Curbside Consult with Dr. Jayne 2/24/25

I’ve written previously about the cost of healthcare and health tech conferences and the need to make sure that attending is worth your while. I skipped ViVE in favor of HIMSS primarily because more of my clients or potential clients will be attending HIMSS and it’s a great way for me to have in-person meetings without having to fly across the country.

Still, it’s a substantial investment from both a monetary and time management standpoint. I usually stay at the Palazzo when HIMSS is in Las Vegas, but I went with a more cost-effective option this year even though it’s a bit of a hike to get to the convention center. I’m sure I’ll be questioning that choice when I’m walking 10 miles a day, but my accountant will be happier. I’ve already mapped out the best way to make it to the sessions without having to walk through a smoke-filled casino, so that’s something especially since my route takes me past a spot where I can grab some gelato if I need a boost.

A reader recently asked Mr. H his thoughts on the value of attending health tech conferences as a frustrated patient. He provided a summary of why it might not be the most productive way to advocate on behalf of patients, and I agree with his points. However, I’d like to add a few thoughts of my own for people working on the vendor side:

Although patients aren’t your target market since they’re not paying your invoices, they should be part of your product management and development processes. Similar to the patient and family advisory groups that many care delivery organizations have, they could provide valuable insight into whether the features and functions you’re planning are going to hit the mark or whether they’ll just result in spending that doesn’t move healthcare forward.

If one is going to spend a decent chunk of change enhancing your product, doesn’t it make sense to deliver the best value possible so you don’t have to revise it in the future? I don’t always trust the provider organizations to really understand what patients need, nor do I trust them to understand what their staff needs. I’d be out of a consulting job if they did this well in the first place, but I’m happy to educate them.

There need to be better ways to make sure your customers understand what new features were intended to do and how to implement them in a streamlined fashion. There also should be better incentives to help your customers use things properly. Consultants have made a tremendous amount of money coming through after a botched implementation and reworking things so that workflows are effective and efficient.

Unfortunately, there are some oddities in certain EHR software that if you don’t do it right the first time, it’s nearly impossible to correct. Anyone who had to work with the McKesson Horizon orderable pick lists, which displayed in the order in which they were built and had no mechanism to reorder, knows what I’m talking about. If you’re a vendor who still has content like this, please, for the love of all things, do something about it.

Although I agree with Mr. H’s comment that software vendors can’t fix the problems that are inherent with our dysfunctional US healthcare system, I do think that vendors can benefit from understanding how that system impacts patients, clinicians, and other users of the systems they produce. Understanding the baseline level of frustration experienced by users can help influence intuitive design as well as features and functionality.

I’ve been in this industry a long time. I’ve seen how the attitudes of my friends who are on the product management and development sides of the house have changed now that they’re older and have had more encounters with the healthcare system. It could be a little thing, like making sure that an error message is helpful and informative versus obnoxious and interruptive, that makes a difference in a user’s day.

The healthcare industry needs to do a better job of addressing the needs of frustrated patients, regardless of whether they attend a conference. I had an absolutely awful experience at a local institution last fall, complete with HIPAA violation. I returned a scathing response on my patient satisfaction survey and checked the box requesting a call from someone at the officel. I never heard from anyone. I also sent a letter to the departmental administrator, with zero response.

Want to know how I finally got a response? By taking the solicitation card from their annual alumni campaign, writing “no donation this year due to poor care at the institution,” and mailing it back in the business reply envelope. Patients shouldn’t have to resort to that in order to get attention.

Over the last several years, I have seen more people attending conferences in the role of patient advocate. Although some may be merely symbolic, others are using the opportunity to shine a light on what really happens in the industry and to raise awareness of chronic conditions where technology can really have an impact, such prenatal care and treatment of mental health. I would be interested to hear more from patient advocates that attend conferences to learn about their strategies for trying to drive change. Individual patient needs and opinions may not drive markets, but if you had strong advocates representing large cohorts of patients, we might see the needle move, even if it’s just a little bit.

In talking with some of my industry colleagues about their HIMSS plans, it sounds like many of them have cut back on their booths this year. Many have booked private meeting rooms in which they can meet clients, while others are just planning to be in town and host lunches and dinners to meet with prospects and customers but still save on costs.

I tried to look up the pricing for a 10×10 booth and it looks like you can’t see it directly on the website this year. Instead, you have to talk to the HIMSS25 sales team. I noticed on the exhibitor page that they’re listing 26,800 registrations under the Attendee Highlights section, which is a far cry from the HIMSS heyday when we used to see more than 40,000 people in attendance. When you’re a health system running at a 1% margin, it’s easy to see how conference budgets aren’t a priority.

What are your HIMSS plans, and how have they changed from previous years? Are there any particular sessions to which you are looking forward? Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 2/20/25

As someone who has been practicing medicine via telehealth since pre-pandemic days, sometimes I am placed in the wise elder role and asked to explain how things started and how they came to be the way they are. It can be a bit of a journey down memory lane, but then again, everything changed when COVID arrived and telehealth will never be the same.

Although large healthcare delivery organizations see telehealth as an extension of what they are doing in brick and mortar facilities, players in the direct-to-consumer space have dramatically shifted the options that patients can choose from in their quest for prescriptions and other services. In my own practice, I’ve seen it shift from being a partnership between physician and patient to being a transactional consumer activity where an outcome is expected and the patient/consumer becomes irate if they don’t get exactly what they think they need.

This is often frustrating to physicians who are new to third-party telehealth and thought it would be an easy way to pick up some extra money while making use of the medical license they spent hundreds of thousands of dollars in tuition payments to acquire.

I was in an online physician forum the other day and this topic came up. A physician was asking what it’s like to work for one of the direct-to-consumer companies that is well known for prescribing medications for erectile dysfunction. The company has added pre-visit questionnaires to gather information, often with somewhat leading questions that coach for patient answers that will generate a prescription. It’s a win-win for profits since the company is selling the medications as well as the professional services.

In some states, clinicians don’t even have to interact with patients in real time. They can treat them based on the equivalent of a one-way message. The medical board of a neighboring state has disciplined dozens of physicians for this since it’s not allowed in their state, but that doesn’t seem to have dissuaded people from doing it.

It always amazes me to see physicians who have no idea what is going on in their own industry and have little visibility beyond their personal practices. I found a recent article about the phenomenon and shared it to the forum. It was clear based on the comments section that people were having their minds blown.

One of the facts from the piece that drew quite a bit of attention was that together, three well-known telehealth companies spent more than $1.5 billion on advertising, sales, and marketing in 2023. Physicians in the forum also had no idea that direct-to-consumer telehealth companies were getting into clinical conditions that involve more complexity, such as mental health or obesity.

One of the physicians in the forum is the chief medical officer at an online weight management program. It works strictly through payer-based contracts and provides a multidisciplinary care team to address patients’ varying needs. She shared horror stories about patients who came to them after being seen at more commercial enterprises, where patients were basically told to use the medications that were shipped to their doorsteps but weren’t given any other counseling or support.

She made some great points. It’s not just that the treatments are ineffective, but that in some situations, they introduce side effects, including metabolic abnormalities that could have been avoided if a more thorough evaluation were performed prior to treatment.

Patients don’t always understand the knowledge and experience that is behind why physicians do or do not recommend a treatment. That’s especially true when they have seen dozens of influencers and paid spokespersons tell them exactly what they “need.” They don’t know the difference between one obesity management telehealth company that only hires physicians who have extensive formal training and years of experience in weight management versus another that is willing to onboard any licensed provider who willing to sign on the dotted line and accept $20-$30 for writing a prescription and a brief chart note.

The article has some great comments from Ateev Mehotra, MD, MPH, a public health professor who focuses on telehealth. He describes the transition from patients who work with their physician to make a treatment plan to a situation where the patient makes their own diagnosis and consults a transactional service whose clinician is a screener who is paid only to make sure that the medication is safe for the patient. That’s the lowest possible expectation for healthcare.

Not to mention that “safe” is a relative term. Is it safe because it probably won’t kill you? Or is it safe because you aren’t likely to have complications that dramatically impair your quality of life, whether briefly or for a longer period of time?

The article mentions situations where a screening-type approach might make more sense, with one of them being the provision of reproductive health services. Especially in states where it might be difficult to obtain reversible contraception, those services can be popular.

For medications that are over the counter in many other nations but remain prescription-only in the US, it’s easier to see that the risk/benefit equation for certain drugs might tip in favor of more streamlined access. I don’t have the statistics in front of me, but would bet that for many healthy non-smoking females in their 20s, the risk of morbidity and mortality from oral contraceptives is likely less than that of pregnancy, given the current state of maternal and infant health in the US.

I’m looking forward to seeing how the conversation unfolds over the next couple of days, which is about the typical length of time one of these threads survives. I’ll certainly make note and share if there are any particularly thought-provoking comments.

I enjoyed reading Mr. H’s recap of one of the Donors Choose grants in which reader donations provided microphones and speakers for a classroom in North Carolina. In addition to students being able to hear their teacher and peers clearly, learning how to use a microphone properly is a life skill that everyone should have.

Conferences that I’ve attended usually have microphones distributed throughout the audience to ensure that people can be heard when they ask questions. Invariably, at least one or two people will declare, “I don’t need the microphone.” They try to talk loudly, but don’t succeed, or they inadvertently sabotage the recording or broadcast for attendees who are not in the room. Some hold the microphone too far away from themselves or place it right up against their lips, both of which are never great for the audience or others who actually would like to hear what the speaker is saying. Hopefully incorporating those skills into the school setting will pay dividends for those students down the road.

If your organization expects you to confidently approach the microphone, do they provide any instruction in how to effectively do so or to avoid the dreaded screechy feedback? Or do they just hope you were a member of the A/V club in high school or that you channel your inner rock star? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 2/17/25

I spent some time this weekend doing something that I’m sure many techie readers have done at least once. I supported an elderly relative who was having technology issues.

My particular relative is in her late 90s and still lives fairly independently, which is impressive in itself. Even more impressive is the fact that she understands the value of the internet in helping her stay connected with the rest of the world, especially as she describes it, “now that my friends who actually used the telephone are all dead.”

We’ve seen plenty of data on the fact that older people do indeed use technology, and we know that utilization numbers are growing as the population ages. Still, actually spending time with someone who is nearly 100 years old and watching them interact with technology was particularly educational.

