QD: News Every Day--public option unsettles Senators

ACP Internist's daily digest of news and events wraps up how the public option has shifted the balance of opinion in the Senate, how the public itself has shifted on H1N1 vaccination, and the economic impact of a rural physician.

Health care reform
The introduction of a public option has precariously shifted Senators' support. Democrats are divided. What bi-partisan support there was has evaporated. Liberals are happy, but that won't carry the day. (AP, Los Angeles Times, Boston Globe)

H1N1 influenza
Some hospitals are seeing their emergency department patient volumes double from H1N1 influenza as doctors are being recruited as the flu police, trying to prioritize who gets vaccinated. To ease the crunch, more than 22 million doses of H1N1 flu vaccine are now available now, and health officials are still saying better late than never. (USA Today, New York Times, AP/MSBNC.com)

Data produced by a supercomputer shows that there could be a third wave of the H1N1 virus in the spring. The University of Texas is using
the "Ranger" supercomputer to make its predictions. (KXAN-TV)

Handshaking was out, and now so is the simple fist bump. Here's some humorous ways to greet people. (NPR)

In case you missed it ...
Doctors' economic contributions are as important to rural communities as their medical ones. The National Center for Rural Health Works estimates that a rural hospital loses $236,565 from clinic visits and $451,169 net revenue for every half-a-physician they are short. When extrapolated to include services purchased by the physician, the clinic and employees, the shortage translates to 13.8 jobs and $533,493 in income. (Iowa Independent)

Irving Harper, ACP Member, discusses how he handles his patients with e-mail, cell phone and video chat. Ahhh, but it's good to practice in Hawaii. (U.S. News & World Report).

Labels: H1N1, health care reform, health information technology, QD, telemedicine, vaccination

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posted by Ryan DuBosar at 11:32 AM   0 Comments

A story that's not going to sell EMRs

I've been to conference sessions where the Veterans Administration was held up as a sort of gold standard for electronic medical records--they've had them longer and used them more than most docs and hospitals. Now it turns out that the VA might not be such a shining example, after all.

An investigation by Congress and the AP just revealed that software glitches in the VA's EMR have resulted in health records being associated with the wrong patient and several medication errors, including overuse of heparin. First, it's scary that this happened. Second, it's scary that the VA kept it quiet. And the third scary thing is the VA's response. A quote from a VA official (via the AP): "VA believes that veterans are active partners in their health care, and encourages patients to always follow up with their health care teams to ensure that their treatment options meet their understanding and their health care needs." So the responsibility is on the patients to make sure that the hospital's computers aren't malfunctioning? Come on.

The real question, though, is how many other EMRs have similar glitches. Obviously plenty of mistakes happen on paper, too, but can anything match the myriad ways computers can screw things up without anyone noticing?

Labels: health information technology

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posted by Stacey Butterfield at 8:00 AM   1 Comments

For when you're bored with YouTube

The surgeon general (the old one that is, not Sanjay Gupta) has a cool new Web tool that could be of real use to physicians and patients. The site helps users construct a family health history which can be printed out or integrated into electronic medical records. You fill in everything you know and then email relatives to complete the missing parts (at which point they can "reindex" the tree to map their own health info, if they want). It takes only about 20 minutes and the results can be "amazingly positive," the acting SG told Yahoo news.

As in, now you can gather useful health information but avoid the embarrassment of interrupting Christmas dinner to ask Grandma for the results of her last Pap smear.

Labels: health information technology

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posted by Stacey Butterfield at 11:53 AM   1 Comments

Ever wonder what people are saying about you on the web?

A new investigation conducted by Slate provides some interesting insight into online physician-rating systems. You know, those things that pop up when you Google a doc and then ask you to "click and pay here" to get all the dirt on him or her. So what's it all worth? Nothing, according to the article. The sites provide almost no information and even less that is useful. But, if you're a doctor with some spare websurfing time on your hands, you might want to try fixing your stats just in case, the author suggests.

Labels: health information technology, quality reporting

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posted by Stacey Butterfield at 4:06 PM   3 Comments

I found my brain tumor on the internet!

The phenomenon of cyberchondria (putting your symptoms into a search engine and coming with a dramatic diagnosis) is already well-known to most primary care physicians. A new study from Microsoft delves a little deeper into the causes and potential remedies of this problem.

