Curbside Consult with Dr. Jayne 3/31/25

As someone who is knee deep in healthcare on a daily basis, there are a lot of things going on in the world that I follow with varying levels of attention. Sometimes these move more into or out of focus depending on the kinds of consulting engagements that I’m doing.

For example, if I’m working on quality improvement projects, I do a lot of reading to make sure that I’m up on the current metrics. If I’m working on a project involving order sets, I make sure that I’m up on the latest and greatest guidelines and treatment plans for whatever conditions I’ll be addressing.

As an HIStalk contributor, I try to keep up more broadly with everything that is impacting healthcare and healthcare IT as a whole, including worldwide health conditions, new scientific discoveries, emerging technologies, and where organizations are spending their money, whether they’re hospitals, healthcare systems, solution vendors, or independent physician practices.

There are dozens of other CMIO and CMO level consultants who are in the same position. Most of us are also keeping a close eye on what’s happening in government, especially where it comes to changes in staffing levels for the Department of Health and Human Services, the National Institutes of Health, the Centers for Disease Control and Prevention, and similar state-level organizations.

Changes in those organizations have a trickle-down effect on the patients who have trusted me with their care, along with every other person in the US. With changes to the US participation in the World Health Organization and withdrawal of funding for global vaccination programs, changes to health policy in the US also impact people around the globe.

These changes have also impacted me as a patient. I recently learned that a clinical trial to which I have been accepted has lost part of its funding. I have met the qualification criteria, but they aren’t randomizing any new patients into cohorts.

It has been months since I started the process to be part of this trial. It was an emotional rollercoaster as I went through the qualifying process, having to send medical records from multiple institutions and hoping they not only got there in a timely fashion, but were accurate and not full of a bunch of EHR-generated nonsense.

Once all the records finally made it there and were reviewed, I went through an intake process that included genetic counseling as well as testing beyond what I’ve already had. I’ve received the results and was in the final stages of being assigned to a trial arm, only to have the rug pulled out from under me.

When people talk about the “waste” in clinical trials in hyperbolic and abstract ways and imply that funding cuts were deserved, it makes my stomach clench. I’ve spent a significant amount of my professional career doing process improvement and eliminating millions of dollars of waste from healthcare organizations, so I know what waste is. I know how to identify programs that aren’t running efficiently and those that are doing well. I know how to lead change and how to strip significant dollars out of organizational budgets in a compassionate way.

None of that has ever been done by just walking into a hospital or health system and announcing sweeping cuts without any consideration whatsoever. There are consultants who do that, but I’m not one of them, nor will I ever subscribe to that philosophy.

Many of the clinical trials that are being impacted by slash-and-burn cuts affect real live patients. We’re not fruit flies in a lab, or some futuristic technology that someone just cooked up to draw down funds.

Fortunately, the study in question has multiple sources of funding, including a number of private ones, so it hasn’t had to shut down completely. Those who were already randomized into a cohort will continue to receive the intervention to which they’re assigned. It’s just the rest of us that are in limbo. I’m happy that it’s continuing to run because hopefully I’ll be able to benefit from the results of the study once they’re known, but watching this unravel has been truly depressing.

When you agree to participate in a trial, you realize that you might receive “standard care” and not the intervention, and you have to come to terms with that. Now I’m definitely receiving standard of care, and it’s not the missing out on the intervention that I’m really sad about as much as having been excited to participate and to be able to make some kind of good come out of my situation. Not to mention that the results of this trial will impact women for decades to come and may yield a change in direction for the care that is received by millions of mothers, sisters, grandmothers, aunts, and daughters.

Some of you may be asking, “What does this have to do with healthcare IT?” or commenting that I’m on my soapbox again. Indeed, I’ll admit it. After nearly 1,500 posts that span more than a decade, I reserve the right to share the patient experience, even if it is my own. I also reserve the right to write about things that might be construed as “political” when they impact patients, because everything that impacts patients is in my physician lane. I will also keep calling out waste when I see it, whether it’s in the form of unnecessary testing and treatment or the misalignment of healthcare resources, incentives, and technologies.

I think that all of us that work in healthcare IT have the opportunity to do better and be better when we consider how our daily actions can impact patients in our world, our nation, and even our neighborhood. We are literally all connected in ways that we might not imagine.

I have a friend who sells interventional radiology solutions that are highly reliable and come from a trusted manufacturer. Physicians prefer them to the competition and feel they they support higher-quality procedures. When he gets tangled up in his company’s sales processes, he focuses on a mutual friend who recently had a procedure that falls within his solution’s scope. He reminds himself that even though he doesn’t like some of the things he has to do in his job, they need to be done to get the best solution to the point of care in more places every year. With the assistance of this mindset and keeping the patient at the center of his work, he routinely meets his company goals, and when you hear him talk about his job, it’s easy to understand why.

There’s an episode of “The Simpsons” called “And Maggie Makes Three” where Homer explains why there are no pictures of Maggie in the family photo albums. He tells Bart and Lisa that the pictures are where he needs them, which is in his office at the nuclear power plant. They cover some letters on a company placard to change “Don’t forget, you’re here forever” to “Do it for her.”

Let’s all remember why we do what we do and remember that there’s a patient on the end of every decision, and eventually we will all be patients. Be aware, be informed, and be involved in understanding what happens in industry segments other than your own. When you’re the one on the exam table in 10 or 20 or 30 years, you’ll be glad you did. 

Email Dr. Jayne.