EPtalk by Dr. Jayne 12/29/22

I’m pleased to report that I made it through the usual family holiday events with a minimum of drama and no outbursts from unruly drunken relatives.

Unfortunately, I just received my first “hey, I’m positive for COVID” text message, so we’ll have to see if there are more on the way. That particular family gathering had way too many people in a small space and too many adolescents who were constantly wrestling around with each other and then going back to the food table, so I’ll be crossing my fingers that everyone else stays healthy. I’ve got a fat stack of COVID tests ready for whatever symptoms make an appearance at my house.

There are a lot of providers ordering expensive respiratory testing panels to try to sort out Influenza from RSV from COVID, but unfortunately in many cases, knowing what specific virus is present doesn’t change the management plan for the patient. Running the test increasees overall healthcare costs and increase the anxiety for patients who “just want to know what virus it is.” There are so many viruses beyond the big three that are running rampant now. Many of us in the trenches refer to them in aggregate as “the crud” and keep advising patients on pushing fluids, rest, and symptomatic treatments.

Apple is being sued over the potential that the Apple Watch’s blood oxygen reader is ineffective on people of color. The class action claim was filed in New York and bases its merit on known issues with pulse oximetry technology, even though it’s unclear whether the Apple devices use the same technology as other devices that are increasingly coming under scrutiny. The suit seeks a jury trial and alleges violation of New York state law as well as a federal law regarding deceptive business practices.

The US Food and Drug Administration (FDA) placed pulse oximetry technology under review back in February of 2021, after studies found that the devices display higher oxygen readings when used on individuals with darker skin tones. Although there were questions about accuracy prior to the pandemic, the pandemic caused rapid expansion in the use of the devices in homes and other settings, which may have magnified the issue. An update by the FDA was issued last month following a virtual public meeting.  When patients have high readings that don’t reflect their actual state of oxygenation, they might not receive oxygen or other treatments that could improve their condition. The problem is believed to affect devices used by medical professionals as well as consumer-facing devices.

Speaking of consumer-focused offerings, many healthcare organizations are seeing the expected surges in requests for on-demand telehealth visits following family gatherings. Based on my experience as a telehealth physician, there are still a number of people who struggle with completing telehealth visits. Sometimes there are glitches with software and video connectivity, sometimes the patient doesn’t answer when the telehealth platform calls the patient to start the appointment, and sometimes patients are multitasking and not paying attention to the visit or the clinician trying to help them. A recent study published in JAMA Network Open looked at whether implementation of a telehealth navigator program would help improve the number of successful video visits.

The program, established at Beth Israel Deaconess Medical Center, was built around scheduled video visits. The navigator was tasked with contacting the patient a day prior to the visit to offer technical support, answer frequently asked questions, and to walk through the steps required for a successful connection. The three-month pilot ran from April 19 to July 9, 2021 in primary care and gerontology clinics. Researchers looked at over 4,000 adult patient visits. Approximately 25% connected with a telehealth navigator prior to the visit. Successful video visits were present in 92% of navigator-enabled visits but only 83% of the non-navigator control group. The cancellation rate was 6% in the navigator group and 9% in the control group. The rate of missed appointments was 2.5% for the navigator group and 8% for the control group. Overall, the navigator group had a 21% increase in successful video visits compared to the control group. In addition to providing greater care for patients, the increased volumes of the navigator group resulted in higher revenues, with a return on investment greater than the navigator’s salary.

Although this specific approach is best applied to scheduled visits, I’ve seen navigators used during on-demand visits too. Some organizations are using medical assistants to virtually “room” patients, gathering and entering the patient’s chief complaint, vital signs, and medical history data elements. One system I worked with that employed this approach reported greater patient satisfaction but some frustration on the physicians’ part if they had downtime between visits while the patient was still working with the medical assistant. Keeping a physician on schedule and reducing patient wait times is challenging whether you’re seeing patients in person or virtually. I’m looking forward to seeing more studies that help identify the best practice approach and whether organizations will adopt flows that have been successful elsewhere or whether they will continue to reinvent the wheel.

Although most of my clinical reading revolves around surging viruses, preventive care, and strategies for better conducting telehealth visits, sometimes it’s nice to come across an article that covers a completely different aspect of medicine. A recent study published in JAMA Internal Medicine illustrates the relationship between major motorcycle rallies and organ donation. The authors estimated 21% more organ donors and 26% more transplant recipients per rally day compared with the four weeks before and after rallies. An accompanying editorial calls on organizations that are associated with high-risk sports to encourage members to consider organ donation.

Looking at the donor demographics, 71% were male and the mean age was 33 years. Recipients were 64% male with a mean age of 49. The most common organ transplants were kidney, liver, heart, and lungs. The authors looked at data from seven major rallies, including the Atlantic Beach Bikefest (SC), the Bikes, Blues, & BBQ (AR), Daytona Bike Week (FL), Laconia Motorcycle Week (NH), Myrtle Beach Bike Week Spring Rally (SC), the Republic of Texas Biker Rally, and the Sturgis Motorcycle Rally (SD). Needless to say, they did not include data from the Cushman Club of America’s 2018 rally in Sturgis, where the riders were generally low speed as well as low key. Here’s a shout-out to my favorite Cushman rider for teaching me what I know about having fun on two wheels.

Are you an organ donor? Have you discussed your wishes with your family? Leave a comment or email me.

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