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.

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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.

EPtalk by Dr. Jayne 4/6/23

As a clinical informaticist who has been around the block more than a couple of times, I know I have more knowledge than the average physician about how EHRs work. As an informaticist who has spent the majority of her career working with large health systems and healthcare delivery organizations, I also have a good knowledge base for all the ways organizations can be set up and how they manage their relationships with physicians in their communities and in affiliated academic institutions.

I’m a member of a couple of groups on social media that help physicians navigate issues with their EHRs. I enjoy helping people find solutions for their issues or at least helping them figure out who in their organization to approach for help. It’s kind of my way of giving back, since I didn’t have a lot of help when I started out in the EHR world and I remember how helpless I felt.

A number of large organizations have extended their EHRs to community partners, and nationwide organizations provide hosted versions of various EHRs to smaller practices. I’m working with someone who just joined a two-physician practice that is on one of these hosted systems, but has no idea how to get help. Part of the problem is that she joined an existing practice that expects her to just take things on faith, even when they’re not working correctly (like when she hasn’t seen financial reports since the 2022 year-end close). The situation is complicated by the fact that the organization has given cutesy names to various EHR initiatives and modules that don’t actually align with the names given by the EHR vendor or standard terminology like “practice management system.”

For a while, none of us could figure out what EHR she was on until the group got her to send a screenshot of her login screen. She doesn’t have access to any vendor resources or education outside of what is offered through her partner health system’s learning management system, which she mistakenly thought was actually offered by the EHR vendor. The office manager is stonewalling, saying that the physicians aren’t allowed to talk to the EHR liaison. 

Although I understand trying to have a local support structure in place to keep physicians from calling about things that could be handled by their office managers or super users, there seems to be a huge disconnect. Most of the large healthcare delivery organizations I’ve worked with that have these kinds of community offerings also have a designated physician liaison to work with the community physicians and make sure their needs are met, and that doesn’t seem to be happening here.

I’m hoping that we can help her figure out ways to learn how to work more efficiently in the EHR as well as ways to work with her practice leadership to make sure they’re not just taking advantage of a new physician fresh out of training who doesn’t yet know the right questions to ask. Unfortunately, most residency training programs don’t include any kind of education in the business of managing a medical practice or in trying to manage colleagues or navigate the minefields of hospital medical staff politics, so I’m hoping we can at least help her a little.

I critique the emails that I get from vendors prior to conferences, but I have to give full credit to Merative for their appropriately themed email promoting Merge Imaging solutions. The subject line was “It’s 106 Miles to Chicago…” and the email opened with “It’s HIMSS… and we’re wearing sunglasses. Hit it!” The Blues Brothers were iconic during my formative years and the musical numbers from the film are some of my favorites. Chicago isn’t my favorite location for conferences, but I always love a good Blues Brothers throwback, so thanks to the team at Merative for making a tired CMIO smile at the end of a long day.

I recently had to change my phone number and the process has caused chaos with some of my online accounts and loyalty programs. I was interested to see that Panera Bread is testing Amazon’s biometric technology at its bakery-cafes, specifically with palm scanning. Customers can scan not only to link their orders to the loyalty program, but to pay for them as well. The technology is already being used at Whole Foods locations along with some sports venues. Although some people are skeptical of giving up their biometric data, using facial recognition to unlock phones is commonplace so it’s hard to argue against palm scanning. Panera is resting at two locations in St. Louis and plans to expand use to up to 20 sites over the next few months.

It’s not about healthcare IT, but all of us are patients at some point in our lives. From a patient perspective, this research article in JAMA Internal Medicine caught my eye. The authors look at more than 200 new drugs approved in the US from 2017 to 2020 and how they were approved (or not approved) in other countries. More than 20% of the drugs weren’t approved in Australia, Canada, or the UK “due to unfavorable benefit-to-risk profiles, uncertain clinical benefit, or unacceptably high price.” Unsurprisingly, the median cost for these medications in the US was more than $115K per patient per year, with some being over $230K per patient per year. As the old saying goes, follow the money.

One of my favorite CMIOs sent me this MIT Technology Review article about how to break the cycle of being hooked on our devices. The highlight reel — screen time isn’t always bad, and sometimes we just need to do some mindless surfing. However, understanding how engaging with the digital world is making us feel can be valuable. Setting boundaries around digital time can be helpful, and developing new things to do when bored can help break the cycle of digital dependence.

I’m a big fan of that last piece of advice. I’ve always been a big reader and usually carry a book if I’m just around town or my Kindle if I’m on a plane. I’m a member of a couple of book clubs that have forced me to read some things that are outside my usual comfort zone. I’ve enjoyed it, plus it’s a good way to force yourself to disconnect. I still have the guilty pleasure of doing the Wordle every morning, but I don’t think that’s going to be too many people’s downfall.

What’s your favorite online time waster? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 4/3/23

I was glad to flip the calendar to April this weekend. Travel, conferences, and a couple of big projects have had me hopping.

Other than going to HIMSS, I get to stay close to home this month. In addition to work responsibilities, I’ve had a couple of big projects at home and was able to put one of them to rest this weekend. Of course, there are always more things to work on, but it was a good feeling to know that it was done and I could move on to something else. Unfortunately, the project I picked up next turned into a bit of a mess. I was hoping to have it done before next weekend, so I’ll be working double time in the evenings to try to get it done.

