EPtalk by Dr. Jayne 7/1/21
Patient engagement is a hot topic. I’m glad to see organizations really starting to think through how patients of different ages, educational statuses, and technical abilities can interact in the digital health world. Organizations that think that everyone can just “use a smart phone” are likely missing out on a good percentage of the population that either doesn’t want to interact that way or who lack the skills (or confidence) to try. I was pleased to see a Kaiser Health News article covering the topic. It starts with a vignette of a person who bought a computer to email and Zoom with her great-grandchildren, but she ended up never taking it out of the box because of concerns around setup and lack of help.
The article cites some good data from AARP about the number of seniors needing help with technology. I’m far from senior status, but I admit that some new technologies leave me baffled, even as a clinical informaticist. Sometimes what 20-something UX designers feel is intuitive isn’t so easy to use for those who don’t share a common digital experience. Also, depending on people’s learning styles there are many of us who prefer to read a manual or follow a tutorial as opposed to just experimenting around with something and hoping for the best. I am being forced by my wireless carrier to upgrade my phone (despite the fact that it works well for me and does everything I need it to do) and am honestly dreading the process. It’s supposed to be seamless but never is, at least in my experience. I have until February to get it done though, so wish me luck.
For those patients who are tech savvy and want to interact through text messaging or video calls, a recent study looked at those modalities for case-managed patients living with HIV. The sample size was small, but both patients and providers were in agreement that text and video interaction was desirable. Convenience was a positive, but cost and access were potential barriers to adoption. As one might expect, “some providers were concerned that offering text messaging could lead to unreasonable expectations of instant access and increased workload.” The authors concluded that overall, both patients and providers found value in expanded lines of communication, however, “taking both perspectives into account when using implementation frameworks is critical for expanding mobile health-based communication, especially as implementation requires active participation from providers and patients.”
Speaking of telehealth, the state of Florida’s executive order declaring a public health emergency expired on June 26, decreasing telehealth flexibility for Florida residents. Phone-only visits are no longer acceptable for delivering services to non-Medicare patients, physicians can’t use telehealth to prescribe controlled substances to existing patients for chronic non-cancer pain, and telehealth can’t be used to recertify patients for medical marijuana. Additionally, out-of-state physician and nurses can no longer treat Florida residents without a specific Florida license, which they’ve been able to do for the majority of the COVID-19 pandemic. As of July 1, Medicaid behavioral health services will be limited in frequency and duration, and by July 15, prior authorization requirements for those services will go back into effect.
Parts of my state are being hammered by continued COVID-19 outbreaks and hospitals are again stressed, but I guess things are just fine in Florida. They might be an outlier, though, because The Commonwealth Fund notes that 22 states have changed their laws or policies during the pandemic to increase coverage of telehealth services. There are a variety of changes that states have made, including coverage of audio-only services (18 states added this for the first time, for a total of 21) and 10 states created payment parity policies. The report concludes that not all patients have benefitted from telehealth, with usage being lower in economically disadvantaged areas and by patients with limited English proficiency.
The fragmentation of care from state to state will continue as long as we don’t have a national health policy or robust public health infrastructure, and I’m not sure that Congress will have the wherewithal to address the inconsistencies. Time will tell whether telehealth really bends the cost curve or whether it can lead to improved clinical outcomes, but we won’t be able to measure those potential changes unless we commit the funding to study them. Based on some of the behaviors I’ve seen over the last couple of weeks, people think we are completely out of the woods with the pandemic, and I’m not convinced that public health efforts will continue to have the visibility or the funding that they deserve.
A recent study by my friends at Regenstrief Institute, Indiana University, and the US Department of Veterans Affairs shows that EHRs are failing to deliver on their promise for improved primary care. Ambulatory physicians are struggling to make sense of fragmented data that fails to show a comprehensive view of the patient. The authors reviewed numerous studies that describe misaligned EHR workflows, usability issues, and fragmented communication that make it difficult for physicians to achieve situational awareness. They conclude that more user-centric design processes could improve the situational awareness, satisfaction, and decision-making capabilities of primary care physicians.
HIMSS has announced more details related to its COVID-19 vaccination requirements. Participants will have to complete a two-step validation process prior to picking up their badges. Step One involves obtaining Clear Health Pass Validation, Safe Expo Vaccine Concierge Validation, or Safe Expo On-Site Validation. Step Two involves bring proof of one of those validation options, along with a photo ID, to the registration area for badge pickup. HIMSS notes that links to the Clear and Safe Expo validation options will be provided in early July. Given that many of us in healthcare have hastily scrawled and often handwritten vaccination cards, I’m not sure how this is going to go. If you’ve been through either of the validation processes, I’d be interested to hear about your experiences.
Regarding masking, the HIMSS21 guidance states: “Masks will be supported but not required on the HIMSS21 campus.” Every year I come home from HIMSS with a nasty cold, which COVID-19 vaccination will not prevent. Based on the fact that there are plenty of non-COVID viruses circulating freely in the population due to reduced masking and increased mingling, I’ll definitely be wearing a medical grade mask, possibly with something decorative over the top.
Should fancy masks be the new fancy shoes at HIMSS? Leave a comment or email me.
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The poem: Well, it's not it's not the usual doggerel you see with this sort of thing. It's a quatrain…