Monday, May 30, 2011

Happy Memorial Day!

Happy Memorial Day to all the US readers. Posts on the blog will be off our regular schedule for the next two weeks, but we will resume normal posting on June 13th. In the meantime, enjoy the start of summer!

Friday, May 27, 2011

3M Mobile Solutions for Physicians

The world of mobile medicine is expanding and physicians are searching for the next new tool to help them in their practice. 3M Mobile Solutions for Physicians is one such tool. It's an app that can be used on an Android, IPhone/Touch/Pad, Blackberry, or Windows mobile device. The app has been ever-evolving, with feedback from physicians, so that it has become more streamlined than its previous releases. Within the app are four modules which offers physicians patient information and tracking:

  • Provides patient test results, as well as medications the patient is taking or any allergies they may have.
  • Tracks patients by appointment dates and location.
  • Allows physicians to dictate their notes by recording straight to the app.
  • Automatically submit charges and billing codes, with alerts if any necessary information is missing before it's processed.
"It's an all-in-one tool that solves a lot of inefficiencies. It reduces the burden of administrative paperwork on doctors and allows them to focus on patient care." ~ JaeLynn Williams, Senior Vice President (3M, Health Information Systems Division)

The initial set-up fee is $250 and then physicians must subscribe annually at a cost of $2,000. However, the benefits to the physician is estimated to be $15,000 so the investment more than pays for itself. Physicians can request further information through 3M's website and ask how to integrate the system into their practice. With the world of medicine moving more towards the mobile market, every tool to make the process more streamlined and the patient outcomes improved is a welcome one.

Wednesday, May 25, 2011

Improving Primary Care

Recently, the Archives of Internal Medicine released an article touching upon some "top 5" lists for primary care. These included recommendations for family and internal medicine, as well as pediatrics, with hints as to how to optimize care with patients. Let's look at the recommendations that were made for family practice.

1. Reduce Immediate Imaging for Lower Back Pain: Patients often come to their doctor complaining of lower back pain. In fact, it's the fifth most common complaint that physicians hear. However, the first response should not be to order imaging. Ordering this test not only increases the costs to patients, but it does not actually improve outcomes. If no other cause or improvement can be seen in six weeks, and the patient is not showing any other red flags that warrant earlier testing, then imaging of the lumbar region is recommended.

2. Reduce Reliance on Antibiotics: When patients complain of mild to moderate sinusitis, physicians' first response may be to order a round of antibiotics. However, this is not the best course of action. Many times, these cases are viral in cause and cannot be treated by antibiotics and must resolve naturally. If the patient sees initial improvement and then worsens or if they are still suffering symptoms after 7 days, then further drug treatment might be needed.

3. Cardiac Screenings and ECGs May Not Be Necessary: If a patient is showing no signs or symptoms of cardiac illness, order a screening as a preventative measure is both costly and unnecessary. If you order such screenings, there's a chance that the results will be a false positive and treatment may actually harm the patient.

4. Pap Tests Are Not For All Women: If a patient is under 21 years old or has had a hysterectomy, a pap test is not necessary. Screening young patients only causes stress and more cost to the patient, while in post-hysterectomy patients there is little evidence that findings will improve health outcomes.

5. DEXA Osteoporosis Screening Is Age Dependent: If a woman is under the age of 65 or if a man is under the age of 70 and shows no risk factors, they do not need to be screened for osteoporosis. Screening is costly and has shown no positive benefits. Wait until the patient is within the risk age group and then start screening, or screen earlier if they have shown risk factors such as vitamin deficiency, smoking, or having a small/thin frame.

Monday, May 23, 2011

Facebook Privacy

Many physicians are engaging in social media. Twitter accounts, blogs, and Facebook account abound among both healthcare providers and medical students. However, it's important to remember proper rules when embarking in this area of interaction.

