Wednesday, December 19, 2012

Explaining the epic failure of EMRs

It is no news a lot of doctors like to stick up a rather snotty nose to EMR. The defenders of the EMR tend to label such doctors as archetypal Luddites, sticking to their archaic ways and unbecoming of change and the new times. But as is usually the case with any two heated but opposite arguments, the truth likely lies somewhere between the two extremes.
On an objective basis, there is no denying that automatisation of medical record keeping is the new way forward. In theory, if the machine could keep records for you and give it back to you when and where you want it, thus freeing up valuable time for the patient encounter, that should be winsome for everyone. That alas, is a vision of the EMR utopia, and let alone being anywhere close to such utopia, it is difficult to ascertain if we are even set in the road leading us there.
Sometime ago, exasperated at the sheer waste of time that the clunky new discharge module was causing because it would not work the way it is supposed to (my hospital is means challenged, so they are building a patchwork of cheapskate EMR suite on top of their legacy system from the 90s, just to placate the gods of CMS), I complained to the IT guy that the thing barely works! The guy was sympathetic and said, “look I know the discharge module sucks, just bear with it until the end of the year when we should be able to weed out the bugs.”
But that’s not all, I said, even if it were working just the way it is supposed to, the discharge still takes me longer than what it used to with paper. “That’s something you will have to learn to live with,” he retorted. “Computer records do take a longer time than paper, and there is nothing I can do to change that.”
Right there, I think is where EMR loses a lot of ground against paper records. At any practice, time is the most valuable resource, and anything that doesn’t offer a straight off benefit to save time will have a hard time being adapted. Add to that the inertia people have about their old ways and you have a deal breaker right there.

Comparison with paper-based records

Paper-based records are still by far the most common method of recording patient information for most hospitals and practices in the U.S.[2] The majority of doctors still find their ease of data entry and low cost hard to part with. However, as easy as they are for the doctor to record medical data at the point of care, they require a significant amount of storage space compared to digital records. In the US, most states require physical records be held for a minimum of seven years. The costs of storage media, such as paper and film, per unit of information differ dramatically from that of electronic storage media. When paper records are stored in different locations, collating them to a single location for review by a health care provider is time consuming and complicated, whereas the process can be simplified with electronic records. This is particularly true in the case of person-centered records, which are impractical to maintain if not electronic (thus difficult to centralise or federate). When paper-based records are required in multiple locations, copying, faxing, and transporting costs are significant compared to duplication and transfer of digital records.[citation needed] Because of these many "after entry" benefits, federal and state governments, insurance companies and other large medical institutions are heavily promoting the adoption of electronic medical records. Congress included a formula of both incentives (up to $44K per physician under Medicare or up to $65K over 6 years, under Medicaid) and penalties (i.e. decreased Medicare/Medicaid reimbursements for covered patients to doctors who fail to use EMR's by 2015) for EMR/EHR adoption versus continued use of paper records as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009.[3]
One study estimates electronic medical records improve overall efficiency by 6% per year, and the monthly cost of an EMR may (depending on the cost of the EMR) be offset by the cost of only a few "unnecessary" tests or admissions.[4][5] Jerome Groopman disputed these results, publicly asking "how such dramatic claims of cost-saving and quality improvement could be true".[6]
However, the increased portability and accessibility of electronic medical records may also increase the ease with which they can be accessed and stolen by unauthorized persons or unscrupulous users versus paper medical records as acknowledged by the increased security requirements for electronic medical records included in the Health Information and Accessibility Act and by recent large-scale breaches in confidential records reported by EMR users.[7][8] Concerns about security contribute to the resistance shown to their widespread adoption.
Handwritten paper medical records can be associated with poor legibility, which can contribute to medical errors.[9] Pre-printed forms, the standardization of abbreviations, and standards for penmanship were encouraged to improve reliability of paper medical records. Electronic records help with the standardization of forms, terminology and abbreviations, and data input. Digitization of forms facilitates the collection of data for epidemiology and clinical studies.[10][11]
In contrast, EMRs can be continuously updated (within certain legal limitations – see below). The ability to exchange records between different EMR systems ("interoperability"[12]) would facilitate the co-ordination of healthcare delivery in non-affiliated healthcare facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management and public health communicable disease surveillance.[13]


Wednesday, December 5, 2012

World's oldest woman died

Besse Cooper of Georgia was declared the world's oldest person in January.

MONROE, Ga. — The woman who was listed as the world's oldest person has died in a Georgia nursing home at age 116.
Besse Cooper died peacefully Tuesday afternoon in Monroe, according to her son Sidney Cooper. Monroe is about 45 miles east of Atlanta.
Cooper said his mother had been ill over the weekend with a stomach virus, then felt better on Monday. On Tuesday he said she had her hair set and watched a Christmas video, but later had trouble breathing. He said she was put on oxygen in her room and died there about 2 p.m.
She was declared the world's oldest person in January. In May, Guinness World Records learned that Maria Gomes Valentin of Brazil was 48 days older. Valentin died June 21.

