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Electronic Prescription

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4581. Poor communication between EHRs is unacceptable. Let’s fix it.

a dormant infection; if our patient was unknowingly infected with tuberculosis (TB), giving our first-line therapies could lead to a disseminated infection — even death. The other hospital had already performed the necessary tests, including a TB culture from the patient’s lung fluid. Unfortunately, because the other hospital used a different electronic health record (EHR) system, it could not send us the patient’s updated digital health record. Instead, it sent us an 80-page printout with the TB result (...) in enabling information exchange, regulatory bodies must be proactive about mandating compliance. Mandating standards for EHR interoperability by a specific time point–akin to the Environmental Protection Agency’s requirement for automotive manufacturers increase fuel economy standard to 54.5 mpg by 2025 — will light the fire under companies’ feet to ensure that their systems meet the prescribed goal. Another solution would be to create a single, unified EHR system contracted, ideally, to a private

2018 KevinMD blog

4582. What is the perfect fee-for-service system?

of the treatments patients receive) accounts for 50 percent of the spending increase, followed by the increase in the size of the U.S. population (23.1 percent), and the aging of the population (11.6 percent). “Changes in service utilization were not associated with a statistically significant change in spending.” The takeaway from this study is that to lower U.S. health care expenditures, we must combat out-of-control pricing for prescription medications, medical testing, and hospital stays, and, dare I say (...) on today’s clunky electronic medical record systems to collect such data, further shifts a doctor’s focus towards compliance and away from patient care. The result is rampant burnout in the medical community, not better care. The first step towards better care in the U.S. is the removal of the excessive administrative burdens created by the U.S. government (E&M payment coding, HIPAA, MACRA, etc.), and insurance companies (prior authorizations, excessive denials). The next step is to develop usable

2018 KevinMD blog

4584. Should You Take An Antioxidant (Supplement or Vitamin) To Prevent Or Treat Heart Disease

in the 1950s suggested that excess free radicals generated by oxidative processes could be responsible for the chronic degenerative diseases of aging. Oxygen, which is essential to animal life, undergoes processing in cells which creates unstable free radicals. Free radicals are short an electron and seek other molecules which can donate an electron and make them more stable. This process is termed oxidation. The molecules produced by oxidation play an important role in a a number of biological processes (...) such as the killing of bacteria and in cell signaling. These same unstable molecules, however, have been implicated in a number of deleterious processes as they can participate in unwanted side reactions and create cell damage. Thus, too many free radicals have been implicated as potentially causal in diseases ranging from cancer to cardiovascular disease to dementia. Antioxidants can reduce damage from free radical reactions because they can donate electrons to neutralize free radicals or their offspring without

2018 The Skeptical Cardiologist

4585. The patient-physician relationship is in critical condition

. The cost of running a small practice is not feasible for many now due to ever-changing regulations, electronic medical record requirements and lower reimbursement for services. There are certainly benefits to larger health care organizations, such as more collaboration opportunities and convenience-of-care coordination for patients. However, physicians must continue to do what is right medically and lead rather than follow when it comes to delivering health care. Despite shifting practice demographics (...) , the larger problem we face collectively is a lack of unity. All too often, we are competing rather than collaborating. The turf battles between specialists and protecting our territory hurt physicians. Yet, we fall in line with regulations imposed on all of us which we know are illogical. We have become customer service specialists, held to the most stringent patient satisfaction expectations, even when doing the right thing medically opposes this. For example, if prescribing an opioid is clearly

2018 KevinMD blog

4586. Doctors: Don’t forget to take care of yourselves

record, we oftentimes look at some action that we’re ordering for them and say, “Hey, don’t I need to do that?” When was the last time that you, a health care provider who knows best, saw your own primary care provider? Are you prescribing medicines for yourself, or having one of your partners send in prescriptions for you? Ordering your own labs, and reviewing them yourself? I guess all I really want to say is, to take care of everyone else we do need to take care of ourselves, especially as we try (...) , heal thyself” and William Osler’s quote, “The doctor who treats himself has a fool for a patient,” you probably have a recipe for disaster, or at least poor care. I can imagine that as each of us sits with our patients and struggles with them to get their health care maintenance items “up-to-date”, while we are simultaneously managing their acute and chronic medical conditions, trying to deal with our daily administrative and regulatory requirements, and navigating the lumbering electronic health

