This months episode of “News you can Use” in the traditions of “Ask Me Anything” on HealthcareNOWRadio features news from the month of February where we saw a reduction in the number of cases of COVID19 occurring but still crossing a somber milestone of 500,000 people dying from COVID19 in the United States
You can read more about the series here and the concept of keeping up with innovating in healthcare. Please send me your suggestions on topics you’d like to see covered. You can reach out direct via the contact form on my website, send me a message on LinkedIn or on my Facebook page (DrNickvT), or on Twitter tagging me (@DrNic1) and #TheIncrementalist or you can click this link to generate a ready-made tweet to fill in:
As I did last month I am talking to Craig Joseph, MD (@CraigJoseph) Chief Medical Officer at Nordic Consulting Partners. With the Pandemic continuing to dominate our lives and much of the news we discuss the the vaccine roll out and the weather challenges that brought many of the already stretched supply chains to a halt. So far the vaccine supply has beetles than the demand so the concern around hesitancy to vaccination has not been an issue but with the ramping up of distribution we may start to see this later in the year.
Tied to this is the need to track vaccination status and what this may mean with the example from Craig of a cinema that might consider offering a theatre or showing for vaccinated individuals only where no protective equipment is required. There are many competing solutions emerging to be able to demonstrate your vaccination status that will be needed not just for movie theaters but travel, offices and beyond.
We discuss the JAMA editorial: Virtual Care, Telemedicine Visits, and Real Connection in the Era of COVID-19 that highlights the incredible positive contribution of technology in keeping our healthcare system operating for many during the pandemic. Remember the days before Google when we worried about bookmarks and tried to remember where information was stored. The same is now available in many EMR’s offering faster path to information in health records.
Listen in to hear our discussion on the all the contributions of technology to healthcare and how we can bring even more positive contributions building on this positive outcome of more Telehealth availability and use.
Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next week at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.
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Raw Transcript
Nick van Terheyden
And this week as I am, each and every month, I’m delighted to be joined by Dr. Crane. Joseph is the chief medical officer at Nordic consulting partners and a pediatrician Craig, thanks for joining me for this month’s episode.
Craig Joseph
Thank you for having me, always a pleasure.
Nick van Terheyden
So we often start with COVID-19, because it’s been a little bit like that plus elastic band, you keep snapping on your wrist, you can’t help yourself, you snap and you keep thinking about it. It’s been an odd month, we’ve started to see an increase in the vaccine rollout. But then this bizarre weather system took hold. And we saw this massive challenge across swathes of the United States. And we’ve seen a big decline. What have you seen and what’s going on in your area? And what do you think is going to be the impact?
Craig Joseph
Well, you know, I think in in the big picture, it’s probably not going to be that significant of an impact. I’m hearing already that a lot of places in the country are already kind of ramping back up. They’ve always had Well, I shouldn’t say always, for a while we’ve had the ability to give a lot of vaccines, and the thing that has been holding us back has been the supply of vaccines. And so you’re absolutely right, a significant chunk of the United States lost the ability to travel, on roads or on airplanes. And so the vaccine couldn’t get to where it needed to go. And so that’s absolutely delayed and delayed areas. Even California, you know, San Diego was unable to beta cancel a bunch of their large vaccine clinics. But as I understand it, you know that that ability to administer is still there. And now when a big bolus of vaccine comes in, they are able to kind of give it quickly, I think, and so I suspect that in a week or two, we’ll we’ll be caught up and you know, be back where we want it to be. So I think it clearly it was bad. And it was some it could be predicted. But we shall overcome this.