Also see:  COKE IS POISON!

Tuesday, December 4, 2012

Americans have the least confidence in parliament and car dealers

Americans have the least confidence in parliament and car dealers

Parliamentary and car salesman - they are the least honorable profession in the opinion of Americans, according to a survey published on Monday and probably not surprise Americans elect, whose lack of popularity is highest, according to AFP.

Institute Gallup asked respondents to give ratings in terms of 'honesty and ethics of people' from a list of 22 professions. First stood nurses, with 85% of the votes of those surveyed, followed by pharmacists, doctors, engineers, dentists and police.

The last places in the rankings, car dealers are considered honest by only 8% of respondents, roughly the same as members of the House of Representatives (10%), employees and vendors advertising actions. Senators occupy a better place.

Many professions were excluded from the survey, but it illustrates the traditional unpopularity of Congress, symbols of inertia and corruption in Washington, says the source.

According to surveys conducted in 1976, only in the immediate aftermath of the terrorist attacks on September 11, 2001 Americans were elected the first places in the ranking. After that brief moment of national mobilization period, they went into free fall. Regularly, American lawmakers are under investigation on ethical issues or for adultery or for embezzlement.

Since 2010, the House of Representatives is controlled by Republicans, while the Senate remains in Democratic hands. With this 'cohabitation' legislative deadlock was almost total in the last two years, each room texts adopted by voting against opponents controlled chamber.

EU institutions have complied with the 82% European Ombudsman's recommendations

EU institutions have complied with the 82% European Ombudsman's recommendations

European Ombudsman Nikiforos Diamandouros considers that in 2011 the compliance rate institutions European Union (EU) on his suggestions was 82%, in the context in which it issued in that year 120 recommendations, positions and friendly solutions, a release of the European Commission (EC) released Monday.

'European Ombudsman's decisions are not binding law. That is why I rely on my arguments convincing force and the availability of institutions to cooperate with me in combat administrative shortcomings and draw lessons for the future. Overall compliance rate of 82% is encouraging, but leaves room for improvement, especially for institutions that are significantly below average, "said Nikiforos Diamandouros, quoted in press.

In 2011, recommendations, positions and amicable solutions proposed by the Ombudsman were related to situations such as the refusal to allow access to documents, problems with procedures, conflict of interest or violation of the right to a hearing.

In one case, the Ombudsman has contributed to the settlement of a dispute between the European Commission (EC) and an NGO on an EU project launched under the 'European Dialogue on Migration'. EC finally returned 70,000 euros NGO concerned.

On the other hand, there was a situation in which the EC has decided not to follow the recommendation of the Ombudsman to facilitate access to the requested documents.

In another case, the European Medicines Agency (EMA) has followed the recommendations of the Ombudsman to publish warnings about possible side effects related to Septrin, a medicine used to treat bacterial infections.

Surgically implanted device that allows controlling diabetes and reducing obesity

Surgically implanted device that allows controlling diabetes and reducing obesity

Doctors at the hospital in Barcelona Bellvitge first appeal to a new type of surgery that allows reduction of obesity and diabetes control, agency EFE reported Monday.

The system consists of placing a device in the small intestine leaving the stomach by endoscopic intervention. The device creates an internal barrier between food intake and first part of the bowel wall, allowing food to get digested faster and less at the other end of the intestine, as if 'by-pass' gastric surgery.

Placing the device is outpatient anesthesia and does not require intervention takes less than half an hour, but the patient must remain in hospital under observation for one night.

This treatment is indicated in patients suffering from type 2 diabetes who do not respond positively traditional treatment. After a year when the patient may lose up to 20% of body weight, the device is extracted all about endoscopy.

Monday, December 3, 2012

HIV developing in Athens

HIV developing in Athens

Athens recorded an alarming increase of new HIV infections, especially among intravenous drug users, health authorities warned Friday, as Greece struggles with a prolonged financial crisis in the financing of health care and drug treatment programs have been reduced, the Associated Press reports.

