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Tag: Annals of Internal Medicine

Electronic Health Records. Are We There Yet? What’s Taking So Long?

I am a family physician, but one who doesn’t currently practice and importantly, one who isn’t slogging day after day through health care transformation. I do not want to be presumptuous here because the doctors and other health professionals who are doing this hard work are the heroes. They are caring for patients while at the same time facing tremendous pressure to transform their life’s work.  That includes overwhelming pressure to adopt and use new information technology.

This level of change is hard, difficult and confusing—with both forward progress and slips backward. Nevertheless, doctors take heart because you are making progress. It may be slow at times, but it’s substantial—and it’s impressive. Thank you.

The Annals of Internal Medicine today published a study (I was one of the authors) finding that more than 40 percent of U.S. physicians have adopted at least a basic electronic health record (EHR),  highlighting continued progress in the rate of national physician adoption of EHRs. The study, also found that a much smaller number, about 9.8 percent of physicians, are ready for meaningful use of this new technology.

Some might say, “Wake up, folks!”   Look at those small meaningful use numbers.  Change course, now.  After all of this time and tax-payer expense, less than 10 percent of doctors are actually ready to use these important tools meaningfully. What’s up with that?

To me, though, this study is good news. All who care about health care transformation should be heartened by the progress—but also impressed by the enormous challenge that our health professionals have undertaken.

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Building a Better Health Care System: Why the Next Blockbuster Drug Probably Won’t Be a Drug at All

A recent meta-analysis published in the American Journal of Clinical Nutrition suggests that coenzyme Q10 is of benefit in congestive heart failure. For those who like the idea that food and nutrients can be excellent medicine, this paper is interesting at the very least. But there is a case to be made that it is far more than that. There is a case to be made that it is, in a word, miraculous.

For resurrection, after all, is a miracle. And according to a paper published in the Annals of Internal Medicine in April of 2000, coenzyme Q10 for heart failure was a dead concept. The authors reported 13 years ago that “coenzyme Q10 has been studied in randomized, blinded, and controlled studies and … these studies have found no detectable benefit” and that “coenzyme Q10 should not be recommended for treatment of heart failure.”

The final nail had been driven into the CoQ10-for-heart-failure hypothesis 13 years ago — and yet now, it’s back. If that’s not a miracle — then what is going on?

First, a bit of relevant orientation. The condition in question here, congestive heart failure, occurs in particular in the aftermath of one or more heart attacks (myocardial infarctions) which cause portions of the heart muscle to die for want of oxygen. Those areas stop pumping, of course, and the whole heart does its job less well.

The pumping efficiency of the heart is routinely measured using ultrasound as the “left ventricular ejection fraction” (LVEF), which, as the name suggests, is the proportion of blood the left ventricle is able to pump out of itself when it contracts. Roughly 55 to 70 percent is considered normal. High values can occur when the heart is stiff and muscle-bound, and tend to mean the heart empties well, but fills poorly. Congestive heart failure is associated with low values.

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The Earbud Epidemic

A new study shows that one in five Americans, 20%, has some form of hearing loss. That is a huge number and much larger than anyone had previously thought. According to the study, in the Annals of Internal Medicine, that means 48 million Americans hear so poorly that they cannot understand a companion in a crowded restaurant. Until this study, estimates had been that the number of Americans with this level of hearing loss was less than half the number found or under 10%.

The study looked at Americans 12 years and older who have had their hearing tested rather than previous studies that relied on self-reported data. This study used the World Health Organization’s definition for hearing loss, which is not being able to hear sounds of 25 decibels or less at the frequencies for speaking. And it found that of those 20%, 13% had hearing loss at that level in both ears. The remainder had it in just one.

The study draws no conclusions about the reasons for this – nor does it state that this is something that has changed over time. It is well known that people’s hearing deteriorates over time and it is also well-known that people can damage their hearing by listening to sounds at inappropriate volume levels for periods of time. That’s why people protect their ears when working with loud machinery, etc.

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