Nick van Terheyden
So I think the interesting thing that I noted around this was that we’ve started to get ahead of the last mile. So I think not all states, but certainly some states had stood up a bunch of capability that would allow them to do mass vaccination. I know in my state, at least I’m aware of three mass vaccination sites, they’re ready. But they were lacking supplies. And of course, the supplies tanked. Because there was no ability to get these vaccines distributed. So there was canceled appointments, that’s going to have some cascading effect, I imagine that there’s some second doses that were impacted. And I have to play a little bit of catch up, that will give us some data to look at in terms of the response for those individuals. But what I find interesting about this is that we’ve we’ve sort of flipped and gotten ahead from a distribution standpoint, and now we really have to ramp up the supply, do you think we’re going to be able to do that, if have we got the capacity to really get this, because I was seeing, you know, the orders of three to 6 million a day necessary to start to bring any kind of normality in, you know, the timeframe of the year?
Craig Joseph
Well, as we’re recording this, I’m hours ago starting to read about both Pfizer and Magento saying that they’re able to or expect to be able to significantly ramp up their production that they’ve figured out, got some of the snack foods out of the way figured out what they needed to do with their factories, and that they are telling everyone publicly that they are going to be able to get those the number of vaccines out in the US at least you know, so that we can significantly put it put a dent in and and start to make use of that that last mile that you’re talking about, which is with any type of distribution process the word the most difficult, right? And if for those who aren’t aware of what the last mile problem is, it’s always been easy, relatively speaking to get something from the factory to a Supply Center. It was Just getting it to people’s houses, to their apartments to their places of work, that was really quite difficult because that that was expensive and needed a lot of personal hand holding and and so now that we have that infrastructure in place, once the supply comes up, which apparently it’s going to be soon as in weeks from now, we should see significant ramp up and and the, the need is out there, the desire is out there, people are still very excited about the opportunity to be vaccinated. And so there’s a big, a big opportunity to really, you know, change the direction.
Nick van Terheyden
I know, good news. And you know, for a small subset of people, I forget what state and maybe it was, in multiple instances, there were some cases where some of the deeper refrigeration units failed. So instead of wasting it, they went hot out and said, What am I think that, you know, the three places one at least was incarceration, where they knew that they could find people, great place to go, because there was lots of problems, you know, continued to be, I think, eldercare, potentially health care facilities, I forget what they were, but they just literally went after it to make sure there was no waste. And so some lucky folks, you know, got vaccinated slightly earlier than they might have. Ordinarily. So there was some good news for some people and all that. And I love the fact that they applied that.
Craig Joseph
Yeah, well, you know, it’s good to be lucky. I read about Rice University as well. Right. Right.
Nick van Terheyden
Next, that’s right.
Craig Joseph
Yeah, a bunch of they just called for they had a bunch, and they were about to be destroyed, just called for any college student who could walk over and get a vaccine. And so yeah, much better to put it in someone’s arm. Even if they’re not the highest risk, as opposed to throwing it away, if that’s what happens.
Nick van Terheyden
Yeah, I just I find waste at this point is entirely unacceptable. There is no excuse for that. It needs to go. And of course, the other thing that is tied up in here, and it sounds like you feel that there is I don’t want to say well, maybe there is less vaccine hesitancy from the population, there is still there’s still the desire to get vaccines exceeds the supply. So we’ve got a, you know, demand. Currently, at some point that might change and we weren’t vaccinated. I’m wondering where that it eventually falls? And will it be high? And?
Craig Joseph
Well, that’s the that’s the the million or billion or actually trillion dollar question. Right now, you’re absolutely right, there’s there’s a hot, much higher number of people that want it then can get it? And what will happen? You know, I would I would imagine it’s going to be mid summer, where we start to say, Okay, we have now more than then there are people who want to get it. And then what do we do? And how do we convince those folks to help, you know, get us up to the, to the level that we need, so that we can, you know, think about at least as much as we can kind of getting this behind us and going out, and I’m not sure everything in life will return back to normal. But I think a big everything in life could return back to normal, you know, once we hit the numbers that we need to, and we don’t really know what those numbers are. It’s a moving target. Right?
