New JAMA Network site offers daily insights on hot health care issues

With voting for the 2020 presidential race officially underway, health care will again take center stage in the political and policy discussion. To meet the need for “high-quality content to inform the debate about the future of health care in the United States and globally,” JAMA Network™ has launched JAMA Health Forum™, a new way “to assemble and highlight health policy content from the JAMA Network with interpretive commentary and analysis.”

My latest for the AMA. The whole shebang.

Why physicians’ use of digital health is on the rise

Physician use of technology to provide televisits or virtual visits has doubled since 2016, with nearly 30% of doctors adopting the digital health technology, according to an AMA survey of 1,300 physicians.

The survey found that rising shares of physicians are using many digital health tools to enable:

  • Consumer access to clinical data—58%.
  • Point of care or workflow enhancements—47%.
  • Clinical decision support—37%.
  • Patient engagement—33%.
  • Remote monitoring and management for improved care—22%.
  • Remote monitoring for efficiency—16%.

Nearly 90% of doctors see at least some advantage in digital health tools, and more doctors are likely to see a definite plus to using them. That’s more likely to be the case among primary care physicians, 40% of whom see the sure upside in these digital health tools, compared with 33% of specialists—a change from the 2016 results.

My latest for the AMA. The whole shebang.

Tracking the Wuhan coronavirus: 5 things doctors must know

A man hospitalized in Everett, Washington, has been diagnosed with the 2019 novel coronavirus (2019-nCoV) after returning to the U.S. from travels to Wuhan, China, the city of 11 million people. At this article’s deadline, the infectious respiratory disease had already killed 18 people and spread to nine countries since first being identified last month.

Because there’s so little known so far about 2019-nCoV, there’s no vaccine or specific treatment available and the care is primarily supportive rather than curative. The World Health Organization is declining, for now, to declare a public health emergency of international concern but will meet again in early February and has offered recommendations to China and other countries.

My latest for the AMA. The whole shebang.

New Jersey rejects bill to weaken doctors’ role as care team leaders

Lawmakers in New Jersey this week opted against moving forward with legislation that would have allowed advanced practice registered nurses (APRNS) to prescribe without any physician oversight. The legislation (Senate bill 1961 and the identical Assembly bill 854) would have also given APRNs full signatory authority, meaning they could have signed off on any document requiring a physician signature by law.

The New Jersey Senate’s health committee moved the bill to the floor in June 2019, but the state’s physicians were able to persuade lawmakers against taking up the bill to weaken the physician-led health care team during the 2018–2019 legislative session that closed Monday. Most states do not allow APRNs to prescribe independently.

My latest at the AMA. The whole shebang.

Distracted driving: Most states aren’t cracking down on deadly practice

Eight Americans are killed every day in a car crash involving a distracted driver, and more than 1,000 are injured daily in such accidents, says the National Highway Traffic Safety Administration. Six percent of drivers in fatal crashes were distracted at the time, the NHTSA says, yet most states are coming up short when it comes to cracking down on a major cause of distracted driving.

While 48 states bar texting and driving, only 20 states ban drivers from using hand-held cellphones entirely while operating a motor vehicle, according to the Insurance Institute for Highway Safety.

My latest for the AMA. The whole shebang.

Vaping: Move to ban some flavors only 1st step in addiction fight

Amid pressure from the AMA and other physician and public health organizations, the Trump administration is moving to ban the sale of flavored e-cigarette cartridges used in closed system e-cigarettes such as those made by Juul, a subsidiary of Marlboro owner Altria Group Inc.

However, the new Department of Health and Human Services (HHS) announcement leaves untouched—for now—the sale of tobacco- or menthol- flavored cartridge-based products, as well as open systems in which users refill their e-cigarette devices with exotic flavors of nicotine juices widely sold at vaping shops.