Patient privacy is important. Physicians and medical students should never endanger patient privacy by posting pictures or information about them. However, just excluding the name is not enough. If any identifying information is given, enough that someone could figure out who is being talked about, that's an endangerment to patient privacy. Physicians in multiple areas have been disciplined and even fired for making vague comments about patients that turn out to be not so vague at all. When in doubt, don't do it.

Additionally, posting information about the physician or medical student themselves may also be something to avoid. Patients have increased ability to go online and search for medical information, as well as information about their care provider. What will be a patient's impression if they see their doctor smoking or drinking? What will a potential employer think if they see off-color jokes or explicit comments? The old rule applies. When in doubt, don't do it.

Social media has opened the doors of communication in many ways. Physicians can pass along health education to patients and consumers, increasing the potential health benefits among the population. However, physicians should always maintain a strict professional relationship when engaging in social media. Don't pass along private medical information, don't friend patients, and don't endanger your own practice by giving more information than you should.

Friday, May 20, 2011

Hands-On Training

Medical students have multiple training opportunities to test their skills on adult patients. These range from practicing on cadavers, mannequins, and standardized patients. However, the same opportunities are limited when learning how to deal with younger patients. Being able to test on real patients is limited and the availability of other training opportunities is not widespread. However, Rice University are trying to change that.

The Pediatric Evaluation Device Intended for Training (Ped.IT) is the senior project of a group of four bio-engineering students at Rice University. Doctors at the Texas Children's Hospital requested that they find a way to provide hands-on pediatric training without the need to force young patients to endure invasive exams. That's where Ped.IT comes in.

"I've been trying since 2003 to develop a mannequin, but I didn't have the bioengineering skill. For a long time I've wanted to be able to teach medical students physical exam skills without having to use patients who are not feeling well and whose parents really aren't comfortable with medical students coming in to examine them." ~ Amy Middleman, Pediatrician (Texas Children's Hospital) and Associate Professor (Baylor College of Medicine)

The Ped.IT device has a regular mannequin base, but also includes simulated organs and skin so that users can feel what a normal and abnormal body part may feel like, and thus be better able to diagnose illness. The device also has the ability to add more organs in the future so that even more can be learned. The hope is that it can be mass-produced to be distributed to medical schools across the country.

Wednesday, May 18, 2011

Mobile Medicine

Physicians are outpacing the general public in their adoption of mobile technology. As we noted in an earlier blog post, while 50% of people 18 to 34 own a smartphone, 64% of physicians own one. Doctors are accessing their email, the web, and mobile apps while making their rounds and going over patient data while not in the office. This sets up a perfect opportunity for the mobile market to expand and focus on mobile health.

There are a number of medical applications already available. From reading x-rays to looking up billing codes, the app market has been providing educational tools for medical professionals across the country for quite a while. With the abundance of these types of tools, medical schools and professional settings should seek ways to more fully integrate the technology into their schools and practices. Access to information while not tied to a computer will give medical professionals the ability to provide faster and more complete treatments for their patients.

Additionally, with the expansion of such technology, certain requirements should be set on the deployment of medical apps to assure that the user is getting the most accurate and complete information available with which to make treatment choices. Perhaps this means getting the government more involved in certifying such tools or forming an independent medical committee that would take on such approvals. Whichever way the market sets out to pass approval, it's necessary for the validity of medical technology tools. By approving certain apps as valuable, and thereby medically sound, all physicians can benefit from what technology can provide for them while being assured they're getting the best possible information out there.

Mobile medicine is here already. It's important that the entire medical community use the tools that are available to them, else they get left behind in the push to increase quality care of patients.

Monday, May 16, 2011

Placebo Prescribing

Many issues have been raised about the topic of using placebos for treatment. In clinical trials, doctors may prescribe a sugar pill or salt water injection that has no medicinal benefit whatsoever. However, the act of taking such medication may cause the patient to experience relief of symptoms. Why might that be?

