EPtalk by Dr. Jayne 4/14/22

I wrote at the beginning of the pandemic about the increased visits my practice was seeing for sexually transmitted disease testing. A recent Washington Post piece covers the increase in syphilis and gonorrhea during 2020, partly attributable to clinic closures and delays in seeking care. Scarce public health resources were focusing on COVID-19 and availability of testing services was variable. I was distressed to see a significant rise in cases of congenital syphilis, which rose 235% since 2016 and hit a new high of 2,148 cases. Pregnant patients who are infected can experience pregnancy loss and infants who are born with syphilis can have devastating health issues.

Other diseases were also on the rise in 2020, including gonorrhea. Surprisingly, chlamydia was on the decline, although that may be due to decreased testing and delays in seeking care. Many infected patients don’t have symptoms and are only diagnosed on routine screening, so a decline in face-to-face visits might also be a driver. With the power of all the data we have in our electronic health records, organizations should be able to do a better job of identifying patients who are eligible for STD screening and can use patient engagements solutions for outreach. Depending on configuration, there may be barriers to outreach because it’s a sensitive topic; but that doesn’t mean we shouldn’t do our best to address an entirely preventable category of illness.

Many of us in healthcare IT cringe when healthcare workers incorrectly cite HIPAA as the reason that they can’t provide patients with their own health information. As a field consultant, I shuddered every time someone claimed a regulation wouldn’t let us configure the EHR in a certain way or modify a workflow so that the site would run more efficiently. The American Medical Association has created a series of articles that debunk regulatory myths. Hot topics that impact our field:

• HIPAA does not explicitly state that physicians can’t respond to online reviews from patients. However, they must maintain privacy, even if the patient has revealed personal information. Responding may however violate community guidelines for review sites, so physicians and practices should do their homework before responding.
• Clinical support staff who perform non-clinical tasks in the EHR are not required by federal or state law or regulation to log out and back in when switching back and forth between clinical and non-clinical tasks. They also don’t have to log out/in when switching back and forth from a scribe role to a clinical support role.
• The Joint Commission does not support or prohibit the use of documentation assistants such as scribes.
• Medicare doesn’t require physicians to re-document information captured by the staff, only to verify it, as long as there are no state or institutional policies to the contrary. This includes documentation completed by medical students.
• There is no federal rule that physicians are the only clinicians that can enter orders via computerized provider order entry. Other members of the care team are permitted to pend or send orders as requested by the physician, as long as state law allows.

One of the most often cited (and incorrect) myths is that The Joint Commission and/or OSHA prevent food and beverage at clinical workstations. I’ve seen dozens of nursing supervisors tell people that the hospital will fail a Joint Commission inspection if there are cups at the nursing station. In reality, The Joint Commission does not address where food or drinks can be located. Even the Occupational Safety and Health Administration doesn’t determine specific locations where workers can eat or drink. They do, however, prohibit eating and drinking in places where one could be potentially exposed to blood or infectious materials.

Hopefully, organizations aren’t allowing blood, urine, or stool specimens at the nursing station, not only because it can lead to contamination, but because it’s simply gross. Employers can make their own rules, and certainly it’s a good idea not to allow open drink containers in areas where a spill would damage electronic equipment or patient records, and people shouldn’t be eating by the computer and dropping crumbs in the keyboards. The reality of healthcare staffing these days is that often people don’t get dedicated meal breaks and sometimes scarfing a granola bar while you’re giving report on patients is the only way you’re going to power through. But when employers decide to put the hammer down, they need to not blame other organizations that have no opinion on the matter.

Speaking of regulations, I’m spending part of this week working on my bucket list. Despite being in a helmet-optional state for the week, I’m glad that my course requires reasonably adequate helmet coverage. I always feel a little squirrely when I participate in activities that have inherent risk since I know that I’m likely the highest trained medical professional available if something goes wrong. I’ll be glad to not have to manage the consequences of failing to protect against head trauma. The weather is looking rather frightful, so I’m hoping for the best.

I ran across a solution today called JustAskEvie. It offers real-time EHR support for clinicians, powered by a network of fellow clinicians who provide peer-to-peer support. Services include coaching on specialty-specific workflows either during a physician’s onboarding process or during their first days using the EHR. Their goal is to be complimentary to the training offered by organizations or as a replacement option for those who might not have been able to attend scheduled training. They also offer go-live and upgrade support as well as after-hours coverage.

The company is hiring “Evies” for a variety of EHRs. I like the idea, but I imagine there might be some challenges when working with organizations who have heavily customized their EHRs. Several physicians who were part of the conversation voiced interest in checking it out as a potential side gig, with two noting that their organization doesn’t offer compensation for those physicians who agree to be super-users or to provide peer-to-peer support. It reminds me of the staffing equation we’re seeing in nursing and elsewhere in healthcare. Rather than pay for in-house resources who know the local system and climate, organizations are willing to give money to a third party to achieve a similar outcome. I understand why it happens, but on some level, it is still baffling.

How does your organization compensate clinician super-users? Or does it expect them to do it out of the goodness of their hearts? Leave a comment or email me.

Email Dr. Jayne.