The “new policy to address the youth e-cigarette epidemic by limiting flavors in some vaping products is a step in the right direction, but does not go far enough,” said AMA President Patrice A. Harris, MD, MA. “The AMA is disappointed that menthol flavors—one of the most popular—will still be allowed, and that flavored e-liquids will remain on the market, leaving young people with easy access to alternative flavored e-cigarette products.”

My latest for the AMA. The whole shebang.

Latest ACA ruling: What it means now for doctors, patients

The 5th U.S. Circuit Court of Appeals has ruled in the case of Texas v. United States that the Affordable Care Act’s individual mandate provision is unconstitutional. While that ruling affirmed a portion of the decision by the U.S. District Court for the Northern District of Texas, the appeals court did not go along with district court ruling vacating the entirety of the ACA, which has expanded health insurance coverage for tens of millions of Americans.

Instead, the appeals court has remanded the case to the district court to further analyze which of the ACA’s many vital provisions remain constitutionally valid.

The “decision leaves important health insurance protections shrouded in uncertainty despite overwhelming public support for these policies,” said AMA President Patrice A. Harris, MD, MA. “The decision underscores that the district court’s initial ruling striking down the entire ACA was made without appropriate analysis, ignoring the extensive reach of the law and its many provisions that have no relationship to the individual mandate.”

Read the whole shebang at the AMA.

Physicians have duty to monitor their own competence

Physicians’ ethical responsibility to provide competent care is fluid and context-dependent at different phases of their careers, according to an AMA Council on Ethical and Judicial Affairs report adopted at the 2019 AMA Interim Meeting.

“The ethical responsibility of competence requires that physicians at all stages of their professional lives be able to recognize when they are and when they are not able to provide appropriate care for the patient in front of them or the patients in their practice as a whole,” says the report.

My latest for the AMA. The whole shebang.

How border conditions threaten our nation’s decency, health

AMA President Patrice A. Harris, MD, MA, has issued a clarion call to the country to avoid turning a blind eye to the inhumane conditions among people claiming asylum at the U.S.-Mexico border who are being held in detention: open toilets, around-the-clock lighting, not enough food and water, extreme temperatures, severe overcrowding and no access to basic hygiene.

“Our nation cannot turn our backs on the thousands of children and families whose lives have been torn apart by our government’s draconian approach to immigration; this will have negative physical and mental health impacts for generations to come. To ignore this crisis is to lose sight of the humanitarian values and decency that comprise the core of the American experience,” Dr. Harris wrote in an op-ed published today on the Healthline website as the AMA House of Delegates gathers at the 2019 AMA Interim Meeting held in that border city.

My latest for the AMA. The whole shebang.

Google-Ascension deal comes as concerns rise on use of health data

Google and the 2,600-hospital Ascension health system are collaborating on an effort—dubbed Project Nightingale—that puts identifiable patient data in the hands of the tech giant’s engineers for use in projects on machine learning (ML) and augmented intelligence (AI), often called artificial intelligence.

Google and Ascension say the activities, first reported by Rob Copeland of The Wall Street Journal, are covered by a business associate agreement, which is a long-standing, and legal, way for health care providers to share identifiable data with third parties under the Health Insurance Portability and Accountability Act (HIPAA).

The third parties may only use the data for certain purposes and must protect it as HIPAA requires. Failure to do so can result in direct liability for the business associate. The Department of Health and Human Services’ Office of Civil Rights has announced that it will seek to learn more to ensure that HIPAA protections were fully implemented.

My latest for the AMA. The whole shebang.

New research links hard-to-use EHRs and physician burnout

The electronic health record (EHR) systems now used in the vast majority of U.S. hospitals and physician offices get an average grade of “F” on the usability scale in the results of a newly published survey of nearly 900 doctors. Given that EHR work gobbles up as much as two hours of physicians’ time for every one hour they spend delivering patient care, that result is grimly unsurprising.

After researchers adjusted for physician respondents’ age, gender, medical specialty, practice setting, and hours worked, they found that how well doctors rated their EHRs’ usability was “independently associated with the odds of burnout,” according to a study published today in Mayo Clinic Proceedings.

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