April 4th, 2011 by RyanDuBosar in News, Research
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Improving handoffs from the emergency room back to the primary care physician will require changing how electronic health records are used, better reimbursement to both the hospital and ambulatory doctors, and malpractice reform, according to a study. The rising use of hospitalists and larger primary care practice sizes has contributed to the difficulties faced when an ER doctors tries to reach a physician who best knows the patient.
Haphazard communication and poor coordination can undermine effective care, according to a new research conducted by the Center for Studying Health System Change. Researchers conducted 42 telephone interviews between April and October 2010 with 21 pairs of emergency department and primary care physicians, who were case-matched to hospitals so the perspective of both specialties working with the same hospital could be represented.
Among the findings in the report, telephone communication was essential in some cases, but particularly time-consuming. Both emergency and primary care physicians reported successful completion of each telephone call often required multiple pages and lengthy waits for callbacks. While placing and receiving telephone calls might seem straightforward and quick, providers said each small action multiplied across dozens of patients can become a daunting burden, with little immediate reward or reimbursement. Read more »
*This blog post was originally published at ACP Hospitalist*
April 3rd, 2011 by RyanDuBosar in News
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Patients may not want to discuss clinical matters via social media, but they’d gladly set pay their bills when reminded. Social media’s value in communicating with patients is limited to the administrative aspects of it.
Americans still want traditional ways of communication when they need a clinical consult. A survey finds 84% would not use social media or instant messaging channels for medical communication if their doctors offered it, according to the communications firm Capstrat.
Respondents were more favorable toward conferring with the doctor via e-mail (52%) than they were by Twitter and Facebook (11%), chat or instant messaging (20%) or a private online forum (31%).
Even among those 18 to 29 years old, 21% said they would take advantage of an online forum if their doctor offered it, while 72% would take advantage of a nurse help line if available.
Respondents said they’d take advantage of online appointment scheduling (52%), online access to medical records (50%), or online bill payment (48%).
“It appears consumers are willing to move administrative experiences such as bill payment and records access online, but when it comes to conferring with their health care providers, people still prefer more traditional communications,” said the firm’s president, Karen Albritton, in a press release. “The implications include a way for doctors to free up more time for their patients by moving the right interactions online, and an opportunity to forge stronger connections through personal interaction.”
Patients want the same convenience of online appointments and bill paying from their doctor that they get in other areas of their lives, reports a second survey.
73% of those surveyed would use a secure online option to get lab results, request appointments and pay medical bills. The first caveat is that this survey was done by Intuit. The company is best known for QuickBooks, but its health care division offers patient portals for doctor’s offices. The second caveat is that respondents were surveyed online, which would skew results to people digitally inclined anyway.
With those two caveats in mind, the survey also found that:
–Almost half would consider switching doctors for a practice that offered online access.
–81% would schedule their own appointment via a secure Web service and fill out medical/registration forms online prior to their appointment.
–78% would use a secure online method to access their medical histories and share information with their doctor.
–59% of generation Y respondents said they would switch doctors for one with better online access, compared to only 29% of baby boomers.
–45% of patients wait more than a month to pay their doctor bill, and when they pay, half still send a paper check in the mail.
*This blog post was originally published at ACP Internist*
March 7th, 2011 by Debra Gordon in Health Policy
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The latest from moi: “Implementing Electronic Medical Records: Advice from the Trenches” in the March/April 2011 issue of HIT Exchange magazine. An excerpt:
The news released in late December from the Centers for Disease Control and Prevention that more than half of the nation’s physicians are now using electronic medical records (EMR)—double the adoption rate of just five years ago—is surely worth celebrating. Until, that is, you take a look and realize that just a fourth of office-based physicians have access to a “basic” EMR system including patient history, demographics, problem lists, clinical notes, and computerized physician order entry (CPOE), while just one in 10 has a “fully functional” system, which also includes the communication system required for meaningful use, such as the ability to send tests and prescriptions electronically.
But the floodgates are about to open. In January, the Centers for Medicare & Medicaid Services (CMS) began registering physicians and hospitals in 11 states for the EMR incentive program announced in 2009 as part of the federal stimulus package. Registration for California began in February, and the rest of the country should be up and running by the end of the year. Physicians could be eligible for up to $44,000 in bonuses over five years through Medicare and up to $63,750 over six years through Medicaid.
*This blog post was originally published at A Medical Writer's Musings on Medicine, Health Care, and the Writing Life*
February 25th, 2011 by Peggy Polaneczky, M.D. in Opinion, True Stories
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A pathologist uses the EMR to find out just a little more about the patient whose cerebro-spinal fluid she has under her microscope — and changes her diagnosis:
This patient had a diagnosis of plasma cell myeloma with recent acute mental status changes. So the lone plasma cell or two I was seeing, among the lymphs and monos, could indicate leptomeningeal spread of the patient’s disease process. I reversed the tech diagnosis to atypical and added a lengthy comment – unfortunately there weren’t enough cells to attempt flow cytometry to assess for clonality of the plasma cells to cinch the diagnosis. But with the information in the EMR I was able to get a more holistic picture on a couple of cells and provide better care for the patient. I cringe to wonder if I might have blown them off as lymphs without my crutch.
The much-hoped-for improvement in quality due to the adoption of EMRs has been elusive to date, so anecdotal experiences like this will be important evidence to consider in judging the impact of the EMR on healthcare outcomes.
Kudos to pathologist Gizabeth Shyner, who writes over at Mothers in Medicine and her own blog, Methodical Madness, for “thinking outside the box.”
*This blog post was originally published at The Blog That Ate Manhattan*
February 7th, 2011 by EvanFalchukJD in Opinion, True Stories
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Some people may tell you that healthcare IT will solve many of the quality and cost problems in healthcare. I don’t believe them.
I know a 70-year old man named Carlos (not his real name) who was hospitalized following a bout of hydrocephalus. Hydrocephalus is a build-up of fluid in the skull, which affects the brain. Among other things, people with hydrocephalus can be confused, irritable, and nauseous. Carlos had all of these symptoms.
Carlos’ problem was fixable by inserting a special kind of drain in his head called a “shunt.” This kind of shunt is, essentially, a series of catheters that runs from the brain into the abdomen, and which drain the excess fluid. You can’t see it from the outside, so it’s meant to stay inside of you for a very long time.
For a week after Carlos’ shunt was installed, his symptoms completely disappeared. But they soon started to re-emerge. Worried, his family took him to the hospital. Doctors found that his hydrocephalus was back — the shunt wasn’t draining properly. They admitted him to the hospital, and the next day they put in a new shunt. The surgery went well.
But again, about a day later, he started to have the same kinds of symptoms. The doctors sent him for a CT scan, which showed, to their surprise, no problems with the shunt. Unsure of what to do, they decided to wait and see if the symptoms resolved. It was possible, they thought, that the symptoms were from the quick drainage of fluid through the shunt. Read more »
*This blog post was originally published at See First Blog*
