EPtalk by Dr. Jayne 5/22/25

The American Medical Informatics Association hosted its Clinical Informatics Conference this week in Anaheim. It’s a relatively small meeting compared to some of the healthcare IT blowouts, with a reported attendance of just over 600. A couple of readers sent their thoughts on the meeting, leading to an overarching but not surprising conclusion that much of the conversation was “all AI, all the time.” Just looking at the list of the sponsors for the meeting, three out of the top four are ambient documentation companies – Nabla, Abridge, and Suki – so I’m sure that was a significant topic as well. Another reader mentioned a panel on career trajectories for women in the informatics realm that had good advice for those at the midpoints in their careers. I’m always a bit envious of the clinical informaticists who had coaches and mentors as they came up in the field. Those of us that learned at the school of hard knocks followed by a graduate program in making it up as you go definitely have some unique experiences compared to the newer generation of informaticists.

I’ve only attended that conference a couple of times, and each time I’ve enjoyed its low-key nature and robust conversations. It’s not a place that you go in hopes of coming home with a tremendous amount of SWAG items, but I daresay I’m a bit jealous of this reader’s submission. It reminds me of one of my favorite HIMSS giveaways, a shirt from Intermountain Healthcare that said, “I Like Big Data and I Cannot Lie.” Props to the folks at Regenstrief Institute for knowing your audience and how to reach them. During the meeting, the organization also inducted its 2025 class of Fellows of the American Medical Informatics Association. Congratulations to the 87 new Fellows recognized for their contributions to the field of clinical informatics.

One of the hottest stories around the virtual physician lounge this week covered accusations that UnitedHealth Group paid nursing homes to block hospital transfers in order to slash the cost of care. The scheme involves UnitedHealth care coordinators that were embedded within facilities and is supported by two whistleblower complaints submitted to the US Congress. Another part of the alleged misconduct involves incentivizing providers to place Do Not Resuscitate orders on patient charts despite the wishes of those patients stating that they wanted medical interventions to keep them alive. As expected, the insurance company denies the allegations, but I don’t think any of the physicians that were chatting about this would be shocked should they be proven accurate.

A reader who knows I like to report on various wearables sent me some comments on Whoop, which is apparently “designed to improve your fitness, health, and longevity.” Claims of the ability to make people live longer always catch my attention, and this one did not disappoint. The solution claims to calculate the user’s “Whoop Age,” which might be younger or older than their birth age based on various lifestyle factors. It also claims to translate “the body’s monthly vital signals into guidance that extends healthspan, not just lifespan.” The company’s CEO touts its ability “to help our members perform and live at their peak for longer.”

The device does contain an FDA-cleared ECG feature, but its documentation is a little more vague about its “patent-pending technology that delivers daily blood pressure insights.” It also claims to deliver “hormonal insights” for women who are “navigating menstruation, pregnancy, or perimenopause,” but I guess those that are actually menopausal are just out of luck. The company promises a “next evolution in personalized health” to include blood tests that are integrated into the app along with clinician reports. The company offers multiple technical garments to allow the device to be worn in different ways, which is also a great revenue stream. It’s sold in three subscription tiers ranging from $199 to $359 per year. I couldn’t shop any of the accessories or apparel without a login, so if you’ve got intel on their offerings feel free to send me your best “fashion week” writeup.

I caught up over lunch this week with one of my pediatrician friends and we spent a good portion of the time talking shop about EHR enhancements and her recent experience with an ambient documentation solution. She has been trying to integrate it into her practice for several months, but let me know that she had decided to notify the IT department that she wanted to be taken off the licensing list for the application. Although she felt that it might be beneficial for some, she was spending too much time editing documents compared to when she used to document manually in the EHR. One of her main concerns was the inability of the system to differentiate key elements of conversations with parents during visits. For example, a parent with multiple children might be discussing the patient who is having a visit and also make comments about her other children – such as comparing the children’s temperaments, developmental milestones, or experiences with respiratory infections being passed around the household. She also ran into a number of hallucinations where social history elements that were erroneous had been injected into notes. Her parting comments: “I’ve been doing this a long time and I’m fast, and this felt like taking one step forward and two steps back.” I’d be interested to hear from other clinicians who have decided that ambient documentation just isn’t for them.

After writing previously about the Open Payments review and dispute resolution process, I’m pleased to report that the mystery payment I reported has been removed from my file. The vendor in question didn’t provide any of the information I asked for in the dispute report, such as when or where the payment supposedly happened. Instead, they just informed me that they were removing it from their reporting. Since I’ve been watching the Netflix detective series The Residence, I was looking forward to having answers to my pressing questions, but I guess I’ll just have to live with the item being off of my record.

Have you had to dispute an item in Open Payments, and if so, did you get a full resolution? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 5/19/25

One of the hospitals where I am on staff has decided to take a dip into the waters of virtual nursing, at least according to a buzzword-filled newsletter that came out last week. Apparently, the project is going to be transformative, innovative, and cooperative, although having all those words in the same opening paragraph made me wonder if hospital administration was having fun with a thesaurus app while writing it. They left out some of the adjectives that we sometimes associate with technology projects, including disruptive, aggressive, and intrusive.

At no point in the newsletter did they actually explain what type of virtual nursing workflows they planned to implement, or what the timeline might look like. I’ve done plenty of work in this space and know that if you’ve seen a virtual nursing project at one organization you’ve seen one project and that rarely do two of them look alike. There are so many variables, including which EHR will be incorporated, what kind of equipment will be used, and which of the many problems the organization is trying to solve with the solution. There was also no mention of the timeline, the holding of stakeholder sessions, or any contact information about the project other than to contact the director of nursing for questions. I don’t envy the volume that her inbox is likely to see with all the questions I heard thrown about in the physician lounge.

I thought the timing of the newsletter was particularly interesting, since we just had our quarterly medical staff meeting last week and that would have been a fantastic opportunity for socializing the concept with the majority of physicians who are on staff at our facility. Of course, that begs the question of whether administrators actually want to have a dialogue about the project, leading my more conspiracy-minded colleagues to think the lack of information was part of a well-orchestrated plan to cut physicians out of the process. Having watched a number of technology projects unfold here, I’m not sure that I would give some of our leaders credit for being organized enough to intentionally alienate us. More likely than not, it’s just the usual confusion and lack of communication and coordination that we see most of the time.

One of my colleagues asked me what I thought about virtual nursing and which variety of the solution we should adopt. In thinking through current needs and what I hear from the floors, I think a quick win would be to adopt a solution that enables virtual sitters. Right now, the hospital is so short staffed for sitters that they’re floating registered nurses to do the job, which creates an incredible cost burden every time a physician orders a sitter for their patient’s safety. There’s a lot of pushback when the order is placed, which isn’t a good look for any healthcare facility. It’s also a dissatisfier to the nurses who are floated, since they end up working far below the level of their licenses. Although implementing a virtual sitter program would create some operational savings, it’s a huge capital investment, as it would require adding cameras and technical infrastructure throughout the facility.

Having that kind of technology in patient rooms could also be used as a stepping stone to implementation of AI-powered fall prevention programs, which I think are going to be increasingly important as the average age of hospitalized patients continues to increase. Due to the technology lift, organizations that employ these kinds of solutions usually do so on a unit-by-unit basis, which makes sense to reduce disruption. Still, I could see the neurology unit duking it out with orthopedics and the general medical service to see who gets to go first. I suppose if hospital leaders wanted to get creative they could throw in some teambuilding and elements of competition and turn it into a formal challenge to see who can earn the right to go first. Personally, I think it would be more entertaining than the usual teambuilding they try to do, which usually leads to worsening resentment by the lunch break, if not before.

While we were talking about it, someone asked whether I thought it would be better for the staff of such a program to be employed by the hospital or by a third party. There are certainly pros and cons with either approach. Making the virtual sitters part of our hospital would have the potential to build collegiality and trust, and might allow us to tap a larger candidate pool due to the virtual nature of the work. On the other hand, having them work for a third party might lead to culture issues if there is a perception of difference as to how those sitters are treated versus in-person employees. It certainly changes the appearance of the balance sheet, which is more important to some administrative types than others.

When it comes to virtual nursing of the registered nursing variety, I think it’s critically important that the nurses be employed by the hospital so that there is a single cohesive nursing workforce. Virtual nursing has enormous potential when it comes to creating longevity in the staffing pool – allowing nurses to float to virtual roles when they need to because of illness, injury, or disability. There’s potential for hybrid roles where nurses work both virtually and in person, which helps keep skill sets sharp for future role changes. Such an arrangement also prevents the feelings of “us versus them” that I’ve seen in other virtual projects, where the virtual staffers may be in another state or otherwise never set foot within the facility.

I’ve seen so many different kinds of projects, though; I think it would be challenging to figure out where to start first in our facility. Would we want to have virtual nurses primarily for admission, discharge, or both? Or would we use a more hybrid model where several less experienced bedside nurses might be paired with a more experienced virtual nurse who serves as a supportive mentor to the group? Of course, one of the first things we should be doing is having conversations with our stakeholders, which don’t seem to have happened yet based on how the newsletter sounds.

For the projects on which I’ve worked, usually I become involved after the decisions are made and I’m working on implementation and training, so it would be great to understand the thought process of organizations who have tried the different solutions in different combinations. Is there one way that’s more foolproof than others to implement in a mid-tier community hospital as compared to the academic medical centers that many vendors seem to have worked with? Is there enough consistent experience in the field that pitfalls have been identified for organizations to avoid?

What are your thoughts with virtual sitters or virtual nursing? Did it do all that you expected or did the efforts fall flat? Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 5/15/25

I was at a neighborhood gathering the other night. One of my neighbors was talking about her health experiences, and in particular, with wearable devices. Just from what I could see, she had an Oura ring, an Apple watch, and a continuous glucose monitor sensor. Someone asked her if they were recommended by her physician, and her response was essentially that she was following various wellness influencers for recommendations.

One of my older and more curmudgeonly neighbors (who is of course my favorite) made a comment about “not wanting all those people spying on me,” which made me smile. He’s the kind of guy who can type up a binding contract in minutes and can explain the appropriate use of a comma at the drop of a hat, so I enjoyed hearing his thoughts on End User Licensing Agreements and how “the young people are just giving their rights away.” The comments shocked the neighbor with the wearables since she had no idea that her health data isn’t covered by HIPAA when using consumer devices.

