EPtalk by Dr. Jayne 11/30/23

We’ve made it past some of the early fall holidays, and those of us on the front lines are waiting to see if they will cause a spike in respiratory illnesses.

Heading into Thanksgiving, many parts of the US were feeling the pressure already. Respiratory Syncytial Virus (RSV), COVID, and influenza are leading the pack. At one point, all of the pediatric hospital beds in the Dallas-Fort Worth area were full, which should ring alarm bells for those who care about children.

My colleagues at Cook Children’s in Fort Worth mentioned that they were seeing up to 500 patients daily in the emergency department and were boarding critically ill patients in the emergency department because there were no ICU beds. New vaccines for RSV are in short supply in some regions, which will likely add to the problem later in the season.

This week, I ran across a couple of articles that talked about the fact that ChatGPT has only been around for a year or so. Headlines included phrases such as “ChatGPT scared the heck out of us,” and there was a lot of retrospective thought about whether its launch opened as big of a Pandora’s box as everyone thought it might.

Generative AI has certainly matured over the last year. There’s still a lot of hype about how it’s going to transform the way people work. One suggested that managers use AI to help define ambitious deadlines for projects that are underway, or that they can use it to create motivating speeches for their teams. It went on to say that AI could help identify ways to make the workplace more exciting.

Another gave the idea that AI could be used to create employee satisfaction surveys and to process results to determine how employees want to be incentivized. I kind of like this one since I’ve worked for several employers that totally disregarded employee sentiments. Maybe because AI is such a darling, they’ll pay attention to those results just because they were processed using a tool versus a basic employee survey. One article brought up an interesting tidbit about OpenAI’s GPT-4, namely that certain restrictions can be bypassed by using less-common languages such as Gaelic or Zulu. That’s definitely interesting, and you can bet I’ll be playing around with that idea.

Just a few days prior to the Veterans Day holiday in the US, the Department of Veterans Affairs (VA) met its goal of enrolling one million veterans in its genetic database, aptly named the Million Veteran Program. The database is unique because it links genetic information with electronic health records and also includes information on diet and environmental exposures. Researchers have been working for 12 years to reach the goal. Compared to other genetic databases in Europe, this one represents a more diverse population. The data is only available to physicians and scientists at VA facilities. Veterans can continue to enroll either through the link above or by calling 866.441.6075 to make an appointment at a VA facility.

Although the VA’s EHR project certainly gets a lot of press, there is so much more that the organization is doing to support veterans. It’s a vast organization, with locations from coast to coast. This year, the Veterans Health Administration delivered 116 million patient appointments at 1,300 facilities, beating the previous record by 3 million. It’s not only a care provider, but manages benefits applications and compensation programs, which necessitates maintaining a different staffing profile than other healthcare organizations. It’s also responsible for delivering services around those parts of its business. To give you an idea of scale, its Health and Benefits App reached 1 million downloads this year.

The VA is also actively investing in the artificial intelligence space, working on tools to reduce employee burnout. It plans to launch an AI-related contest that features $1 million in prize money for teams that create the best solutions in speech-to-text for medical appointments and in document processing as non-VA medical records are added to the patient’s VA chart.

Several of the physician groups that I follow on Facebook have had an overwhelming number of posts about cybersecurity incidents. Since organizations tend to take their entire network down when there is an incident, that means that physicians have no access to downtime solutions such as disaster recovery servers or third-party information archives. Although the health systems in question typically put out press releases that state that patient care is being delivered safely and effectively, comments from the trenches seem to reflect an environment that is anything but:

• No ability to look up labs.
• No way to access history and physical forms for surgical procedures.
• Hand writing operative reports.
• Clinicians who are relatively new grads have never charted on paper.
• Systems haven’t practiced for downtime events, resulting in mass chaos.

One clinician whose system recently went through a cybersecurity event but is back online noted that she recommends keeping copies of all handwritten notes. Apparently, many were lost during the event and were not scanned or otherwise added to the system, resulting in requests for her to redo documentation weeks after the event. Another reported that his hospital was down for over a month, which as a clinician, I can’t even imagine. Hackers are a reality and organizations that think it couldn’t happen to them are mistaken. I challenge all the CIOs and CMIOs out there to ensure their organizations have adequate supports in place and that they’re practicing for a potential event.

I dropped by my primary care office this week to get a vaccine booster. Despite having just had my photo ID scanned at another office in the same system last week, I had to again present photo ID to be scanned as opposed to just being verified. I could see the previous scan of my photo ID on the receptionist’s screen, since there was no privacy filter on the monitor. I could also see my photo on my patient chart, which matched the already-scanned ID. I understand she was likely just following an office policy, but this is where I challenge people to make sure that the policies in place make sense and/or provide value or whether they’re just process for process sake.

I was also greeted with a 2020-esque COVID interrogation, including being asked if I had traveled internationally in the last six months (yes), whether I had been around sick people (yes), whether I had traveled internationally in the last 30 days (yes), and whether I had any respiratory symptoms (no). There were no follow-up questions to any of the positive responses.

As I sat waiting to be called back, another couple came in, and when asked the question about sick people, they asked, “What do you mean by sick?” It was clarified to be “measles, mumps, or chicken pox.” I suppose I should have been a “no” on that one then. They weren’t asked the question about symptoms. The couple was already wearing medical masks, so I’m guessing the receptionist made an assumption if the intent of the questioning was to determine if patients should have masks. Respiratory season is upon us and it will be interesting to see if the questionnaires morph as the season progresses.

The good thing that came out of that visit is that they pointed out that I had an open order for follow-up testing, which was interesting because the test had been allegedly scheduled during the in-person visit at another office last week. Apparently it hadn’t been scheduled properly, and had I not gone for that vaccine, I wouldn’t have had a clue. Four phone calls later, I finally had it scheduled, and I must say the patient experience component of the entire process has been lacking. At no point during any of the conversations did anyone apologize for the dropped ball, not even a lukewarm “I’m sorry you’re feeling frustrated by this.” It’s not an experience I want for my patients either, which is making me rethink my referral patterns. Where’s a patient satisfaction survey when you need one?

Does your organization actively work to stamp out non-value-added processes, or is it content with simply doing things the way they’ve always been done? Have they shifted processes to put more of the burden on the patient? Leave a comment or email me.

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