EPtalk by Dr. Jayne 6/20/24

The team at Geeks for Geeks has published its list of the 50 most common passwords, as identified through security incidents. I’m not surprised by entries such as 123456, password, admin, or 111111, but I was surprised to see these: monkey, dragon, princess, whatever, starwars, and startrek. My favorite from the list is trustno1.

At my most recent visit with a physician who I see annually, the office didn’t have her schedule template built for the coming year. They promised to send me a postcard when they open her schedule, but could not give an estimate of when that might happen. I don’t have a lot of faith in mailed reminders and my schedule is chaotic, so I put an appointment on my own calendar to follow up. I would rather receive a patient portal message that would alert me to the ability to schedule, as well as the ability to just schedule it myself.

A recent healthcare consumer preference survey showed that while nearly 40% of patients would like to schedule appointments online, 22% reported that their provider doesn’t offer that option. The report also addresses why patients are choosing urgent care over primary care, which is good food for thought for those who are trying to figure out the best ways to deliver care in their communities.

Miami Today reports that after 16 years, Miami-Dade County has agreed to sell naming rights to a transit station. The Civic Center Metrorail Station has been purchased by the University of Miami Health System for $2.9 million over 20 years. Starting in July, the station will be known as UHealth Jackson Station. Proceeds of the sale will go to the county for transit-related projects. Jackson Health System, which is owned by the county, was part of the initiative to gain the county commission’s approval. In additional to the ongoing fee, UHealth will pay for updated signage with the new name at the station and at other locations across the Metrorail system. The agreement also allows installation of digital displays to share branded materials.

MIT Technology Review ran an article last week about a new safety tool for operating rooms.AI-enabled “black box” devices are intended to capture information about surgeries. The idea comes from the black boxes that are found in aircraft, which allow investigators to review captured data following crashes or significant flight events. For operating rooms, data capture happens through audio/video as well as data from anesthesia monitors. Several medical device companies are working in this space, but a Stanford University surgery professor is looking at the entire operating room environment, not just the procedure itself.

This approach raises questions about patient and staff privacy, as well as legal issues. Surgeons have refused to work where systems are present, and devices have reportedly been sabotaged. The data that is captured can be compared against surgical safety checklists and other standardized measures of surgical proficiency. To train the models, surgeons or highly-trained technicians label items and actions so that the system can learn.

I reached out to a couple of surgical colleagues for their opinions. One feels that the technology would have been better received a decade ago, because physicians have increasingly come to feel like they “have a target on their back” for any perceived irregularities in the hospital, from their tone of voice to their leadership style in the operating room.

Speaking of workers worried that they are being monitored, Wells Fargo recently terminated more than a dozen workers after concerns of “simulation of keyboard activity creating impression of active work.” I bought my first “mouse jiggler” more than a decade ago to prevent my laptop from going to sleep while I was seeing patients. My health system had a lockout if the unit was idle for more than 90 seconds, and no one in IT would listen to a family doc who tried to explain that most physical exams take more than that brief time. Also, that it was ridiculous to lock out the laptop when it was sitting in the exam room in my direct line of sight. I’ve had corporate laptops where the USB ports were disabled, so I’m a bit surprised if a USB device was the approach that was used by the employees versus something more exotic. Wells Fargo has zero tolerance for “unethical behavior,” according to a statement, and the employees in question worked in financial management units, resulting in the situation being disclosed in a filing with the Financial Industry Regulatory Authority.

Pharmacy Practice News recently ran a piece on hospitals using smart speakers such as the Amazon Echo Dot in patient rooms. One installation allowed patients to ask questions about their medications while allowing the pharmacy team to communicate quickly with patients. Patient questions that are beyond the system’s standardized content can be converted to EHR messages that are delivered to pharmacy staff. The system is designed to accept various drug pronunciations that patients might use, which is great since there is often confusion around medication names.

In a deployment at Houston Methodist Hospital System, the system can also be used to help pharmacists quickly respond to orders for drugs used to reverse bleeding. The pharmacy-side device announces an urgent order and its notification ring flashes. Teams at the facility are looking into other uses for the device, including capture of patient-provider discussions.

I was a guest lecturer at a local residency program this week and enjoyed chatting with young physicians who were about to mark another year of training complete. The educational year traditionally runs from July 1 through June 30, and a couple of the attendees have precious few days left before they’ll be expected to work on their own. My presentation was on topics related to the business of managing a practice. Most questions were related to the role of private equity in healthcare. I wish my lecture had been scheduled a few days later, because when I arrived home, I found an email about the newly introduced Corporate Crimes Against Health Care Act of 2024. The bill was introduced in the US Senate and specifically addresses abuses that have occurred under private equity ownership of nursing homes, medical practices, hospitals, and other healthcare organizations.

The Act provides for increased transparency around changes in ownership such as mergers and acquisitions; criminal penalties for executives when abuses lead to the death of a patient; the ability of state attorneys general and the Justice Department to “claw back all compensation, including salaries, that is paid to private equity and portfolio company executives within a 10-year period before or after an acquired healthcare firm experiences serious, avoidable financial difficulties” due to “looting” by those executives. A press release from the bill’s co-sponsor, Senator Elizabeth Warren, specifically addresses the “private equity greed and mismanagement” that pushed Steward Health Care into bankruptcy.

What are your thoughts on reining in the role of private equity in healthcare? Will this bill become law? Leave a comment or email me.

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