She called me initially to say that she thought she had a virus on the tablet she uses for internet access, Based on her description, I knew it would be easier to just go see what was happening myself rather than trying to figure it out over the phone. For some of my other older relatives who primarily use PCs and laptops, we’ve installed remote access solutions so we can troubleshoot when they have issues, but I have exactly zero experience doing remote access on tablets.

I had a couple of thoughts about how I could help her, including doing a factory reset on her device versus buying a newer tablet versus replacing it with something else like a touch screen laptop. I’m not a fan of tablets because I think the user interface is clunkier than what you get on a Windows interface, plus the ability to install remote access software would be a plus. Like many older people, she’s significantly hard of hearing and also has a tremor, which can make it interesting when the user interface requires fine motor control. I packed a bag of different devices and headed out.

The first thing I identified was the fact that she actually has two tablets, although it was initially unclear why she needs two or how she decides which one to use. Seeing them jogged my memory, as I remembered hearing about this from another relative who had  helped her manage two email accounts and two Facebook accounts. She didn’t understand then that accounts can be accessed across different devices, so she had just made new accounts when she got the second device.

I asked her to show me how she uses each one and what kinds of sites she accesses with them so that I could see it for myself and not make any assumptions about her technology needs. As I watched her, we had some good conversations about how Facebook actually works and the fact that it primarily exists to make money off of people’s viewing habits, by way of explaining why her feed was entirely clogged with junk and not things she actually wanted to see.

In addition to social media, she’s a fairly heavy user of MyChart, which always impresses me. She gave me access to her account many years ago so I could help explain some of her lab results. Although Epic has proxy functionality, she prefers that I use her login and password.

That made sense once I saw her password management system in person. She uses an old Rolodex to keep track of her passwords, with a card for each website or app. Thank goodness she doesn’t write down her usernames right next to the passwords, but still it was enough to make me cringe. She writes down new passwords when she changes them, but doesn’t always cross out the old ones, which added to the adventure as I was trying to gather all of her important information in case we had to do a factory reset on her devices.

It was interesting to see the password choices of someone in their 90s, especially for sites that require some degree of complexity. I laughed when I came across a password of “OldLady” plus her age to satisfy the numeric requirement of her last password reset. There were plenty of passwords with names of people who I’ve never heard of and also words in another language. I was glad that I didn’t see “Password123,” the name of her late spouse, or other easily guessed options. We talked a little about how the Rolodex probably isn’t a great idea unless she’s willing to keep it in her lockbox, but I made a note to myself to explore password manager solutions for tablets.

One of the issues that she was having with the tablet interface was not being able to unsubscribe to emails or easily mark them as spam. As a Windows user, I can see clear links in the different email clients I use. For her, she would need to press and hold on the screen to get a dialogue that would allow her to do this, which was difficult given her motor abilities even though she is using a stylus.

She agreed to let me access her email from my laptop so I could rapidly clean up her inbox and take care of a lot of junk mail. As we began that process, I discovered how difficult it is when you don’t have a smart phone and systems want to text you a code to confirm that you are logging in on a new device. Although some of these platforms also allow you to receive a phone call for a verbal code, you can imagine the comedy of errors that ensues when the person is using a landline and a telecommunication device for the deaf to receive her phone calls.

After clearing up her primary problem — which was annoying popup ads that were being generated by a solitaire game that she didn’t remember installing — and working to clean up her tablets, we decided to send the older one to the next electronics recycling event to reduce any future confusion. Now that we had her back in action with a device she knew well, I decided to forego auditioning new devices since I have good hopes that we can probably get another six months of use out of this one. No need to upset the proverbial apple cart if we have something that meets her needs. I know from experience that the future value of a problem can sometimes be worse than the current value of a problem, but I’m willing to play the odds on this one.

The experience was a good one to remind me that although many of the elderly have access to technology, they may not understand how it works or how to stay out of trouble when they’re online. It also gave me a new appreciation for people with mobility and sensory challenges who are trying to access technology platforms. That will give me some things to think about the next time I have to write scripts for end user testing. I’m glad I could help her and she treated me to an ice cream at the end, so you can’t go wrong with that.

If you work for a technology vendor, do you consider the needs of the elderly or those who have additional needs as you design your solutions? Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 2/13/25

California legislators are getting on the AI regulation train. A bill was introduced earlier this week that would prevent AI systems from calling themselves health professionals. Mia Bonta represents California’s 18th Assembly District, which includes the East Bay area, and chairs the Assembly Health Committee. She stated, “Generative AI systems are not licensed health professionals, and they shouldn’t be allowed to present themselves as such.”

The legislation, AB 489, is supported by SEIU California and the California Medical Association. It would help patients understand whether they’re interacting with a licensed professional or an AI-powered chatbot. Perhaps clear definitions around the idea of “AI nurses” would have helped avoid some of the confusion that the new Secretary of Health and Human Services encountered when he was recently at the Cleveland Clinic.

Another AI-related headline that caught my attention this week was around using the technology to “make our physicians superhuman.” A health system is using AI tools to help detect lung cancer by using radiology reports where nodules are mentioned, then reviewing and tracking those reports. One of the organization’s leaders stated that physicians are “receiving a CT report on the patient, then having to read the entire body of it and make multiple decision analyses of the individual nodules. Let’s automate that. Let’s make our physicians superhuman in their ability to manage the number of patients under their purview.”

I don’t have an issue with the concept of making physicians more efficient or allowing them to better manage the patients in their care. I do have an issue with the use of the word “superhuman,” though. As someone who saw patients in emergent settings through the worst parts of the COVID pandemic, I feel strongly that this idea of physicians needing to be superhuman is detrimental. It conditions us and our patients that physicians aren’t allowed to fail, have a bad day, or make mistakes. It can raise patient expectations beyond what one can reasonably deliver. I saw this acutely during the pandemic, when we were expected to see ridiculously high patient volumes without appropriate personal protective equipment, support staff, or supplies.

I’ve practiced in a small town as well as in the big city. I honestly feel like the time I spent in rural America and interacted with my patients regularly outside the office was better as far as helping set expectations about what physicians should and could do. When you see your patients at the grocery store picking up bread and milk just like everyone else, it gives both the clinician and the patient a different perspective. There’s nothing more human than sitting in the stylist’s chair at the local hair salon or “beauty parlor” with foils all over your head and chatting with your patient over a People magazine. I definitely miss those times when I’m working on projects that turn patients into numbers and physicians into productivity widgets.

I frequently work on EHR adoption and optimization projects, so I always like reading about others’ efforts in the literature. A recent article on team approaches to training and optimization caught my eye. The authors surveyed health organization informatics leaders and received 193 responses from 147 organizations. Some of the statistics were rather interesting: “Of these, 69% offer ongoing EHR training, and 52% offer some version of an ETOP (EHR Training and Optimization Program).”

That leads me to wonder what the other organizations are doing. One might assume that they are training once and then just hoping that clinicians wing it as they go. The authors suggest that ongoing optimization and training programs can lead to reduced healthcare worker burnout through improved EHR efficiency and satisfaction. They recommend that additional research be done “to identify the optimal features, methods, and outcomes of ETOPs, and to disseminate them across HCOs.”

Although I’ve seen cool presentations at various EHR user group meetings about how different organizations approach it, I know that in my own consulting practice, what I see varies widely.When I was a health system informaticist, I certainly didn’t want to reinvent the wheel when I could copy from someone who was successful. The article confirms the variety of different offerings, including tip sheets, videos, training software, one-on-one training, clinic rounding by trainers, and formal programs.

As keen as physicians are on the concept of evidence-based practice in caring for patients, I would think they would be more excited about developing best practices for implementing and maintaining EHRs. I think we’re going to see shifts in what is needed as the clinician workforce demographics change, and it will be interesting to see how the research keeps up with this evolution.

Worker retention is a huge issue in healthcare. Especially in cities with multiple health systems, there can be frequent movement among IT roles as people try to improve their compensation. It always amused me as a health system leader that I couldn’t pay my valued workers more, but if they quit and I had to replace them, I could get the role moved into a higher salary band. It seems like it would have been easier to just pay people commensurate with their skills and experience, but hey, I’m just the doctor.

A healthcare article states that the average worker with capped vacation days takes 14 days off annually, while those with unlimited PTO take an average of 16. This is in stark contrast to European countries, where more paid time off is typically the norm. Jefferson Health notes that “executives typically use for to six weeks of PTO annually,” but doesn’t mention how much other employee classifications typically use. I would be interested to hear from care delivery organizations that have unlimited PTO and what their statistics are like. I’m happy to maintain your anonymity.

I appreciate the shout out from Mr. H last week as he mentioned the expanding partnership between EHR vendor CampDoc and Scouting America (formerly known as Boy Scouts of America). I read the press release in detail and noted that CampDoc will also be used for the 2026 National Jamboree.

This means that CampDoc has replaced Cerner, which made a simplified version of its flagship software available for previous major scouting events ,including the 2019 World Scout Jamboree where I made friends with quite a few Cerner implementation specialists who were there to support us. I have to say that it was the easiest version of Cerner I’ve ever used since we only had to document the important parts of acute patient care. We didn’t have to worry about the other data elements that are required for long-term population health, preventive screenings, or billing.

I hope the folks from CampDoc get into the spirit — the Cerner team had patches to trade and were a lot of fun. If you work for CampDoc and you are looking for someone to advise you on how to be the coolest kids at camp, I might know someone.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 2/10/25

I attended a regional medical society meeting this week where the agenda was entirely taken over by physicians who are concerned about the fallout from the recent deluge of executive orders. The American Academy of Pediatrics and other groups have called for the restoration of federal health information online. Two of my former colleagues have spun up a website that hosts archived copies of the missing and edited documents so that clinicians don’t have gaps in the resources available to treat patients.

Since our part of the country is chock full of research institutions, there was also concern about the National Institutes of Health slashing research funding, with concerns about the larger economic impact of immediate funding changes. Most of those who are speaking about the topic understand that while the way research is funded needs to be reformed, yanking the rug out from under research institutions with no warning isn’t the way to go.

Others were concerned about potential cuts to Medicare and Medicaid and the devastating effect that would have on patients who already have trouble getting care because physicians are opting out of those programs due to low payments and attached federal and state penalties. The wait in my area for subspecialty care for a patient on Medicaid is usually anywhere between nine and 18 months. That assumes that the clinics, which are usually teaching clinics that are affiliated with the local medical schools, even agree to put a patient on a wait list. I was impressed by the number of physicians who normally don’t speak out about that topic who were engaged in the conversation.

