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EPtalk by Dr. Jayne 5/5/22

May 5, 2022 Dr. Jayne 12 Comments

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Those that follow me on Twitter know what I’ve been doing this week as I traveled to the rolling hillsides of Verona, Wisconsin. Epic’s Expert User Group (XGM) meeting was in its second week, with a heavy focus on clinical topics. It was great to catch up with some old friends, most of whom I worked with on other EHR systems across the last two decades. Each hospital and health system has certainly had its own healthcare technology journey, but it’s clear that for quite a few of them, all roads have led to Epic.

I’ve attended a variety of user groups across most of the major vendors and there are quite a few elements that set Epic apart as far as meetings. Rather than having to rely on hotels or conference and convention centers for meeting space, Epic’s purpose-built facility makes things incredibly easy for attendees. Presentation rooms are interestingly named, amusingly decorated, and full of light – unlike the cavernous spaces divided by portable walls that many of us are used to when we go to meetings. The meeting area also featured booths from various local vendors selling various kinds of cheeses, chocolates, locally produced soaps, and more. I enjoyed seeing everything Wisconsin has to offer and from the number of sales transactions, it appears others did as well.

Another thing that sets Epic apart is its outstanding culinary team. I’ve had plenty of questionable meals at conferences, but the menu selections at XGM were truly over the top. There’s a definite “farm-to-table” feel with lots of healthy offerings. Goat cheese and asparagus options appeared at several meals, which made me very happy, as I like them but don’t often cook them. Attendees were even able to download a 95-page document with recipes in the event they wanted to replicate the experience at home. I’ll definitely be availing myself of the recipe for scones.

Many attendees toured the campus, although rain on Tuesday put a small dent in that. It’s been great meeting other physicians involved in clinical informatics work, especially in disciplines that I haven’t worked in for a while. I enjoyed learning about different groups’ approaches to trauma-informed care and how to use EHR tools to better support patients. One of my favorite presentations was by UCLA Health, which has been using Natural Language Processing to identify patient portal messages that contain high-risk topics. It allows clinical care teams to address those messages more quickly, which hopefully will lead to improved outcomes. The team acknowledged the impact that the COVID pandemic has had on its work, and I know there was a lot of sympathy from audience members whose own projects may have been sidetracked or even canceled as a result of changes in organizational priorities.

It’s always a challenge to balance what’s going on at your day job with attending a conference, and I had a couple of conversations with physician informaticists who were reacting to the idea of a Supreme Court decision overturning Roe v. Wade. My OB/GYN colleagues are noting increased patient demand for appointments to place long-acting contraceptive devices as well as those to discuss prescriptions for emergency contraceptive medications. With several states having laws in place that would go into effect immediately upon the event of an overturn, I understand their desire to be proactive. There have been requests to alter physician schedules to add procedure slots as well as to create outbound patient portal messaging to try to reduce the number of phone calls the offices are receiving. Life as a clinical informaticist is certainly never dull.

The COVID-19 pandemic changed the landscape for virtual contraceptive services, which were offered by the majority of clinics surveyed for a recent article. Pre-pandemic, only 11% of those surveyed offered telehealth consultations for contraception, with the number rising to 79% after March 2020. Apparently, 22% of those surveyed had drive-through contraceptive clinics. Although I don’t recall hearing about any of those in my area, it’s a great idea. I found it interesting that 20% of people closed their in-person clinics and only offered services via telehealth. The study had a relatively small sample size of around 900 respondents. It will be interesting to see what happens to this landscape in coming months.

In speaking with other attendees, behavioral health continues to be a hot topic. There are too few providers to meet demand and organizations are looking to creative offerings such as teletherapy and self-service interventions for patients. Staffing challenges were also a common theme, and organizations are looking to use pre-visit questionnaires to help gather data prior to the visit so that the patient rooming process is more efficient. Automated alerts to let patients know when their care teams were running late are gaining traction. Many of the solutions presented by clients focused on shifting various tasks from the staff to patients. Although those moves can definitely support patient engagement, they’re also ways to help mitigate staff burnout. Many organizations are still struggling to hire office-based nurses, medical assistants, care coordinators, and patient care technicians, so they’re looking for whatever efficiency boosts they can find. It sounds like there are a lot of optimization projects going on, with hospitals trying to fit that work in before a potential next pandemic wave.

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On Wednesday, which happened to also be Star Wars Day, a couple of presenters included Star Wars references in their slide decks, and I spotted several attendees in costume. I closed out my meeting experience with a trip to “Xtra Hour,” which was advertised as a social event for food and fun at the end of the day. The event featured a variety of food and drink, including a lovely crab and leek appetizer and sparkly galactic-themed lemonade. I heard the mini cupcakes were good as well as the mini meringue desserts. Attendees had the chance to take part in several activities including craft projects and giveaways, and of course there was plenty of good old-fashioned socializing. Then it was back to the hotel to put my feet up and to pack so I can head home in the morning. Overall, it was a great experience and I’m heading back with a notebook full of ideas and thoughts to make life better for my end users and their patients. I was also happy to be able to have in-person encounters with many of the people I work with regularly. Building relationships is always one of my favorite parts of these events.

What is your favorite part of a user group meeting? Leave a comment or email me.

Email Dr. Jayne.



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Currently there are "12 comments" on this Article:

  1. Forgive my ignorance, but who foots the bill for the room and board here? Sounds like a review of the country club in the old days when drug reps hosted docs for a CME event. And we wonder why health care is expensive. . .

  2. Oh to have those margins paid for by government funded hospitals (all of them!!) that enable you to build 9,000 seater underground conference rooms….what wise ways we have spent out HC dollars! Glad you had fun Jayne!