To the positive, I discovered that the book I’ve been hustling to finish in time for tomorrow’s book club isn’t actually due until the following month, so that was an unexpected bonus. The book, “Demon Copperhead” by Barbara Kingsolver, is one of the most challenging books I’ve read in a long time. It’s fiction, but a big part of the plot revolves around the growth in high-volume prescribing of opioid pain killers and the resulting devastation across parts of the US. The book features a broad cast of characters – the pharmaceutical representative who assures physicians that the medications aren’t addictive to patients with legitimate pain, the well-meaning country doctor who prescribes liberally, the drug dealers who take advantage of patients who have become addicted, and the family members who have to cope with the aftermath.

It’s also a scathing portrayal of the foster care system and those who abuse not only the process, but also the children in their care. Those sections were difficult to read and I’m sure they would be triggering to many. It’s also the story of a child in crisis who grows up to be a teen who encounters crisis after crisis, and just when it looks like he’ll make it out the other side, tragedy strikes. As a physician who has cared for patients in some of the situations portrayed, I can’t imagine what it would be like to be confronted with so many and in rapid succession. Although I feel a sense of accomplishment at having finished the book, I’m not sure I would have read it if it hadn’t been chosen by my book club.

From a healthcare IT perspective, it’s always a slow news time in the lead-up to HIMSS. Companies save up their news to release it at the beginning of or right before the conference, when there is always the potential that it will get lost among other “big” news stories.

I don’t have a sense of how large HIMSS will be this year. The organization is notoriously quiet about discussing its projected attendance and I haven’t even heard any rumors this year. Last year’s event was a shadow of itself, and after attending some of the competing conferences, I understand how they are more attractive to attendees than the granddaddy. At least this year I haven’t seen HIMSS promoting its less-than-useful Accelerate platform in the lead-up to the conference. In fact, I’m not sure I’ve heard anything about Accelerate at all in the last year.

Last Thursday was National Doctors’ Day in the United States. It dates back 90 years to its first celebration in Winder, Georgia. Although the day was designed to recognize physicians for their work with their patients, their communities, and society, it happens on March 30 as a commemoration of the date in 1842 when Dr. Crawford W. Long used ether anesthetic for the first time. It became a national holiday in 1991.

This year seemed different for many of my physician colleagues, with little recognition even after the difficult years of hard service during the pandemic. One of my emergency department friends found it ironic that her hospital distributed the Doctors’ Day snacks via a lounge that the ED physicians were unable to access because they didn’t have the right permissions on their keycards. That contrasted mightily with the week of celebration that one of our mutual friends experienced, with breakfast on Monday, lunch on Tuesday and Wednesday, a dessert buffet on Thursday, and gift baskets of Girl Scout cookies on Friday.

As far as tangible gifts are concerned, it seems like most of the people that received something physical received an item with the hospital name or logo on it, including umbrellas, backpack coolers, and some less than thoughtful items like stress balls. One colleague posted a picture of the elegant wooden cutting board she received from her hospital, which given its 12×17 inch size, seems like an interesting choice. Other celebratory options included chair massages, gift cards, aromatherapy supplies, and the always popular visit by the therapy dogs. Several of the physicians I talked to said they planned to pass on some of the gifts to their staff members, who don’t often get recognition if they’re not nurses or other professionals with designated recognition days.

My hospital solicited patients to give financial gifts in honor of their care teams, while giving the actual physicians zero recognition, not even an email. I realize that I’m a community physician and not employed by the hospital, but I thought it was tacky that I received the solicitation email (I’m also a patient) but not any other kind of greeting. Several of my residency colleagues reported having a similar experience, although two eventually did receive emails but they arrived well after 3 p.m., making them seem like an afterthought.

I was surprised that I didn’t receive emails from some of the big hitters that should be celebrating physicians in the US, like the American Medical Association or even my own specialty societies. In an informal poll in one of my physician-only Facebook groups, less than 30% received any recognition at all. That’s surprising given the number of physicians who are thinking about cutting back or leaving the workforce.

The bottom line is that it’s not about the gifts or the meals or the puppy petting zones. For many physicians, it’s about feeling like their hospital administration appreciates them and the work that they do for patients. Each person in the hospital – whether they’re in engineering, housekeeping, food services, supply chain, pharmacy, or any of the numerous other roles – has a critical role in helping patients and it’s important to make sure that everyone feels like their organization appreciates them, especially after the struggles of the last three years.

What would make you feel like your organization appreciated you? Leave a comment or email me.

Email Dr. Jayne.

ViVE and CHIME Wrap Up with Dr. Jayne 3/30/23

It was another busy couple of days at the conference. I had the opportunity to walk the show floor with a couple of friends yesterday and today as well as to hit a couple more sessions.

Overall, I liked the conference better than HLTH. It wasn’t as in your face trying to be cool as HLTH, but it was well organized. The exhibitor booths are all formatted the same way, depending on size and a couple of other factors, and I found it made for a less-distracting trip around the show floor. It’s less glitzy than you see at HIMSS, but it felt like it was easier to visually scan a booth. A vendor I spoke to said they like the setup because it helps level the playing field and also makes it easier to get the booth up and running compared to all the packing and unpacking at some other shows.

I’m still not a huge fan of having sessions on the show floor, but understand how it came to be. None of the panels I attended were jaw-dropping, but I had low expectations and wasn’t disappointed.

I thought the food service was better at HLTH, especially the grab and go options. At ViVE, the meal lines seemed long regardless of when I tried to eat during the scheduled blocks. On Monday, I ended up at the CHIME member luncheon that was held upstairs. It was a quieter venue to have a solid conversation with one of my colleagues about some healthcare IT problems I’m trying to solve.

