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Saturday, January 29, 2005An article by Jeanne Lenzer in our 1 January issue (BMJ 2005;330:7) reported that the US Food and Drug Administration was to review confidential Eli Lilly documents that had been sent to the BMJ by an anonymous source. The article stated that these documents had gone 'missing' during a 1994 product liability suit filed against Eli Lilly. That statement has been the subject of a detailed investigation conducted by the BMJ following a complaint by Eli Lilly. That investigation has revealed that all of the documents supplied to the BMJ that were either Eli Lilly documents or were in the hands of Eli Lilly had in fact been disclosed during the suit. At the end of the trial, all the documents were preserved by Court Order or were disclosed by Eli Lilly to the plaintiffs' lawyers in related Prozac claims. The original article, no longer available online unless you want to pay $8, did make Eli Lilly look pretty bad (a copy of it is here.) Now, how do you get all the newspapers who published the original story to publish this one, too, and with the same amount of sensationalism? posted by Sydney on 1/29/2005 11:56:00 PM 0 comments
Friday, January 28, 2005It was one of those cryptic messages that physician's offices are famous for: Your blood tests have uncovered a problem; please make an appointment to see the doctor. But it would be two weeks before Patty McGinley's doctor -- Dr. Bob Juhasz of the Cleveland Clinic's Willoughby Hills Family Health Center -- would be able to see her. A phone call to the office revealed that her cholesterol was the problem. But how high was it? Was McGinley, as she put it, ``a little unhealthy or a lot?'' Seated next to President Bush at a forum at the Cleveland Clinic on Thursday, McGinley talked about her problem and its resolution. ``I'm a worrier,'' the 48-year-old Concord Township woman said. ``I felt pretty helpless and concerned.'' Then she got an e-mail message from the Cleveland Clinic that included a link to her electronic medical records. In the message were not just her test results, but also charts that showed where her results fell in relation to normal ranges of cholesterol and triglycerides. ``I went from feeling helpless to being in complete control,'' she said. ``It really empowered me.'' Of course, her worry could have been avoided if her doctor had just sent her a note in the mail with her results and the explanation instead of sending the cryptic "call the office" message. You don't need computerized systems to avoid problems like that. The Administration has ambitious goals and hopes: Dr. David Brailer, Bush's national health information technology coordinator, said the goal in the next 10 years is to have every doctor use a computer to record and read patients' medical records, to order tests, to write prescriptions and to view images, such as X-rays or CT scans. The real challenge, Brailer said, is creating connections between different -- sometimes rival -- hospitals, so that if people find themselves in an emergency room in a different city, their medical records will be readily available to doctors who have never seen the patient before. That will improve safety, said Dr. Martin Harris, Cleveland Clinic's chief information officer. ``A patient will never have to worry about receiving the wrong dose or an inappropriate medication simply because someone couldn't read the handwriting on a piece of paper,'' Harris said. No, but a patient will have to worry about typographical errors in their prescription. It will be some time before there's a Micro-Soft of EMR, used universally by everyone, large and small. And that's what they're really talking about, isn't it? A system that's used universally so that information can be freely shared electronically? Who's going to develop that? Who's going to pay for it? As to empowering the patient, the only advantage my electronic medical record affords my patients is that I can fax their prescriptions over to the drug store so they don't have to spend so much time waiting for it to be filled. The EMR is more an advantage for myself and my staff than it is for my patients. It does improve patient care somewhat, by improving the organization of the chart, but the main advantage is to myself and to my staff. A physician reader who has some experience with electronic records thinks they aren't all that advantageous to physicians, either: I was involved with a task force which evaluated computerized records for a large medical group. The bottom line is that computerized records, as currently formulated, will slow down the productivity of MDs. The data entry is slower than handwriting or dictating. The pull downs on some encourage fraud in record keeping. (as a side note I review charts for the state medical board. The state's investigators never believe a chart when it is done with computer records. It has been their experiance that more often than not that computer records are false and do not reflect what occured at the visit.) Interestingly the advocates of computerized record keeping do not suggest that it makes you more efficient. The selling point is that it can improve reimbursement by documentation (see above sidebar) , that it is more readable, or that it is easier to find information. Unless it actually improves efficiency it may remain a geewiz device that is nice to have if you have a lot of excess money in the practice and a minimal patient load. Good Luck with making it work when you are busy. (You might want to try check off sheets for common complaints. that is what the large medical practice ended up doing) Although right now it's slowing me down as I enter old patient information (past history, allergies, medications, etc.) in each patient's chart, eventually it will make me more effecient. I