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Medical Records News

 

Research suggests computerized record-keeping may lower mortality, costs.

Bloomberg News (1/27, Waters) reports, "Putting patients' health records on computer systems instead of handwritten paper charts reduces medical complications, deaths and costs, according to a study of 41 Texas hospitals." The paper appearing in the Archives of Internal Medicine lends "support [to] President Barack Obama's campaign proposal that spending $50 billion a year for five years on technology for electronic records would save money." During the study, researchers at Johns Hopkins University asked doctors at 41 Texas hospitals "whether they used computers to keep patient notes, order medications, list test results, and track the reasons for other aspects of patients' care." Investigators "found that the hospitals where doctors made the greatest use of electronic records had lower death rates, cheaper costs, and shorter lengths of stay."

Furthermore, "when computers replace paper, patient mortality rates drop 15 percent during hospitalization, among other metrics," according to Modern Healthcare (1/26, Conn). In addition to the lower mortality rates, "hospitals with higher scores for computerized order-entry systems posted 55 percent lower odds of death for patients undergoing surgery for coronary artery bypass grafts and nine percent lower odds of death for patients with myocardial infarction."
 

Google responds to charge from consumer group regarding alleged EMR lobbying effort.

 

Healthcare IT News (1/28, Ledue) reported that "Google has responded to Consumer Watchdog's call to end a rumored lobbying effort aimed at allowing the sale of electronic medical records [EMRs] in the current version of the economic stimulus legislation." Consumer Watchdog "is urging Congress to remove loopholes in the ban on the sale of medical records and include other privacy protections absent from the current bill." The "non-profit consumer education and advocacy organization" alleged that "Google is pushing for the provisions so it may sell patient medical information to its advertising clients on the new 'Google Health' database." Google officials said that the "claim is 100 percent false and unfounded." The officials said, "It's unfortunate that they did not contact us before making [these] unfounded statements, because we could have told them that their claims were patently false."

        In the Wall Street Journal (1/28) Health Blog, Sarah Rubenstein noted that "Google's ear is likely fine tuned to this issue, considering some folks in the medical community have already pointed out the company is not a type required to follow a federal patient-privacy law called HIPAA."

 

Study indicates 75 percent of hospital patients may be unable to identify their physicians.

 

The New York Times (1/30, Barrow) reports, "Hospital patients are rarely able to identify their doctors by name or to describe their roles in the patients' care," according to a study published in the Archives of Internal Medicine. The study included "2,807 adults admitted to the" University of Chicago's "hospital over a 15-month period." Patients were interviewed "about the roles of the various physicians attending to them and to name the doctors on those teams," which "consisted of three to four people, including medical students, residents, and attending physicians." Researchers found that an estimated "75 percent of the patients were unable to name a single doctor assigned to their care." Furthermore, "of the 25 percent who responded with a name, only 40 percent were correct." Some experts, however, disagree on "whether patients need to be familiar with hospital staff." Dr. Ernest Moy, medical officer at the federal Agency for Healthcare Research and Quality, questioned whether knowing about "processes that will help" patients "get at the information [they] need" is "more important" than physicians' names.

 

 

EHR adoption still low among physicians, hospitals.

The Baltimore Sun (3/2, Kohn) reported that over the past twenty years, "electronic health records (EHRs) have been the Next Big Thing in healthcare: a way to simultaneously improve care and reduce waste in a system clogged with paper and manila folders." To date, however, "90 percent of U.S. doctors and more than two-thirds of U.S. hospitals still use paper for patient records." According to David Merritt, director of the Center for Health Transformation, a think tank based in Washington, "Healthcare is at least a generation behind the rest of society in terms of technology." While "almost everyone agrees that moving from paper to bits will improve healthcare," progress in this area has been hampered by "a colossal, inertia-filled health care system, a paucity of good software, no incentives to adopt new technology, and a lack of government leadership." In addition, there is concern that patients' personal data may be vulnerable to hackers.

Despite these concerns and drawbacks, Government Health IT (2/29, Moore) reported that "New York City officials said a two-year-old project to deliver electronic health records (EHRs) now has 200,000 participating patients, and aims to reach more than one million people this year." According to Mayor Michael Bloomberg (I), "200 providers have signed on to use the EHRs, and more than 1,000 are expected to join by the end of 2008." Should New York City meet that target, the city will have the "largest community network of EHRs" in the U.S., Mayor Bloomberg noted.

 

Florida high court widens patients' access to records.

