EPtalk by Dr. Jayne 8/2/18

From Captain Obvious: “Re: AMA policy advocating for EHR training in medical school. Seems like that horse has already left the barn.” Initially, I was surprised to see that it was just released in June 2018. It seems like something that should have come out way earlier, say back when regulators were cooking up Meaningful Use and other endeavors that would dramatically increase the use of EHRs. Reading a bit deeper, the AMA is alleging that some hospitals and training programs are restricting access to EHRs for students and trainees. That hasn’t been my experience in the local community, where so-called scut work continues to roll downhill to the students and lower-level trainees.

I do agree with the AMA that there are “concerns about the effects of the EHR on student and resident relationships with patients, in that students and residents may be more engaged with the chart and computer than with the patient.” It doesn’t sound like the EHR is restricted, though, if trainees are engaged with it. AMA asks that training include education on “institutional policy regarding copy and paste functions” as well.

AMA also goes on to state the obvious: “Students may receive poor role modeling from faculty, as well as from the entire care team, on appropriate use of and best practices for EHRs.” The document goes on to ask that training programs “provide EHR professional development resources for faculty to assure appropriate modeling of EHR use during physician/patient interactions.” Banging on keyboards and kicking computers on wheels is something I’ve seen more often I care to, so I certainly support that last bit.

The Medical Board of California launches the first “license alert” mobile app. Rather than searching on the Board’s website to see if providers had new discipline notices on their licenses, the app can directly notify patients when changes are made. Suspensions can be communicated in a matter of hours to panels of patients, who are able to follow up to 16 providers at a time. The Board believes users will want to follow not only their own providers, but also those of close family members. Users will also receive notification of address or practice status changes as well as license expiration. The app is only available for Apple devices, but they do plan to deliver an Android version next year. I’d be game to just subscribe to my own updates, which I’ve been stalking on my State’s board for the last couple of weeks. Every time our practice opens a new site, it’s an adventure to get dozens of providers updated in a timely fashion and I always wonder whether I’m current.

Centene announces its intent to explore a joint Medicare Advantage plan with Ascension. They plan to target several US insurance markets by 2020, creating a “preferred model” for providers in the Ascension health system. Ascension is the largest non-profit health system in the US. The agreement is non-binding with approval required by the respective boards of directors, so there’s always a chance the wheels will fall off before it launches. No details were provided as far as how the plan would operate, how patients would join, any fees, or what would happen if patients need out-of-network care.

This week, CMS finalized three 2019 Medicare Prospective Payment System (PPS) rules, covering Skilled Nursing Facilities, Inpatient Rehabilitation Facilities, and Inpatient Psychiatric Facilities. CMS cites them as victories in the battle for “Patients over Paperwork” along with reducing “unnecessary burden” and “easing documentation requirements” while “offering more flexibility.” The release reads like a game of buzzword bingo, and I honestly had to stop reading it before I lost my mind. I struggle to keep up with the ambulatory payment rules in depth and the inpatient payment rules at a high level. I applaud the people who are able to keep up with all the different rules covering all the different sites of care.

A recently study presented at the American Society of Clinical Oncology meeting  looked at patient acceptance of genetic counseling using a remote platform compared to care in the community without genetic providers. Researchers hypothesized that remote access to specialists would increase access to genetic testing. The data did suggest that both telephone and video conference can improve adoption of genetic testing, although researchers note that a comparison of video vs. telephone modalities will be needed to identify the best way to drive outcomes. Having been through genetic counseling myself, I know there is a vast body of knowledge that I can’t begin to address as a primary care provider. Knowing how many people are taking advantage of consumer-oriented genetic testing, I’d rather see patients meet remotely with an expert than to be subjected to my efforts at ad-hoc research.

As we are increasingly connected through technology and social media, it feels like there is a frenzy of competition for our time and attention. I’m not sure if it’s a direct reaction to that phenomenon, but I feel more frequently drawn to getting away where I can think without distraction and experience some of the wonderful things that our continent has to offer. Already in that frame of mind, I came across this piece from earlier this year where former Surgeon General Vivek Murthy talks about the level of loneliness that people are experiencing despite being “connected” 24-7. He recommends that we put down our phones and try to make actual face-to-face connections with the people that are important to us.

Researchers believe that feeling loneliness can be as harmful for health as smoking nearly a pack of cigarettes each day. Loneliness leads to stress and inflammation, which sets us up for illness. Although choosing to be alone is different than loneliness, it can still be risky. Murthy encourages us to “focus on rebuilding our connection with each other.” Having seen many families at airports this summer all staring at phones rather than talking to each other, I endorse his relatively straightforward prescription. Cigna released similar data in May – it’s worth a read.

It’s hard to believe, but today marks my 800th post for HIStalk. It’s been an amazing privilege to be part of this team and to be able to put my finger on the pulse of healthcare IT. Thank you to all our readers and sponsors who help make it possible every week.

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