2018 KevinMD blog

4587. 10 ways this primary care physician will work smarter in 2018

about scanning the New England Journal of Medicine on my iPad every Wednesday night. I’m usually on call that night, so it will be easy to remember this resolution. 3. In my northern clinic, where routine prescriptions are filled by the providers, I will save myself up to an hour a week by refilling routine, non-controlled medications for a whole year and relying on the other existing systems for making sure patients don’t get “lost to followup.” I learned this from Christine Sinsky’s work many (...) years ago, but because my southern clinic has standing orders for routine prescription renewals, I haven’t had to worry about it so much. 4. In both clinics, I will invest a little more time polishing my EMR templates in order to speed up and beef up my documentation. I will also continue to ponder how I can insert a visit snapshot near the top of each progress note so I can get the gist of it without scrolling down to the bottom when rereading it at the next, follow up visit. 5. I will more

2018 KevinMD blog

4588. Difficult Patient vs Difficult Doctor

a study that found that patients that were labeled noncompliant had underlying issues and NOT mental illness or just being difficult. Of patients that were not taking medication, the issue was that the patients could not afford the cost of the medications prescribed. The paper encouraged physicians to see if this was the issue and seek cheaper alternatives for the plan of care. (Source: ) This has been around for a long time and I have seen nurses commonly share this on social media. I have also heard

2018 Bioethics Discussion Blog

4589. 5 ways poorly thought out health IT can worsen patient safety

5 ways poorly thought out health IT can worsen patient safety 5 ways poorly thought out health IT can worsen patient safety 5 ways poorly thought out health IT can worsen patient safety | | January 19, 2018 122 Shares The frontlines of health care have been transformed over the last decade as electronic medical records have been rolled out across America. Unfortunately, information technology has yet to live up to its immense promise in health care­ — a topic that I frequently write about (...) concerning ways communication and patient safety can actually be impaired with ill-thought out computer systems: 1. Reviewing results. Electronic medical records present physicians with vast swathes of data, often redundant. Unfortunately, it’s become far too easy to mindlessly click on a box, import results into, for example, a progress note—without actually reading it and thoroughly reviewing what’s in front of you. In the days of the paper chart, doctors were forced to write down anything abnormal

2018 KevinMD blog

4590. Hospitals and doctors: Is their role in soaring health care costs overlooked?

. “Covering the business of healthcare is so interesting,” Herman told me. “There should be more scrutiny and more criticism of it.” While drug manufacturers and insurance companies are “easy targets,” he said, hospitals and doctors often get overlooked. “I’ve never really understood that,” Herman said. “That’s where so much of the money is.” accounts for about one-third of the country’s health expenditures; physician services make up 20 percent, and contrary to public perception, prescription drugs (...) . “In theory value-based care means better care for less money,” Herman said. But does it? How would it affect premiums? How would it make care simpler and better? Proponents of value-based care want you to believe providers and insurers are on the same page, but . A hospital’s financials are the key to learning where a hospital or hospital system is headed financially. Herman recommends that reporters familiarize themselves with a database called (Electronic Municipal Market Access), a portal run

2017 HealthNewsReview

4591. A conversation with a Rigvir flack

and regulations (in our case standards for clinical trials) are used with backward date. Yes for new registrations – we know the rules – we will provide proper RCT data, but as for now, please respect that the medicine is prescription medicine that is prescribed only in national clinics and by certified doctors for last 13 years. They have alternatives and even reimbursed ones. So obviously these doctors have deeper knowledge about the therapy with RIGVIR, than just analysis of published data, since (...) and most of the evidences is not published. Doctors and clinics in Latvia use this medicine for majority of melanoma patients in Latvia for many years. In Latvia medicine is prescribed only in national clinics and by certified doctors and they have also other alternatives, so probably they know what they do. 2 years ago we started EMA (centralised EU) commercialisation process and even obtained EU commission support from Horizon2020 grant, we also obtained EMA regulatory advice. There is no doubts

