Health and Medical News and Resources

General interest items edited by Janice Flahiff

[Press Release] MyChart use skyrocketing among cancer patients, UT Southwestern study finds

From the 9-Jul-2014 EurkAlert

 

 IMAGE: From left to right are: Drs. David Gerber and Simon J. Craddock Lee.

Click here for more information. 

DALLAS – July 9, 2014 – There has been a sharp increase in the number of cancer patients at UT Southwestern Medical Center using MyChart, the online, interactive service that allows patients to view laboratory and radiology results, communicate with their healthcare providers, schedule appointments, and renew prescriptions.

Over a six-year period, the number of patients actively using MyChart each year increased five-fold, while the number of total logins each year increased more than 10-fold, according to a study by Dr. David Gerber, Associate Professor of Internal Medicine, and Dr. Simon J. Craddock Lee, Assistant Professor of Clinical Sciences.

“This pattern suggests that not only are far more patients using this technology, but also that they are using it more intensively,” Dr. Gerber said.

These findings, published in the Journal of Oncology Practice, are noteworthy because no prior study has systematically examined the use of electronic patient portals by patients with cancer, even though use of this technology is surging nationwide, creating new terrain in clinical care and doctor-patient relationships.

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In 2009, Congress allotted $27 billion to support the adoption of Electronic Medical Records. The Department of Health and Human Services began allocating the funding in 2011. UT Southwestern started offering these services years earlier.

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“I was struck by the immediacy of the uptake and the volume of use,” Dr. Gerber said. “I suspected that the volume would be high. I did not think that it was going to be multi-fold higher than other patient populations.”

Use of MyChart was greater among cancer patients than among another other patient groups except for children with life threatening medical conditions, according to the study.

“We undertook this study because we suspected that the volume of electronic portal use might be greater among patients with cancer than in other populations,” Dr. Gerber said.

While the study did not directly compare use patterns with non-cancer groups, the average use in the current study was four to eight times greater than has been reported previously in primary care, pediatric, surgical subspecialty, and other populations.

Dr. Gerber explained that patient use of electronic portals to receive and convey information may have particular implications in cancer care. Laboratory and radiology results may be more likely to represent significant clinical findings, such as disease progression.

“I think we are still learning how patients understand and use the complex medical data, such as scan reports, that they increasingly receive first-hand electronically,” Dr. Gerber said.

Furthermore, symptoms reported by patients with cancer may be more likely to represent medical urgencies. Notably, the study found that 30 percent of medical advice requests from patients were sent after clinic hours.

 

July 11, 2014 Posted by | health care | , , , , , | Leave a comment

[Reblog]Technology and the doctor-patient relationship

Technology and the doctor-patient relationship.

From the 1 July 2014 KevinMD article

I often hear people talking about their doctors.  I overhear it restaurants, nail salons, while walking down the street. I hear what people think of their doctors, what their doctors said or what they didn’t say, why people were disappointed by or validated by their doctors.  I hear people analyzing, criticizing, and surmising about this relationship quite a bit, and I don’t blame them. The relationship you have with your doctor is a critical one, and yet it is fraught with misunderstanding, disappointment, and distrust. People didn’t used to doubt their doctors the way they do today, and I believe the essence of the doctor-patient  relationship has degraded in our culture.

 

In large part, I believe this is due to technology.

The Mayo Clinic recently announced they have partnered with Apple to create what they call the Health Kit.  Although the details are still unknown, the product is supposedly one that will allow patients to become more involved in their health care, from diagnosis to treatment delivery. This has always been the doctor’s job, but with the technology booming, it is no surprise that the next step would be computerized health care.

So is this a good thing, or a bad thing? I have mixed feelings, and I think the results will be mixed as well. Statistics show that positive relationships and supportive interactions with others are crucial parts of living a healthy life. Can a computer ever truly replace that je ne se quoi that occurs between a doctor and a patient?  In my own practice, I would like to believe that the interaction between my patients and myself is part of what leads to healing. I don’t believe a computer could do that as well as I can.

Here’s the problem, though.  Doctors are inundated with demands from insurance companies, paperwork, accountability measures, and check lists upon checklists required for medical records, billing, and measurable use. This situation worsened several years ago, with the mandatory implementation of Electronic Medical Records, and then even worse since the implementation of the Affordable Care Act.

These changes have also affected patients, many of whom have had to drop doctors they have had for many years because those doctors didn’t take the new insurance. The message, whether stated outright or not by advocates or detractors of the new systems, is that this doctor-patient relationship is not really all that important.

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July 9, 2014 Posted by | health care | , , , , , , | Leave a comment

[Reblog] The disturbing confessions of a medical scribe

From the 9 March 2014 KevinMD article

Screen Shot 2014-03-13 at 7.16.13 AM

As a medical scribe working with a large, well-known scribe company, unnamed to protect my job, it makes me proud reading all the articles published about how much having a scribe benefits a physician, especially in the emergency department. I enjoy my job immensely and I am grateful for the opportunity to learn and engage in patient care. However, as a pre-medical student working next to several other doctor-hopefuls in a high stress environment, being a scribe frustrates me on an ethical level.

 

 

 

Let’s examine the structure and reasoning that has made medical scribe programs so successful. When EMR systems were first introduced, there was resistance, but it gave way to the push for efficiency. The biggest benefit of EMRs is easy: risk management. By allowing for documentation of every little part of a patient’s care, EMRs significantly decrease the risk of mistakes slipping through the cracks. It allows for better defense of the physician’s medical decisions, even months down the line.

