EPtalk by Dr. Jayne 10/31/24

It’s Halloween, and there’s nothing spookier to me than Oracle Health’s announcement of a new EHR that is coming in 2025.

Those of us who have been in the EHR space for a long time immediately had questions. How far along is the development? How much have they spent already? Who do they plan to have pilot it? What is their certification plan? Do they have physician informaticists working on it? And of course, the rhetorical but honest “Are you kidding me?” So many questions here.

I reached out to some Oracle (and former Cerner) pals as well as CMIOs of current systems that are using the product formerly known as Cerner. Their comments ranged from eye roll emojis to no comment. If you have the inside scoop, do let us know, we’ll be happy to preserve your anonymity.

The fact that Oracle thinks Millennium has a “crumbling infrastructure” is interesting. If I held the CMIO title at an institution that is using the product, I would probably be using it as an excuse to try to get funding for a rip and replace to Epic rather than listening to years of promises about an as yet unseen system. My experience in the industry is that the devil you know is better than the devil you don’t know about 80% of the time. I wouldn’t want to risk my career plunging into the abyss with Oracle.

My other thoughts on the Oracle announcement. Their mention that it’s largely voice driven isn’t reassuring to me, because sometimes menus or drop downs can be useful to remind a busy physician of something they should be thinking about. Taking those away means that we’re reliant on memory or having the right data framework in our head, which can be difficult to do at the end of a 24- or 36-hour shift or even after 12 hours in a busy urban emergency department. The article has examples of this – asking if the patient has had lung cancer screening is dependent on the clinician remembering that the patient was a smoker and other risk factors. There’s also the issue that many of us process faster through visual and motor pathways than we do through speech, so it will be interesting to see data on how fast these visits go.

I didn’t see any folks with clinical titles from Oracle speaking about the product in the major media reports. We had a senior vice president for product management and of course Seema Verma quoted in most of them. Do they even have a CMO or CMIO? I’d love to hear from the people in those roles, regardless of their actual titles, and understand how they think about this. It would be good to understand who the patient safety and regulatory experts are and how they’re contributing to the effort, as well as understanding who is approving the build requirements from a clinical standpoint.

From Booth Crawl Betty: “Re: HIStalk’s guides to the major shows like HIMSS and HLTH. Exhibitors should list what kind of food they are offering in their booths. At HLTH there were some good options including Twilio, which had espresso that could be ordered in advance using a QR code, as well as booths with snacks, ice cream, and liquor outside the all-show happy hour time frames.” Nothing beats the scones that used to be baked at HIMSS, so I’m fully in support of a foodie’s guide to the shows. Last year’s HIMSS also had some amazing chocolate chip cookies that weren’t baked in the booth, but were better than 90% of the cookies I’ve had, and that’s saying a lot.

From Optimize Prime: “Re: inboxologists. It’s an interesting term to describe taming patient message beast.” I’m not a fan of the term, but I’m a fan of the concept. In fact, most of us who do process improvement work with medical practices have been championing that idea for the last two decades. It’s the old “work at the top of your license” concept under a new name. For those of us who practiced in outpatient offices pre-EHR, this is similar to having a triage nurse who fielded the majority of phone calls, bringing patients onto the physician schedule if they needed more than could be appropriately managed over the phone. In many organizations, the rise of EHRs meant those messages could be routed directly to the physician, even though they probably shouldn’t be. Practices looked at it as a way to cut costs — most of the primary care offices in my area don’t have nurses, and some barely have trained medical assistants — without looking at the bigger picture of shifting that work onto higher-cost resources like physicians.

Another not-so-shocking finding using tech-enabled workflows: Patients who receive electronic communications that encourage them to get influenza vaccines are more likely to get a vaccine than those who get no communications. The six electronic letters used in the study varied in effectiveness, but all of them were better than no letter. These kinds of patient-facing campaigns are just about the easiest thing you can do with an EHR and a patient portal, so if you’re not doing it, please encourage your patients to get their flu vaccines.

As I see for-profit entities sucking the “care” out of healthcare, I enjoy a good skewering of those who are not acting in the patients’ best interests. A recent report from the US Senate Permanent Subcommittee on Investigations looked at how Medicare Advantage plans are gaming the system using prior authorizations to deny care and boost profits. Long story short: they’re counting on the fact that physicians and their office staff are exhausted and simply won’t appeal a certain percentage of those denials. Health plans claim they are doing this in the name of savings, but those savings are a big part of what creates profit for the plans. They’re certainly not giving any money back to patients, providers, or the taxpayers who fund Medicare.

From Put a Ring On It: “Re: your recent post about the Happy Ring that recently received FDA approval as a medical device. If no one has acted on your suggestion, I recommend you buy an Oura ring for yourself, because life is too short to not buy your own jewelry.” Although it’s also a cool looking wearable, I found this New York Times piece that talked about the device’s shortcomings. According to the author, the device and its accompanying app rated his sleep as “good” despite seven awakenings, noting that “this was a classic case of an algorithm failing to objectively measure the very subjective nature of how I was supposed to feel about my sleep.” He also cited inaccuracies in step count and a comment from the company that it plans to update its algorithm in 2025.

Are tech/wearable rings worth the money or should I stick with my preference for ethically sourced vintage jewelry? Leave a comment or email me.

Email Dr. Jayne.