March 22nd, 2009 by RamonaBatesMD in Better Health Network
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This isn’t really plastic surgery related, but considering that I am always trying to get patients to get more active or to remain active, then maybe it is. I like to tell my patients that I have the easy part, they have the hard part of maintaining the results. This is especially true for the liposuction or abdominoplasty patients where keeping their weight in line is an issue to outcome in years to come.
There is a new article published in Circulation: Journal of the American Heart Association earlier this week which looked at different types of exercise after a myocardial infarction (MI).
The authors, Dr Margherita Vona et al, did a controlled trial using 209 patients who were referred to cardiac rehabilitation after having an MI. These patients were then randomly assigned to one of four groups: aerobic training, resistance training, both combined, or no exercise.
The researchers looked at flow-mediated dilation (improve blood vessel function) at baseline after 4 weeks of exercise, and then again one month after stopping training. The flow-mediated dilation more than doubled with exercise, from about 4% to about 10% in all three exercise groups. Those in the no exercise group had a small increase from the baseline 4% to about 5%.
The benefits of physical activity did not last when the activity ended. Within a month of no exercise, the flow-mediated function returned to baseline levels.
The important finding of this study is as Dr Vona said, “Long-term adherence to training programs is necessary to maintain vascular benefits on endothelial function.”
Exercise / physical activity has to be like “brushing your teeth”. It needs to be something that you do regularly and not just once or this week, but for life.
It is not important which physical activity you choose to do, it is important that you do it. It is important that you continue to be physically active on a regular basis.
Source
“Effects of different types of exercise training followed by detraining on endothelium-dependent dilation in patients with recent myocardial infarction”; Circulation 2009; DOI: 10.1161/CIRCULATIONAHA.108.821736; Vona M, et al
**This blog post was originally published at Suture For A Living.**
March 21st, 2009 by DrRob in Better Health Network
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Electronic Medical Records are coming. The economic stimulus bill (furious spinning kittens notwithstanding) assured this.
Under the terms of the bill, CMS will offer incentives to medical practices that adopt and use electronic medical records technology. Beginning in 2011, physicians will get $44,000 to $64,000 over five years for implementing and using a certified EMR. The Congressional Budget Office projects that such incentives will push up to 90 percent of U.S. physicians to use EMRs over the next 10 years.
Practices that don’t adopt CCHIT-certified EMR systems by 2014 will have their Medicare reimbursement rates cut by up to 3 percent beginning in 2015.
(From Fierce Health IT)
There will be even more money for implementation. We look forward to our checks (and are not counting on them yet).
Now it is time for the flies to start gathering. Wherever there is lots of money, “experts” pop up and new products become available that hope to cash in. Doctors, who are never lauded for their business acumen, will be especially susceptible to hucksters pushing their wares. It seems from the outside to be an simple thing: put medical records on computers and watch the cash fly in.
Anyone who has implemented EMR, however, can attest that the use of the word “simple” is a dead giveaway that the person uttering the word in relation to EMR is either totally clueless or running a scam. It’s like saying “easy solution to the Mideast unrest,” “obvious way to bring world peace,” or “makes exercise easy and fun.”
Run away quickly when you hear this type of thing.
Just like becoming a doctor is a long-term arduous process, EMR implementation happens with time, planning, and effort. It’s not impossible to become a doctor, but it isn’t easy. With EMR adoption, the most important factor in success is the implementation process. A poorly implemented EMR isn’t simply non-functional, it makes medical practice harder. A well implemented EMR doesn’t just function, it improves quality and profitability.
How do I know? Our practice ranks very high for quality (NCQA certified for diabetes, physicians are consistently ranked high for quality by insurers), and we out-earn 95% of other primary care physicians. EMR allows us to practice good medicine in a manner that is much more efficient.
So how’s a doc to know who to trust? What product should he/she buy and whose advice about implementation should they follow? There are many resources out there. Here are a few I think are especially worthwhile:
- Buy a product that is certified by Certification Commission for Health Information Technology. CCHIT is a government task force established to set standards for EMR products. Its goal is to allow systems to communicate with each other and enable more interfaces in the future. The bonuses for docs on EMR are contingent on the system being CCHIT certified (think of it as something like the WiFi standard).
- The American Academy of Family Physicians’ Center for Health Information Technology and the American College of Physicians both have tools to help member physicians decide on an EMR. Your own specialty society may, too.
- Several professional IT organizations have programs to improve EMR adoption, including HIMSS and TEPR.
- Austin Merritt has written a good article of advice on his website Software Advice that underlines the importance of implementation.
The best advice I can give, however, is to visit a doctor’s office who is using an EMR successfully. This office should be as close in make-up to your office as is possible. You should be able to look at how they do it and see yourself in that situation. Never buy a product before visiting at least one office like this (no matter how good the sales pitch). When you visit, make sure you ask them about the implementation process. How did they do it and how hard was it?