won't have to go look for a chart when I have an abnormal lab, I can just pull it up on the computer. The staff won't have to pull charts for the next day and insert paper for the note. I type much faster than I write, and the electronic record I have is designed to use codes for frequently used phrases. For example, if I type amox500, what shows up on the screen is "Amoxicillin 500mg po tid x 10 days. Disp:#30 No refill." It's true that some templates are more expansive than most people ever are in the office, but it would be a mistake to assume that everyone who uses a template is lying. An auditor should never go into an audit assuming their victim, er client, is guilty. Even when I write my charts by hand, I write the same things over and over and over again when it comes to physical exams. A template just makes the process faster. If I use a template that's just like my repeatedly handwritten exams, then it's really no different, except that it's much faster. And check-off sheets are subject to the same problems as templates - it's easy to mistakenly check off something you didn't actually do. And if you're going fast, you might not even catch it. posted by Sydney on 1/28/2005 08:05:00 AM 0 comments
Wednesday, January 26, 2005Today, I teach the staff how to use the new computerized medical records. I'm a little worried about their ability to adapt to new technology, or to newness in general. Monday, I introduced them to the new fax/copier/scanner and they were a little freaked just because it doesn't act like the old one. Change is always hard, but add computers to it, especially for folks who came of age before computers were wide spread (or before video games) and its's doubly hard. Yesterday, I overheard the oldest staff member say "computers scare her." We may have a rough couple of weeks, if not months, ahead of us. I haven't yet gotten to the point that I can say the system makes my work faster. I began trying it myself on Monday, but abandoned it for my old paper ways after two patients. We were busy and I just couldn't handle the volume and make the switch at the same time. My routine is a well-oiled one, and disrupting it slows me down - a lot. The next day, I used it on six patients before abandoning it. But a lot of that slow down is due to data entry. Once my staff knows how to use it, and once our more complicated and established patients have all of their baseline info entered, it should go much smoother and be at least, if not more, efficient than our current paper system. Meanwhile, it's definitely a mistake to expect the computerized system to reduce errors. (Something I've argued all along. Typos are much more common than hand-written errors. And a second party knows when they can't read handwriting (a signal that they should ask for clarification), they don't know if they're reading a numerical typographical error.) posted by Sydney on 1/26/2005 08:25:00 AM 0 comments
Tuesday, January 25, 2005posted by Sydney on 1/25/2005 03:55:00 PM 0 comments
Monday, January 24, 2005But the funniest part of the article was the claim that radiologists were attracted to the centers not for the easy money, but for the chance to interact with patients: The business also appealed to radiologists who normally send reports to doctors but have little contact with patients. At the scanning center, though, Dr. Brant-Zawadzki sat down with patients and discussed their scans. "It was very pleasurable," he said, adding that "it also promoted the value of radiologists to those patients." This is closer to the truth: Dr. Carl Rosenkrantz, a radiologist in Boca Raton, Fla., said the business had another appeal - it promised radiologists a good living without being on call at a hospital and even without necessarily being present at the scanning center. "The goal in life seems to be to try to figure out some way where you don't have to go to the hospital, where you don't have to take calls," Dr. Rosenkrantz said. "Radiologists saw this as a cash business and a way out." ....As for Dr. Giannulli, he has moved on to other things. He founded a company, CareTools Inc., which sells software for medical record keeping to doctors' offices. That, he says, is the new frontier in medicine. No call, no patients, no hospital. The radiology dream job. posted by Sydney on 1/24/2005 08:10:00 AM 0 comments
Sunday, January 23, 2005States have begun dropping their restrictions on flu shots now that falling demand has led to surpluses, and some health officials want the federal government to take similar action. The federal government last month eased its restrictions, imposed when production problems in October cut the flu vaccine supply in half, and allowed shots for adults age 50 and older. Since then, at least 17 states have lifted all previous restrictions, according to the Association of State and Territorial Health Officials. The states previously had reserved the vaccine for older adults, infants and people with chronic medical conditions. Some health officials say the Centers for Disease Control and Prevention should recommend that restrictions be lifted nationally. An article in our local newspaper said that the health department now has about 400 doses of flu vaccine on hand, but just three weeks ago, they still had an answering machine message saying they had none. Evidently, the supply didn't come available until this month, when it's really not all that worthwhile. In this part of the world, flu season usually peaks around January or February. The vaccine works best if given a month or two before flu season. It's too bad the vaccine supply wasn't made available in November or December. The distribution plan moved at a snail's pace, or at least at a bureaucracy's pace. posted by Sydney on 1/23/2005 10:21:00 PM 0 comments
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