EPtalk by Dr. Jayne 5/9/24

The American Medical Informatics Association is working with the Patient ID Now Coalition to persuade members of Congress to reject language in Section 510 of a 2025 appropriations bill that continues to ban the US Department of Health and Human Services from investing money towards a national unique patient identifier.

Organizations are still using a hodgepodge of matching algorithms that often work, but sometimes don’t. There are particular challenges with pediatric patients when organizations include phone numbers in the algorithm. Infants who might not yet have a Social Security number are also at risk. I’ve seen EHR conversions that inadvertently combined a pair of infant twins due to inadequate matching algorithms, so I would very much like to see a unique patient identifier even if it’s voluntary and patients have to opt in. The risks to patient safety remain great and I want my care teams to have access to all of my data.

Also in Congress, the House Ways and Means Committee is entertaining a two-year extension of Medicare telehealth rules that have improved reimbursement since the COVID-19 pandemic. There are multiple bills under consideration, including the CONNECT for Health Act and the Telehealth Modernization Act. Without an extension, the rules will expire at the end of this year. Primary care docs are leaving my state’s rural areas in droves, and increased coverage would allow patients to have visits with physicians in other areas of the state without driving for multiple hours.

I’m so used to working in high-reliability organizations that it shocks me when I encounter an organization that probably should be more high-reliability than it is. I was at a large regional post office this morning, and apparently they had experienced a power outage and the electricity had just come back on. There was one customer at the counter and two in line, so the postal employee announced what had happened and asked for our patience as they rebooted the systems. It took a few minutes for her station to come back up, and when the customer was ready to check out, apparently the credit card machine didn’t work. She was sending several registered mail items, so went out to her car to rummage for cash or a checkbook.

The employee suspended her transaction and called me to the window, making an announcement to the dozen or so people that had accumulated in line that the credit/debit machine was down and that they could only take cash or check. Everyone behind me turned and left, and I was grateful that I had my friend Andrew Jackson in my wallet, although I haven’t carried a checkbook in decades. One would think that the US Postal Service would be critical infrastructure and have at least some level of UPS backup (uninterruptible power supply of course, not the competition) with generator backup. They can deliver despite rain, heat, and gloom of night, but a power outage is going to put a dent in things.

I’ve been a panelist for several Women in STEM events and am always on the lookout for ways to increase the number of girls interested in healthcare and technology careers. During a recent talk, one of my co-panelists talked about “The Scully Effect,”  which shows that women who watched “The X-Files” were more likely to pursue careers in STEM-related fields. According to 2017 data, 63% of study respondents who were familiar with the Dana Scully character admitted an increased their beliefs in the importance of STEM.

Many of the young women I work with weren’t alive when Gillian Anderson began playing Dana Scully in 1993, so it will be interesting to see who will be STEM role models for newer generations. Media popularity now seems to be centered on TikTok and various social media influencers, many of whom share unscientific and downright dangerous content. I’d love to see a campaign to raise awareness about the roles available to women in healthcare IT, since I’ve run across multiple medical students who didn’t have a clue that it was a career path.

Federal regulators in the US are taking a greater interest in the issue of organizational consolidation in healthcare. They’ve opened comments looking to understand “the effects of transactions involving health care providers (including providers of home- and community-based services for people with disabilities), facilities, or ancillary products or services, conducted by private equity funds or alternative asset managers, health systems, or private payers.” You can browse the submitted comments (1,400 so far) and see how frustrated patients, physicians, and other providers are with our healthcare non-system. Hot topics in the comments I screened include lack of competition, greed, hospitals requiring pre-operative labs to be done in-house at a higher cost than competitive labs, the negative effects of companies like CVS expanding their scope of business, and compromised patient care. All the talking heads in healthcare should have to understand comments like this one from Lindy:

I am a retired home health caregiver, as well as an American citizen who lives below the poverty line financially. It has been a lifelong struggle for me to access good healthcare, and it is only getting worse. Corporations are by design intended to maximize profit, and in the health care field, this translates into sacrificing the good of a human being for the profits of a corporation. Every human being should be prioritized over profit, failing that is to put money over humanity which degrades us all. How can it be that dollars are more important than a mother, a father, a child who is suffering and in need? It is cruel, heartless, and inhumane on every level. It is time to put the genie back in the bottle, prioritize human beings over dollar signs, and prevent moneychangers from having the ability to dictate who lives or who dies because of money. America must be better than that, and corporations must be kept in line with humanitarian priorities.

It’s National Nurses Week, so here’s a shout-out to all the nurses out there who are caring for patients day in and day out. Special props to my nurse informaticist colleagues, who have taught me so much about thinking about systems from different points of view.

Of course, there are still hospital executives behaving badly as they attempt to show gratitude to the people that make their facilities run. One example of a tone deaf gift choice was sent to me by a nurse in the Midwest. The hospital gave nurses lunch boxes, which felt particularly insulting to night shift workers since the facility removed all hot food service for them. They also require workers to use self-checkout for prepackaged items on the night shift. The only overnight worker is a cook who is doing prep work for daytime workers, who still have full food service, including salad bar.

It sounds like managers suspected that the gift wasn’t going to be well received and provided these adorable badge reels plus breakfast out of their own pockets.

What’s the most irritating thank you gift you’ve received from leadership? Leave a comment or email me.

Email Dr. Jayne.