Remote Ultrasound

A surgeon from Detroit has shown that it is possible for a minimally trained person to capture good ultrasound images and send them via the Internet to a remote site where a trained radiologist can then interpret them. This is another telemedicine application that will allow for the "virtualization" of medical expertise. The ability to capture ultrasound images using a portable unit by a non-radiologist can prove very useful. An ultrasound is a very important diagnostic device for emergency situations, such as an impending aortic aneurysm rupture in a patient presenting with abdominal pain. The problem is that many community hospitals do not have ultrasound techs or radiologists on site during nights. Being able to capture images locally and transmitting them remotely for interpretation will allow these hospitals to offre this service and in doing so, will surely save lives . Read more...

If you're interested in reading further about "Diagnostic ultrasound usability, reliability, comparisons, news and reviews", see this blog.

List of References for "Care Transitions"

Here is a list of References that I found very useful while researching the topic of "Care Transitions"

AHRQ website, Care Transitions Perspective by Sunil Kripalani, MD, MSc



Deficits in Communication and Information Transfer Between Hospital-Based and Primary Care Physicians
Implications for Patient Safety and Continuity of Care
Sunil Kripalani, MD, MSc; Frank LeFevre, MD; Christopher O. Phillips, MD, MPH; Mark V. Williams, MD; Preetha Basaviah, MD; David W. Baker, MD, MPH
JAMA. 2007;297:831-841.


Dangerous Transitions Health Research for Action by the U of Berkley. Very good discussion on the Hospital to home transition and the problems encountered.

Medical errors related to discontinuity of care from an inpatient to an outpatient setting.

J Gen Intern Med. 2003 Aug;18(8):675-6.


Carlton Moore, MD,1 Juan Wisnivesky, MD,1 Stephen Williams, MD,1 and Thomas McGinn, MD1

CONCLUSION: prevalence of medical errors related to the discontinuity of care from the inpatient to the outpatient setting is high and may be associated with an increased risk of rehospitalization.



Conversation with Eric A. Coleman, MD, on Care TRansitions.

Coloroda Business Plan for care transitions http://caretransitions.org/documents/Colorado_Business_Plan.pdf





Lost in transition: challenges and opportunities for improving the quality of transitional care


Ann Intern Med. 2004 Oct 5;141(7):533-6, Coleman EA, Berenson RA



Post Discharge Communications, The Discharge Summary


Deficits in Communication and Information Transfer Between Hospital-Based and Primary Care Physicians
Implications for Patient Safety and Continuity of Care ,


Sunil Kripalani et al, JAMA. 2007;297:831-841.

Telemedicine in Action

Interesting article on a Telemedicine Pilot by Dr Siddiqui, who is using it for infectious disease and wound care remote consultations. Its becoming clear that we will be experiencing a severe doctor shortage in the next few years. In my own community, I do not see any new physicians starting their practices. Our local hospitals have become frustrated in their attempts to recruit new primary care physicians and specialists. Over the next 5 years, I see a significant number of physicians retiring or winding down. In order to efficiently use our limited physician resources, telemedicine will need to be more main stream. Dr Siddiqui has presented an excellent case study and I look forward to reading his findings when they are published.

...Partnering with Dr. Javeed Siddiqui of UC Davis Medical Center, the staff at
Sonoma Valley Hospital is routinely able to get expert opinion on infection
cases using the state of the art technology."Programs like this are great
because they allow us to offer high quality medical care in this small community
that we would never have been able to offer otherwise," said Carl Gerlach, chief
executive officer at Sonoma Valley Hospital. "When we don't have that particular
specialist on board, telemedicine allows us to reach out to the best medical
centers for their expertise.".....hospital partnered up with Siddiqui, an
infectious disease specialist, who agreed to help guide the hospital's response
to infection.
To date, Siddiqui has consulted on dozens of infection cases
ranging from diabetic foot ulcers and wound checks to pneumonia and
osteomyelitis. McMahon said the technology is almost as good as having the
doctor in the room, because he can use the camera to zoom in to get an up close
look and talk to the patients in real time.

Misys Healthcare and Allscripts to Merge

I heard this rumor while at HIMSS, but both parties denied it. Well it happened. Supposedly, with this merger, 1 in 3 physicians will be working with an Allscripts-Misys system in some capacity. See Misys Healthcare and Allscripts to Merge.

ROI of EMRs not worth the cost ?

Interesting piece in the AMA news. Blue Cross Blue Shield of MA (BCBSMA) has determined that the ROI of an EMR is not worth the investment to doctors, and as a result, will not require physicians to purchase an EMR in order to participate in their P4P programs. This news is especially significant since it was BCBSMA that funded the very high profile $50M community based EMR project, Massachusetts eHealth Collaborative. One objective of this project was to understand the cost and quality implications of implementing EMRs, so BCBS's conclusion is based on solid data. It will be interesting to see how this plays out in justifying future EMR roll outs.

Wound Care EMR Screenshots

A very good demo of a wound care application.

Medication Reconciliation

John Halamka had a very good post on medication reconciliation at BIDH.
Here are a few screen shots:

Community Wide Medication


Discharge Medication Summary