EPtalk by Dr. Jayne 11/21/24

The number one topic of discussion at a recent meeting of primary care physicians that I attended was how their health systems are using AI to help with documentation. The majority of the conversation was around using AI to create draft responses to inbox messages.

One physician was vocal when speaking of a specific vendor’s AI technology: “I don’t know who this guy is, but he seems to think I give out controlled substance refills like candy.” Apparently a lot of the inbound messages are asking for refills, but I would think it would be fairly easy to tune the algorithm to have different responses for controlled substances versus those that aren’t, especially since the medications are represented by discrete data in the EHR. I’ve not used the technology from that specific vendor personally so I can’t comment on it, but I suggested that he reach out to his IT department and provide feedback.

Although AI can be part of the plan, there are some fairly straightforward non-technical tactics that can help with inbox management. The American Medical Association summarized these in a recent piece on creating a “saner” inbox. The suggestions were not surprising:

• Set clear expectations for patients.
• Give new patients a printed handout that outlines reasonable expectations for responses and guidelines for portal use.
• Restrict the ability to send messages to patients who have seen the physician within a certain time period.
• Maintain uniform workflows and avoiding exceptions.

I have not seen anything like a printed handout in any of the practices where I’m a patient, but it seems like an inexpensive intervention that could help. It gets even cheaper when you send the document through the patient portal. The article also recommends discussing excessive portal usage directly with patients and setting boundaries if needed. Low tech as well, but also likely effective.

As more AI-enabled tools are brought into regular clinical use, finance types are going to look for ways to pay for them. A CPT code was recently issued for Eko Health’s AI-powered Sensora cardiac screening tool. The tool is designed to identify heart disease by detecting certain heart murmurs and irregular heart rhythms. It works with one of the company’s advanced digital stethoscopes that has built-in EKG functionality. Physicians can use the billing code starting July 1, 2025, although it’s unlikely that it will result in payments without buy-in from insurance companies.

From Greek Islands: “Re: consulting firms. I’m in all-day meetings with one that is trying to earn our business. I’m watching the high-priced consultant sitting nearby access various websites, including online bill pay. Not a good look.” Like the say, you only have one chance to make a first impression and this certainly was not a good one. I am reminded of the time when I was doing an EHR optimization project for an urgent care where the physicians complained bitterly that they didn’t have enough time to get their notes done. During a single day of workflow observations, I watched one of the most vocal members of the group look at over 200 offerings on the website of a major footwear retailer. If you are a compulsive multitasker, learn to close your laptop or take notes on paper so that you avoid doing something you might regret later.

I’m a nice, compliant patient with a well-controlled chronic condition, so I only have to see my care team once a year. Following best practices for ensuring patient follow up and reducing future phone calls, they schedule your next visit before you leave the office. When I get home, I download the appointment through the patient portal and add it to my trusty Outlook calendar.

This year when I went for my visit, I got a surprise. I discovered a sign on the darkened office door that they had moved up the street to a new building. Although I was plenty early for my appointment, I wasn’t early enough to backtrack to my car and drive to a different parking garage, so I had to hoof it down the block.

I looked at recent communications from the practice and found that some of them had the new address and some had the old address, but in none of them was it called out that the practice was moving or had moved. My primary method of contact for this practice is patient portal and none of its messages talked about the move. It takes at least 90 to 120 days to do a build-out on a new medical office, so it’s not like the practice made a spur of the moment decision to relocate.

Since they moved up the street, I suspect that many people won’t notice the address difference on a reminder message. When you have been going there for a decade, would you notice a change from 5200 Maple Lane to 5300 Maple Lane on the fourth line of the text message? Are you likely to plug the address into your GPS for a trip that you have made over and over? Some might, but it didn’t cross my mind, and I suspect that for many patients with varying levels of health literacy, it won’t cross their minds either.

Knowing how easy it is to send a blast message to all the active patients in a practice via a patient portal, I wondered why in the world they wouldn’t have done so. As I sat in the waiting room, the receptionist fielded a call from a patient saying that they were going to be late because they were in the wrong building, so at least I know it’s not just me. I provided feedback to the office that it would be useful to send a message to patients, especially those who only come in once a year, but they didn’t seem to be interested in improving their patient satisfaction scores in that way.

There were plenty of other unsavory things about the visit, so I’m eagerly awaiting my post-visit survey. Things I’ll be specifically mentioning besides the office relocation issue: failure of patient care team members to introduce themselves, lack of confidentiality of staff conversations in the waiting room, incorrect taking of vital signs, and inappropriate comments added to patient chart during medication reconciliation.

And one more thing – the colossal HIPAA violation when the medical assistant accessed the practice’s secure messaging app while doing my intake, allowing me to see other patients’ full names and medical information on the very large wall-mounted monitor. Not to mention her failure to lock the computer when she left the room. At least the rendering provider was appropriately horrified by that when she came in, so that’s something.

I tried to offer additional feedback in person during the visit and was directed to “include that in the patient survey when you get it.” Obviously people in the office don’t understand how those surveys work and how it would have been easier to take my feedback real time then for me to put it in writing. Or maybe they just don’t care.

What kind of communications do you do for your clinicians when their offices relocate? Should I plan to plug every visit into my GPS for the next 30 or 40 years? Leave a comment or email me.

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