EPtalk by Dr. Jayne 8/24/23

As a clinical informaticist, a lot of my time is spent thinking about how technology impacts physicians and other users of the systems that care delivery organizations implement. Patient experience is sometimes an afterthought, with organizations doing a variable job taking that into consideration.

However, I’m seeing more and more discussions in the clinical informatics world about how technology is impacting patients. Predictably, there’s a lot of attention on artificial intelligence right now, but I’m starting to see more attention given to the basics – namely screen time among children and adolescents. An article recently published in JAMA Pediatrics looks at the amount of screen time that children are exposed to at one year of age and how it might impact communication and problem solving skills at age 2 and 4.

The study was conducted in Japan and used questionnaires about screen time that were completed by parents of nearly 8,000 pediatric patients. Data showed that children of first-time mothers who were younger, those whose mothers had postpartum depression, and those with lower income and educational levels tended to have higher levels of screen time. The authors concluded that children who were exposed to more than four hours of screen time daily were more likely to have developmental delays. Both areas were delayed at age 2 and 4, and additionally, it was noted that fine motor and personal/social skills were delayed at age 2 but resolved by age 4.

Most of the major EHRs I’ve used have prompts for pediatric providers to deliver anticipatory guidance around screen time when they are conducting well-child visits, but I wonder if we’ll see action from professional organizations that change these recommendations.

From Madison Maiden: “Re: Epic UGM. Judy opened the executive address with her ‘family photo album,’ including pictures of her adventures in Minnesota and Oregon as a young person along with tales of her time swimming, canoeing, and otherwise being outdoors. This year’s theme is ‘Castaway’ and she described the healthcare environment as ‘tumultuous’ and listed hospital closures and reduced access to services as critical issues facing patients. She said that Epic’s headcount is up to 14,000 employees who are in the office full time. Another speaker said that more than 38,000 people were watching the session either in person or via live stream.” That background helps explain some of the décor adjacent to the Deep Space auditorium, where an entire level is devoted to overwhelming woodsiness with the inclusion of camping gear reminiscent of the late 1970s and early 1980s. Other readers chimed in to mention that the “Castaway” theme included homage to “Gilligan’s Island” as well as the Tom Hanks movie of the same title.

CMS is launching a new Electronic Prescribing of Controlled Substances (EPCS) Program Prescriber User Group, tasked with giving input on educational content and the usability of the CMS EPCS Program prescriber portal. The application process is open through August 30 at 8 p.m. ET and those interested should plan to commit approximately 10 hours to the group over the coming year. CMS hopes to have various specialties, practice locations, and prescribing patterns represented, so if you’re interested or know someone who is, please submit.

I’m mentoring some alumni from my medical school who have decided that clinical medicine isn’t for them. One wants to dip their toes into clinical informatics and asked if I would take a look at their LinkedIn profile and provide some feedback. Although their work history and education sections looked great, I advised that they replace the photo with a head shot that wasn’t obviously cropped out of a group pictures. Generally, by the time you reach age 30, especially in the era of the Google Photos Magic Eraser and similar features on the iPhone, one should have a passable head shot that doesn’t have other people’s hands or shoulders in it. I also recommended that they update their headline to remove their realtor credentials if they want to be taken more seriously when applying for informatics positions.

Illinois-based Advocate Aurora Health has settled claims about its use of the Meta Pixel and other web trackers for $12.25 million. The settlement covers multiple claims filed after the health system disclosed a breach affecting more than 3 million patients. The attorneys in the case will receive $4.3 million plus expenses and the class representatives will receive $3,500 each. Patients who join the class and file a claim form will receive a payment from the remaining settlement fund.

Blue Shield of California has partnered with Mark Cuban Cost Plus Drug Company, Amazon Pharmacy, and others in a new model to attempt to transform prescription drug management in the US. The plan hopes to achieve a $500 million annual savings on medications for its 4.8 million members. The initiative, titled Pharmacy Care Reimagined, is supposed to improve transparency as well as lowering costs. Prescription drugs are big business, with large numbers of the population taking multiple prescriptions at any given time. US spending on prescription medications is in the $600 billion range, with an average of $1,500 per patient per year. When I was in a traditional family medicine practice, it was a constant battle to try to convince patients that low-cost generic medications were as good if not better than flashy newer drugs with equally flashy price tags.

This particular effort hopes to remove some of the non-value-added links found in the typical pharmacy supply chain, where more than a dozen entities can be part of the process. It looks to reduce the players to five, including pharmacy, specialty pharmacy, benefits management, payer, and complex care management entities. I’ve only tangentially followed Mark Cuban’s entry into the pharmacy world, but I did enjoy a recent Fireside conversation between him and negotiation expert Chris Voss. When asked what he sees that kills time and brain power, Cuban said, “Meetings, meetings, meetings, meetings, meetings, meetings, meetings, meetings.” He went on to say, “People over-meet and over-call … You kill so much time. I try to only do meetings if I have to come to a conclusion or there’s no other way. Same with phone calls. Every meeting is, ‘Who got the donuts? What do you got going on? How are the kids?’ If it were up to me, if I had to have a meeting – and I tried this early on in my career, and I wasn’t established enough to get away with it – I’d take away all the chairs from the meeting room. It’s amazing how quickly meetings get over with if no one has a chair or some place to sit.”

I once worked for a development organization that did some amazing standup meetings and produced quality products at a breakneck pace, so I’m on board with that philosophy. They also brought in a dedicated management consultant to do a quick hit project to simplify their meeting structure, so maybe they were more forwarding thinking than I might have thought at the time.

What are your thoughts about reducing drug costs in the US? Can Blue Shield of California and Mark Cuban get it done? Leave a comment or email me.

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