There were plenty of other concerns, but as I listened, I realized one significant fact: this was the first medical society event I’ve been at in the last 20 years where no one has complained about EHRs, insurance companies, or hospital administrators making decisions that negatively impact patient care. Usually at least one person tries to bend my ear about EHRs or government incentive programs. I had to conclude that there is finally something that physicians detest more than computers, which really says something.

I was catching up on some email this week and had a note from a friend in Colorado, who mentioned that her state lawmakers were again proposing legislation to explore the potential of developing a statewide universal healthcare payment system. The proposed legislation calls for the Colorado School of Public Health to examine a model for a system with a single payer that is designed to be non-profit, publicly funded, and privately delivered. The School would have until the end of 2026 to complete the analysis detailing costs, benefits, and impacts on residents, care providers, and the healthcare industry in general.

The review would also examine how such a system might coexist with current federal and state requirements involving the Affordable Care Act, Medicaid, and Medicare. It will be interesting to see if it passes and if so what the analysis yields. Colorado readers: what are your thoughts on this? Does it have a chance to pass?

I’ve mentioned this before, but I really dislike it when publications promote a link to what appears to be a news article but then turns out to be a video without any kind of transcript. I was lured to an article about new things planned for HIMSS25 only to find a video interview with HIMSS CEO Hal Wolf that included neither captioning nor a transcript. I wonder if HIMSS has thought about the message this sends – that those who require captioning or written communication aren’t valued. Although I don’t require written communication, I definitely prefer it because I can read faster than I can listen to the talking heads of HIMSS TV,  so I guess my needs and preferences aren’t respected either. Especially in the age of AI transcription, there is no reason to have a video without captions or a transcript. Do better, HIMSS.

The Super Bowl is now behind us. I am aware of at least two health systems that dropped significant amounts of cash on ads. NYU Langone Health had a spot championing the idea that “Better Health Starts with a Better Health System,” while MUSC Health ran a commercial focusing on heart and vascular care.

I don’t know the details of the advertising agreements, but I would hope that these were just local ads, which are lower cost than national ads. That would still be an outrageous amount when you consider how much preventive care could be delivered for the same amount of money. The Washington Post offered a list of “best, worst, and weirdest” commercials that was paywalled, but I know I can count on the folks I’ll be on calls with tomorrow to share their ideas about what was the weirdest thing they saw.

My personal favorite ad was the one for On sportswear, where Elmo debated the merits of the logo with tennis great Roger Federer. Elmo said what a lot of us are thinking, that the logo looks like a Q and a C. You can always count on Elmo to have a positive message, so he closes by saying, “Elmo loves you, Mr. Roger Federer. Even if you don’t know your alphabet yet.” Elmo has been a public health ambassador for years, teaching about germs, handwashing, covering your cough, and the importance of preventive vaccines.

I’m not a huge fan of NFL football given the negative health impacts of the sport. However, I do enjoy getting together and sharing food that is usually delicious although not typically heart healthy. Still, I’ve never seen anyone shamed for their food choices as a Super Bowl party and there’s usually at least one green vegetable present in my area, even if it is in the form of celery served with Buffalo chicken dip or wings. I was happy to contribute some baked goods to the effort this year, trying a new recipe and bringing home an empty plate, so I didn’t end up eating the whole thing myself.

What’s your favorite game day food? Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 2/6/25

I’m spending the week in the mountains, trying to find my Zen in front of a roaring fire while I sort through a flurry of new consulting requests. The recent deluge of executive orders in the US has led several of my previous clients to reach out for assistance.

I’ve been offered work ranging from high-level strategic guidance to “get your hands dirty” EHR work as organizations try to quantify the potential patient impact, create appropriate communications, and manage complaints from physicians who are concerned about the risk of providing certain kinds of care. Although my schedule was fully committed going into the new year, I’ve been doing my best to introduce my former clients to other trustworthy informatics consultants. With all the changes thus far, it seems that the only people winning are the attorneys and the consultants.

I’ve never been a skier and have been tempted to consider learning, but then I see someone come down the mountain in a rescue basket and am reminded how much I value the function of my knees. For those patients who have encounters with the health system due to their adventurous pursuits, it’s certainly a different experience than it was even a decade ago. With interoperability gains and the ready exchange of information, it’s nice to see patients be able to message their primary care physicians and ask them to review records and potentially arrange referrals and follow up before they travel home. It’s a definite improvement from the time when you were handed a CD and a pile of papers to hand carry to your physician.

The mountain is a wonderful place to sit around the fire and tell stories, so I’ll respond to a reader request to hear more about the time I practiced medicine in an evening gown.

I used to be on staff at a hospital that had an elaborate medical staff ball every year, with the physicians and their escorts donning tuxedoes and full-length gowns. We were having our event that year in a converted warehouse/loft type venue in our city’s downtown. Although it was a neat facility, there were a lot of stairs involved. As you can imagine, they didn’t necessarily go well with floor-length gowns and people who were not used to wearing them.

One of the medical staff administrators slipped and found herself on the floor, surrounded by a urologist and two otolaryngologists who immediately turned to “that new doc that works in the ER” to manage the situation. I would say I rolled up my sleeves and went to work, but of course there were no sleeves on my gown. But I was glad about the full skirt since I spent the next quarter hour on the floor keeping her from moving until paramedics arrived, as required by the venue. I could have cleared her after my evaluation, but they were insistent, and her husband was grateful that someone other than him was making sure she followed the directions. As a physician, you never know when or where you might be called into action. And for the curious fashion afficionados, the gown was dark violet silk accompanied by a vintage beaded clutch and black crepe de chine shoes.

I have several friends who work for the Centers for Disease Control and Prevention and others who rely heavily on government datasets as part of their research efforts. One clued me in about the lawsuit that was filed earlier this week by Doctors for America. It asserts that lack of access to key clinical information, guidelines, and datasets has created risky gaps in scientific data, reduced the ability to manage disease outbreaks, and impaired the ability to manage patient care.

Mr. H has been asked whether he’ll cover “DC happenings” and he provided his response last week. When there’s an executive order that dramatically impairs a physician’s ability to do their jobs, or a negative impact to the practice of clinical informatics, you can bet I’ll be covering it. Patient safety should be a national priority, and I welcome a conversation with anyone in policy making who would like to convince me that restricting access to Vaccine Information Statements that are used every day by physicians across the US improves patient safety or clinical outcomes.

From Jimmy the Greek: “Re: more return-to-office shenanigans.” I always appreciate his newsy tidbits, and this one describes next-level monitoring of in-office employees. It describes peel-and-stick radar sensors that can help companies understand whether people are in a room, measuring not only movement but carbon dioxide, volatile organic compounds, air pressure, temperature, humidity, and particulates. It’s like a little indoor weather station. On one hand, it can help companies understand the true utilization of their real estate footprint, but on the other hand, it could force employees to take the concept of “coffee-badging” to the next level if they need to demonstrate a presence in a particular area of the office. The comments are pretty good if you’re an executive who wants to better understand why your employees don’t want to return to the office.

Cleveland Clinic has spoken out about RFK Jr.’s claim that they have developed an AI nurse. A hospital spokesperson confirmed in a recent statement that the claim was not correct. I’ve been deeply involved in the world of virtual care for years, looking at how organizations are virtualizing care in a thoughtful way to ensure that patient safety remains paramount. There are hundreds of clinical informaticists and related professionals working to create AI-driven clinical solutions every day. Each of us is savvy enough to know whether what we’re seeing in a demo is an AI nurse or not. One would hope that individuals who have the potential to run one of the most challenging healthcare administrative organizations in the world would surround oneself with people who understand what they were looking at and how it might be used (or not used) to care for patients. Plenty of us would free our schedules to ensure that our nation’s leaders aren’t being confused by what they see or at worst hoodwinked by unscrupulous technology vendors.

What’s your over/under on how many years it will be until we truly have AI nurses that are indistinguishable from human nurses interacting with patients? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 2/3/25

In response to Oracle Health’s comments about its new and improved EHR, a reader recently asked Mr. H whether users are really asking EHR companies for a voice-driven solution. His response was that it “might draw interest if it doesn’t slow clinicians down.”

I heartily agree. The handful of demos that I’ve seen related to this kind of technology are always slower than looking at the summary screens that already exist in most EHRs. For new users or those who have yet to embrace all the whistles in their current systems, I agree that it could be a valuable tool. However, I think the level of potential impact is variable and somewhat depends on a user’s history and their experience with other types of documentation.

Some of us came of age in our medical careers during the era of paper charts. We had to learn to quickly find information and organize it in our heads. We often created summaries in the chart to help us better keep track of our patients. Those paper charts were often horrific messes, and you never knew whether they were fully current with labs printed out. You also couldn’t read some of the handwriting.

As EHRs became standard tools in hospitals, many implementations simply automated that paper process. Because of that, we became good at finding information in digital nooks and crannies just as we had previously. When EHRs came out with summary screens and the ability to graph and trend things, we felt we were in heaven because we no longer had to create those maps in our minds.

The next problem was how to educate users on the new features that are available and to get them to take advantage of those features. The last time I did an optimization project in an ambulatory setting, less than 20% of the physicians were taking advantage of extremely helpful parts of the EHR. For example, one system had the ability to superimpose blood pressure readings over a timeline that reflected medication adjustments. That’s powerful, but the vast majority of physicians had no idea it was in the system, let alone how to use it. They were literally deprived of the benefit of having the EHR synthesize information as well as the quality aspects of reducing the risk that you would miss information if you were digging through the chart on your own.

Then there’s the issue of the digital natives who are now practicing medicine, those who have spent the majority of their professional lives with a smartphone in their hands and the expectation that everything should be right in front of them with pretty visuals that fit on a six-inch screen and require no cognitive analysis. These are the folks who absorbed their medical school lectures via recordings played back at 2x speed. They’re also of an era where medical education has shifted away from “learning for learning’s sake” and more towards being able to pass national licensing exams with high enough scores to secure their spots in competitive residency training programs. Upon reaching independent practice, their needs often differ from those of their more clinically seasoned colleagues.

