EPtalk by Dr. Jayne 4/25/24

The CMS Innovation Center has announced its proposed Transforming Episode Accountability Model (TEAM), which will incentivize coordination during surgical procedures and for the 30 days following the procedure. The model is expected to improve care quality including reducing readmission rates and decreasing recovery time. It is also projected to reduce Medicare expenditures and create more equitable outcomes. The model will initially focus on lower extremity joint replacement, hip and femur fractures, spinal fusions, cardiac bypass procedures, and major bowel surgeries. Participating hospitals will receive a global payment to cover all expenditures during the procedure and follow up period in exchange for requirements that they coordinate with primary care teams to promote long-term health outcomes. The model also includes coordination around therapy and rehabilitative services, home health, medications, and hospice services related to included procedures. The model is included in the FY 2025 Inpatient and Long-Term Care Hospital Prospective Payment Systems Rule for those of you who need some light bedtime reading.

Low tech but cool: Michigan Medicine is incorporating Barbie into virtual visits for pediatric rehabilitation to help patients understand how they should be moving. Physicians can use the doll to illustrate how their joints should move as they complete various portions of a virtual examination. A recent study showed that Barbie-enabled mock visits required less verbal prompting and led to an improved understanding of the physicians’ directions without any increase in the time needed for appointments.

Violence against healthcare workers continues to be on the rise, often in ways you might not expect. The Vermont State Police arrested a 27-year old man after he destroyed property with a chainsaw and assaulted staff at Northeastern Vermont Regional Hospital. At the time of his arrest, troopers noted he was “in the parking lot actively assaulting staff.” Vermont classifies “Assault on a Law Enforcement Officer/Health Care Worker” into a single violation. I’m glad to see crimes against health professionals receiving the same visibility as those against members of law enforcement.

Sometimes the combination of items in my inbox tells a greater story than any of them on their own. Two subject lines fell into that category this week: “AI’s Influence on Provider Verification, Credentialing and Enrollment” followed by “The credentialing game is a joke! It is easier to buy a gun than to get a job.” I have empathy for the physician making the latter statement in a comment on an article about credentialing. I’m now at the six-month mark waiting to be credentialed to work for a care delivery organization, and at least in my current state of residence, I could walk into any sporting goods store and walk out with a firearm. I have a clean clinical record without malpractice claims, reports to the state medical board, or shady resignations. Anyone who works with physicians and wants to understand another way in which we might be frustrated should check out the article and its comments. If AI can help solve the problem, I’m all for it. Unfortunately, the email about that led to registration for a webinar that will happen while I’m on a plane, so I’ll have to wait to see how that solution might pan out.

Another interesting inbox item discussed research looking at how to use a smartphone compass to measure things like blood glucose. It leverages the magnetometer properties of the compass in conjunction with magnetic-hydrogel composites that are responsive to different analytes. The authors used glucose-specific hydrogels as part of a proof-of-concept experiment that measured glucose in one of my favorite substances – wine. They compared levels in sangria, pinot grigio, and champagne. For those not inclined to drink wine, they also measured pH levels of coffee, orange juice, and root beer. It’s an interesting way to avoid the additional processes needed when using human subjects. The authors agree that additional work using biological fluids is needed. Having spent some time recently in California wine country, I can suggest a few additional non-biological substances to sample.

A friend of mine whose company is developing a technology solution reached out to me today to make sure his demo script was believable before putting it in front of prospective clients. I gave him a bit of a talking-to about his company’s approach to development, because if you’re doing the process well, you should have examples of customer use cases that were gathered prior to the creation of the solution in the first place. Those can easily be employed for testing purposes as well as the creation of demo scripts. Unfortunately, that wasn’t the situation here, where they built the solution based on an idea and never really obtained the voice of the customer. Sometimes we refer to that as crafting a solution that’s in search of a problem. I’m guessing that having tens of millions of dollars of someone else’s money to spend might have something to do with their approach.

It certainly doesn’t qualify as healthcare technology news, but the ongoing saga of the Voyager 1 spacecraft has captivated me for the last several months. In short, the 46-year old spacecraft, which is 15 billion miles away from Earth, had been steadily sending back data until late last year, when it started sending back nonsense. For those of us who look at things through a clinical diagnostician’s lens, it sounded like the system had the technology equivalent of a stroke. Scientists have been painstakingly working with the craft, sending various messages and commands that take 22 hours to reach it and the same time to return. Fast forward to last week, when NASA announced that it had identified the problem and was working to solve it. Apparently a single chip in the spacecraft’s Flight Data Subsystem had failed, and there wasn’t enough space anywhere else to move the code that resided there. They split the code into four pieces and moved it elsewhere and are in the process of making other code adjustments to help the system route data appropriately to ultimately restore normal communications.

It’s remarkable that the craft is even functioning at all, given its exposure to the hazards of space. The Voyager support teams have performed the ultimate remote surgery to try to get as much life out of it as possible. I probably have more computing power in my wristwatch than Voyager has on board, which is simply amazing to think about. Other notable happenings in 1977 include the release of the original “Star Wars” movie, initial operation of the Trans-Alaska pipeline, and the introduction of Radio Shack’s TRS-80 computer.

What other technology from the 1970s has stood the test of time? Leave a comment or email me.

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