2017 Respectful Insolence

4592. The annals of “I’m not antivaccine,” part 26: “No, I’m not an ‘vaccine safety’ advocate”

pain? Give me a minimal amount – 1-2 days worth of dosing – so it’s not sitting around. But don’t forbid medication. (Yes, I know what the guidelines say . But I’ve already heard people talking about how doctors are refusing to prescribe adequate pain relief for their kids after surgery.) Apologies for the derail… JDK The vaccine safety gambit is depressingly effective, I find though that I can counter it equally effectively with ammunition from this blog. If you don’t know any better, the safety (...) acceptable. There is one additional factor for trans people: gender reassignment surgery was still a novelty forty years ago. The only case I knew about was Walter Carlos (creator of Switched-On Bach , which showcased the capabilities of the then recently invented Moog synthesizer in arrangements of Baroque-era music), who became Wendy Carlos and subsequently became famous as an electronic music pioneer. The only way trans people could exist before such surgeries were developed was to appear

2017 Respectful Insolence

4593. Can Vaping Help Smokers Quit? The Real Story from a Real Story

, my son's coach approached me after practice and asked, “Can this thing really help me quit smoking?” He was holding a large, black box in his hand — a sort of stylized plastic straw jutted out from one side of the box and four green and red lighted buttons littered the other side. I recognized this as a “vape mod,” a more complicated and some would say, advanced version of the typical electronic cigarette or “vape pen.” In their modern form, electronic cigarettes were developed as an alternative (...) nicotine delivery device in 2003 and were introduced in the United States a few years later. The devices quickly grew into a multimillion-dollar industry and some business analysts even suggested that the sale of electronic cigarettes would by 2021. Rates of use certainly exploded in the last few years among both and , and many countries, including the United States, are still trying to come to regulatory grips with the new technology. The coach must have asked me because he knew I was involved

2017 The RAND blog

4594. The annals of “I’m not antivaccine,” part 26: Hating on those who won’t let their antivax freak flag fly high

pain? Give me a minimal amount – 1-2 days worth of dosing – so it’s not sitting around. But don’t forbid medication. (Yes, I know what the guidelines say . But I’ve already heard people talking about how doctors are refusing to prescribe adequate pain relief for their kids after surgery.) Apologies for the derail… JDK The vaccine safety gambit is depressingly effective, I find though that I can counter it equally effectively with ammunition from this blog. If you don’t know any better, the safety (...) acceptable. There is one additional factor for trans people: gender reassignment surgery was still a novelty forty years ago. The only case I knew about was Walter Carlos (creator of Switched-On Bach , which showcased the capabilities of the then recently invented Moog synthesizer in arrangements of Baroque-era music), who became Wendy Carlos and subsequently became famous as an electronic music pioneer. The only way trans people could exist before such surgeries were developed was to appear

2017 Respectful Insolence

4595. Charlie Goldsmith: A new celebrity quack arises, enabled by TLC

by prescription drugs…these are those murdered by Charlatans. Doctors doing their master’s any cemetery and count the headstones…every one of them (just about) was a patient of a doctor once. The greater percentage of energy healing works… the agenda of the Pharma companies is to keep everyone foolish enough to believe their Doctor i a state of UNWELLNESS. Insiders tell us this truth all the time. what is is. In excess of three Pharma Co lobbyists for every USA congressman and they take 70 to 80 (...) cellular membranes as a given membrane depolarizes by letting ions flow through it –the electrical fields here are a side effect of the gradient, rather than the point of the gradient. And these currents are not of electrons. The resting 70 mV potential across a nerve membrane is due entirely to the difference in ion content on either side. The wave propagating along a nerve to send the signal are in measures of membrane polarization, which is not current at all and not really actually “transmitting

