The Health Care Blog – Page 622 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

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Who Said EHRs Can’t Talk To Each Other?

Jul 16, 2012

By Margalit Gur-Arie

When the hypothetical naked, unconscious and alone patient presents at your ER with no immediately evident reasons for his distress and presumably holding his driver license between his clenched teeth, would you find it helpful if you could see a nicely typed, or hand written, list of diagnoses and current medications for this hapless person?

When a family moves across the country and brings in their eight year old for her first visit with the new pediatrician, would it be helpful to see a slightly fuzzy image of her immunizations list from back home?

When an elderly patient you’ve been seeing for umpteen years is shipped to the hospital in the middle of the night, would it be helpful to find the admission record in your to-do list for today?

Perhaps these things would be nice to have, but EHRs can’t talk to each other, so before any of these miracles can occur we must make EHRs communicate.

How do we make EHRs talk to each other? That’s simple: we look at how people talk to each other, and apply the same principles to EHRs. Thus, EHRs have to share the same language, use the same syntax, know when to speak and when to listen, and when not in physical proximity, use a variety of paraphernalia to carry voice over large stretches of land and sea. And since EHRs are really computers and this is after all the 21st century, we have the blueprint for a solution in our hands, because any computer in Papua New Guinea can talk to any computer in Boonville, Missouri. How? By using the magic of the Internet.Continue reading…

Clinical Trials for Beginners

Jul 16, 2012• 8

By Judy Stone, MD

Have you ever wondered about what goes on behind the scenes—how new drugs are magically produced and brought forth? We’ll continue to take the mystery out of clinical research and drug development and to provide background information so that both patients and physicians can make more informed decisions about whether they wish to participate in clinical trials or not.

Why care?

To develop a medicine, from the time of discovery of the chemical until it reaches your drug store, takes an average of 12-15 years and the participation of thousands of volunteers in the process of clinical trials (Fig 1).

Very few people participate in clinical trials—it is even less than 5% for patients with cancer—due to lack of awareness or knowledge about the process. We’ll go into detail about how drugs are developed in later posts.

An inadequate number of volunteers is one of the major bottlenecks in drug development, delaying the product’s release and usefulness to the public. Of course, many people may suffer or even die during this wait, if they have an illness that is not yet otherwise treatable. So if you want new medicines, learn about—and decide if you wish to participate in—the process. I have, as a volunteer subject, researcher, and advocate.Continue reading…

How Useful Is Personal Genomics? A Case Study

Jul 16, 2012

By Seth Roberts

How much can you help yourself by getting your genome sequenced?

A lot, a little, not at all?

Scenario 1 (big help): You discover you have a greatly elevated risk of Disease X. You do various things to reduce that risk that actually reduce it.

Scenario 2: (a little help): You discover you have a greatly elevated risk of Rare Disease X. You do various things to reduce that risk but they don’t help. At least, when Disease X starts, you will be less upset.

Scenario 3 (no help): You discover that you have a greatly elevated risk for a common easily-noticed disease (such as obesity). You already watched your weight, this changes nothing. Scenario 4 (harm): You discover that you have a greatly elevated risk of Scary Disease X (e.g., bipolar disorder). It is depressing news. Later studies show that the gene/disease association was a mistake. (Many gene/disease associations have failed to replicate.)

A recent Wired article tries to answer this question for one person: Raymond McCauley, a bioinformatics scientist who had his genome sequenced four years ago and learned he was “four or five times more likely than most people to develop age-related macular degeneration (AMD)”. The article says “of all the ailments described in the 23andme profile, AMD has one of the strongest genetic associations”. If I found this in my genetic profile, I would want to know the confidence interval of the increased risk. Is it a factor of 4.5 plus or minus 1? Or 4.5 plus or minus 8? This isn’t easy to figure out. In addition to the question of variability, there can easily be bias (= estimate is too high). Let’s say I do 100 gene/disease association studies.

Gregory House, MD, RIP

Jul 15, 2012• 14

By Robert Wachter, MD

Dr. Gregory House hung up his stethoscope and cane for the last time last night and shuffled off into eternal life in the Land of Reruns. House — the brilliant, misanthropic, drug addicted, my-way-or-the-highway physician — has been an entertaining presence on FOX television for the past eight years. I enjoyed the series and even learned a little medicine. I also took some pride in the show, since House was television’s first hospitalist, a term I helped coin and now the fastest-growing specialty in modern medicine.

But as entertaining as he was, House was a throwback to an era in which the antisocial tendencies of some physicians were seen as irrelevant to their doctoring. As medical leaders strive to redefine “the great doctor” of today, House’s departure is both timely and welcome.

When I went to medical school in the 1980s, many of us valued nothing more than our autonomy. We saw medicine as an individual, not a team, sport, and interpreted professionalism as unwavering advocacy for our patients. While this was often healthy and noble, in some cases it crossed the line into obnoxiousness, even rage. (Today, we call doctors who cross this line “disruptive physicians.” Dr. House would certainly qualify.)

Health Care Future Bright for Nurses. Stinks for Doctors.

Jul 14, 2012• 37

By MERRILL MATTHEWS

There are lots of losers in President Obama’s effort to remake the U.S. health care system, and chief among them are the doctors. But there are also winners, especially nurses and physician assistants (PAs). Indeed, nurses and PAs win big in part because doctors lose badly.

Surveys repeatedly show doctors are fed up with low reimbursement rates from Medicare and even lower from Medicaid, which have increasingly led doctors to no longer see new patients in those government-run plans. For example, a recent Texas Medical Association survey found that “34 percent of Texas doctors either limit the number of Medicare patients they accept or don’t accept any new Medicare patients.” Even more do not accept patients with Medicaid.