I did a quick web search later that evening and discovered that only roughly 9% of users actually read the licensing agreement or terms and conditions that come with new devices, services, or subscriptions. That number actually seemed high to me considering the number of agreements we all run into on a given day. I know I haven’t read one in a very long time, and when I do look at them, I tend to only look at specific portions. I avoid wellness apps and services that touch my health data, so that’s one level of privacy defense right there.

Another search brought me a decade-old Atlantic article that said that if people read the agreements they encountered in a year, it would take 76 work days. Still, knowing the risks of having data shared makes you want to think twice before signing up for anything, and three times for anything involving sensitive information.

From Forest Fan: “Re: visit notes summary. What should the patient do when the documentation is not accurate? One of my doctors was doing a lot of copy-paste, not reviewing, etc. He had the meds all wrong. Medicare uses that documentation to decide whether to authorize his recommended treatments, so I started to think that I need to pay attention. An RN who did the Epic implementation for this organization recommended speaking up, but UGHH. How to do this? It doesn’t seem right to correct my physician.”

From the physician perspective, I’ve seen so many inaccurate notes over the years that nothing shocks me. Early in my career, many of them were errors in dictation and transcription. Most of them were when physicians didn’t read their notes after they returned from the transcription service, but instead simply signed them and sent them out the door. Generally they had an accurate physical exam, diagnosis, and plan content, so I could overlook the semantic issues.

As EHRs came onto the scene, we started to see templated physical exams that were entirely fanciful. My favorite was the one from an orthopedic surgeon who claimed to have performed an eye exam that included visualizing the fundus. I’ve never been in an orthopedic office where an ophthalmoscope was present, so either this was some kind of multispecialty clinic and the physician is a serious outlier or it was simply erroneous.

By this point, I was knee-deep in EHR deployments. I recognized it as either laziness or unwillingness for the provider to spend time customizing his exam template or inappropriately restrictive behavior by IT folks unwilling to support personalization due to fears of increasing their maintenance burden. Now, many of the consultation notes I see are so much gibberish that I end up talking more with the patient to understand what actually happened.

From the patient perspective, I can’t stand errors in my chart. It’s one thing if they’re in a narrative or free text box that isn’t discrete data. As the reader noted, these are seen by insurance folks when notes are sent as documentation of the need for a prior authorization or other approval, so they’re certainly problematic. However, when discrete data is wrong, that’s a different kind of problem since it could be used behind the scenes in various algorithms that form care recommendations and no one is aware that they’re incorrect.

Errors aren’t just a nuisance, but can keep you from getting the care you need and can prevent you from receiving recommendations for care you might not even know you needed. Still, because of the traditional power imbalance between physicians and patients, it’s hard to bring it up.

I’ve had to bring it up myself and have used different strategies depending on the level of the error. For minor errors, I’ve sent messages through the patient portal and asked the clinician to update the note. I think it’s important to have that written record. For more serious errors, I’ve addressed them in person at a subsequent visit and somewhat forced the correction or amendment to be done real time.

For major errors, I’ve invoked my rights under HIPAA and sent a formal communication to the physician and asked for them to modify the chart and send me a corrected copy of the documentation. HIPAA requires that patients submit these requests in writing, after which providers have to either make the changes or provide a written denial with explanation. I’ve also specifically requested that they reach out to downstream systems that may have consumed the erroneous data and address it there or notify me where their data is flowing so I can make the appropriate requests.

For the major errors, I’ve also sent letters to the higher-ups making sure that they know what is going on in their practices. At one, a clinician put inaccurate information into my chart three visits in a row, so I cited that as my reason for leaving the practice and removing them from my referral list as a physician. Shockingly, I’ve never received a response from any of those administrative communications, which I think is a reflection on how little people value accuracy or loyalty these days.

Have you had to correct your medical record, and how did you approach it? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 5/12/25

I had the privilege of spending Mother’s Day with some of the wisest women I know, including some who are in their 80s and 90s. As these events usually do, it included what I’ve heard jokingly referred to as “the organ recital,” when everyone tells everyone else about all of their recent health issues.

As a physician, they tend to expect me to have immediate knowledge of every condition that they discuss and every physician they see, despite the fact that we live in a major metropolitan area with literally thousands of physicians who are divided across a handful of highly competitive organizations. Even when I was in a traditional practice setting, I rarely got to know physicians who were outside of my referral networks. Still, they seem shocked when I say I don’t know one of their physicians.

One of my relatives had a recent hospitalization. Fortunately I had helped them set up their proxies in the patient portal prior to that event. Since I’m one of the people who have access to their data, it was good to be able to see the information myself when other relatives called to ask me what I thought about it. It was initially great to receive all the lab notifications, but as the hospital stay went on, it started to feel more disruptive.

I didn’t see any options in the patient portal to change those to more of a batch notification or to snooze them for a period of time, kind of like I can subscribe to an email digest with a daily update rather than receiving individual emails from some of the groups I’m in. Fortunately, the hospital stay was brief, but along with the appetizer course, I was treated to a tour of their patient portal with all their follow up items.

Having everyone together, we also used the opportunity to make sure that everyone around the table was set up for the two-factor authentication that will soon be required by the health system where most of them receive their care. It was a little tricky for the relative who didn’t have a cell phone, but we were able to figure something out.

Fortunately, they’ve all figured out that if I’m going to be their IT support person, they need to bring their devices when they see me, so we had a little bit of an assembly line going along with the after-dinner drinks. One of my relatives is thinking about upgrading to a smartphone that I think will be nothing but trouble for him, so I’m crossing my fingers that he sticks with what I’ve recommended and doesn’t drop more than $1,000 on something that’s just going to make him mad.

The only thing that threw a wrench in my plan for a lovely day was cooking a multi-course menu in a kitchen that wasn’t my own. I realized how dependent I had become on my trusty first-generation Alexa device to manage all my kitchen timers by voice alone. I immediately found out that asking one’s significant other to set a timer on their phone is definitely not the way to go if reliability is at stake. I couldn’t figure out the timer on the microwave and I know better than to punch any buttons on the high-tech oven other than the ones that control the temperature.

I was able to fall back on a pair of trusty “minute minder” analog timers, which helped a lot. Still, unlike with Alexa, I had to remember what the timers were for. At least I didn’t run the risk of someone turning them off without my knowing about it or accidentally setting the oven to convection when I didn’t want it.

I also had some time this weekend to hang out with some of my oldest and dearest healthcare IT friends. We started implementing EHRs together more than 20 years ago, and one could say that our friendships have been forged in the fire of adversity.

Bringing up systems in the early 2000s was very different than it is today. There was a lot more flying by the seats of our pants and a lot more scrambling at times, even with the best project plans in play.

One of my friends has a child who is now an EHR analyst at a large academic medical center, and watching the look on her face as we told some of our stories was priceless. Many of the things we did would never pass muster today, but honestly I think I’d be relieved if there were systems in place that kept us from doing some of the crazy things we did. It’s nice to have friends that you know are your “ride or die” friends, whether you need someone to help you dig up some revenue cycle benchmarking data or just to be a sanity check before you commit to a major project when you’re feeling a little uncertain.

Following that, I met up with a nurse who has been my friend for more than 20 years. She was regaling me with stories and pictures of the ridiculous things that her nursing friends received during the recent National Nurses Week observance. There were the predictable pizza parties and donut assortments, along with pet therapists and posters. Some of the nurse-themed cookies in her feed were amazing and I can’t imagine the hours that went into making them.

As for her hospital, it really classed it up by giving the nurses reusable utensil sets that fit into a toothbrush holder-like container. Although I appreciate their nod to sustainability, it doesn’t sound like the nurses thought it was that great, especially since the hospital recently announced that they were ending food service in the cafeteria during the night shift. Nothing says “Hey, pack your dinner at home and bring it with you, since there’s nothing for you here” like hospital-logoed flatware. Perhaps they could have also considered a lunchbox-sized cooler or a gift card to the local supermarket.

How did your organization celebrate Nurses Week? If you’re a nurse, what’s the most ridiculous work-related gift you’ve received, and what kind of recognition or gift would really make your day? Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 5/8/25

Farewell, Skype, parting is such sweet sorrow. Not really, since I hadn’t used it in years. In fact, I had forgotten that I even had a Skype account and didn’t remember until I went to the website to try to grab a logo.

I exported my contacts and there were only three, which makes sense since it was a personal account and not the corporate one that I last used in 2018 or so. Supposedly all contacts and conversations were ported to Teams, but I didn’t see them there. Skype was founded in 2003 and headquartered in Luxembourg, which I don’t think I knew when I was a user. It just goes to show that no matter how cool you think your solution is now, there’s a chance that it won’t be around in a couple of decades.

I had a routine trip to the dentist recently and was pleased to see that they had incorporated some newer evidence-based recommendations into their treatment protocols. Apparently they have also upgraded their imaging system, because it’s now using AI to flag areas of concern on the images. I got a kick out of listening to the dental hygienist explain what the AI was doing and how the goal was just to draw the viewer’s eye to areas that needed additional attention and that the AI was not practicing dentistry.

She knows that I’m a physician, but probably not that I’m an informaticist. Regardless, I’m glad that she didn’t make assumptions about my knowledge and did the same educational talk she likely gives to all the patients. The AI flagged areas that I knew were already concerning, so at least it was concordant with my history. I enjoyed being able to see and discuss the images instead of how things used to be when x-rays were still on tiny pieces of film.

I also had a visit to a new consulting physician and was reminded how difficult it is sometimes to try to put yourself in a “just be the patient” mindset when you know what the best practices are in the industry. The receptionist was friendly, but jumped straight into some screening questions that were straight out of 2021, including whether I’ve traveled outside the US recently and whether I’ve been exposed to anyone who has been sick in the last 30 days.

The answer to the latter was, “I’m sure, given all the bugs that are going around,” but it’s really a nuisance question unless you’re asking about particular kinds of illness. I was around someone who later tested positive for Influenza B, but that was two weeks ago and I’m asymptomatic, but I doubt the receptionist wants to get to that level of history. I’m also sure I’ve been exposed to COVID-positive people given the wastewater numbers in my area, but it seems that no one is testing at home any more and people are likely just walking around with viral symptoms. She also asked if I had been positive for COVID in the last ten days, which was more relevant, but again if people aren’t testing, they’re unlikely to know.

