Many people have returned to a comfort level with business travel and seem to be flocking to conferences. Redox promotes their Connect Customer Conference will be held in Philadelphia on October 18. The one-day conference is priced at $99, although current customers can obtain a discount code through their account manager. Fee includes breakfast, lunch, snacks and admission to the Philadelphia Museum of Art. The conference itself will be held at the Philadelphia Masonic Temple, so props to Redox for putting on what could be the most architecturally interesting conference of the year.

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I had to renew my registration with the Drug Enforcement Administration this week and the $888 fee always hurts. Most mainstream telehealth-only doctors are not allowed to prescribe controlled substances, but we are required to maintain registration with the DEA to serve as a proxy for proof that we haven’t done anything questionable. The DEA, like many state-level controlled substance agencies, has yet to come to terms with the reality of telehealth. They still want you to provide a physical address where the patient care takes place, which some of us don’t have. I hate using my home address, but it’s the only way to sign up. Hopefully agencies will evolve to realize that some of us may never see patients in person again.

I appreciated the “Renewal Application Quality Assurance Survey” that appeared after my registration was complete. The questions included some comments that fall into the “things we wish we could say” category. For example, the first question asked for feedback on the overall experience, noting “Please note that some common complaints describe aspects of the app that work as intended,” including the fact that failed logins don’t explain why (so fraudsters can t to use this data point) and that the burden of information required to enter is intentional. In addition to rating the login experience, users should rate the usefulness of help/error messages and the overall ease of use of the app.

My readers know I don’t love a catchy title and a hint of research that would explain Why Thinking Hard Makes You Tired certainly got me. The theory is that intense mental activity causes substances to build up in the brain. Specifically, the chemical glutamate builds up in the decision-making center of the brain, leading to changes in thought processes and the progression of mental fatigue. The authors used magnetic resonance spectroscopy to assess changes in the brain during the workday. Glutamate is processed during sleep, so most importantly, it’s probably a good idea to avoid making critical decisions while you’re tired.

I’m a big fan of patient portals and empowering patients to schedule their own appointments, tests and diagnostics if that’s something they want to do. Of course, not every patient will be able to do this or want to do this, but for those who do, it can take the burden off office staff and call centers. A recent article examined whether self-scheduling of diagnostic imaging studies affects health disparities. The authors reviewed the results of a trial using the UC San Francisco patient portal and a subset of diagnostic imaging studies that were flagged as eligible for self-scheduling. The portal-based scheduling process was only available in English and allowed scheduling of a subset of MRI and ultrasound tests, as well as CT scans, bone density scans, and mammograms, as long as the provider placed an order accompanied by a “ticket” that would help patient to schedule the correct test type, location, and date. The time period analyzed is from January 1 to September 1, 2021.

The authors found that subgroups of active patient portal users were less likely to benefit from self-scheduling, including Hispanic, Black/African American, and non-English speaking patients. Additionally, those with Medicaid or Medicare coverage were less likely to plan online than those with commercial insurance coverage. There is always a chance that patients will not write their own schedule, and backup processes should be in place to ensure that no one falls through the cracks. Still, more than 18,000 tests were scheduled over an eight-month period alone, which is nothing to sneeze at. The authors note several limitations of the study, including an inability to determine whether the patient actually scheduled the test on their own or whether they had assistance from a family member or caregiver.

Looking at the design of this study, the patient stratification part was probably pretty straightforward, as organizations have been required to collect these specific demographics for quite some time. As researchers seek to further understand patient behavior, it will be more important to understand other data covering the social determinants of health. Another article that came out this week looked specifically at clinicians’ awareness of their EHRs’ ability to capture this kind of information. The authors examined data from the National Electronic Health Record Survey and analyzed it based on physician, practice, and EHR characteristics. They found that physicians practicing in community health centers were more likely to document these factors than those practicing elsewhere. Likewise, physicians participating in payment models that include social care initiatives are more likely to document. Regardless of practice location, physicians who were more aware of enhanced EHR capabilities, such as patient engagement or population management functions, were more likely to document social factors.

The authors recommend that organizations develop strategies to increase providers’ awareness of documentation capabilities, particularly in practice settings where they are less likely to be aware. I was surprised that payer-owned clinics were found to have lower awareness of opportunities to document social determinants, so there is certainly room for improvement in this setting. The authors also call for policy efforts to expand the use of a clinical quality measure that addresses social risk screening.

I agree that promotion of less commonly used EHR features should be part of ongoing optimization efforts, whether related to social determinants, provider efficiency, or otherwise. Unfortunately, many organizations have reduced budgets for optimization efforts and continuing EHR training.

What is your organization doing to improve documentation standards and get the greatest return on its EHR investment? Leave a comment or email me.

Email Dr. Jane.

EPtalk by Dr. Jayne 9/22/22

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