Nick van Terheyden
It’s I’ve seen a number of modeling tools that sort of take lots of things into account. And what was interesting. And you know, it’s almost counterintuitive when you first think about it. But of course, it makes sense. If we pull off all of the restrictions and say Don’t worry about mass just, you know, hang out and spread the disease, of course, that actually increases the total number of people infected and that might get you to whatever herd immunity is for the populace. Now, to be clear, not something I’m advocating but hadn’t even thought that the reduction in some of those controls was going to cause or could potentially get us to that level. So you know, there’s so many factors. And obviously, the folks that are creating these models are working hard, but I think for the most part relatively good news, but it’s still going on for a lot longer than all of us would really care about. So
we’re on travel. I mean, have you seen anything regarding travel? We’ve sort of heard some closure or change in terms of the requirements. I think there was certainly some discussion internally to the US. Can you imagine this being required to test if you went from one state to another on an airplane?
Yeah, I can imagine it. Absolutely. I can absolutely. Imagine it. And that’s where you can you know, where you can actually enforce it. It would be relatively easy to do I think it would, it would decrease. A lot of certainly decreased travel
there’ll be people who wouldn’t be willing to be tested and wouldn’t want to know that they were positive.
But yeah, actually, at this point, I don’t find it. I don’t find anything. unimaginable. You know, hopefully, it won’t come. Challenge accepted. I’m gonna keep on coming I yeah, that’s fine. You know, Dr. Nick, I think you should continue to push me but so far. Yeah, I can, I can totally imagine I can imagine
having the vaccine having proof of vaccination as a requirement to go to the movies, or to go to some movies, right? Hey, you want to go into this public place where we are relaxing, pretty much all the safeguards, maybe we’ll have one theater or part of the theater reserved for people who have come show us that they’ve been vaccinated. And, you know, there’s certainly no requirement to go to the movie theater. And there’s certainly no requirement to go to the side of the movie theater versus that side of the movie theater. But there, I think there will be people who are interested in that sort of
have that sort of consistency, hey, I don’t want to go to this place. If I’m going to be exposed unnecessarily to people who have not been vaccinated. I wouldn’t be interesting idea, folks. You heard it here. First, is with vaccinated sections. I, you know, I’m not again, I’m not as wild as it might sound I i’m not saying you know, half of the movie theater, I’m saying if you think about a big movie theater with a, you know, a bunch of on the left, you have five theaters on the right, you have five theaters, hey, we’re gonna put these five movie theaters over here. And only you can only get into those if you’ve got proof of explanation. And in fact, we might charge a little I don’t own a movie theater, maybe I should look into that, hey, maybe I’ll charge an extra $2 to go into the more exclusive part of the theater to go into the vaccine.
You know, the section where you have to prove that you’ve gotten vaccinated because there might be fewer people who are willing to do that. And for a few extra bucks, I don’t think I would mind that if I fight once I get my vaccine once I once it’s my turn, and I’m able to go get it. Yeah, I think it would be.
I think it’s a reasonable statement. And so certainly, if it works in a movie theater, it would certainly work in a plane or train. Yeah, I think it’s gonna work everywhere. And, you know, I was reading just today that
a number of the airlines are working together to find a standardized methodology. You know, there’s generally a view that it must be digital to preclude, you know, some of the fraud that’s gone on, we’ve seen multiple instances in different countries I know, in the Netherlands, in the UK, and some other countries where groups have been offering fake tests, negative tests to satisfy which, you know, is just frustrating. But, you know, we’ve obviously got to take account of that, and they’re trying to come up with a digital version of the yellow fever paper certificate that we certainly familiar with. And I think we’ll see something similar to that, but
all gonna happen over the course of time. For those of you who are just joining, I’m Dr. Nick the incrementalist and today I’m talking to Dr. Craig Joseph, he is the chief medical officer at Nordic consulting partners. And as we do each and every month news, you can use our discussion on what went on in the past month.