The office visit was uneventful, although the practice could benefit from a few patient-centric tweaks. The exam room had a bulletin board with a handful of flyers attached, but it was across the room from the patient chair, so there was no way to read it without walking over to it. At that point, you would be behind the door if someone opened it. The flyers were also bad photocopies in small font, so they weren’t terribly welcoming to patients who need readers or other visual aids.

There was only one patient chair, leaving no place for family to sit and no place to put a purse or tote other than the floor, which I don’t like in a medical facility. The physician asked about my job, and once I said “clinical informatics,” I got an earful about his dislike for ambient documentation. Apparently he’s been burned by hallucinations and the need to spend excess time doing edits, so he is phasing it out in practice. He’s in a subspecialty where every detail can have meaning, so I’m not surprised that he’s meticulous as far as his note content.

After the consultation, I was sent across the hall to the hospital-owned lab and made a beeline for the “sign in here” poster that points to a clipboard. The receptionist interrupted her conversation with another patient, turned to me, and said “You can use the kiosk.” She pointed over my shoulder to a kiosk that was on the wall behind me, next to the door that I had just come through, but positioned in a way that I wouldn’t have seen it entering the room. I think a sign that says “please check-in on the kiosk behind you” might be in order, since I heard her do the same thing several times while I was waiting.

I was also unamused to see a dirty waiting room with crumbs and dirt on the floor at 7 a.m. If one were giving the benefit of the doubt, one could think there might have been a patient eating a messy breakfast in there. But based on the distribution of the mess, it’s more likely that whoever is mopping is just pushing things back under the chairs since it was also all over the waiting room. I guess I’m just a curmudgeon expecting healthcare facilities to be clean. Still, I know from my leadership roles that it’s difficult to hire these days and also difficult to ensure quality. Still, if I were this facility’s manager I would be embarrassed.

From there, I went to a non-medical appointment, where I was also asked to check in via a kiosk. This time it was more visible to the average customer. I got a kick out of the fact that the “title” picklist in their system included such options as “crown princess,” “baroness,” and “viscount” and was very much tempted to use one of them just to see if it would raise eyebrows. Since I’m generally a rule-follower, I went with a more appropriate choice.

By the time I finished that appointment, I was already getting lab notifications from my patient portal, which was pretty surprising given the kinds of tests that were ordered. Some of the more obscure ones actually resulted faster than the standard chemistry panels, which is unusual. I suppose the speed and accuracy of the results might outweigh the state of the waiting room, but I guess that’s just healthcare in today’s world.

What’s your definition of clean? Do your facility’s floors shine like the top of the Chrysler building? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 5/5/25

An article that was published in the Journal of the American Medical Informatics Association this week addresses the realities of primary care staff members trying to manage the ever-growing volumes of EHR inbox messages. The research was done using qualitative methodology, including focus groups and observations at four academic primary care clinics. The output of those sessions was analyzed and coded into different themes. The study was small, with three nurses and nine medical assistants included. The authors highlighted key themes in the abstract: “Staff described inbox work as fragmented, feeling like an assembly line, requiring frequent communication with other team members to clarify and manage tasks, and requiring navigation of expectations that varied between patients, clinicians, and clinics.”

As someone who has spent a great deal of her career working on process improvement projects, I can feel in my core how the staff must have been trying to articulate a day in the practice. I’ve been around since the pre-EHR world and would note that some of these feelings are not unique to managing an EHR inbox. When we managed paper-based phone messages, we had a lot of these same issues, with the additional problems of having delays in messaging due to having to pull the chart from the file room, or even profound delays when the chart couldn’t be found because it was in a pile on the physician’s desk, their floor, or possibly even in their car or at their home. Working messages in the EHR is certainly faster, which makes one think of the old adage about how technology just makes a bad process go faster.

Seeing these results makes me wonder how much process improvement work the organization did alongside the EHR implementation. Did they spend resources to look at unnecessary process variation and make an effort to try to streamline workflows? If they did, what was the plan for sustaining those changes over time and not allowing the processes to drift back to individual ones?

In a group practice environment, it can be challenging to meet everyone’s needs when each clinician or care team is doing their own thing, and this study seems to illustrate that. The authors noted that there were some protocols available to those working the inboxes, so it sounds like there was at least some work in that regard. They also noted, though, that staff had to address messages that contained information that conflicted with the medical record, which required additional work. We had those issues in the paper world as well, especially when patients called about lab or imaging results that had been done elsewhere and we might not have had a copy at the ready.

In the background section of the article, the authors note that primary care physicians often spend an hour or more managing the inbox for every eight hours of patient care delivered. They also comment that primary care clinicians tend to receive more messages than other specialties and as a result have a higher time burden for inbox management. Not surprisingly, they’re often among the most burned out clinicians. As a result, many organizations are delegating some of this work to support staff, with this concept being studied less than physician work in the inbox, hence the need for this type of research.

The work was done at UW Health, which is affiliated with the University of Wisconsin-Madison, and looked at two general internal medicine clinics and two family medicine clinics. The article notes that they focused on adult primary care practices because those clinicians “receive more inbox messages than pediatricians or physicians in other specialties,” which caught my attention. I think we sometimes think that parents make a lot of calls to their pediatricians’ offices, but I suppose that’s more of a perception and not a reality.

The authors used EHR metadata to identify sites where support staff users were helping manage the inboxes based on functions such as pending medication orders during refill requests for controlled substances. This measure was selected because managing those refills is complex, but uses protocols so that staff can review the chart and pend orders for clinician review. They identified sites with high and low levels of this workflow in order to diversify the sample.

Due to the small number of clinics participating, the number of respondents was low, with some sites having only one medical assistant and one nurse participate, and other sites having three medical assistants but no nurses participate. The most common workflow was where messages sent to clinicians would go to the staff pool rather than directly to the clinician. Members of the pool would then either manage the message or forward it on to a clinician based on protocols.

Some of the fragmentation themes weren’t unique to an EHR workflow, such as being interrupted to bring patients back to exam rooms while also trying to manage messages or having to float to another clinic to cover a staff shortage. Another in that category was the fact that different physicians had expectations that the protocol shouldn’t be followed for their patients, which is not an EHR issue but an operational and clinical quality one. Others were unique to EHR work and particularly pool work,  such as refill requests, coming in through multiple pathways (phone, pharmacy interface, patient portal) leading to three different staff members unknowingly working on the same task.

One of the themes in particular caught my attention, that of limited control, with a staff member commenting, “They made these teams without… asking about how we felt about it.” One of the key tenets of any change management project is to identify stakeholders and understand where they’re coming from. If you don’t do this, it’s nearly impossible to define the “what’s in it for me” needed to support a change management campaign.

There’s a chance that this was done early in the process change, but the people who made the decisions are no longer with the practice. Based on some of the projects I’ve recently seen, there’s also a chance that supervisors made the decisions without discussing with frontline staff. Although that kind of effort can make a project go faster, it’s rarely the right answer for long-term success or happiness of the end users.

The authors note “several fruitful directions for future research,” but I’m more interested to learn what the organization is doing with the information that was uncovered through this study. Have they expanded efforts to collect data from a broader segment of the staff, or looked at experiences in more clinics? Have they compared the protocols from site to site to identify areas of unwarranted variability? Is anyone addressing physicians who are telling staff not to follow an agreed-upon protocol? The devil is in the details for all of those elements when trying to move forward with positive change. If you’ve got the scoop, I’d love to hear from you and of course can keep any comments anonymous.

What do you think is the most successful intervention to reduce inbox burdens for support staff members? Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 5/1/25

A hot topic around the virtual physician lounge this week was the potential for an impending staffing crisis. It’s not the nursing crisis that everyone talks about, however. Instead, it is the risk that we’ll see a bulk retirement of physicians in their late 50s and early 60s who are tired of fighting the system.

These are the folks who have watched medicine completely transform. They’ve witnessed the rise of Health Maintenance Organizations in the 1990s, the creation of Evaluation and Management codes, HIPAA, and more. They bore the brunt of early EHR transitions that may not have been smooth or well orchestrated, and some of them may have gone through two or three EHRs before arriving where they are today. They’ve dealt with increasing prior authorization requirements, aggressive case management and utilization review, and patients who are constantly challenging their knowledge.

With their departure goes quite a bit of collective knowledge, along with many years of learning related to the art of practicing medicine. These physicians are of the generation that were trained that touching the patient is essential and that it can perform a healing function as well as a diagnostic one. Many of them have diagnostic skills far beyond that of newly minted physicians. They also have a “Spidey sense” that they’ve honed over decades of practice. Some organizations have recognized this and put together plans that allow physicians to retire gradually so that the impacts of their departures are more subtle.

One of my favorite colleagues has a desire to retire early. She approached her health system with a plan to transition out of full-time primary care over the next two years. It can take a while to recruit a new primary care physician, and although she is only legally required to give them a 90-day notice, the lengthier notice was intended as a bargaining chip. In exchange for that, she requested the ability to continue to purchase health insurance coverage through the health system while working half time during the latter part of her proposed transition. They typically only allow workers to participate in the plan if they work at least 36 hours per week.

Although the physician leaders of her medical group were supportive, the plan was immediately scuttled by attorneys who were unwilling to even consider evaluating the modifications that would be needed to meet her requirements. 

Her practice is already understaffed by at least one, possibly two, full-time physicians. Recruiting has been difficult because of its location and challenging payer mix. The idea that the organization would risk her walking away rather than taking a structured approach to a long goodbye seems short sighted. There has been an open posting for a primary care physician for over 18 months, which is evidence of the challenge they’re going to face should she decide to leave.

During our quarterly physician lunch today, she confirmed her decision. She will be putting in her notice to depart the organization in August. It will be interesting to see if they counter with a retention offer or if they just let her go. We all agreed that it’s something that health systems need to start figuring out, because none of us is getting any younger and AI solutions aren’t going to replace us anytime soon.