Patients expect certain results when taking medication. There exists a psychological feeling that medicine equals improvement of illness. Even when the pill or injection contains no medication at all, patients' bodies still show marked improvement over their prior state. Studies have shown participants taking placebos having an increase in natural hormones and improved heart rates, as well as decreased symptoms from their original illness. And when the medication cycle is over, their body may go through the same process as those taking a true drug. They may experience withdrawal symptoms simply because their mind thinks this is the proper response.

However, while these situations can be observed in clinical trials, should they be undertaken in proper practice? If the same results can be met with placebos as real medication, is it ever okay for physicians to simply prescribe the false pill? That's a question that's being considered by many across the country. If the moral obligation of the doctor is to provide the best treatment possible for their patients, shouldn't that include the proper treatment as well? By prescribing a placebo, whether or not there may be psychologically-mandated improvements in the patient's body, the physician is also eliminating the possibility of benefits from the proper medication.

These kinds of situations are what one must consider when entering the medical field. Taking care of patients should be the physician's number one responsibility, but at what point does that backfire when placebos are involved? If treatment has been proven effective for an illness, it seems morally questionable to then choose a treatment that has no medical benefit but which may encourage the patient to feel better on their own. It's a tough decision to make.

Friday, May 13, 2011

iPad EMR

The expansion of EMR technology has revolutionized medicine. Now, physicians can easily integrate notes and patient records from a number of sources, as well as cutting down on errors that come about from deciphering messy handwriting within files. However, this technology has never been developed specifically for the iPad, which is also gaining popularity among health professionals for its ease of use and portability. But now, Nimble from Clear Practice is building an EMR that was designed specifically for this mobile device.

With this technology, physicians can comprehensively chart patient records and schedule their appointments. It also allows for ordering of labs, electronic prescribing, voice recording, and more. Since it was designed specifically for the iPad, it takes full advantage of all that the iPad has to offer in terms of usability. Best of all, the app is totally HIPAA compliant through the ClearPractice server.

Nimble provides a clear and concise desktop from which to work. You can easily keep track of new messages that have come in, notes sent for review, and lab results that have been submitted. While making hospital rounds, you can quickly bring up patient records to keep you better informed of any changes that have occurred since you last saw your patient. And you can easily take your files home to be completed, rather than having to stay in the office until all the paperwork is signed. It presents true versatility and mobility for the physician on-the-go.

Wednesday, May 11, 2011

VisualDX Mobile

Learning through visuals helps students acquire and retain information, as well as aiding physicians in properly diagnosing a disease presenting visual symptoms. The VisualDX suite of programming focuses on this method of training by connecting health professionals withover 19,000 realistic case examples of a wide range of diagnoses. To expand this range of training even further, they have developed and released a VisualDX Mobile version of their database.

VisualDX Mobile has images that represent different diagnoses through a number of stages, as well as reflective of a number of ages and skin types. This allows for the health professionals to get a better comparison between what they're seeing with their patients and what the database has recorded. Additionally, physicians can look up the possible disorders based on medications the patient was taking, as well as helpful diagnostic pearls and ICD-9 codes. In order to access the interface, the user must have a VisualDX subscription. The app is available for iPad, iPhone, iTouch, and Android currently. Work is currently being done on integrating the database into a mobile browser as well.

Monday, May 9, 2011

Medial Apps Worth A Look

As more medical students and professionals move towards using mobile technology, it's important to highlight the apps that would be beneficial to their interests. Here we highlight five iTouch apps we think are worth checking out.

