EPtalk by Dr. Jayne 2/15/24

I’m always amazed when people want to use EHRs to drive non-EHR behavior, almost forgetting the concept of free will. A friend reached out to me to ask if I knew how to configure Epic EHR tools to help her track how much time she spends using the EHR on her days off, which includes work done during weekends, holidays, and when on vacation. She said she felt “blown off” by the IT team after opening a help desk ticket since they are only tracking so-called “pajama time” on scheduled clinic days. She feels that tracking the data on weekends and non-clinic days would help motivate her to work less. I explained how IT teams manage their work and how they typically focus on system enhancements that would benefit large numbers of users and explained that she’s essentially asking for a one-off behavior modification program. I offered some options for free time-tracking software on her phone, which I think would be even better, since she will have to consciously decide that she’s going to start her timer and use the EHR versus “just popping in for a moment” as she has become used to doing.

In talking through it, she never thought about using any other way to track her time – such as an old-school notebook or even a time-tracking app. I also mentioned the importance of tracking other time-sucking ways she spends her day, including social media, random internet surfing, online shopping, and more. Sometimes we just need to take responsibility for our own choices, and it’s not always the IT team’s job to figure it out or the EHR’s responsibility to track it. Of course, I know that EHRs have a way of wasting a lot of clinician time, especially if their organizations don’t have policies and procedures in place that allow clinicians to work at the top level of their licensure. However, this particular physician also admits she brings her own laptop to work so she can do things that aren’t allowed on the office computers, so I suspect the problem is much larger than her ending up doing work on the weekends.

I recently took over a new volunteer position and was given access to a shared drive full of documents and files with the advice that “everything you need is in there.” The extremely painful process of going through the folders reminded me of how spoiled I have become working for high-performing organizations where version control information is required to be clearly present on every document. Sure, you can access that information electronically from within the applications, but for long-standing documents, that can require a lot of digging. It’s also helpful to see who authored the document, the business reason for its creation, and a high-level overview of key changes that have happened along the way. You can bet that when I hand off the materials to the next person, the documentation will be a little stronger. I’m trying to dig through them with a glass of wine in hand, but I’m afraid my cellar will be empty before I get through all of the documentation.

Happy 30^th birthday to the Journal of the American Medical Informatics Association. The publication launched in 1994 and has had significant growth during its lifespan. The journal’s 2023 statistics: 1574 submissions received with 254 accepted for publication. Here’s to the next decade of quality clinical informatics literature.

From Cube Dweller: “Jayne, I appreciate your ongoing coverage of the return to office situation. I’m one of those people who has enjoyed being in the office all along, mostly to get away from my children and have a bit of peace and quiet. Now that all these hybrid people are being forced back to the office, our management is making us have all kinds of forced fun to welcome them back. I wish they’d take a page from this article about how to not make it feel like a bad middle school mixer.” I appreciated the content of the article, which shared one company’s idea of a better way to get employees to connect. The employer profiled is Verkada, which provides security equipment. CFO Kameron Rezai created what they call the “3-3-3 program,” which offers a reimbursement of up to $30 each for employees who meet at local businesses in groups of three or more after 3pm. Rezai cited autonomy as one of the goals of the program, stating, “We trusted our employees to go out and make their own connections.”

Since the program’s inception in April 2023, the company has had good uptake, spending more than a half-million dollars from a fund that formerly paid for structured events. As someone who has felt the pressure of trying to plan workplace events that have something for everyone, this feels like a win-win. Want to go hike with your coworkers and get a beer afterwards? Check. Want to visit a local tearoom or coffee shop? Check. Chill at the local gelato shop after a long day of meetings? Check. Staffers do have to post event snapshots before they file their expense reports, which I think would be great for helping others generate ideas. This would also potentially scale to remote workers, who could arrange delivery of snacks and drinks then hop on a virtual meet and greet together. Local businesses also benefit, so that’s another plus.

I’m mentoring a young clinical informaticist, and we have a lot of conversations about study-related concepts such as statistical power, correlation, and causation. There are so many studies out there that “link” different concepts or events together, which may have a tangled web of causes. My mentee brought up a recent Epic Research study that noted that for patients in the emergency department, there was a correlation between providers having access to outside records and a reduced risk of a “code blue” event. The article notes that previous research has shown a link between the presence of outside medical records information and patient outcomes such as visit length, tests and diagnostics that are ordered, admission rates, and even charges.

As someone who has spent a long time working in the emergency department, I understand that piece – having more information helps you better understand a patient’s current state and how their various health conditions have progressed. You can also see if they had recent testing that would reduce what you need to order today, or the presence of data can make a comparison easier. From a code blue standpoint, my experience is that those events are most closely tied to the patient’s current presenting problem: major trauma, heart attack, respiratory failure, etc., and are less closely tied to chronic conditions. As a scientist, it’s fun to find things that correspond, but the best studies are those that generate actionable data that can be used to improve patient outcomes. Maybe I’m missing something here, so if you’re seeing what I’m not, please clue me in.

My mentee is also working on a public health project that looks at foodborne illness and came across what can only be described as an attention-grabbing title: The Great Michigan Pizza Funeral. The “ceremonial disposal” of nearly 30,000 frozen pizzas occurred in Ossineke, Michigan on March 5, 1973, following a recall due to concerns about botulism-causing bacteria in mushrooms used to top the pizzas. The pizzas were placed in an 18-foot deep grave with the governor of Michigan in attendance. Later testing revealed that the mushrooms were not indeed contaminated, and that laboratory mice found dead during the initial testing suffered from an unrelated infection.

What kind of pizza would you never eat, unless it was the only food left to sustain you? Which is best – thin crust, thick, or pan? Leave a comment or email me.

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