EPtalk by Dr. Jayne 10/26/23

From Jimmy the Greek: “Re: clickbait healthcare headlines, try this one: ‘Designing Playful Experiences with Imaging Capsules.’” Jimmy kindly shared a link to Exertion Games Lab, and I found the section header of Ingestible Games just as compelling. Capsule endoscopy was first approved by the US Food and Drug Administration in 2001, but its use is limited. The website notes, “We believe that the capsule’s experiential perspective is often overlooked, i.e. we argue that there is also potential for  ‘fun.’” The company created a wearable system named InsideOut where users can see a real-time video of their digestive tract as the camera capsule travels through and can interact with a couple of different games that harness the images. There are links to scholarly articles if you’re interested, as well as a video of the concept in action.

Halloween is almost here, and IMO has shared 13 ICD-10 codes appropriate for the occasion. The codes address injuries related to sewing, pumpkin carving, and handcrafts, as well as open bites of the neck which might occur in vampire-rich areas. My favorite is R46.1 Bizarre Personal Appearance, which I hope to see a fair amount of when I’m handing out candy next week. For your further entertainment, they did a winter holiday code update last year.

The CHIME fall forum is coming up, and Genzeon gets my thumbs-down award for silly giveaways. This Arizona-shaped luggage tag was mailed to attendees and is just one more piece of conference swag for many attendees to add to their trash cans. Colorado State University had a blog piece about this earlier in the year, noting that the annual spend on promotional products in the US is in the neighborhood of $20 billion, with estimates that 40% of it ends up in landfills.

I personally prefer when conferences let you pick and choose the promotional items you want rather than handing you a pre-filled swag bag. At last year’s CHIME event, light-up cowboy hats were a popular take-home item. I wonder how many of them are still in use. I won’t be at CHIME this year, so if you are going, feel free to send me your swag report.

Everyone is talking about burnout, but an article I read this week introduced me to the concept of “rusting out.” It’s described as being on the other side of the spectrum from burnout, and is defined as what happens when an employee’s talents are underused. It can lead to disengagement and lowered productivity. I’ve seen this phenomenon first hand. A good manager will be on the lookout for it and discuss ways to better use the skills of workers.

Although the article mentions recommending workers for retraining programs, in some situations, it could be much easier. This might involve removing repetitive lower-level tasks and adding more complex projects that encourage critical thinking or problem solving. This is tricky to do as a manager, especially if you don’t have resources towards which you can shift those repetitive tasks. Depending on the culture of your organization, it can be difficult to make the case for realigning resources, but executives who ignore these kinds of requests do so at their own peril. 

A friend sent me a link to a digital tool called Wellspring, which is designed to help clinicians individualize treatment plans for menopausal patients and uses guidelines from the UK’s National Institute for Health and Care Excellence. There have been many shifts in recommendations for treatment of menopausal symptoms over the years. It is challenging for physicians to make time to address them when they’re pressured to deliver quick visits that satisfy all the check-the-box metrics in front of them. It will be interesting to see if there is any movement on this type of tool in the US and whether frazzled physicians would be willing to adopt it.

I’ve written in the past about some of my experiences with my local health system. I had another one this week that makes me wish I could do some consulting work for them.

I’m registered with their high-risk breast cancer program, which means I have imaging studies performed twice as often as people of normal risk. The program handles pre-approvals with the insurance company since most companies won’t pay for additional screening without appropriate supporting documentation. Additionally, the imaging appointments are scheduled in conjunction with clinical appointments, so that the studies are read and results are given to me before I leave the building.

I received a letter from the hospital this week telling me that it was time to schedule my mammogram and I should call for an appointment or visit the mammogram van, along with a schedule of its locations. Since my next imaging is always scheduled before I leave the office, this made me worry that either my appointment had been canceled or something else had happened to it. As a patient, this causes anxiety as well as time spent calling the hospital to confirm or logging into the patient portal to confirm whether there is an appointment or not.

In addition to the inconvenience factor, there’s also the clinical appropriateness factor. Someone who is part of this particular high-risk program shouldn’t be doing a walk-in at the mammogram van. The letter had my medical record number on it, so it’s not like it was a generic letter. Given the capabilities of the health system’s EHR, there’s no reason that they should be sending out letters like this. It’s entirely possible to construct the outreach campaign by filtering out those patients who are already scheduled for imaging so that we don’t send patients on a wild goose chase looking for their appointments.

It’s wasteful to send out scheduling letters for patients who already have appointments on the books. If you insist on sending something, send a reminder letter with the date of the upcoming appointment. Additionally, patients who are flagged as being part of the high-risk program should likely receive a different letter, even if they are overdue for their imaging and don’t have anything scheduled. The program prefers that these patients call the coordinator to set up the appointments since they get linked with clinical appointments, rather than just showing up at a facility.

I talked to a colleague about the situation, looking for suggestions on how to advocate on behalf of patients. She promptly one-upped me by sharing her experiences with a health system that continued to reach out about her mother’s appointments more than a year after they were made aware of her passing. These are just things that shouldn’t happen given the technology we all have in place.

Is your organization maximizing its use of EHR reporting and recall campaigns, or is it traumatizing patients? Leave a comment or email me.

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