EPtalk by Dr. Jayne 12/7/23

Researchers at Brigham and Women’s Hospital, Massachusetts Institute of Technology, Celero Systems, and West Virginia University have created a new ingestible device that can monitor vital signs such as respiratory rate and heart rate. The so-called Vitals Monitoring Pill uses an accelerometer to pick up small movements in the digestive system that occur each time the patient’s heart beats or they take a breath.

The device was initially validated in an animal model, then used for humans as part of a sleep study trial. Although the study was small with only 10 patients, researchers found that the data the device collected was comparable to that collected using standardized monitoring equipment. The study was also limited by the fact that participants were either sleeping or resting in a bed and the authors note there is the need to evaluate it in a more natural environment.

Researchers plan to focus on modifications that could keep the device in the digestive system for up to a week and to develop systems that could release medication in response to certain readings. They propose to be able to use it to detect opioid overdoses and treat them without external intervention.

From ShowMe: “Re: the state of Missouri. The last one in the nation to get on board with a prescription drug monitoring program (PDMP). For several years, in the absence of a state solution, the St. Louis County PDMP has been the de facto solution and other counties participated. Missouri is finally rolling out their solution next week, but users have been warned that they’ll have less functionality with the new solution. Way to go, technology.” I reviewed the materials forwarded by ShowMe and it looks like providers will lose the interstate sharing options they previously had through St. Louis County’s PDMP. Instead, they’ll have to separately register for access to neighboring states and use those individual state PDMPs to perform queries. Illinois requires that registrants of their PDMP have an Illinois controlled substance license, which many Missouri physicians may not have, so drug-seeking patients may be able to exploit the data gap. Additionally, not all counties have agreed to transfer their historical data from the St. Louis County solution to the state solution, so gaps will exist there as well. Physicians have been asked to “please keep this in mind when making clinical decisions. As a result, co-prescribing of naloxone with opioid prescriptions is recommended.” Technology is supposed to support clinicians rather than cause new issues, but I guess it’s to be expected when a state is dead last at doing the right thing. Missouri was one of the last states to bring up an immunization registry, if I recall correctly.

From Jimmy the Greek: “Re: return to office. My organization’s leadership has asked us to ‘practice’ working in the office. Having spent more than half of my career in an office, the idea that I need to practice coming to the office before I do it for real is insulting.” Jimmy’s screenshots made my head spin. Although I appreciate the company’s sentiment, there are ways to offer the same information without being patronizing. Despite this being a team of IT professionals, they were encouraged to come to the office for a “dry run” to test the wi-fi, headsets, and desks as well as to experience the parking arrangements and practice booking a conference room and eating in the company cafeteria. Additionally, employees were told to test their commute to evaluate travel time and traffic considerations, but gave no mention of the fact that hundreds of employees returning to the office are going to totally change the traffic patterns around the facility. As someone who has been a people manager in both remote and in-person situations, I’d like to think that managers know their people well enough to know who has worked in an office setting before and who might be at risk for issues or might require extra support. At a minimum, the organization could have offered a free meal to help entice employees back.

The Joint Commission has unveiled a new certification which will become available starting January 1. The Responsible Use of Health Data certification will evaluate hospitals across key areas including deidentification, data controls, data use, algorithm validation, patient transparency regarding deidentified data, and oversight structure for use of deidentified data. It will be interesting to see how organizations prepare their employees for this certification and whether clinicians will discover that there is so much more to using health data than they realize. I recently was in a spirited discussion with a clinician who had been ignoring a patient’s request for an amendment to their medical record. When the chair of the compliance committee and I informed the clinician that this was a violation under HIPAA, she said we were “full of crap, because no patient information was shared.” It had never occurred to her that HIPAA covers much more than information sharing, because the organization’s training had a narrow focus. A follow up survey to other clinicians revealed that 90% of them didn’t know patients had a right to request an amendment and 12% thought it was acceptable to just ignore patient portal messages. It looks like this organization has some work to do, not only in education, but also in fostering professionalism.

NorthShore-Edward-Elmhurst Health has rebranded itself as Endeavor Health as a follow up to the $5.3 billion merger that was responsible for its creation. The transition effort will include new names for its hospitals as well as updated employee uniforms, websites, and of course a social media campaign. Statements from leadership were around the “inspirational and aspirational” nature of the name, but when I hear it, I only think of the similarly named PBS program. I wonder how the cost of a health system rebrand compares with filming a gritty period drama, but suspect the latter has a better return on investment.

After considerable good-natured cajoling by younger colleagues, this blog marks my first attempt at trying to stop using two spaces after a period. As someone who is in my fourth decade of touch typing and who learned on the venerable IBM Selectric, I can attest that it’s hard to learn new tricks. Objectively, the process change added frustration and reduced my typing speed significantly, but I found the mental overhead to be the worst. I think I’ll go back to the old ways that will die with me, along with the use of handwritten thank you notes, formal invitations, and knowing how to set a table to accommodate a five-course meal.

One space or two? Is it worth it to try to eliminate the extraneous keystroke? Leave a comment or email me.

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