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4501. 5 health care IT tips for President Trump

) to research the costs and benefits of a national health care identifier. Let’s create a national health care identifier and be done with it. It’s the simplest and most reliable way to coordinate care across multiple providers and heterogeneous EHRs. Let’s create a national directory of electronic provider addresses that any application can query to make data exchange simpler. Let’s create a unified baseline privacy policy and universal consent for data sharing across all 50 U.S. states. As I’ve said many (...) clinician burden and prescriptive regulations while moving to an outcomes focus. Demanding that my ophthalmologist report smoking cessation and vital sign data is not helpful. Ophthalmologists should be graded based on the visual acuity, field of vision and intraocular pressure of their patients. The outcome we want is healthy people. How you achieve it with technology should be up to each hospital and professional. It’s fine to require some reporting of appropriate quality measures and cost data

2017 KevinMD blog

4502. The Two Pots? Experiences of peer workers within mental health services

to explore how their perspectives related to the nature of the peer support innovation; their professional colleagues; the service users; and the social, organisational, economic and political context. Research to date has highlighted the cultural change necessary in the UK health service before peer support can become a core part of what we do. Methods Electronic databases including PubMed, CINHAL, Web of Science, Cochrane Library and PsycARTICLES were searched for studies published between 1998 (...) statutory mental health, I was brought in to set up and coordinate a peer mentoring project where Peer Mentors who have experienced their own mental health challenges and who are now managing this well are trained and supported to work with clients who have been referred to/ are being supported by statutory mental health. I listened to a speech at “Peer Fest” just as I started saying the same as this article that peer mentoring within statutory mental health does not work as it is too prescriptive. I am

2016 The Mental Elf

4503. Turn on, tune in, burnout: clerical burden, e-health systems and doctor burnout

, coding diagnoses, dictating and signing off discharge letters, and interacting directly with patients through electronic patient portals. Many organisations have favoured these over traditional handwritten records for ease of sharing of information, legibility, and integrations with other databases to build expert systems which improve patient safety; for example if you try to prescribe contraindicated medications, the system will alert you with a warning. On the flip side though, systems can (...) Turn on, tune in, burnout: clerical burden, e-health systems and doctor burnout Clerical burden, e-health systems and doctor burnout Search National Elf Service Search National Elf Service » » » » Turn on, tune in, burnout: clerical burden, e-health systems and doctor burnout Aug 31 2016 Posted by A survey of more than 6,000 US physicians shows an association between burnout rates and doctors’ use of electronic record systems. Declaration of interest: I use an electronic health record system

2016 The Mental Elf

4504. EMR alert fatigue: Can we learn from the aviation industry?

that says the heart has stopped beating. Electronic medical records may also alert physicians to key safety issues, such as prescribing a medication to which the patient is allergic. But these alerts may also serve as a reminder the patient needs a vaccination or that his or her cholesterol pill is due for a refill — hardly life-and-death matters. So why not just ignore these alerts? A 2011 Boston Globe investigation found that more than 200 deaths over a five-year period were attributable (...) online retailer. How many of these alerts are really important? It’s easy to ignore a media news flash — but what if you miss an important alert about the cancellation of your flight? “Alert fatigue” describes our reaction to the unmanageable and sometimes overwhelming barrage of electronic alerts. The Agency for Healthcare Research and Quality describes “how busy workers become desensitized to safety alerts and as a result ignore or fail to respond appropriately to such warnings.” All told, missing

2017 KevinMD blog

4505. The side-effects of antipsychotics: let’s systematically assess, discuss and act! #NPNR2016

in treating psychosis, improving symptoms and reducing relapse risk. However, there is ongoing debate about the effectiveness of this type of medication. In particular, there is some disagreement about the positive impact and outcomes of antipsychotic medication versus the negative impact that side effects have on people’s lives. At any one time, at least half of all people prescribed antipsychotics are not adhering to them (i.e. they are not taking their medication). It’s frequently reported (...) and the study was publicised during May-June 2015 on three occasions in an electronic newsletter. This was sent to approximately 3,330 people. Potential participants were directed to follow an email link that led to an information letter, embedded in Survey Monkey. All responses were anonymous. Results We note the relatively low response rate (171 questionnaire returns from 3,330 surveys mailed out to ACMHN members). What are the headline findings? First, most of those taking part (two thirds) indicated