The American Telemedicine Association is holding its annual Nexus conference in New Orleans this year, running from May 3-6. ATA is showcasing its Center of Digital Excellence (CODE) that includes provider-side member organizations such as Mayo Clinic, Stanford Health Care, UPMC, Sanford Health, MedStar Health, Ochsner, Intermountain Health, OSF HealthCare, and WVU Medicine Children’s. Solution-side members include AvaSure and Access TeleCare.

For those of us who were working in the telehealth space before COVID, it felt like we were making things up as we went along because there were no solid playbooks for various telehealth use cases. CODE pulls together organizations that are willing to share their successes, create implementation toolkits, and lobby together to promote the value of telehealth in the overall healthcare ecosystem. I’ve attended the conference in the past and found it valuable as far as bringing back a number of practical insights. Unfortunately, this year’s schedule puts it on top of a graduation weekend for one of my favorite students, so I’ll have to miss it.

I was interested to see this article in JAMA Network Open, “Cumulative Burden of Digital Health Technologies for Patients With Multimorbidity.” The authors specifically set out to answer the question, “What digital health technologies (DHTs) are available for patients with multimorbidity and how many individual DHTs would a hypothetical patient need to benefit?” They defined multimorbidity as a patient with five chronic conditions — type 2 diabetes, hypertension, chronic obstructive pulmonary disease, osteoporosis, and osteoarthritis.

They looked at 148 DHTs that had been approved by the US Food and Drug Administration or that had been vetted by the Organization for the Review of Care and Health Apps. They found that only five of the DHTs were intended to help monitor, treat, and/or manage two or more conditions. Some only offered a subset of features, such as recording or tracking health data, where others offered information or real-time interventions. Given the tools on the market, the patient in the hypothetical scenario would need prescriptions for as many as 13 apps and seven devices to provide the benefits that at least three of five clinicians felt were important. 

When I was in a traditional primary care practice, many of the patients I saw had multiple chronic conditions, with the most common combination being hypertension, obesity, and hyperlipidemia. A subset of those patients also had diabetes. All of those can benefit from lifestyle changes and several of them impact each other, so it would make sense to create one app to rule them all as it were.

I’m sure there are challenges with the FDA approval process in trying to get a submission approved for multiple health conditions, but I wonder if it is easier in other countries that have a more holistic approach to health. I’d be interested to hear from readers who may be more involved in the creation and use of DHTs.

Would you use a DHT that was proven to improve your own health condition? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 4/28/25

Even though I’m a contributor, I rely on HIStalk as much as the next healthcare IT person to keep me up to date on what’s going on in the industry. It’s challenging to sort through all the noise out there and the number of podcasts, newsletters, and emails that are trying to get the attention of leaders in our industry. The newsy tidbits are great for conversation openers when talking to my peers. I would much rather ask someone what they think about an industry happening rather than making small talk about someone’s boat or what they did over the weekend.

This week’s tidbit was the item that Mr. H picked up about virtual EHR education and how it has moved from being an uncommon training tactic to being one on which organizations now depend.

I remember my first experiences with virtual training, which were VHS recordings of my organization’s HIPAA training. It included a Roaring 20s gangster theme and questionable production values. From there, things evolved to recorded voiceovers with multiple choice questions that required clicking through to get to the next part of training. By the time I left my first EHR leadership role, we were starting to get modularized training that lived within a learning management system. Users could move through courses with some level of choice rather than having to follow a rigidly prescribed path.

Modern EHR training and education strategies are much more capable of meeting users where they are, rather than assuming that everyone needs the same type or level of training. There’s a difference between training a newly-hired physician who has never embraced computers and merely tolerates them versus training someone who is straight out of residency and who has used computers since they were toddlers. A recent KLAS Arch Collaborative survey shows that almost 70% of clinicians surveyed found it helpful that self-directed learning can be done at the time of their choosing. Most of the organizations that I work with use a blended training approach that includes asynchronous learning, interactive online learning, and in-person learning for those who want or need it.

The last organization where I worked as an in-person physician employed this approach, though it was less than ideal. The initial asynchronous content represented out-of-the-box functionality from the EHR vendor. When I reached the second phase, I realized that the organization had heavily customized its system. In fact, they had customized it in a bad way, taking away the ability for users to personalize their workflows and forcing everyone into the same cookie cutter approach.

There were some online sessions that covered the organization’s customized content, but I didn’t feel that the trainer was terribly capable. Some of the ways that she presented the material created confusion. We had five people in my training cohort, ranging from medical assistants to physicians, and some were directly out of their school-based training with minimal clinical experience in the field.

That probably wasn’t the trainer’s fault, but rather the organization’s shortsightedness at realizing the value of separate role-based training as well as integrated training. Still, she didn’t do much to try to pull it all together so that half of the class didn’t feel like their time was being wasted at any given time.

Personally, I like being able to go back to training that I’ve done in the past when I need a refresher. It’s similar to the concept of circle-back training at 30, 60, and 90 days post-implementation, but it allows people to do so at their own pace. When you’re seeing 40 patients a day, workflows get baked in pretty quickly. You often wind up so focused on getting through them that you don’t have time to appreciate the bells and whistles that might be in your EHR that you aren’t using.

Being able to go back to the training syllabus might be enough to remind you that maybe you should customize or personalize a particular part of a workflow. Or, you could revisit the content for the details if you couldn’t figure out how to do it in a less-than-intuitive EHR.

Embracing virtual training also means that organizations are showing that they value the learning experience of newer members of the workforce. Most of the high school students I know have been using online learning since their early grade school days, so the idea of old-fashioned classroom training may not resonate with them at all.

Many of this decade’s medical graduates were plunged into virtual learning due to the pandemic and had a front row seat to its quick evolution. The medical students who I talk to often don’t attend lectures, but consume the content by watching recordings at high speed and supplementing the school-provided lectures with online flashcards, videos, and tutorials. They’re not going to be excited to sit in a computer lab and be forced to try to learn at a pace that doesn’t match what they’re used to.

I’ve trained on most of the major EHRs at one point or another in my career. The biggest advantage that I see for recorded or asynchronous virtual training is the standardization factor. Variation between trainers doesn’t exist because everyone is presented the same material in the same way.

I’ve had some pretty bad trainers along the way, as well as a handful of truly outstanding ones. I have felt acutely how someone’s methodology or comments or anecdotal stories can have a negative impact on users’ ability to learn. I worked with one trainer who had some unique personal mannerisms and it made me wonder if his supervisor had ever watched him in the virtual classroom. It was clear by the facial expressions of others in my Zoom window that they weren’t a fan of his teaching style either.

Despite the effectiveness of virtual teaching and learning, it’s important for people to be able to access not only in-person support session,s but one-on-one support sessions if needed. Some learners are reluctant to ask questions in front of others for a variety of reasons, such as not feeling like they are looking bad to their peers or to subordinates. Others just need that individual touch to feel like they have reached the point where they can be confident using the system. That’s a corner that shouldn’t be cut, although the costs can be reduced by employing effective virtual learning strategies upstream.

What do you think about the evolution of virtual learning? How is your organization using it? Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 4/24/25

I enjoy reading research articles that confirm what many of us have long suspected. It increases the ammunition that we need when we are trying to convince people to make changes.

A recent Research Letter in JAMA Internal Medicine looked at what happens when the EHR was changed to default to a 90-day supply of a particular medication that is used to treat a chronic condition. In the literature, previous studies show that 90-day prescriptions are linked to greater medication adherence and reduced mortality, so getting an adequate supply to patients is a significant benefit.

To no one’s surprise, the change in the default led to an increase in the number of patients who were prescribed a 90-day supply. The authors noted that before the intervention, the patient groups that were least likely to receive a 90-day supply included Hispanic patients, non-Hispanic black patients, those on Medicaid, and those with ZIP codes whose median household incomes is lower than $50,000.

After the change, all of those groups were equally likely to receive the recommended 90-day prescription except for Hispanic patients, and even then the gap for those patients decreased. The recommendation to prescribe 90-day supplies with a year’s worth of refills to patients who have stable, chronic conditions has been there for decades, but a lot of prescribers still don’t do it. I’m glad to have one more tool in my belt when I try to convince people to do the right thing.

I recently started studying French. As part of that, I’m making a point to read articles from European sources. I was excited to learn about Robeauté, which is creating microrobots to aid in neurosurgery. The devices are the size of a large grain of rice and are shaped a bit like protozoa. The company’s goal is to use them for minimally invasive brain surgery procedures.

The company has only raised $29 million, so my guess would be that they aren’t as far along as others might expect them to be given the typical trajectory for and cost of development of a new medical device. One of the sources that I saw mentioned the potential for a clinical trial in 2026 with a focus on brain tumors, using the devices to take micro biopsy samples. Thus far, they have been using sheep for preclinical trials as they measure the safety and effectiveness of the devices.

I spent the majority of my clinical time in emergency and urgent care, so I’ve experienced the phenomenon of emergency department boarding first hand. It’s a problem that hospital executives work diligently to solve, although the causes are multifactorial and you often have to make many adjustments to see improvement. It’s exacerbated by nursing shortages, housekeeping shortages, physical plant issues, and a host of other factors, including the number and types of patients arriving at the emergency department for care.

A recent article in Louisville Public Media caught my eye. It mentioned the rising numbers of older patients who have dementia, noting that 50% of patients who are boarded in the emergency department are age 65 and older. As the US population ages, this is going to be a greater issue. Organizations should be looking at their patient demographics and forecasting how their population will age in order to begin solving the future version of this problem, which is likely to be much worse than the current state.

Virtual nursing, home-based care, quicker discharges, improved staffing, streamlined discharge processes, internal float pools, telehealth, and improved advance care planning all play a role. From the healthcare IT perspective, all of them have technology components, so it’s good to learn about potential solutions if you want to expand your ability to jump into different work streams.

We’ve all heard the old adage that “time is money,” but apparently the marketing folks at my preferred parking vendor don’t value my time as much as I do. They sent an email about updates to the Parking Spot App that are “available now in the App Store and coming later this month to Google Play.” They went on to recommend that users “download these updates when available.”

I guess Android users just have to keep checking back to see when the new app is available? Would it have been too much to consider sending another email when the Android version is available? Some days when you’re exhausted from travel that serves up a host of tiny annoyances, it really is the little things that matter. This detail tells me that the folks who are in charge of customer communications don’t put themselves in the customer’s shoes anywhere near what they should. 