When you’re considering the addition of a voice assistant to the patient care environment, however, the physician’s needs are only one part of the equation. The always astute Bill Spooner commented, “I can imagine the patient visit during which the doc is talking to the computer, but I’m not sure whether the comment is directed to the computer or me. “Hey, doc, quit talking to the damn computer and tell me what’s going on. Who the hell is Hey Oracle?”

If the computer is returning audible information with the patient in the room, it had better be accurate and free of inappropriate interpretation or hallucination. As primary care physicians who have endeavored to build trust with our patients, we already have enough difficult discussions when we have to address potentially stigmatizing medical conditions like obesity. If our patients don’t want us to use that word, they definitely don’t want to hear it from a computer in the exam room.

Not to mention that at normal speeds of speech, this exchange of information may take longer than a typed and visualized interaction, especially if the clinician is a fast typist and a quick reader. You can ask nearly any ambulatory physician in the US – our visits certainly aren’t going to be allowed to be of longer duration unless we want to work 10- or 12-hour days to fit them in. It feels like every administrator is trying to figure out how to cram all of our visits into six-minute boxes, which is simply absurd.

I would love to see actual data on visits performed with these tools, using standardized patients with standardized scenarios just like we go through in medical school. I’d love to see transcripts of those visits and also a scoring rubric from the standardized patients about how the visits made them feel.

Like many of my clinical informatics colleagues, I’m a “Star Trek” junkie. Although I’ve never been to a convention or dressed up as a character, (although I did portray a nonspecific officer in a medical school class show), I can quote more episodes than is likely acceptable in the company of my non-clinician, non-informatics friends. If you want to talk about Darmok and Jalad at Tanagra or discuss the variety of desserts that are available from a standard Federation replicator, I’m your girl.

I’ve dreamed of being able to ask the “Computer” to do a variety of things to make my life easier. I would love to have Majel Barrett’s voice power my current digital assistants. However, I can think of specific patients who would be confused by having a third voice in the visit and who might be distracted by a verbal interaction during the visit.

Oracle Health isn’t the only company doing this. If you’re with one of the other EHR vendors using virtual assistants to provide information to clinicians in real time as they treat patients, I’d love to showcase what you’re doing. If you have data about your testing, that’s even better. If you’re a clinician who has used this technology in your practice, I’d love to hear your impressions of the initial weeks of use, any subsequent ramp up time , and where you’ve been able to take the technology.

Is ”Tea, Earl Grey, Hot” your kind of beverage? Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 1/30/25

The only thing being discussed in the virtual physician lounge today was the Senate confirmation hearing for Robert F. Kennedy, Jr. Colleagues whose specialties are directly related to public health are understandably concerned, and even those who didn’t seem to have thoughts on his positions or beliefs were captivated by the spectacle of the proceedings.

I had a chance to catch up with a friend of mine who spent the first half of her life in the United States but now resides in Wales. She has plenty of experience with both health systems. We’ve had numerous deep conversations over the years about our respective systems and what works and doesn’t work. Apparently, recent goings-on in the US government are quite the hot topics at her local pub, with some referring to it as “the American soap opera.” I can’t wait to hear her ideas about the confirmation hearing when our daytime hours sync up again.

A key part of the testimony today revolved around care for those who reside in rural parts of the US. This PBS News video captures his comments on technology that he recently saw at the Cleveland Clinic, including “an AI nurse that you cannot distinguish from a human being that has diagnosed as good as any doctor.”

I would love to hear from his hosts at that esteemed institution as to what he actually saw and how the health system might be using it. I suspect that there are some elements of the technology that might not have been fully understood, including some level of humans in the loop, which are still necessary for oversight as well as for liability and blame-laying purposes when the AI runs amok. The hearing continues on Thursday, and I look forward to reading the recaps.

Over the last year, I’ve read multiple articles about large, multi-state health systems that are going through EHR consolidation projects. They are often moving away from multiple instances of Epic that may have been customized or configured to meet the needs of an organization that has since been impacted by a merger. These massive migrations to a single gold standard installation can take years. They may involve numerous committees, change control and governance processes, and countless thousands of hours of analyst time.

I read another article about one of these efforts this week and was surprised to see that only one member of the C-suite was featured and it wasn’t a CMIO or CNIO. If nothing else, I would have expected the interviewee to at least give a shout out to the folks behind the scenes who are leading the actual work of such an effort. As we’ve seen a rise in “chief digital officers” and “digital experience” leaders, I’ve seen some CMIOs become a bit sidelined at their own organizations.

Hopefully, this was just an oversight and plenty of informaticists are involved in getting the decisions made and the workflows modified. Word to the wise for those being interviewed: it’s never a bad idea to give credit to other members of your team for helping you get to the place where people might want to read about your efforts.

I was talking with some informaticists this week about the role of real-world evidence in the current care environment. We’re constantly being peppered with newsy articles from various vendors about their findings using these tools. A recent piece reviewed the correlation between a particular vaccine and the reduced likelihood of dementia. Although its related headline was attention grabbing, it did nothing to explain why there might be an association or what the meaning of what such a correlation might be. Maybe those who get the vaccine fall into a group of people with generally healthy behaviors compared to those who might not get the vaccine because they don’t have a primary care home or follow other preventive advice.

There’s certainly more to this than a simple association, and when I see articles like this, it sort of feels like they’re drawing conclusions for the sake of drawing conclusions rather than really trying to understand how two clinical concepts might be related and how the information might be used to drive outcomes for real world patients. 

Mr. H and I have often shared our thoughts about the industry buzzwords that make us batty. As a primary care physician, “wellness” has become one of those that annoys me. We used the wellness concept 20 years ago to describe preventive visits – such as well child and well woman – in an attempt to be more descriptive than “going in for a check-up” and to emphasize the value of preventive care and the fact that it was a distinct type of service. Since then, so many entities have jumped on the wellness bandwagon, often for the purpose of generating revenue.

Wellness, as opposed to a well visit, is a nebulous term that doesn’t necessarily refer to any concrete medical concepts. It is often used as a euphemism for “things that will make you feel good but that don’t necessarily have strong medical evidence.” It reminds me of when vitamin and supplement manufacturers use the term “immune support” or “supports gut health” on their products because they don’t have the data to show that a product treats any particular condition.

Wellness is also used to sell products that have dubious and possibly harmful effects (check out Goop if you’re not sure where I’m going here). The word has been overused by for-profit entities and is used often in telehealth, taking away from more serious kinds of care that can be delivered within that framework. Although I adore Kohler plumbing products (I’m still trying to figure out how to install the mythical, magical bathtub that debuted at CES 2021 into my hideous 1980s bathroom), I give them a C-minus on their new ad campaign. The wellness theme grates on me, as does the tagline “immerse yourself in transformation.”

What do you think about wellness? Is it a term that’s past its prime, or are we just at the beginning of a wellness journey? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 1/27/25

Several people have reached out this week to try to schedule meetings with me at ViVE, which is coming up next month in Nashville. As much as I would like a good excuse to visit a city that can be a lot of fun, I just couldn’t justify the expense of another conference, especially given how close it is to HIMSS.

Registration for ViVE is over $2,000, which is a substantial sum when you’re paying for it out of your own pocket. I’ve attended in the past as a boutique consultant, and once I factored in travel and other costs, the return on investment just wasn’t there.

When I’ve written about the expense of going to conferences in the past, I’ve been asked why I don’t just get a media pass and go for free. It’s tricky to do that when you’re an anonymous blogger, since conferences undoubtedly want your real name. I managed to get CES to approve my application to attend virtually under the Jayne HIStalk, MD identity the year they had a virtual show. That made sense because people couldn’t see me as I listened to pitches and presentations. I can’t exactly walk around with a name badge that says “Dr. Jayne” without a lot of questions.

As for HIMSS, it’s still a place where I can accomplish a lot of meetings and gather the information that I need to help my clients, in an atmosphere with less hype. I’ve grown accustomed to the predictability of the large convention hall atmosphere and don’t need a lot of flashing lights or bold visual displays pulling my attention from the work at hand.

Exhibitors tend to send larger teams to HIMSS compared to other shows, so it’s easier to connect with resources when you find a new vendor that you want to explore. My past experiences at ViVE and HLTH have been that the person I need to talk to isn’t at the show, although I understand that I’m a small sample size and that experience might not be typical.

I got my first HIMSS party invite this weekend, which always makes me smile. I’ve already got my dancing shoes ready for the occasion, which puts me ahead of where I usually am with planning efforts.

I’ve done a fair amount of consulting work in non-traditional areas, so I wasn’t surprised when an organization contacted me to help with a project to migrate school health records from one system to another. I’m not new to technology in the school health setting or to record conversions.

If you haven’t been in school or haven’t had children in school in the last decade, you might not be aware that schools have been embracing healthcare IT. Initially, the uptake I saw was mostly around digital health histories and immunization records, which certainly made it easier for school health officials to identify students who might not be in compliance with state laws or district policies. Electronic systems were also used to track the forms that parents submitted to allow their children to self-administer medications such as asthma inhalers and allergy rescue injections. These are pretty straightforward uses of technology and wouldn’t make most people think twice.

As schools began to have more medically complex students wo attend full time (as opposed to being in a specialized school setting), I started to see districts invest in systems that supported medication administration documentation, not unlike those that are used in hospitals. I also saw inventory tracking systems and triage systems come into play.

Even before the arrival of COVID, school districts were starting to use technology to deal with the inability to staff a nurse into every school due to budgetary constraints. In situations where schools don’t staff a nurse, many of those nursing tasks fall to school secretaries, teacher aides, or other administrative staffers. If a nurse was shared between buildings, those resources could host a video conference while evaluating an ill or injured student.

Around the same time, we also started to see hospitals and health systems partner with school districts to deliver health services in the schools in an attempt to close gaps in care and reduce preventable visits to the emergency department. These school-based clinics often involved rotating nurse practitioners who would evaluate and treat patients in consultation with a hospital-based physician, using shared electronic health records hosted by the health system. Funding for these programs was often tenuous, however. As true telehealth rose to prominence, we started to see hospitals and health systems pull back on those in-person clinics and opt instead for virtual care, which could be delivered in a less costly way.

As I was putting together my proposal for the records conversion, I decided to see what was out there in the literature regarding school health. It was a timely search since there was a great article posted this week in JAMA Health Forum. It’s a good reference to learn about the history of the school nurse role and how much it has changed. The authors talk about health and hygiene efforts in the early 1900s and the evolution to where we are today.

