This months episode of “News you can Use” in the traditions of “Ask Me Anything” on HealthcareNOWRadio features news from the month of October
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. This month we discuss the latest in VOCIV19 booster guidance as we review who should get a booster and who might want to wait. As with all things pandemic related the answer is never straightforward, in fact this is the case with science in general as our understanding continues to evolve. Craig highlights the concerns around LongCOVID disease that continues to impact people
We break down the different guidance for booster doses for Pfizer, Moderna and Johnson & Johnson/Janssen vaccines taking account of the FDA guidance just released and review the risk reared equation from different perspectives.
We review a recently published article Analysis of Electronic Health Record Use and Clinical Productivity and Their Association With Physician Turnover that looked at click data from physicians use of Electronic Medical Records (EMRs) and the challenge this has to individual privacy and why monitoring and tracking of click data is no as innocent as it first appears.
And Craig highlights a term he heard at the HLTH conference
Minimum Viable Compliance
from the current HHS Health IT Coordinator Micky Tripathi
Ohhh. @mickytripathi1 talks about not falling into the trap of “minimal viable compliance” with respect to info blocking rules. He implores hospitals and medical groups to not aim for lowest possible information sharing. #HLTH2021 pic.twitter.com/gpxkitgdsm
— Craig Joseph, MD (@CraigJoseph) October 19, 2021
Unfortunately we expect that term to stick
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Raw Transcript
Nick van Terheyden
And today as I am each month I’m delighted to be joined by Dr. Craig Joseph is the chief medical officer at Nordic consulting. And as we do each month we feature a news you can use episode. Great. Thanks for joining me today.
Craig Joseph
It’s my pleasure as always, thank you for having,
Nick van Terheyden
though, always a busy time with a lot of things going on. But boosters seems to be the major topic of conversation certainly in the circles that I’m in and with people asking, you’re heading out fuel booster, you think you’d have done it weeks months ago, right?
Craig Joseph
Um, so let’s be clear, we’re not talking about my tetanus shot here, we’re talking about our COVID vaccine booster. And I did mention to you as we were preparing for today’s session that in several hours, I’ll be going for my my Pfizer booster I was eligible about supposed to wait at least six months from the time you got your second. We’re talking specifically about Pfizer now if you got to Pfizer’s then six months after your second one. If you’re in a certain category, then you are eligible for a booster a third. Pfizer at the exact same dose. And yeah, I’m going today, I have done very well with the other two in terms of side effects, hardly any side effects and I’m quite nervous about this one. Because I’ve talked to too many a physician who have done equally well as I have in terms of you know, minimal side effects slowly sort of arm. But I’ve heard a lot of people say that they really did feel the second one other third, I’m sorry that they got some, you know, aches and pains and we’re kind of not in good shape for 12 to 24 hours so I’m prepared for that. I’ve got my my ibuprofen and acetaminophen if I need it. But yeah, I’m going for it. Now I am, I qualify for it for several reasons. If you’re over 65 to qualify, thankfully, I’m not I’m not there yet.
Nick van Terheyden
I was gonna say you’re checking off the boxes here. No,
Craig Joseph
I’m a young, young pop me young pop doctor Nick. I’m only 18 if you believe my fake ID. So if you have certain medical problems, you qualify if you are in a occupation that puts you at higher risk to qualify. I think that’s pretty nebulous, but they’re certainly looking at health care workers, for sure are in that category. But also, I think people that deal with the public and have to be close to the public, which would include both vaccinated and unvaccinated folks. You you’ve qualified. So I I’m a I’m a big proponent, and I’m going for it. And but you know, I’m interested in hearing your, your thoughts. And let’s be clear, though, that the advice that I was just discussing was for the Pfizer vaccine. Janie j is different, as is my journal a little bit? Did you want to go into, you know, maybe discuss what’s what’s the difference between the j&j and Madonna in terms of the booster box?