While there were around 10-14 new HIV infections per year among drug users in Athens from 2008 to 2010, that number soared to 206 new cases last year and 487 new cases until October of this year - an increase of 15 times and 35 times, respectively, officials said.
"There is no doubt that we have a large fast growing epidemic in Athens," said Angelos Hatzakis Professor at the University of epidemiology and preventive medicine in Athens.
A total of 1,049 new cases of HIV infection were recorded in Greece in the first 10 months of this year, including 487 drug users. Among others, 256 are male homosexuals, while 108 were infected with the virus through heterosexual intercourse, figures show.
"One of the reasons is the financial crisis," said Director of the European Centre for Disease Prevention and Control / ECDC / Marc Sprenger. "There are many people who are vulnerable, marginalized" and using drugs.
They turn to cheaper drugs and inject them instead of smoking them to get the maximum effect from a smaller amount, officials said.
"We are very worried," said Sprenger. "What we see now is that growth, and if we do not pay serious attention to this work in the future will become a huge burden."
Greece is hit by a financial crisis in late 2009, he left the country to experience a sixth year of deep recession and a quarter of its workforce unemployed. To remain solvent, the country relies on international rescue loans from other European countries that also use the euro and the International Monetary Fund, notes AP.
But instead, the Greek government has imposed several rounds of spending cuts and tax hikes in an effort to reform the economy and reduce the country's huge debt. The cuts have affected health care costs, many hospitals reported lack basic materials, while charities dealing with drug users and persons with HIV also are struggling to find funds.
One of the main ways to prevent the spread of the virus that causes AIDS among drug users is the free distribution of needles, clean, officials said, and programs in this regard in Greece were able to increase the number of needles distributed it to 40 up to about 50-60 per dependent per year. But the actual number required for these programs to be effective, officials said ECDC is about 200 per drug per year.
"The cost of prevention to avoid HIV infection is significantly lower than to treat those who become infected," remarks Sprenger

Sunday, December 2, 2012

Is Drug Addiction part of Human Evolution?

 Is Drug Addiction part of Human Evolution?

The human mind is a wondrous and expansive thing that is constantly learning and adapting itself to the changing universe that surrounds us. Nonetheless human beings have a habit of becoming unsatisfied with our surroundings. Dealing with mental anguish and boredom has always been one of our greatest challenges as a species. To meet these challenges many of us have resorted to the use of recreational drugs in an effort to either expand our minds, embrace new experiences or simply to nullify the pain that life has inflicted upon us. Since the time of the ancient Egyptians mankind has sought out, cultivated and harvested a wide variety of recreational drugs to satisfy our cravings, alleviate our shortcomings and nullify our insecurities. The more advanced we evolve as a species the more sophisticated and widespread our involvement in the drug culture. But if we are to believe the teachings of Darwin about evolution, the strongest of the species will always thrive and dominate over the weaker of the species. Hence, given the proliferation of drug use with the technological advancement of our society, we must ask ourselves some fundamental questions. Is the use of recreational drugs just part of the human condition, and to that end is drug addiction actually part of our natural evolution as a species?

Regardless of your attitude to drugs you cannot argue that over thousands of years they have become increasingly diverse and prevalent in our society. Perhaps it is the growth in the variety of drugs and their use that has seen a very modern phenomenon emerge; the moralization and strict legal classification of drugs and their users. This recent trend of ascribing a moral label to drugs has meant that now there are basically two types of drugs that exist in the world. In the black and white world of our politically correct society drugs are classified as either medicinal or recreational in nature. Politicians, religious groups, social welfare groups and lawmakers have drawn a very distinct line in the sand between drugs that are good and drugs that are bad. Drugs that are medicinal in nature (eg: modern pharmaceutical drugs) are generally considered to be good for us and hence are classified as legal. In general recreational drugs are considered to be bad for us and are hence deemed illegal. The only recreational drugs that are legal are the ones that are so entrenched in our history and culture they are too hard to eliminate from society (eg: alcohol, coffee and tobacco).

Is Drug Addiction part of Human Evolution?
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Saturday, December 1, 2012

Does Africa need help?

Does Africa need help?
(CNN) -- Some of the bravest people I know are cowering today in eastern Congo, wondering where their supporters are. While our daily news zeroes in on Syria and Gaza, the fiscal cliff and Christmas sales, our friends in the war-ravaged part of the immense, mineral-rich Democratic Republic of the Congo are once again convulsed in a conflict they did not choose.
A resident from Goma, in North Kivu province, who for security reasons must not be named, sent me a heartbreaking e-mail accompanied by a photo taken by The Associated Press' Jerome Delay. It shows a tiny girl leading a long line of displaced women who carry enormous loads on their backs, a look of utter desperation on her face as tears stream down her cheeks.
Susannah SirkinThe e-mail says, "This girl is a future mother, barely four years old and she must walk many kilometers due to the attack on her village. She cries, but who is listening? No one takes care of her, no one to console her. Her mother can't help because she is carrying their entire household's possessions on her back. Just one attack on this column of displaced people and she will find herself alone in the jungle. We only ask for peace. It's unacceptable that we deny her the chance to grow up and become a mother one day."

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It is shocking how ill-prepared the international community has been for this latest round of violence in Africa. A leading hospital in Goma, where guerrilla forces have been poised to enter the city for months, sent desperate e-mails to friends around the world pleading for antibiotics, painkillers, plaster and bandages, as international agencies focused on evacuating their staff members from border areas. E-mails I received showed bloody, shattered limbs of children and badly wounded patients with expressions of horror and despair.

