EPtalk by Dr. Jayne 8/31/23

Sometimes a marketing campaign just resonates with me, as did this one from Intelligent Medical Objects with its connection to “How to Train Your Dragon.”

I receive a tremendous number of emails from companies that are trying to get my attention or trying to get me to consider their products. The majority of them are annoying (especially the ones that address me as “Hey Jayne!”) but this one not only hit the mark, but gave me a smile as well.

Large language models are going to continue to be a hot topic for the foreseeable future, and the data used to train models can vary widely in quality. Bad data can lead to bias and unanticipated outcomes.

IMO continues to be a leader in the field of semantic interoperability, helping organizations make sure that data makes sense not only on the back end, but for the clinicians who have to look at it every day and the patients who are increasingly exposed to their healthcare data. I remember first implementing its products many years ago, and the fact that its ProblemIT solution was the only initiative for which my physicians actually sent me “thank you” emails.

New legislation is pending in the US Senate. The Behavioral Health Information Technology Coordination Act would provide $20 million in funding annually for behavioral health EHRs and would also require the development of standards for those products. Additionally, CMS would work with different bodies, including Medicaid, to promote EHR adoption and interoperability for behavioral health.

Many organizations have struggled with documentation of behavioral health care in EHRs, including keeping up with privacy regulations for different jurisdictions and age groups and dealing with information-sharing among the treatment team. Primary care physicians in the US provide a great deal of behavioral health services, but many find it difficult to get the information they need to adequately care for their patients, including histories of previous treatments and medication records. They sometimes struggle to coordinate with therapists, even when both are employed by the health system, because organizations are especially worried about inadvertent disclosure of this specially protected data.

In my area, it seems like the majority of non-facility behavioral health providers are not employed by large health systems. Many are independent and don’t participate with insurance companies, requiring patients to pay out of pocket. This shortage means that the wait time for a psychiatrist for Medicaid patients is 9-12 months, which pushes even more care to be delivered by primary care physicians. One health system recently opened a behavioral health emergency department to help address surging access needs, but it was quickly overwhelmed.

When you’re not taking insurance or participating in governmental payer programs, there is little incentive to use an EHR versus traditional paper documentation, especially when you’re not expecting to have to share data very much if at all. Behavioral health wasn’t initially included in the Meaningful Use incentive programs of the Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009, which also likely contributed to reduced technology adoption.

From Latent Luddite: “Re: technology’s unanticipated consequences. Did you see this article about autonomous car crashes in San Francisco? Great example.” I hadn’t seen the article before a reader sent it along, but the long and short of it is that General Motors is having a problem with its Cruise autonomous vehicles. As a result, they’re cutting the size of the San Francisco fleet in half while investigations are underway after recent crashes. In the most recent incident, a vehicle without a human driver was struck by an emergency response vehicle, leading to a request by the Department of Motor Vehicles to reduce the number of Cruise vehicles in service. The new guidelines call for no more than 50 vehicles in service during the day and 150 at night.

A recent decision by the Public Utilities Commission allowed competing autonomous taxi service Waymo to also operate in the city at all hours, so one can speculate as to what might be happening when services are competing for fares. The general manager of Cruise in San Francisco stated that the recent incident was “complicated by the fact that the emergency vehicle was in the oncoming lane of traffic, which it had moved into to bypass the red light.” I’ve been in plenty of situations in urban areas when an emergency vehicle is approaching and it’s difficult to figure out where it’s coming from due to echoes and clutter on the street. It’s also difficult to predict how other drivers might react when you’re deciding how to try to move your vehicle to get out of the way. Data from the company notes that Cruise vehicles have encountered emergency vehicles more than 168,000 times this year, which seems an amazing statistic to me.

The American Telemedicine Association recently rebranded its conference, which is now referred to as ATA Nexus 2024. The upcoming event will be held May 5-7 in Phoenix. I’m not a huge fan of conferences that run on the weekend and also spill into the workweek, making them the worst of both worlds. ATA has moved its conferences back and forth in the last couple of years, so it will be interesting to see whether this format is better attended over time. There is quite a bit of work to be done in telehealth, especially in the legislative and policy arenas. I anticipate this conference will continue to be a hot ticket for those focusing on that particular modality. The conference’s call for speakers is open and interested parties can submit proposals through September 22.

I recently met up with a colleague whose employer provides multi-week sabbaticals at certain employment milestones. We discussed that having time away from work often makes people think about how they manage their time, whether they have acceptable work-life balance, and how they want to manage their priorities moving forward.

My friend spent his sabbatical in a relatively spartan location, leading him to think twice about the luxury he came home to, with its large TV and what he describes as “entirely too much sporting equipment.” He said the most profound thing he experienced was a desire to better explore and experience his hometown, which he felt he’s been limited in doing by the hours he works.

I’m personally a big fan of the staycation, which is a great way to explore your surroundings and figure out what you might be missing out on. Our conversation reminded me of the need to take time for myself, so I’m hiking with a friend this long holiday weekend. Fortunately, the weather has calmed down a little bit, so I’m looking forward to seeing what the trail has to offer.

What are your plans for the long weekend if you’re able to take time off? Leave a comment or email me.

Email Dr. Jayne.