2016 The Mental Elf

4506. Lithium for bipolar disorder: the best maintenance mood stabiliser protection against self-harm and suicide?

between January 1, 1995, and December 31, 2013, by The Health Improvement Network (THIN) system. Individuals ( aged 16 and older ) with diagnoses of bipolar disorder were included in the study if they received 2 or more consecutive prescriptions for treatment lasting 28 days or longer of lithium , valproate , olanzapine or quetiapine Patients were followed from the time of first prescription to 3 months after medication discontinuation (if that occurred). Patients prescribed any of the medications (...) a different approach to answering the question about the relative benefit of different common treatments for bipolar disorder. It examines a large dataset derived from electronic health records (EHR) to determine whether exposure to lithium results in improved outcomes compared to sodium valproate , olanzapine or quetiapine , three commonly used acute and maintenance treatments for bipolar disorder. The authors used a propensity score to adjust for baseline clinical characteristics to try to make

2016 The Mental Elf

4507. Doctors and patients want the same thing in health care

and better managing chronic illness through diet, exercise, and preventive services. The results were discouraging. The study found that fewer than one-third of those surveyed reported receiving advice from their doctors encouraging them to increase their levels of activity, eat better and undergo the preventive screenings needed. When patients failed to make appointments or fill prescriptions, most reported never being contacted by the physician–or anyone in the doctors’ office. And 40% of primary care (...) doctors said they could not access their patients’ electronic records when they were hospitalized or visited the emergency room, making continuity of care problematic. A question that arose from the first survey was why these shortcomings were so pervasive. Did they reflect doctor and patient preference, or were they failures in the current health care system? To answer it, CAPP this year sponsored focus groups of consumers and physicians to ascertain what each wanted from the health care system

2017 KevinMD blog

4508. Medication errors haven’t gone away

of inpatient drug orders and outpatient prescriptions is in the billions; more than 100 million Americans take four or more medications regularly. From beginning to end, the medication process is a malpractice minefield for providers all across the field of health care. Given those big prescription figures, the raw number of malpractice cases is relatively small: physicians and nurses (and patients) mostly get it right. But, within the realm of malpractice, medication-related events often represent (...) establish expectations about efficacy and safety. New prescriptions may demand sharper attention than renewals; high-risk drugs require extra surveillance; but all medication orders imply a commitment to monitoring and managing the immediate and long-term effects. As was seen frequently in our analysis, even greater vigilance is necessary for patients with challenging comorbidities and unresolved health issues, and a low tolerance for drug-related complications. Of course, many patients receive care

2017 KevinMD blog

4509. Pre-authorization is hell. Here’s why.

, that the prior authorizers need to get involved. I guess I’ll just have to write more prescriptions for Percocet now because I don’t have time for all these prior authorizations. Not to beat a dead horse (prior authorizations), but now we are being encouraged to go through Cover My Meds to obtain medication prior authorizations. Cover My Meds “was founded in 2008 with a mission to help patients get the medication they need to be healthy … by electronically automating the medication prior authorization (PA (...) a message from a type 1 diabetic patient that he was running out of his Lantus insulin. He has been on Lantus for years, and of course, needs it to survive. I spoke to my nurse, who informed me that the prescription was held up in prior authorization. The patient’s insurance recently informed him that Lantus was no longer a preferred medication on his formulary. Apparently, despite using this vital treatment successfully for many years, we now need to make the case that he has failed with Lantus

2017 KevinMD blog

4510. How to fix the EHR mess we’re in

How to fix the EHR mess we’re in How to fix the EHR mess we're in How to fix the EHR mess we’re in | | June 25, 2017 302 Shares Computers, more specifically, electronic health records (EHRs), will someday revolutionize the practice of medicine. In fact, successful computerization of medical care is the most critical step necessary to transform the American health care system from its current sorry state to the 21st-century system of our dreams. It is ironic, then, that today EHRs represent one (...) prescriptions and appointment notes, recording diagnoses and communications with staff and patients, etc., quicker and easier than it was prior to having EHRs. And usable EHRs would generate clinical data automatically, without extra work, and would communicate with one another seamlessly. And finally, EHRs should enable and prompt better care. I guarantee that physicians would want to use such a system. How do we get that system? This would be a great opportunity for government to fix the mess