 

For example, a physician I worked with was asked to go to court for a patient who had been assaulted by her boyfriend. The patient had been seen several months ago in the ED. Few physicians would be able to remember all the details of an encounter so long ago. His testimony was therefore entirely based on the medical chart, written by me and approved by him. The EMR allowed for comprehensive, detailed documentation of test results, discussions with the patient, and interactions with the police.

 

Unfortunately, such comprehensive medical records take time and effort to write. Physicians complain that they were becoming little more than data entry specialists, dedicating large portions of the time they should be spending with patients to clicking buttons. In comes the scribe. Usually students or recent graduates interested in becoming a medical provider, we become the physician’s right hand. Scribes are purported to decrease physician burnout considerably and increase ED efficiency. Better documentation also leads to better billing, so hospitals make more money. The physicians I work with, in a hospital who has been using scribes for over 3 years now, have all been grateful for the program.

 

Sounds great, right? The winning combination of EMRs and scribes. The road to increased efficiency, increased Press-Ganey scores, increased billing accuracy, increased fraud, increased profits for the administration. Happiness abounds.

 

How many of you missed the “increased fraud”?

 

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Read the entire article here

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March 13, 2014 Posted by | health care | , , , | Leave a comment

Health Care Consumerism: Patients Still Lack Agency at the Point of Care | Health care and the digital revolution

Health Care Consumerism: Patients Still Lack Agency at the Point of Care | Health care and the digital revolution.

From the 27 January 2013 post at Health care and the digital revolution — A graduate student’s take on health care going digital – Claudia Paz

Something we have been hearing a lot of lately is how this is the moment for the healthcare consumer (see, Bloomberg Review videoMedCity Article, Forbes article on trends to be excited about).  Basically, people are noting that EMR’s and patient portals, the proliferation of health and wellness related mobile apps, and greater transparency across the system, will all lead to a new age of health care where patients have the information and tools to savvily navigate a streamlined healthcare delivery system oiled by customer reviews, online tools, and digital gadgets. Think Yelp and MenuPages meets healthcare.

While all of the trends listed above are exciting leaps forward, not enough attention is being paid to the patient’s needs at the point of care. Research on patient activation andshared or participatory decision making all points to the following:

Empowered patients who actively participate in decisions about their health and treatment options are more likely to be compliant with their medications, make less risky and more cost effective decisions, and are more confident in the management of their health outcomes.

For the purposes of this blog, I am focusing on the concept of a patient as an active participant at the point of care. From my own personal experience, it seems that “doctor knows best” remains the dominant paradigm. Instead of having a conversation about treatment options, the pros and cons of alternatives, variations in costs and side affects, I am more often than not prescribed a medication or treatment option and sent about my day. If I feel like knowing more about the medication (that I have already agreed to take), I usually conduct research after the appointment.

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January 30, 2014 Posted by | health care | , , , , , | Leave a comment

More information does not equal better care

 Chalmette, LA, December 16, 2005 – A patient describes his symptoms with a nurse at the Primary Care Clinic in St. Bernard Parish. The facility located in a triple-wide office trailer offers free medical care to area residents, staffed by personnel from the U.S. Public Health Agency and FEMA Disaster Medical Assistance Team (DMAT). Robert Kaufmann/FEMA

A wise, sobering post on the limits of medical/health related information.

Technology is increasingly used to collect and store personal health and medical data. While the amount of personal stored data is rising, this does not necessarily translate into better care. For example, the information stored in electronic medical records is only as good as the data entered.  Medical devices (as imaging and gene testing instruments) generate data that may or may not be useful depending on why they were ordered and how they results are interpreted.

The use of the data is also troublesome. As this post states, medical test results are often misused by the diagnostics industry in over testing.  This leads to unneeded treatments which divert money and resources.  Health care providers, especially those in primary care have less time to listen to and counsel patients.

The money spent on unnecessary treatments is a burden not only on individuals, but also health care facilities and government agencies. Health care facilities become caught in a spiral of justifying diagnostic equipment through marketing and at some point they will find it nearly impossible to recoup their investments. Medicare and Medicaid funds are not used wisely to diagnose and treat, resulting in ever more increased costs to the system.

As this post points out, health care providers would be wise to take a deep look at their role and be realistic about their expectations.
The same can be said about those who consult with health care providers.

From the 1 November 2012 article at KevinMD.com

I have found that this concept is hard for non-healthcare people to really grasp – that a less aggressive testing approach knowingly misses disease, but makes no difference in the overall prospects of the patient. It is crucial that the U.S. culture fights the prevailing scare tactics of the diagnostics industry, or we’ll never lower the rate of over testing. Any administrative tricks to lower testing rates will be subverted by both physicians and patients who assume more tests equal better care unless the underlying culture and conventional beliefs are changed.

The change required is deeper than administrative rules. It has to come from a more humble attitude on the part of doctors, patients, employers, and insurers that just because a patient could be labeled as having a disease, there is nothing to be gained by doing anything about it. More information does not equal better care.

Our American culture proclaims, “Just Do It.” To reclaim resources from the healthcare industry and return them to the general economy, we must proclaim, “Don’t just do something for the sake of doing something, stand there.”

 

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November 7, 2012 Posted by | health care | , , , , , , | Leave a comment

   

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