The commercial health IT ecosystem and its implications for patients

Health Technology
December 15, 2010

At “Background On The ‘Ecosystem’ of Commercial Healthcare IT” I wrote:

… In reading about HIT difficulties it is important to understand the “ecosystem” of commercial health IT, that is, the identity and nature of the principal constituents and stakeholders, and their interrelationships. Familiarity with this environment is useful in order to place the social and organizational issues affecting HIT diffusion in the proper context.

By implication, I made the case that the …

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The commercial health IT ecosystem and its implications for patients

A poetry reading at Bellevue Hospital

Physician
December 14, 2010

The waiting area in Bellevue Hospital was full. Every chair was taken. But the people kept streaming in. More chairs had to be brought in. It wasn’t clear if the room could accommodate everyone.

This wasn’t the emergency room or the clinic waiting area, however. It was the scene of the Bellevue Literary Review poetry and prose reading. More than 100 people poured into Bellevue Hospital on a Sunday evening to …

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A poetry reading at Bellevue Hospital

Medical errors that involve handwritten prescriptions

Physician
December 14, 2010

by Daphne Swancutt

Two people in the United States just died in the last hour. Seventeen more will die in the next 7 to 8 hours. Over a year, that number will accumulate to about 7,000.

The reason? Medical errors that include misread or otherwise misinterpreted handwritten prescriptions. Believe it. This means that doctors are being sloppy, pharmacies are making mistakes and people are getting dead.

Even more …

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Medical errors that involve handwritten prescriptions

Health reform repeal should make conservatives nervous

KevinMD
December 14, 2010

Early last year, I wrote that conservatives should have been happy with health reform.

Maybe they just didn’t realize it yet, because they’re rejoicing after yesterday’s news of a federal judge ruling the individual mandate unconstitutional.

But by supporting repeal, conservatives should be careful what they wish for.

The fact is, the Affordable Care Act is a moderate piece of legislation. There’s no public option. It leaves private insurers intact. There is …

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Health reform repeal should make conservatives nervous

Quit smoking in 2011: 5 steps you need to know

Conditions and Diseases
December 14, 2010

by Paul M. Cinciripini, PhD

If you smoke, quitting the habit is the best New Year’s resolution you could make — and keep — in 2011. That’s true even if you’re just a social smoker.

A new report from the Surgeon General shows that even occasional smoking and secondhand smoke cause immediate damage to the body.

The good news is that people who stop smoking before age 50 cut their risk of dying …

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Quit smoking in 2011: 5 steps you need to know

Infant resuscitation in the ED

Conditions and Diseases
December 14, 2010

by VeronicaB, MD

A baby died today;  a very small infant.  One minute I’m excited by the end of my overnight shift quickly approaching, and the next I am hearing the words you never want to hear come over the radio, “En route to home for infant not breathing.”  I think the whole ED staff stopped for a minute waiting for the next report.

Then we begin to …

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Infant resuscitation in the ED

Solving treatment resistant depression

Conditions and Diseases
December 13, 2010

About 60% of patients suffering from depression do not find any benefit from their first antidepressant. Up to 20% of patients find depression impossible to overcome even after 1 year. Assertive treatment of depression from the get go is essential to helping recover from depression.

Psychiatrists don’t have a shared definition of treatment resistant depression. However, most would agree that your depression may be treatment resistant if it has not resolved …

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Solving treatment resistant depression

Physician time should be considered a resource

Physician
December 13, 2010

Being a physician always has been a busy job.

This is especially true for primary care physicians who set as their goal the delivery and coordination of comprehensive care for patients. Achieving such a goal requires availability, a broad spectrum of medical knowledge, effective use of the local health care system, and attention to both the “big picture” and the details of a patient’s life and …

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Physician time should be considered a resource

Obesity patients are not victims

Conditions and Diseases
December 13, 2010

Call it the McVictim syndrome. Too many pundits, public health experts and politicians are working overtime to find scapegoats for America’s obesity epidemic.

In his latest book, former FDA Commissioner David A. Kessler argues that modern food is addictive. In it, he recounts how he was once helpless to stop himself from eating a cookie. In a paper in this month’s Journal …

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Obesity patients are not victims

Accountable care organization (ACO) and medical home differences

Health Policy
December 13, 2010

by Kevin Fickenscher, MD

In the great healthcare alphabet soup, it’s easy to lose sight of the differences between proposed solutions for making healthcare more efficient and effective.

Rather than tackling payment reform in isolation of care delivery, Accountable Care Organizations (ACOs) and Medical Homes offer a consolidated approach to both issues. While the models are still developing, various pilot programs are being implemented around the …

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Accountable care organization (ACO) and medical home differences

7 favorite ER superstitions

Physician
December 12, 2010

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Emergency physicians, nurses, and paramedics are a superstitious lot. I thought it might be interesting for those not in the business to read about some of our superstitions. In no particular order, here are my favorites.