2017 KevinMD blog

4511. Communication in health care should be better than it is

CYA — just doing what’s best for the patient, where we both were making sure he had the best outcome, not so worried about everything that all too often goes along with this. Using our electronic health records in the most efficient way, and new technologies that will allow us faster and safer communication across institutions, will ultimately help smooth the way towards a better way of taking care of our patients. How it should work How, in the 21st century, can we not know what a patient’s (...) , and every system should be able to speak to every other, so that we can see every last dose of medicine the patient has taken, who prescribed it, and how to reach them to discuss the issues that may arise around the care of our patients. When someone has some questions about the perioperative management of a patient, I can assure you that handwritten scrawls across the cover sheet of a fax (that may lie in a fax machine somewhere and not get delivered to the appropriate eyes for hours or days

2017 KevinMD blog

4512. The future of EHR: Here are 5 predictions

, procurements by other local institutions, or the sentiment that “no one gets fired for buying vendor X.” I have a sense that EHR requirements are changing and we’re in transition from EHR 1.0 to EHR 2.0. Here’s what I’m experiencing: 1. Fewer government mandates. The era of prescriptive government regulation requiring specific EHR functionality is ending. In my conversations with the government (executive branch, legislative branch), providers/payers, and academia, I’ve heard over and over (...) for service is dying and is being replaced by alternative quality contracts based on risk sharing. Dr. Allan H. Goroll’s excellent article notes that EHR 1.0 has achieved exactly the result that historical regulation has required — a tool that supports billing and government reporting — not clinician and patient satisfaction. Our electronic tools for EHR 2.0 should include the functionality necessary to document care plans, variation from those plans, and outcomes reported from patient-generated health

2017 KevinMD blog

4513. The Terrible Price Paid When Doctors Fail to Test and Treat Patients for Hepatitis B

screening her for liver infection or damage. She died in her early 20s from liver cancer. The epilepsy drug accelerated her hepatitis B-related liver disease. A recent article published on the Monthly Prescribing Reference , describes how a primary care provider was sued for malpractice after he failed to monitor a patient for liver damage despite the fact the Asian-American patient told him he had hepatitis B in his teens. The patient, who was treated by the doctor for more than 15 years, died from (...) guidelines and discuss a care plan with my daughter. The worse simply do whatever I ask, and I am no doctor. I have found one of the best tools available are software programs that link a patient’s electronic medical record to current medical guidelines. It makes it easy for doctors to know what tests should be ordered, especially if they have never treated hepatitis B before. But they need to have the software and the desire to use it. I appreciate that doctors are human, over-worked and are driven

2017 hepbblog

4514. EMRs should be like rental cars

this, of course, but why is the “send” button on my prescription module marked “fax” with a drop-down menu choice of an electronic prescription, which is the way we have to send prescriptions to comply with meaningful use? Is it there to confuse clinicians? I can think of no other reason. A child, or a middle-aged physician, can pick up an iPhone and quickly work the basic features by intuition, and wouldn’t be completely lost if suddenly handed an Android phone instead. And, truth be told, my iPhone does (...) EMRs should be like rental cars EMRs should be like rental cars EMRs should be like rental cars | | April 12, 2017 103 Shares When a new doctor joined our clinic, she spent a week learning our electronic medical record. She had used two other systems before, so she was no stranger to EMRs, but that’s how different they can be. That’s crazy! EMRs should be like cars, which range from the likes of Smart, Mini Cooper, and Skoda to Mercedes Maybach, Rolls Royce, and Porsche. They range from simple

2017 KevinMD blog

4515. From “do no harm” to “reduce harm.” It’s time to change the paradigm

heroin, can cause death, it has a far safer drug profile than heroin as well as carefully dosed prescribing by specially trained physicians. E-cigarettes, the ill-named electronic nicotine delivery device that aren’t cigarettes at all, have garnered a similar stigma as methadone. Real (combustible) cigarettes like Marlboro or Camel burn tobacco at high heat. In addition to releasing the nicotine from tobacco, the heat releases tar, carcinogens, and other toxins that get drawn into the lungs. E (...) with morbid obesity. There are countless other examples. We routinely prescribe insulin, a drug that carries the known side effects of hypoglycemic coma and death, to people with diabetes. The much-applauded drugs that can cure hepatitis C may also cause severe liver failure. Lasix, an essential medication that helps people with heart failure get rid of fluid buildup in the legs or lungs, can also cause kidney failure. And every consent form for surgery, even operations to remove tumors, includes death

