The Hot Ones is brilliant. There have been many great interviews, the host does his homework. Also worth looking for…
EPtalk by Dr. Jayne 6/27/24
From Jaded CMIO: “Re your recent comments about the Medication Access and Training Expansion Act (MATE) and its 8-hour DEA education requirement being a time waster. I’m in the same boat – I don’t even see patients, but my institution forces me to maintain a DEA regardless. Did you see this commentary on Medscape?” The op-ed from Melissa Walton-Shirley, MD is subtitled “8 Hours of My Life I’d Like Back.” The author calls for reform of DEA regulation, including waiving the requirement for physicians who don’t issue prescriptions for outpatient narcotics (such as intensivists who might be giving controlled substances in the ICU) and issuing a nationwide DEA number instead of forcing providers to have separate ones for individual states. The piece has over 140 comments already and some of them are pretty entertaining. My favorite: “We should get 0.5 hrs just for reading this informative dragging of MATE. And Pharma should be forced to fund the DEA, not provider licensing fees – since when does the taxi driver pay your fare?”
US Surgeon General Vivek Murthy penned a guest essay for the New York Times this week, calling for a “surgeon general’s warning label” on social media platforms and advising users that “social media is associated with significant mental health harms for adolescents.” This would require an act of Congress that I doubt we’ll see anything about soon, however. Murthy issued an advisory last year with specific recommendations to make social media safer, and although there have been some interesting congressional hearings, I haven’t seen a lot of change. I’ve seen in my own community the level of peer pressure for young children to be on social media. I wish we could lure kids and their parents to consciously choose the outdoors and other activities rather than focusing on screens.
From Informatics Doc: “Re: patient portals. I just went to my mom’s Epic portal to see what meds she was currently on since there was some question about whether any of them were making her more confused and sluggish. When she first got her portal, I was impressed that it did a better job than the Cerner portal in terms of usability. It also had an option to print out a wallet card with an easy to read medication list, allergies, and problem list. Fast forward to today. Every option that I tried for getting a medication list showed the same cluttered view in which the info on each drug and its dose and times was interspersed with the pharmacy name, the prescribing doctor, the start date, and a refill button. Hitting the print button gave you the same thing in a PDF with slightly better layout. To get a medication list to send to my siblings meant taking an added 15 minutes to cut and paste into Word and clean out all the extras. Do the EHR vendors have something against a nice clear condensed med list? (I know Joint Commission contributed to the poor med list formats within the EHR by their dislike of Latin abbreviations, but have they caused this problem in the portals as well?)” I test drove this with a couple of organizations and it appears that it might be a setup issue rather than a vendor issue, but I’m not entirely sure. At the first system I logged into, the “current medications” page was cluttered up by information telling me how to request an amendment to my medical records for two of the system’s physician groups. The print version was a little better, but the entire first page was taken up by an inch and a half worth of text about the amendments, pushing the medications to another page. Only the first page had a patient identifier on it, which makes it a little less useful as something that you might take with you to a visit with a physician who uses a different EHR. The second system wasn’t displaying any of my meds, which is definitely unusual.
I’m not ready to blame the EHR vendor because I’ve seen enough client-inflicted setup issues in my career. One of the institutions in question clearly has a setup issue in another part of the system. My recent pathology results had a blank diagnosis (which to me should be a required field before they’re finalized) and also had a tagline at the top of my results that stated “EPIC results best viewed via link to PDF,” which I thought was odd since I had to scroll three times to find the link to the scanned document and it didn’t say anything about it being a PDF. I’m sure there are patients who might not know what they’re looking for or who might not have scrolled. My report was also missing important clinical information that I provided at the time of care (documented as “not provided,” which is simply not true). Sloppiness all around, but not necessarily the vendor’s fault. I think that a concise med list is important for patients to be able to put in a wallet, so if that’s an option, I hope our expert readers will weigh in.
The clinical informatics job market has been a hot topic in recent conversations with colleagues. I have several friends who are highly capable and genuinely nice people, but who have been impacted by sweeping layoffs at their organizations. Most have school-aged children, elderly parents, or both, so they are reluctant to relocate for a new position, which might get cut in a year or two just as easily as their previous one was. In a recent chat, one mentioned that they had made it through multiple interviews, but the companies in question had gone radio silent for a matter of weeks. That’s not only disheartening, but unprofessional. It takes a few seconds of a recruiter’s time to type an email saying, “Thank you for your time, but we will be moving in a different direction” or something similar. Another countered that although that experiencing is depressing, it can be a blessing in disguise when you figure out that the organizational was dysfunctional before joining it.