CHIME provided several other networking opportunities, but my favorite was the CHIME League of Women luncheon on Tuesday. The program’s theme was “Mentorship in Action” and included a mentor-mentee pair among the speakers. The comments of panelist Kris Nessa from Innovative Insights really resonated with me. Kris was talking about the community of CIOs and other execs that has come together through CHIME and how the relationships and support have helped lift a lot of people up and encourage the development of the next generation of healthcare IT executives.

It made me think about the early days of my career, when our health system’s CIO was intent on crushing the IT project I was working on because it was being led by the operations group with IT support as opposed to being run by IT. He made it clear that he didn’t think clinical people should be working on IT projects and seemed particularly hostile to the women on the team, despite the fact that we were going live with some bleeding edge technology that ended up being the subject of numerous conference presentations. Thinking back, it’s likely he viewed innovation as a threat.

I’ve never had a non-clinical mentor. The conversation made me wonder what my career might have been like if someone from the technology side had taken me under their wing. I hope that in the current phase of my career I can be helpful to those working their way up the ladder or trying to break out of a mold that they might not have chosen.

Dr. Nick van Terheyden @drnic1 and I stopped by the Health 2047 booth to ask what it was all about, since “helping early-stage startups transform bold ideas into healthy returns” sounds interesting. It’s actually an initiative of the American Medical Association, and the year is tied to the anniversary of the founding of the AMA rather than the timing of any bold initiative.

Nomi Health’s booth reps were engaging. In addition to sharing the local favorite Goo Goo Cluster candies, we had a great conversation about the design of their booth and some of their ideas for enhancing it. I admire the knowledge or marketing folks. There’s so much more to color, graphics, and flow than most people appreciate.

CoverMyMeds was sponsoring haircuts, blowouts, and makeup applications. If you timed it right, you could get all fancied up then head over to the DrFirst booth for a complimentary headshot.

Speaking of DrFirst, their team did not disappoint, with matching shirts. Apparently they had matching shoes earlier in the week, but I missed those.

The Best Shirt award definitely goes to Perx Health’s VP of marketing. I think he said it was from Australia, and he was a great sport to pose.

The costumes at Teletalk reminded me of HIMSS of yore, when lots of exhibitors tried to be as catchy as possible. The boots were nice also.

The Best Shoe/Sock Combo was found at the Intelligent Medical Objects (IMO) booth. They’re always a strong contender in this category, and I can’t wait to see what they have in store for HIMSS. Since it’s local to their home base, folks might not even have to be choosy when they pack.

Hyro’s Whac-A-Task booth was a hit. I’ll have to use this pic to explain to some of my younger colleagues who never had the pleasure of playing the original Whac-A-Mole game.

Saving the best for last, Liberty Solutions hosted a bourbon tasting at their booth. They were giving solid advice on the characteristics of the different options, which makes sense given the fact that they’re a consulting firm.

The closing bash was a concert with the Black Crowes at the Wildhorse Saloon, although I preferred the opening group Chapel Hart. They were clearly having fun with their performance. The entire event was sponsored by Clearsense. From where I was standing on the second floor, I could see the decibel meter and it was interesting to see how it got louder as the night progressed.

I ducked out early but not before spotting the ultimate bedazzled ViVE jacket. Everyone seemed to have a good time, although threading my way through the crowds on Broadway as I headed back to the hotel seemed more like a contact sport than a walk.

On Wednesday, I had a little more downtime than planned at the Nashville airport and was glad to take advantage of some of the local food offerings that were better than the generic fare you find at most airports. Although the airport is undergoing construction, it didn’t feel chaotic. I decided to walk off some of the southern hospitality I’ve experienced this week with a lap through all the concourses. At the end of the A gates where some of the more commuter-type carriers arrive, I spotted some workers looking out the windows and acting generally giddy with excitement. It turns out that a Boeing 777 aircraft was diverted in from Atlanta last night and they were watching it being moved on the tarmac. Several of them couldn’t get over how large it was (towering over the other planes) or that a small tug was pulling it around the airport. Sometimes you just run across things that make you smile and I was glad to be part of that moment.

I wrangled the email beast and played catch up on the plane and was glad to see that the FDA has cleared the opioid overdose reversal drug Narcan for over-the-counter sales. Overdoses are a major problem across the US and we’re seeing lots of accidental ingestions by children as well. Hopefully removing the prescription hurdle will make a difference for people. I had to provide the date of my last COVID booster on a form I was completing, so I popped into my patient portal to confirm the dates. I was surprised to see a recommendation to schedule a flu shot. The flu season is long over in most of the US and I’m also current with a vaccine documented in the portal. It also recommended that I schedule my mammogram, and I’m current on that as well.

Alert fatigue is real and applies to patients as well as clinicians, and inappropriate reminders just encourage people to click through without reading. I’ll have to ask my IT friends at that institution what they’re trying to solve for with those reminders, which weren’t there a couple of weeks ago.

What aggravates you the most about your patient experience in patient portals? Leave a comment or email me.

Email Dr. Jayne.

From ViVE and CHIME with Dr. Jayne 3/27/23

This week I’m in Nashville to experience the combined event that is CHIME and ViVE. I didn’t attend ViVE last year, but I heard stories about it, although Miami might have provided a different vibe than Nashville. 

