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First Study to Show EMRs, EHRs Lead to Better Outcomes in Diabetes

A great post over at the Doctors LoungeElectronic Records Tied to Better Diabetes Care — cites a new study published in the New England Journal of Medicine today, Sept 1.  The study, Electronic Health Records and Quality of Diabetes Care by Cebul et al,  is a fairly big one considering the place where it was published and the naysayers out there citing past studies that failed to show significant improvements in health outcomes in the setting of implementing EMR and EHR use.

However, as a previous insider to the academic, ivory-tower world, I have a hunch that some major liberal politicking is likely involved at least a bit here.  After all, the HITECH Act is the initiative of a democratic administration that desperately wants to be vindicated as being right and not wasting money in a downtrodden economic time.  But nevertheless, once a study like this — from reputable centers such as The Cleveland Clinic and Case Western Reserve University — is through the strict hurdles of getting published in a journal with the magnitude of the New England Journal of Medicine, the message will be quite powerful.  A new king-of-the-hill in studies of EMR efficacy may be afoot.

ADDENDUM:  Since posted this, a lot of other news sites, including the Bangor Daily News and the Minneapolis Star Tribune, have now come out with even more coverage on this big news

Dr. West is an endocrinologist in private practice in Washington, DC.  He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.  He can be reached at doctorwestindc@gmail.com.

September 1, 2011 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

Do EMR and EHR Registries Equal Better Care?

Meaningful Use includes the creation and transmission of patient registries for reporting various medical data such as vaccinations, medications, lab results and vital signs including weight, body mass index (BMI) and blood pressure.  To be honest, I don’t know any real practicing doctors out there who worry about their EHR’s ability to perform registry generation, but non-doctors with more time on their hands seem to think it’s the Holy Grail.  As it turns out, a recent post by Ken Terry EHRs Give Docs Analytics Tools They May Ignore sparked my interest.  

It was pretty intriguing that an insurance company like Blue Cross Blue Shield would be sponsoring a pilot experiment to correlate doctors’ access to EMR and EHR technology with doctors’ ability to generate patient registries.  Clearly, this is the first step in making searchable databases that will enable users to ask more detailed questions.  Since the pilot study was not clear on what or how much information was shared with the insurance company by the administrating body for the study, the Massachusetts eHealth Collaborative, there’s an interesting closed door there that the public can’t see behind right now.  Why does an insurance company want such information?  Let’s be honest:  it’s got to be money, plain and simple.  Insurance companies are for-profit entities after all.  Assigning report cards and pay-grades to doctors based on performance?  Stratifying out “good” and “bad” doctors?  Door #3?  If they just want to study problem areas for public health improvement, then it would be preferable to define their end goals publicly ahead of time — which has been one of my big beefs with Meaningful Use.

I loved the comment by Jane Metzger, a CSC consultant who is an expert in registries.  Most of today’s EHRs can do a registry-like function, but it takes work to do that… Not every practice that adopts an EHR is committed to care management–having guidelines for care, knowing who your diabetic patients are, and deciding you should see them at least once a year and so forth.”  Wow — what a negative connotation of docs who might have other ways to benefit their patients.  However, Metzger did mention something I agree with in the end:  ” it’s extra work to do it.”

Dr. West is an endocrinologist in private practice in Washington, DC.  He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.  He can be reached at doctorwestindc@gmail.com.

August 9, 2011 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

Templating notes improved my healthcare delivery: an anecdote

Recently, I sat down with my trusty practice manager Ken and we went through our monthly profit and loss — P&L — statement, as we do every month about this time.  Excellent business person that he is, Ken noticed an interesting trend.  Lately, my Pneumovax vaccines have been flying off the shelves since I moved to templating my notes on a full-time basis back around April.

Nowadays, all of my new diabetes patients are asked, with nearly 100% precision, when is the last time they had a Pneumococcal vaccine (Pneumovax 23, made by Merck) to prevent bad outcomes in case of pneumonia.  If they cannot recall or find out from a previous doctor, then they are a candidate for this vaccine.  If their sugar patterns are under reasonable control to render the vaccine effective, then I offer to give it to them on the spot.  If not, then I write it into my plans for future visits to rediscuss this when they do reach a reasonable level of control.  I used to give out maybe around 5-6 vaccine doses each month, but for the last three months, the count is up to about 13-15 doses monthly.  Since diabetes patients are pretty much the only people I give this vaccine to, I have to conclude that healthcare delivery is improved for my diabetic population.  Interesting, no?

Dr. West is an endocrinologist in private practice in Washington, DC.  He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.  He can be reached at doctorwestindc@gmail.com.

July 26, 2011 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

HHS EMR rules that don’t help anyone get better healthcare

The other night I read an amazing story about a new rule from HHS, which will allow patients to see who has accessed and viewed their electronic medical record.  Needless to say, I was fairly unimpressed with how much money, time, and energy was likely expended to produce more government red tape that doesn’t help anyone get better healthcare.  Does this rule surrounding patients actually do anything to better healthcare outcomes?  How does this improve anything other than the potential for patients to be able to sue a peeping Tom?  Can someone help us out here?  It seems like such a waste of money to me.  Maybe I’m missing something.

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.  He can be reached at doctorwestindc@gmail.com.

June 3, 2011 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.