    • EHRs are not the reason why something like an MRI can cause 4x as much in the United States as in other developed countries. These takes are always intellectually lazy reactions. You realize Epic has many customers in countries with much cheaper healthcare, right?

      As a patient, I will prefer health systems that use Epic simply because I know it’s the best product on the market, and the vast majority of care facilities in my region are connected through Care Everywhere which makes record exchange very simple. You can go to the place that uses the EHR put together by a cubicle farm in India. Please, be my guest. I’m sure it will be fine.

      • You’re right that Epic Systems Corporation has never charged anyone for an MRI. They do sell a competitive club that large sellers of healthcare use to beat small sellers of healthcare into extinction. I think that makes them at least complicit in high healthcare prices which largely hurt already disadvantaged people. Since Epic uses their outsized power within the system to make money, they’re more culpable than the Verona Tesla dealership or a medical assistant at a customer.

        I buy that line of thinking and made sure my next employer aligned with it. I know some others in tech do, like Google employees not selling to the military. It’s harder to see that when they write your checks and maybe employees at Epic feel they aren’t in a position to make a difference. But theres a lot of nice cars in the parking lot. That’s before we even get into the Union busting and tone deafness on equity issues.

        • There are many, many, many valid criticisms of Epic that you allude to. “Epic’s nice campus is the reason we spend more of our GDP on healthcare than any other developed country” is not one of the valid criticisms.

          • Total US healthcare spend in 2020: $4,100,000,000,000 (4.1 trillion)
            Estimated Epic annual revenue in 2021: $4,000,000,000 (4 billion)

            That is 0.093%.

            CMS report on overall healthcare spend in the US doesn’t even break down any category of spend below 1% (DME at 54.9 billion dollars). But sure, Epic’s XGM is the reason why your hospital/PBM/Pharmacy/freestanding ER/PE owned ambulance service fleecing you.

          • I’d argue that .093% has had a pretty high ROI compared with the other 99.907%

        • I have some sympathy for concerns you bring up about giving red meat to the biggest, meanest consolidators on the block.

          That said, what’s the alternative? As Elizabeth H H Holmes noted, which vendor would you back to both fight for fixing the system AND supply you with a high quality EHR?

          Purity tests in the wrong context are immensely problematic. It’s fine to say “If only Epic would fight the current at risk of losing business from megacorp clients”, but it feels a bit wrong when I read a comment that seems to throw Epic employees under the bus by having nice cars. Do we want to talk about Cerner gouging the DoD/VA for a nonfunctional platform, eCW for their kickbacks, etc? Complaining about a nice trim on a Subaru Legacy feels a bit disingenuous in that light, in my opinion.

          • At the point of big health system makes EHR purchasing decision, there’s not much to be done. There’s tons of other leverage Epic has. They have their lobbying people, they make product decisions (invest in community connect vs a workable product for standalone community hospitals), they define industry standards and effectively make decisions for their customers about data accessibility. In the day to day, there’s doable features their existing customers have been asking about for the better part of a decade that Epic won’t spend the money on, opting instead to invest in add-on products to cut smaller point vendors out of the market. The bar is set low in HIT; even if Epic went about crushing their competitors in a different way they could move mountains for the peoples benefit.

            As someone in their 30s mid career, I’m not trying to shame the new grad in their first year at Epic. For anybody, it’s good to pick your head up every couple years and take a clear eyed look to see if what your employer is accomplishing with your efforts aligns with your values. Epic spends a lot of time shaping the moral idea of what they’re doing; it may be the only workplace where the all hands meetings have organ music and sermons. It’s easy to take their idea as gospel, especially when they have nice campus, food, checks, etc.

        • Have you looked at the balance sheet of any of the hospitals? Do you even know what their biggest cost is? Surprise – it is salaries. One of the main reasons why healthcare is so expensive in United States, is what they pay to doctors. If you don’t believe me, check out glassdoor for physician salaries in various countries.

          Dr. Jayne – there is an old proverb – those who live in glass houses, shouldn’t throw stones.

  3. Everyone has a very myopic view on why healthcare is so expensive in the United States, including me.

    I believe we all know there needs to be reform in the delivery of our healthcare but how we go about it is debatable.

    The changes cannot be directed solely at the hospitals and providers. Reform needs to include the payors. Not to mention FDA reform. While we are at it, tort reform needs to be included as well. And, what about welfare reform? Behavioral Health is finally getting attention, and that may help locally with so many other social issues.

    To me, most important factor in healthcare reform is the patient. How do we address patient compliance? How many of the top CMS diagnosis are results of lifestyle versus genetics? A change in patient habits can have a positive effect on their health – often without the need for drugs. Will we ever hold the patient accountable? That’s a tough issue to address. Just a few of my thoughts on how patients need to take ownership of their health.

    Here are the top chronic conditions according to google, attributed to CMS, how many are a result of lifestyles?
    High blood pressure (58%)
    High cholesterol (45%)
    Heart disease (31%)
    Arthritis (29%)
    Diabetes (28%)

    See, reducing healthcare costs in the US is not as easy as eliminating 10,000 seat theaters and paying doctors less money. I am sure there many other areas that need to be addressed (food supply, reduction of middlemen in supply chain that add no value, etc…).

    Too much of our economy is reliant on the costs of healthcare. Are any one of us willing to take less money or eliminate our role within this ecosystem? The collective “we” make way too much betting on the poor health of our country.

    I have no clinical background and do not work within the healthcare system. I work with a company that has a small stake in healthcare. But, I am a taxpayer helping to fund this chaotic mess.

    This is a long rant and I am sure I have managed to piss off almost every subscriber, sponsor, and even Mr Histalk himself. For the last, I apologize.







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