Speaking of, it’s been some time since I’ve visited. Nashville has undergone some dramatic transformation in the last decade. The downtown Broadway-adjacent areas are chock full of party buses, pedal pubs, and bachelorette parties, at least on a Saturday night. Fortunately, I had a local guide for the evening, and after tapas downtown, we were able to avoid the tourist traps in favor of more interesting neighborhoods with plenty of local color.

It’s amazing to see all the new construction being interspersed with cute bungalows and historic features. It seems to work better in some areas than others, although the real estate prices are pretty high for things that are going to be torn down anyway. Germantown was a neighborhood that caught my eye and we’ll have to plan for extra time there on my next trip. Saturday night was also a quest for the best Old Fashioned cocktail, with the barrel-aged version at the Black Rabbit winning hands down.

Sunday kicked off with registration at the Music City Center. It was a low-key process with no lines. Swag was fairly standard, with a conference bag, water bottle, and mints, with an optional hat. Among the goodies in the bag was a reusable drinking straw from Lirio. I’m a huge fan of reusable straws at home, but I’ve never used them when traveling. If I decide to do so, the little carry bag is a plus.

Then it was back across the street to check in with the CHIME side of the conference, which was even more laid back. I was able to connect with a colleague over breakfast and also make some new friends, so that was a plus. Today was a day for CHIME Foundation members to host focus groups, and there was quite a bit of traffic for the offerings. My first experience with the focus groups was last fall. I found them to be a valuable way to hear about some of the challenges that other organizations are facing and how they’re dealing with addressing them. After hearing some of the stories told in the groups, you feel like you’re not alone.

I attended a couple of focus groups today, and although they were great for networking, the sessions themselves were a bit of a mixed bag as far as content. The attendee evaluation sheets are supposed to include stated goals for the focus groups. One group I attended didn’t seem to have stated goals and the presenter nearly lost control of the group. The discussion veered way off topic, but that conversation still delivered some learning. Namely, that if you get a bunch of CIOs, CTOs, and CMIOs in a room, you never know quite what you’re going to get.

Another group that I attended used an audience polling tool, not only to gather information, but to make sure the participants were engaged. I liked that strategy. Because of the way the polls were constructed, it was clear that they had spent time pre-session to determine what they were trying to achieve with it and how to get the information they wanted. The way the meeting rooms were positioned brought in lot of street noise that was occasionally distracting.

I managed to get out in the afternoon to enjoy the sunshine. I enjoy looking at historic buildings and downtown Nashville doesn’t disappoint. Plenty of buildings have interesting details and there are lots of historic markers around town that I didn’t see when I was out last night.

There are plenty of sassy shoes and boots out on the streets of Nashville, but I wasn’t able to capture pictures without seeming like a creeper. I didn’t have a wing woman with me at the time to act like she was posing for me while I surreptitiously captured a pic of the shoes in question. If you didn’t bring your own boots, there are several boot shops close to the convention center, so there is still time to pick up a souvenir. From there, it was back to the room to do a spot of email, and then on to the CHIME welcome reception.

The reception was hopping, although there was a bit of a check-in process for those of us who didn’t have the right symbol on our badges to indicate that we were CHIME members rather than just ViVE attendees looking to score some appetizers. The crowd was a veritable Who’s Who of healthcare IT, but it was so dark I couldn’t be on the lookout for shoes. The accessory of choice was apparently the light=up cowboy hat that came in black, blue, pink, white, or yellow. One attendee was even spotted wearing one of each color, which seemed excessive, but hey, when in Nashville, you do you.

The lights came on at 7 p.m.and they started moving people out, which coincided with the start of the ViVE opening reception proper. The event was packed. I ended up peeling off for a dinner date, but from the reports I received, I didn’t miss anything earth shaking. If you were there and have something different to report, please let me know.

Because I’m often blogging on the road, I travel with two devices to ensure that there are no questions about inappropriate use of my employer’s resources. My trusty Surface Pro 4 has served me well for more than six years. It has  been nice to carry as my secondary device because it’s not only small, but has great resolution and all the features and functions of a laptop. It also has the Surface Pen, which is great for my drawing-intensive hobby.

Unfortunately, my Surface has started having some battery issues and runs a little hot. I decided to look at options for a replacement. If it gave up the ghost on a trip it wouldn’t be the end of the world since everything I do is backed up to a cloud solution, but when I have free time, I usually don’t think about spending it to shop for hardware. I got a popup on my device today about considering a trade in, and decided to walk through the process just for giggles. My trusty pal has served me well, but apparently it’s worth less than a tank of gas as a trade in. I’ll hang onto it until it fully dies because the value of having a backup device in case of emergency is worth much more than 40 bucks.

If you were replacing an aging Surface Pro, what would you buy? Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 3/23/23

People are always asking me how I’m reacting to various things in the news. I was saddened last week to see that Pear Therapeutics is searching for ways to remain viable. They were one of my favorite finds at HIMSS22.

Unfortunately, I don’t think frontline physicians really understand what Prescription Digital Therapeutics (PDT) products are and how they differ from recommending that a patient just download an app. PDTs have to be approved by the US Food and Drug Administration before they can be marketed for patient use. Pear has treatments for substance abuse disorder, opioid use disorder, and insomnia that are clinically proven to provide benefit to patients.

For the technology to make it to patients, however, it has to be prescribed by a licensed clinician, and many clinicians are simply overwhelmed. It’s challenging to get them to learn about new drugs, let alone entirely new paradigms. If someone knows about PDTs, they have to identify appropriate patients, then prescribe the solution. A prescription transmission goes to the PDT company, which then has to fulfill it. In Pear’s case, by providing an access code that allows the patient to download it from Apple or Google Play.

