EPtalk by Dr. Jayne 10/14/21
As my readers know, I’m a big fan of prevention. I went this week for my regular dental visit and was interested to see a wireless headset sitting on a charger on the dental hygienist’s counter where she usually charts. She mentioned that they had installed a new system that would allow her to dictate her findings as she was performing my preliminary examination, so my informatics senses were tingling.
Looking closer as she was getting ready, I noticed that an Echo Dot had also been added to the exam room, so I figured it was part of the new solution. Unfortunately, the system failed to respond to the wake word after several tries. Since patient care was the priority and not troubleshooting the technology, she said she was going to go “old school” and key in the data manually as they had done in the past. It was disappointing not to be able to see their new toy in action, but I have to give them full credit in doing what was better for the patient (and likely for their schedule). As always, I scheduled my six-month follow up before I left, so hopefully the system will be better behaved in April.
Digital transformation has certainly impacted care delivery organizations, but it is also impacting those that support clinicians. The American Academy of Family Physicians announced last week that they are no longer requiring a certain number of live Continuing Medical Education (CME) hours for physicians to maintain membership. In the past, physicians had to report 25 hours of live CME every three years. Reductions in the availability of live meetings due to the COVID-19 pandemic impacted the ability of physicians to claim these credits, leading initially to the AAFP granting extensions on the time needed to obtain the hours.
However, AAFP also realized that the definition of “live” has become more fluid in the digital world. Rather than deal with the complexity of defining whether “live” means “in person” versus “virtual” versus “livestream” or something else, they’re eliminating the category altogether in the name of allowing active members “to pick the learning formats that best suit their needs and preferences.” Active members will still need to report 150 hours of CME every three years and half must have the AAFP Prescribed credit designation, so we’re not entirely to the point where we have total flexibility in how we obtain our CME. The response in the comments section was overwhelmingly positive, so kudos to AAFP for helping make physicians’ lives at least a tiny bit less complicated.
Speaking of blurred lines between in-person interactions and other modalities, I enjoyed learning more about what Cleveland Clinic is doing at its Indian River Hospital in Florida. As part of a new program, patients are being “seen” by mental health providers during emergency department visits, an approach that not only reduces the time for patients to receive services, but is improving quality. Psychiatric consultations are being seen in less than an hour versus the 24 hours that could occur previously. Often, treating psychiatric concerns in the emergency setting can be a challenge, and in my area, we recently opened a dedicated psychiatric emergency department to better serve patients in a more welcome environment. From the day it opened, though, it’s been at capacity, so maybe augmentation with telehealth resources – either there or within traditional emergency departments – is something to think about.
JAMIA Open published an article last week looking at an AI-based system that can flag medication errors in the EHR by looking at clinician ordering behavior in context. Researchers looked at pharmacy orders over a two-week period in a major metropolitan hospital system. The goal was to identify orders requiring pharmacist intervention then to further refine it within a given clinical context. Contextual data included specialty, clinician type (attending, resident, midlevel provider), day of the week, time of day, and the therapeutic class of the medication. The data used was from two weeks in July 2017, which somewhat limits the study – July is when new interns start and residents typically advance, resulting in changing responsibilities. The authors note this, and also that the small sample wouldn’t account for seasonal variations. Still, it’s important work, and developing effective systems to help reduce medication errors is a good thing.
I’m prepping tonight for a community presentation about COVID-19 vaccines, as a local volunteer organization tries to push its vaccination rate beyond 90%. I expect quite a few questions about third doses versus boosters as well as the usual questions about vaccines in general. I’m on a couple of groups’ COVID advisory panels, so I have to keep up with a steady stream of news along with being able to play my own little version of “MythBusters” every time I do a public forum. Today provided some interesting material about long COVID, which now has been officially defined by the World Health Organization. The clinical case definition of “Post COVID-19 Condition” as it is called includes lingering fatigue, shortness of breath, and cognitive dysfunction (also referred to as “brain fog”). Symptoms may continue for months after the initial COVID infection and are often severe enough to prevent patients from completing daily activities. Additionally, other explanations for the symptoms must be excluded before a patient is considered to have the condition.
In parallel, the US Centers for Disease Control and Prevention formally added an ICD-19 code for long COVID: U09.9 Post COVID-19 Condition, Unspecified. Additional guidance from the US Department of Health and Human Services explains that the condition can be considered a disability under the Americans with Disabilities Act. For those who think that COVID-19 infection is not a big deal, I hope we can look back in a few decades and it’s actually true. In the short term, however, I have significant concerns about the overall cost of COVID care to our health system and ultimately to the global economy. Seems like the $20 vaccine is looking like more of a bargain every day compared to the potential of hospitalization, disability, and death.
CMS announced that the Quality Payment Program website will no longer support Internet Explorer 11 after October 13, 2021. I was shocked by the fact that approximately 2% of users access the site through IE 11. If you’re still using it, you’re missing out on the features offered by other browsers, so hopefully those users will like what life is like on the other side of the fence.
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Re: Online educational sessions There's one detail that I've noted, and I wonder if anyone else has. I often find…