EPtalk by Dr. Jayne 8/3/23

HIMSS finally sent out a communication about changes to its conference offering. The email was sent by President Hal Wolf and described the change as “a landmark partnership with Informa Markets to propel the growth and evolution of the HIMSS Global Health Conference & Exhibition.”

As a student of language, I noted the lack of description around how or where the conference was being propelled, which are usually important parts of a complete idea. It was further described that Informa will take on management of the conference, but HIMSS will oversee content development and programming. The email closed with standard corporate statements intended to mollify members who don’t feel they’re getting much value for their money, namely that member discounts will continue for the conference, and that HIMSS will “continue to provide and enhance the highest quality thought leadership, services, events, and experiences for our membership base.”

For those of us who don’t feel that HIMSS has been doing an adequate job of providing those things in the first place, the email doesn’t inspire confidence in a bright future.

Wolf goes on to brag on “the unparalleled thought leadership that HIMSS has established in the health tech community” with zero acknowledgement that many of us have shifted our loyalties to other conferences and forums because they’re better meeting our needs.

The email closes with a link to a HIMSS press release that really should have come out before this news broke last month. Informa Markets organizes shows for other economic sectors, including engineering, construction, and fashion, so we’ll have to see what their expertise brings to the often humdrum land of healthcare.

From Regulatory Inertia: “Re: PDMP. This article says the Missouri Prescription Drug Monitoring Program (PDMP) is on track to go live despite the fact that no go live date has been set. Isn’t this a pretty obvious project management failure? Not to mention, Missouri is the only state in the US that still doesn’t have a Program.” States have been implementing electronic PDMPs since 1990, when Oklahoma implemented the first electronic database. The idea of a database goes back to as early as 1918 in New York, while California has the oldest continuously operating program since establishing it in 1939. Legislation for a statewide program in Missouri was finally approved in 2021, with a task force made of representatives from the Board of Registration for the Healing Arts, the Board of Pharmacy, the Dental Board, and the Board of Nursing all weighing in. The program’s executive director is the one cited as saying the program is on track. Missouri providers are served by the St. Louis County PDMP, which has been live since 2017 and provides information for 85% of residents and 94% of providers. The state has selected Bamboo Health as the PDMP’s vendor and plans to convert data from the St. Louis County PDMP during the implementation process. Let’s see if Missouri can live up to its claim to be the Show Me State and whether it can play catch-up with the rest of the US.

Thermo Fisher Scientific has settled a lawsuit with the family of Henrietta Lacks. Lacks was a patient at Johns Hopkins Hospital in 1951, when physicians took cells from her cervix to use for research without her consent. Lacks ultimately died of cervical cancer, but her cells were the first human cell line that was able to continuously reproduce in the laboratory environment. The so-called HeLa cells became key to many scientific developments, including vaccines. Although consent was not a legal requirement when the cells were taken, the case is often cited as an example of the exploitation of black patients. There have been plenty of commercial endeavors that relied on those cells, and descendants of Lacks sued Thermo Fisher Scientific due to their ongoing use of the cells without compensation. Her grandchildren were among the participants attending settlement talks in the case. The terms of the final settlement are confidential, with representatives of both parties refusing to comment on the outcome.

Lacks died at age 31 and was buried in an unmarked grave, but the cell line created from her tumor is often referred to as immortal. The larger story is detailed in “The Immortal Life of Henrietta Lacks” by Rebecca Skloot, and a 2010 HBO movie further publicized the issue. Although Johns Hopkins denies selling or otherwise profiting from the cell lines, they aren’t blameless in the situation. They acknowledged “ethical responsibility” after the book’s publication. With regard to the court case, numerous briefs were entered in support of the Lacks family and provide additional details about the nonconsensual involvement of patients in research and details of procedures performed on enslaved persons in the name of science. It will take decades for modern medicine to come to grips with this legacy. The family announced the settlement and paid tribute to Lacks on a date that would have been her 103rd birthday.

I’m always amazed by the number of physicians that think they’re not allowed to talk about problems they find in their EHRs or that they’re not allowed to report defects. There are myths about contracts that health systems have signed that will result in punishment for physicians who do so. Despite having been in the industry for a long time and knowing hundreds of people within it, I don’t know anyone who has ever seen this kind of contract language. With that in mind, I was interested to see this recent JAMIA article that looked at so-called EHR “gag clauses” and whether a policy change from the Office of the National Coordinator for Health IT that restricts the use of such clauses has made a difference in whether EHR screenshots appear in peer-reviewed literature. The authors looked at journal articles that were published between 2015 and 2023 to identify how many contained screenshots. For those that didn’t have such graphics, they determined whether the articles would have benefitted from them.

The articles focused on EHR usability and safety. The authors found that the percentage of articles that contained screenshots remained stable even after the prohibition of gag clauses. Prior to the change, 10% of articles would have benefitted from screenshots, where after the change, they determined that 20% would have benefited from screenshots. They concluded that additional work is needed to promote inclusion of screenshots in scholarly publications. In talking to some of my physician colleagues, most don’t understand that there’s been any change in the situation with respect to gag clauses or restricted disclosure of EHR content. I suspect it will be a long time before the idea of such clauses is fully dispelled.

Have you personally seen a gag clause in your EHR vendor’s contract, either before or after the ONC policy change? Leave a comment or email me.

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