I got tapped to present at a residency program’s “procedure night” event this week. My particular area of expertise is how to do procedures in environments where you don’t have the resources you woud typically have at a tertiary medical center’s emergency department. Depending on their career choices, the adjustment can be pretty significant when you move from being at a facility that has everything you need at your fingertips to one where you have to get creative to just do the basics.

I’ve done a bit of wilderness first aid. I have also practiced medicine in a tent, cleaning, and stitching wounds by light of a hand-held shop light, so I’m definitely qualified to present the topic. I think some of my stories were a bit eye-opening, but hopefully will serve as inspiration to residents who are feeling a little stuck and overwhelmed as they approach the end of their training year.

We were doing some joking about practicing in alternate environments. I said that maybe I should come back and do a class on paper charting. Since the program’s faculty members are young, I’m betting that I have significantly more experience on paper charts than some of them added together. It’s a skill, and if you ever have to make your way in a downtime situation for more than a couple of hours, you might wish you had a few more skills. It’s something to consider.

Does your hospital teach about paper-based charting as part of its downtime plans, or do you just hope for the best? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 4/21/25

I’m doing a consulting gig in a different part of the country and was excited to get out and see a bit of the local color. Those colors trended towards red, white, and rosé, which for me typically lead to a low-key afternoon.

I was certainly glad to visit an area where the weather doesn’t seem to be out to get me with torrential rain, flooding, or tornadoes as I’ve experienced in my travels over the last year.

As I work in different parts of the US, I’m constantly aware of the differences in healthcare resources depending on where people live. I’ve worked in affluent areas where no one ever seems to be uninsured and I’ve worked in places where the majority of patients are uninsured or underinsured. You’ll find compassionate and committed physicians in both of those settings, but there are different skill sets needed depending on the makeup of your patient population.

Even when I’m working on strategic planning projects, I like to start from the ground up with a little bit of workflow observation and some stakeholder interviews. This week, I worked with an organization where it feels like the physicians are 80% social worker and only spend 20% of their efforts on what people would consider typical physician tasks. Every exam room had cheat sheets to help physicians know which social services organizations might be able to help their patients.

One of my first questions when analyzing their workflow was why those resources weren’t somehow captured electronically so that physicians could make them part of their discharge documentation as patients left the office. Although some physicians had incorporated some of the information into their personal documentation shortcuts, it sounded like there isn’t any appetite in the IT budget to spend time on things that aren’t considered critical to patient care, such as maintaining the medication formularies and order sets. The organization tightly controls access to EHR resources, so even if there were physicians or other clinicians who might be capable of building additional tools to better support clinicians and patients, they wouldn’t be allowed into the system anyway.

Given the size of the location and the patient mix where I was observing clinicians that day, I asked if the organization had considered embedding social workers or care navigators in the practice to assist with patients’ needs. Apparently they used to have a part-time nurse navigator in the practice, but the role was eliminated and the nurse was moved to a centralized location to help with phone triage.

One could make a theoretical argument that having someone in a role like that would pay for itself because it would free up the physicians to see more patients, but the reality is that the physicians already have full schedules and full patient panels. They are doing the extra work either on top of their clinical responsibilities or instead of them. They are already optimizing their coding and billing processes to document all the work they’re doing “coordinating care” for the patients, which is a good thing, but doesn’t create the opportunity to bring in more revenue unless there’s some way to adjust the payer mix.

I looked at a lot more factors, not only in this location, but in several others. I found several areas in the EHR that could be optimized and others that needed significant work just to bring the existing content up to support the current standard of care. As an example, it didn’t look like the immunizations or health maintenance portions of the system had been kept current with changes to guidelines over the last year.

That lack of regular EHR maintenance was creating additional work for both physicians and clinical support staff. Knowing the system in question, fixing it all would probably be less than 10 hours of analyst time if you include requirements writing, approvals, build, testing, and implementation. The physicians I spoke with didn’t know if anyone had opened a ticket with the help desk to request the updates, and the EHR team had such a backlog of requests that they didn’t know if they had the respective requests on file.

After a lot of back and forth trying to sort it out, several things were clear to me:

• There was no proactive process to monitor for guideline changes and ensure they made it into the EHR in a timely fashion. This is important when there are major changes and there hasn’t been time for EHR vendors to get them into an update release.
• The organization was woefully behind on taking their vendor-recommended updates, as I knew a couple of the issues had been fixed in patches that weren’t terribly recent.
• There was a disconnect in the ability of the IT team to know whether the system was really working for its users or not.

As I often see in consulting engagements, researching each issue led to other issues. We found many more opportunities for changes that would benefit both physicians and patients.

As I returned to the hotel each night, I had a little bit of consulting whiplash, which happens when you’re working with one client during the day, finishing up projects for other clients in the evening, and reflecting on the stark differences between the projects.

The evening project on one of those days was for a client that is definitely more on the resource-rich end of the spectrum. They hired me to work on some custom content for a particular disease process where they’re trying to improve their clinical quality scores by a very small percentage. Their clinicians are not only using the most updated EHR content available, but also have access to human scribes at some locations as well as ambient documentation solutions nearly everywhere else. Clinics have health coaches and others to support some of the same processes that I had seen physicians doing during the day.

Those of us who have worked on population health projects know how significant your ZIP code can be as far as predicting your health status. This week brought it home to me in a way that it hasn’t done in several years.

These kinds of disparities aren’t something you can solve by throwing AI at them, although AI can help illustrate the nature of the problem more quickly than manually crunching the numbers. I’m going to have to think creatively about the strategic planning project I’m working on for my daytime client, although it’s going to be one of the trickier engagements I’ve done in a while. On days like this I wish I could find a magic lamp with which I could make three wishes to improve the healthcare system. Instead, I’ll have to come up with some incremental changes that can be done quickly and on the cheap while we formulate a strategy for the larger issues.

What are the major challenges facing your organization this year? If you could make three wishes, what would they be? Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 4/17/25

I’ve been a follower of prescription digital therapeutics for years. I have watched with great sadness as companies have come and gone without getting the traction their products needed to help broad groups of patients.

Click Therapeutics recently received FDA marketing authorization for the first prescription digital therapeutic for prevention of migraine headaches. The solution, called CT-132, is designed to be used in conjunction with other preventive or acute migraine treatments for patients aged 18 years and older. The study used for its application looked at the therapeutic’s use in patients who were already receiving treatment that met the standard of care and was able to significantly reduce the number of migraine days per month.

The company already offers solutions for a number of conditions including depression, diabetes, schizophrenia, insomnia, multiple sclerosis, and opioid use disorder. I’ll be eager to see how it does over the next couple of years.

I was also interested to see a write-up of research on using an AI-powered wearable to improve function for patients with essential tremor. I have relatives with the condition, and it can significantly impact quality of life. The Felix NeuroAI device  is considered investigational but was shown to reduce tremors and improve the ability of users to perform daily activities by delivering electrical stimulation to the peripheral nerves in the wrist. Additional research is being conducted at the University of Kansas School of Medicine. Of note the company that makes the device was founded through the University of Minnesota, so here’s to cool tech coming from the Midwest.

I’ve taken a cautious approach to using real-world evidence in my practice, making sure that I’m using it in conjunction with traditional evidence-based recommendations. Those of us who have been in practice for a while know the risk of the “everyone’s doing it” approach to medicine (Vioxx, anyone?) rather than ensuring that the risks of new treatments don’t outweigh their potential benefits.

For drugs that are already in broad use, however, real-world evidence can be useful to identify adverse effects and unanticipated outcomes. A recent study looked at three GLP-1 receptor agonist weight loss drugs, examining adverse events. They found that one drug had significantly fewer reports of adverse drug reactions , but another was associated with some serious adverse events, including suicidal ideation and vision loss. It remains to be seen whether these results will be flagged to help develop larger or more comprehensive studies, but they’re important, nonetheless.

One of the most rewarding elements of my work as a consultant specializing in EHR optimization was identifying non-value-added steps in workflows and eliminating burdensome documentation that couldn’t be clearly linked back to a regulation, official requirement, or quality measure. A recent study in The Permanente Journal addressed the misinterpretation of regulations by compliance professionals. The authors presented 16 study subjects with five clinical scenarios and scored their interpretations for variability of interpretation. Only one-third of the subjects had formal training as a compliance professional, which I found interesting. As the authors presented the scenarios, they found that given the same scenario, some subjects identified noncompliance where others voiced no concerns.

One of the scenarios presented was the bane of many healthcare workers, namely whether food and drink can be consumed in work areas. Others included order entry by non-physicians, compliance with HIPAA requirements, the need to document a pain assessment, and whether physicians have to document the history of present illness independently. If you’re finding that your organization has workflows that have “always been done that way” but no one can link them back to a requirement and there’s an easier or better way to do them, it might be time to push back and ask for a review with the goal of removing such burdens. The last thing that burned out care teams need is overzealous interpretation of requirements or enforcement of those that don’t exist.

I was excited to learn that one of the states where I am licensed is implementing new functionality in their Bamboo Health-powered Prescription Drug Monitoring Program (PDMP) system. Prescribers will now be able to see a risk score for unintentional overdoses that takes into account the different drugs for which a patient has filled prescriptions as well as the duration of those prescriptions and the number of pharmacies at which they’ve been filled.

My primary practice is in a state where this is not yet implemented, but then again, we don’t even have the PDMP integrated into the EHR. Even though we have to log in separately, the system has still helped me identify concerning patterns for a number of patients in my care. It’s also been used in my state to identify physicians behaving badly, so I’m grateful to have a system that helps protect my patients and colleagues from those who might do unscrupulous things.

Yesterday was National Healthcare Decisions Day, which was created to encourage patients and their care teams to discuss advance care planning. I hadn’t heard of it before this year and was amused to learn that the April 16 date was selected with a famous Benjamin Franklin quote in mind: “In this world, nothing is certain except death and taxes.” Individuals are encouraged to do their US taxes by April 15 and review their health care directives the next day. The observance was founded in 2008 and encourages not only patients and providers to participate, but also community groups, healthcare facilities, and religious organizations. More information is available at The Conversation Project, which is part of the Institute for Healthcare Improvement.