Nick van Terheyden
Yeah, so I think I’m great discussion, highly topical, because the approvals just went through CDC, and the FDA. And we’re now at the sort of recommendation standpoint. And to be clear, in all of these instances, to be considered fully vaccinated, you still only have to have the original set of vaccines, and that is to for Madonna, and Pfizer, one for Johnson and Johnson, and the relevant period of time after each of those, but they are now recommending, as you rightly described, boosters, or third or second doses, in the case of Johnson and Johnson Johnson, that can be given in the case of the messenger RNA vaccines, so Madonna and Pfizer to that population that you described. So I think that’s true as as you described, over 65. Anybody in you know any of the special populations which is relatively broad that includes if you live with people, you work in a circumstance, all of those things that would contribute, obviously to be done in consultation with your medical provider, Johnson and Johnson Johnson vaccine is the one that’s different and worth calling out briefly. That’s the single dose. It had slightly less vaccine efficacy or V as it’s described online. And the guidance now is for 18 and over should be getting a boost. We’re all second dose, but interestingly can be of any of the other vaccines, including the Johnson and Johnson. So if you had one of Johnson and Johnson, you could go have number two, or you could have a Pfizer or Madonna. There is some interesting papers that show different responses. And mixing and matching has actually been an approved strategy, in part for just pure logistics because it might be challenging. But I think there is also some sense that you get a better immune response for those in our household, we actually have the full selection. So we found all different versions. I personally have the Madonna one. And I’m in a slightly different circumstance for the one family member that is on the Johnson and Johnson, I think the advice is reasonably clear and getting another booster to essentially improve your immune response. And just, I don’t know, give it a notch, I guess, I think makes sense. And, you know, if you look at some of the data that’s emerged, you might pick another messenger RNA, so not the Johnson and Johnson. And there is some differences between but I wouldn’t be sort of pushing hard on any of that. But for me, personally, I’m not in a rush, I will, you know, I’m certainly not resistant to it. And I believe in getting it but I don’t feel a compulsion to race out and get it, I’m happy to get it at the appropriate time. If I feel like I’m in that category. And it’s available, I think there’s wide availability, and in my case, I might go with the same vaccine, or I might go with the Pfizer, which is the other messenger RNA vaccine. But I’m not quite in the same rush, because there was some changes to the dosing specifically with Madonna, they were giving a larger dose, the booster dose is actually 50%. And you are challenging the immune system, we’ve seen some side effects around cardiac issues or in flat inflammation around the cardiac muscle that has specifically gone or seems to target the younger generation. That includes me like you, I, I don’t have a fake ID because I never knew how to get around that they didn’t need one in the UK, I’m just gonna say that that whole thing here just continues to amaze me, but I’m ready to get it but not quite in the same rush. I would push back and say, on you worried? What, why, and why are you not worried?
Craig Joseph
Yeah, it’s a good question. You know, I think the risks are minimal. And the benefits are, are, are there. And, you know, one of the one of the struggles we’ve had for the last year and a half, and we’ll continue to have for a long time is science keeps changing, because we’re learning new things. And some things you can hurry up and try and get results from and others are just going to take time. And, and so you know, I’m certainly I worry, I read about ROM COVID, I read about some of the patients who often have very severe problems, hospitalized and then when they go home for months, or years, are having complaints and concerns that they never had before. And so it seems reasonable to say that that’s related to the disease process. Well, those are typically typically we see long COVID patients who had more severe disease processes already, we also see it and people who had very mild disease, so might have just had a cold and under certain circumstances never would have been tested. Now that there’s COVID, we’re testing all the time as we should and find out Well, I’ve had a minor cold, I have COVID. And I don’t want to, you know, then you’re going to stay home for the prescribed amount of time. Anyway, some of those people, some of those patients have developed one COVID tune. And, you know, that concerns me and I think a lot if you ask me, Hey, did you kind of create a spreadsheet and look at the risks of this versus that? I did not. This is, you know, my perception is and I spent a lot of time looking at this, but not as much as the experts who do this for a living. You know, my perception was, Hey, I am in several of those risk categories. I’m not over 65. That’s true, but I hit a couple of the other ones and I I think the risk is small, but it’s worked, but and the reward is great, and so on. And I’m gonna go for it. And I, you know, I had this conversation as you. As you know, I was at a conference this weekend in the real world that was very exciting and coming home, happened to start talking to the person in front of me, in line, who was not vaccinated, she was happy to share with me, and had a, I had about a 20 minute conversation with her, trying to debunk some of the myths that she was unwittingly propagating to me. And, you know, I, we’ve had some of these conversations before where as a as a pediatrician, I’m very comfortable and telling people about risks versus benefits of of immunizations. And as I’ve mentioned, I think I’m on the show. I’ve had, you know, when parents asked me, Hey, can you promise me guarantee me there will be no side effects? I absolutely cannot, I cannot do that. And in the same sentence, I say, and I also cannot promise or guarantee you that when you drive home, from my office to your to your house, you won’t get into a terrible car crash that can happen that has that. And but that doesn’t mean that I choose or that most of us choose not to get into a car. Because we think the benefits outweigh the risks. And so now, should you wear a seatbelt in the car? Of course you should. If you wear a seatbelt, does that mean you can’t get hurt? The car crashed? Unfortunately, it doesn’t. It drastically improves your odds. But it doesn’t guarantee anything. So yeah, that was the suit. That is the decision I have made. And I think like you I’ve got younger children are old enough that they’ve already all been vaccinated. I am not pushing them. I am not I am not pushing them to go get it. I am pushing them to go get your annual flu shot. Hashtag to get your flu shot. I’ve got my absolutely I ran out to get that as soon as I as I could. So yeah, I’m not pushing them to get it. I suspect that get their boosters. I suspect that they will, at some point. And yeah, that’s where that’s where I’m at. And I do I think it’s worthwhile to say once again, what you already established, you already said, which is you are if you’ve gotten two doses of the mRNA, that the Pfizer or return or one dose of j&j, you are fully immunized, you are fully immunized, all of what we’re talking about now is kind of icing on the cake. And an attempt to to to take your already excellent ads and make them even better.