In this case, February
we were just talking about COVID-19 as we do most, most months because it’s really been a focus but moving on to some other areas. I think you had mentioned the editorial that talked about technology that was maybe changing its perspective to something that’s not quite the big ogre that the healthcare system continues to perceive technology to be and I know you and I are slightly different I think at least I know I am maybe you’re not different you’re just like everybody else But
wait, I’m not even gonna take that bait. There’s no there’s no way I’m responding to that. Well, I you know,
certainly I work in healthcare IT and have you know, been told sometimes that the tools that I try to help implement and help by doctors and nurses use are not always their favorite and so I’m talking specifically about electronic health records and and you know, healthcare it in general, sometimes has been accused often has been accused of getting in between patients and their and their physicians and caregivers. And
there’s just been this editorial in the Journal of the American Medical Association was simply saying
Hey, we’ve been, we have said these things, we have believed them that technology really has been
a hindrance in some aspect. But boy, oh boy, when there’s a pandemic, it sure is helpful. And so kind of getting a different different perspective without the ability to ramp up telehealth. Of course, people have been doing telehealth for the past couple of years, but at a very, very small scale, and to be able to ramp that up so that people could see their doctors or
from their own homes, not for everything, but for a lot of things. really did. You know, technology really did come in and kind of save the day. So not always the ogre, I think, Well, I know, you certainly are in this camp. And I definitely have, you know, I’ve always believed that technology is the great enabler. And now it’s not
evenly distributed. It’s not even the access that not everybody gets as much value from it. I think that’s a failure in the technology more than anything else. But it’s heartening to hear that, at least there is some recognition. The other sort of data point that I have to that is that if you asked 10 doctors that are using an electronic medical record, okay, we can take this away and put you back to paper notes. I’m pretty sure that 10 physicians are gonna say, No, no, I’ll keep this even though I don’t like it a lot. Because there are some problems with it. I would still rather use this because the value exceeds some of the challenges and pain that I have to endure and the use of it. And I think we just have to fix that, that pain and agony and start to give something that works better for the individual.
Yeah, well, I could not I could not agree more. And no one. Yeah, you’re 100%, right, in that 100% of physicians would say we’ll stick with, we will stick with technology and not ignore the electronic health record. It’s kind of like to me, going back to the days before Google, and almost anything I want to know right now, fat wise, I just go, I just go to my search engine of choice. And I can find the answer to that question. So I still may not know how many angels can dance on the head of a pin. But if I want to know what the atomic number of strontium is, and by the way, I don’t know what it is. But if I wanted to know what it was, I could find it very quickly. And if we were to stop using electronic health records, we would go back to those days where I need to know what happened and I can’t just find out. So 38, just so that, you know, it’s an if you didn’t look that up. The atomic mass is at 7.62.
And it’s a it’s, it has to 818, eight and two electrons per shell. But I just know that off the top of my head. Yeah, yeah, yeah. Well, you paid attention in chemistry. And I think you should be, Oh, I love cameras on it for that. I realized this when I was reading through my old school reports that my parents were kind enough to keep going back to when I was eight years old, actually younger than eight.
And it was very evident that I loved chemistry, albeit I was a little bit of a troublemaker, I had a tendency to double everything, which I do in the kitchen as well. It’s sort of carried through. But that wasn’t a good strategy in the chemistry lab, because it created an awful lot of challenges with some reactions. We had an evacuation courtesy of me one time, it was all to do with chlorine gas. Well,
what’s a little chlorine gas among friends? Really?
Yes.
It was a big ventilation problem anyway.