Modern Healthcare (3/7, Evans) reported, "Florida's Legislature wrongly denied patients' access to medical-error and incident records made available after voters amended the state's constitution in 2004," according to a ruling by the Florida Supreme Court. The ruling stated that "[p]atients may access records created prior to Nov. 2, 2004, when the amendment became effective." In the court's 4-to-3 ruling, the justices "cited a lower court judge's conclusion that the constitutional amendment: 'heralds a change in the public policy of this state to lift the shroud of privilege and confidentiality in order to foster disclosure of information that will allow patients to better determine from whom they should seek healthcare, evaluate the quality and fitness of healthcare providers currently rendering service to them, and allow them access to information gathered through the self-policing process during the discovery period of litigation filed by injured patients or the estates of deceased patients against their healthcare providers.'"

 

New York City announces plan to help doctors use electronic medical records.

The New York Times (2/26, B3, Santora) reports, "After two years of planning and a public investment of more than $60 million, Mayor Michael R. Bloomberg (I) said on Monday that New York City was ready to equip doctors with computer software that can track patients' medical records in order to provide better preventive care." The new "software package [was] developed with $30 million from the city and roughly $30 million from the state and federal governments, [and] would let doctors do much more than is possible with paper charts by integrating a patient's medical history, lab results and current medications into one electronic interface." According to city officials, "the system will give up-to-date information to doctors through a series of alerts, like overdue dates on prescriptions or cholesterol checks," and will also "share data with other doctors and provide information about the current best practices for treating illnesses." The goal is "to have 1,000 doctors with one million patients using it by the end of the year."

 

 

Additional Links:

Transforming Health Care: The President’s Health Information Technology Plan



Posted at http://blog.curbside.md

Financial Incentives in Medicine

A recent article in the New York Times “Many Doctors, Many Tests, No Rhyme or Reason” reminded me of the distorted financial incentives that permeate the practice of medicine in the United States. In the article, the author, a NY cardiologist states, “In our health care system, where doctors are paid piecework for their services, if you have a slew of physicians and a willing patient, almost any sort of terrible excess can occur.” He then goes on to detail the evidence of excess both at a national level and on an anecdotal basis.

Unfortunately, I have to concur with his bottom line conclusion: “Doctors are doing too much testing and too many procedures, often for the sake of business. And patients, unfortunately, are paying the price.”

This article reminded me of my own early experiences in the hospital. I remember as a third year medical student I commented to one of my classmates that my internal medicine hospital rotation was so easy! All we did was call consults every morning based on all the abnormalities we found on the labs and imaging from the day before. Okay – so I’m being a bit glib and over-exaggerating. But I do remember the conversation and sentiment very distinctly. I felt like we spent a lot of time asking for consults when maybe they weren’t necessary. But then again – I was a naïve third year medical student with no experience. What did I know? 

But I have to say, I’ve had those same nagging feelings through the years  – that utilization of consults and testing is driven by financial incentives; maybe even “throwing a bone” to one of your medical colleagues. Where I did my internship, many of the medicine patients I took care of on the wards were either uninsured, underinsured or within an HMO model. In that situation, where there really wasn’t the willing patient (or matching reimbursement) I felt we were a bit judicious and restrained in our testing and consults. But in other environments where I have practiced, where patients were more generously insured, I definitely have felt a trend towards overutilization and unnecessary testing. 

So what is a patient supposed to do in an environment of distorted incentives for testing and work-up? Some solutions will hopefully come from our site, MyDailyApple. Over the next several weeks, we will be introducing a set of content, features and tools on MyDailyApple to assist patients with understanding the world of medicine and to take action with managing their health.  Some of this is already there and I encourage you to check it out.

But even with all the great Health 2.0 technology, it is probably unrealistic to expect a patient to look up information and search on the internet while in the hospital. So how can an individual advocate and maybe to a certain extent – protect themselves within this environment? Probably one of the first steps, in addition to all of the technology out there, is an old-fashioned Health 0.0 solution - engage your provider in an honest discussion. Someone has to start the process. And it is always fair to ask, “Do I really need this? What happens if we find something – then what? What if there is a false positive result? What are the alternatives? Is this all necessary?” Physicians probably aren’t used to such pointed questions. But times are changing – and so should the nature of the interaction between physicians and patients. And perhaps this will start the frank dialogue to understand the distorted incentives that operate in the American health care system. 

I think one of the final quotes from a hospital executive in the New York Times article really sums up my feelings on this one.  “The hospital is a great place to be when you are sick. But I don’t want my mother in here five minutes longer than she needs to be.”


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