EPtalk by Dr. Jayne 6/1/23

Midwestern health systems BJC Healthcare and Saint Luke’s (Kansas City) have announced plans to join through a $10 billion merger. They have been previously connected through participation in the BJC Collaborative, which Saint Luke’s joined in 2012 as the organizations sought to share resources and cut costs.

Announcements from the organizations note plans to operate under their existing brands and operate from headquarters in both St. Louis and Kansas City. Detailed plans for the merger are slated to unfold through the rest of the year, with a goal of closing the deal by the end of the year. I reached out to some Midwestern friends who know both organizations well and it sounds like there may be some significant cultural differences that come into play. It should be an interesting one to watch.

I receive dozens of cold call emails every day despite my best efforts to filter them into junk mail or spam folders. My favorite of the week was one that gave three different stylistic treatments to the healthcare entitlement program for seniors: MediCare, MediCARE, and ultimately Medicare. Maybe their marketing team will eventually create a style guide so that they can remain consistent, but since I made use of the block sender functionality, I hopefully won’t be seeing it again.

I don’t practice as often as I used to, but when I do, there’s always a patient who asks about something they saw on the internet and how it might relate to their reason for seeking medical care. A recent Forbes article discusses data that more than a third of members of Generation Z trust TikTok more than doctors. It’s not the only player in the equation – another 44% of adults surveyed visit YouTube before contacting their physician. One in five respondents trust health influencers more than they trust medical professionals, citing access, cost, and avoiding judgment from medical professionals.

The article goes on to emphasize the need for care providers to meet patients where they are. I agree with that approach. I’ve not seen many mainstream health organizations fine tuning their social media sites to go after that demographic, but I’ll keep an eye out. There is plenty of medical misinformation out there that needs to be countered, but competing against influencers might be an uphill battle.

For health systems and other organizations that are trying to build their brands (and often renaming themselves in the process), they might want to target older demographics. A recent article notes that members of Generation X and Baby Boomers are twice as likely to trust brands than members of Generation Z. Topping that brand list and possibly providing inspiration for marketers: Band-Aid, UPS, Amazon, Lysol, and Kleenex followed by Cheerios, Visa, Dove, The Weather Channel, and FedEx. The survey noted that Generation Z doesn’t trust many brands to do the right thing – non-profit brands were the only category to which it responded well. I tried to poll a couple of the members of Generation Z about the topic, but hit a dead end because they were heads-down on their phones.

I have a visit later this week with a new physician who is part of the medical group where I’m already established. I was relieved to receive an electronic check-in notice through the patient portal. My previous physician left the practice for health reasons, but I’ve been a patient in both the practice and its database since 2019 (and in its precursor, which was converted, for a decade prior) so it should have been smooth sailing.

I completed the electronic check-in and was met with a notice that “you might be asked to complete additional paperwork in the office,” which jogged my memory that indeed they had mailed me a packet six months prior. I found it in the file sorter on my desk and was dismayed to find that it contained four pages of materials that are redundant to my existing chart, including the pharmacy information and medication list that I just confirmed during the electronic check-in process. When I scheduled the appointment, I made it clear that I was transferring from her former partner. Since I’ve been seen within the past three years by a physician of the same subspecialty who bills under the same tax ID, I’m technically an established patient even though I’m new to her. I assume they send the “new patient” paperwork to everyone, but it’s still disheartening.

No one wants to arrive at the office and be turned away because they don’t have the (totally unnecessary) paperwork, so here I sit filling out information when I’m 100% confident that it’s all in the chart already, because I’ve seen it in my past visit notes. The real kicker was when I arrived at page four and found the “physical examination do not write below this line” section, where presumably the physician (who has a multi-million-dollar EHR) will not be documenting my exam because her contract requires her to use said EHR if she wants to get her annual bonus. I helped institute those contracts in a past life, and according to my former colleagues, they are still in place, so that should make for a fun conversation when I get to my appointment. The photocopies themselves are no longer crisp and are marked by smears from repeated copying, which is just sad.

Getting to the end of the paperwork, I realized that it didn’t even ask for some of the key elements of my history that are important to the topic of the upcoming visit, as well as being critically important for a physician in that subspecialty regardless of whether they’re a topic of this specific visit or not. As a physician, I know this is a big deal, but many patients might not volunteer that information if the physician doesn’t specifically ask for it.

Based on the paperwork and the pre-visit experience, I’m not confident of what to expect from this visit. For an organization that is worried about patient experience and their patient satisfaction ratings, I’ll be sure to give appropriate feedback when the inevitable survey arrives in my inbox. If they’re interested in some management consulting and EHR optimization, I might just know someone.

What’s the most frustrating healthcare IT-related issue you encounter as a patient? Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 5/25/23

A recent article in the American Academy of Family Physicians’ journal FPM summarized “Clinical Workflow Efficiencies to Alleviate Physician Burnout and Reduce Work After Clinic.” The first of their four suggestions was for EHR users to make use of macros and defaults in their systems so that they can easily insert content into their visit notes.

I continue to see physicians who won’t take advantage of basic system personalization. When I was in traditional primary care practice, my goal was to be able to do visits using as few clicks as possible and there’s no way I could have been as fast as I was without defaults for common physical exams and orders. It’s still difficult for me to understand the psychology where a user will waste time visit after visit, day after day, week after week, but won’t spend 90 seconds to create a default. The article even includes a link to a blog with a starter list of EHR macros for those who might have users who are reluctant to take steps to make their lives easier.

One of their other recommendations was to “consider cutting note bloat by writing in short phrases rather than full sentences and including only what is essential.” My first EHR made it easy to create notes in a format that was more akin to a bulleted list than beautiful, flowing prose. For many, reading a list like that is easier than reading a block of text, so I agree that it’s a valid strategy.

They also go on to mention that the EHR should be used as a database and not as a way to recreate the paper chart. Providers are encouraged to ask for help and to take advantage of organizational resources such as clinical informaticists, or even to get help from more efficient colleagues.

Even as a CMIO, I’m always willing to sit down with our clinicians to coach them through more efficient workflows. One of my early clinical informaticist roles involved implementing some challenging users. I miss the days when I could work with them and watch the proverbial light bulb go on when they had figured out how to breeze through their visits.

Many of the organizations I work with are big on telehealth, and I hope all organizations are making their plans to move to HIPAA-compliant telehealth technologies now that the public health emergency has ended. Organizations have had three years to move to compliant tools, but there are always going to be groups that wait until the bitter regulatory end before they do the right thing for patient privacy. The Office for Civil Rights is providing a 90-day grace period, but penalties for HIPAA violations will resume on August 10.

In the interim, organizations should look at their telehealth programs and technology, conduct a risk assessment, and confirm that they are using HIPAA-compliant tools. I suspect some purchases may be on the horizon and can imagine some vendors salivating at the organizations that left their transitions until the bitter end.

From Jimmy the Greek: “Re: marketing. Check out some of the language on this corporate website. ‘We create value by making sustainability an integral part of our vectors of superiority.’ There’s also ‘Improving lives for generations to come with irresistible superiority that is sustainable.’” Wow.” Any time I see the word “vectors,” my infectious disease brain immediately thinks of rats, flea bites, ticks, and other disease vectors. These linguistic gymnastics are found on the Procter & Gamble investor site, which is an otherwise interesting read if you’re so inclined. Given their product lines, I suggest that P&G might be better served by a tagline such as, “Assimilation through personal care, one buzzword at a time.”

Speaking of buzzwords, I’m currently disliking this one the most: omnichannel. The way I keep seeing it used, it falls squarely into the “I do not think it means what you think it means” category more often than not. I’ve also recently run into a resurgence of “circle back,” which I think should be eradicated from the business lexicon, along with “synergy,” “new normal,” and “out of the box.”

I had a visit at my primary care physician’s office this week. I scheduled it online and had my choice of a next-day visit that didn’t work for my schedule or one the following week, which I booked. Online check-in was a breeze, and the patient questionnaire related to my issue was easy to navigate.

The only blemish in the workflow was when the medical assistant had to free text every field when documenting my vaccine administration. At a minimum, I would have hoped the EHR would have had a vaccine inventory management system that would have presented things like the lot numbers and expiration dates as dropdowns or pick lists to help reduce errors and manage inventory. Even the site had to be free texted despite the fact that there are generally only six places on the human body where intramuscular injections are administered. She also had some kind of paper sheet that she was performing dual entry on, so I’m not sure what was going on with that and was afraid to ask.

When I arrived home, I was pleased to see that my patient-visible note contained an accurate History of Present Illness and that the exam matched what was actually performed, which is a big contrast to a visit I had with a specialist in the group last year. However, as I was reading my note, I realized that they never asked to collect my co-pay. Since they’re owned by my former employer, I know that collecting the co-pay at the time of service is a requirement. It’s also an industry best practice that everyone should know about. It helps avoid statement costs as well as the risk of never receiving the co-pay.

This means that I’ll get an annoying statement in the mail (I haven’t been able to turn off paper statements despite trying) and then have to go online and make a payment. Usually, I don’t receive an electronic statement notification until after the paper one has arrived, which seems to be a less than optimal way to configure your revenue cycle.

What makes you cringe when you visit a healthcare facility and see that best practices aren’t being used? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 5/22/23

I’m a big fan of experiential learning, especially after having just finished teaching some Outdoor Classroom sessions for a local youth organization. It’s great to see people use the skills you’re teaching as they interact with each other and try to solve problems. It works best, however, when you have a good blend of instructional time with practical or application time.

Having hands-on time can be great if you at least understand the concepts that are being presented and the goal is to either learn them at a deeper level or become more capable in performing them. I liken it to a surgical skills lab. First, you learn about wound repair, and make sure you understand how skin will heal depending on the repair technique and how different types of sutures will work in different ways. Then, you actually practice either with a simulator, or back in the dark ages, we practiced with pigs’ feet. You don’t just start throwing stitches into live patients without understanding the fundamentals.