I’ve seen enough things in my medical career to know that I never want to be without a document that details my wishes for care (or lack thereof). When I arrived at the hospital for what could be one of the most medically risky events in any woman’s life, the labor and delivery nurse acted stunned when I handed her a copy. She said it was the first time she’s seen one from a patient. Let’s normalize talking to our families and loved ones about our wishes and help them to document theirs.

Do you have a living will, advance directive, or healthcare power of attorney? If not, why? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 4/14/25

Mr. H currently has a poll in the field, courtesy of this week’s Monday Morning Update, that asks, “What’s your biggest red flag when evaluating a health IT vendor?”

Of the listed response options, my top two include “Leadership team is all career investors or executives” followed by “Lists no real customers, just pilots.” By way of additional suggestions, I would add “Leadership team has no idea what the average person experiences when they have a health-related need.” This answer was brought into the spotlight for me this week, as I had the opportunity to interact with a large number of ladies at a senior women’s seminar.

I normally try to downplay the fact that I’m a physician when I meet people I don’t know, because I don’t want to field the resulting clinical questions. However, in this situation I was a presenter and the person doing my introduction mentioned it, so I couldn’t escape it.

Once that proverbial cat was out of the bag, I heard a lot of healthcare stories, ranging from heartbreaking to inspiring, and a couple that spawned ideas for innovation. For those of you who don’t have a lot of real-world healthcare experience but are operating in this space, I give you my guide to understanding what a random sampling of what people want to talk about concerning healthcare when given the chance. 

At the first meal break, I was asked where I practice. I explained about being a virtual physician, thinking that my tablemates might not be familiar with it. The first person that spoke wanted to know, “What do you think about the fact that Medicare is going to stop paying for online doctor visits, because I’m pretty mad about it.” Talk about a softball being dropped right in my lap.

She went on to explain that in her Arizona community, many of the residents are elderly, some no longer drive, and certain specialty care is a 2.5 hour drive away. She and her husband have been having virtual visits for the last several years, only going in person once a year or when a specialized test is needed. They are able to have labs drawn at a satellite draw site for one of the nationwide lab vendors. She has been able to avoid long hours on the highway as well as the hassle of getting her mobility-impaired spouse into the car.

The conversation segued from there to the need for non-traditional home services. Another mentioned the fact that her local emergency medical services agency’s funding shortfall led them to start charging for any calls that don’t result in transportation to the emergency department.

She was worried about a couple of things. First, people may not call for help when they need it, resulting in them “winding up sicker than they need to be.” Second, there’s a gap in providing services that are important but non-emergency. The example she gave was when someone falls and needs help to get up, but doesn’t need to go to the emergency department. This happened to one of her neighbors who called her, and when the weren’t able to find a younger neighbor to help, they ended up calling 911.

This immediately gave me an entrepreneurial idea — like a ride share service, but for things like this. I did a quick online search and most of the answers to “how to safely pick a loved one up after a fall” involved calling 911 or the fire department for a “lift assist,” which may or may not have an associated charge. What if there was an app where you could summon an available person who is not only physically capable of providing this kind of assistance, but has also has had their background checked and vetted by a third party so that seniors would be more comfortable calling them?

I’m seeing an opportunity for off-duty healthcare workers to make some cash in a way that they’re comfortable with, but that requires no charting and has few hassles. Kind of like TaskRabbit but with a personal assistance twist and with rapid access.

Maybe it could also have a “schedule in advance” component for non-urgent calls, again kind of like a ride share service, when you don’t need to move a person but just need to move that box of cast iron skillets so you don’t break your foot (which also happened to one of the ladies at my table who was in a walking boot). There may be some variations of this out there, but none that I’m aware of has the breadth of availability that would be ideal for a growing population of aging seniors.

From there, the conversation flowed to the predictable topics, including physicians who always run behind, long waits for new patient appointments, the hassles of dealing with insurers, expensive medical bills, and whether or not I watch medical TV shows. Nearly everyone at the table had used a patient portal to communicate with a physician at least once, and about half of those have received text messages from medical providers. All of them had smartphones and didn’t hesitate to pass around pictures of the grandkids, the great grands, or their various craft projects.

They were universally comfortable with using the internet to find information, whether it was for a health-related topic or just to find out general information. It was validating to see this in person since I run into a lot of people who still think that seniors aren’t technology savvy.

My dinner table assignment had several retired healthcare workers who each had something to say about the current state of things. A correctional health nurse midwife said that the greatest need is for better behavioral health services and supports “to keep people out of prison in the first place.” A retired physical therapist from a VA hospital was extremely vocal about the need to make sure that our veterans are taken care of and that any cuts at the VA should be done thoughtfully and “not in some all-fired hurry.” Another was a nurse who medically retired sooner than she would have liked. She was most excited to learn about virtual nursing opportunities, which might have allowed her to stay in the field longer.

All of them had EHR experience and thought things were better in some ways and worse in others when EHRs came to their facilities, which many of us agree is a fairly accurate statement. All three had children or grandchildren who were in the medical field, so that gave me a little bit of hope as far as healthcare still being a desirable career choice.

Vaccines were a hot topic among those who weren’t healthcare retirees. One of my dining companions told the story of when she received one of the first polio vaccines and “people were lined up around the block because it was a horrible disease and there wasn’t a single mother who didn’t want her children to take that sugar cube.” She was an amazing dinner companion, a retired university professor who has traveled the world and had stories that made me hope I’ll still be globetrotting into my eighties as she is. She ended up accepting my LinkedIn request about an hour after I sent it, which impressed me. She doesn’t have any content associated with her profile, which adds to her mystique, I guess. No need for self-promotion in that generation.

At the end of the meal, there was a raffle with proceeds going to a family that has three children with medically complex needs. Hearing the raffle chair tell their stories was incredibly moving. I can’t imagine navigating the healthcare system with one of their situations, let alone with three. It was gratifying to see several thousand dollars raised to support them.

These are things that average people in the US want to talk about when they find out that you’re in healthcare. If you’re a healthcare technology leader and none of these resonate with you, it might be time to obtain some experiential learning through hanging out with people who consume a fair amount of healthcare resources. It might confirm your thinking, give you new ideas, or give you something to think about that you haven’t considered. If nothing else, it should remind you that there are humans on the other end of your solution, whether they’re patients, family members, care delivery team members, or those who support them. And as leaders, if you don’t have a clear line of sight to those people and understand how your solution impacts them, you might just have some work to do.

What kinds of things do you hear when people find out you’re “in healthcare?” Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 4/10/25

An article in Nature Medicine caught my eye this week. It examined the results of a tool that looks at real-time data for patient deterioration. These kinds of tools have been under evaluation for a while, but this one differs from some of the other ones out there because it looks at the content of nursing notes as opposed to the laboratory and vital signs data that are used by many other options. The Communicating Narrative Concerns Entered by RNs (CONCERN) tool was found to reduce sepsis risk by 7%, length of stay by 11%, and risk of death by 35%.

The study was conducted across two health systems with 60,000 hospital encounters and took place in 53 acute care units and 21 intensive care units. Examples of data that were found in nursing notes that wouldn’t otherwise be captured by some predictive tools include subtle mental status changes, changes in the tone of narrative comments, or increased frequency of nursing surveillance.

I would be curious to see the study taken a step further to look at how the tool performed based on the relative tenure of the nurses who are documenting the notes. We’re continuing to see a tremendous drain of bedside nursing experience and it would be helpful to have that kind of evidence to use when seeking funds for nursing retention initiatives.

From Jimmy the Greek: “Re: blood cleaning. This piece seems like the perfect thing to make Dr. Jayne shake her fist at the wind.” How could I pass up a clickbait headline like, “Clean blood is trendy, if you can afford it” when it’s served to me on the proverbial silver platter? Long story short, a London-based startup is looking to capitalize on microplastics fears with their $13K blood cleaning service. It sounds a bit like dialysis, but with a machine that removes microplastics “and other undesirable chemicals” from blood plasma before returning it to the body during a roughly two-hour session.

Claims abound as far as what the process is supposed to do, ranging from helping with chronic fatigue and long COVID to improving sleep. Although we don’t know the full risk related to microplastics, I was unable to find any high quality clinical trials that showed benefit from this approach in treating any diagnosed condition. Like other unproven interventions such as full-body scans, stem cell injections, and various unproven supplements, the only sure thing about this solution is its ability to part consumers and their cash.

I attended a seminar this week that featured several presenters who are from government-related entities. One agency in particular has put new rules in place such that everything that will be seen by an external audience has to go through a legal review. Despite having started the process a few weeks ago, the presenters from that agency were not able to get approval for their presentation, which covered some scholarly research on AI tools. They had no choice but to cancel, which was unfortunate as there was quite a crowd waiting to see the presentation. I wish the organizers would have been able to communicate this in advance, but I suppose that the presenters were hoping for a last-minute approval that never came.

I was able to connect with one of them between sessions later in the day. They mentioned that they’re attending the conference using vacation days and paying for it out of pocket because their agency will no longer cover travel to educational meetings. They’re actively seeking a new role because they’ve been told that if they stay, their work will be subject to censorship, which sounds like a way to get people to resign without actually terminating them. They were reluctant to say much more than that as they fear for their job and the wellbeing of their subordinates. Hopefully they will be cleared to present their work in the future because it sounded interesting enough to those of us in the packed meeting room.

I was able to slip into another session that was running at the same time and heard one of my former medical school classmates speak, which was great since I haven’t seen him in years. We’re all older and some of us are a bit grayer, but he still gives the same “nutty professor” vibe that he had while we were in school together. It has served him well over the years as he has received multiple teaching awards from his institution, where he’s been a fixture since residency. If we had created class predictions I don’t think I would have picked him as a long-term teacher, but after sitting through his lecture, I can understand why his students love him.

I also had the opportunity to catch up with a classmate who left her hospital-owned practice and set up shop as a direct primary care physician. She’s only been in that arrangement for a couple of years but is already making the same salary as she did as an employed physician while demonstrating higher clinical quality scores with less stress. Her panel of patients has gone from 2,500 to 500 and she spends between 30 and 60 minutes for each office visit. She’s about to add a second physician to the practice and mentioned that she had more applicants for the role than she thought she would see. The majority of her patients have high-deductible insurance plans coupled with healthcare spending accounts that make a direct primary care practice more appealing.

