EPtalk by Dr. Jayne 12/22/22

Home health is a hot topic for many healthcare organizations as they look to maintain control over all aspects of the patient care continuum. Some are trying to maximize the use of technology to not only better serve their patients, but to help solidify an ongoing relationship.

They may be using platforms which are extensions of their EHR, such as an integrated patient portal. They may be using third-party solutions such as chatbots or other add-ons. A recent report from the Office of the Inspector General (OIG) of the Department of Health and Human Services looked at how home health agencies responded to the challenges of the COVID-19 pandemic.

Like most care delivery organizations, home health agencies struggled with staffing during the pandemic, and those challenges haven’t been resolved. Their use of telehealth has expanded, particularly due to flexibilities granted by the Centers for Medicare & Medicaid Services (CMS). For the report, OIG surveyed a sample of 400 home health agencies, nearly all of which participated in Medicare. They did more in-depth interviews with 12 agencies, and also interviewed staff at CMS about their perspectives on home health during the pandemic.

In addition to staffing challenges, OIG found that infection control was a major concern. The survey found that various incentives were useful to help retain staff, including offering paid leave. Staffing challenges were also mitigated by updates to regulations that allowed an expanded set of provider types to perform some patient assessments, and to order home health services.

The addition of telehealth provided a boost to many organizations. The report recommended that CMS further evaluate how telehealth fits into the overall home health landscape and better understand the types of patients who benefit from those services. It will be interesting to see what happens with the proposed extension of telehealth flexibilities and whether other solutions such as chatbots or automated patient engagement will bring the results that agencies hope for. From an employee perspective, it would be great if organizations continued to look at people and process solutions as well, including better compensation for home health workers and expanded benefits such as paid leave.

Speaking of paid leave, the virtual physician lounge was buzzing this week with discussions about whether physicians should work while sick. One physician colleague was describing how she was at work with a fever and chills but avoided testing herself for influenza because she didn’t feel she could go home if her test was positive. She figured that since she was wearing an N-95 respirator the risk of exposure to patients was low.

It’s a sad situation when a physician has to choose between feeling like they’re letting their patients down and burdening their colleagues or taking care of themselves. A recent Medscape article looked at this phenomenon. They polled physicians and found that 85% have come to work sick during 2022, with most coming to work sick on multiple different occasions. Nearly a third have worked with a fever and 7% have worked with both strep throat and COVID.

Concerns about inconveniencing patients were at the top of the list for reasons to work sick, along with concerns about staffing and revenue. A whopping 76% of physicians stated that that going to work sick was expected in their workplace, with 58% saying there wasn’t a clear policy about coming to work while ill.

At one of my previous employers, which had a fairly toxic culture, providers would routinely receive IV fluids on the job so they could keep working. I know that if I was sick enough to require fluids, I don’t think my mind would be as sharp as it should be to safely care for patients.

There is also the issue of informed consent for patients. They should be aware that they are being asked to see a provider who is not 100% or who may have a communicable disease, but my employer never provided that information to patients. Providers who did this often bragged about it on the company’s internal social media platform, and it certainly wasn’t discouraged by management. Unfortunately, I don’t see improvement on the horizon for the issue of working while sick. The realities of short staffing and coercion by leadership make it a near certainty.

I was horrified this week to learn about Google’s efforts to secure access to a collection of pathology samples from veterans of the US armed forces. The situation dates back to 2016, when Google had the idea to turn the Joint Pathology Center’s collection of pathology slides into an exclusive digital archive featuring Google’s AI technology. Staffers at the Department of Defense have appropriately identified the ethical concerns around this process, since the service members in question most certainly didn’t consent to having their medical specimens used by a private organization.

The collection contains more than 31 million blocks of human tissue and 55 million slides, dating back decades. (For reference, many healthcare organizations only maintain their specimens for 10 years.) The collection has been tapped to determine the genetic sequence of the 1918 Influenza virus and contains samples of significantly rare diseases.

Discussions about Google’s use of the samples have had their ups and downs, with Google lobbying legislators for greater access to the collection. Google’s various proposals would have resulted in giving access to the coveted resources without a competitive bid, which raised red flags. Other scientists balked at the information requested by Google – including diagnoses, images, gender and ethnicity information, birth dates, and death dates – that could allow identification of supposedly de-identified samples. Google also demanded exclusivity, as well as payments from the government to store and access the information. The ProPublica article notes the similarities between the use of military specimens without permission and the situation of Henrietta Lacks, whose cells were used without permission for research and commercial endeavors.

The rest of the article is a good read, with plenty of intrigue, undue influence, sketchy job offers, and whining when Google wasn’t selected during an open bid process. Google even went as far as claiming it as a matter of national security that they be allowed to be part of the process. Google-funded lobbyists continue to try to influence the process, leading the pathology repository’s team to craft a publicity campaign to call attention to the situation and its ethical concerns. There’s even mention of a Shakespearean plot at the end. If you’ve got downtime during the holiday season, I would recommend reading through it. I thought it was a fascinating commentary on how technology companies are weaving themselves into parts of our world we never even think about.

What do you think about Google obtaining exclusive access to sensitive information and pathology specimens belonging to members of the US armed forces? Leave a comment or email me.

Email Dr. Jayne.