EPtalk by Dr. Jayne 1/4/24

I didn’t ring in the new year in Auckland, but since I visited there earlier in the year, I could at least visualize more accurately what it must be like to celebrate in one of the first major cities that greeted 2024.

I spent the evening in my Midwest neighborhood, where the fireworks started at 6:35 p.m. courtesy of some folks who I suppose either wanted to get a head start or were celebrating with small children before they sent them off to bed. The random gunfire held off until midnight. at least, and fortunately was short lived. Maybe I’ll plan a trip to greet 2025 in a more spectacular locale.

I always like reading various year-end review articles and Google shared the top 10 health-related searches of 2023. The list was wide ranging and showed that even post-pandemic, infectious diseases are still top of mind for many:

1. How long is strep contagious
2. How contagious is strep
3. How to lower cholesterol
4. What helps with bloating
5. What causes low blood pressure
6. What causes warts
7. Why do I feel nauseous
8. What causes preeclampsia
9. How to stop snoring
10. How long does food poisoning last

I have to admit I was a little surprised by #8, which is a pregnancy-related complication. However, a quick Google search of my own revealed that the condition affects over 200,000 pregnant patients in the US each year and the rate of the condition in the US has increased 25% in the last two decades. It’s good to know that people are seeking additional education about the condition, which is a leading cause of maternal and infant morbidity and mortality.

I also got a chuckle out of #7, since it’s decidedly first-person in comparison with the other queries. I doubt Google knows whether the person asking the question recently consumed Flamin’ Hot Cheetos and a Mountain Dew or whether they just returned home from a wild night at the local dance club, so maybe a more refined search is in order.

I spent a few hours on New Years Day catching up on my inbox, which has been overrun the last couple of weeks. One message advertised an upcoming webinar for automated fax processing, which made me chuckle. I’ve had a situation for over a year where a particular pharmacy chain is sending refill requests to my practice fax line for patients (and providers) who have no affiliation with my clinical practice. I thought it had been resolved, but it started up again, leading me to believe that the pharmacy chain somehow downloaded an outdated prescriber database.

I sent a formal notification to their corporate entity, but it hasn’t been corrected yet and they haven’t even responded to my message. If you work for a pharmacy company, please make sure you have updated provider profiles, because this kind of thing keeps patients from receiving their refills in a timely manner.

Also on New Year’s Day, I spotted this ad for Amazon’s clinical care options. I appreciate the sentiment that they are trying to express, namely that they are available for various clinical situations, but nasal foreign body removal isn’t listed as in scope for their in-person offices and it’s definitely not a problem that can be resolved during a virtual visit.

I’ve fished plenty of items out of kids’ noses and ears in my career, and while it might be helpful to talk to a medical professional for advice on whether to go to an urgent care (older kids with certain foreign bodies) or whether to go to the emergency department (pointed objects, young children who might need sedation), waiting for a consultation might lead to a delay before a child gets appropriate care, which can make extraction more difficult due to swelling. Here’s to all the parents who have survived the trauma and drama of this happening and the process that is needed to reverse it.

The US Government Accountability Office has appointed five new members to serve on the Health Information Technology Advisory Committee (HITAC). The group advises the federal government on implementing healthcare IT and has been around since 2016. Four of the new appointees are physicians and one is a nurse. Their experience includes quality standards, innovation, health plans, applied clinical informatics, AI models, and having personally been a caregiver for someone with a serious health condition. Personally, I think the latter element is one of the most important. If we had more healthcare consumers making decisions about healthcare strategy, we might see a different health system than we have today. Each will serve a three-year term with the potential for reappointment.

I’m continually amazed by the number of physicians that don’t understand some of the basics of clinical informatics. This wasn’t such a big deal a decade ago, but now that nearly everyone is using EHRs, there is a minimum level of knowledge that one needs for survival. The first thing to understand is that most EHR installs have significant differences, even if they’re from the same vendor.

I lurk in some unofficial user forums, and people working at different hospitals seem baffled that there aren’t magical pixies that move their favorites and defaults from hospital A to hospital B even though “it’s all Epic.” They’re also confused about the governance of IT systems, that one hospital might tightly lock down their EHR against customizations where another is permissive, and that the EHR vendor isn’t responsible for hospitals that make bad decisions about EHR configuration.

I was glad to see a recent article in the Applied Clinical Informatics journal that calls for the support of informatics curricula in US-based residency training programs. Graduate medical education bodies are focusing on telehealth competencies, clinical quality, and documentation, but I’m not seeing education that helps physicians understand why their systems are the way they are and what they can do to help.

I’d be happy to go back to my medical school or residency program and deliver the same governance lecture that I delivered to countless healthcare executives and physician leaders during my time as a field consultant. I’ve found that helping people manage expectations can lead to happier end users, especially when users are educated on which pieces of the EHR can be customized or configured, which ones can’t, and who makes the decisions. One physician colleague who was recently griping about his EHR was shocked to learn that his practice partner sits on the EHR steering committee. The look on his face when I explained it to him was priceless.

Do your physicians and end users understand that your organization has made the majority of decisions around how your EHR is structured, or do they just assume the vendor is responsible for the things they don’t like? Leave a comment or email me.

Email Dr. Jayne.