She mentioned the cost savings that she is able to pass along to her patients through her laboratory and pharmacy arrangements and I was shocked at how she’s able to deliver care with that level of cost effectiveness. It sounds like the majority of her patients are middle income, but find her care model to be a better value than traditional insurance as far as not having to take as much time off of work and being able to get all their needs addressed during a single longer visit compared to having to come back multiple times or see additional specialists. Talking to her was quite a contrast from what we were hearing from the mostly academic speakers, but I’m glad we were able to connect.

Are you part of a direct primary care, concierge, or retainer practice? Would you recommend it or not? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 4/7/25

I spent the majority of this weekend training to use a new electronic health record system and completing practice onboarding.

I’m going to be doing some per diem work at a local practice. It is busier than it wants to be, but not quite busy enough to support adding an additional physician. The practice needs additional coverage, especially before and after their physicians have scheduled vacation. Those are windows of time that usually end up overbooked, as physicians struggle to see people before they leave town or face an overloaded schedule when they return.

They are also looking for inbox coverage and possibly some acute care coverage during the vacation. It’s an ideal scenario for me because the physicians typically schedule their vacations six months in advance. That gives me plenty of lead time to build my consulting engagements around those weeks. I’ll also be doing some coverage here and there during the intervening months to become familiar with how the office runs.

The practice uses a fairly well known EHR. They signed me up to watch some online training modules first. I’ve used so many different EHRs over the years that I didn’t expect anything earth shaking as I sat down with my laptop and a nice cup of tea.

The first thing that struck me as I logged into the learning management system was that they had assigned comprehensive training to my profile, which included a broad swath of specialties that I don’t practice and won’t be covering. I called the office manager to make sure that this was intentional since family medicine uses a lot of the subspecialty templates. It wasn’t immediately clear whether that choice was made by the office or the EHR vendor.

Since I was being paid for the full time that was needed to cover all the assigned courses, I didn’t want to spend more time arguing about it. Not to mention that I figured that it would be a great way to see what vendors are developing and whether there’s anything new.

I had the practice’s training environment open while I was watching the modules. I have found that to be the easiest way to handle content, such as personalizing the physician workspace or setting up medication favorites. I learn by doing, so I was surprised that following the prescribed learning plan meant sitting through almost 90 minutes of content that didn’t contain anything that was remotely interactive. It reminded me of the old-school training I used to see when I was first doing informatics work, with a deluge of material that just droned on and on.

I’ve had enough experience working with people who are well versed in adult learning theory to know that this isn’t ideal. The voiceover for the training almost lulled me to sleep several times. I decided to switch from tea to my favorite coffee concoction, which is jokingly referred to as rocket fuel by those who have sampled it.

I have to say that this level of caffeine jolt was sorely needed. I ended up having to wade through specialty documentation with no way of fast forwarding or indexing to the part covering templates that would actually be of use to me. For example, the OB/GYN content wasn’t subdivided by template or visit type. I’m not going to be doing any obstetric visits, but do need to know what content is available for acute GYN problems.

I ended up just letting the video run its course and randomly surfing through the content that was available in the training environment, learning in a more hands-on way. I’ve done enough locum tenens and per diem work over the years that if I can document my top 15 most common visits, I’ll be good to go for at least the first day and will eventually pick up the rest of the workflows I need to know.

I was somewhat surprised when I arrived at the coding and billing part of the documentation template. It didn’t seem to be taking into account the newer coding guidelines that went into place a couple of years ago. The suggested codes were easy to override, but it gave me a bad feeling about the vendor in general, as if they weren’t keeping up with the times.

I couldn’t figure out how to see what version I was using or when the last update was, so I jotted those down as questions for my next conversation with the office manager. It also didn’t look like the Health Maintenance guidelines were totally up to par, because the recommendation for RSV vaccination for non-elderly adults wasn’t current, either. That’s a newer item, so I could see how it might be coming in a future upgrade, but  not having it in the reminders would be a bit of a pain for clinicians.

Day 2 was filled with completing all the practice’s HIPAA, Conflict of Interest, Ethics, and Fraud / Waste / Abuse training. I’ve done so many of those over the years that I can just about recite them. I can also generally predict the clinical scenarios that are going to be used. As someone who has worked in so many different places, I have a dream of a training passport that would exempt people from having to do the training at every new place, but I know organizations like to put their own spin on training.

I’m always on the lookout for a module that will top the wildest one I’ve ever seen, which I had the pleasure of watching when HIPAA first came out. It was a badly acted video with mafia overtones, kind of likening the idea of violating HIPAA to a brush with organized crime. It was so bad, but so attention getting, that nothing has really topped it yet.

I also had to fill out a ridiculous amount of credentialing paperwork, which I haven’t had to do in a number of years. Fortunately, I had a copy of the last packet that I had to complete, so it was straightforward. although tedious. Once I turn that in, they’ve assured me that I will be granted access to the production EHR. Then I can see what’s really in there and start the process of making sure that I have all the shortcuts enabled that I can, such as medication favorites, quick phrases, and other preferences.

It’s always fun to get those things set up. It reminds me a bit of getting your backpack ready for that first day of school. Even though it’s not as cool as a 64-pack of brand name Crayola crayons, I’m pretty hyped about going for my first day. We’ll see whether the reality meets the expectation in a few weeks.

What’s your favorite “first day of school” memory? Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 4/3/25

I finally have some solid data from the recent residency match, as administered by the National Resident Matching Program.

For those who might not be familiar, this is where medical students indicate where they want to do their residency training; training programs indicate who they want to fill their allocated number of training slots; and an algorithm tries to bring them all together. This year’s match had 52,409 applicants, for which only 47,208 submitted a final rank order list. The candidates were competing for 43,237 positions. At noon Eastern time on match day, all the applicants learn where they’re going to be for the next three to seven years.

Different medical schools handle the big reveal in different ways, with some handing out sealed envelopes for class members to open privately. Others throw blowout match day celebrations complete with “walk-up” music like you might see at a major league baseball game, followed by live reveals as candidates open their notices. The latter can be a difficult environment for those who didn’t get their top choices, but everyone still acts thrilled regardless.

Those who didn’t match were notified earlier in the week and have the opportunity to compete in The Supplemental Offer and Acceptance Program (SOAP), commonly referred to as “the scramble,” where unfilled slots are offered and candidates have only two hours to accept a potential offer. If you saw a graduating medical student with their phone glued to their body March 17-20, chances are they were part of the scramble.

It’s a brutal process for those who have been through it, although some of my classmates who had top scores were largely unfazed. The final match data can be telling as far as what students think about a particular specialty, and following the worst parts of the COVID-19 pandemic we saw a significant drop in matches to emergency medicine as students saw what that specialty had become. After experiencing an 81.8% fill rate in 2023, emergency medicine rebounded to 95.5% in 2024 and landed at 97.9% for 2025.

Primary care specialties ended up with a 93.5% fill rate, even with an increase of 877 in the positions available. Family medicine matches fell from 87.8% to 85.0%, which means that we will continue to have shortages in that specialty for years to come. Unless healthcare payment policies change (and workloads shift), we’ll continue to see a decline as students choose specialties with higher compensation and better work-life balance.

I had dinner with some friends last week, and one of them was showing off her Oura ring. She and her husband bought matching rings in an effort to use data to determine who was more disruptive during sleep. The company has been working to improve its sleep tracking algorithm, and although it’s better than competitor devices, it’s still not as accurate as formal polysomnography. Although it will probably be good enough to force one of the parties to consider seeking medical help, it’s not classified as a medical device, nor is it approved to diagnose, treat, or monitor health conditions. If you think your bed partner has apnea or another serious condition, it is best to see a licensed professional.

In another discussion, a friend asked me about this article on Gather Health, which aims to provide primary care services with a focus on keeping older patients out of the emergency department. Founded by an emergency physician who was tired of seeing patients seeking care in high-cost facilities when it could be better managed elsewhere, over 2,500 patients are enrolled, with the majority being covered by Medicare and Medicaid. The company has raised $17 million in funding and hopes to break even in 2025. The company pairs office-based care with home health, remote patient monitoring, and social opportunities to improve patient outcomes.

The article mentions revenue forecasts of $44 million this year. It hopes to expand from four to 17 sites in Massachusetts. Of course, when venture capital is involved, there’s an expectation that the services will yield a profit, and it would be interesting to learn more about how much money they think they can make on something like this. I’m not against people making a profit, but it’s the extreme focus on profitability that I’ve seen create a lot of issues in healthcare delivery organizations. Nearly every physician gathering that I attend features at least one horror story related to private equity or venture funding of care delivery organizations.

Caring for complex elderly patients is expensive and challenging. The company’s founder also served as chief operating officer of VillageMD, so it will be interesting to see what he does differently with this endeavor. From the patient perspective, I wish the company well and will be interested to see how it performs over the next few years.

The Open Payments program is a national system that creates transparency around payments made to physicians from drug companies, device manufacturers, and other regulated entities. Each spring, data is released so that physicians can review what is associated with their name and potentially dispute anything unexpected. It’s been many years since I attended so much as a drug company lunch, so I was surprised to see a significant amount of money posted against my name for the recent reporting period.

I’m glad I reviewed it, because the entry was from a company I don’t associate with and was tagged with a nebulous “food and beverage” category for a single event in the first few months of 2024. I’ve opened a dispute about the entry and hopefully it will be resolved quickly and with a minimum of extra work on my part. If you’re a provider subject to reporting, it might not be a bad idea to take a look at your account. Even if I’m unable to resolve it, my understanding is that my record will be flagged as “disputed,” which is good because I hate to break my record of perfect zeros.

Mark your calendar for the next DEA National Prescription Drug Take Back Day on Saturday, April 26. Communities will be holding collection events, often at local police departments or other health facilities. Unwanted and expired medications are a health hazard and also pose risks to the environment when people dispose of them incorrectly. Fortunately, my local law enforcement agency has a box that’s available for drop off around the clock, and I made good use of it when a relative passed away, leaving behind a cache of pain medications with a street value in the thousands of dollars. The program has collected 19 million pounds of medications over the years, which is pretty impressive.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 3/31/25

As someone who is knee deep in healthcare on a daily basis, there are a lot of things going on in the world that I follow with varying levels of attention. Sometimes these move more into or out of focus depending on the kinds of consulting engagements that I’m doing.

