EPtalk by Dr. Jayne 8/22/24

I’ve spent a fair amount of my career working with the underlying datasets and codes that make EHRs work, including ICD-9, ICD-10, SNOMED, LOINC, RxNorm, CPT, DSM, and HCPCS. Normally I’m not that excited about changes to the data, but I am closely following the efforts of clinicians and military personnel to advocate that the American Psychiatric Association update the name of “posttraumatic stress disorder” in the next revision of the Diagnostic and Statistical Manual of Mental Disorders. They are proposing that it be renamed to “posttraumatic stress injury” on the grounds that the current name has the potential to cause harm. Advocates note that the word “disorder” brings stigma to the condition, where “illness” frames it as something that can be treated. Considering the numbers of my colleagues who have been impacted by the condition since the COVID pandemic, anything we can to do help them heal is welcome.

The American Board of Internal Medicine (ABIM) has revoked the board certification status of two physicians who are accused of disseminating COVID misinformation through an organization that was advocating the use of ivermectin to treat viral infections. The physicians in question claim that their promotion of the treatment falls under free speech and that the ABIM’s actions were an “attack” on that. I agree with commentary in the article by a professor of bioethics that there’s a difference between free speech and practicing outside the standard of care.

From The Name Game: “Re: health systems buying sports venue naming rights. I know you’re not a fan. Did you see this article about Northwestern Medicine’s newly-named stadium?” The temporary stadium will host Northwestern University’s football, soccer, and lacrosse under the Northwestern Medicine Field name for the next two years while a permanent facility is being built. New rules on commercial advertising at the college sports level are a result of updated NCAA rules. Since Northwestern Medicine provides healthcare services to the university’s athletic programs and students, it at least makes more sense than some other facility naming agreements I’ve seen.

If you’re all about digital health and contemplating a career change, the Veterans Health Administration (VHA) is hiring for the role of chief digital health officer. The position involves a four-year appointment with the potential for reappointment. The position is open to physicians, dentists, or health science officers. Although it’s advertised as a 40-hour-per-week job Monday through Friday, I suspect the workload is likely more than that since areas of impact include “integrating and resourcing digital health functions, providing a consistent approach to digital health integration, and establishing and implementing the VHA digital health transformation strategy.”

I particularly liked the part about needing to “collaborate closely with end users in the field and VHA patients to understand their needs and how VA’s digital health solutions are and are not working for end users.” Based on the stories I hear coming out of VA digital health projects, that element seems to have been lacking for some time.

From Follow the Data: “Re: hospital error. I’d love to be part of the root cause analysis at the hospital that told next of kin that their loved one was discharged against medical advice, when in reality she had died and her body had been misplaced.” According to news reports, records indicate that the patient was discharged in April 2023. More than a year later, a Sacramento County sheriff’s office detective notified the patient of her death. The family has filed a lawsuit that seeks $5 million in actual damages and $10 million in punitive damages.

Pet peeve of the week: I was on no fewer than three webinars this week where they posted QR codes and expected attendees to use their phones to take a picture to get to a link. If your webinar platform has a chat function, please consider using it to push out your links rather than making people use their phones. Many of us will need to send the links to ourselves to view the content on a different device instead of trying to read downloaded information in a space barely larger than the palm of your hand. Webinars that put URLs on their slides but don’t share them in a clickable fashion also go on the list. An even better solution would be to send the appropriate links and downloads in a follow up email for those of us who are old school, along with a copy of the presentation and/or a link to a recording.

Bad news for all of us IT types who have had to perform overnight upgrades and installs. The journal Sleep Advances recently published an article that looks at the negative effects of even a single night of sleep deprivation. The authors analyzed 500 proteins and found that sleep disruption changed the composition of human blood. The study size was small, consisting of eight adult women aged 22 to 57 years. The participants were their own controls, with blood samples obtained after adequate sleep and then after inadequate sleep. Researchers found 66 proteins that were expressed differently after sleep deprivation, including ones that involved platelet function and blood clotting. This study wasn’t powered to find clinical impacts, but may lead to additional research and future learnings.

Some of the most fun nights of my professional career have been spent doing late night testing for projects that could only be tested on production systems, as well as performing upgrades and feature releases. In the early days of EHR rollouts, teams were small and often I was the only clinician on the team who could sign off on clinical regression testing and certify that a release met the criteria to be unleashed on clinical users the next business day. I cherish those times as well as the relationships they helped build. To this day, many of you are still on my “phone a friend” list for when the healthcare IT going gets tough. Thanks for the laughs and for teaching me about Citrix and single sign-on solutions in the wee hours of the night. We deployed Vergence with a vengeance, and I’m grateful for each of you.

Several readers sent me pictures and commentary from the Epic UGM this week. The theme was “Storytime!” and Judy Faulkner dressed as “Lady Swan,” which was her homage to Mother Goose. Supposedly this swan boat was available on one of the campus lakes for attendees who wanted to give it a gander (thanks, I’ll see myself out). It sounds like one of the key themes was the importance of childhood brain development and reading to children, and Judy shared a story about setting her family TV to PBS and hiding the remote control from her children. Other thoughts sent by readers:

• UGM is getting too big, so they’re considering strategies to split it similar to a few years ago when they spun off XGM.
• The new record for “bigger bang” go lives is upwards of 45,000 users.
• There was a lot of talk about AI-augmented responses in the In Basket, helping clinicians respond to patients more efficiently.
• Carl Dvorak stole the show with his story of flying to California for the birth of a grandchild. He thanked the clinicians for their excellent care, but apologized for looking over the nurses’ shoulders while they cared for his family.

If you attended the Epic UGM this week, what were your takeaways? Leave a comment or email me.

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