I have a couple of certifications on EHR products that I rarely use, but for which I like to stay up to speed. One of the vendors rolled out a new product that I’ve not been certified on. Given my past work with the application, they offered me the opportunity to take the certification classes for the new product.

I was excited about the opportunity and ready to prepare for the classes. Unfortunately, there wasn’t any kind of preparatory work – no pre-class readings or training videos. There was a PDF for the class, but what was in there looked mostly like exercises without any foundational content. I wasn’t sure if I was missing materials or whether it was intentional, but I decided to head to class with an open mind.

I have to say that it was one of the most frustrating classes I’ve ever taken. The entire thing was taught in a hands-on fashion, with no structured presentations or materials that summarized the functionality. Each module was a situational vignette, and after reading it, we were expected to go into the application and figure out how to take the necessary steps.

It was completely frustrating. I knew the general layout of the application and the main menus, but I didn’t know all the shortcuts that this class apparently expected us to not only know, but use. It was made worse by the fact that many of the desired tasks had more than one way for them to be accomplished, but you only deduced this after working through the scenario a couple of times. At no time did the instructor explain why one might want to embrace one workflow over another.

Not having any kind of initial summary or teaching also made it difficult to figure out what the various options were. I felt like I was more focused on writing things down in my notes so I could try to put it together in a cohesive manner rather than trying to understand how to manipulate the different scenarios. Because of that, I found myself missing key information because I was still trying to figure out something that happened a minute or two earlier in the simulation scenario.

Even if I would have been given a one-page summary that listed the different workflow possibilities and explained why a user would select one compared to another, it would have been a significant step up. A handout of the system’s keyboard shortcuts would have been helpful as well. After completing the class, I ended up spending several hours in the system’s demo environment running through common scenarios and seeing if I could figure out how to execute them on the platform.

At the end of the course, there was an evaluation that contained a couple of the question formats I hate the most. The first was what my medical school used to call “multiple-multiple choice” questions, which typically had four answer options (A, B, C, D) but then would have additional options like “A and B” or “A and B and C” and other combinations. Inevitable you’d find more than one thing on the list that was likely to be correct, but you spent excess time trying to psych yourself out about which items to exclude.

The other most hated question format (which unfortunately continues to also be present on my medical specialty board certification platform) is the “choose the best answer” type question. “Best” is really a subjective question, especially when you’re talking about patients and how they might take or not take a medicine. There have been campaigns for many years to get those kinds of questions off the recertification exams, so I’m used to seeing them more rarely. However, those questions were all over this software training, with the problem being that finding the “best” solution depends on many more factors other than just the test taker.

For patient care, the best solution might be one that balances clinical effectiveness with cost and makes it easier for patients to take their medications they way they intended. Best could also mean the treatment that will give a patient the most longevity, or the highest quality of life. But it can also represent treatments that might save your life, but that also might cause horrific side effects and deterioration in your quality of life at the same time.

This can also be true in the healthcare IT side of the house. The term “best” might represent the solution that has the most bang for the buyer’s buck. It could also be the solution that has the lowest risk of patient care errors. Or perhaps the one that takes the least amount of time for nurses to complete their workflows. When you put on your client hat while reading test items like that, one can’t help but overthink them or overanalyze similar decisions you’ve made in the past.

After feeling like I had been led astray but the hands-on training and then burned by the confusing test questions, I was ready to give up. Sure, I could follow the instructor to perform a bunch of different tasks, but I had no idea how the application would help my daily work or benefit my organization. I’m a pretty decent test-taker, so I ended up passing the evaluation step, but I still don’t feel like I know anything as far as being able to operationalize the functionality.

One of my co-presenters at Outdoor Classroom has dyslexia, and working with him made me think about how others would perceive the class. Similarly, people who learn best from reading rather than watching an instructor perform tasks and then try to emulate them might be out of luck. Organizations need to do more thought around different learning styles and need to spend time crafting strategies that will work for the diverse groups of users that their products will certainly encounter.

What are the best and worst types of software training you’ve experienced? Any advice that you’d give those who create the strategies? Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 5/18/23

A colleague clued me in about an article that was published in JAMA Network Open last week, “Perspectives on the Intersection of Electronic Health Records and Health Care Team Communication, Function, and Well-being.” The associated qualitative study looked at the habits of more than 70 attending and resident physicians and found that the EHR dominated most inter-office communication.

Although it can be helpful for management of patient-related tasks, they found that communicating through the EHR limited the “rich communication and social connection required for building relationships and navigating conflict.” The authors suggest that “the technology shifts attention away from the human needs of the care team, and interventions to cultivate interpersonal interactions and team function are necessary to complement the efficiency benefits of health information technology.”

Digging into the study design, I found it interesting that the participants in the qualitative interviews were separated in time, with a significant event in the middle with the emergence of the COVID-19 pandemic. The first of the two cohorts was interviewed from March to October 2017 with the other being interviewed from February to April 2022. The authors called this out as a limitation of the study. They also noted that the first study focused on EHR-related distressing events and their role in physician emotions and actions, where the second study focused on EHR use and “daily EHR irritants.”

I would propose that in a post-pandemic world, even the smallest of daily annoyances is felt much more acutely than it might have been in 2017. This is exacerbated by the staffing and financial pressures that have been magnified since the pandemic’s start in 2020. I’d be interested to know what the relative level of staffing was during the two cohorts’ interview periods, since a significantly understaffed practice will yield different sentiments than one that is running with adequate staffing. Interestingly, information on respondent demographics wasn’t collected.

The authors also note that communicating through the EHR was felt to negatively affect team function and team well-being, namely by “promoting disagreement and introducing areas of conflict into team relationships related to medical-legal pressures, role confusion, and undefined norms around EHR-related communication.” There was specific discussion of physicians being expected to manage EHR-related messages across multiple platforms such as in-basket, email, and text.

One interviewee compared this to driving a car before stoplights were developed. “Some of my colleagues text; some of them send it in… email; some of them send it as Epic provider-to-provider messages. What a mess… there’s no sort of manners and rules. Right? Sort of like… before they developed stoplights, and there were starting to be more and more cars. Right? Man, this is nuts. It’s like, ‘Who’s going first. Who’s talking to who?’” I feel that frustration, especially when you look at the fact that different platforms might offer different subsets of functionality that can be confusing.

In some of my experiences with startups, we ran into this with differences in what IOS versus Android platforms would support, and even with IOS, on what might work on iPhone but not on iPad. This is magnified when you’re dealing with a full-feature EHR that people are trying to use from disparate platforms. You can also throw in some desktop support requirements and the Apple Watch and it’s a doozy.

I tend to only perform “real work” on a laptop or desktop, so I can’t imagine the cognitive overhead that people who try to manage on different platforms are experiencing as they try to remember which device will allow them to do what. Especially with portable devices, people are also trying to use EHR-based communication while doing other things, such as attending events with family, which adds a layer of distraction to what might already be some fairly brief communications.

Others in the study noted that “now that I can place an order from anywhere, everyone assumes I can place an order from anywhere, and expects me to do so anywhere, anytime.” In my experience, this blurring of personal and professional time adds to clinician burnout and resentment towards the workplace.

I was saddened to read the part of the article where they discussed the EHR being used to air disagreements, including clinicians who “would document petty, kind of nasty comments in the EHR about residents.” Others noted that concerns about potential litigation may “put people under the bus” in the EHR with documentation about who was paged and when, and whether the response from the contacted clinician was to their satisfaction. There were also the expected comments that delivery of care to the patient has “completely been subsumed in documentation requirements.”

The authors noted that there is a need for greater understanding of optimal EHR use and that “the development and improvement of local work culture is critical and may have a greater influence on physician burnout than EHR improvements alone.” They go on to suggest that “organizations support physicians in implementing small, structured peer-group discussions to enhance team function and individual well-being.” I’m a big fan of the concept of self-organizing teams and the latter comment resonated with me. People need to be able to talk about how they like to be communicated with, and any additional needs they have in processing information, but may not be likely to address these needs unless it’s clear that the workplace is supportive of accommodating them.

I received quite a bit of reader mail about my recent Curbside Consult that talked about May being graduation season. Many readers have graduates in their families and it sounds like there is an even split between those going into technology-related fields and those pursuing careers in the arts and humanities. A couple sent pictures of their graduates and it was great to see the proud parents and the excited faces of the graduates in the photos. One correspondent noted that her daughter is headed to work for Epic, with another sending a child to a public health organization. They’re looking forward to seeing what their children think about the industry after seeing it from another side. I’m sure new entrants to the healthcare field have an entirely different idea of what it will be like than many of us did 10 or even 20 years ago.

What did you think healthcare IT would be like when you first started in the industry? Has it met your expectations or crushed your dreams? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 5/15/23

May can be a busy time for families who have graduates. When I was in Madison last week, I saw plenty of people who were taking pictures at the state capitol wearing caps and gowns. It was fun to see their excited smiles and to wonder where they are heading next on life’s adventures.

This weekend, I attended a graduation at my state’s flagship engineering and technology school, and it didn’t disappoint. It was inspiring to see so many people going into careers in science, technology, engineering, and math fields. It was particularly gratifying to see the number of women graduating in fields that have been historically male dominated, including geophysics, mining, metallurgy, and explosives engineering.

Due to the size of the ceremony, graduates of various departments were recognized in groups by their majors before coming to the stage individually to receive their diplomas. Although mechanical engineering was dominant at the ceremony I attended, there were quite a few aerospace engineers and a surprising number of metallurgical engineers who had the most stylish hair, shoes, and eyeglasses in the crowd. In addition to computer science and computer engineering, degrees from a new program in information systems and technology were also conferred.

The “best decorated graduation cap” honors goes to the biology major who had three Petri dishes affixed to her cap, along with the metallurgical engineer who had gilded designs on the top of hers. Several of the biology majors had plush bacteria toys dangling with their tassels after being gifted them from their department chair. During the departmental recognitions, the audience figured out that there was a lone economics major among the hundreds of graduates, and he received some extra applause and cheering.