1. The “Q” word. “Quiet.” it’s truly the kiss of death. The “S” word, “slow,” carries the same jinx. Usually some newbie nurse or clerk who is …

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7 favorite ER superstitions

How to find and treat lice in children

Conditions and Diseases
December 12, 2010

“Dr. Roy, you’ve got to help me!”

The most heartfelt pleas I ever hear from parents are for three things:

  • The three year old who won’t use the potty—so can’t register for school.
  • The 15 month old who still isn’t sleeping through the night.
  • The school-aged girl(s) with recurrent lice.

Parents hate the idea that their child has lice. They’re icky, they’re crawly, and even talking about them makes everyone in the room start scratching. …

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How to find and treat lice in children

Physicians need to compare themselves with their peers

Health Policy
December 12, 2010

Imagine that an innovative health plan – aware that half or more of health care cost is waste and that physician costs to obtain the identical outcome can vary by as much as eight fold – hopes to sweep market share by producing better quality health care for a dramatically lower cost.

So it begins to evaluate its vast data stores. It’s goal is to identify the specialists, outpatient services and …

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Physicians need to compare themselves with their peers

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Check for skin cancer and melanoma, even with dark skin

Conditions and Diseases
December 11, 2010

The mole on Ivis Febus-Sampayo’s face looked odd. But it wasn’t until her son needed treatment for acne that she went to a dermatologist.

“As mothers, we’re working, we’re busy,” she said. “I forgot about me and called the dermatologist to make sure my son was getting taken care of.”

The doctor removed a sliver of the mole, and reassured Ivis that it was probably nothing to worry about. Two weeks later, …

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Check for skin cancer and melanoma, even with dark skin

Good patient communication by managing expectations

Physician
December 11, 2010

My father suffered a mild heart attack last year. In his 80+ years, he has never had any indication he had a problem with his heart!  A variety of other health issues have arisen over time, but Dad’s heart was always thought to be as strong as could be.

In fact, despite protestations (“I don’t really think these chest pains are a big deal… let me just …

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Good patient communication by managing expectations

What meaningful use stage 1 will mean to patients

Health Technology
December 11, 2010

As State Health Information Exchanges and Federal efforts (NHIN Connect/NHIN Direct) implement the data sharing technology that will enable all providers in the country to achieve Meaningful Use Stage 1, I’m often asked  “but when will this healthcare information exchange technology be able to retrieve all my records from everywhere when I’m lying unconscious in the Emergency Department and cannot give a history?”

Here are …

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What meaningful use stage 1 will mean to patients

The secret to better healthcare is the primary care physician’s brain

Physician
December 10, 2010

When I first stared hearing about the Patient-Centered Medical Home (PCMH) concept, I perceived it to be a euphemism.

For whatever reason, the concept of primary care or family medicine hasn’t resonated with politicians, corporate benefits managers, or the general public. To me “medical home” was just a warm fuzzy term that at least gave an unknowing listener a sense of the benefits of a strong relationship with a competent primary …

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The secret to better healthcare is the primary care physician’s brain

Facebook Page or Facebook Profile, what doctors need to know

Social Media in Medicine
December 10, 2010

Now I am going to confess my bias – I am fast becoming a Facebook junkie! As an entrepreneurial physician who has to keep feeding and nurturing a business, I sense Facebook’s huge potential and I’m eager to learn how to participate effectively in this brave new world.

Both Twitter (an instantaneous but fleeting stream of chatter mixed in with pointers to valuable resources) and LinkedIn (a searchable Rolodex on steroids) …

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Facebook Page or Facebook Profile, what doctors need to know

Loss of an empathic connection between doctors and their patients

Physician
December 10, 2010

It has been reported that up to 60% of doctors suffer from symptoms of psychological job-exhaustion, or physician burnout, leading to diminished career satisfaction, substance abuse, divorce, quitting the profession, and suicide.

An article in a recent Journal of the American Medical Association by Helen Riess, a Harvard psychiatrist, attributes much of this psychosocial carnage to the loss of an empathic connection between doctors and their patients.

The author summarizes a …

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Loss of an empathic connection between doctors and their patients

Mortality risk associated with lack of social relationships

Patient
December 10, 2010

PLoS Medicine recently published an article commenting on an earlier study exploring the link between social networking and mortality.

The result speaks for itself: “the degree of mortality risk associated with lack of social relationships is similar to that which exists for more widely publicized risk factors, such as smoking.” You read that right, according to this study which examined over 300,000 participants in a meta-analysis, social relationships are as important …

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Mortality risk associated with lack of social relationships

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