First, the impressive statistics: a quarter of 250,000 studied users engaged in a medical search, and more than half of 500 Microsoft employees had at some point interrupted their day to search for information about a serious illness. (And not being medical reporters, they can't count that as work.) But what's truly shocking is that a large proportion of the study participants assessed the likelihood of their symptom being caused by a serious disease (i.e., is that headache a brain tumor?) based on the ranking of search results. (If brain tumor comes up before caffeine withdrawal, then you've probably got a brain tumor.)

The finding points out a flaw in the theory behind search engines. While search results are meant to be the product of our collective intelligence (best results at the top of the page), they are just as affected by our collective idiocy/hypochondria.

The computer guys do have some ideas about solutions, although the remedies are almost as scary as the problem. Search engines could be tailored based on individual search histories, they suggest, to keep people who tend to escalate their searches (e.g., from chest pain to heart attack) from getting the most dire results up top. Seems unlikely to be a popular idea, though, since 40% of survey participants admitted to having mistakenly thought they had a serious condition, but only 3.5% of them self-identify as hypochondriacs.

Labels: health information technology, hypochondria

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posted by Stacey Butterfield at 10:55 AM   1 Comments

When patients control their own records

Steve Spadt, ACP's Director of Interactive Product Development for projects such as the College's Diabetes Portal and the MKSAP product line, delivers a round-up of the latest in electronic health records, including patients taking control of their own health records and Web communities that let patients connect with other patients with similar symptoms and diseases, and possibly by-pass medical providers.

Learn more about the latest in medical informatics from the American Medical Informatics Association's annual meeting in Washington, DC.

Patient Health Records (PHRs) continue to gain steam, though there is a key differentiator which is whether or not the system is "tethered," meaning connected to or integrated with a full Electronic Health Record (EHR) or other clinician-managed systems. Medical informatics experts almost universally share the belief that untethered PHRs (systems that operate independently and contain data that is managed solely by patients) may actually negatively impact care as they could strain patient/clinician relationships as clinicians struggle to coordinate the data in their own systems with that in the patient's PHR--an effort that would further burden an already critically low level of time and resources available per patient encounter. AMIA'S journal recently addressed this topic.

Dr. Robot to the rescue

In all the whining about the impending crisis of primary care, everyone has forgotten one obvious solution at our disposal--robots. Two news items released today describe how electronic devices will soon be replacing health care providers:

"In the not-so-distant future, American seniors may turn to helpful, uncomplaining robots to fill the worrisome 'care gap' that many face today," explains the HealthDay News. In addition to buying groceries, fetching dropped keys and checking blood pressure, the rolling, talking robots (think Rosie, the Jetsons' maid) will have internet connections and video monitors so distant relatives can "jump into" them. In its most creepily sad touch, the article explains how a grandmother could hold the robot's hand as she shows her garden to her faraway grandchild.

And if the realization that you've so neglected Grandma that she is reduced to cuddling titanium has depressed you, tell it to your cell phone. A Japanese professor has launched the world's first web-based cognitive therapy program available through your mobile. The enterprising psychotherapist had previously treated the country's crown princess (although presumably she got in-person service).

He explicitly states that the program is intended to compensate for a national shortage of psychotherapy specialists and doctors. Could a robotic, wired general internist be next?

Labels: health information technology

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posted by Stacey Butterfield at 12:50 PM   0 Comments

Acronym fatigue

Do you know your EHR from EMR from PHR? How about whether you're dealing with an HIE or an HIO?

The EHR vs. EMR issue seems to be one of the most perplexing and commonly confused. According to a report which The National Alliance for Health Information Technology (or NAHIT, if you needed another acronym) put together to explain the terms to the government (comforting to know they're so on top of it, isn't it?), an EMR is a electronic record that is confined to a single office's computer system, and EHRs are interoperable with other health care providers/facilities.

Presumably then what most people would want is an EHR. But, according to this article from a software advice firm, more web searches are conducted for EMRs than EHRs. Guess a lot of us are confused about this. Check out the NAHIT report for the full explanation of these terms and other confusing HIT (sorry, health information technology) terminology.

Now if only we could get our Microsoft Word to stop auto-correcting EHR to HER, we'd be all set.

Labels: health information technology

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posted by Stacey Butterfield at 8:00 AM   0 Comments