I sat next to the mother of one of the information systems graduates and was learning a bit about the new program and how it was founded as part of a major donation to the university. That funding led to the addition of a college that covers entrepreneurship, information systems, technology management, and more. Although some of those disciplines existed previously as part of the college of engineering, it’s interesting to see them grouped together under a new umbrella.

My assumption is that the new organizational structure also helps ensure that they’re funded in the way that the donor intended, rather than the money being washed through a larger department and potentially sidetracked. Since the new college carries the donor’s name, it also needed to contain actual departments, so I’m sure that was a factor as well. According to his mother, that new graduate interviewed at a healthcare software company, but she wasn’t sure which one it was.

Being well into my career, it’s sometimes easy to forget what those milestones that our younger selves experienced meant to us at the time. I don’t have deep memories of my college graduation other than lining up in the bowels of the basketball arena with other graduates in my department and singing our school song for what would be my last time. (I admit, I haven’t visited since graduation, but I’ll be doing that later this month as part of a milestone road trip with my former college roommate.) I remember my medical school graduation in great detail, especially the processional that involved bagpipers and a parade down a couple of escalators. With the bagpipes and the gowns and hoods and having been through the wringer during the four years prior, it seemed quite surreal at the time.

I also remember the fact that the main speaker failed to follow the program, which led to us not being administered the appropriate oath (in our case, the Oath of Geneva rather than the Hippocratic Oath) during the ceremony. They tried to rectify that after the ceremony concluded, but many of us had already scattered to meet with families and loved ones.

I’ve made use of that fact at least once in my career, when a patient was upset that I wouldn’t give her what she wanted and told me that I had to do it because “you took an oath.” I said very calmly that actually I didn’t take that particular oath, but that wasn’t going to keep me from giving her high-quality, evidence-based care regardless of the fact that it wasn’t what she wanted on that particular day. I think most of us in medicine would agree that the core values we follow are ingrained in us long before any oaths become topics of discussion, and that we don’t need to say prescribed words to do the right thing. Quite a few medical schools allow their incoming classes to write their own oaths during the first year, enabling them to memorialize values and intentions that are important to them.

There are situations where oaths are important, and I was able to experience one of those as well while attending my first ROTC officer commissioning ceremony as part of the graduation festivities. During that ceremony, a military officer administers the Oath of Office to each newly appointed Second Lieutenant, and then family members or loved ones help pin on their ranks. They also receive their first salute from an enlisted service member who has been important to them. It was interesting to see who the cadets chose to perform the different parts of the ceremony. Some of them had relatives who were officers administer the oath, one had a former scout leader who was a naval officer do his, and one woman received the oath from her husband who graduated and was commissioned last year. The most touching was the cadet who had his grandfather, a Korean War veteran, give his grandson the first salute. There were few dry eyes in the house after that one.

It was inspiring to see these young people, most of whom could have headed off to solid careers in engineering or technical fields, commit to serving their country. Instead of following the money, they’ll be supporting our military as cybersecurity resources, civil engineers, logistics coordinators, pilots, and missile operations officers.

The latter job role is one that most people don’t think about. It feels strange to understand that in a world where so many people are focused on what they see on TikTok or Instagram, we have officers underground 24×7 ready to launch what might be world-ending missiles should the order arrive. Knowing that gives me a new perspective on my daily work struggles or the things that some of us think are emergencies on any given day. There’s a lot of uncertainty in the world that these newly minted officers are headed into, but I have high hopes that this generation has leaders among it that can do a better job than what we might be seeing today.

Are you headed to any graduations this spring, and what are your hopes for the futures of these recently degreed individuals? Are graduates gravitating to technical fields or finding their futures in the arts or humanities? Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 5/11/23

I’ve been in Wisconsin this week attending the first week of Epic’s annual XGM, or Xpert Group Meeting. Although there’s always a lot of chatter about the fabled User Group Meeting in late summer, I hadn’t heard of XGM until a couple of years ago. I’ve spent the majority of my clinical informatics career working with other EHR platforms (McKesson Horizon, anyone?) and had only interacted with Epic in an end-user capacity previously, but this has been my favorite of the Epic conferences so far. XGM is split across two weeks.

This week seemed more clinical in nature, with the more technical sessions following next week.  Although I’m confident that I could learn plenty at either, this is the one that worked best with my schedule, and it’s been jam-packed. Unlike some of my experiences at HIMSS, I’ve been surrounded by thought-provoking presentations that have a lot of applicability to my ongoing work, and I’ve met lots of people who are beyond energized about working in the industry. 

Some random thoughts. Epic requires you to attest to being fully vaccinated as a condition of registering for the conference. For those of us who came home from HIMSS with the plague, I appreciate it. I’ve seen a number of people who are wearing masks, including plenty of staffers. It seems prudent when you are interacting with large numbers of people, because there are plenty of circulating viruses other than COVID that I wouldn’t want to bring home to my family, and interacting with a couple of thousand people from across the country and around the world is a risk factor. I saw a couple of N-95 masks on people’s elbows or clipped to their backpacks, which isn’t doing anyone much good, but there were quite a few being worn properly as well. Distancing was possible in most of the sessions, and although mealtimes were busy, there was the option to take a carry-out box outside except for the day when it was raining.

The sessions that have been the most packed include those on clinical decision support and Epic’s Cosmos database, which includes de-identified data from millions of patients. Telehealth sessions were also popular, as were those on optimizing clinical alerts. It feels like a lot of attendees are serious about making sure that their technology investments are generating value for clinicians and making sure that patients are being included as beneficiaries of those efforts as well as clinicians and other end users.

As far as the sessions themselves, the Epic moderators run a pretty tight ship, keeping sessions on time. They’re also good at making sure that audience members who are asking questions remember to use a microphone so that the session recordings include all the questions. Of course, there are still some people who don’t want to wait for a microphone and jump right in, but the presenters were good at addressing those, too. As with any conference, there are always audience members who confuse the Q&A portion with their own personal story time, but it seemed less than what I have encountered recently at other conferences I’ve attended.

Even the “attendees behaving badly” weren’t that bad, although I was ready to throttle the person I’ll call “crinkly bag guy” who seemed to have everything in his messenger bag double-shrouded in cellophane, resulting in a tremendous amount of noise every time he looked for something, which was often during the 40 minutes we were together. His nearest neighbor even shushed him librarian-style. There was also the guy who spilled coffee on the bus (and also on himself) because he put his partially full coffee cup in the side pocket of his backpack.

Generally, though, everyone was pleasant and patient with any lines or crowded situations, which made the entire meeting feel smooth. The weather was fantastic Tuesday and Wednesday and I was able to get out and stroll the campus and have some random interactions with other attendees who were doing the same thing. The continued campus construction was a common topic, as was the legendary Epic culinary department. Highlights of the menu included the spinach-asiago breakfast tart as well as a chocolate cake that was enrobed in a delightfully crispy coating.

A couple of presenters got into the ChatGPT spirit, with one using the tool to write the introduction to his presentation and another asking it to detail some thoughts about the future of patient experience. I took what felt like a million pages of notes, trying to capture every useful thing I heard. Many of the client presentations dealt with issues that are common no matter what EHR platform you use, and I’m surprised that they’re still being discussed. This includes such advice as “put the things you want used most often at the top of a menu and the things you want used least at the bottom of the menu” which can make a huge difference for providers being able to order common tests as efficiently as possible. It can also make a difference when you’re trying to steer patient behavior, such as encouraging them to use a refill request workflow or an appointment scheduling workflow rather than just defaulting everything to a message to their primary care physician.

Reducing the continued increased in post-pandemic patient portal messages was a common theme, with several clients sharing their strategies as well as Epic giving information on its features to support their efforts.

Speaking of features, one non-technical feature that I’ve only seen at Epic conferences is the inclusion of local and regional businesses for attendees to shop in between sessions. Several Wisconsin-based businesses were featured, including one that had handmade soap and gift items, gift boxes, everything badger-themed, and local snacks. There were also chocolatiers and creameries selling a variety of cheese, snacks, honey, sweet and savory pecans, truffles, and more. This is on top of the Epic shop, where attendees could pick up themed t-shirts, notebooks, jackets, water bottles, and other items that are offered at cost. The conference also knocked it out of the park from a sustainability standpoint by having dedicated recycling and trash bins everywhere you turned, but also by including recycling instructions on the standard slides that played in the meeting rooms between sessions.

The Epic campus is known for its quirky art. The piece that gave me the most delight on this trip was this planter that appeared to have microscopes mounted on it. Instead, the eyepiece revealed a kaleidoscopic view of the plants that changed as the planter was spun, reminding the viewer that what you see is not always exactly as others see it. This will be important to remember as I bring back a virtual treasure trove of presentations of cool things that work at other institutions but might not work at my own or might be beyond what my own users are ready to experience at the moment. I met some new people who will be great to bounce ideas off of down the road as well as some who can commiserate with the challenges I run into on a regular basis.

I’m sad that I’ll miss the second week but trust that my team will bring back lots of other ideas.

What’s the best idea you’ve picked up at a conference in the last year? Leave a message or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 5/8/23

I’m back in the air this week with some weekend travel, which I don’t usually do. My flight was nearly all vacation travelers. The boarding process started with someone spilling his coffee all over the exit row, which led to a string of urgent maintenance issues and caused confusion and delay. Since he soaked nearly all of the seat belts in the exit row, those had to be changed out. Additionally, the flotation devices under the seats also had to be checked. Meanwhile, no one was able to board into that row or adjacent rows while the spill was being addressed, causing a lot of grumbling.

I’ve seen so many spills and messes at the airport and on planes due to Starbucks and fast food cups that it’s a miracle there aren’t more delays than they are. I don’t understand how people think they’re going to board with a roller bag, a shoulder bag, and a non-secured beverage and expect everything to turn out OK. I also see a lot of impractical shoes, which isn’t going to help anyone in the case of an emergency. I think most people never think of the fact that they might have to emergently exit a plane, but as someone with an interest in disaster preparedness, I’m always ready to deploy that exit door and head out in my trusty running shoes.