I think most people consider issues like vaccines, injuries, illness, and preventive screenings as the purview of the school nurse. Unless they have personal exposure to other health needs in the school setting, they might not consider other responsibilities, such as assisting students with insulin pumps or with tube feedings. The number of students who are taking medications at school is much higher than 40 years ago, and people who don’t work regularly with young people are often surprised to learn how many people under age 18 are taking at least one daily medication.

School nurses are also more involved in behavioral and mental health interventions than in previous decades. In some areas, they serve as the only healthcare professionals who might interact with a child. I’m excited to see schools and communities that realize the value of school nurses as key members of the healthcare team, especially those who are willing to use data captured in the schools to better inform community health decisions.

Even though this project is primarily a records conversion, I’m excited to potentially become a resource for future projects involving health data in the schools. It’s much easier to craft a proposal around an area of informatics where I’m passionate, so here’s to hoping I ultimate win the contract.

What are your thoughts about the role of informatics in the schools? Have you worked on a school-based health project? Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 1/23/25

I had a bittersweet moment today. I watched one of my favorite pieces of healthcare software fade into the sunset. The health system where I spent the majority of my career finally retired the clinical repository that it built back in the 1990s when it was on the cutting edge of innovation.

As students, we were fascinated by the idea that we could see information from different hospitals in the network. The system served as the core of what eventually became a homegrown EHR. Although the EHR piece has since been replaced by a sequence of vendors, the repository continued chugging along in the background, serving as both an archive and as a testament to the system’s longstanding commitment to technology use in patient care. Farewell, my dependable and sturdy app. I never thought you’d last this long.

I’m a card-carrying member of Generation X and remember learning a thing or two from TV shows like “Sesame Street” and “The Electric Company.” Understandably, this press release from NewYork-Presbyterian caught my eye as the organization is partnering with Sesame Workshop to create campaigns that promote children’s health.

The project starts with an “Ask a Doctor” video series that includes Sesame Street characters alongside physicians covering topics like healthy sleep, food allergies, and routine health visits. Some of the episodes are already live on YouTube. As a primary care physician, I give the wellness visit episode two thumbs up. Watching it took me into an internet rabbit hole involving The Count, who has been my crush for longer than I care to admit. Watching him sing a duet with Billie Eilish was amazing. If anyone knows the physicians who were featured in the videos, I’d love to hear what it was like to film them.

Mr. H recently pondered on the question of why telehealth physicians need to wear scrubs or a white coat, going on to note that maybe he will buy “one of those ill-concealing exam gowns for future use in amusing the online doctor.” As someone who has delivered quite a bit of telehealth care over the last decade, that would absolutely make my day if I popped into my virtual visit and saw someone wearing a gown.

I’ve certainly had experience with the varying dress codes in telehealth organizations. One of my former telehealth employers required that we wear white coats for all of our patient-facing interactions, and I wasn’t a fan. When I was an old-timey primary care physician in solo practice, I never wore a white coat. The primary reason was that they have a tendency to store and spread germs. I also felt that some patients were intimidated by it, and that not wearing a lab coat helped build rapport with those patients.

When I moved to the emergency department, I wore a white coat because it was policy. My hospital also provided scrubs for us to wear and always ensured that we had two white coats laundered for every shift. That way, if you ended up being soiled by something unpleasant, you could quickly swap it out.

Once our group stopped being employed by the hospital and was outsourced to a staffing company, the laundry services stopped. I’d say we were then 50/50 on wearing white coats. If you ran into something messy, you either had to go coatless or have a spare in your locker. Given that change, many of us opted to wear isolation gowns to protect our clothing more frequently. Although this probably increased costs, no one really cared.

When I started seeing patients in telehealth, only one of the three companies that I worked for required white coats. The others required “professional dress,” and some of those dress codes were nebulous. One called for collared shirts, with no recognition of feminine norms of business dress where someone might wear a suit jacket with a non-collared blouse underneath. That undoubtedly is more formal / professional than, say, a collared golf shirt, but the latter was allowed while the former was technically against the rules.

Another company was more specific, calling for dress that is “business casual or greater in formality.” It went on to further evaluate that clothing should be clean, in good repair, and without excessive wrinkles. I personally thought that was pretty reasonable, because we all know that even if you start your day fully pressed, you’re likely to be at least a tiny bit rumpled by the end of the day. You shouldn’t look like you’ve just exited your bed, however.

For me, a white coat is strictly functional rather than ceremonial. Are you a medical student who needs to tote a lot of things in your pockets? Then a lab coat may be for you. I’ve also seen students wearing the equivalent of a Batman utility belt, and that always makes me smile. Are you in a surgical subspecialty that requires that you keep your scrubs covered if you’re not actively in an operating suite? Then it may be for you, too, with a couple of caveats such as remaining in designated areas of the hospital and changing to street clothes if you’re going to leave them. Personally, I’ve practiced medicine wearing an evening gown, hiking boots, and everything in between, and I’ve brought my A-game regardless of my outfit.

In many hospitals, people of all different roles wear white coats, so it doesn’t help differentiate whether you’re a physician or not. It’s not a mantle of authority, so when those of us who are normally in those environments are forced to wear them so that we “look like physicians,” it doesn’t ring true.

Do you know how people tell physicians from non-physicians in the hospital? Name tags. Especially the ones that have “MD” or “DO” or “RN” or “PharmD” or a host of other titles in big bold letters so that patients know with whom they are interacting. Do you know what I never had in telehealth? If you guessed “name tag,” then you’re a winner. Even though patients aren’t seeing us in person, I think that having a professional name tag with a photo and credentials just like the hospital ones would help build credibility and trust in the same way as a white coat. And for those of us who feel that wearing a white coat might be an issue for our patients, it would allow us to make the choice.

What do you think? Should telehealth physicians be required to wear white coats, or be empowered to dress like the professionals they are? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 1/20/25

Several of my primary care friends got together tonight to drink margaritas. Partly because we’ve all got cabin fever from the weather, and partly to commiserate about our worries about what’s about to happen to public health in the United States.

We did the math and estimated that the group has easily spent over half a million hours in scheduled patient care during the last 25 years. If you figure a conservative four patients per hour, that’s more than two million times we’ve walked into an exam room asking, “How can I help you today?” and creating an individualized care plan for the patient in front of us. Some of the group have been practicing medicine for longer than 25 years, and especially once the tequila was flowing, the good stories started coming out.

On the whole, we think we have some well-founded fears. One member of the group has spent her career working in public health and is worried about the gag clauses that some states have put in place that prohibit conversations about vaccines, even ones that have been around for decades. As one does when one is a clinical informaticist and having drinks with other physicians, I asked my favorite generative AI tool to list the top 10 public health achievements.

Vaccinations are right up there, along with fluoridated drinking water and family planning. These have been under fire for years and the administration that takes office this week has them in their crosshairs. Also in the top five are tobacco control, which we’re improving upon in the US, and improvements to maternal and infant health, where we’re not doing well compared to other developed nations.

Another top item is workplace safety, where I agree that in thinking back over a century, we’ve come a long way. However, healthcare folks are still at high risk when they go to work, facing everything from infectious diseases and radiation exposure to musculoskeletal injuries and workplace violence. Families of police officers and firefighters have long faced the possibility that their loved ones might not come home from their scheduled shifts, but now healthcare workers are starting to have the same conversations. Additionally, physicians and emergency medical services staffers are more likely to die by suicide than the general public. I’m hoping that sobering statistics will lead lawmakers to allocate more resources to care for the caregivers, but I’m not sure how much state governments or our national legislature will take this on.

A couple of us had recently been at a former colleague’s retirement party and shared what we heard in his retirement speech. He was leaving primary care after 20 years in the patient care trenches, which seems short based on how much training you have to do to become a physician, but which can seem like an eternity when you’re working in a demanding, production-based environment where moral injury is occurring daily.

He finally decided to leave after a series of administrative disasters in his health system-owned practice, such as penalties for physicians who run late with their office schedules. The idea that patients should be scheduled for 10-minute slots and that spending 15 minutes on a visit was too much time was more than he could personally take.

Although a couple of us knew the full story behind his decision, most of the people at the retirement party didn’t. We expected him to throw at least a little bit of shade at his soon-to-be former employer. We were pleasantly surprised when he gave a recap of some of the things he’s been through in practice and some of the good things that have happened over the last two decades, reminding us that physicians have traditionally persevered during times of adversity.

Some of the notable events he mentioned included increases in discussions of end-of-life care following some dramatic court decisions and the creation of Medicare Part D. He talked about severe challenges physicians have faced, such as Hurricane Katrina, when patients were stranded in hospitals without electricity, water, or sanitation. He reminded us that it wasn’t just lobbyists that pushed for electronic health records, but patient safety advocates who saw what happened with that hurricane as well as Hurricane Rita, which came just a month later and where tens of thousands of patient records were damaged or lost.

As expected, he had a few choice words about Meaningful Use and excessive clicking in EHRs, but reminded us of some good things that have come with technology, such as no longer having to take our board exams in a convention center with hundreds of other test takers bearing handfuls of sharpened number two pencils. He reminded us that physicians have historically risen to the occasion when it seemed like the world went sideways, and that the majority of us had survived a global pandemic together. It was a nice reminder that although we may be facing difficult conversations with our patients about vaccine safety, fluoride in the water, and the risks of drinking raw milk, at least we don’t have a novel pathogen stalking the globe at the moment.

He told the assembled crowd that he plans to do volunteer work in a part of the world that has few medical resources. He hopes to regain some of the joy found in caring for patients, even though it will be a physically and mentally challenging environment. I’ve known him for a long time and am very glad to hear that he isn’t hanging up his stethoscope just yet, but based on his career and his involvement in medicine outside his practice, I know that both his patients and the community are going to miss him.

My margarita-drinking colleagues enjoyed hearing about some of the things we mentioned from the speech. Especially since for many of us, some of those events have moved to the far reaches of our memories or have been suppressed as a coping mechanism. Any that any time someone talks about the pandemic, I’m still prone to flashbacks of how I felt coming home from the emergency department, changing clothes in the garage, and trying desperately to not bring home a virus that could kill my family. Still, there were some good reminders that things have been worse and that there are still plenty of people out there who respect physicians, public health workers, and the experience and expertise that we bring to the table.