Once the patient begins using the tool, the clinician receives notifications through a prescriber dashboard and can monitor patient progress. It’s not unlike prescribing a medication. The intervention still requires monitoring and follow up by the prescriber, and patient adherence can be an issue. I hope Pear Therapeutics finds what they’re looking for and can continue the good work that they are doing.

I also received some questions about the potential for telehealth use to mitigate the unfolding tragedy in pediatrics, namely, the increase in all-cause mortality for children in the US. A research article published in JAMA last week looked at the increase in child and teen deaths that began pre-pandemic but worsened during last few years. The largest increase in pediatric mortality in 50 years is being led by injuries, which include motor vehicle accidents, overdose, homicide, and suicide. All of them were on the rise prior to 2019, with suicide being on the rise as early as 2007. Even children from ages 1 to 9 had increases in death rates. Infants younger than 12 months were the only ones spared. The article summarizes some of the racial disparities that accompany the rise in mortality, with non-white children being the most impacted.

When talking with people about potential interventions or solutions, everyone says “telehealth” as if it’s a magic bullet. Although telehealth can reduce the burden on families who are trying to get their children help — through easier access, reduced driving, etc., — the reality is that there simply are not enough therapists to go around. Social workers and others who deliver telehealth therapy are leaving the field at an alarming rate. Policy makers need to go deeper and look at the causes of increased mortality. Nearly half of the increase in 2020 was related to firearms deaths, which were the leading cause for children aged 1 to 19 years.

The article points out that nearly all the gains that have been made in pediatric longevity over the past few decades are being erased by “bullets, drugs, and automobiles.” So much for improving outcomes with asthma, vaccine-preventable diseases, premature birth, and the like. I continue to come across parents who bury their heads in the sand about what is going on with their children and who seem shocked when the physicians caring for them suggest that they need to talk to their middle schoolers about sex, drugs, and guns. Frankly, by middle school, it’s a little late for a lot of that, depending on who your kids run with, but as family physicians and pediatricians, we’ll keep trying. We can throw some telehealth at it as well, but it’s a much bigger issue than the majority of people understand.

Several people have also asked for my reaction to “The Match,” which is the National Resident Matching Program. It’s the multi-month mating dance where medical students try to figure out where they will continue their training through internship and/or residency, and where training programs figure out who their workforce will be for the next several years. There were some huge shakeups in Match data this year, with emergency medicine taking a serious hit. It was bad enough that the American College of Emergency Physicians and other organizations issued a joint statement about the specialty’s prospects. It cites “workforce projections, increased clinical demands, emergency department (ED) boarding, economic challenges, the impact of the COVID-19 pandemic, and the corporatization of medicine, among many others” as reasons leading students to choose specialties other than emergency medicine.

I’m not an emergency medicine physician, but I’ve spent the last 17 years of my career practicing alongside EM physicians in the emergency department and high-acuity urgent care settings. The specialty has been absolutely dumped on during the last three years. If you don’t know what ED boarding is, that means that when there aren’t enough beds in the hospital to admit new patients (usually because of nursing or other staffing shortages), those patient stack up in the emergency department. Depending on the facility, often the emergency team has to care for them. Sometimes it’s bad enough that patients are even discharged from the hospital after a multi-day stay without ever going to a regular room.

That’s not what EM physicians signed up for, and it’s not their particular skillset. When primary care practices shut down due to COVID, everyone went to the ED and the urgent cares. Some physicians were seeing 80-100 patients each shift, while other physicians shut down. It was brutal, and the things we saw were horrific. The moral injury from having to ration care still haunts many of us. The sense of powerlessness that most of us felt for weeks grew to months and into years with little relief. Some of us are still coping with the symptoms of post-traumatic stress disorder, and a lot of us have left the profession.

For those frontline healthcare IT folks who have been trying to support the emergency department through all of this, you’ve seen it and understand why students don’t want to choose a career in the emergency medicine trenches. Thank you for your patience and compassion when we were frustrated day after day and the technology seemed like just one more thing causing torment. For those of you who haven’t seen this, or who haven’t been a patient lately, the downstream effects of this Match will ripple through our health systems for years to come. Ultimately patients will continue to bear the brunt of the mess that is the US healthcare system.

Would you encourage your child or loved one to pursue a career in medicine? What about healthcare technology? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 3/20/23

I was hanging out with one of my favorite computer science students over the weekend and ChatGPT was a hot topic. He has been working on a group project, and someone who didn’t have a partner asked if they could join the group by way of an email that was clearly AI generated. The first couple of sentences weren’t too bad, but then the email started laying it on thick with comments about how hard the new member planned to work and “rest assured I will do my best” type syntax which isn’t typical of the age group.

Since this student has access to better AI toys than I do, I decided to have some fun. A lot of people in my life know that I write for a blog but they don’t read it or really know what it’s about, so I wondered what generative AI thought about my alter ego: 

Tell me what you know about the writing style of Dr. Jayne HIStalk.

Dr. Jayne HIStalk is the pseudonym of a physician who writes a popular blog about healthcare information technology. Her writing style is characterized by a unique blend of humor, wit, and incisive analysis of industry trends.

Dr. Jayne often uses anecdotes and personal experiences to illustrate her points, and she is known for her ability to distill complex concepts into clear and accessible language. Her writing is often critical of the healthcare industry and its shortcomings, but she also offers practical suggestions for improving healthcare delivery and patient outcomes.

