen with exhibitors and whether people will drop out. At this point, I think I have as good a chance of predicting that as my old-school Magic 8-Ball. In looking at the vendor-side organizations I’ve had involvement with over the last couple of years, the breakdown is 10% not attending, 25% going stealth (will not have a booth but will attend the show and have private meetings), 15% exhibiting but might cancel or send a smaller team, and 50% forging ahead business as usual.

One of the things I’m most looking forward to is seeing people in person who I haven’t seen since HIMSS19. Although I attended virtually in 2020, that experience paled in comparison to the past. Friends humored me with lots of after-hours pictures and shenanigans, but I’ll be glad to be part of the adventure again.

Of course, that assumes that we don’t have another variant of concern pop up between now and then. It’s hard to believe we had no idea that omicron was going to be such a nightmare a couple of months ago. Here’s to hoping that given all the people who have been infected, the immunity it provides will be at least somewhat durable. It’s likely we won’t know that for quite some time, but I’m still hopeful. If it turns out that all the death and suffering and healthcare workers’ exhaustion of the last few months were for nothing, that’s going to make it all the more terrible.

I’m part of an online group that discusses alternative careers for physicians who want to leave traditional medicine. Sometimes the suggestions are decidedly non-medical, such as getting one’s real estate license or flipping houses. They may also include non-clinical careers that still require physician expertise, such as pharma, life sciences, or medical device manufacturers. Sometimes they even include staying in your specialty, but moving from a traditional practice to a locum tenens format to have more flexibility and variety.

This week, the discussion veered off into the realm of clinical informatics. I almost spit cocoa on my keyboard when one author said they were interested in clinical informatics because they wanted to get away from working with people.

I was happy to see several clinical informaticists chime in on how we work with people all the time. One noted that not only do we work with people, but often they are often tired and overworked clinicians just like the original poster. Another described the not-so-fun state of being caught between administrators who want to bloat the EHR’s configuration for business reasons and end users who want a streamlined experience that makes it easier for them to care for patients. It was clear that many of the people asking about it don’t understand the requirements needed to work at the top level in our field, such as fellowship training, board certification, or considerable experience.

I was proud of how the clinical informaticists represented our specialty – recommending an online typing tutor for the one-finger typist, AMIA 10×10 courses for the budding informaticists, and more. They encouraged the physicians interested in learning more to volunteer for technology committees at their organizations, take additional training for EHR workflows, or even pursue becoming a super-user if they are really interested in crossing to our side of the clinical trenches. We get to do and see a lot of cool things and it’s a different way of using our clinical skills to help large numbers of patients rather than just influencing those we could see in our own practices.

I was less proud of the non-informatics physicians on another thread that piled on for some complaints about EHR vendors. One chap talked all about his experiences with a particular system and how terrible it was and listed specific defects that made it unusable in his opinion. As someone who has used that system extensively, I became suspicious. Only by reading well below the scroll did you get to the part where he says that he hasn’t used the system in more than a decade. I’ve seen a lot of good EHRs and some bad ones too, but the biggest struggles I’ve seen are with decent EHRs that were ineffectively configured and implemented. I’m working with a vendor now that has extensive training resources and I wonder how many users know what’s available at their fingertips.

I wasn’t surprised that the COVIDtests.gov website had a soft go-live on Tuesday ahead of its scheduled debut. It seems to be working relatively well except for some issues processing requests from multi-family buildings. The tests are limited to four per household and won’t ship for a while, which limits their utility during the current omicron surge. Testing capacity has somewhat improved in our community, but at-home test kits are still hard to find, leading to challenges for those hoping for a quick turnaround. A good friend knew I had a stash of kits and asked to use one, which was a fair trade given his history as a maker of excellent gin and tonics. After 15 minutes in my outdoor driveway COVID clinic, he headed home with at least a small measure of reassurance.

I didn’t think much about it because I was just glad to help a friend out, until he sent me a thought-provoking text: “You know what just struck me about last night? In the richest country in the world, I, a fully insured patient, had to turn to what amounts to a black market supplier for a medical test.” Funny but not funny, and painfully true. Maybe next time I have to offer some driveway swabbing, I’ll pair my gloves with a trench coat and some kicky boots.

What’s your most challenging experience trying to obtain a COVID test? Leave a comment or email me.

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