One of my projects for the day involves helping a former client. They reached out to me earlier in the week about a custom application that I installed for them way back in 2011, and I was frankly surprised to learn that it was still chugging along. It was designed to help with routing of laboratory results, and it sounds like its simplicity is what led to it still being in service more than a decade later. Since it was a custom build, the client opted at the time for a no-frills approach with a straightforward user interface. I figured they would have retired it long ago as they transitioned from a dedicated ambulatory EHR to an enterprise application, but apparently they continued to use it for some non-employed private practice clients who had steadfastly refused to migrate to the enterprise platform. The last of those physicians is retiring at the end of June and they were looking for advice on how to wind down his laboratory feeds as he transitions out of practice.

As a consultant, I’ve helped with a number of practice and provider “disengagement” processes over the years, so I was able to dust off some existing documentation and point them in the right direction to manage some of the non-application tasks that need to be addressed before they shut it down. Although they were more worried about what to do about the technical infrastructure, I let them know that the issue will largely resolve itself once the lab vendors stop feeding information. Fortunately, the physician is a subspecialist who orders very few laboratories and has been good at tracking outstanding orders, so the odds of a rogue result needing management in the practice’s final days are slim to none.

I enjoyed catching up with the analyst who was tasked with winding down the practice from the information technology side since I had worked with him when we initially configured the system. It’s rare to see someone continue to support a one-off application like that for the duration that they had with this one, but it was fun to talk about where the industry has gone in the years that have passed since we were both relatively new to the clinical informatics world.

My other project for the day is finishing a sorely overdue library book. I’ve had a lot going on in both my professional and personal lives and the amount of time I’ve had for those kinds of pursuits has been largely non-existent. Fortunately, my library has a no-fine policy, but I feel bad about keeping this book out of circulation, especially since someone has now put a hold request on it.

Since I’m spending the rest of the weekend in a hotel, it’s not like I can work on household projects, putter in the yard, do laundry, switch out the winter clothes in my closet for summer ones, or do any of the dozen other projects that are looming. I’ve got some downtime at my destination later in the week and I hope to see some of the sights and do a little shopping, so it will be a good change from my normal routine. Sometimes it’s good to just change things up, so we’ll see what the rest of the week brings.

I’m also still recovering from the respiratory funk that I picked up at HIMSS. Although it wasn’t COVID, it has put a dent in my activities, and I’m realizing that I don’t bounce back like I used to. Even though I no longer work in person in the emergency department or in a high-acuity, high-volume urgent care situation like I did during the height of the COVID pandemic, I feel like those experiences have taken months if not years off my life. I’ve watched nearly everyone I worked with during that time leave frontline healthcare roles, so I know I’m not alone in feeling like the experience was a turning point.

Some of my former colleagues have moved on to subspecialty positions that have more predictable working hours, but others have left clinical medicine entirely. When COVID started, we all promised to see each other “on the other side,” but several were lost along the way, including one to suicide. Thinking about them reminds me how important it is to savor every day even if you don’t feel well or if it’s particularly stressful. It’s also a good reminder of how we need to look after each other because you never know what’s going on in the parts of someone’s life that you don’t see.

Once the business component of this trip ends, I’ll be zipping home to get ready for some family functions. I’ve also got an upcoming girls’ trip that I need to plan, so hopefully I can knock a big chunk of that out on the flight home as long as wi-fi cooperates and we don’t have any major in-flight issues. After June, I can finally enjoy some long-needed R&R.

How do you spend your travel time? Is it full of catch-up tasks, or do you manage to find time for yourself? Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 5/4/23

I was back in the patient trenches this week, having my regular trip through the scanner to determine whether the next six months will be smooth sailing or something else entirely.

What I didn’t plan for was a bumpy preregistration and appointment confirmation process that was scheduled to occur while I was supposed to be off the grid enjoying the outdoors. I just happened to be in cell phone range when the first call came, asking if I had time to complete preregistration. All of the questions I was asked to answer or confirm could have been easily served up as part of a patient questionnaire via the patient portal (as they are when I see the surgeon who is part of the same institution) and could have been sent well in advance of the procedure.

About 20 minutes later, a call came in from the radiology department. This one was a recording, and my Google Assistant picked it up without me realizing it. I had pulled out my phone to check the weather forecast and noticed the call already in progress and recognized the hospital prefix and picked it up. I had to listen to the recording loop through and could finally confirm my appointment. Again, this could have been done through email and/or a patient portal message.

Still, I was left wondering what would have happened had I been truly off the grid as planned? Would they have canceled my appointment, which had been painstakingly scheduled six months in advance and for which I had canceled and rescheduled work meetings? Or would they have accommodated me if I rolled in without confirming? We’ll never know.

Even with that pre-confirmation, things were not smooth on arrival. When I reached the registration desk six minutes before my allotted arrival time),I had to stand there for a few minutes while the registrar copied my details (first initial, last name, time of study, type of study) out of the computer and onto a little sticky strip of paper.

She phoned back to a registrar, who came out and picked up the sticky strip, then hustled me back to the registration area where she rushed me through the process saying, “we can’t have you being late to the waiting room.” Mind you, it was just now my arrival time. She then stuck the paper strip to a notebook in her work area, asked me to confirm my name and DOB, and then asked me to sign on an e-signature pad without even telling me what I was signing. According to the text at the top of the pad, it was my consent for treatment, but I was never offered a copy or advised as to what I was signing. As a physician I know what’s in a typical consent, but the average patient doesn’t, and either way, the consent is invalid unless a patient actually reads it.

From there I was led down the hall at a rapid clip to the appropriate radiology sub-waiting room, where I was handed the proverbial clipboard and asked to complete three sheets of questions, none of which were even remotely populated with my information. As a CMIO, I know it’s entirely possible to generate forms that already have key patient information on them, and for the organization to continue to make the patient print their name, date of birth, and Social Security number on each page is just poor patient experience.

After filling out loads of information that was already in the EHR, I turned in the clipboard and proceeded to sit for a full 10 minutes before I was taken to the changing room. I had enough time to notice the trash under the chairs in the waiting room, and since I was one of the first appointments of the day, it was likely from the day before.

In the changing room, in addition to some fantastic gowns, I was greeted with dust bunnies the size of a plum that had probably been there for several days based on the look of them. I know that all organizations are struggling with retaining lower-wage workers such as housekeeping staff, but I had to ask myself if the president/CEO of the hospital or the members of the board would be proud of their facility. For an institution with billions of dollars in the bank, maybe they could loosen the purse strings a little bit to help recruit and retain staff.

Fortunately, the clinical staff was outstanding. It was one of the best IV starts I’ve had in a long time, and a friendly radiologic technologist had the positioning process down to a fine science. She also honored my request to sleep through the procedure. I’ve had it enough times that I don’t need to be warned every time a new sequence starts, and given the early test time, I was grateful to grab some extra shuteye before heading back to work. At least this time they subsidized the first $1.50 of the parking fee. I always find the idea of paid parking at a world-renowned cancer center to be repugnant when the organization is sitting on a Scrooge McDuck level of reserves.

I usually get my results within 24 hours, but this time it took two full days, which was somewhat agonizing. When the patient portal notification finally came through, I discovered that my biometric settings no longer worked, and the hospital wanted me to log in using my password and then re-enable biometric authentication. Having been a biometric user for years, I didn’t have my password saved within my password manager, so that was a race to try to get the results before going to my next meeting. I was surprised to see that the results had been reviewed by a provider prior to release (usually they release directly) so I’ll have to ask my clinical informatics contacts at the institution what the story is with all the changes.

Although the process was frustrating, at least it took my mind off the other frustration of the week, which involved organizations that I spent a substantial amount of time with at ViVE who have yet to follow up. I’ve got money to spend and time to dedicate to these particular projects, but my patience is flagging. I sent a last round of emails, so we’ll see who responds and which project will get to start first. The others may just have to wait.

Have you had any recent patient adventures? Were they positive or negative? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 5/1/23

Over the last couple of years, I’ve been trying to learn more about marketing. It’s a critical part of what we do, whether it’s trying to promote a company, advertise a hospital, or convince patients to adopt healthier behaviors or take advantage of cancer screening tests.

When I was training to become a physician, I thought that it would be about learning all the science and figuring out how to apply that to examining patients and identifying a diagnosis and treatment. Over time, I learned that identifying the diagnosis and making a treatment plan was only half the battle. Convincing the patient to get on board with the proposed plan was a tremendous lift. I learned more about persuasive speech and sales techniques than I ever expected to know, except I was using them to try to convince patients that taking a cheap generic medication to treat their conditions would actually be a better option than the flashy drugs that they had seen advertised on television.

Working for a large health system, I also learned a lot about the ways that organizations market themselves. Sometimes this was productive, trying to increase community awareness about available services. For example, when we launched a mobile diabetes screening unit, there were multiple marketing campaigns to drive awareness and create buzz about the importance of diagnosing diabetes early. Things became more challenging when those patients were actually diagnosed but ran into insurance issues or inability to get the care they needed. I wish that the campaign to launch the mobile unit had included training for primary care offices on how to best handle the influx of patients we were seeing, especially in a startup office like mine.

I also saw plenty of counterproductive marketing efforts, such as when two hospitals that were part of the same health system launched competing orthopedic surgery marketing campaigns, both aimed at the same patient population in the geographic area where I also lived. It seemed like every time I opened the mailbox, I had a competing flyer from one of the programs. Since the flyers had the health system branding as well as the individual hospitals’ branding, I’m sure it was confusing for patients. As a physician who was on staff at both hospitals, it created plenty of confusing conversations with patients and without the requisite talking points that would  have been good for staff physicians to have at their fingertips.