Dr. Jayne’s writing is also notable for its use of pop culture references, particularly to science fiction and fantasy, as well as her ability to inject humor into even the most serious topics. Her style has been described as irreverent, thought-provoking, and engaging.

Overall, Dr. Jayne HIStalk’s writing style is distinctive and engaging, and has helped to establish her as one of the most influential voices in healthcare information technology.

I felt like that write up would be useful for the back of a book, should I ever write one. I think it sums up what I’ve been up to for the last 13 years, although it seemed a little schmoozy with the compliments. Since physicians are starting to use ChatGPT to write everything from prior authorization forms that help patients get medications approved to school and work notes excusing absences, I decided to see if I could get it to do my work for me.

Write 500 words in the style of Dr. Jayne HIStalk about the value of telehealth.

Dr. Jayne here, and today I want to talk about the value of telehealth. With the rise of digital technology, telehealth has become an increasingly popular method of providing healthcare services. Telehealth, also known as telemedicine, is the delivery of healthcare services through digital communication technologies such as video conferencing, remote monitoring, and mobile health applications.

Telehealth has become especially important in recent times due to the COVID-19 pandemic. The pandemic has forced many healthcare providers to pivot to telehealth in order to continue providing care to their patients while minimizing the risk of transmission. This has led to a surge in telehealth usage, with patients and providers alike recognizing the many benefits of this approach.

One of the main benefits of telehealth is increased access to healthcare services. Telehealth allows patients to receive care from the comfort of their own homes, eliminating the need to travel to a healthcare facility. This is particularly beneficial for patients who live in rural or remote areas, where healthcare services may be limited. Telehealth also allows patients to receive care outside of traditional office hours, making it more convenient for busy individuals who may not have time to visit a healthcare facility during regular business hours.

Another benefit of telehealth is improved patient outcomes. Telehealth allows for more frequent monitoring and communication between patients and their healthcare providers, which can help identify potential health issues early on and prevent them from escalating. Telehealth can also improve patient education and self-management, empowering patients to take a more active role in their own healthcare.

Telehealth can also lead to cost savings for both patients and healthcare providers. By eliminating the need for in-person visits, telehealth can reduce healthcare costs associated with travel, parking, and time away from work. Telehealth can also reduce healthcare costs associated with hospital readmissions, as frequent monitoring and communication with patients can help prevent complications and ensure timely interventions.

Finally, telehealth can improve provider satisfaction by reducing administrative burdens and improving work-life balance. Telehealth can eliminate the need for providers to spend time on administrative tasks such as scheduling and paperwork, allowing them to focus more on patient care. Telehealth can also provide more flexibility in terms of scheduling, allowing providers to work from home or outside of traditional office hours.

In conclusion, telehealth is a valuable tool for providing healthcare services in today’s digital age. Telehealth offers many benefits, including increased access to care, improved patient outcomes, cost savings, and improved provider satisfaction. As telehealth continues to grow in popularity, it will be important for healthcare providers and policymakers to work together to ensure that telehealth services are accessible, affordable, and of high quality.

Although it’s an accurate essay, it doesn’t seem to incorporate anything specific from a stylistic standpoint that makes this feel like a sassy HIStalk blog versus a middle school essay. I decided to ask it about the pitfalls of telehealth to see if using a less positive topic would allow it to pull in some humor, pop culture references, or particular insight:

Write 500 words in the style of Dr. Jayne HIStalk about the pitfalls of telehealth.

Telehealth has become increasingly popular in recent years as a way to provide medical care remotely. While telehealth has many benefits, including increased accessibility to healthcare, reduced travel times, and greater flexibility for both patients and providers, there are also several pitfalls to consider.

One of the biggest challenges of telehealth is the lack of in-person interaction. While video conferencing and other forms of remote communication have come a long way in recent years, there is still a sense of distance that can make it difficult to establish a rapport between patient and provider. This can be particularly challenging for patients with complex medical needs or those who require a more personal touch.

Another challenge of telehealth is the potential for misdiagnosis or missed diagnoses. Without the ability to perform a physical examination, providers may miss important signs or symptoms that could indicate a more serious underlying condition. In addition, there may be technical issues that could impact the quality of the video or audio, making it difficult to accurately assess the patient’s condition.

Privacy and security are also major concerns with telehealth. While providers are required to follow certain guidelines and regulations to ensure patient confidentiality, there is always the potential for sensitive information to be intercepted or shared inadvertently. In addition, patients may be more hesitant to share personal information over a video call, which could impact the quality of care they receive.

Finally, there is the potential for telehealth to exacerbate existing health disparities. While telehealth has the potential to increase access to care for those who live in rural or underserved areas, there are still many barriers to accessing care, such as lack of reliable internet or computer access. In addition, some patients may not feel comfortable with the technology or may prefer in-person care, which could impact their willingness to seek care remotely.

Despite these challenges, telehealth has many potential benefits and can be a valuable tool for both patients and providers. To mitigate the risks associated with telehealth, it is important for providers to receive proper training and education on the use of telehealth technology, and to be aware of the potential pitfalls and limitations of remote care. Additionally, patients should be informed of the risks and benefits of telehealth and encouraged to ask questions and voice their concerns about the use of remote care. By working together, providers and patients can ensure that telehealth is used in a safe and effective manner, improving access to care and helping to bridge the gap between patients and providers.