Many call Congo the "rape capital of the world," and when you work as I have with the doctors and nurses who have treated tens of thousands of rape survivors, it's hard not to acknowledge some truth to this terrible epithet. For the past 16 years, armed factions supplied by Rwanda, Uganda and the ragtag and ill-paid army of the Congolese government itself have carved up the Congolese provinces of North and South Kivu, marauding, pillaging, killing, abducting children to be soldiers and, yes, gang-raping women and girls as well as men and boys.
All the while, gold, diamonds and precious coltan ore have continued to be extracted and exported as the people of the Kivus have suffered without electricity, roads, schools and good government.
The single largest U.N. peace-keeping force in the world, MONUSCO, stood by virtually impotent last week as some 1,500 M23 rebels overran Goma. Congolese troops, many of them hungry and penniless, ran for the hills. And while we gathered around our Thanksgiving tables, the people of Goma hid in their homes or fled.

Read more here

Resident physicians can earn up to $ 3,000 a month in Israel

Resident physicians who will be selected for scholarships for three years at the prestigious university of Sheba Hospital in Israel, following a program organized by Wizrom Software and Sheba Israel Hospital will receive a gross monthly salary of up to $ 3,000 (2,400 euros), informs a company release Wizrom Wednesday.

Initial enrollment period, Nov. 22, was extended by five days, at the request of resident doctors who intend to apply, but need time to finalize cases.

The scholarships cover all costs of accommodation and transport, plus salary for three years as a resident doctor at Sheba Hospital in Israel. The package also includes health insurance, including accommodation for couples, malpractice insurance and more.
'For resident physicians in specialties neonatology, anesthesia / intensive care and pathology, this is a once in a lifetime opportunity: not only will you probably work best hospital in the world, but you will be paid accordingly, "said Eli David, entrepreneur who controls the company that sponsors the internship program, Wizrom Software, one of the largest providers of ERP solutions in Romania.

The program, entitled SHI Training Fellowship, started on 18 October in Romania with the selection of the six candidates by a prestigious jury. Ideal candidates must be resident doctors in specialty training in neonatology, anesthesia / intensive care and pathology to participate in SHI Training Fellowship. Months spent in Israel will be equivalent and will be considered upon completion of residency.

Wizrom, a leading provider of ERP solutions in Romania, organized this program unprecedented scholarships for resident doctors to mark the anniversary of 20 years since its establishment by an act of donation to the community.

Files can be submitted on or can be sent by post or e-mail until 27 November 2012, at 24:00. Winners will be publicly announced at a ceremony to be held on December 12, 2012. They will have to commit to accomplishing contract that three years Israel will return to Romania and the Romanian medical system will practice for at least five years.

Founded in 1992, Wizrom Software is one of the top companies in Romania providing business software solutions. The company has a total of 3,424 active customers and over 31,000 licenses installed. Wizrom Software has in recent years strengthened regional presence and visibility through the operation of subsidiaries in Moldova and Bulgaria, starting projects with multinational clients in Serbia and Hungary, as well as creating a local network of certified partners.
The company has 160 employees from 15% growth in the first half of the team.

Sheba Medical Center is the largest medical center in Israel and the Middle East, providing complete care in virtually every medical discipline.

The risk of stroke is higher in people who lose their jobs

The risk of stroke is higher in people who lose their jobs, which is bad news in the current context. Job loss may increase the risk of heart attack, according to a study published in the journal 'Archives of International medecine' and noted

By reaching these results, the researchers studied more than 13,500 people aged between 51 and 75 years, from 1992 to 2010, twice a year: 14% of them were unemployed at baseline and nearly seven in ten and have lost at least work during the 20 years. In nearly two decades, researchers have recorded nearly 1,000 heart attack.

Lead author of the study, Matthieu Dupre at Duke University in North Carolina found that heart attack risks were much higher in the unemployed who lost their job in the first year and increasing with each dismissal. People who have resigned are not included in these figures.

Researchers have observed that the rate of heart attack in people who have lost their jobs in the first year increased by 27%, regardless of profession. The effect appears to be cumulative: the risk would increase by 63% in people who have lost their jobs four or more times, the study said.

Taking into account such factors as obesity, smoking and lack of sporting activity, researchers found that job loss is an additional factor that would have the same impact on heart health as hypertension, type 2 diabetes and certain cardiovascular diseases. Risk of stroke in a person who has lost four or more times work are comparable to those of an old smoker.

Stress is not itself a direct cause of heart disease, although it may contribute to increased risk. The survey data did not take into account the reasons for dismissal and Matthieu Dupre states that do not yet know 'how stress increases the risk of heart attack. Further research is needed in this respect '.