2017 Respectful Insolence

4596. Integrating Pharmacogenomics in Practice: One GIFT at a Time or a Package Deal?

a one at a time genomic testing platform for single applications seems highly inefficient. If warfarin pharmacogenomics data were readily available in the electronic health record (EHR) when individuals were prescribed warfarin, there seems little doubt that the data would be used routinely. But, if an entire system needs to be developed at the point of care for obtaining and using warfarin pharmacogenomics data at the time of a decision to treat, it may never become part of routine care. It is time (...) laid over the last decade by the groups such as the of the American Health Information Community, and a broad group of government and non-government interested in this topic. Developing electronic health records that can manage genomic data is crucial for the future U.S. health care system in order to ensure broad and equitable access to pharmacogenomics and other evidence-based genomic interventions. Posted on November 6, 2017 by W. Gregory Feero M.D., Ph.D. Faculty, Maine-Dartmouth Family

2017 CDC Genomics and Health Impact Blog

4597. Improving transparency and replicability of healthcare databases to increase credibility of “real world” evidence

Improving transparency and replicability of healthcare databases to increase credibility of “real world” evidence Improving transparency and replicability of healthcare databases to increase credibility of “real world” evidence - The BMJ ---> Evidence generated from “real world” data (e.g. administrative claims and electronic health record databases), alongside clinical trials, is highly valuable for regulatory, coverage, and clinical decisions. While randomized clinical trials (RCTs (...) for the risk-benefit profile of drugs and other medical products is reflected in recent policies such as Adaptive Pathways in the European Union, the 21 st Century Cures Act, and Prescription Drug User Fee Act (PDUFA) VI in the United States. Each of these policies has sections designed to advance use of “real world” evidence to support regulatory decisions. However, due to highly variable quality, decision makers are currently unsure how to use evidence from database studies. Equipping decision-makers

2017 The BMJ Blog

4598. Robert F. Kennedy, Jr. and his World Mercury Project: Antivaccine, NOT “fiercely pro-vaccine”

rare and serious adverse events following immunization. The VSD uses electronic health data from each participating site. This includes information on vaccines: the kind of vaccine given to each patient, date of vaccination, and other vaccinations given on the same day. The VSD also uses information on medical illnesses that have been diagnosed at doctors’ offices, urgent care visits, emergency department visits, and hospital stays. The VSD conducts vaccine safety studies based on questions (...) insurance claims data from four national healthcare plans: Aetna, HealthCore (Wellpoint), Humana, and OptumInsight (United Healthcare). And more: PRISM is one component of FDA’s Sentinel Initiative, which monitors the safety of a variety of FDA-regulated medical products by examining information in electronic healthcare databases. Sentinel performs what is called “active” surveillance, as opposed to “passive” surveillance. Passive FDA surveillance systems depend on industry, consumers, patients

2017 Respectful Insolence

4599. 5 lessons I learned about medicine from yoga

requirements of the electronic medical record is documenting at lunch, not attending yoga. Workload and compression of time dictate the day’s schedule. Additionally, by nature of where and when the courses were offered, the yoga itself was reduced to its barest elements. It was by nature, made reductive. It’s as if we thought that by bringing in the “asana” physical postures and “pranayama” breathing techniques, we were bringing yoga. But it was never just about the postures and the breath. yoga makes (...) enter an exam room to remind ourselves of our intention,and — for those few moments — work with an awareness of who we choose to be. We may remind ourselves that it is the energy we choose to bring into each encounter that has the power to change the lives of others. Often far more than any medication we can prescribe. Everything we desire, of ourselves and of our colleagues is available to us. We just have to unlock the practice. Rana Awdish is a pulmonary physician. Image credit: … … 338 Shares

2018 KevinMD blog

4600. Why “happy” doctors commit suicide

anxiolytics and was suffering from rebound anxiety and insomnia — sleeping just a few hours per night and trying to operate and treat patients each day. Then his psychiatrist retired and passed him on to a new one. Eight days before he died, his psychiatrist prescribed two new drugs that worsened his insomnia, increased his anxiety, and led to paranoia. He was told he would need medication for the rest of his life. Devastated, Ben feared he would never have a normal life. He told his sister it was “game (...) for occupationally induced mental health wounds, they become even more desperate. If physicians do seek help, they risk being disciplined. Doctors rightfully fear lack of confidentiality when receiving mental health care as private conversations with therapists could be turned over to medical boards and illegally accessed by their supervisors via electronic medical records at their institutions. So physicians drive out of town, pay cash, and use fake names in paper charts to hide from state boards, hospitals

2018 KevinMD blog

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