EPtalk by Dr. Jayne 12/14/23

From Patient Satisfaction: “Re: patients navigating coverage choices during open enrollment. You are right on target. The challenge of navigating the maze between coverage and patient care is overwhelming. I sympathize with physicians and staff that have to navigate this mess. I appreciate their efforts. I am fortunate to have a great PCP and a network of specialists who care for me. I have been impressed by the coordination of care I have received in my area, even though all the practitioners are not with the same health system. They are all on Epic and share my medical information, which may account for this.” Having your records on a common EHR platform certainly makes some kinds of sharing easier. The most reliable sharing seems to be clustered around the data elements that were required as part of federal incentive programs and now have become table stakes: medications, allergies, and problem list.

Things become murkier when you’re trying to share laboratory data even among systems using a common vendor. Some require mapping of specific lab tests among all trading partners, which can be laborious. Even mapping the top 100 labs can be challenging when you’re dealing with different hospitals using different analyzers. Reference ranges and normal / abnormal flags have to be dealt with, and I’ve seen plenty of organizations just throw up their hands and avoid the problem by doing minimal mapping. Sometimes a thyroid test isn’t just a thyroid test, after all.

For years, I’ve been a keen follower of footwear fashion, but a reader recently clued me in to advances in surgical wear. Surgeons at Mayo Clinic have partnered with Cardinal Health to create the first commercially available surgical gown  with pockets. It boasts two instrument pockets and one holster, suitable for different users, “right, left-handed; any gender of clinician; standing or sitting procedures; etc.”

Although I like the sales talking points around reducing handoffs and drops, or avoiding breaches to the sterile field, I’m less enamored of the gown’s ability to give “an extra hand to understaffed ORs” since that feels like a way for administrators to justify continued understaffing. I reached out to a couple of colleagues. The first said “heck yeah, it’s amazing,” but it sounds like he hasn’t experienced it yet. The second colleague, a 20-year veteran scrub nurse, was a bit more skeptical. She felt it may create issues with lack of standardization in how different surgeons put equipment in their pockets, creating potential confusion for surgical assistants and scrub staff that could ultimately impact patient outcomes. In a salute to the litigious folks out there, Cardinal Health warns that “sharp, hot, heavy, or long instruments should not be placed in the pockets or holster.”

CMS recently released data on National Health Expenditures for the 2022 fiscal year. Here are some of the highlights:

• Healthcare spending grew by 4.1% to reach $4.5 trillion.
• The percentage of insured persons in the US reached 92%.
• The share of Gross Domestic Product devoted to healthcare is 17.3%.
• Hospital care is responsible for 30% of spending, followed by physician / clinical services at 20%, and retail prescription drugs at 9%.
• Private health insurance pays 29% of the bills, followed by Medicare at 21% and Medicaid at 18%. Patients paid out-of-pocket for 11% of care delivered.

It’s important to keep in mind that although the percentage of insured persons has reached a historic high, that figure doesn’t say anything about the comprehensiveness of their insurance coverage, whether it’s affordable, or whether it’s delivering high-quality care.

The Association of Health Care Journalists has released a tip sheet educating reporters on how to spot and report on deepfakes, following concerns about cybercriminals trying to impersonate health system executives. Informatics guru Dean Sittig, PhD and professor of biomedical informatics at the University of Texas Health Science Center at Houston contributed to the document. Potential scenarios include using the technique to get employees to engage in activities that would allow criminals to gain access to technology, creating media that impacts an institution’s reputation, or creating media for use in blackmail efforts. The article also includes guidance from the Department of Homeland Security on how to spot faked images and videos and things to listen for in faked audio recordings.

From Renee’s Friend: “Re: lawsuit award. As a nurse, I’m always interested in stories about whistleblowers that address quality issues. This one about a Kaiser nurse who was awarded $41.49 million has me scratching my head a bit – check out the part about the isolette.” Apparently the nurse claimed retaliation and wrongful termination following her quality and safety complaints. However, the article notes that “In their court papers, Kaiser attorneys maintained that the 30-year employee admitted that in 2019 she took off her shoes and socks and placed her bare feet on an isolette, a medical device that holds sick or premature newborn babies. The defense attorneys included a photo of Gatchalian doing so in their court papers.” This seems truly bizarre and I can only imagine the events leading up to its occurrence. If anyone has more details, do share.

Axios reports on a recent survey that found patients are concerned about how their physicians may be using AI. The article noes that four out of five patients are concerned with the use of AI in making diagnoses or determining treatment plans, with the majority voicing concerns that they don’t know where the information feeding the AI tools is coming from or whether it should be trusted. Half are concerned about the creation of false information, while eight in 10 were concerned about AI using information from internet searches. That number fell to 63% when patients were told the tool was from a reputable healthcare source.

Even as a clinical informaticist who understands how various organizations are creating their AI-powered solutions, I am concerned about the frequency with which they engage clinical resources during the development process and the level of scrutiny present when engineering teams are determined whether a solution is ready for deployment.

An article published last week in the Journal of the American Medical Informatics Association looked at another angle to this issue – ethical perspectives on the development of algorithms used in healthcare. The authors identified areas where greater attention to ethics may be needed, along with technical challenges that influence clinical usefulness, and how solutions support the key ethical concepts of beneficence and justice. We are indeed living in interesting times.

What do you think about the role of ethicists in the development of AI solutions? Leave a comment or email me.

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