EPtalk by Dr. Jayne 4/4/24

As usual, Epic put smiles on peoples’ faces with its annual April Fools’ Day webpage, stating that “the newest building on Epic’s campus will have the coolest theme, like, ever: Barbie Dream House.” It went on to say that the fictional building would include a pool slide and conference rooms named Beach, Girls’ Night, and Mojo Dojo Casa House.

The page also joked that Epic had been selected by television network ABC as the official EHR of “Grey’s Anatomy” to add more medical realism to the series. It wrapped up with a discussion of MyHeart: Epic’s New Dating Portal that “runs advanced searches to find patients near you who might be a good match based on hundreds of criteria, including your problem list, allergies, medications, and more.” Well played folks, well played.

I’m in the middle of an onboarding process for a new position, and although I was dreading the experience, it’s one of the better ones I’ve been through. As a consulting CMIO, I’ve worked with dozens of health systems and care delivery organizations and have gone through either full onboarding processes (when I’m an employee) or through modified onboarding (when I’m a contractor.) The experiences have varied dramatically. One of the worst processes I’ve ever seen involved demands to sign documents attesting to the fact that I had received and read policies that didn’t exist, which I only found out after asking to see them. I wonder how many of their regular employees just signed blindly? Some of the better processes have a clear onboarding checklist to ensure that you’re doing everything in the right order, and the best have that plus the ability to ask questions real time.

I’ve been through dozens of HIPAA training courses, as well as education on fraud, waste, and abuse, to the point where I could probably teach the curriculum. For this position, even though the role is technically non-clinical, I had to go through training on proper lifting, ergonomics, and the importance of non-skid footwear, none of which I’ve gone through for patient care despite the fact that they would have been useful. If you’re looking for an example of training that will engage people rather than make them snooze, I highly recommend Skip, the workplace safety superhero. It will be interesting working in an actual office again. Even though I’ve done patient care in person, this will be a different type of environment, and I’m excited that it doesn’t require navigating a TSA checkpoint or wondering whether my rental car will be there when I arrive. It’s time to dust off my trusty lunchbox and pack my Thermos for what I’m sure will yield many good stories.

From Jimmy the Greek: “Re: telecommuting. I’m a fan, but also recognize that with privileges come responsibilities. Now that I’m fully entrenched in a hybrid model where employees within a one-hour commute of an office are required to be in the office three days per week, it’s been interesting to see how our remote employees still enjoy a certain relaxed atmosphere in their home offices. The company I work for has a strict tobacco-free policy on all company campuses, but it also covers remote work, where employees are prohibited from ‘smoking or using tobacco products’ while visible on a web conference. It was a bit jarring, therefore, when one of my fully remote co-workers stepped onto her front porch to enjoy a smoke while fully visible on a Zoom meeting. I don’t smoke, but if I did, seeing someone light up a Marlboro while I was stuck in a conference room almost a kilometer away from an area where I could smoke without fear of disciplinary action would definitely reduce my overall job satisfaction.” I’ve read a number of employee handbooks in my career and this is one place where the devil might be in the details and sentence structure is everything. The use of the phrase “prohibited from smoking or using tobacco products” implies that they are only blocked from smoking tobacco cigarettes and not others. Vaping, which is certainly as distracting as smoking cigarettes, isn’t mentioned, nor are marijuana cigarettes. Perhaps the human resources department might want to consider more specific language that includes all the different things one can smoke as well as vaping and/or use of other tobacco-containing products. For the employee in question, a refresher on learning how to operate camera controls might be in order.

I was excited to see that the Department of Veterans Affairs is implementing some solid use cases for artificial intelligence. One model called REACH-VET is designed to help identify veterans who are at highest risk for suicide. Another uses natural language processing to flag patient feedback for comments that suggest homelessness or other issues where human intervention might be appropriate. A third model looks as veterans with prostate cancer to differentiate those who will do well after initial treatment from those who need more frequent follow-up. Congressional subcommittee members responsible for VA oversight want to ensure that safeguards are in place when AI is used, with Technology Modernization Subcommittee Chair Matt Rosendale pushing the VA to make veterans aware of instances where their data is being used in AI models.

I was also pleased to see the US Senate looking into whether emergency department care delivery has been harmed by the involvement of private equity firms. The inquiry follows interviews with emergency physicians who are concerned about patient safety issues related to aggressive cost control activities. The most recent investigation falls under the Homeland Security and Governmental Affairs Committee and follows one that is already in progress by the Budget Committee that is looking at hospital systems that are associated with private equity.

I’ve worked for some of the companies that are part of the investigation, and based on my experiences, I don’t think the Senate is going to like some of the things they uncover. It’s no secret that what are considered the most cost-effective ways of delivering emergency care often involve the least-trained and least-experienced clinicians. When things get wild, there is no substitute for a seasoned emergency department physician with decades of experience under their belt, but organizations are certainly eager to replace them strictly on cost alone.

How do you feel about the rise of private equity in healthcare? Have you seen examples of where it’s helping or hurting? Leave a comment or email me.

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