EPtalk by Dr. Jayne 9/26/19

It’s US National Health IT Week, as promoted by HIMSS. I’m working with several organizations right now and none of them is doing anything to “celebrate” the occasion.

The reality of things is that we’re all exhausted by our health IT endeavors. Back in the early days, and before Meaningful Use gummed up the works, it was exciting to be on the cutting edge (and sometimes bleeding edge) of things. As an early adopter organization, we had some pull with our vendor and could demand improvements in the software. Now that they’re just trying to keep up with federal regulations and satisfy shareholders, there’s no initiative to make the customers happy.

If your organization is actually doing something to mark the occasion, I’d be interested to hear about it.

CMS has updated the Medicare Plan Finder website for the first time in a decade. Medicare beneficiaries can access it on Medicare.gov and use it to compare Medicare Advantage and Medicare Part D plan. The upgrade is supposed to be mobile-friendly with enhanced readability. I asked one of my favorite Medicare beneficiaries to tell me what they think of it and he couldn’t find it, probably because he was looking in Google Play rather than the website. I gave it a peek myself and it was pretty vanilla. Apparently the coverage I’d want costs a pretty penny in today’s dollars, so I better work on my skills for retirement savings. Approximately 10,000 people enroll in Medicare every day, so who knows if there will even be any money left for coverage by the time some of us get there.

Most of us are familiar with the Google influenza tracker that used to be available. Although it has been sunset, it used symptom searches to try to identify flu cases. I was excited to see this article in the Journal of the American Medical Informatics Association that looks at internet search data as a way to predict emergency department volume. The authors looked at whether Google search data can be applied to ED volume forecasting to improve accuracy compared to existing methods. The data was from Boston Children’s Hospital, local public school calendars, National Oceanic and Atmospheric Administration weather data, and Google trends. As they added data sources, the model became more accurate. I wish my facility would get on board with this kind of big data, because right now our staffing model is very, very off.

From CliqBait: “Re: hit man. Definitely a head-turner, if not also a head scratcher.” A former University of Iowa medical student goes to prison for trying to hire hit man. The Gazette details the story of a man who wanted to kill one of the university’s associate deans after he informed the student he could no longer attend. The accused pleaded guilty to a firearms charge, but the murder-for-hire plot increased his prison sentence. Pro tip: Don’t hire people to kill other people, especially when your supposed hit man is an undercover law enforcement agent. And if you do make the mistake of trying to do so, don’t offer illegal machine guns as payment for the deed.

Surprise, surprise: a recent journal article notes that data found in EHR visit notes doesn’t always match the examinations performed by physicians. Reviewers compared real-time observational data to EHR documentation and found that they could only verify the Review of Systems 40% of the time and the physical exam only 50% of the time. Most of the discordant findings were in clinical systems that were less clinically relevant to the patients’ presenting complaints. For example, patients who presented with gastrointestinal or genitourinary issues had a small number (5.4%) of findings in those systems that didn’t match. For the same patients, there were plenty of unsubstantiated ear / nose / throat exams (81.8%). One could surmise this happens because of overly-detailed defaults or copy/paste, but either cause culminates in physicians not proofreading and correcting their own notes. The authors call for additional studies to determine how extensive these findings might be since the physician subjects were residents in training and a small number (180) of patients had their encounters observed. They also encourage payers to remove financial incentives that lead to physicians over-documentation.

New England Journal of Medicine Editor-in-Chief Eric Rubin, MD, PhD is shaking things up by saying that “thought print may not be dead, it might soon need palliative care.” He plans to continue to bring the publication into the current century by making it more interactive with a greater online presence. There’s even talk about relaxing rules regarding authors who post copies of manuscripts on preprint servers, getting information into the hands of other researchers faster than the typical peer-reviewed publication pathway. Times are changing and it’s difficult for traditional media outlets to keep up. Print media continues to struggle. In a neighboring corner of the Midwest, the St. Louis Post-Dispatch just moved out of their historic building in downtown St. Louis. The new tenant: mobile payment technology company Square.

Mr. H mentioned this earlier in the week, but Amazon has moved into the telehealth space with its launch of Amazon Care. According to the public-facing website, the service offers virtual visits, in-person visits at home or office, and “prescriptions delivered to your door.” Services will include both urgent care and preventive scope of practice, including contraception and testing for sexually transmitted infections. Nurses can provide vaccinations and collect laboratory samples at the patient’s location. Eligibility is limited to Amazon employees and their families who are enrolled in an Amazon health insurance plan and who are based in the Seattle area. Employees who are enrolled in Kaiser Permanente plans are ineligible. The service is available Monday through Friday 8 a.m. to 9 p.m. and weekends from 8 a.m. to 6 p.m. Medical services are provided by Oasis Medical Group, which hopefully provides a layer of privacy for employees seeking care. Since this is a pilot program, employees have to request an invitation to participate. It will be interesting to see how this plays out in the coming months.

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