EPtalk by Dr. Jayne 6/8/23

When I certified, one of the major components of the clinical informatics board exam curriculum was public health informatics. As a family physician, I understand the value of public health, and especially after the pandemic, most of us understand how underfunded it is in the US.

Various studies show that a dollar spent on public health has the power to reduce future healthcare spending by anywhere from $11 to $80 depending on the nature of the intervention, yet it’s still not where we prioritize our spending. The reality is that prevention isn’t sexy and doesn’t make money for the people who pay for lobbying, but a girl can hope that eventually policies will shift in a way that makes better funding a reality. A recent article in the American Journal of Public Health looked at the US life expectancy compared to that of other nations over the better part of the last century.

The author found that the US life expectancy began falling in the 1950s and continued to worsen over the last four decades. He also noted regional variation across different parts of the US, finding that the Midwest and south-central states fared worse than other regions. Almost a third of the US states have 60% or fewer of their children vaccinated, and that’s a basic public health intervention that is proven to save lives and reduce days missed at work and school. When people don’t see the value in that, it’s hard to get them on board with funding more “exotic” interventions like community gardens, food pantries, nutrition and cooking classes, and healthy environments for exercise and community activities.

As a clinician, it’s difficult to watch the decisions that health systems continue to make as they prioritize high-earning surgical subspecialties and cutting-edge interventions while they refuse to fund staff expansions in primary care. I’d love to see more research looking at the long-term cost savings and quality of life improvements when preventive care is prioritized.

I had that on my mind when I came across an article about how Regenstrief Institute is working with the National Association for Chronic Disease Directors on a project that will use EHR data to estimate chronic disease burdens at the national and local levels. I wasn’t aware that there was a project in the works for a Multi-State EHR-Based Network for Disease Surveillance (MENDS) or that local public health organizations will be able to tap into it.

The goal is for the EHR-derived data to replace more manual efforts, such as health department workers having to canvas at the community level. There are barriers to the data sharing, however, including the lack of a mandate for hospitals and provider organizations to share their data with public health agencies. Other potential issues include lack of accuracy in diagnosis coding and lack of staffing at public health agencies.

The Office of the National Coordinator for Health IT is looking for feedback on expanding the US Core Data for Interoperability classes and elements. The list of data elements was expanded to better reflect the clinical quality measures that are in use with Centers for Medicare & Medicaid Services quality reporting programs and also to incorporate greater use of FHIR-based reporting. The draft list of data elements for USCDI Version 4 will be open for public comment until June 30.

I had the chance to help a colleague out today when they were working on a specific formatting issue for a scholarly work. It’s been a long time since I’ve published anything, and as I was digging into the details, I was impressed by the number of resources available on the internet. Back in the day when I was a regular on the presentation circuit, you had to have a stack of reference manuals to make sure you got everything right before submitting your paper, which had to be sent in a box since it was typed, double spaced, and printed with multiple copies. As we think about standards in healthcare and standards in the digital universe, it’s intriguing to remember that some of the first usability standards were set for written scholarly works. When papers were all written with the same stylistic features, it made it easier to understand the content and less likely for the reader to have to wade through a confusing format. Usability principles have evolved over time, but still adhere to a common core of thinking, and it was nice to be pulled in as an “expert” on the topic.

I’ve been back on the road recently and summer travel is in full swing. Unfortunately, I started today’s leg of the trip at an airport that decided it would be good to shut down 50% of the women’s restrooms for maintenance at a time when they had 20 arrivals and departures in the hour surrounding my flight. Needless to say, it created some bottlenecks.

I always wonder if people exhibit the behaviors that I see in the airport during their “regular” lives. At least where I live, I never see people ordering hard liquor with their breakfast, but you see it a lot at the airport. In the boarding line today, I had two guys behind me chugging beers after they had been told they couldn’t take them down the jetway. There was also a group of high schoolers, the majority of whom had full-size bed blankets for their trip and were juggling all their gear while trying to figure out how to repack to try to get it all on board. I felt bad for their chaperone, who had largely lost control of the group. I’ve chaperoned groups of teens before and we always had strict rules about what they could bring or not bring so that we could avoid issues at the gate like I saw today.

On the plane, one of the students in front of me spent the majority of the flight kneeling backwards in her seat, talking to the person in the row next to me. Their chaperone, who was in the same row, just ignored it. Although it was annoying, I remember what it was like to be a teenager, so I decided to just tune it out. There have been so many changes to the typical US teen experience during the last couple of years that this might the only trip these kids have taken (or might ever take), and it’s good to see schools who are encouraging their students to see the world. I also learned today that you can’t take a bowling ball through the TSA checkpoint at this particular airport even though the TSA app says it’s permitted.

What’s the most interesting thing you’ve seen during travel this year? Leave a comment or email me.

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