I’m sure things will look a bit less rosy when the tequila wears off, but we’ve agreed to try to get together regularly to support each other in the months to come. We also created a buzzword bingo card to help us find some humor to go along with the feelings of futility some of us are likely to feel. It will be interesting to see how many more of us retire early or move to a different type of practice with the continued evolution of healthcare. Some of the group are exploring alternatives, but given my work in clinical informatics, I don’t think I’ll be writing a retirement speech anytime soon.

What are you seeing in your healthcare crystal ball for 2025? Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 1/16/25

For many readers, CES will always be the Consumer Electronics Show in our heads, no matter what kind of branding updates the conference receives. It’s been on my bucket list for years, although I’ve never quite gotten around to attending.

Planning travel in January is always tricky for those of us who live in states where snow and ice happen. Had I planned to attend this year, it’s doubtful that I would have been able to get there due to snowpocalypse. Regardless, I’m still a fan, and get plenty of press releases related to the event. A couple of things caught my eye this year.

The first is robot vacuums and their continued evolution. Companies used CES to launch products that media folks are referring to as butlers since they have the ability to retrieve items. Roborock and Dreame have units with graspers that can pick up items so that they can vacuum, adding them to a bin for later human intervention. The former can pick up a 300-gram item, while the latter can lift up to 500 grams. This puts a lot of pet toys in the pickup range, so I can see the utility. Other units have been enhanced with capabilities that let them go up and down floor transitions, and apparently Samsung has one that can identify unexpected movement and notify the owner.

I also was drawn in by the press releases from Withings, which released its Omnia product at CES. The solution goes beyond the smart scale platform to incorporate a so-called smart mirror that can deliver health insights and wellness recommendations based on data from Withings devices and third-party apps. The Cardio Check-Up feature can enable reviews of heart-related data by cardiologists, although I’m sure any end user agreement will include plenty of disclaimers about this not being intended to form a physician-patient relationship. I’ve used a wi-fi enabled Withings blood pressure cuff for years, and not only is it accurate, it has outstanding battery life. I’m not quite ready for a smart scale or a smart mirror yet, unless the latter can help me apply eyeliner when I don’t have my contact lenses in.

HIMSS is emailing members to promote its new membership program, trying to convince us it brings value other than a discounted admission to the annual conference. It promises “tailored professional resources” and “expanded networking opportunities” in a vague and unenticing way. I’m sure some of us remember its ill-fated online engagement platform, which disappeared after fizzling in a noticeable way. The email urges recipients to stay tuned for more information, but honestly I’m not sure what is being offered that wasn’t already present.

I’m on a local committee to try to improve health outcomes for the young people in our community, so I was eager to read the most-viewed articles of 2024 list from JAMA Peds. I wasn’t surprised at all that some of the pieces that topped the list were tech related. These are the articles that pediatricians are reading the most, so if you have small children in your life (or care about the health outcomes of all small children), it’s good to take note. Here’s the highlight reel:

• “Screen Time and Parent-Child Talk When Children Are Aged 12 to 36 Months.” Validating what I see nearly every time I travel, the authors conclude that “screen time is a mechanism that may be getting in the way of children experiencing a language-rich home environment during the early years.” It doesn’t take a high-powered study to see that when parents are glued to their phones and their toddlers are glued to tablets, no one is having a conversation.
• “Early-Childhood Tablet Use and Outbursts of Anger.” Tablet use contributes to a cycle of frustration as “child tablet use at age 3.5 years was associated with more expressions of anger and frustration by the age of 4.5 years. Child proneness to anger / frustration at age 4.5 years was then associated with more use of tablets by age 5.5 years.” If you want your child to have greater skills for emotional regulation, tablets are not the way to go.
• “Early-Life Digital Media Experiences and Development of Atypical Sensory Processing.” Higher levels of early exposure to digital media correlate with “specific sensory-related behaviors, including those seen in autism spectrum disorder.” The authors propose additional research to understand why as well as to determine whether limiting media exposure can improve outcomes.

Lake Superior State University, which I’ll admit that I hadn’t heard of prior to this week, released its 2025 list of words that should be banished. Mr. H and I both have words that are on our pet peeve lists, and some of these are a definite overlap for me:

1. Cringe.
2. Game changer.
3. Era.
4. Dropped.
5. IYKYK (if you know, you know).
6. Sorry not sorry.
7. Skibidi.
8. 100%.
9. Utilize.
10. Period.

The list of words began in 1976 when the university’s public relations director and his team released its first “List of Words Banished from the Queen’s English for Mis-Use, Over-Use, and General Uselessness.” The list’s popularity has grown and the University now receives suggestions from around the world. If you have a few minutes to visit the site, it’s worth your time since they provide specifics on why the words were included. Overuse is a prime reason.

For some of the words, alternatives are offered, reminding us that as our elementary school teachers always said, the thesaurus can be our friend. General annoyance was also cited several times, including for skibidi, and in that case, I wholeheartedly agree. The word utilize has long been on Mr. H’s pet peeve list, so I’m glad it was called out. Next year will be the 50th anniversary of the list, so I can’t wait to see what makes the cut for such a momentous occasion. If you’ve got a word you want voted off the linguistic island, you can submit it here.

What are your top picks for words that are weak, pitiful, wretched, cheesy, uninspired, or warmed-over? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 1/13/25

I’ve worked in two different situations where the arrival of private equity funding dramatically changed the patient care environment.

The first was when I was working in the emergency department. Although I was a contractor, I worked for a physician-owned organization that treated us fairly and was overall pleasant to work for. Unfortunately, our contract ended, and rather than renew it with us, the hospital went with a private equity-backed firm that promised to onboard the existing staff so that there would be no problems with quality of care. As one can guess, this didn’t happen. Although the full-time physicians were hired, none of the part-time physicians were offered contracts. Instead, we were replaced by midlevel providers, some of whom were brand new to the safety net hospital environment.

Since I was also working on the informatics team, I saw that in the first six months, there were spikes in emergency department wait times, an increase in patient complaints, and a host of other data findings that supported concerns about how the new provider group was operating. We went from having zero administrative leadership meetings where the emergency department was a topic to having to address issues at nearly every session. Hundreds of hours of administrative time were spent dealing with all of the complaints and issues and threatening the new group with contractual penalties. They would improve just enough to get our leaders to back off, and then things would slide again. After three years of this, their contract ran out and they were replaced with another group. I can’t help but think about how many hours were wasted dealing with their nonsense and how that time could have been better spent on patient-centric initiatives.

The next time I encountered private equity folks in the clinical space was in the urgent care setting, when the physician founders sold a 51% stake to a private equity organization. There was a lot of cheerleading when the announcement was made on our 7 a.m. provider call. I was fortunate to be at home during that call and not at one of the facilities, so I could immediately dig up some information on who had just bought us.

It turns out that although they were an established organization, they were just starting to get into the healthcare space. Their experience had been with multiple franchises of a chicken wing restaurant, although they had a couple of imaging center acquisitions under their belts. Although we had been pressured previously to maximize billing and promote our highly profitable in-house pharmacy, the pressure to focus on these measures rather than actual patient care outcomes was intense. I ended up resigning not long after the private equity firm took control, but had to work out a 90-day notice period, which was far more painful than I would have imagined.

It was with these experiences in mind that I saw an original investigation piece that was published in JAMA this week, directly addressing the topic of “Changes in Patient Care Experience After Private Equity Acquisition of US Hospitals.” The authors looked at 73 private equity-acquired hospitals alongside 293 control hospitals, finding that “global measures of patient care experience worsened after private equity acquisition of hospitals, as did patient-reported staff responsiveness.” Additionally, the changes in these measures continued to increase with each year following the acquisition.

In digging deeper into the research, I found that it looked at data from 2008 to 2019 and looked specifically at patient experience measures from three years prior to an acquisition to three years after. The primary outcomes of the study were part of the standardized Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPS) survey, namely the overall hospital reading and patient willingness to recommend the facility. Secondary outcomes were also assessed from among the remaining HCAPS measures and included those on clinical process, communication, and environmental measures. It should be noted that this goes beyond patient satisfaction – bad experiences have been associated with longer times to recover from an illness, failure to follow treatment plans, and increased utilization of healthcare resources.

The authors followed a thorough process in matching the acquired hospitals with relevant controls, looking at bed count, whether or not the facility was a teaching hospital, metropolitan versus non-metropolitan, safety status, geographic region, and year. In their discussion, they review a number of reasons why care experience might change as a result of private equity ownership of hospitals. The first one is fairly straightforward – nurse staffing. There is a strong association with staffing ratios and patient care experience, and one of the first things that private equity-led organizations do when they come in is to reduce the nurse-to-bed ratios. In states where there are no laws addressing this, conditions can become downright dangerous. I’ve heard horror stories from my peers at large for-profit organizations, and concerns that leadership just becomes desensitized to the fact that patients are actual human beings and not just nebulous “consumers.”

These organizations also institute cost-cutting measures that span all aspects of patient care, from the supply chain to housekeeping and facilities management. The authors note that such strategies “may not be aligned with clinician and health system efforts to improve patient care.” They go on to call upon policymakers to consider a higher level of oversight for private equity acquisitions and to consider minimum staffing ratios to further protect patients. The authors note that there are some limitations to the study, one being the relative opacity on data surrounding private equity acquisitions. In my experience, however, when PE comes to town, all you have to do is talk to the people caring for the patients because they’re highly motivated to share what is going on. They also start buffing up their resumes and may ask if you’re hiring within your competitor organization. It doesn’t take much to figure out what is going on.

Large numbers of my physician colleagues are burned out and quite a few continue to choose early retirement. When you ask them what the most significant issues are, inability to do the right thing for their patients tops the list, along with lack of physician autonomy. The problem of administrators who are more focused on profits than patients is right up there, and depending on the facility, might be cited as the primary problem. As long as our healthcare system is for profit (we all know the non-profits are making buckets of cash too, they’re just not calling it a profit) I don’t see anything changing.

What do you think about the continued movement of private equity into the healthcare space? Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 1/9/25

The hot topic around the virtual water cooler this week was the push to use real-world evidence (RWE) while caring for patients. This topic has become more relevant as increasing number of clinicians have access to RWE while caring for patients.

This kind of data can have particular strengths, including demonstrating how medications and other treatments actually work with real patient populations versus those found in clinical trials. It can also be used for post-marketing surveillance of new drugs and treatments.