So I hope the authorities are not listening to this. I’m not sure what the statute of them the statue of limitations and countries comes into play here. So but I was held responsible, but I you know, I take responsibility, because it was definitely my doubling of, of the the content in that particular but that was because I loved it so much. I wanted to see more of the reaction of AI who could who could question you’re really unsure once the cleanup and the fire department went away, everything was good. Yeah, exactly. But I think you’re right. I mean, you know, it’s interesting that you you highlight that when you think back to Days before Google and you know, I do remember that as a search engine. And it replaced I used to carry around I mean, I think bookmarks and the the collection of bookmarks that I copied it in you know files and HTML formats and all the rest of it. That was my Bible have access because I couldn’t remember how to find it. Now. I don’t even care I don’t even know if I have any bookmarks if I even care about them, because it never really it’s not relevant anymore. And I think you know,
That’s true with a lot of information, and I don’t think we’ve quite gotten there with healthcare information. Do you think as a physician, can you get to things just by using decent search at this point? Or is it still, there’s still more work to be done? It’s getting a lot better. So you’re talking about specifically in the EHR, huh? Yeah, you know, there’s a, in many of the major EHR, there is a search box. And it, I think the functionality is getting better and better. So it’s always, I think, easy to type in a word. So if you’re interested in searching for high blood pressure, typing those words in and finding where in the chart that’s mentioned, however, it’s actually a little smarter now. Because of course, if hypertension is mentioned, that’s the same search. And so I need the system to be smart enough to find that a lot of them are, although they are absolutely insanely HTN is how we commonly abbreviate, or in the olden days, abbreviated hypertension. And so yeah, finding those things that is absolutely for those common searches is absolutely doable. And a lot of the bigger ones, yes, but I you know, what I’m interested in, I find a lot of physicians don’t think about it, like they, if they want to know anything from the internet, they go to Google or wherever they want to go and just type it in. And they know, a common misspelling, or, you know, another way of saying it, it’s gonna pop up, because, because science, that’s why. And, and they can do that in a lot of EHR. But for some reason, they they don’t think it’s there and don’t doesn’t work 100% of the time, but 90% is still pretty good.
Yeah, I think it’s there. And I think, you know, that data normalization, and the, you know, the cross referencing with terms that are used, that you would want to find, I think is important, that’s part of that sort of application of natural language processing, which was, you know, very much the artificial intelligence, although it wasn’t called that at the time. But that was very much the sort of purpose, although,
you know, we don’t even necessarily have to tag data as part of the process. It was codify to allow for that in the early days, now, there’s less of a requirement to actually codify the data so that you can get to it, even if you don’t know the right search term to find all the hypertension. Yep. Yep. Yeah. Well, I again, I think, I think the technology is catching up. But I think if you ask most physicians, they will say it’s not.
So that that article in JAMA is
points to one particular instance. But we’ve still got work to do, unfortunately. So the march continues to try and improve the user interface. Closing minute, any thoughts as to how we fix that problem? I mean, what what, what one thing Do you think you could change in the electronic medical record system that would really bring huge impact?
I’ll tell you what I think it would be and it would not be inside the electronic medical record, it wouldn’t be outside it would involve the people that use it, allowing the concept of a care team, I think would be the biggest benefit to the patient and to the physician, allowing others who are not physicians to work at the top of their license and to do things that they have done for
a century, at least decades, and can no longer often do so. Back in the day, I had a medical assistant, and she, she did a lot of work, she would start notes, she would do rapid strep test before I even walked in if the patient met certain criteria. And nowadays, you see that very rarely because of our regulatory system and our legal system. And because most doctors now work for large corporations. So that’s the thing that I would like to see the most and the American Medical Association, believe it or not, has been working to try to make that happen to remove unnecessary administrative burden. So I know your question was about technology, but boy, I think the technology would work much better if people would allow non physicians to help to function in the in the world. Yeah. So physicians to enter data points that could be entered by others. And you know, absolutely. I would say that my, my pitch would be for clinical architects, that are clinicians that understand the workflow, understand the detail that orchestrate and I’m borrowing from a good friend of mine, Dirk Stanley, this is something that he talks about extensively. We have architects involved in building buildings, but you still have a contractor who actually puts it all together. You’ve got the basic ideas, these
The individuals that sit in the middle that essentially translate and understand both ends of that spectrum I think will bring maximum value to optimize the workflow. And, you know, I’m with him on that think, you know, an essential part of our future, but not enough of them around. So we need more of those folks. Anyway, as usual, we’ve run out of time, unfortunately. So just remains for me to thank you, as usual, Craig, for joining me this week. Again, always a pleasure. Thank you.