Nick van Terheyden
I think great points, fascinating to find you interacting with somebody that was not vaccinated for an extended period of time, which I got to say would be a little bit unnerving at best. I think you make a great point relative to the long COVID it’s easy to sort of forget about that unless you’re sort of in the middle of it. And in fact, I did a interview with somebody who will be coming on my show a little bit later on. And he had an has suffered long COVID and a nice we’ve been through cycles of it that were really quite significant. And you know, preventing that is a huge, huge deal. And I know you didn’t produce a spreadsheet, but I think if you did, it might have some risk reward kind of chart that said the older you were, the more likely you are potentially to take one of those boosters because the benefits vastly outweigh It is always a risk reward, discussion and arrangement with yourself. And you know, I hope that people have the real data to be able to do that. For those of you just joining I’m Dr. Nick the incrementalist today I’m talking to Dr. Craig Joseph, Chief Medical Officer for Nordic consulting in our news, you can use addition we will just covering off the boosters and sharing a little bit of our own personal experiences which hopefully will be helpful to others. Moving on to a paper that we both saw and read that I think maybe you had slightly different reactions to I’m curious about yours was the analysis of click behavior in physicians that essentially allowed the researchers to identify physicians who are going to be leaving sooner rather than later. And I had a fairly negative reaction to that because to me, it highlighted the challenge of privacy. And the problem that we have with all this monitoring, it reminded me a lot of the metadata discussion that took place around the sucking up of all of the metadata as it was called around telephone calls. We’re not listening to your calls, but we’re getting all the metadata. Nobody says, Well, I’m not doing anything wrong. And here is a perfect example of why that has problems that you may not anticipate. And in this case, the researchers, I don’t think we’re looking for that, but they identified it. And that now becomes a data point that your institution if they’re tracking all of this, and I’m pretty sure that most are now have information and insights on.
Craig Joseph
Yeah, I, surprisingly, I did not have a negative or a cynical a reaction as you did, which is shocking to me. And I’m a little disappointed in myself. Actually, now that I think about it. I will tell you that my first reaction was to laugh out loud, I tried to think I literally did when I read the abstract. So these were researchers that are looking at how doctors engage with the electronic health record. one specific EHR has tons pretty much every time you click, every time you click the EHR makes it a note of that and can summarize it then. And then those have been opened up to researchers who have been poring over there’s been, there’s probably been at least a dozen articles in the last six months with this particular vendors, data log information. And so again, emphasizing there’s no patient privacy issues, this is really just where I backtrack spending their time in the EHR. And how long are they spending in the in the area where they get messages? And how long are they spending? reading notes? And how long are they spending looking up information. And I think as you point out the researchers, the goal for this study was to see if they could look at burnout, inflammation and predict. We know that physicians are becoming burned out next week many of us are whether it’s clinical or not. But physicians in particular habit and high risk of not wanting to do their job in or long before the before the pandemic and certainly the pandemic has added to that concern. So that was what they were looking for. And Curiously, what they found was physicians who spend less time in the message, I’ll call it the message center in basket, the inbox, whatever you want to call it, that’s been shown to be a major dissatisfied. We can get into that if you if you want later as to why that is. But so what they found was that to spend, and certainly the premise the hypothesis was well, the more time you spend doing this kind of work, looking at test results, looking at other pieces of information, which may or may not be relevant to the care that you’re trying to provide. The more time you spend
Nick van Terheyden
using retro q for a second and say work in inverted commas, but go on
Craig Joseph
work. And we could spend, I could spend, you know an hour talking about why this is and some suggestions for how we can make this better. But be that as it may, what they found was the opposite of what most of us were expecting, what they found was physician to spend, that would be anticipated was physician spent a lot of time doing this work that many of us don’t really think brings a lot of benefit to the patients and don’t don’t really want to do that those would be the people that would be quitting, quitting practice quitting their job going to do something else. And I was faced with the opposite that dogs who spend very little time actually doing this work are the highest risk of leaving, and again, that might be going across the street to a different hospital. Or it might be tiring, you know, kind of checking out from doing that work. And so I laugh because it’s the exact opposite of what I thought they have the thought process no one knows for sure. But the way they explain this