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Fixing our EHR mess: What needs to be done Print E-mail
Written by Kevin Campbell, MD | KevinMD   
Thursday, 22 September 2016 00:00

In 2009 the Health Information Technology for Economic and Clinical Health Act (HITECH) was signed into law by President Obama and this law quickly changed the way medicine in the United Sates is practiced. The law was a first step in requiring all physicians to utilize electronic records. The president promised that creating and electronic record mandate for physicians would result in a national, universal electronic medical record system and improve care and communication. Ultimately, the legislation that required EMR implementation in 2009 began the process of penalizing physicians who do not use them and started a lucrative business for healthcare IT vendors such as Allscripts, EPIC, Cerner and many others. The requirements to implement EMR resulted in thousands of physician practices having to make harsh financially motivated decisions - either close the doors or sell out to larger healthcare systems.

Certainly, EMR systems do have their benefits - standardized documentation and portability all improve care. When a patient travels and has an illness care is improved when another hospital and provider can easily access long-term medical records. Communication between physicians of different specialties and organizations is significantly improved.

However, EMR vendors have not yet created exchangeable, universal systems as Mr. Obama promised they would.

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Last Updated on Saturday, 24 September 2016 10:22
Mylan Pharmaceuticals Made these Two Critical Mistakes Print E-mail
Written by Justin Reno, MD | KevinMD   
Thursday, 08 September 2016 00:00

Pharmaceutical companies are brilliant. They make profit off of chemicals that can be potentially life-saving. The list is quite impressive: antibiotics for somebody who would otherwise succumb to sepsis, insulin for someone whose pancreas loses the ability to function, antivirals for chronic viral suppression, antineoplastic agents for somebody whose cells have lost their regulatory mechanisms, just to name a few.

The recipe seems to be quite simple: Charge as much money as insurance companies are willing to pay. And do this as quietly as possible: Don't let the American public know how much a drug costs.

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Marketing in Healthcare: It Ain't What It Used to Be Print E-mail
Written by Jeff Cohen | Florida Healthcare Law Firm Blog   
Tuesday, 30 August 2016 16:25

Healthcare professionals and businesses are routinely barraged with people who claim to be able to generate business for them. The business of healthcare is like none other in its abhorrence of anything that even smells like payment for patient referrals, so professionals and businesses alike have to be extremely cautious and well advised in crafting marketing and related business-enhancing relationships.

The key here is to realize that, while the laws haven't changed, what regulators are doing with them has! The environment of healthcare marketing has never been more treacherous than it is today. So what's changed? How about...

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Last Updated on Monday, 19 September 2016 16:54
Exciting implications of the neuro-immune link no one is talking about Print E-mail
Written by FHI's Week in Review   
Monday, 15 August 2016 00:00

Keith Pochick, MD, in an August 13, 2016 KevinMD post, comments on a recent research paper from the University of Virginia which "may pound the final nail into the coffin of the long-standing medical dogma which rigidly labels diseases as organic or psychiatric".

According to Dr. Pochick:

...The researchers and reviewers of this paper assert that the immune system exerts effects on the brain...what if the reverse is also true?

...After nearly four decades on this Earth and a decade and a half in clinical medicine, I am absolutely certain that the brain influences the health of the body, and the body influences the health of the brain. Every health problem is an organic one. Every health problem is a psychiatric one.

The author queries:

...What if the dopamine and endorphins released after a challenging exercise session are making you even healthier than we thought? What if the serotonin and dopamine released while you eat a meal lovingly prepared by a family member are exerting beneficial effects on your immune system? What if the serotonin released when you perform an act of kindness makes you more likely to fight off infections? What if the dopamine and oxytocin released during satisfying sex with someone you love helps your immune system recognize and destroy cancer cells?

...Couldn't this discovery (and my creative daydreaming) help explain why happy people are generally healthier, and why depression can bring physical illness?

Read more in the current issue of Week in Review>>

Last Updated on Wednesday, 17 August 2016 10:50
Fixing the Breakdown in Patient Satisfaction Print E-mail
Written by Kevin Haselhorst, MD | KevinMD   
Thursday, 11 August 2016 00:00

Ruth was a spry, but frail 98-year-old woman who was stiff and sore following the 6-hour drive from California to Arizona. She had suffered a recent wrist injury and was not recovering well after spending three weeks in a rehabilitation center. She was in the midst of upheaval and discontent - in the throes of relocation to an assisted-living residence closer to her son. The facility's coordinator had begun to evaluate Ruth's aptitude and appropriateness for assisted living, but thought it best to have Ruth seen in the emergency department.

Ruth was hungry, but did not wish to eat. She felt like her bowels needed to move, but did not wish to use the bedside commode. While still engaging, Ruth wished to be left alone. Ruth had explained that she used to be able to tell herself not to be sick, but her higher power seemed to be failing her now. When a patient feels abandoned by a higher power, what hope is there for patient satisfaction? When patients are uncertain of what is in their best interest, how can physicians succeed at meeting their expectations? Does it become the physician's duty to tell Ruth that she is not doing well and further deflate her self-image?

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The BVS Disappearing Stent: Promise, Hype and the Tension Between Progress and Safety Print E-mail
Written by Dr. John M   
Tuesday, 02 August 2016 17:06

Medicine does not stand still. You want innovation; you want progress. But you also want safety.

Millions of patients have coronary stents placed in the arteries supplying blood to the heart. It's big business.

Metal cages placed in the setting of a heart attack can be life saving. In other settings, however, the strongest quality evidence says metal cages perform no better than medicines.

One of the two main reasons stents don't improve long-term outcomes for patients with stable coronary disease are that they trade improved blood flow (good) for the presence of a metal cage in the artery (bad). The metal cage can stimulate inflammation and cause the artery to lay down more blockage (neo-atherosclerosis). Also, the exposed metal can attract platelets and form clots (really bad).

But what if you could design a stent that dissolved over time? It opens the blockage, improves blood flow, stabilizes the vessel, and then disappears.

This is the promise of Abbott Vascular's Absorb GT1 bioresorbable vascular scaffold (BVS) system. It's been used in Europe since 2011 and was just approved by the FDA.

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A Failed Transition of Care Print E-mail
Written by A Country Doctor Writes   
Thursday, 28 July 2016 00:00

Alvion Barr had a four month delay in his diagnosis.

He is technically a patient of my colleague, Dr. Laura McDonald. But he had drifted between two of our regular doctors and a locum tenens physician we hired to work during March, when both Laura and Dr. Wilford Brown were on vacation.

I saw him late Thursday afternoon for a rash, but he also asked what he could do about his heartburn.

"Tell me more about your heartburn", I said.

What followed was a near classic description of angina pectoris.

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