My favorite quote of the conversation says it all as my colleague described some of the organizational personalities he’s encountered in his job hunt process: “I feel like some of us spend so much time and thought honing our skills and presenting ourselves professionally and some others just Mr. Magoo their way from one executive role to another.” I think most of us have encountered leaders like that in our travels, bouncing from one unsuspecting organization to another. I’m grateful to have had at least a few experiences where I’ve worked with exceptional leaders, but that’s not the case everywhere.
How do you think the hiring process has changed over the last five years? Have things improved or are they only getting worse? Leave a comment or email me.
Email Dr. Jayne.
I think hiring of informaticists has been hit by a supply and demand issue. The demand has dropped as organizations consolidate and the number of EHR installs diminishes, and EHRs themselves become more and more advanced so they need less duct tape to make them work, and what is needed doesn’t necessarily require a highly paid MD to assist with. The financial impact of COVID is also still a major issue, with organizations freezing or slowing hiring, and some reducing workforce.
At the same time, all of AMIA’s dreams have come true and we’ve dramatically increased the trained informaticist workforce. We’ve also been affected by the horrible morale problems in healthcare, so a lot of clinicians are leaving patient care and looking for something related, and informatics looks like a great option. One of the people on my team just got through fellowship and said most of their classmates were there because they wanted a C-level position that didn’t involve patient care (most were still not employed in that capacity). I regularly get asked by practicing clinicians if they can move onto my team.
Add in the effect of social media (mostly LinkedIn) “influencers” that promote their tiny projects as if they’re the next big thing in healthcare and subsequently land high-level jobs where they hope to be able to fake it til they make it, and you have a tough job market for people that are actually competent.
Unfortunately, what hasn’t changed is that healthcare leaders still don’t seem to understand the value informaticists can provide to an organization, try to get us as cheaply as they can (“you can still have a full-time clinical practice, right?”), and can’t discern who actually knows what they’re talking about. Maybe it wouldn’t be so bad if we could fix these longstanding issues.
Re: Med Lists in Patient Portals
When I hear comments like, “[why can’t we have] a nice clear condensed med list”, I just sigh.
You see, I used to do a lot of reporting out of an EHR. You know what my experience taught me? There is an essentially infinite demand for varying data presentations. As a person tasked with meeting an infinite demand, it was exhausting.
You’d make a wonderful report. And it was great, the users were happy. So someone would recommend this report to a different set of users, thinking they’d like it too. Well, usually it didn’t turn out that way. Your ‘wonderful report’ would get trashed, because the needs and expectations were so different.
Let me make an educated guess about what InformaticsDoc wants. They want a list of drugs a patient is on, in the most compact possible format. This I deduce from the comment about wallet cards. This answers the question What Meds, but only the What. And since there is this requirement to be as compact as possible, the focus is mainly on stripping out anything extra. The output is incredibly optimized, but that makes it unsuitable for any other purpose.
Now, imagine InformaticsDoc takes this wallet card to another clinician. Immediately, they are hit with questions. Why is this patient on drug X? Who authorized these? When did this start? “Well, I don’t know, this is the only information I have.” And now the additional clinician drops the critique bomb. “This wallet card is useless, what EMR vendor would ever think such a Meds List would be acceptable?”
There are an infinite number of data presentations. What works great for one client, often is completely unsuitable for another. And the more highly tailored the presentation? That tends to limit the potential audience.
The clients don’t see this side of the picture. All they know is their scope and their needs. It’s easy to say something like, “well, this is OK I guess, but it ought to be ported to a smartphone, and interactive, and I’d like a button to connect to a Live Chat to the dispensing Pharmacist”. No matter how good the suggestion? It often implies hundreds of hours of analytical time to make that happen. Then 5 years later, the needs change again.
Try to imagine just how much existing EMR functionality is going to be disrupted by AI. Those AI systems were barely a glimmer 5 years ago. And it won’t matter how great they were when they were created, if the expectation arises that the EMR “ought to have AI, it’s so obvious! What idiot created an EMR without AI??”
The good news is, there is lots of work available. The bad news is, you’ll never make the perfect system, and you’ll never make everyone happy.