However, there can be challenges depending on how clinicians are looking at the data. For example, if you’re looking at how clinicians are treating certain types of patients, one has to still understand why they might be choosing those therapies and whether those patterns are consistent with the evidence from rigorous clinical trials.

If you don’t take that into consideration, there can be a slippery slope where “everyone’s doing it, I should too” overrules graded recommendations. Depending on how data is sourced, there’s the potential for RWE to function as an echo chamber.

For example, if a large health system is pulling RWE data from their EHR, it’s going to be influenced by the formularies that are in place at its facilities. One might not see more appropriate treatment patterns that better match conventional evidence because the majority of drugs that are being prescribed for a given condition are done so in order to achieve formulary compliance and to avoid prior authorizations or additional work.

The consensus among physicians in the discussion was that real-world evidence has its place, but it shouldn’t overshadow the recommendations that are gleaned from robust clinical trials or gathered through expert consensus.

Mr. H. mentioned it earlier this week, but I would be remiss if I didn’t include my own mention of the Lown Institute’s 2024 Shkreli Awards, recognizing “the worst examples of profiteering and dysfunction in healthcare.” The list is named after so-called pharma bro Martin Shkreli. If you’re not familiar with his exploits, I would recommend spending a minute or two with your favorite search engine.

There have been a number of terrible individuals and organizations in healthcare over the last several decades. I might have reconsidered my career choices had I known how bad it could be. My academic advisor had a sweet job lined up for me in the world of publication, and although I’m sure it would have been interesting, I can’t imagine it would have been as much of a thrill ride as healthcare has been.

For people who are new to the industry, I would encourage you to look at previous iterations of the Awards. Many of you are inspired and altruistic, and previous lists will provide some clues about things to watch out for.

This year’s list includes a medical school that failed to notify the next of kin before selling the body parts of the deceased, inappropriate procedures to “treat” infant tongue ties, exorbitant air ambulance bills, the focus on profits of private equity hospitals, and insurance companies behaving badly. Although it only ranked fourth on the list of 10, my personal pick for the worst of the worst is an oncologist who recommended unnecessary cancer treatment for patients. Let me know if you have other callouts for folks that should have made the list but didn’t.

Speaking of tacky behavior, I recently received a so-called “grateful patient” solicitation from an organization where I recently received care. The problem is that the care I received was not in keeping with the standard of care and left me confused, concerned, and a witness to a HIPAA violation. I reported these issues to the provider at the time of care and was asked to reflect them in my patient survey when I received it. I did that and have had exactly zero contact from the institution. Let’s see if attaching a summary of my recent visit to the grateful patient response card inspires anyone there to reach out.

I admit that I fall victim to clickbait-style headlines as much as the next person, so this one caught my attention: “Hospital at home needs an ‘Uber app,’ Mayo Clinic leader says.” The piece features comments from Michael Maniaci MD, chief clinical officer of advanced care at home for the organization. He notes that Mayo Clinic can’t scale beyond its current volume of 30-35 patients per day due to lack of coordination for staffing, supply, and other patient needs. He states, “Imagine an Uber app where the car chassis, the tires, the fuel, the engine, and the driver all show up separately. You have the tubing coming from someplace, prescription medication coming from another place, the nurse coming from one place, the DME and the pump coming from another place — and they all have to show up at the same time.”

Sounds a bit like what healthcare organizations have been doing in other developed countries for years, minus the “we need an app” bit. I have a medical school classmate who worked for an organization in Germany that provided care to patients in their homes. It sent out a fully equipped medical vehicle that was stocked with almost everything you could receive from a high-acuity urgent care or freestanding emergency department. Another classmate who worked in the United Kingdom was partnered with public health nurses who rounded on patients and provided care beyond what we consider typical nursing care in the US.

For these models to be successful, you need a certain degree of vertical integration that we don’t typically have in our fragmented healthcare system. When your insurance contracts with a home care agency that isn’t affiliated with the hospital from which you were just discharged, there will be disconnects. I’m not convinced that an app is the answer, and would instead put my money on concepts that align all facets of care with the patient and their outcomes rather than aligning with profit motives or passing the buck to other agencies.

Another article that caught my eye this week was a viewpoint piece in the Journal of the American Medical Association that addressed health privacy and the use of synthetic data. Although this approach can help mitigate issues with insufficient private health data, it introduces additional challenges due to the fact that healthcare is a complicated and highly regulated environment. The authors note difficulties in creating data points that accurately represent rare conditions or highly complex clinical presentations such as scenarios that take place in the intensive care unit. There is also the risk of bias with synthetic data particularly when it is used at scale.

They go on to state the need for standards to generate and evaluate synthetic data. I woud be interested to hear from readers who are involved in organizational use of synthetic data and the approaches that are being taken to ensure that the promise is fulfilled.

Shortly after many people around the world rang in the New Year with a cocktail, US Surgeon General Vivek Murthy released a recommendation that alcohol products receive a warning label that advises consumers of the increased cancer risk associated with alcohol consumption. This would literally require an act of Congress. As we head towards HIMSS and another year of conferences, it will be interesting to see if health-forward organizations continue hosting alcohol-laden happy hours in their booths or if they use it as an opportunity to trim budgets as well as to promote health.

Will you reduce or eliminate alcohol consumption based on these recommendations? Whether yes or no, what’s your favorite beverage pick for 2025? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 1/6/25

Since the Snowpocalypse is upon large portions of the US, I decided to show solidarity by staying home, making baked goods, and working on my reading list.

I’ve gravitated towards audiobooks in a big way. They have become my preferred way to consume fiction because I can enjoy them while doing household tasks, driving, and in many more situations than I can enjoy a paper book or even one on my trusty Kindle. For non-fiction, I still like to have a physical book in hand, especially one that references previous sections or chapters since it’s so much easier to flip back and forth.

This weekend’s paper read was one I had picked up from the library a number of weeks ago. I decided to finish it so that it could go back into circulation. I was originally drawn to the book through a reference in an article I was reading that talked about how the internet is responsible for making people “dumber.”

Barely into the first chapter, I was seeing parallels between the book’s discussion of how true expertise is being devalued and the conversation I had recently with a colleague who cited “patients arguing with me all the time” as the chief source of her burnout. The first chapter addresses the idea of differentiating “experts” from “citizens” and the role that each has played in society. Experts typically have specific credentials, although the book identifies different levels of experts bearing credentials: those with aptitude or talent or experience in the field who also have credentials, and those who just have credentials.

We see the latter in medicine and I see it often in the startup world. People who have the MD or DO degree decided to go into business rather than completing a residency, and thus have never cared for patients independently or learned to bear the direct individual responsibility for another person’s life. It’s different when you’re talking about lives in the abstract or in the aggregate than when you’re sitting at the bedside with a patient and family whose treatment didn’t go the way they expected. Those with credentials but not experience or aptitude may be charismatic and may be recognized as entrepreneurs, but they will never be recognized in the same way as a physician who actually went through the steps to be board certified and to carry that kind of a load personally.

Partway through the first chapter, I had to check on its publication date. The copy I had in hand was a first edition version from 2017. On one hand, I was relieved, because reading about the debacle that was the first couple of years of COVID is still triggering for me as a frontline provider who had COVID deniers coughing in my face during the 12-hour shifts that were nearly always 14 hours long.

A lot of us who went through that experience felt at the time that COVID had magnified the willingness of patients to argue with us, largely due to conspiracy theories and medical misinformation that was found all around us. But the book reminds us that it was happening well before then, which reminds me of a patients who would arrive with stacks of pages printed from internet blogs that they would cite as evidence for the treatments they were demanding.

The book also talks about influencers and uses Gwyneth Paltrow and her GOOP brand as a prime example. I’ll admit my bias upfront here – it is my strong personal belief that “influencers” will be the death of Western Civilization as we know it. I remember when I was a kid, and there was such a focus on the idea of peer pressure and how it was something to be avoided, and that people should be critical thinkers and use their own values rather than doing something just because their friends were doing it.

The in-your-face nature of influencers and the rise of social media and TikTok have been terrible for many segments of the population, whether it’s because they wind up in the emergency room after doing some inane TikTok Challenge or whether they waste their money on unproven treatments or so-called wellness products that are more multilevel marketing than evidence-based.

The book has a short section on conspiracy theories that made me chuckle. At least to me in hindsight, the conspiracy theories that were out there in 2017 were far more benign than some of those we hear today. There’s an interesting section on how changes in higher education have led to the death of expertise, including the up-branding of small local colleges to universities without a commensurate change in the education they’re delivering, along with an attitude that people attend college or university because they are pressured to do so or feel they have to as a next logical step in their lives.

The author talks about the difference between “having a college experience” and “getting an education” and how the former has changed attitudes at institutions of learning. We’ve definitely seen this in healthcare and I’ve seen it quite a bit in the for-profit healthcare training programs out there. Graduates come out of some of these programs with no experience other than shadowing, which is truly a travesty.

My favorite chapter is the one titled “Let Me Google That for You,” which really should be the anthem for my generation. I run into a lot of people who think that because it’s on the internet it must be true, and I agree with the author that many people don’t have the skills to critically appraise their sources and to determine whether they should be trusted. Honestly, if I see one more friend posting on “cough CPR” — which is where if you think you’re having a heart attack while driving you are supposed to cough forcefully while driving yourself to the hospital — I am going to scream. This is a myth and that has been debunked by numerous reputable sources. I always post links to those sources when I see that post and remind people that if you think you’re having a heart attack while driving, you should pull over and dial 911 or hit the emergency button on your phone rather than trying to drive yourself and risk the lives of those around you.

Even in 2017, the author touches on Robert F. Kennedy, Jr. and vaccines and other medical misinformation. He reminds us that “a search for information will cough up whatever algorithm is at work in a search engine, usually provided by for-profit companies using criteria that are largely opaque to the user.”

He notes that “The deeper issue here is that the Internet is actually changing the way we read, the way we reason, even the way we think, and all for the worse. We expect information instantly. We want it broken down, presented in a way that is pleasing to our eye – no more of those small-type, fragile textbooks, thank you – and we want it to say what we want it to say.”

People do not do research so much as they “search for pretty pages online to provide answers they like with the least amount of effort and in the shortest time.” The resulting flood of information, always of varying quality and sometimes of uncertain sanity, creates a veneer of knowledge that actually leaves people worse off than if they knew nothing at all. It’s an old but true saying: “It ain’t what you don’t know that will hurt you. It’s what you do know that ain’t so.”