For example, if I’m working on quality improvement projects, I do a lot of reading to make sure that I’m up on the current metrics. If I’m working on a project involving order sets, I make sure that I’m up on the latest and greatest guidelines and treatment plans for whatever conditions I’ll be addressing.

As an HIStalk contributor, I try to keep up more broadly with everything that is impacting healthcare and healthcare IT as a whole, including worldwide health conditions, new scientific discoveries, emerging technologies, and where organizations are spending their money, whether they’re hospitals, healthcare systems, solution vendors, or independent physician practices.

There are dozens of other CMIO and CMO level consultants who are in the same position. Most of us are also keeping a close eye on what’s happening in government, especially where it comes to changes in staffing levels for the Department of Health and Human Services, the National Institutes of Health, the Centers for Disease Control and Prevention, and similar state-level organizations.

Changes in those organizations have a trickle-down effect on the patients who have trusted me with their care, along with every other person in the US. With changes to the US participation in the World Health Organization and withdrawal of funding for global vaccination programs, changes to health policy in the US also impact people around the globe.

These changes have also impacted me as a patient. I recently learned that a clinical trial to which I have been accepted has lost part of its funding. I have met the qualification criteria, but they aren’t randomizing any new patients into cohorts.

It has been months since I started the process to be part of this trial. It was an emotional rollercoaster as I went through the qualifying process, having to send medical records from multiple institutions and hoping they not only got there in a timely fashion, but were accurate and not full of a bunch of EHR-generated nonsense.

Once all the records finally made it there and were reviewed, I went through an intake process that included genetic counseling as well as testing beyond what I’ve already had. I’ve received the results and was in the final stages of being assigned to a trial arm, only to have the rug pulled out from under me.

When people talk about the “waste” in clinical trials in hyperbolic and abstract ways and imply that funding cuts were deserved, it makes my stomach clench. I’ve spent a significant amount of my professional career doing process improvement and eliminating millions of dollars of waste from healthcare organizations, so I know what waste is. I know how to identify programs that aren’t running efficiently and those that are doing well. I know how to lead change and how to strip significant dollars out of organizational budgets in a compassionate way.

None of that has ever been done by just walking into a hospital or health system and announcing sweeping cuts without any consideration whatsoever. There are consultants who do that, but I’m not one of them, nor will I ever subscribe to that philosophy.

Many of the clinical trials that are being impacted by slash-and-burn cuts affect real live patients. We’re not fruit flies in a lab, or some futuristic technology that someone just cooked up to draw down funds.

Fortunately, the study in question has multiple sources of funding, including a number of private ones, so it hasn’t had to shut down completely. Those who were already randomized into a cohort will continue to receive the intervention to which they’re assigned. It’s just the rest of us that are in limbo. I’m happy that it’s continuing to run because hopefully I’ll be able to benefit from the results of the study once they’re known, but watching this unravel has been truly depressing.

When you agree to participate in a trial, you realize that you might receive “standard care” and not the intervention, and you have to come to terms with that. Now I’m definitely receiving standard of care, and it’s not the missing out on the intervention that I’m really sad about as much as having been excited to participate and to be able to make some kind of good come out of my situation. Not to mention that the results of this trial will impact women for decades to come and may yield a change in direction for the care that is received by millions of mothers, sisters, grandmothers, aunts, and daughters.

Some of you may be asking, “What does this have to do with healthcare IT?” or commenting that I’m on my soapbox again. Indeed, I’ll admit it. After nearly 1,500 posts that span more than a decade, I reserve the right to share the patient experience, even if it is my own. I also reserve the right to write about things that might be construed as “political” when they impact patients, because everything that impacts patients is in my physician lane. I will also keep calling out waste when I see it, whether it’s in the form of unnecessary testing and treatment or the misalignment of healthcare resources, incentives, and technologies.

I think that all of us that work in healthcare IT have the opportunity to do better and be better when we consider how our daily actions can impact patients in our world, our nation, and even our neighborhood. We are literally all connected in ways that we might not imagine.

I have a friend who sells interventional radiology solutions that are highly reliable and come from a trusted manufacturer. Physicians prefer them to the competition and feel they they support higher-quality procedures. When he gets tangled up in his company’s sales processes, he focuses on a mutual friend who recently had a procedure that falls within his solution’s scope. He reminds himself that even though he doesn’t like some of the things he has to do in his job, they need to be done to get the best solution to the point of care in more places every year. With the assistance of this mindset and keeping the patient at the center of his work, he routinely meets his company goals, and when you hear him talk about his job, it’s easy to understand why.

There’s an episode of “The Simpsons” called “And Maggie Makes Three” where Homer explains why there are no pictures of Maggie in the family photo albums. He tells Bart and Lisa that the pictures are where he needs them, which is in his office at the nuclear power plant. They cover some letters on a company placard to change “Don’t forget, you’re here forever” to “Do it for her.”

Let’s all remember why we do what we do and remember that there’s a patient on the end of every decision, and eventually we will all be patients. Be aware, be informed, and be involved in understanding what happens in industry segments other than your own. When you’re the one on the exam table in 10 or 20 or 30 years, you’ll be glad you did. 

Email Dr. Jayne.

EPtalk by Dr. Jayne 3/27/25

It looks like I’m one of the users who have been selected to test the beta version of the new Amazon Health AI digital assistant.

According to news articles, the tool is designed to field health and wellness questions, and of course to suggest products. Some responses have a “clinically verified” indicator that shows that the information has been “reviewed and confirmed as accurate by medical experts.” I couldn’t find any indication of their definition of “experts,” which can vary widely. It also didn’t indicate how often such information is reviewed or how long ago this particular excerpt was reviewed.

I tried a number of scenarios, including questions about an ongoing cough and a query about what a measles rash looks like. For the cough question, it suggested that I might be interested in purchasing Lipton tea or an over-the-counter inhaler.

For the measles question, I was shocked that it answered the question by providing a correct answer, but for a different question than the one that I actually asked. If I’m asking what a measles rash looks like, I would expect to see a photo of a measles rash (there are dozens out there that are easily accessible from search engines) rather than a description of a vaccine-associated rash.

Initially, when I read the answer, I missed the word “vaccine” because I skipped over the regurgitated question directly to the bullets. I would want to read more carefully next time. I also thought it was odd to add a disclaimer about “while I cannot provide an exact cause for your symptoms” when I didn’t indicate that I was asking about symptoms. I was just asking a health educational question, so the system isn’t sophisticated enough to understand that and probably assumes everyone has a symptom. Users have the ability to provide feedback on the responses, so you can bet I gave that one a thumbs down.

Next, I specifically asked whether the tool had a picture of a measles rash. It apologized for not having an image, but then went on to again discuss a rash that is related to a measles vaccine. It then offered me the opportunity to join Amazon One Medical, which I guess is not surprising.

I also asked how to care for a sprained ankle. The output was missing key information in the form of sentences that didn’t populate correctly: “Over-the-counter like or can also help manage pain and inflammation.” I guess the model forgot to throw in medication names like “acetaminophen” or “ibuprofen.” This search generated a suggestion that I may be interested in buying an elastic bandage as well as visiting Amazon One Medical. I repeated these questions in another search engine and frankly got better answers, so overall I’m going to give Amazon’s new tool a D-minus. Try again, folks.

From Primary Care: “Re: this article Did you see this article in JAMA Network Open? It talked about the fact that states with less regulation of health insurance offerings have higher rates of diagnosis for late-stage cancers. I don’t understand how people can see this data and not think we need payment reform or overall healthcare reform.” I can’t say that I’m surprised. Here’s the full scoop: the study looked at 1.3 million patients in states that had either no regulations or limited regulations on short-term, limited-duration (STLD) insurance plans. These are sometimes purchased by patients who are between jobs or who lose coverage for other reasons. They’re usually pretty poor plans and have waiting periods and other elements within the policies that essentially discourage the patient from receiving care. They typically have high deductibles and high out-of-pocket costs for patients. They are not compliant with the Affordable Care Act (ACA) requirements, which results in higher patient responsibility for tests that would have been fully covered by an ACA-compliant plan.

The study was led by the American Cancer Society and looked at adults aged 18-64 years who had a cancer diagnosis between January 2016 and February 2020. It covered 47 states plus the District of Columbia and used information from the National Cancer Database. States were classified as to whether they prohibited these plans before and after 2018, stopped them after 2018, allowed them with restrictions, or had no additional regulation of the plans. The study adjusted for social and demographic factors, year of diagnosis, and state random effect.

The authors found that in states with no additional regulations of STLD plans, there was a net increase of 0.76 percentage points in late-stage cancer diagnoses compared to those states that continuously prohibited such plans. States with some regulations had a net increase of 0.84 percentage points compared to those with continuous prohibition.

The authors concluded that “the 2018 federal policy loosening restrictions on STLD plans was associated with an increase in late-stage cancer diagnoses in states without or with inadequate additional STLD plan regulatory protections. Findings were consistent among cancer types with recommended screening tests (i.e., female breast and colorectal cancers) and extended prior research conducted in a limited number of states, underscoring the importance of state policies and federal efforts to limit STLD plans.”

This illustrates the difference between allowing healthcare and healthcare finance to be regulated at a state level versus at the federal level. The latter would promote more consistent care delivery across our population. Looking at my own state, the level of education of many of our legislators varies greatly and very few have any firsthand experience with healthcare policy. The year is 2025 and I can’t believe we haven’t gotten on board with the idea that everyone in the US deserves high quality healthcare and that a state patchwork of rules isn’t going to do that for us.

Doctors’ Day is March 30 in the US, celebrated on the day when ether was first used for general anesthesia back in the 1840s. It’s on a weekend this year, so hopefully hospitals and healthcare institutions are planning to do something either before or after. It’s been a while since I worked anywhere that had any kind of formal recognition of the day, so if you have doctors in your life, please consider doing something nice for them or at least just wish them a Happy Doctors’ Day.

How does your organization celebrate Doctors’ Day? Is there a pizza party or a challenge coin involved? Leave a comment or email me.

Email Dr. Jayne.