EPtalk by Dr. Jayne 2/29/24

Lots of folks around the virtual water cooler are talking about the ransomware attack that has brought Change Healthcare to its knees. In addition to negatively impacting financial transaction, the trickledown effects are preventing patients from getting needed medication refills at the pharmacy.

The BlackCat gang claims that they took 6 TB of data, including clinical, payment, and claims files as well as patient demographic data. This includes data on active US military personnel. Spokespeople for parent company UnitedHealth Group have stated that 90% of affected pharmacies have switched to new processes to get the prescriptions moving. You can follow along on a dedicated status page.

From Phi Beta: “Re: healthcare financial departments. Are in full battle mode with claims authorizations and eligibility all off line due to Change Healthcare / Optum cyberattack. I’m hearing Duke Medicine cannot send out any claims. The financial costs for US healthcare entities are going to be massive. No one seems to be telling that story.” Now that the outage has gone as long as it has, I think people are starting to have those conversations. The impact of this will be staggering and cause everything from tsunami-size waves to ripples through revenue cycle processes for the next year.

Several people have sent me fun and sassy pics from ViVE, which were much appreciated since I’m hanging out at home in chilly weather rather than partying it up in LA. Roving reporters indicated that the Billy Idol concert was “shockingly good.” I did get annoyed by the repeated emails from ViVE asking if I had “FOMO.” By definition, can you still have “fear of missing out” when you are actually missing out? Inquiring minds want to know.

Even though many of us in the industry have followed the VA and US Department of Defense IT projects closely due to their sheer size and visibility, the fact that I have active duty military personnel in my family makes it even more interesting to me. I was intrigued by the reports that the EHR transition had slowed down recruiting and onboarding and wanted to know exactly why. Having used both systems in the past, it didn’t make sense to me that switching from one system to the other would have made such a huge difference in workflow or click counts that it would delay entry. Additionally, there were reports that after the new system went live, twice as many recruits were disqualified. That didn’t make sense at all, unless the new system had totally different parameters than the old one.

After doing some digging, reading a lot of articles, and confirming with military personnel, I finally understand. Although the EHR is involved, it’s really not the cause. It’s the sheer volume of records that reviewers are now having to address compared to what they had before. In the legacy workflow, reviewers had access self-reported patient histories coupled with a relatively small number of medical records for each recruit. In the new system, health information exchange technology is used to pull much larger volumes of data about individuals. Although some branches of the military have refused to comment on it, an Air Force spokesperson did provide information to National Review, which confirmed that higher numbers of records are revealing more disqualifying conditions, which then need to be investigated and evaluated.

Previously, 81% of all Air Force applicants passed on their initial screening during fiscal year 2021, but after reviewers had greater access to patient data, that number dropped to 69% in 2022 and eventually to 58% in 2023. Increased access to data led to increased time needed for review, and until additional reviewers were added to help catch up, there was a lag. I’m not sure how failure to staff up in the face of a significant increase in workload can be attributed to the EHR rather than to lack of understanding of the time needed to review records coupled with poor capacity management. It’s always easier to blame the technology than it is to hold management accountable, I suppose.

A UK coroner’s classification of a young woman’s death as “preventable” has landed the EHR in trouble. The 31-year-old patient died from a pulmonary embolism after presenting the day before at the hospital. The coroner’s inquest confirmed that staff identified the diagnosis, but there were “errors and delays” in administering the correct treatment on an appropriate timeline. The hospital’s new emergency department EHR was named as a contributor, noting that it lacked clear and color-coded indicators for patients who needed urgent care, which had been present in the legacy system. Instead, the Cerner system has symbols next to patient names that had to be clicked to indicate the acuity of care rather than the acuity being immediately apparent. The coroner noted that there had been clinician complaints that went unresolved after the transition to the new system. The hospital has 56 days to respond to a demand for action. When we implement healthcare technology, we have user acceptance testing for a reason. Let this be a warning to people who don’t listen to the users or overrule their findings.

From Less-than-happy Hybrid: “Re: return to work. I feel like a ping pong ball going back and forth between the annoyances of working in the office and my Zen home office setup. In the office, my entire group was moved to a different floor that is nothing but cubes. I can’t even see if other people are here, and since none of us have actual cube assignments I don’t know where to find people if I wanted to collaborate. There are no lockers or storage cabinets. so I’m stuck hauling my stuff home at the end of every day, which isn’t an employee satisfier. There’s also a cheapo battery-powered clock on the wall whose ticking is making me crazy. It may not survive the morning. I also just heard a very distinctive sound coming from across the aisle and confirmed that some guy was brushing his teeth. At his desk. I’m so glad we’re building all this culture.” Other readers have weighed in with annoyances with remote colleagues, including attendees who are consistently doing school drop-offs or pickups during standing calls, yet will not admit that the call is scheduled at a bad time and should be moved. I’ve worked with people like that and it’s maddening since you know that they are not paying attention and are possibly placing themselves and their children at risk driving while on calls. One reader shared some photos of backgrounds they’ve seen on calls, including messy unmade beds, sinks piled high with dishes, and inappropriate artwork in the background. I use a lot of platforms and every one of them has an option to use digital backgrounds or at least blur the background, so there’s no excuse for appearing to be in an unprofessional environment even if you are indeed in the middle of one.

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