Then there’s the heavy-handed regulations and requirements from both government and private health insurers. Complying with all those requirements and paperwork creates expensive and time-consuming administrative burdens. And to top it off, there’s the looming shadow of a high-cost lawsuit if things don’t turn out well.

And that’s all before ObamaCare kicks in, which will exacerbate every one of those problems. So it’s little wonder that there are physician shortages, especially in lower-paying primary care, and those shortages are only going to get worse if ObamaCare succeeds in getting an estimated 32 million more Americans insured.

The increased demand for medical care and lower reimbursements—which is one of the primary ways ObamaCare will try to hold down costs—is a recipe for a mass exodus of doctors willing to practice medicine. As “Physicians Practice” reported in August from its physician survey: “Nineteen percent say they plan to move to another position in the same field. An equal amount says they plan to leave medicine—not to retire, but to pursue something new.”

Will Anyone Listen When Former CMS Chiefs Call For More Objective Physician Payment?

Jul 13, 2012• 9

By Brian Klepper

On May 10^th, the US Senate Finance Committee, co-chaired by Senators Max Baucus (D-Mont) and Orrin Hatch (R-Utah), convened a remarkable panel of four former Administrators of the Health Care Finance Administration (HCFA) and the Centers for Medicare and Medicaid Services (CMS): Gail Wilensky, Bruce Vladeck, Thomas Scully and Mark McClellen. (See the video here.) Against a backdrop of intensifying budgetary pressures, the roundtable was to provide perspectives on Medicare physician payment, including several controversial issues: the Sustainable Growth Rate (SGR) formula, the Resource-Based Relative Value Scale (RBRVS), and the RVS Update Committee (RUC).

Ironically, the day before, a Maryland Federal District judge dismissed a suit brought against HHS and CMS by six Augusta, GA primary care doctors over CMS’ longstanding relationship with the RUC, based on a procedural technicality and without weighing the substance of the complaint.

Your Doctor’s Brain

Jul 12, 2012• 4

By Rob Lamberts, MD

I have a split medical personality. On one hand, I am a pediatrician; I light up around babies and love to mess around with little kids. On the other hand, I am an Internist; I love complex problems and love talking to the elderly. But the one part of internal medicine which gives me perhaps the most joy is the opportunity to solve medical puzzles. Yes, pediatrics has puzzles in it too, but they are far more common in adults.

The term used for a medical puzzle-solver is diagnostician. It is always a great compliment to a physician to be called a great diagnostician. It means you are a good thinker, have a good store of facts, know how to organize your thoughts properly, and can see patterns in things you otherwise would never have found. It is the Sherlock Holmes, Lord Peter Whimsey, or Harry Dresden side of medicine. The diagnostician searches for clues, but especially searches where they are most often missed: right out in the open.

I am not sure anyone has called me a good diagnostician, but there are few things that give as much satisfaction in my job. It calls on my creativity, my memory, my mental organization, my ability to ask questions, my power of observation, and my ability to put all the disparate pieces together to form a cohesive whole. It’s not just coming up with an answer; it’s coming up with a plan.Continue reading…

Call For Innovators: Just Two Weeks Left to Enter the EHR Accessibility Module Challenge!

Jul 11, 2012

By Hemali Thakkar

The deadline for the EHR Accessibility Module Challenge is slowly approaching, with less than two weeks to go!

Sponsored by the Office of the National Coordinator for Health IT (ONC), this challenge emphasizes accessibility and usability in health IT, which are high priority issues for the disabled community. A consumer-oriented system providing easy-to-use access to health information would be a valuable tool and significantly improve the health of disabled individuals. First place winners are awarded $60,000 and opportunity to demo at one of Health 2.0 premier conferences or at another national conference. The second place winner will receive $20,000 and third place, $5,000.

Where’s the Controversy in Saving Lives?

Jul 11, 2012• 1

By Melinda Gates

As we get closer to the London Summit on Family Planning, people often ask me, “Why is family planning so important to you?” The simple answer is that it can mean everything to so many of the women and families I meet. It means the difference between being empowered and feeling powerless. It means the difference between celebrating a daughter’s graduation and watching her drop out of school. It even means the difference between life and death.

Providing family planning information and services to millions of women and girls in the poorest countries in the world gives them the opportunity to determine their own futures, and the best future for their children.

As a woman and a mother, I can’t imagine anything more important.

The women and girls I speak with, whether in India or Kenya, tell me they want to be able to plan for their families. They tell me they want what’s best for themselves and their children. They want the right to participate freely and equally in society.

You Want to Sue Me?

Jul 11, 2012• 27

By Mandy Huggins, MD

“I’d be lookin’ to sue you.”

I’m sorry, what?? That is what I heard from the mother of one of my patients. I was evaluating a high school athlete who had recurrent stingers (nerve injury that affects an upper limb, usually resolves with time) and a possible episode of transient quadriparesis (affecting all limbs this time). I wasn’t on the sidelines for these injuries, so I had to go on the reports given to me by the athlete and the school’s athletic trainer. However, with that information, I did not want to clear this player to return to football until I could be certain he didn’t have any cervical stenosis or any other abnormality that might put him at risk for permanent damage if he suffered another neck injury.

I told the athlete and his mother that I needed to get an MRI of his cervical spine (neck) in order to determine this. The athlete was understandably upset with my decision, but his mother supported my decision to proceed with caution. She explained to me that if her son played again, sustained another injury, and something “bad” happened, she would be more than happy to take legal action against me. Fantastic.

First of all, I can’t say that I would blame her for being angry (at the very least) if I screwed up. But to tell me in my office, to my face, that she’s already thinking about suing me? I found that ridiculous. I must be in the minority, however. If you Google “how to sue a doctor,” an abundance of information follows. There’s an “ehow” on the subject, and even CNN offers an opinion.