EPtalk by Dr. Jayne 9/14/23

Updated COVID-19 vaccines should be available soon, following approvals by the US Food and Drug Administration and the Centers for Disease Control and Prevention. They’re recommended for everyone age six months and older, so I anticipate that quite a few IT folks will be scurrying around to add the vaccine to EHRs near and far.

Although many healthcare folks seem to have stopped following the data, hospitalizations have been increasing recently, but might be leveling off. I’ve been traveling and have definitely seen an uptick in masking, with the most recent trip revealing about 5% of passengers and 20% of service workers being masked. The latter are less likely to have paid time off than other categories of workers and are likely to have negative impacts from illness, so it makes sense. Of the people who are masking, most seem to be wearing higher-filtration masks rather than basic surgical masks, and I didn’t see any cloth masks. Of note, two of my recent flights have been less than half full, so it appears the summer travel season is indeed winding down.

As far as masking in healthcare environments, I’ve seen a couple of articles addressing the topic. A recent opinion piece in the Annals of Internal Medicine suggests that healthcare organizations should make decisions that place patient safety first and should consider masking “as part of routine healthcare policies.” They suggest that care delivery sites “should be mindful of continuing areas of uncertainty while integrating the lessons learned into our hospital-based practices to prevent harm to vulnerable patients rather than reverting to suboptimal pre-pandemic behaviors.” I appreciate the fact that they called out the notion that the good old days weren’t necessarily that good in many care locations. In addition to vulnerable patients, there are plenty of vulnerable healthcare workers out there who deserve a safe work environment.

Regardless of the COVID case counts, the reality is that a lot of hospitals and health systems are still stressed. Some of the urgent care centers in my area have been closed for an extended time period due to lack of staffing, and many of my former colleagues have retired or left practice for other pursuits. My hospital colleagues tell me they’re still having staffing issues especially in labor and delivery, and apparently there’s a shortage looming for anesthesia medications, so it might be a bumpy winter.

I visited the local Costco for my flu vaccine this week and it was a seamless process, although I skipped the hot dog and soda combo and instead went for the sample of Kinder Bueno chocolate on the way out the door. There’s also a new vaccine out for Respiratory Syncytial Virus (RSV) intended for pregnant women as a way to protect their newborns, so I anticipate people are updating their EHRs and clinical decision support reminders to promote that one during patient visits as well.

This month’s issue of the Journal of the American Medical Informatics Association features an interesting back and forth about so-called EHR “gag clauses,” in response to a recent article that looked at whether those clauses had negatively impacted the inclusion of screenshots in peer-reviewed literature. Informatics guru Ross Koppel submitted a letter to the editor noting that informatics experts had been pushing for removal of those clauses since 2009. He also mentioned that informaticists may still be living in a climate of fear that vendors will punish them for publishing screenshots, regardless of moves by ONC or anyone else to remove such gag clauses. He concludes by stating, “Ethical vendors should have welcomed feedback about problematic EHR screens, rather than punishing medical informaticists who sought to improve those EHRs by demonstrating their dangers to patient safety.”

The authors of the original article responded to Dr. Koppel, agreeing with his comments but also pointing out that ONC and scientific journals should encourage the inclusion of screenshots in submitted articles and also that such screenshots should be included in safety bulletins and other documents covering EHR issues. They suggest that research needs to be done to understand why screenshots aren’t being included, and one way to do this would be to ask authors whether they’re aware of policy changes that prohibit gag clauses. They conclude by calling out Dr. Koppel’s comment that “…we should all be troubled by EHR vendor actions to prohibit sharing screenshots and that the EHR vendor insistence that the gag clauses are necessary for protecting intellectual property (IP) is meaningless if the IP is protecting poor design.” For those of us who have worked in EHRs that range from suboptimal to downright dangerous, that’s pretty much a mic drop right there.

As medicine has become more complex, the need for patient advocacy has increased. I was surprised to see a recent research letter in JAMA Internal Medicine about the prevalence of industry ties in patient advocacy organizations. The authors looked at the top 50 US patient advocacy organizations (ranked by revenue) and looked at ties between their senior leaders and the pharmaceutical or medical device industries. They found that a whopping 74% had board members or senior leaders with prior or current industry ties, with half of the organizations having conflicts of interest among paid staff or executives.

Although past ties are certainly worrisome, having a current conflict of interest seems particularly concerning. I appreciate the authors’ methodology. They used publicly available data from GuideStar to identify the high-revenue patient advocacy organizations and investigated the LinkedIn profiles of those listed on the organization websites. They also used other readily available sources such as annual reports, public tax documents, personal websites, and publicly posted biographies.

The authors listed some limitations, including “incomplete disclosure of board members, senior paid staff, or executive employment history, as well as the possibility of omissions from website profiles, limited (and likely underestimating) our characterization of industry ties.” Overall, they raise the concern that industry is influencing the advocacy organizations’ positions on patient education, policy making, and treatment guidelines. Definitely something to think about when you’re following the money in the complex web of the healthcare industry.

What do you think about conflicts of interest in patient advocacy organizations? Leave a comment or email me.

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