This article about Mercy’s personalized healthcare marketing strategy caught my eye. I originally thought I was going to learn something about how precision marketing can help patients, but unfortunately, the first quote in the story left me somewhat baffled. The health system’s chief marketing office, Kristina Dover, stated, “One of the examples I really like to use is that a 55-year-old male OB-GYN should never see our mother-baby advertising if we’re doing our job right.” Actually, I think the midlife, male OB-GYN is exactly who should understand the health system’s mother-baby marketing strategy, because it’s his patient base that is the target of that advertising. Who better to understand a hospital’s advertising tactics than those who are expected to deliver on its promises? Expectation mismatch is a key factor contributing to patient dissatisfaction so that the care delivery team is well-served by understanding those expectations.

Other comments that Ms. Dover made were confusing. She mentioned trying to balance supply and demand through personalized advertisement, by pointing patients to service lines with openings at the time. She is quoted as saying, “We are honestly having conversations every day to say, ‘We have the access for inpatient primary care visits today, let’s increase our marketing or let’s dial back a little bit,’” which makes no sense. I wonder if she can even define what an “inpatient primary care visit” is or whether she understands that you can’t just go out trolling for inpatients as a way to increase your census. As a former emergency department physician, there were plenty of patients that I would like to have been able to admit, but factors like insurance, acuity requirements, and more were always standing in the way. How wonderful that a marketing team has found a way around all of that.

Of course, I’m being facetious, and for Ms. Dover’s sake, I’m hoping this was some kind of misquote or misunderstanding on the part of the reporter. Helping patients understand their healthcare choices is complex, and I struggle to understand how it can be reduced to an Amazon-like shopping experience regardless, given all the drivers such as insurance coverage, acuity, provider experience, accreditations, and more. It’s not exactly a retail commodity, and trying to reduce it to that level might not be the best thing for solidifying a medical home or providing continuity of care that drives outcomes. It’s been a decade since the two marketing examples I discussed at the beginning of this piece happened, but it seems like there is still plenty of dysfunctional marketing out there.

I’d like to get a better understanding of how health systems might take a more informed approach to marketing. Do they consider the opinions of patients, caregivers, providers, and employees as they create their campaigns, or are they created in corporate lock-ins or Madison Avenue-style conference rooms? Do health systems consider previewing their campaigns to their internal constituents so they are prepared for any patient questions, and if so, do they ever make changes based on feedback they receive? Maybe I’ve just been in health systems that didn’t give us a sneak peek, but I’m eager to learn what’s going on in the greater healthcare marketing universe.

I’d also like to learn other opinions on personalized marketing strategies. Are other organizations using different tactics than what the article described is happening at Mercy? Have you found that new strategies have made a difference in how patients and potential patients receive marketing messages? What do you think about hospitals moving towards consumer-focused marketing as a way to drive volumes? Are we all eventually going to be a commodity? Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 4/27/23

Lately, it seems like my travel is never uneventful. The trip home from HIMSS added to my recent adventures.

I scored my usual exit row seat and everything went normally during the emergency briefing. However, we had a delay on the tarmac and one of the passengers in the exit row in front of me started asking “have we left yet?” followed by chanting “let’s go, guys, let’s go, guys” over and over before ultimately quieting down. After we reached altitude, though, his behavior became more erratic and he was bothering the passengers next to him while asking over and over if we had taken off yet.

The flight attendants were on top of it, arriving in a group to invite the passenger to move to a seat in the back of the plane near the galley. He acted a bit disoriented, but was able to follow instructions, although the lead flight attendant had to tell him several times to stand up, grab his backpack, and follow them. As he passed by my row, there was a strong smell of alcohol, which made me wonder whether he chugged his drink at the gate to comply with the rules to keep alcohol in the terminal or whether there was something medical going on.

It was a short flight and the police were happy to meet us upon landing and escort the gentleman to an alternative destination, but I hope he was OK. I’ve got a few more flights planned for the next three months and I’d really like to have just one where nothing noteworthy happens.

While I was flying, a couple of readers sent me some pics on the last day of HIMSS:

Biofourmis had custom branded sneakers. Thanks to a reader for sending this picture along.

Spa Girl says she saw these in a shop on the Magnificent Mile and thinks I need these for my next beach trip. They are undeniably cute, but probably not the most practical for travel. I could see wearing them around the house with a plush robe, however, in the mode of a Hollywood starlet.

As long as the Wi-Fi works properly, I’ve found that I’m pretty productive on the plane. While cleaning up email, I spotted this article about the ongoing debate about policies that require workers to return to the office. The piece mentions a bizarre call where Clearlink CEO James Clarke questions his own employees’ ability to manage work/life balance. Apparently, there has been some confusion within the company over the last couple of months as to whether employees would be asked to return to the office or whether they had been hired under the assumption of a remote-first culture. The first group of employees asked to return include those who live within 50 miles of the company’s Utah headquarters.

During a company town hall meeting to explain the changes, Clarke went on a rant about employees that had not used their laptops for a month, which is as much a management issue as it is an employee issue in my book. Did those employees’ supervisors not notice that they weren’t working, or was Clarke just making this up? He went on to ask employees to increase productivity by “30 to 50 times” normal and challenged employees to outwork him. He went further to praise an employee who had gotten rid of the family pet as a result of the change to in-person work.

Not wanting to exclude anyone in his unhinged speech, he also criticized working mothers specifically and working parents in general, saying “only the rarest of full-time caregivers can also be productive and full-time employees at the same time.” Sounds like it’s time for the HR department to provide some education and the company’s executive leadership to consider an alternative direction.

Another article that caught my eye was about a golf cart accident at Wake Forest Baptist hospital in North Carolina. The tragic crash resulted in the death of a patient and injuries to the cart’s two other occupants. The cart had been used to transport patients and visitors between the facility and parking structures. An investigation is underway, but I hope it will prompt other facilities to look at how they’re using different modes of transportation on campuses. No one wears a seat belt on a golf cart, and in the event of a sudden stop or a collision, it’s not a lot different than being on a motorcycle as far as being ejected is concerned, except that you’re probably not wearing a helmet. The articles I saw didn’t specify whether the fatally injured party was a rider or was struck by the cart. My sympathies go out to the family of the deceased and those involved in the incident who will be forever impacted.

A recent article in JMIR Human Factors looked at the use of speech recognition technology in the exam room. This wasn’t the fancy AI-driven kind of speech recognition, but rather the old school dictation-style voice recognition approach that many of us have used in our careers. In the study, physicians completed the Assessment and Plan portions of the patient’s after-visit summary while still in the exam room with the patient. The summary was then printed and a survey performed. Compared to “usual care” without an in-room dictation, patients felt that providers were better at addressing patient concerns and felt that they better understood the providers’ advice. The authors concluded that patients have a positive perception of speech recognition use in the exam room.

I first saw this approach in probably 2011 or 2012, while shadowing one of the Oklahoma Family Physician of the Year recipients. He dictated every visit in the presence of the patient and gave them the chance to ask questions, and it had been part of his routine for years. It’s difficult to believe that more than a decade has gone by without more people using this fairly straightforward strategy.

As a clinical informaticist, I see plenty of examples of clinicians and their teams struggling to adopt strategies that have been proven to improve efficiency and reduce documentation burden. Nearly every health system I’ve worked with has a super-user program and many also have robust physician champion programs. However, there are always physicians who don’t want to take advantage of those options. I see people who will do the same inefficient workflows over and over because they don’t want to take an hour or two to personalize EHR features or save their own default Review of Systems or Exam templates. I see providers manually typing differential diagnosis paragraphs that they could save and use as a base for future notes when seeing common conditions. They say they’re too busy to save them as quick phrases, but I would argue that they’re too busy to not take the time to make their future lives easier. I’m not sure what the answer is or how to motivate some of the more resistant providers, but I’m open to ideas.

What good ideas can be found in your bag of EHR optimization tricks? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 4/24/23

As a primary care physician at heart, I know how important it is for patients to learn how to make better food choices. A friend clued me in to the Plateful app, which helps consumers make better choices by providing information that may be more understandable than the typical “Nutrition Facts” label. Once a user scans the UPC found on a packaged food, or uses the PLU code on a fruit or vegetable, the app displays a Nutrition Value and an Eco Value, each of which ranges from 0 to 100. In addition to the numbers, star values also display to help users understand the relative value of a food choice.

The Nutrition Value is based on the Tufts Food Compass Score, which was validated over nearly two decades. I wasn’t familiar with it before seeing the Plateful app. This isn’t surprising given the huge lack of nutrition education at medical schools when I was in training. I think we had a four-hour block to cover the entire topic, and you can bet that people paid less attention to it than they did to competing educational priorities like the surgical skills lab or cramming for the USMLE licensing exams. If I remember correctly, it was tacked on to the end of second year almost as an afterthought.

Although medical education has become more well-rounded since then, I’d bet that nutrition still gets less coverage than it probably should. Some of the most damaging chronic health conditions, including coronary artery disease, stroke, diabetes, and certain cancers can be impacted by nutrition, but it seems that our society would much rather spend its healthcare dollars on pills and injections rather than addressing the root causes of the diseases.

The Tufts Food Compass looks at 54 attributes across nine categories, including: ingredients, nutrient ratios, vitamins, minerals, fiber/protein, lipids, phytochemicals, additives, and processing. Foods with a higher Food Compass Score are associated with more favorable Body Mass Index, blood pressures, lipid profiles, and fasting blood glucose values as well as being associated with lower all-cause mortality rates. The validation studies were performed with a nationally representative sample of nearly 48,000 adults aged 20-85 in the US.

As you may guess, whole foods get higher scores, where heavily processed or additive-laden options get lower scores. Consumers are encouraged to use the app to scan similar foods and compare them. One of the use cases mentioned on the app’s website is comparing two loaves of bread to see which one has a higher Nutrition Value. The Eco Value looks at a food’s relative level of environmental friendliness, with a nod to climate, land, and water impacts. Foods with an Eco Value of more than 50 are more associated with a sustainable food system. While reading the website, I was surprised to learn that some foods that are conventionally thought of as healthy are actually less great for the environment due to water and climate impacts.

