Screening questions may seem benign, but may come with some unintended consequences. During a medical appointment last year, I asked…
From Former Cerner: “Re: Oracle CloudWorld meeting. It’s hard to hear about the company’s goal (which is becoming more of a mantra) to ‘drive Cerner profitability to Oracle standards’ when you see what they’re spending money on, including a Formula One race car and of course the racing yacht. When you think about in the context of the fact that they laid off the clinical resources that a lot of us depended on, it’s absolutely nauseating. But I guess it might be a short-lived situation, since all of us are waiting to wind up on a layoff list some time soon.” I have several friends who work for Oracle, and all have shared the same sentiments. In addition, they noted the ongoing global focus (including the CloudWorld Tour 2024, which visits Dubai, London, Milan, and Singapore, among others) as detrimental to understanding the realities of the US healthcare system. Sounds like a lot of people at Oracle are job hunting, and I wish them well as they look for their next adventures.
From Atlanta Express: “Re: updating systems when new vaccines are rolled out. The new COVID vaccines caused havoc with the Vaccines.gov website. What did they think would happen when they authorized a new vaccine on the same day they removed the old vaccine, and removed all the vaccine inventory in the system? Especially when locations don’t have any inventory for the new vaccine? Searching for a ’location near me’ produces zero results. Lots of assumptions were made and now people are surprised, and everybody is scrambling.” I’m not surprised by any government chaos anymore. This seems like a classic cutover-type project, although on a larger scale. We’ve known for weeks that the new vaccines were coming even though we didn’t have a specific data for the Food and Drug Administration and other approvals. Organizations go through a similar process every year with updated influenza vaccines, so it’s disappointing to hear that this was messy. Hopefully, the lessons learned will be well-documented for the next vaccine update, which might be happening every year for the foreseeable future.
There has been a lot of whining by large health systems about the federal requirements for price transparency that were implemented in 2021. Some organizations worked hard to make it difficult for patients to find information where others quietly complied but didn’t promote the availability of data to patients. A recent article posted in JAMA Internal Medicine compared hospital online price calculators with prices obtained via phone for the same services. The authors used vaginal childbirth and brain magnetic resonance imaging (MRI) as their service price points. They concluded that “…at US hospitals, price estimates for shoppable services posted online correlate poorly with prices obtained via phone; these findings suggest that patients will continue to face barriers to comparison shopping.” Only 14% of hospitals had matching prices given via phone and online for childbirth; the figure for brain MRI was 19%. The authors also noted that at up to 12% of hospitals, billing staff couldn’t provide a price estimate even though the hospital had a functional online pricing calculator. Of course, it’s nearly impossible to comparison shop for urgent or emergency services, such as a same-day appendectomy or a critical fracture, so it remains to be seen how useful these price transparency tools are in the long run.
Although many organizations had already embraced electronic health records in the 1990s and early 2000s, it took until the US government’s so-called Meaningful Use program’s inception before other organizations fully embraced the concept. Over time, clinicians and their support teams have been asked to gather increasing amounts of information about their patients with the hope of improving clinical outcomes. First, it was basic medical information such as medications, allergies, and a problem list. Then, we moved on to smoking history, tobacco and drug use, and other factors that are linked to health outcomes. Now, organizations are being asked to collect information across a variety of domains, with social determinants of health receiving much of the current focus.
A recent Viewpoint article in the Journal of the American Medical Association cited the “Inadequacy of Current Screening Measures for Health-Related Social Needs” as something that needs to be addressed. The authors note the presence of new quality standards that are designed to promote health equity in the face of “an indisputable connection between social factors (e.g., low food security, housing instability), structural racism, poverty, and health.” In an unexpected twist, they note that “without additional considerations, these well-intentioned mandates will impede progress in health equity and have the potential to increase long-standing racial and socioeconomic inequities.” They point out that although policymakers use the terms somewhat interchangeably, there is a difference between social risks and social needs. Social risk screening requires validated screening instruments, and social needs screening involves asking the patient about desired assistance. Many health systems have created and employed their own screening instruments without looking at the difference between the two and that approach may lead to paternalistic care as opposed to trying to understand the patient’s perception of their unmet needs.
The authors have some specific recommendations for moving forward with screening in a productive manner, and not surprisingly, those approaches don’t involve standardized pre-visit questionnaires delivered via a patient portal. They recommend that regulatory bodies should provide incentives to health systems to better partner with their patients through a shared decision-making process. This involves cultural understanding and real conversations along with the flow of data among care delivery and social service agencies. They advocate for prioritizing social need screening over social risk screening, focusing on meeting the needs already identified by patients themselves. Staff members need to be trained to do this with empathy rather than just reading a canned questionnaire to patients and capturing their responses.
The authors call for strong social safety nets to better support patients, including nutrition programs and support of policies that promote equity. Unfortunately, in working with large health systems over the better part of two decades, I see a lot of people who still believe it’s easier and better to just throw technology at a problem, and I suspect we’ll be seeing more automated pre-visit questionnaires and fewer direct contact staff members as organizations try to tackle these issues.
How is your organization dealing with social needs data? Is it taking a technology-driven approach or using actual humans to make a difference? Leave a comment or email me.
Email Dr. Jayne.