EPtalk by Dr. Jayne 9/18/25

This week marks the fifth annual Telehealth Awareness Week with the American Telemedicine Association hosting numerous online events. Many of the clinicians I know didn’t have any awareness of telemedicine prior to the COVID pandemic and some of them had to be diligently persuaded to offer video visits. I had been doing telehealth work (both on the IT side as well as clinically) for several years prior to its significant expansion in 2020, so I was used to working with that modality and was able to do some provider coaching and education when things started getting busy. It’s important to remember that there are many different varieties of telehealth beyond the traditional patient/provider video visit. I’ve worked with organizations using telehealth for referral/consultation visits where the referring provider is in the room with the patient, for physician triage in the emergency department, for additional expert coverage in the intensive care unit, for lactation support, and more. The benefits of a well-run telehealth program are substantial, and I hope organizations continue to refine their telehealth offerings.

In celebration of the event, I’d like to share a classic article from Smithsonian Magazine, which reports that the idea of telemedicine was initially predicted in 1925. Radio pioneer Hugo Gernsback envisioned a device called the “teledactyl” that would allow physicians to view patients but also perform remote examinations via robot arms. As I read the article, I noted the similarities between this and surgical robots, which can be used to perform surgery when the surgeon is at a remote location. The article is a quick read and there are some links to similarly interesting articles at the bottom detailing “The iPad of 1935” and “The Episode Where George Jetson Rages Against the Machine,” which covers some topics that are still relevant more than a decade after the piece was written.

Speaking of TV, I’m a big fan of the show “Call the Midwife,” which depicts community-based nurses and midwives in London’s East End from the 1950s to the 1970s. The series’ writers do a great job showcasing different healthcare events of the various eras including major happenings such as the availability of oral contraceptives and the injuries caused by the drug thalidomide. It’s a window into how healthcare has been delivered in the home and how having nurses and physicians who actually know their patients can make a difference. Although a lot of health systems are expanding home health offerings, including “hospital at home” efforts, they still feel more fragmented than the community-based approaches with which patients may have even more benefits. Since the midwives in the show support home deliveries (as well as ones at the community maternity hospital), they also provide postpartum care in the home, so a recent article about “How home-based postpartum care could improve health for women and children” caught my eye.

It looks at how home visits can support patients who just gave birth as well as their infants, how they can improve breastfeeding outcomes, and how they can reduce emergency visits. I always think about the fact that in the US you have to take a test (both written and skills-based) to become licensed to operate a motor vehicle, but it’s assumed that everyone has the skills to take home a newborn without any formal training or scheduled support. Things may be different in situations where new parents live close to family members or have community support, but I often encounter new parents who feel like they’re adrift and end up having an urgent care visit to try to make sense of what’s going with their own body or with their infant.

The article mentions a 2024 study that looked at newborns and caregivers in South Carolina and found that those participating in a home-based program had fewer emergency department visits in the first twelve weeks postpartum than those who weren’t in the program. It also mentions lower costs and better outcomes for infants receiving home visits. I don’t see a lot of insurance companies advertising these kinds of benefits, so if there are readers whose organizations are involved in similar programs, I’d love to hear your thoughts.

There have been a few studies looking at the number of problems a patient mentions at the average primary care visit compared to the number of problems documented in the medical record and the number of diagnoses that make it to the billing screens. In general, physicians talk about more issues than they document, and bill for even fewer. A recent article in JAMIA titled “Comparing patient-reported symptoms and structured clinician documentation in electronic health records” caught my eye. I agree with the authors as to the importance of these types of information, especially with the focus on real world data, which relies on what is documented in EHRs. Patient-reported outcome measures (PROMs) are a way of getting more structured data into the chart rather than relying on clinicians adding structured elements as they gather the patient’s story. The authors set out to see how symptoms reported via PROMs compared to those reported by clinicians via EHR data entry.

The study looked at 913,000 adult primary care visits for “annual physical” done between January 2019 and December 2023. With that specified visit type, there should have been a lot of preventive care going on, with possibly a smattering of chronic condition management depending on how strictly the clinicians interpreted the concept of the annual physical. Regardless, most visits have a Review of Systems that is designed to elicit additional symptoms beyond what the patient volunteers as part of the History of Present Illness, and one would try to document them accurately. Unsurprisingly, the authors found that patient-reported symptoms for some conditions (joint pain, headache, sleep disturbance) were more numerous than those reported via clinical documentation. However, other symptoms had a higher frequency via clinical documentation (anxiety and depression). Researchers noted that “agreement between symptom self-report and clinician-documented structured codes was low to moderate.”

Most medical studies need to be replicated across diverse populations and in different care settings in order to have maximum validity. They also often lead to discovery of additional questions that need to be researched. Given the push for ambient documentation across all facets of healthcare today, one could hypothesize that ambient should do a better job of helping clinicians capture all the symptoms that patients report. I’d love to see this research replicated in an organization that is exploring the use of ambient documentation tools and perhaps comparing two sites that have the same EHR setup, but only one has access to ambient documentation tools. I think it would make for a fascinating read. I’d also be interested to see whether organizations that use tools specifically designed to capture PROMs have better agreement with clinical documentation, especially if they have workflows where the patient-generated data is reviewed as part of the visit. If you’re doing work using patient-reported outcome measures, I’d love to hear from you.

What’s a topic that you really wish healthcare technology researchers would sink their teeth into? Leave a comment or email me.

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