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EPtalk by Dr. Jayne 10/5/23

October 5, 2023 Dr. Jayne 3 Comments

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Registration is open and agendas have been published for the 2023 ONC Annual Meeting, to be held December 14-15 in Washington, DC. Hot topics include artificial intelligence in healthcare, public health standards, policymaking, and of course information blocking. Mainstage sessions will be livestreamed on HealthIT.gov, but breakouts and other sessions will be in-person only.

I’ve never been to an ONC annual meeting, but it looks like there will be some good sessions covering racial bias in health care artificial intelligence. Given the fact that my state recently gave up some federal money because of antiquated public health systems, I’m particularly interested in the Thursday session on “Public Health Data Modernization at the Local, State, and Federal Level.”

The conference is free and the room block rate for hotel accommodation is $188 per night, which isn’t terrible compared to other venues, but be sure to budget an extra $55 per night for parking if you’re driving in. My conference budget this year doesn’t permit me to go, but if anyone wants to send me the scoop from that public health session, I’d be eager to hear what strategies are discussed.

I visited a family member in the hospital recently and took a moment to reflect on how much the technology in the patient rooms has improved since I was a trainee at the same institution. The chart carts and racks have given way to ergonomic workstations in each patient room. The IV pumps have become smarter and more connected, and the in-room patient education is a vast improvement from the crummy printouts we used to give to patients on the day of discharge. It made me think about whether any of our current technologies will still be in service in the future.

I was musing about this with a fellow astronomy and space afficionado, who mentioned an event that took place with the Voyager 2 spacecraft earlier this summer. Apparently it’s still alive and kicking at the tender age of 46 years, although it had gone quiet for a bit. Like parents who have to yell at teenagers from across the house, NASA engineers sent an interstellar “shout” across 12 billion miles of space to get Voyager to turn its antenna back toward Earth. The idea of a piece of equipment from that era still functioning today is pretty impressive. It will be interesting to see which healthcare technologies stand the test of time.

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Planning for the American Medical Informatics Association AMIA 2024 Clinical Informatics Conference is underway, and its Scientific Program Committee leadership is seeking interest from those interested in joining the Committee. Members will review submissions and help define the content of the conference. Submissions are being accepted through October 13.

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One of the hot topics around the virtual physician water cooler this week was the entry of Costco into the world of telehealth. Essentially, the retail giant is partnering with Sesame to offer discounted virtual primary care and mental health services. Even though I’m not in a traditional primary care practice anymore, I struggle with the transactional nature of some of these offerings, Amazon’s most recent one included. Use of on-demand services like this can fragment care, and I’ve experienced how hard it can be it from the telehealth provider side.

One venture capital leader hit the nail on the head: “From what I can tell, neither Sesame nor Costco have ambitions around a longitudinal relationship with the patient, and definitely no intentions of assuming risk, as it’s a cash pay offering. This is really a story around convenience and incremental growth.” Most patients probably don’t understand this, however. Certainly few of the ones who flocked to the independent urgent care where I worked understood what it means to get care from a third-party provider who doesn’t have access to your records. For the most part, they assumed that all doctors are connected and that I would know everything about them. Magnify that by patients chasing the cheapest visit and moving from provider to provider and it’s going to get messy.

From Off the Grid: “Re: remote work. I enjoyed your recent Curbside Consult on the topic, especially with the true stories from the trenches. I’ve also worked at companies that have handled this well, and also at those who are doing it badly. It seems like a lot of new leaders forget that companies have done this for years and have done it successfully. Check out this article on managing remote teams. I think it has good advice for newbies who are struggling to navigate these waters, which are less uncharted than they think.” The piece has a lot of good advice, including how to make sure that remote teams don’t experience burnout through having regular conversations about how people are doing but “without a string of action items.” It also discusses the need to have clear goals and objectives. I would add that those goals should be set not by management in a top-down fashion, but collaboratively. I still run across leaders that don’t understand how to create reasonable and/or achievable goals, and instead saddle their teams with either shifting targets or ones that simply cannot be accomplished.

I particularly like the article’s advice to “use technology, but wisely,” especially when it discusses communication hierarchies. Some of the most productive teams I have worked with have clear communication matrix documents that explain what should be communicated, by what means, and to whom. This avoids spamming or interrupting people who don’t need to be party to an issue and making sure that items that need attention get the focus they deserve.

My favorite self-organizing team had guidelines around how to communicate based on time sensitivity. For example, anything that needed attention in fewer than three business days required a phone call. Otherwise, an email could be sent, but with the assumption that the recipient had three business days to handle it.

In hindsight, that was luxurious compared to the noisy world of texts, Slack, Teams, various other messenger apps, and general chaos that I live in with my consulting clients. For groups using Slack, Teams, or similar platforms, encourage people to set their status accordingly so people don’t think they’re available when they’re actually busy with someone else and not checking messages. And for those organizations that expect people to be instantly available at all times – good luck, because if you think your teams aren’t using mouse jigglers or other strategies to look active, you’re deluding yourself.

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Speaking of remote work, I’m currently on a project that involves mostly heads down work and very few meetings, so I’m taking advantage of the opportunity to do some travel with a friend. For the next few weeks, we’ll be seeing the USA in our Chevrolet, so here’s your “Where in the world is Dr. Jayne?” moment for the week.

What’s the most unusual roadside attraction you’ve visited? Leave a comment or email me.

Email Dr. Jayne.



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Currently there are "3 comments" on this Article:

    • Primary Care started getting fractionated 20+ years ago with the paradigm shift from “my doctor” to “my doctor’s practice.” There was a day when your GP held the spreader during your cholecystectomy. Now the Hospitalist replaces the primary care following you into the hospital. Your personal doc is replaced by the staff available that day. Off to the Urgent Care if you need a visit on short notice. Now telemedicine, which was fueled by the pandemic. So from a patient’s perspective, it’s a battle of convenience v coordination. And my 2c is that the assorted initiatives around connecting all the PHI sources will never quite work until a new paradigm shifts stewardship, control and ownership of PHI to the patient. “Interoperability” will never work properly if the steward remains healthcare entities instead of the patient.

      • Counterpoint:

        Moving stewardship, control and ownership of PHI to the patient, will create a whole new set of interoperability problems. It will solve them for specific subsets of patients, to the detriment of the entire patient group.

        Some patients are very invested in their care. This makes them willing to invest in data quality, data updating, and all of that. Think, people who have chronic conditions that need a lot of management. Think, parents of small children. Think, parents of adult children who are unable to live independently. These people tend to be engaged and will take advantage of data ownership.

        But for the average citizen, who mostly engages with the healthcare system in response to urgent (but widely spaced) care episodes? Not so much.







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