Which EMR do I recommend? Remember, I have been on EMR for over 12 years, so haven’t had much of a chance to shop around. You hear raves and horror stories with every product. Here is some basic advice:
- Get a solid CCHIT-approved brand that has been around for a while
- Don’t pay as much attention to price as you do function. Since the EMR will be absolutely central to the function of your office, it is a dumb mistake to overly-emphasize cost.
- Realize you are paying for a company, not just a product. It is not like buying a car, it is more like having a child or getting married. REALLY research that side of things. A good EMR with a bad company behind it should be avoided like the plague.
- See how connected the user-base is as well. A solid user group will do much to make up any deficiencies in the product and/or company.
So much time is spent shopping over EMR products, but buying an EMR is like being accepted into Medical School; your work is just beginning. That’s OK, because like medical school, the effort put in gives a very worthwhile product.
**This post was originally published at Dr. Rob’s blog, Musings of a Distractible Mind.”
March 20th, 2009 by Dr. Val Jones in Health Policy
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What would it be like to have most of healthcare’s key stakeholders in one room, and allow each of them to take turns at a podium in 3 minute intervals? It would be like the meeting I attended today at the Institute of Medicine.
The goal of this public forum was to allow all interested Americans to weigh in on prioritization rankings for comparative clinical effectiveness research (CCER). CCER, as you may recall from my recent blog post on the subject, is the government’s new initiative to try to establish “what works and what doesn’t” in medicine. Instead of answering the usual FDA question of “is this treatment safe and effective?” We will now be asking, “is this treatment more safe or more effective than the one(s) we already have?”
There are many different treatments we could study – but let’s face it, 1.1 billion isn’t a whole lot when you consider that some CCER studies (like the ALLHAT trial) cost upwards of 100 million a piece. So we have to think long and hard about where to channel our limited resources, and which treatments or practices we want to compare first.
The public forum attracted most of the usual suspects: professional societies, research organizations, industry stakeholders, health plans, and advocacy groups. But the imposed time limit forced them to really crystallize their views and agendas in a way I’d never seen before.
I “live-blogged” the event on Twitter today and if you’d like to see the detailed quotes from all the presenters, feel free to wade through the couple of hundred comments here.
For those of you more interested in the “big picture” I’ll summarize my take home points for you:
Almost everyone agreed that…
- The process for establishing research priorities should be transparent and inclusive of all opinions.
- More information is good, and that CCER is a valuable enterprise insofar as it provides greater insight into best practices for disease management.
Most agreed that…
- Preventive health research should be a priority – so that we can find out how to head off chronic disease earlier in life.
- CCER should be considered separately from cost effectiveness decisions.
- One size doesn’t fit all when it comes to patient needs and best disease treatments.
- Physicians should be included in the CCER research and clinical application of the findings.
- Research must include women and minorities.
- CCER should not just be about head-to-head drug studies, but about comparing care delivery models and studying approaches to patient behavior modification.
- CCER should build upon currently available data – and that all those who are collecting data should share it as much as possible.
Some agreed that…
- There is a lack of consistent methodology in conducting CCER.
- We need to be very careful in concluding cause and effects from CCER alone.
The best organized 3 minute presentations:
In my opinion, the industry folks had the best presentations, followed by a powerful and witty 3 minutes from the American Association for Dental Research. Who knew the dentists had such a great sense of humor? Here are the top 4 presentations:
#1. Teresa Lee, AdvaMed – best all around pitch. In three short minutes, Teresa persuasively argued for transparency in CCER priority-setting, presented her top disease research picks (including hospital acquired infections and chronic diseases like asthma, diabetes, and clinical depression), the importance of physicians and patients making shared decisions about care (rather than the government imposing it), and the need to distinguish CCER from cost effectiveness.
#2. Randy Burkholder, PhRMA – “Without physician input, the questions we pose via CCER will not be clinically relevant.”
#3. Ted Buckley, BIO – “What’s best for the average patient is not necessarily best for every specific patient.”
#4. Christopher Fox, American Association for Dental Research – he said that “his good oral hygiene made it possible for him to deliver his presentation today.”
Most innovative idea
Dr. Erick Turner of Oregon Health and Science University suggested that FDA trial data be used as the primary source of CCER-related data analysis rather than the published, peer-reviewed literature since journals engage in publication bias – they tend to publish positive studies only.
Most shocking moment
Merrill Goozner, from the Center for Science In The Public Interest, essentially told the public forum hosts that the event was a terrible idea. He suggested that industry stakeholders were inherently biased by profit motives and should therefore not be allowed to influence the IOM’s CCER priority list. The crowd squirmed in its seats. For me, Merrill’s suggestion was like saying that a plan to reform the auto industry should exclude car manufacturers because they have a profit motive. Sure profit is a part of it, but reform is just not going to happen without buy in and collaboration. As I’ve argued before – there’s no such thing as complete lack of bias on anyone’s part (patients, doctors, nurses, dentists, health plans, advocates, or industry). The best we can do is be transparent about our biases and include checks and balances along the way – such as inviting all of us biased folks to the table at once.
I’m glad that happened.
