EPtalk by Dr. Jayne 11/7/24

As many patients with traditional health insurance do in the US, I scheduled some additional medical appointments for the fall and early winter once I realized that I had met my insurance deductible. One of those appointments provided examples of how poorly we manage certain elements of healthcare.

The adventure started with a string of phone calls the week prior to the appointment, with a confusing voice mail about lack of insurance authorization for the visit. Since my insurance doesn’t require authorization or a referral for this kind of appointment, I tried to call back. The office was closed and I was transferred to a billing service that couldn’t help.

After much phone tag, it turned out that the office had requested multiple authorizations for service and had misplaced the original response from my insurance company that told them that I didn’t need an authorization. The office is still using a paper process and my particular paper was in a drawer.

In the following days, I received several text messages in the days before the appointment to remind me to arrive 15 minutes early. It offered no ability to do check-in tasks online. As part of the front desk paperwork, I was given a special consent form to opt in to the practice’s patient portal, so I was grateful that they’re finally coming into the modern age.

However, it went downhill from there. They marched me back to a chair in the hallway, slapped a blood pressure cuff on my wrist, and told me to hold my arm up at the level of my heart while the cuff did its thing. The assistant bent over me trying to look at the screen, which folded up next to my body since I was holding my write-up as directed.

For those who might not be clinicians, that’s just about the most inaccurate way to take a blood pressure that one can consider. Even if you have non-medical people gathering vital signs, there are better options out there for a more accurate reading. As expected, my reading was high because I had just raced from a packed schedule of calls to a crowded parking lot, but no one asked me about it.

I was also surprised that the office didn’t have my allergies in the chart despite the fact that I’ve been seen there half a dozen times. I’m not sure why they added blood pressure to their pre-visit tasks if they’re not going to do anything about it. The clinician didn’t seem to have too much of a problem with the method in which the blood pressure was taken. I’m going to have to just keep shaking my head because I can’t bring myself to write another cranky letter to a faceless medical director.

From Conference Diva: “Re: HLTH. I was cleaning out my bag from the conference and found the urine dipstick that I picked up in the women’s restroom. I don’t know if the advertising placement in the restrooms was a formal paid exhibitor placement or more of a side effort by the vendor.” Digging back through my pictures, I found an image that I captured that went along with the test sticks, which were taped to the doors of some of the stalls and also on the counter. Due to my short time at HLTH, I’m not sure if other vendors were doing the same in different parts of the venue. It’s certainly an eye-catching way to place your product, but I would be interested to know how many serious leads the effort actually generated and whether it was worth it from a cost perspective.

Hearing from a reader about HLTH reminded me that I had sessions whose recordings I wanted to watch because they were in conflict with other sessions I was attending. Although it was easy to find the sessions on the HLTH website, I was surprised by how much of the background noise was reflected in the recordings. I have a love/hate relationship with the setup of conferences like HLTH and ViVE, where the sessions are smack dab in the middle of the exhibit hall craziness. Although it’s nice to be able to pop in and out of sessions and it’s convenient to get to networking opportunities, I find the excess noise distracting. Having listened to enough live albums in my lifetime, even back to the vinyl days, I know that it’s possible to engineer out the background noise from the recording.

It makes me wonder if HLTH doesn’t care, didn’t want to spend the extra effort, or thinks that the relentless hum adds to the conference’s cool factor. HLTH described itself in a post-conference email as “The Event That Broke the Internet” without further explanation or discussion of how they claim to have done that. They also described attendees as being “in the midst of history” being made, so I’m suspecting that it’s the latter.

Another pic I saw from my captures at HLTH was this Physician Side Gigs booth. It was interesting to see a physical representation of what started out as a Facebook group, then grew to a website and an online community that describes itself as a “virtual physician lounge.” Rest assured, that group is not the virtual lounge to which I refer at times. It’s a for-profit enterprise that is chock full of sponsorships and affiliate links. It is populated by large number of physicians who are trying to side gig their way to escaping clinical practice. I wonder how productive HLTH was and what kinds of interactions they might have had with payers, health systems, or vendors.

I was interested to catch this mainstream news article that claims that AI-powered transcription tools that hospitals are using are inventing “things no one ever said.” The article lists specific comparisons between what was said and what was transcribed. The hallucination examples that were given are certainly more problematic than the mix-ups that we used to see when people used dictation services in crowded medical records rooms.

The article is a good read and provides not only specific examples, but also statistics about the frequency of hallucinations. Researchers found that 40% of hallucinations were concerning or potentially harmful. The article gives examples of hallucinations that added inappropriate racial context as well as violent language. Based on conversations with my colleagues, it sounds like there is little editing or review being done by some physicians who are using these systems, so patients (as well as consulting healthcare professionals) should proceed with caution.

Another interesting article this week looked at smart but bored teenagers as being the next big cyberthreat. TechCrunch refers to these individuals as “advanced persistent teenagers” and notes their propensity to access systems through manipulating people rather than high-tech hacking. With time on their hands, perpetrators use voice spoofing and phishing along with other techniques to obtain logins and passwords that are then used to cause mayhem. I’ve been around some incredibly smart teens in the last few years and some of them have tech skills that I could only have imagined at that point in my life. Here’s to hoping they find ways to use their skills for good rather than being drawn to groups that are doing these kinds of things.

What do you think is the biggest threat to healthcare IT in the coming year? Leave a comment or email me.

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