2017 KevinMD blog

4516. Why it’s hard for physicians to order fewer tests

experience. “Then I can hear the administration say that was a fee-for-service patient. I just lost money, right?” Giusto meets with doctors to present data on how many tests or prescriptions they order and how that compares to others. At one clinic, she shared slides showing that some doctors were ordering more than 70 opioid pills at a time while others prescribed fewer than 20. In response, Sutter set a goal of 28 tablets in hopes of reducing opioid abuse. “Most of the physicians changed,” Giusto said (...) to think that more is better. “We have excellent patient outcomes, but it’s at a very high cost,” said Dr. Harry Sax, executive vice chairman for surgery at Cedars-Sinai. “There is still a continued financial incentive to do that test, do that procedure and do something more.” In addition to financial motives, Sax said, many physicians still practice defensive medicine out of fear of malpractice litigation. Also, some patients and their families expect antibiotics to be prescribed for a sore throat

2017 KevinMD blog

4517. How a mathematician developed an algorithm to help treat diabetes

glucose regulation drug, and no recorded diagnosis of type 1 diabetes, which . We also had access to each patient’s demographic data, as well their height, weight, body mass index, and prescription drug history. Next, we developed an algorithm to mark precisely when each line of therapy ended and the next one began, according to when the combination of drugs prescribed to the patients changed in the electronic medical record data. All told, the algorithm considered 13 possible drug regimens. For each (...) who make informed judgments about potential courses of treatment. We conducted our research through a partnership with Boston Medical Center, the largest safety net hospital in New England that provides care for people of lower income and uninsured people. And we used a data set that involved the electronic medical records from 1999 to 2014 of about 11,000 patients who were anonymous to us. These patients had three or more glucose level tests on record, a prescription for at least one blood

2017 KevinMD blog

4518. Physical Therapy: First Line of Defense Against Sexual Dysfunction

by approximately 50%, and 73% of patients were not prescribed any medications for low back pain (Fuhrmans 2007). Early access to physical therapy can prevent unnecessary medical spending. Early access to physical therapy may prevent unnecessary medical spending We are movement experts, with defined evidence-based treatment strategies and pain management skills that allow patients to take control of their bodies, and rely less on prescription drugs for relief. The APTA campaign, , aims to educate about (...) back pain are both musculoskeletal conditions that drive healthcare costs up due to – in some cases unnecessary and avoidable – prescriptions for medication, imaging, and surgery. Low back pain had an estimated direct cost of $86 billion in the US in 2005 (Martin et al. 2008). In a landmark Virginia Mason study, when primary care and physical therapy were paired from onset, wait times for care decreased, and improvements in function and satisfaction were observed. Health care costs decreased

2017 Students 4 Best Evidence

4519. Let primary care doctors practice more outpatient medicine

the inpatient electronic health record (different from our outpatient EHR) — let alone take care of septic patients with metastatic cancer awaiting brain biopsies on Monday morning. We are highly skilled at managing outpatients, but when we are asked to cover the quite ill patients who are lying on the inpatient service, many of my faculty have been open and honest in expressing their lack of confidence in their skills and ability to really safely take the best care of these patients. As the voices (...) , easily handled with some medical advice or a prescription sent to the pharmacy. But often times these are things that require a visit to the doctor, the laying on of hands, the palpating and auscultating and probing that we do. And even more intensive interventions. Right now, the options for patients from the on-call providers are to go to the emergency room, or to a local urgent care center. Long waits. Providers that do not know them. Different EHR’s. Overtesting. Overtreating. Doing what works

2017 KevinMD blog

4520. Solving the telephone problem in primary care

. If every time a patient calls and requests a refill, the person answering the phone says, “Hey, why don’t you sign up for our online portal, so you can request a refill of this medicine with a simple click of a button, and your provider can respond with a click of a button that sends your prescription electronically to your pharmacy in a flash? Think of it; you will never again need to call for a refill.” That simple act during that phone call will save multiple phone calls during the year when

2017 KevinMD blog

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