Reading and Writing
  • VitalSource Bookshelf: This is an e-reader app that extends the accessibility to your Vitalsource Bookshelf® downloaded to your desktop or online. Students can use tools such as highlighting and sharing your notes with classmates, changing the layout of the text, getting automatic updates to the books you've downloaded, and integrating references into the text. The app is available on your iPhone, iTouch, or iPad.
  • Noterize: This is an iPad app that's centered around note-taking. You can view any PowerPoint or PDF, as well as directly importing them from online sources. The app allows you to make in-text notes, highlighting, and sticky notes to make yourself reminders. You can also record lectures so that you can go back and listen to them again, instead of trying to rely solely on your notes.
Access
  • LogMeIn: This app extends the LogMeIn functionality of your desktop. With the program, you can remotely log into any computer that is also running LogMeIn and has granted access. This can allow you to access your notes from your desktop without having to ask someone in your office to send it to you. Newly-added, you can save your files directly onto your iPad though the program. The app is available on your iPhone, iTouch, or iPad.
  • Jump Desktop: Accessible on the iPhone, iTouch, and iPad, this is another remote access program that you can use to control your PC even when you're away from home. The app connects all your devices through your Google account, to make it easy. The program also boasts that with its easy set-up, you can be remotely accessing in less than five minutes.
Listening
  • MedicalRadio: This app gives you audio content from ReachMD, which broadcasts on Sirius XM 167. You can get over 5,000 podcasts and CME/CE courses, as well as directly accessing the post-course exams if they are available for credit. New content is added weekly, so there's always something new to listen to.

Wednesday, May 4, 2011

Expanding Rural Rotations

The need for rural healthcare is evident and that means physicians-in-training must be educated in the needs of these areas. Medical schools have approached this issue in multiple ways, but three West Virginia medical schools are taking more control of the matter. They are requiring that all their medical students go through a three month rotation in rural health. There are political implications, such as shifting funding away from community health centers and instead dedicating it to the universities, that make this particular matter a bit tricky, but the baseline motivation should be considered by medical schools across the country.

Rural areas are not able to access medical professionals as easily as more urban areas. That means that community health is often at risk because of lack of proper, consistent care. Additionally, issues of medical costs must also be considered for rural areas because often community members may not be able to pay for necessary medical expenses. The reasons are varied, but paramount is both because of limited health coverage and the additional travel costs it takes to be treated in fully equipped hospitals. Medical schools must identify these concerns and teach students how to best handle these types of situations. Without exposure to this training, medical students may be blind to the different aspects of care that exists across different community structures. There is also the need to bring more trained medical professionals to these under-served areas, so by requiring students to do a rotation it may interest them enough to continue serving these areas after graduation.

In whatever way medical schools approach the issue, it's clear that rural health needs to be addressed and solutions found in how best to get needed care into these communities. The dynamics and requirements are different than in other areas and physicians-in-training must be best prepared on how to approach these needs as they embark on their careers.

Monday, May 2, 2011

The Impact of Healthcare Reform

Healthcare Reform has been a hot topic recently. Our system is being overhauled so that more of the population will have access to treatment, hopefully lowering the long-term costs of healthcare by treating issues early. However, the changes will also call for a new way of approaching medical education. US News and World Report touched upon three prominent issues that have to be considered in the new generation of physicians.

1. Make Primary Care More Appealing: The rate of new PCPs entering the medical field has been steadily going down. However, with new patients set to join the treatment population, primary care providers are significantly needed. The lower rate of pay for PCPs versus specialists is one reason the latter is more appealing, but the changing healthcare reform structure means that PCPs may have increased reimbursement from Medicare and private insurance, while specialists may find their reimbursements lowered.

2. Compensation Structure: As noted, the reimbursements will change as more insured patients enter the marketplace. It's possible that PCPs will see their compensation increase while specialists will see their compensation decrease. This may affect career choices medical students make, which may increase the number of PCPs available for the increased patient population.

3. Prepare for Increased Patient Load: Time is a luxury for physicians already. They have to go through more and more patients just to meet their payment quota from insurance providers. However, with the influx of new patients into the market, their time will become more valuable. Medical schools must prepare students on how to maintain a balanced schedule so that all patients receive the treatment they deserve as well as being seen in a timely manner.

Healthcare reform is set to revolutionize the way patient treatment is approached. It is important that the next generation of physicians are fully trained to embark on this new world of medicine.