According to the website, parent company Opsis Health has more cool tools on the horizon, including the ability to take a picture of a plateful of food and have it converted to detailed nutrient information. That’s going to be a lot more accessible to most people than weighing or measuring food, which is often the first step in trying to take control of your eating habits. We’ve had so much portion inflation in the US that people often have no idea what a realistic serving of anything is any more. (I had to guess the weight of the amazing bone-in pork chop I had in Chicago, so I’m among the masses who might benefit from this innovation.) Turning your phone into essentially what is a 3D food scanner sounds a lot cooler than logging things into Nutritionix or MyFitnessPal or any of the other tools that are out there.

In learning more about Plateful and the company, I liked the website’s clean look and bright colors, and the amazing food photos as well. I also liked the fact that I had to dig pretty deep before I saw mention of AI as being part of the upcoming solution. It seems like many other companies are entirely in-your-face with AI-this and AI-that, so it was refreshing to find that it’s part of the solution but they’re not leading with it. I’m looking forward to following them over the coming months to see how the solution evolves and will definitely have fun doing some food comparisons in the coming months.

For the chocoholics out there who may be wondering, my go-to “survival chocolate” vendors were pretty much neck and neck, with the Hu Kitchen Salty Dark Chocolate (vegan, paleo) leading with a slightly higher Nutrition Value while the Ghirardelli Intense Dark Sea Salt Almond squares squeaked by with a higher Eco Value. I give them both five stars for their mental health boosting properties, so it would be a toss-up to choose one over the other. As the Plateful website says, “Lower NV foods, eaten on occasion, can fit into a healthy eating pattern if the majority of foods you eat over time are nutritious.” Sometimes you just need a little bit of dark chocolate to get you through the day.

It would be interesting to learn about the business model for the coming solution and whether it will be presented as a consumer-driven offering or whether it will be made available as part of an employee benefits plan or as part of a payer-based offering. The latter two would be smart as potential enhancements to reduce overall healthcare costs. I don’t have a frame of reference for what kind of databases are out there to create the library of UPC codes, PLU codes, and nutritional values, let alone what the R&D lift looks like for the “scan your plate” app that will be coming. I always enjoy learning about something that’s not in my usual lanes of EHR, HIE, and patient portal, so learning about this was a welcome diversion. Knowing that it may be able to help patients with healthy food choices, which is one of the solutions to healthcare crisis of our times, was a bonus.

Is your organization doing anything to promote nutrition education or healthy eating? Leave a comment or email me.

Email Dr. Jayne.

From HIMSS with Dr. Jayne 4/20/23

Wednesday opened with me feeling a little draggy, which wasn’t surprising since my trusty Garmin watch revealed that I had walked more than 13 miles the day before. Looking through my past HIMSS activity histories, that’s about par for an opening day and it wasn’t anything a couple of ibuprofen couldn’t resolve.

A change in the weather and my meeting plans led me to take the shuttle from the hotel to McCormick Place. It was a quick trip down Michigan Avenue, but a long and winding trip around the underbelly of the convention center as the bus reached its unloading area at Gate 20-something. I ignored the signage and just picked a random escalator that popped me up in the middle of the exhibit hall, which was much better than the “up down and all around” journey from yesterday.

I started the day with some casual meetings, both with former colleagues who are in various places in the industry, but whose spheres overlap my current one. Topics were far ranging and included rural health, clinical terminology, regulatory issues, and suggestions for good books to read. We’re all doing our best to keep up with what’s going on in healthcare and how it applies to our individual IT roles, but it’s daunting.

Still, it was good to catch up and get some advice from seasoned professionals that I trust. I’m also helping with some matchmaking magic, trying to introduce clinical informatics friends looking for work to vendor friends who might benefit from their knowledge.

From there, it was on to the exhibit hall, where the Ellkay team wins the “friendliest” title for the day by having people actually say good morning to those walking past.

I found the Puppy Park in the North exhibit hall. It was populated by some energetic doggos. The people playing with them all seemed to be having a good time.

Less exciting was the grime next to one of the pillars in the South exhibit hall, which was quite visible due to the lack of carpet. I was also annoyed by the large blue open-topped bins in the hall that were marked “recycle” but had no specialized drop slots for cans, paper, etc. which led to them being used as all-purpose trash cans. The only designated recycling bins that I could find that were being used as designed were in the lobbies by the escalators or over in the West building.

I was amazed to capture the bright shoes and even brighter suit all in one photo.

I had lunch at the CXO experience lounge in the West building, meeting some new CIO friends and learning about the projects their organizations are working on. The lounge was hopping and seating was at a premium – they definitely could have a larger area next year and still fill it. Top themes include chronic disease management, avoiding ransomware attacks, trying to meet behavioral health needs, and updating their telehealth strategies pending the end of the public health emergency declaration.

From there it was off to my annual booth crawl with Nordic Consulting’s Chief Medical Officer Dr. Craig Joseph. We checked out the art at the Epic booth then started combing the aisles for things that were interesting or at least eye-catching. We noted only two multi-story booths this year. Nuance’s double-decker featured a theater complete with people waiting in line to get in. Pure Storage also had a two-level booth, but we missed their bourbon tasting.

From there, we headed to the Edifecs booth to check on the progress of their #WhatIRun message wall. It was filling up with messages of what attendees run at home and in their work lives. I give full credit to the person running their son’s den meetings. As someone who has spent a bit of time in the scouting world, I know how much work that can be. Mentions of the #WhatIRun hashtag trigger donations to BrightPink.org which is an advocacy organization for breast and ovarian cancer.

When hanging out with Craig Joseph, you never know where the conversation might go. Topics included adventures in specialty pharmacy, patient education solutions (triggered by a stop by the Healthwise booth to look at their new Healthwise Advise offering), the Mastodon social network, and more. We definitely went down the social media rabbit hole, and I introduced him to networking resources for the physician mom interested in casual (or not so casual) doomsday prepping – talk about your niche audience. We decided that in the event of a zombie apocalypse we would barter our physician skills for survival, so perhaps it’s time to practice our laceration repair and minor surgery skills.

After dropping him off at his booth, I needed a little rest and found a mysteriously large area in the South exhibit hall that had grass-colored carpeting and park benches. It seemed like an odd use of real estate in a high-traffic part of an exhibit hall that otherwise had inadequate seating areas. It made me wonder if a vendor had backed out and they were trying to fill the space, but I was grateful for a place to sit for a few minutes and find the last remaining ibuprofen at the bottom of my conference bag.

Matthew Holt and the team at First Databank sent their submission for best shoes.

Unfortunately for them, however, IMO dominated again with this submission, earning the company the “best all-around footwear of HIMSS23” championship title. I’m glad so many people have joined the challenge to find the best HIMSS shoes and receiving your pictures definitely puts a smile on my face. After two full days of exhibit hall adventures plus miles of walking on Monday, I’m ready to put my feet up, then pack my suitcase and get ready to head home.

If you’re at HIMSS, what has your favorite part of the conference been? Leave a comment or email me.

Email Dr. Jayne.

From HIMSS with Dr. Jayne 4/19/23

Tuesday was a strong first day for the exhibit hall at HIMSS, and for the first time in a couple of years, I found myself wishing I had more time planned for the exhibit hall.

Today I had quite a few sessions and meetings on my dance card, with very little time to visit vendors. That means I have to cram it all in tomorrow since I’m leaving on Thursday. Even going back to pre-pandemic HIMSS meetings, the exhibit hall had been feeling a little lackluster, and then last year it felt like the conference was struggling to recover from COVID. I have some key things I need to get home for, so I decided to just do two days at HIMSS, but now I’m having some buyer’s remorse.

On the other hand, now that I think things through, it’s likely my first-day enthusiasm talking. By Thursday, it’s likely that the exhibit hall will have lost a lot of its energy, so we’ll have to see how tomorrow shapes up. I’ve got a couple of booth crawls planned for tomorrow that I’m really looking forward to.

Today was a strong day for shoe sightings, with Intelligent Medical Objects (IMO) bringing its absolute A game. Do note their contrast against the bare concrete floor, which was a prominent feature of the exhibit hall this year. Only the main aisles were carpeted, with the smaller aisles being left bare. That created not only tired feet, but trip hazards with the transition to the carpeting in the booths and with exposed service panels in the floors. One of my companions tripped over a taped-down wire that would have otherwise been under carpet and had to get ice for her ankle.

Stories on the reasoning behind the lack of carpet ranged from “wanting the exhibit hall to be more green” to “not wanting to pay the setup crews overtime.” Regardless, it created not only an aesthetically unpleasing environment, but also a dangerous one in places. I hope HIMSS rethinks its flooring decisions prior to the next iteration of the conference. I spent some time looking at the IMO Studio offering, and in particular their value set authoring tool, and I’m looking forward to being able to use some of the tools.

Edifecs brought back their #WhatIRun theme, but this year added some Dolly Parton to the mix. I wholly endorse their message. Life’s too short to be walking down the wrong road, for sure. From there I caught up with some friends at First Databank and then swung over to the Epic booth, which feels a little smaller than in past years, but it was still packed. Even dropping by later in the day it remained full, so I’ll try to say hi to my friends there tomorrow.

I attended a HIMSS corporate focus group today. Although I really enjoyed the discussion, the setup of the room was less than ideal, with rows of seats behind the main U-shaped table that led to awkward turning around by those who were seated in front of the extra rows. There were plenty of open seats at the table, so I wish the facilitator had asked those in the seats to move up with the rest of us, but it was a missed opportunity. There was also a loud conversation going on in the service corridor behind the focus group room and it was quite distracting.