I’m wondering if the fact that I used sequential prompts to ask the questions contributed to the fact that it didn’t include a reference to the author or a definition of telehealth. I think it did a good job pulling in some of the concerns that are often voiced about telehealth, but it still felt a bit like a school essay and not anything that readers would find engaging or otherwise different from the dozens of bland articles that pop up in healthcare IT publications. It’s certainly not to a level of sophistication where I can let it write for me, but it was a fun exercise and it was good to hear what someone from another generation and point of view thought about whether generative AI is ready for prime time or not.

I spent the rest of the weekend playing catch up and getting ready for the fact that I’ll be out next week for the ViVE and CHIME meetings. I’m headed to Nashville on Saturday so I can spend some quality time with one of my favorite shoe junkies and see what has happened to the town in the decade or so since I’ve last been there. I’ll be writing my next couple of posts from there, so if you’re in attendance and see any good shoes or wild conference behavior, be sure to send your thoughts my way.

What’s the best way to spend a cold dreary weekend, when ChatGPT isn’t as entertaining as you hoped? Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 3/16/23

I’ve been carefully following the Silicon Valley Bank implosion, especially the stories about the electronic transactions that contributed to its death spiral. The most striking data point: customers were attempting to withdraw more than $42 billion within a 24-hour period, which works out to approximately $500,000 per second.

I admit that I’m one of those people who has grown used to being able to transfer money on a timeline of minutes to seconds, but the idea of that much money moving around is nearly unfathomable. The bank failure, along with concerns about other lenders, has led to the flow of more than $15 billion to Bank of America. Other large banks, such as Wells Fargo and Citigroup, have yet to comment on the amount of new money flowing in.

People frequently compare what we’re doing in healthcare IT to the digital revolutions that have occurred in other industries. I enjoyed this article about accounting firm PwC and its plans to use an AI chatbot to help its legal team boost efficiency. More than 4,000 workers will have access to an AI-enabled chatbot provided by Harvey with the expectations that it can assist with tasks such as due diligence and contract analysis. Harvey works with large language models in the legal space and uses OpenAI and ChatGPT technology.

Even though we’re several days past the Daylight Saving Time transition, several people I know are still struggling with sleep/wake cycles, especially where children and pets are involved. There’s plenty of push for making Daylight Saving Time permanent, but the medical establishment isn’t convinced. A recent article in JAMA notes that medical societies such as the American Academy of Sleep Medicine “overwhelmingly” support the continuation of Standard Time if we’re going to stop jumping back and forth. They note that during Daylight Saving Time, “the body’s internal circadian clock, which synchronizes to solar time, is out of step with the social clock, or local time.” This results in higher numbers of motor vehicle crashes, depression, and stroke, not only during the transition period, but throughout the summer. There’s not a ton of research on time changes, though, with the authors noting that only 159 articles have been published since 1962.

The reality is that there’s a finite amount of sunlight each day, and choosing one time paradigm over the other determines whether that extra light is in the morning to help us get going or whether it’s later in the day for after-work and after-school activities.

Interestingly, some of the most prominent research in the field stems from Russia, which instituted permanent Daylight Saving Time from 2011 to 2014 before moving to permanent standard time. In a retrospective study of adolescents and young adults, researchers found that ongoing Daylight Saving Time created a dissociation between social and biological clocks which “potentially exerts a negative influence on adolescents’ sleep habits, mood, and behavior.” People also forget that the US tried year-round DST in January of 1974, resulting in an extended period of dark mornings during the winter when children are headed to school. Standard time was restored by October of that year. There’s plenty of other great information in the article, so if you’re looking for a deep dive, I’d give it a read.

I was interested to learn about proposed legislation that would prevent companies from using health data for advertising and marketing purposes. US Senators Amy Klobuchar, Elizabeth Warren, and Mazie Hirono introduced the Upholding Protections for Health and Online Location Data (UPHOLD) Privacy Act, which would curtail the profits companies generate by using personally identifiable health data for advertising. Where HIPAA focuses on covered entities, this bill takes protections to the next level, allowing patients even more control over their health data when it resides with apps, tech companies, and other organizations. The bill would impact the numerous companies that harvest health information but aren’t regulated by HIPAA and would also ban the sale of location data.

From Igloo Fan: “Re: organ donation. Did you see this article about the donated liver that got stuck due to road closures for a marathon?” I hadn’t seen it, so I appreciate the share. Apparently the liver was stranded by the Philadelphia Half Marathon with 30,000 participants hitting the streets. Dr. Adam Bodzin ran into the field, traveling half a mile to where the van carrying the organ had reached a literal road block. Fortunately, police were able to transport him back to the hospital with his precious cargo. I had the privilege of working on my hospital’s transplant team during training and it was an unbelievable experience, if often surreal. Our team treated each organ procurement surgery with the reverence and awe it deserved and as a surgical subintern I was honored to be left behind to help return the donors to the best appearance possible for their families. Once those cases were complete, we caught up with the team performing the actual transplant procedures, and the sense of awe continued. There’s nothing like watching a donor organ start functioning. If you’re an organ donor, make sure your family knows your wishes. If you aren’t, please consider making it possible to give the gift of life should something unforeseen happen.

