EPtalk by Dr. Jayne 5/19/22

A friend clued me in to an article about the state of patients’ ability to schedule their own healthcare visits. It points out all the industries that have migrated from scheduling via human interaction to scheduling online: airlines, restaurants, and fitness programs are examples. The authors note that some demographic groups want to avoid making phone calls “like the plague” and go further to comment that “there’s no better way to forcibly eject younger generations from your onboarding and acquisition process than by putting them on hold.”

The article provides a great summary of the difficulties in allowing direct scheduling, including pre-visit requirements, insurance requirements, and varying lengths of appointment slots. For some specialties, there’s also the risk of rescheduled or bumped appointments due to emergencies or operating room delays. They dig into issues around physician preferences and control as well.

When I worked on my first EHR implementation, it also involved conversion of the practice management system. We reviewed well over 1,000 different appointment types that physicians had demanded over the years and winnowed them down to about 70. We analyzed past performance and found that the physicians who had the most rigid scheduling rules often had unused appointment slots, while those with more flexible “open access” schedules had more consistent use of their schedules.

It’s difficult to wrest control away from physicians who have little business training and who aren’t encouraged to challenge the status quo. It’s even more challenging when their office staff members have developed a culture of shielding the providers from change.

I’ve found that practices can benefit even if they only allow a small subset of visits to be directly scheduled, such as allowing only well visits, since they tend to have longer time slots, or same-day sick visits, which would be shorter time slots that are sometimes worked in to the schedule. One of my personal physician offices allows only same-day sick visits to be scheduled via the patient portal, and they are usually gone by 9 a.m. As long as the technology lift isn’t too heavy, sometimes even a small benefit can give both staff and patients a bit of a morale boost. If your office hasn’t considered making the change, I would strongly recommend starting to dig into the pros and cons.

Speaking of shaking things up: CNBC has published its 2022 Disruptor 50 list, which includes a number of health technology companies that I’ve followed over the years including Medable (distributed clinical trials), TruePill (virtual pharmacy), Maven Clinic (virtual women’s health), Ro (virtual pharmacy and diagnosics), and Oura (wearable ring for fitness data). My favorite addition to the list is Biobot Analytics which uses wastewater to detect disease. In an era where people can skew population health data by specifically opting out of testing, that might be the best way to go in order to determine where the COVID-19 pandemic is going.

Telehealth startup Cerebral has lost its CEO with the departure of Kyle Robertson. The company has been under scrutiny for some time, but experienced increased criticism around its prescribing processes in recent weeks. Cerebral is accused of excessively prescribing stimulant medications such as Adderall. It has received a grand jury subpoena from the US Attorney’s Office for the Eastern District of New York as it investigates possible violations of the Controlled Substances Act. Cerebral has stated it would largely stop prescribing controlled substances, which is likely to create some interesting care-seeking patterns in the brick and mortar world as patients have their refills curtailed.

The changes occurred following a board meeting which included other leadership changes. President and Chief Medical Officer David Mou will take over, COO Jessica Muse will become president, and clinical advisor Thomas Insel will join the board. Cerebral has tried to recruit me as a provider several times, and the way they conduct their recruiting gave me the heebie jeebies as it felt like they were basically trying to rent my license so that they could generate as many prescriptions as possible.

I always enjoy hearing about different EHR vendors and their client conferences. A regular reader clued me in that CPSI is holding its National Client Conference in St. Louis this week. The conference schedule has a number of interesting offerings and wrapped early enough in the evenings for attendees to take advantage of the city’s food scene, including Italian, Vietnamese, and Bosnian offerings. The customer appreciation event featured the Anheuser-Busch Brewery Experience, complete with brewery tours, a biergarten, and of course the Budweiser Clydesdales. Sounds to me like a great way to cap off a conference.

Other things I enjoy hearing about: the intersection of science with one of my favorite treats. The American Institute of Physics journal Physics of Fluids recently explored Oreology, which it defined as “the fracture and flow of milk’s favorite cookie.” Researchers looked at the failure mechanics involved in twisting an Oreo apart, including the variables of filling amount, rotation rate, and flavor. They assessed a stress-strain curve as well as “postmortem crème distribution” that was typically unequal. Researchers went as far as creating an “open-source, three-dimensionally printed Oreometer powered by rubber bands and coins” in order to encourage “higher precision home studies to contribute to new discoveries.”

Little did I know that Oreo filling could be characterized as having “complex or non-Newtonian viscosity” or the many ways in which science impacts the processing of different foods – from using fractional calculus models to evaluate cheese structure to using physics to improve chocolate quality. Although sections of the paper seemed to be bordering on sarcasm, I thoroughly enjoyed reading it and look forward to discussing it with my favorite physics students when I see them over their summer break. The authors note the need for further research on other varieties of sandwich cookies, custard creams, macarons, and ice cream sandwiches, although I’m particularly intrigued by their mention of the physics of Nutter Butters since they were a special childhood treat.

What’s your favorite variety of Oreo? Leave a comment or email me.

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