He also tackles the evolution of journalism (fun fact: I now know the origins of the TV show “Nightline”) and reviews some specific studies from the University College of London about how people often interact with the internet by “reading” articles by consuming the first few lines or sentences and then going on to the next thing.

The phrase “power browse” was used and I definitely see that in some of my own behavior, usually when I’m trying to cull through all the noise out there in order to write for HIStalk. It’s useful in that context, but might be dangerous if I’m trying to read about patient care or learn the nuances about a specific course of treatment. It makes me wonder how easily people can shift between those approaches in the fragmented timeline of a day caring for patients.

The book is a relatively quick read at 230 pages, and of course you can power browse it if you’re not quite ready for a deep read. I’d encourage the latter, however, because they author has a couple of really funny statements in there that I would have missed by skimming.

Have you read it and what did you think? Any other good reads you’d recommend for 2025? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 12/30/24

The end of the year is within striking distance. I was fortunate to have a nice break since nearly everyone who I work with was taking time off.

Running your own business can be labor intensive, so now it’s time to finish up those end of year accounting reports and get ready to open the books on a new one. I enjoy opening a nice, clean spreadsheet, probably a holdover from the heady days of picking out school supplies and having brand new Pink Pearl erasers at your disposal. Maybe I should start the new year with some brand new shoes as well. I’m sure there will be something sparkly in the post-New Year’s sales that would be suitable for HIMSS. 

Plenty of people ask me what I predict will happen in healthcare and healthcare IT in the coming year. I think we are going to see a lot more conversation about the role of insurance in the healthcare system and how it needs to change. Unfortunately, I think it’s going to be all talk and little action, as powerful lobbying forces work to prevent any kind of substantive change. Profit is a powerful motivator, and shareholders aren’t going to stand for lower returns when more dollars are spent on patient care.

There will also continue to be resistance to any kind of universal healthcare, despite the fact that other developed nations do a pretty good job at it, with better clinical outcomes at a lower overall cost. Anecdotal stories about people who had to wait for care in Canada will continue to sway opinions, despite the fact that care rationing and delays have been the norm in the US for years if you don’t have “good” insurance that comes at a hefty price.

One prediction that I think many of us would agree with is that Epic will continue to grow market share. Given the uncertainties at Oracle Health, Epic is a safe bet when you’re about to open your wallet to the tune of tens or hundreds of millions of dollars. Small to mid-sized practices might continue to select niche EHR vendors for a particular specialty, especially if they have a low need to integrate with the local health system, but everyone else is gravitating towards the folks in Wisconsin.

Hopefully, this leads to more patients demanding full use of the Epic solutions, including self-scheduling or the lower-key ticket scheduling option, which would allow patients to have greater control over the services they receive without having to make inconvenient phone calls to try to book appointments. I still marvel at the number of organizations that haven’t implemented these features and am always happy to have a conversation with the physicians who are typically blocking their implementation.

Another prediction: physicians will continue to leave medicine earlier than they planned, particularly if they are in primary care. I hear from a number of former colleagues who are trying to find non-patient-care roles and who think that informatics is a logical jump. I advise them that it takes more than being an EHR user to be a successful informaticist and recommend that they do some formal coursework before they decide that it’s the next phase of their career.

It feels like the majority of physicians I know have some kind of side hustle (including real estate, life coaching, crafting, baking, and photography) that they are hoping to grow to a point where it can generate income if they are too burned out to practice. I’ve already received notice of three retirements this year, along with one offer to buy a practice for an insanely low price that I gently declined.

As for non-physician workers, I think we’ll continue to see more of the so-called “quiet quitting” and “coffee badging” phenomena. People are continuing to realize that employer loyalty is a thing of the past in many areas. They will work the amount that they feel is appropriate for what they are being paid.

I think we’ll see this more in people who feel they have been forced to be physically present in the office when it does nothing for their productivity. It’s hard to build culture when you demand that people interact just because they receive a paycheck from a common employer even though they don’t even work in the same sector as others who are also forced into the office. I have a couple of friends that drive 20 to 30 minutes to their offices every day to engage in back-to-back Zoom meetings with team members who are located in other states. One goes to an office that is a non health-related division of a large corporation, but it has the same logo as their paycheck and is within 60 miles, so it’s required. Based on our conversations it’s not making for a happy work environment and employees will do the bare minimum in person so as to not be penalized. 

My final prediction is that we’ll continue to see companies try to enter the health sector because they think that they are smarter than everyone else who has been there before, which positions them uniquely to solve problems that are significantly more complex than they think. They will raise a fair amount of money along the way by convincing people that they are unique or have special skills, but I think we’ll see the majority of these companies fizzle out in the same way as their predecessors. I’m hoping that they’ll be smarter about how they operate than the last crop of startups, but I guarantee that we’ll see plenty of them blowing through cash and parading around at the trade shows. It’s what makes the industry interesting at times, and even though you want to look away, you can’t, because it’s just such a spectacle.

I’d be remiss if I didn’t end 2025 with a mention of the passing of former US President Jimmy Carter, who reached age 100 and died at home after choosing hospice care over more invasive treatments. His desire to pass with grace and dignity is admirable and resonates in a particular way with those of us who have had to perform so-called heroic measures on patients who most likely would not have wanted them had they fully understood what was involved. Carter is remarkable less for his presidency than for what he did following it, working to advance the democratic process around the world and to demonstrate a culture of service at home. He embodied service throughout his life, from his time with the US Navy to the White House to Habitat for Humanity and beyond. There’s a lot of talk about servant leadership out there, but he embodied it. Today’s leaders could learn a lot from his example. My condolences to his family and loved ones.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 12/23/24

I enjoyed Mr. H’s recent survey asking, “Which winter holiday is most important to you?” It came at a time when someone had sent me a meme about how to best leverage holidays in 2025 for long-weekend travel, and my first thought about it was “yeah, if you’re not a frontline healthcare provider.”

In my first job as an employed physician, we received the minimum holidays: New Year’s Day, Memorial Day, Independence Day, Labor Day, Thanksgiving, and Christmas Day. The rest of the time, I was expected to have my office open and available to see patients, regardless of whether my entire staff wanted to take time off or not. There wasn’t any such thing as flexible holidays and the physicians had no autonomy to modify the schedules in a way that suited them. I’m glad to see that many organizations have evolved from this approach, although I’m sure there are some that still only recognize a minimum number of holidays.

When I moved from traditional primary care into the emergency department, we were assigned to Holiday Track A or Holiday Track B, which alternated years and made it clear which holidays you would be working each year. Honestly, it made things more straightforward and I enjoyed the predictability of the schedule. I suppose that’s why I selected New Year’s Day as my survey response. I’m nothing if not predictable, and I enjoy starting the year with fresh new spreadsheets to track my household budget, fitness goals, and various other things. I use some online tools as well, but there’s just something about seeing my data in the same format I’ve been using since 2009 before wearables and linked software really changed the game.

If your favorite holidays involve snow and you’re a physician, Epic is hiring for its physician team. It’s a relatively small team and I’m not sure if someone is leaving or if they’re expanding, but the job posting was shared in one of my online physician forums. Unlike other physician informaticist job postings I’ve seen over the years, this one doesn’t have a lot of detail as to the actual job description. It focuses on the positive aspects of working for Epic, including the campus, the food, and Epic’s sabbatical program for workers who stay at least five years. The posting received some scathing reviews on the forum where it was shared, primarily because the requirements specify “MD with several years of inpatient and/or outpatient experience” which raised the hackles of physicians who are DOs. I’m not sure if that’s an oversight or if Epic believes the MD credential is more relevant to the work. Others pointed out the fact that it requires COVID-19 vaccination, which isn’t something you often see in job postings in 2024. Let’s just say it was a lively discussion.

Although some people love the holiday shopping experience, I’m not one of them, so I made sure to time my Target run for 10 p.m., which seemed to work out well. In addition to the bathmat that I was in search of, I was surprised to see Oura rings for sale. It’s the first time I’ve seen them in person and the finishes available seemed nice. The store was sold out of sizing kits, so I’m guessing it’s likely to be a popular holiday gift.

Whoever does the merchandising at my local store has a sense of humor. There was an entire endcap display of “things you need to make fudge” but without any kind of signage or display. I only recognized what was going on with those particular shelves because I had just made a batch. I’m not sure others would make the connection. The Christmas section of the store was picked almost clean, but there were still a few things left in the Hanukkah section. I didn’t see specific areas for any of the other winter holidays and observances. Based on my recent mood, if they had anything for Festivus I would likely have considered it.

I wrote a couple of weeks ago about my decision to be part of a clinical trial, and I’ve just completed my first round of testing. Although completing the tests was straightforward, I’ve been told to expect to wait four to six weeks for release of my results. That experience is a departure from what we’ve all become used to over the last decade, with near-instant release of most labs performed locally. Even those that are send-out or complicated typically result within a week or so, unless they’re something really unusual.

It’s a good reminder of the progress we’ve made in healthcare, even when a lot of the other aspects of care delivery seem to be undesirable. Once the test results are back I’ll find out which of the screening interventions I’m assigned to. Not sure how long that piece will take, but at least it gives me something to look forward to in my email other than solicitations by other LinkedIn members looking to sell me something.

I receive hundreds of press releases each week and I admit I probably miss a lot of interesting news because there is just so much junk out there. I did enjoy reading a recent release that covered Providence Mission Hospital’s efforts to provide concierge services as an employee benefit. The goal is “to make life easier for hospital staff by helping them tackle everyday tasks so they can focus on what they do best: providing exceptional care to patients.” Services offered include running errands, scheduling personal appointments, arranging travel, shopping and gift wrapping, and managing household tasks. I’m sure the devil is in the details, but this sounds like a great benefit to me. I know I’m not the only one that puts off straightforward tasks because I don’t have the time to make phone calls during the day and can’t make appointments online – things like having my car’s tires rotated or scheduling a chimney inspection.

I know a lot of corporate employers offer conveniences at the office to increase employee willingness to work long hours, including dry cleaning services as well as discounted meals, gyms, and fitness classes. I’m wondering how many offer this kind of personal concierge service and how it’s working out. Does your employer offer unique benefits? Which is your favorite? Leave a comment or email me.

Email Dr. Jayne.