EPtalk by Dr. Jayne 1/27/22

ECRI has released its 2022 list of Top 10 Health Technology Hazards for hospitals, medical practices, and home health organizations. Cyberattacks are at the top and no one should be surprised by some of the others on the list: supply chain limitations, insufficient emergency stockpiles, and issues with disposable gowns and inadequate barrier protection. The fact that we’re still dealing with some of these issues in Year Three of the pandemic is a travesty. My local nurse friends keep me apprised of the personal protective equipment situations at their various hospitals. At one hospital, it has only been in the last two weeks that there have been enough N95 respirators available so that medical/surgical nurses can have a fresh respirator every shift. Previously, they were limited to one per month. One can’t help but wonder whether the fact that so many nurses were out with COVID infections played a role in opening the supply cabinets.

Nearly every industry has been impacted by the labor shortage, and healthcare is no exception. An article published at the end of 2021 in Mayo Clinic Proceedings: Innovation, Quality & Outcomes looked at “COVID-Related Stress and Work Intentions in a Sample of U.S. Health Care Workers.” The study looked at 20,000 workers across more than 120 organizations, surveying them between July and December 2020. The authors found that burnout, increased workloads, and concern about infection were associated with plans to reduce work hours or leave the field entirely. The presence of anxiety or depression were also associated with those plans, as was a higher number of years in practice. Nurses had the highest intention to reduce work hours followed by physicians and advanced practice providers. Surprisingly, administrators had the lowest intention to reduce hours.

I was in a conversation recently with early career physicians who were contemplating changes to their workloads. Both women and men in the discussion were eager to learn more about nontraditional practice opportunities including job share arrangements or part time work. Considering the physicians I’ve worked with over the years, the proportion of physicians who view medicine as a calling and who are willing to make great sacrifices for their careers is shrinking. While some view this as an erosion of professionalism, others view it as a healthy acceptance of reality by people who are navigating challenges that previous generations could not have envisioned.

Based on the survey results, nearly one-third of physicians, advanced practice providers, and nurses intended to reduce their work hours. Ten percent of physicians and 20% of nurses intended to leave practice entirely. The authors note that feeling valued by the organization was protective, lowering both the intention to reduce hours and the intention to leave. They conclude that additional research is needed to determine whether mitigation strategies can prevent a healthcare workforce crisis. In speaking to physician and nurse colleagues alike, many are looking for tangible changes to improve working environments. These include improvements to staffing ratios, expanded access to employer-sponsored childcare, and protection from workplace violence. It would benefit administrators to work on these issues in depth rather than continuing with their ineffective strategy of pizza parties and challenge coins.

Maybe they can take advantage of the $103 million that the Department of Health and Human Services has allocated to reduce healthcare worker burnout. The funds are part of the American Rescue Plan and will be granted to organizations serving providers in underserved and rural areas. Over $28 million will go to programs to promote mental health and well-being, $68 million will go towards burnout reduction and resilience, and the remaining $6 million will be used to create the Health and Public Safety Workforce Resiliency Technical Assistance Center. Most of the burned-out healthcare workers I know are tired of hearing the word resilience, so maybe they can think of something else to call the Center.

In telehealth news this week, the US Court of Appeals for the District of Columbia Circuit ended efforts by telehealth provider RemoteICU to obtain Medicare coverage for services rendered by virtualist physicians outside the US. The company had alleged that an emergency rule allowing Medicare to pay for critical care services via telehealth extended to physicians outside the US. The judicial panel stated that RemoteICU “failed to present its challenge in the context of a specific administrative claim for reimbursement of services” and failed to meet the criteria laid out for judicial review of Medicare claims. As always, the devil is in the details where Medicare is concerned.

I had several people reach out to me regarding the EHR performance issues I wrote about earlier this week. I checked in with my colleague this afternoon to see how things were going after his vendor’s interventions. Despite the changes, the organization continued to have issues with sluggish chart loads and delays in rendering various screens, but it seemed better overall. A couple of times a day, the system would come to a screeching halt, though. With additional eyes on the issue, they identified a potential cause they hadn’t captured previously. Because of changes in childcare schedules, a worker who typically handles billing processes at night had been working during the day. She had no idea that the processes she was running were resource-intensive since she had always worked nights and no one had ever mentioned it. Her supervisor was similarly unaware, working during the daytime.

Once that was addressed, performance stabilized, and although the crushing delays had stopped, the system was still slower than was ideal. Average chart load time was improved by about 50%, though, so the users were borderline ecstatic per his report. The performance team has continued to make various adjustments in an attempt to improve things further, but they’re trying not to make too many changes at once, which is prudent given everything the organization has been through. I wonder what they’re doing for the rest of their clients who might also be struggling with volume-related challenges, and whether the improvements made for this organization will be propagated to others proactively or only when things become dire.

Is your technology team proactive or reactive? Leave a comment or email me.

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