Telemedicine for Orthopedics

Orthopedics may be an opportunity for telemedicine. It may be especially useful in the correctional center setting where travel time for an orthopedic physician mY be an inefficient use of a valuable resource. See the abstract below:


Outpatient Orthopedics and the Impact of Telemedicine Upon Costs and Patient Care
Richard M. Garden, MD

Utah Department of Corrections, P.O. Box 250, Draper, UT 84020. Phone: (801) 576-7100.rgarden@utah.gov

In an effort to investigate and evaluate a start-up telemedicine program, the first two years of conducting orthopedic clinics via telemedicine were analyzed. These years were compared to the last full year during which all such clinics were conducted off site. The numbers of off-site visits, surgeries, total visits, grievances (patient complaints), and costs associated with on-site telemedicine (telecasts) were compared for years 1997, 1999, and 2000. A major reduction in the need for off-site visits, a small change in costs, a small increase in total utilization, a decrease in orthopedic-related grievances, and minimal changes in the number of surgeries were found. It was concluded that telemedicine is a fruitful endeavor and also offers a few less tangible benefits and lessons learned.

Journal of Correctional Health Care, Vol. 9, No. 1, 53-61 (2002)
DOI: 10.1177/107834580200900106

Providers skeptical of meaningful use reimbursement process

Providers skeptical of meaningful use reimbursement process"Under a draft of potential measures released in September by the HIT Policy Committee, eligible providers would have to use CPOE (computerized physician order entry) for all orders, implement drug-drug, drug allergy and drug-formulary checks and maintain an up-to-date problem list of current and active diagnoses based on ICD-9 or SNOMED.
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The issue of interoperability with hospitals in the local community is essential:
"...physicians from small practices often interact with more than five community hospitals and several labs, each with a different system. Doctors need to know that whatever electronic health record they buy will work with the systems the labs and hospitals have."

WSJ: Video conferencing in Medicine

More Hospitals Are Using Video to Connect Patients With Specialists Far Away, Speeding Treatment

see the WSJ article here.

Guest Post: Clinical Process in Pain Management

Clinical Process in Pain Management
It’s definitely not easy when you know you have a terminal disease like cancer. What’s worse is the fact that you know you’re going to suffer a painful death, one that will not come quickly but is drawn out and excruciating. Pain management is thus a very important part of palliative care, the kind that is provided to people who have been given just a few months to live at best, people who have lost all hope and for whom chemo and other treatment options are no longer effective. Even those patients who see a sliver of hope in the form of radiation and chemotherapy are in pain, because for this dreaded disease, even the treatment is a form of unbearable pain.
The clinical process in pain management includes the following steps:
• Assessing the pain and documenting its aspects – like how bearable it is and where it originates, if it is radiating or localized, if it is continuous or sporadic, and so on.
• Recognizing the triggers of pain – identifying the factors that cause the pain to flare up or intensify is important because it helps minimize trauma.
• Finding the cause of the pain – the triggers for the pain may be different from the cause. The cause may be a broken bone, but the trigger may be someone touching the injured area or moving it. It is imperative that the cause is identified and treated if the pain must be stopped for good.
• Assessing the risk in the situation – some treatment methods fail to take into account the risks involved. It’s important to assess all the risks, especially when treating people with prior medical conditions.
• Devising a care plan to manage the symptoms of pain – this is especially important when you’re looking after terminally ill patients who need long term pain management plans if they are to live out their last days in relative comfort.
• Treating the cause of the pain – the cause of the pain must be treated if possible, like in the case of broken bones or torn ligaments.
• Considering alternative action when the patient is unresponsive to one method of management – people respond differently to different drugs, so each person’s care plan has to be formulated with precision.
• Dealing with adverse drug reactions – some patients may be allergic to certain drugs, so you must ask the right questions before you begin treatment or pain management therapy.
• Continuously monitoring the situation to see if there has been any improvement – the patient has to be watched for signs, both of improvement and relapse. It’s important that non-verbal cues like grimaces and frowns be taken into consideration as well when caring for patients who are very ill.
Pain management is important in not just cancer but also in post-surgery situations and in acute care conditions. And when the clinical process is efficient, it makes it that much more bearable for the patient.


This guest article was written by Adrienne Carlson, who regularly writes on the topic of nurse practitioner schools . Adrienne welcomes your comments and questions at her email address: adrienne.carlson1@gmail.com

EHR Killer App

Great, insightful article on the need for a EHR Killer App:

"...So where is the EHR 'killer app'? Unfortunately, it doesn't yet exist, and instead providers find themselves courted by innumerous EHR vendors, each offering their own, proprietary methods for accomplishing familiar tasks. If providers aren't careful, they might find themselves locked into vendor-specific software systems and siloed IT universes."

HITECH and its effect on HIT

An interesting article on how HITECH has its own set of unintended consequences. In this case, the government can "screw things up" by forcing providers into acquiring HIT systems at a such a fast rate (less than 24 months), that they end up buying " certified" systems by large vendors. The result being they end up with systems that are less innovative with poor usability. This is a sure way to stiffle HIT innovation and destroy entrepreneurship. And then we wonder why HIT systems are so primitive compared with systems in other industries. Remember, Meditech introduced the ability to point-and-click by a mouse only within the last 5-7 years. This article does a great job in explaining this:

Mapping Lab terminologies

There can be anywhere from 5000 to 15,000 labs code at a given institution. The task of mapping these codes to a standard code set to another institutions codes for the purposes of use in Health Information Exchanges, EHRs for trending lab results can be daunting.

This task cannot be done by someone who understands just the bits and bytes. Considerable domain knowledge is required in order to this efficiently as well as accurately. It is common knowledge within this domain that far fewer than the 5000-15,000 codes account for the vast majority of the commonly ordered tests. And among this subset of commonly ordered, a smaller number of codes are actually important for the purposes of trending.

For example, in the in patient setting, each morning during review of patients lab during rounds, the most commonly trended lab observations are the lab elements contained within the "Comprehensive and Basic Metabolic" profiles, and the CBC. The CPK and ESR rates are trended, but usually for a limited time duration within a patients hospital stay. Test such as the Rheumatoid Factor or ANA on the other hand do not typically require a trended analysis for clinical decision making.

This paper by Daniel Vreeman et al (Regenstrief Institute, Inc. and Indiana University, Indianapolis, IN) makes the following conclusion:

"Given limited mapping resources, our findings support the strategy of focusing the effort on the small subset of observations that account for the majority of volume. Mapping the observation codes that cover 99% of the reported results would ensure that all of the results for more than 99% of patients would be mapped. Mapping even the few (49 to 68) observation codes accounting for 80% of reported results would cover all results for 91–98%
of patients."

Also see: Automated Mapping of Observation Codes Using Extensional Definitions