EPtalk by Dr. Jayne 4/17/25

I’ve been a follower of prescription digital therapeutics for years. I have watched with great sadness as companies have come and gone without getting the traction their products needed to help broad groups of patients.

Click Therapeutics recently received FDA marketing authorization for the first prescription digital therapeutic for prevention of migraine headaches. The solution, called CT-132, is designed to be used in conjunction with other preventive or acute migraine treatments for patients aged 18 years and older. The study used for its application looked at the therapeutic’s use in patients who were already receiving treatment that met the standard of care and was able to significantly reduce the number of migraine days per month.

The company already offers solutions for a number of conditions including depression, diabetes, schizophrenia, insomnia, multiple sclerosis, and opioid use disorder. I’ll be eager to see how it does over the next couple of years.

I was also interested to see a write-up of research on using an AI-powered wearable to improve function for patients with essential tremor. I have relatives with the condition, and it can significantly impact quality of life. The Felix NeuroAI device  is considered investigational but was shown to reduce tremors and improve the ability of users to perform daily activities by delivering electrical stimulation to the peripheral nerves in the wrist. Additional research is being conducted at the University of Kansas School of Medicine. Of note the company that makes the device was founded through the University of Minnesota, so here’s to cool tech coming from the Midwest.

I’ve taken a cautious approach to using real-world evidence in my practice, making sure that I’m using it in conjunction with traditional evidence-based recommendations. Those of us who have been in practice for a while know the risk of the “everyone’s doing it” approach to medicine (Vioxx, anyone?) rather than ensuring that the risks of new treatments don’t outweigh their potential benefits.

For drugs that are already in broad use, however, real-world evidence can be useful to identify adverse effects and unanticipated outcomes. A recent study looked at three GLP-1 receptor agonist weight loss drugs, examining adverse events. They found that one drug had significantly fewer reports of adverse drug reactions , but another was associated with some serious adverse events, including suicidal ideation and vision loss. It remains to be seen whether these results will be flagged to help develop larger or more comprehensive studies, but they’re important, nonetheless.

One of the most rewarding elements of my work as a consultant specializing in EHR optimization was identifying non-value-added steps in workflows and eliminating burdensome documentation that couldn’t be clearly linked back to a regulation, official requirement, or quality measure. A recent study in The Permanente Journal addressed the misinterpretation of regulations by compliance professionals. The authors presented 16 study subjects with five clinical scenarios and scored their interpretations for variability of interpretation. Only one-third of the subjects had formal training as a compliance professional, which I found interesting. As the authors presented the scenarios, they found that given the same scenario, some subjects identified noncompliance where others voiced no concerns.

One of the scenarios presented was the bane of many healthcare workers, namely whether food and drink can be consumed in work areas. Others included order entry by non-physicians, compliance with HIPAA requirements, the need to document a pain assessment, and whether physicians have to document the history of present illness independently. If you’re finding that your organization has workflows that have “always been done that way” but no one can link them back to a requirement and there’s an easier or better way to do them, it might be time to push back and ask for a review with the goal of removing such burdens. The last thing that burned out care teams need is overzealous interpretation of requirements or enforcement of those that don’t exist.

I was excited to learn that one of the states where I am licensed is implementing new functionality in their Bamboo Health-powered Prescription Drug Monitoring Program (PDMP) system. Prescribers will now be able to see a risk score for unintentional overdoses that takes into account the different drugs for which a patient has filled prescriptions as well as the duration of those prescriptions and the number of pharmacies at which they’ve been filled.

My primary practice is in a state where this is not yet implemented, but then again, we don’t even have the PDMP integrated into the EHR. Even though we have to log in separately, the system has still helped me identify concerning patterns for a number of patients in my care. It’s also been used in my state to identify physicians behaving badly, so I’m grateful to have a system that helps protect my patients and colleagues from those who might do unscrupulous things.

Yesterday was National Healthcare Decisions Day, which was created to encourage patients and their care teams to discuss advance care planning. I hadn’t heard of it before this year and was amused to learn that the April 16 date was selected with a famous Benjamin Franklin quote in mind: “In this world, nothing is certain except death and taxes.” Individuals are encouraged to do their US taxes by April 15 and review their health care directives the next day. The observance was founded in 2008 and encourages not only patients and providers to participate, but also community groups, healthcare facilities, and religious organizations. More information is available at The Conversation Project, which is part of the Institute for Healthcare Improvement.

I’ve seen enough things in my medical career to know that I never want to be without a document that details my wishes for care (or lack thereof). When I arrived at the hospital for what could be one of the most medically risky events in any woman’s life, the labor and delivery nurse acted stunned when I handed her a copy. She said it was the first time she’s seen one from a patient. Let’s normalize talking to our families and loved ones about our wishes and help them to document theirs.

Do you have a living will, advance directive, or healthcare power of attorney? If not, why? Leave a comment or email me.

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