June 30th, 2011 by admin in Health Policy, Opinion
Tags: Adoption, Design, Disparities, EHR, Electronic Medical Records, Health Outcomes, Healthcare Disparities, HITECH, Meaningful Use, NIST, Patients
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According to Kendra Blackmon at FierceEMR.com and a new study published by the National Institute of Standards and Technology (NIST), the answer is maybe.
Earlier this year, NIST published a report – Human Factors Guidance to Prevent Health care Disparities with the Adoption of EHRs – which declares that “wide adoption and Meaningful Use of EHR systems” by providers and patients could impact health care disparities.
Making this happen, however, will require a different way of thinking about electronic health records (EHRs). While the report notes that EHRs primarily are used by health care workers, patients still interact with these systems both directly – such as through shared use of a display in an exam room – and indirectly. For patients to obtain the intended benefits of this technology, EHR systems should display or deliver information in a way that is suitable for their needs and preferences, the report says. Read more »
*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*
June 30th, 2011 by admin in Opinion
Tags: App, Dosage Calculator, Drug Names, iPhone, JCAHO, Not Ready For US Market, PALS, Pediatric Emergency Drugs, Pediatrics
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Pediatric Emergency Drugs is designed to be a quick med list calculator for pediatric emergencies. For folks who deal with pediatric emergencies have the challenge of not only determining the proper drugs to use, but also to get the dosage right by age.
At the first page you are met with a screen to enter the age of the child and either allow the program to pick the estimated weight or put your own weight in. This is a nice feature as often in pediatric emergencies patients arrive through the door needing immediate care and a weight is unavailable. The estimated weight it appears to pick is the 50% for a boy of the selected age. Allowing you to pick the gender of the child would be helpful in narrowing down the weight a little further since girls of a given age would weigh a little less. Another option would be to allow the use of Broselow colors. These days the standard for most ERs is the Broselow tape which is a plastic foldable tape that doses based on length.
Once you select your patient you have a section of drugs broken down into: cardiac arrest meds, infusions, and bolus drugs. The cardiac arrest meds are short a few drugs. There are no drugs for treating ventricular fibrillation (amiodarone) and they do not make mention of the dose of electricity for synchronized cardioversion (only for defibrillation). The infusion list assumes you are mixing all drugs in 50mL bags which is not usually the case. (we usually use 100 or 250mL bags for drips). Also, in America thanks to JCAHO regs medicated infusions need to be have standardized concentrations and not use the “rule of 6” employed by this program. The list of bolus drugs is missing a few key drugs as well such as midazolam and hydrocortisone for sepsis. Read more »
*This blog post was originally published at iMedicalApps*
June 30th, 2011 by Bryan Vartabedian, M.D. in Opinion
Tags: Cocktail Party, Doctors, Social Media, Twitter
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There’s a temptation to think of Twitter as it once was. As recently as 3 years ago there were very few physicians using Twitter. Early physician adopters enjoyed a tighter experience than today. Everyone followed everyone and actually finding another doctor was cause for celebration. It was a cocktail party – less a tool as much as a place to goof off. It was easier in many respects.
But Twitter seems to be evolving from a curious toy to a more focused space of sharing among the like-minded. I see new docs play out this broader evolution of Twitter: near obsessive early preoccupation gives way to the question of how it can actually work for them. Experimentation with relationships gives way to connections that are more likely to give us what we really need.
We’ve hit a point where many physicians on Twitter are looking beyond the cocktail party. There are simply too many of us. As a consequence of nothing other than our numbers, we’re increasingly divergent. Values, interests, and motivations vary – we gravitate to the like-minded. In some respects Twitter’s evolving practicality is a good thing. But it comes with a cost. I don’t know how and if it can be countered.
As much as Twitter is different now compared to 3 years ago, don’t get used to it. Things never stay the same.
*This blog post was originally published at 33 Charts*
June 29th, 2011 by Elaine Schattner, M.D. in Health Policy, Opinion
Tags: Bending The Cost Curve, Clinical Trials, CTS, Empowered Patient, Excessive, Informed Consent, NEJM, Oncology, Patient Autonomy, Surveillance Tests
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This is the second in a series of posts on Bending the Cost Curve in Cancer Care. We should consider the proposal, published in the NEJM, gradually over the course of this summer, starting with “suggested changes in oncologists’ behavior,” #1:
1. Target surveillance testing or imaging to situations in which a benefit has been shown. This point concerns the costs of doctors routinely ordering CTs, MRIs and other imaging exams, besides blood tests, for patients who’ve completed a course of cancer treatment and are thought to be in remission.
The NEJM authors consider that after a cancer diagnosis many patients, understandably, seek reassurance that any recurrence will be detected early, if it happens. Doctors, for their part, may not fully appreciate the lack of benefit of detecting a liver met when it’s 2 cm rather than, say, just 1 cm in size. What’s more, physicians may have a conflict of interest, if they earn ancillary income by ordering lab and imaging tests.
My take:
It’s clear that some and possibly most cancer patients get too many and too frequent post-treatment surveillance tests. Read more »
*This blog post was originally published at Medical Lessons*
June 28th, 2011 by Dr. Val Jones in Opinion
Tags: ABPMR, Diagnostician, Good, Healthcare Costs, Oral Exam, Physical Exam, Physical Medicine And Rehabilitation
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I’ve often heard physicians say that “the history is 90% of the diagnosis.” In other words, they can usually determine the underlying cause of a patient’s problem just by listening to their account of how it evolved. The physical exam is merely to confirm the diagnosis, and is often cursory, limited, or ignored.
I believe that the physical exam is far more important than it seems – and I learned this during my recent oral medical specialty board examination. Although I have been sworn to secrecy regarding the content of the test questions, I will share an epiphany that I had during the exam.
The examiners’ job is to describe a patient and then ask the examinee what else she’d like to know and what she’d do next. With each description, I found myself struggling to visualize the patient – wishing I could see their face and hear their tone of their voice as they described their condition. I hadn’t realized that so much of my clinical judgement was based on laying eyes on a patient – I needed to see if they were in pain, if they were straining to breathe, if their skin was pasty or pale, if they were disconnected and potentially drug-seeking, if they were fidgety, if they were articulate, forgetful, or well-groomed. All of these subtle cues were gone. I was left staring at the examiner – who himself couldn’t describe the patient more fully because he was to stick to the script, reading verbatim from a prepared list of signs and symptoms. Read more »