The focus group included a box lunch with a salad option, which was much appreciated since finding decent food choices at HIMSS is often a challenge. I’ve been to a number of HIMSS focus groups over the years and this one was located deep within the bowels of the convention center, in an area of Level 1 that I could only find by going up two escalators, across the building, and back down to Level 1. Little did I know that I’d have to make that trek again at the end of the day when I decided the bus was a better option back to my hotel than my tired feet.

A cooler full of free beer in the middle of the morning is always an attention getter.

My favorite women’s shoes of the day were cute and springy yet comfortable. I think they were described as “like walking on clouds,” which is always appreciated on a day when you might be walking more than a couple of miles.

The “Most Engaging Booth Staff” award of the day goes to Relatient, whose staff was not only friendly, but quickly figured out which of their solutions might be useful to a CMIO and doubled down on it to gather my interest. Kudos to the rep who explained the complexities of orthopedic surgery scheduling decision trees like a pro. I also liked the texture of their mossy green backdrop, which was a nice counterpoint to the previously mentioned bare concrete throughout the exhibit hall.

After a brief nap on the bus back to my hotel, I put my feet up for a few minutes then was off to a regional dinner at a legendary steakhouse. The bone-in pork chop did not disappoint, and I met some new friends and had great conversations, which is what HIMSS is really all about. I’m looking forward to a big day tomorrow, starting with a walking meeting in Grant Park. The weather is looking promising, and I plan to meet up with a couple of my vendors, so it should be a good day.

Email Dr. Jayne.

From HIMSS with Dr. Jayne 4/18/23

It was a slow start at HIMSS on Monday. I attended a couple of conference calls for my day job and got a little work done in the morning. I waited by my designated shuttle stop and never saw a bus, so decided to take the multi-mile walk from my hotel to the convention center.

Although it was a little breezy, it was definitely good to be out and moving. I had planned ahead and had a headband to control my hair and keep my ears warm, so that was a plus. Not to mention that I know I’ll be well off script this week with my eating habits, so getting ahead with some exercise was likely a good plan. The sidewalks were dry and the snow flurries were actually kind of pretty. Had I taken the shuttle, I would have missed this interesting art installation with headless forms that was on the north side of Michigan Avenue.

With my early afternoon arrival, there was virtually no line at the badge pickup station I found. Apparently, there are several throughout the complex, and it felt like every time I turned around, I was running into one. The conference bag was standard issue, blue this year, but I took a pass since I brought my usual trusty tote. The only other giveaway was a pen.

I scored a notebook at the Slack “scan your badge and win a prize” kiosk that was also dispensing PopSockets and other trinkets. It was nearly empty by the time I stopped by. Hopefully, they will restock it for future arrivals. Being at McCormick Place felt strange and unfamiliar. I was struggling to remember the last HIMSS conference I attended here. It feels like there’s been a bit of construction since the last one, or maybe my post-pandemic memory just isn’t what it once was.

I had an unexpected encounter with an old friend that led to a long discussion of hobbies and life outside of work, which was refreshing indeed. I clued him into a niche business that I’m working with that has quite a backstory and which provides an interesting case study for entrepreneurs being in the right place at the right time. Following that, I had a pre-scheduled meeting and used the CXO Networking Lounge in the West building. It was nice to have a space where I could plan a meeting and know that there would be chairs rather than wandering in search of seats like I’ve had to do at other conferences. The Lounge was nearly empty, but I suspect it will be hopping later in the week.

My plan for the week includes attending multiple sessions, chatting with a number of vendors and organizations that I’d like to do business with, and looking for new solutions that will inspire or delight me while also bringing value to the patients I serve. Normally I try to attend a number of social events, but this year, I’m opting for quality over quantity, planning some deep catch-ups with colleagues and some regional HIMSS events.

The opening reception actually kicked off a little early, which was good given the crowds massing outside the doors. The entryway featured a garden theme with women whose heads were obscured by large balls of flowers. Once you made it past that, a woman was riding some kind of “wine cycle” that had glasses in the umbrella area and had an automated pouring mechanism that tipped the bottle. It was gimmicky, and I’m not sure how it fit into the theme or if it was meant to just be attention-grabbing. It also featured an apparatus on the back that looked like a gramophone trumpet full of flowers, so I’m still trying to figure it all out. I ran into half a dozen old friends who also couldn’t quite sort it out, so if you know more about the wine cycle, please let us know.

My time at the reception was truncated by an urgent phone call, but not before I spotted my first pair of pink socks for the event and also some sparkly sneakers. Once I had everything squared away with the call, it was time to head out for my dinner reservation at Girl and the Goat. One of my local BFFs had scored us a reservation there on short notice, which turned out to be a chef’s table type experience as we were seated right in front of the pastry station, just adjacent to the wood-fired oven. The meal was amazing. The pretzel pull-apart bread taught me that I needed more caramelized onion mustard jam in my life, and the chickpea fritters did not disappoint. The sauteed green beans were divine and the staff surprised us with a complimentary order of goat empanadas. Being able to sit right at the pass was amazing and it was clear that the staff took pride in their work and enjoyed interacting with customers.

From there it was a quick Uber back to my hotel to rest up for what tomorrow brings including keynotes, meetings, panels, and of course the exhibit hall.

Email Dr. Jayne.

From HIMSS with Dr. Jayne 4/17/23

I’m on my way to HIMSS after an eventful weekend. Saturday evening was to be a gala in celebration of the 50th anniversary of the program where I completed my residency training. The planning committee has been working for months to make it a bit of a reunion, a bit of a commemoration, and a celebration, not only of the past, but of what is yet to come. It was time to dust off the little black dress, slip into some heels that were a little more comfortable than what I wore when I was a young resident, and dance the night away.

Unfortunately, the weather was less than cooperative, with severe thunderstorm warnings giving way to a tornado watch and finally a tornado warning. We were in the middle of cocktail hour in the special events annex of a local museum when the sirens went off and they asked everyone to move to the designated storm shelter areas. Being asked to choose between the kitchen area and the ladies’ room, I opted for the latter since I knew it would be less hot and humid than the kitchen.

It was a time to experience a whole new level of networking, as we leaned on the cool porcelain tile and talked about how we were affiliated with the residency program. Several attendees were current program staffers and enjoyed hearing the stories my date and I told about our time as residents. Back in the day, the hospital had on-campus housing ,which created an environment that was significantly different than programs where everyone lived away from the hospital. The more recent graduates were interested to learn what it was like before work hours limits and mandatory vacation days.

Our “shelter in place” time also led to my spotting the best shoes of the night, which were a pair of glittering Tretorn sneakers. Knowing I was headed for HIMSS in the morning, they made me seriously question my footwear choices. I hadn’t packed anything quite as memorable as those, so I’m definitely going to have to start upping my game.

After nearly an hour, the weather was downgraded to a severe thunderstorm, and we were allowed to finally make our way to the cocktails and appetizers. We ended up at a table with two members of the class of 1985, who had even wilder campus housing stories than we did, including an episode where one of them rented a hot tub and had it delivered to the hospital’s parking lot for an evening of debauchery. One of them is in a private practice locally and the other is at an academic medical center on the West Coast, but they were both eager to learn about clinical informatics.

After dinner, it was time for some speeches and recognition. My class was recognized due to its distinction as the first all-woman class in the program’s history, which has not been repeated until recently when the class of 2025 entered training. We learned that the 300-plus graduates of our program are actively practicing in more than half the states in the US, and that since its inception, our residency program clinic has treated over one million patients. It was a good night to see old friends and to remind ourselves that we’re part of a legacy of people who went into medicine for all the right reasons, and to recommit ourselves to doing the best for our patients each and every day.

By the time the dancing wound down, and a couple of younger physicians learned from us “seasoned’ ladies that it’s perfectly acceptable to bring your dancing slippers in a tote bag for the later parts of the evening, the rain had stopped. The organizers had thoughtfully commandeered some golf carts to take us back to the parking lot, so we were able to avoid the puddles. I headed home, eager to get a good night’s rest before heading to chilly Chicago. The weather for this week’s HIMSS conference certainly isn’t the lovely Chicago spring that many of us had expected, and I swapped out my cute spring jacket for the more practical ski-ready puffer.

My flight was a bit of a roller coaster, so I was glad to make it to the city in one piece. It was followed by a baggage jam at Midway that led to an hour’s delay in getting my luggage. Normally I wouldn’t check a bag, but I had a special situation this time which required it. Delays always leave me questioning my life choices, but everyone in the baggage area was friendly and there was a sense of camaraderie since we truly were all in it together.

My taxi driver spent most of the trip cautioning me about my personal safety given some recent violence that occurred downtown. While I appreciated his caution, I didn’t appreciate his bait-and-switch at the end of my trip by trying to have me swipe my credit card through his personal Square reader.

Upon arriving at my hotel, I discovered that it still has limited food service and no room service options, so knowing that I have some back-to-back calls in the morning, I made a quick Target run. It’s always entertaining to see people who have never seen a store that has a cart escalator. They are amazed watching the shopping carts go up and down. Fully stocked with Diet Dr. Pepper and snacks, it was back to the room to do some work before an evening out with friends.

The weather in the morning is supposed to be dicey and I haven’t figured out the HIMSS shuttle schedule yet, so it should be an adventure. At check-in, my hotel didn’t seem to recognize that my reservation was part of the HIMSS block, and the agent said they didn’t have any information on the shuttle schedule. I was able to find one on the HIMSS website, but it looks like it was part of a welcome packet from January, so who knows. My original plan was to walk to McCormick place since the mileage to and from my hotel is similar to what I walk at home on a daily basis, but the forecast has changed that. We’ll just have to see what things look like in the morning. HIMSS has been characteristically quiet on the forecast attendee counts, so there’s no way to know what the morning migration will look like.