I love it when readers send me funny emails, even though I don’t always have time to reply to them. I’ve had some long-term back and forth correspondence with some readers to the point where I feel like I really know them. One of those readers and I have had an ongoing dialogue about virtual workplaces where you’re constantly expected to be on camera. It was the best laugh of the day when I opened a message to read this: “I’m on a Zoom and this woman is casually sipping a bottle of magnesium citrate.” I’m just hoping his co-worker was knowingly drinking a laxative and didn’t have it confused for some other beverage in the refrigerator. March is Colorectal Cancer Awareness Month, so perhaps she was getting ready for a recommended screening test.

What’s the wildest thing you’ve seen on a conference call? Leave a comment or email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 3/13/23

A recent article in JAMA Health Forum caught my eye with this title: “Association of Primary Care Visit Length With Potentially Inappropriate Prescribing.” The study’s goal was to answer the question, “Are primary care physicians more likely to prescribe potentially inappropriate medications during shorter visits?” in part as a proxy for seeing whether shorter visits resulted in lower-quality care.

The authors looked at visits from 4.3 million patients, noting that “those who were younger, publicly insured, Hispanic, or non-Hispanic Black had shorter primary care physician visits.” These visits were associated with higher rates of antibiotic use for inappropriate conditions, such as upper respiratory infections. They were also associated with prescriptions for both opioid analgesics and benzodiazepines in patients who presented with painful conditions. The authors concluded that shorter visits were associated with some measures of inappropriate prescribing, but not all.

It’s a difficult study to analyze, especially looking at the demographics included in the study. We know from other research that there can be racially and ethnically associated differences in care quality. We know that black women have higher maternal mortality and less prenatal care compared to white women, and there are plenty of other examples of racial disparities in care. It’s also difficult to understand from the write-up exactly what kind of EHR data was used in the study, which was conducted from March 2022 through January 2023.

The researchers pulled a dataset from multiple states across the US that encompassed both claims and EHR data from users of the Athenahealth platform. EHR timestamp data was used, including flags for check-in, patient intake, the clinician encounter, checkout, and signoff. In some clinics, these stamps can be a poor proxy for patient visit duration, especially when there’s a lot of waiting involved or when physicians don’t appropriately change the status of visits as they move through their schedules. I would be interested to see data on the concordance of those timestamps with actual visit durations as observed in the practice before using them as a proxy.

The visit time was variable between physicians, and although the median visit length was 18.9 minutes, the range was 14.1 minutes to 24.6 minutes. There was some data I didn’t expect when looking at visit length alone. Those visits that were scheduled for 30 minutes rather than 10 received more physician attention, as one would expect. However, the difference in time spent was only four minutes for the longer appointments. That might indicate that triage algorithms or human schedulers aren’t doing a great job predicting the correct appointment slot for a given patient.

Not surprisingly, visits that had five or more diagnoses were 9.1 minutes longer than those with only one recorded diagnosis. New patient visits were 4.1 minutes longer than those with established patients. The data supported previously proven conclusions, such as female patients having longer visits than male patients and older patients having longer visits than younger patients. It also showed that patients with commercial insurance had slightly longer visits than those with Medicaid or other payers.

The researchers found a correlation between longer visits and a decreased likelihood of inappropriate antibiotic use. On the flip side, longer visits had a positive association with potentially inappropriate prescribing among adult adults, which was an interesting finding. The authors note that “many of the prescriptions that we observed may have been refills; thus, it may have taken the physician less time to refill the medication than to engage in a discussion about de-prescribing.”

The authors end by stating that there are opportunities for additional research and operational interventions for visit scheduling and prescribing decisions in primary care. They also note that data showing that non-Hispanic black patients had shorter visits than non-Hispanic white patients seeing the same physician, which could result in accumulation of time disparities that can potentially contribute to racial disparities. They conclude that the data “should motivate organizations and policy makers to detect, interrogate, and address underlying systemic causes such as structural racism.”

It would be interesting to compare data pulled from Athenahealth users and that from users of other EHRs that may have varying levels of clinical decision support or guidelines content within the clinical workflows. In my community, the user base of the Athenahealth EHR tends more towards an independent primary care practice user base. Practices that are owned by or affiliated with the large health systems or academic institutions tend to use a different EHR, as they do across the US. Therefore, using data from one vendor alone might not be representative of primary care practices across the US.

It would also be interesting to control the data for owned versus independent practices, large versus small, and those who are participating in risk-based contracts versus those who aren’t. I’ve found that certain kinds of practices tend to have a more systems-based approach that can make short appointments more efficient than they might be elsewhere.

I work with physicians who practice in a face-to-face environment, those who practice entirely via telehealth, and those who either do a hybrid approach from within their practices or who practice at separate in-person and telehealth jobs. I’ve seen telehealth physicians held to standards that some of their in-person counterparts aren’t monitored for, because there’s a suspicion that somehow telehealth physicians are doing a worse job at following guidelines and standards than their in-person colleagues.

It would also be interesting to compare and contrast the data for telehealth visits done by third-party providers versus those delivered by the patient’s medical home. You would also have to look at hybridized care models such as a primary care office that uses an acute care telehealth pool that’s part of an overall health system, or primary care offices that allow third-party providers to work within their own EHR.

There’s not a tremendous body of literature looking at the length of telehealth visits compared to the outcomes of those visits, and maybe someday I can be part of the research into how telehealth can best be used for what kinds of care and what clinical decision tools work best to provide care in different environments. It’s been a long time since I was involved in research, but I enjoyed it. I’ve just entered a new Maintenance of Certification cycle with my specialty board and a practice improvement project is in order, so one never knows.

What do you think about the association with visit length and care quality? What have your experiences been from the patient side? Leave a comment or email me.

Email Dr. Jayne.