after we got the data was well maybe these are Doc’s who are already in their mind checked out. And so they just don’t care for it anymore. And they’re just not going to do it. And again, let me emphasize, we’re not saying that they’re not taking good care of patients. Since we’ve had labs, we’ve had lab results and doctors have looked at those. But now we are in many cases we clinicians, doctors, nurses are inundated with with what is often extraneous information which we’re required are supposed to look at review. And And oftentimes, it’s just it’s just junk mail. And And so yeah, so maybe people are just yeah, I’m not doing the junk mail stuff anymore. I’m just not doing it and and so Your point I never went to where your headwinds, which was, well, now if they’re looking at which I don’t think folks are going to do but yeah, you’re right, that they could they could say, well,
Nick van Terheyden
seems an obvious thing. If you’re now employing people, you’re worried about loss, and, you know, you’ve got all these non compete contracts, it seems an inevitable consequence. I mean, it’s hard for me to imagine somebody’s not directly there. Well, and this may be an initial correlation with people that are already burnt out and checked out. But that doesn’t matter if this is data that serves you and you know, gives you information. It’s just very troubling. To me that that’s the case, you
Craig Joseph
know, again, I tend to be the most cynical person I know. And I’m sad that I’m disagreeing with you on this and being more positive and upbeat. I do know. Because if you just look at it from dollars and cents, almost always, it’s much cheaper for an organization to retain a physician than it is to replace that physician. And so I one could take a more positive view and say, Okay, well now we’ve identified Doc’s that are at high risk for leaving the Leaning practice or going to a different hospital, we should now throw more resources at them to try to make their lives better and convince them that to do that, too,
Nick van Terheyden
because a DEF CON DEF CON neck, evil knee goes, Oh, great. So now there’s an opportunity to gain the system, I’m going to spend less time in the message center, because what that will mean is that the institution is potentially going to give me a more favorable contract. I mean, I it just involves me, because not the way that we incentivize and create the best possible healthcare. I mean, I’m respectful of, you know, intent. But the problem is when this stuff becomes available, you only have to go to debt. I wish everybody could go to DEF CON at least one time, because you would see, and it is extremes, but it’s extremes that demonstrate the challenge with this absolute power corrupts absolutely.
Craig Joseph
It’s just what are you gonna do? Yeah, again, let the tracks to the auditor myself for not going there. And I don’t know how I’ve been so optimistic. And I’ll try and I’ll try and improve my wait.
Nick van Terheyden
No, please don’t. It’s good to flip roles occasionally. My house is always full, as I’m always heard to
Craig Joseph
be you are you’re very optimistic and
Nick van Terheyden
Vikas is always full, it’s half full of whiskey half full of that we’ve we’ve established that very clearly throughout all of the episodes in all of my postings. So fair enough. Fair enough. We’re almost out of time, if you’ve got just the briefest of comments about minimal viable compliance.
Craig Joseph
Yeah, I wanted to I was a term so as we mentioned, I was at the health conference, and that’s h l th, because they couldn’t afford the two vowels B health conference in Boston. And it was my first one, and it was great. And a term I heard that I never heard before, which I wanted to share was minimal viable compliance. Certainly, we’ve heard many of us in involved in startups or, you know, Silicon Valley talking about minimal viable product, meaning what’s the one of the least number of features and functionality that I can sell to get this thing on the market? And then we’ll make it better from there minimal viable compliance was the concept that I heard about a hospital hospital systems and helps health systems saying, hey, what is the requirement? What is the regulation say, we absolutely have to do we’re going to do that. We’re not going to do anything more. So for information sharing, you know, let’s, let’s find the the things that we absolutely have to share. We’re going to share that we’re not going to go with Hey, well, it would be nice to do that. Or that might be the intent of the people who made this law or regulation. So yeah, I the the National Coordinator for Health Care it Nikki Tripathi was at the health conference and he was really asking systems to not take that approach and to really share all the information that they can share and not try to find the minimal viable compliance from a wireless or regulatory standpoint. So
Nick van Terheyden
I thought it was a great term but it’s a very sad very sad I think it’s a it’s useful shorthand to call people out for what is you know, I think in in Mickey Tripathi, his view is his misbehavior. It’s it’s, you know, behaving with less than the best intentions for the patient. Unfortunately, as We always do we’ve run out of time just remains for me to thank you as always for joining me and wishing you the best for your booster dose that you are about today.
Craig Joseph
Thank you And yes, your positive energy to me. I am a male, which means I don’t deal well with adversity when it comes to aches and pains. And so I do need thoughts and prayers.