Are you at HIMSS, and if so, are you looking forward to it? What’s your goal for the meeting? Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 4/13/23

From the “it’s always good to double check your work” file. A general practitioner’s practice in the UK mistakenly sends text messages related to a diagnosis of aggressive metastatic lung cancer instead of the planned holiday greeting. The practice, or “surgery” in NHS terms, has 8,000 patients who may have received the message. A corrective message was sent about an hour later, but there’s no way to know how much agony the original message caused. As expected, the practice was then slammed with phone calls and patients were unable to get through. In a past life, I was responsible for putting together population health campaigns that were broadcast to large segments of our health system’s population, and you can bet we had a “two sets of eyes” policy on everything that went out to large cohorts of patients.

Earlier this week, I had the opportunity to attend a presentation given by colleagues at the local academic medical center. Unfortunately, the presentation was marred by blatant sexism. It was a panel discussion, and the moderator habitually referred to the male members of the panel as “Dr. Surname” while referring to the female member of the panel by her first name. All three of the panelists were fully introduced, including their credentials as medical doctors and professors at the institution, so it’s not like there was any confusion about her status as a physician.

Even if she had asked to be called by her first name, which she assured me she didn’t, the thing that made it worse was that neither of the male panelists tried to rectify the situation. When referring to their colleague, it would have been easy for them to refer to her as Dr. Jones to make it clear to the moderator that his address was not appropriate, but instead they joined in. There are numerous published studies about the fact that women physicians are more likely to be addressed by their first names rather than being addressed as Doctor. It was sad to see this at what was supposed to be a progressive institution. Had there been a continuing education evaluation form, I would have commented, but unfortunately there wasn’t.

From a travel standpoint, except for the impacts of COVID, I’ve been a road warrior for more than a decade. This week I had one of the worst travel-related days in recent memory, and none of it had anything to do with the airlines, flight delays, or weather. The first issue involved a parent who insisted on lifting her stroller (including the accompanying strapped-in toddler) onto the parking shuttle rather than folding the stroller and carrying on the toddler. She was snapping at the shuttle attendant  — who in my opinion shouldn’t be responsible for loading a human — and demanding help while not even using two hands to load her child because her other hand was tied up with not only her phone, but also a Starbucks cup. She also snapped at other customers who tried to help, so it wasn’t a good opportunity to fulfill the slogan to do a good turn daily. I know that for some people coffee is life, but it felt like there may have been some misplaced priorities. Ultimately the driver was frazzled, which is never good.

Once I made it through the blissfully quick security checkpoint and arrived at the gate, I ended up in the boarding line in front of a woman who was facilitating a video-enabled conference call on her phone. Other passengers were trying to talk to her to figure out boarding positions and she was ignoring them. Of course, when it came time for her to scan her boarding pass, she was still on the call, and plenty of fumbling ensued. Props to the gate agent who sidelined her and let others through while she tried to get her act together. That’s always preferred to letting one person hold up the whole line.

We also had issues on the plane with passengers failing to follow crew member instructions, with infractions ranging to baggage issues to one gent sitting in the exit row who insisted on trying to lay out his jacket in the overhead bin on a full flight, refused to close his laptop, refused to properly stow it, and then became sassy when asked to fasten his seat belt. I was across the aisle from him just hoping it wasn’t going to turn into an incident where they would have to call security onboard to forcibly deplane him. Eventually he got with the program, but not without causing delays. The flight crew did a good job with service recovery, however, and I enjoyed my complimentary premium beverage, but it was just so unnecessary for him to act that way.

Due to an availability issue, I wasn’t able to use my usual rental car agency and ended up going through Costco Travel to book with Budget, so I wasn’t familiar with the processes at my destination. After waiting in line at the rental counter as instructed by the email I received, I was told, “You have Fastbreak and you’re in the wrong place” and was redirected outside. I was assisted there by a lovely agent who was in training, only to have her supervisor stop her in the middle of processing my rental and tell her to give me a different car from Avis, which is also owned by Avis Budget Group. When I got to the Avis lot, the neighboring vehicle was parked so close that I couldn’t get into it, and neither could the rep when I went back to the counter for help. They had to move two cars to liberate my assigned vehicle. Note to the folks parking cars – if it’s so tight that you have to fold the mirrors in so the cars don’t hit, it’s probably too close for a person to get in the car.

The next annoyance was a badly striped and signed parking lot, where following the exit sign and arrows led me to a dead end and a multi-point turn to get back on track. I mentioned it to the agent at the exit gate, who admitted, “Yeah, we changed that a while ago, we should probably change those signs.” Yes, indeed. He then asked me to show my license for the fourth time in 10 minutes, and finally I was on my way. The rest of the trip included wild drivers, erratic speeds, and the usual highway fun.

I finally made it to my hotel, where I was greeted with a digital key that didn’t work. I went to the desk and got a new key, which was handed over just by saying my room number and without providing ID, which is a safety concern. From there, I went back up to my room, only to find someone in it with the door propped open. It turned out to be the housekeeper, who just let me walk in without unlocking the door or proving it was actually my room. Not the safest feeling, but by this point I was in full “it is what it is” mode and just wanted to get settled so I could attend some conference calls. That’s what multiple layers of security locks are for, I guess.

They say travel is broadening, and I generally enjoy it. Still, let’s hope for less eventful transit next week as I head to Chicago for HIMSS.

What are your wildest stories from recent travel? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 4/10/23

I was dismayed to see an announcement over the weekend that Pear Therapeutics has filed for Chapter 11 bankruptcy protection and has drastically scaled back its operations. The part of this story that isn’t obvious to many is that for some patients, prescription digital therapeutics may be a major part of their opioid treatment care plan. The Pear Therapeutics website notes that it is no longer accepting new prescriptions for its three major products, nor will refills be dispensed. They “will attempt to keep our products available for patients who are already using the products for the duration of the current fill of their prescription, but there can be no assurance that we will be able to do so.”

The company is seeking a sale of the business or assets, but who knows how this will unfold? Prescription digital therapeutics has been a promising technology and the ReSET product from Pear Therapeutics was the first approved by the US Food and Drug Administration. I hope this isn’t the beginning of the end for this type of treatment option.

The team at KRIS 6 news in Corpus Christi reports that a Texas teen posed as a physician assistant at two hospitals for nearly a month. The impersonator showed up in Corpus Christi Medical Center’s Bay Area Hospital wearing newly purchased scrubs and asked for a badge, stating that he was a traveling physician assistant. A volunteer coordinator who was covering the human resources office while its staff was out of the office made him a badge. The suspect began to interact with staff, not only at that facility, but also at Doctors Regional Hospital. After he was found loitering in an intensive care unit and talking about topics that seemed unusual, staff became suspicious. He told staff that he was a student at Stevens College in Missouri, which is a women’s college, raising concerns. Nurses found the suspect’s social media accounts, identified him as an impostor, and had him escorted from the facility.

A hospital spokesperson noted that the suspect didn’t interact with patients and that they were assisting in the law enforcement investigation. However, records show that his badge was used to access the emergency department, intensive care unit, operating rooms, cardiac catheterization lab, and the newborn nursery. Badge records show that tried to access several other areas without success, including the operating room’s locker room and the physician parking area. Investigators noted that the suspect also has bank fraud charges against him in Missouri. A search of his room at a local hotel uncovered a homemade firearm, a bulletproof vest, ammunition, firearms-related accessories, and a shirt with “sheriff” printed on it, raising suspicions that he was planning to impersonate a law enforcement officer. He was also found to have been driving a Crown Victoria police interceptor with accessories that are consistent with a law enforcement vehicle. They also determined that he tried to obtain a badge at Driscoll Children’s Hospital, but was unable to do so.

Following arrest, the suspect was released on bond then arrested shortly thereafter, having violated his GPS tracking system limitations nearly 200 times. He entered a guilty plea to multiple third-degree felonies and was sentenced in such a way that his conviction will be removed from his record after six years, as long as he completes requirements such as completing a GED or a high school diploma, maintaining a required curfew, and meeting with a community supervision officer. He immediately violated the terms of his sentencing agreement by leaving the state.

This story definitely falls under the category of “you can’t make this up,” but it’s shocking that he was able to obtain an ID badge in the first place. The volunteer who started the ID process was terminated from the hospital, even after notifying her supervisors of the strange situation the same day it happened. She was quoted as saying that the hospital “basically beat it into our heads that we needed to be all about customer service” and that’s why she started the process. Maybe having this story circulate will motivate facilities to check their processes and make sure their policies are a little tighter than those at the facility in question.

The last thing that caught my attention this weekend (during a major attempt at cleaning up my inbox) was a research article in JAMA that looked at the “Association Between Drug Characteristics and Manufacturer Spending on Direct-to-Consumer Advertising.” My understanding is that the US is one of a few countries that allow drug manufacturers to advertise prescription-only products to patients. (It might be one of two, with New Zealand being the other, but I’m running into some conflicting data.) The authors looked at 150 prescription drugs with the highest US sales in 2020 and found that drugs with lower clinical benefit received a higher portion of promotional spending.

As a practicing physician, I spend entirely too much of my time explaining to patients that although I appreciate the idea of “ask your doctor if this medication is right for you,” either the medication in question isn’t indicated for any of the conditions with which they have been diagnosed or that there are a number of inexpensive generic medications that have been proven to treat a condition just as well or better than the drug being advertised. It’s usually not a quick conversation, and ultimately saying no has a negative effect on patient satisfaction scores, but it’s the right thing to do.

Direct-to-consumer (DTC) advertising of prescription drugs didn’t start in the US until the mid-1980s. In speaking to colleagues, I haven’t yet found anyone who thinks that the practice has been shown to deliver better outcomes for patients. For those of us trying to deliver high-quality care and being faced with EHR alerts telling us to go with better options that are well proven for our patients, it’s one more frustration that contributes to burnout. It’s a major dissatisfier for physicians, but money talks, so I don’t see the practice being changed any time soon. I’d personally love to see all the money that is being dumped into DTC be diverted into health literacy and patient education instead, but that’s definitely a fever dream.

Since we’re in the healthcare IT news doldrums in the run up to HIMSS, what articles or news stories caught your attention this week? Leave a comment or email me.

Email Dr. Jayne.