elegation’s posterous

el·e·ga·tion: being highly effective, yet simple  
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November 14, 2008

Clinical Informatics: The Document Should Drive

Web 10.0 


The above link is an Interesting video presentation by Kevin Kelly.  He really invites us all to think and dream big about the future of the internet.  It wont be what we expect.  It inspired me to think about the current state of electronic medical records and where it could go.

I like his idea of the new extended self, which now includes all the knowledge accessible on the net.  Without access we feel like we are missing something of ourselves.  That power of extending myself beyond my physical body is actually what makes us able to use tools and technology so well.

I also like the ideas of teaching search engines to pull data from text, and make it smart.  I feel I am most creative when I have a blank document, or even better, a blank piece of paper in front of me.  If I can create and keep typing or writing I can get into a flow.  If i have to constantly switch from mouse to click then back to my keyboard to type, my flow, my thoughts, and patterns are interrupted.  This makes for a difficult to read document with the added negative trait of being slower.

This idea, I believe is going to be what breaks open the field of medical informatics.  Physicians are used to thinking and speaking or dictating.  They are used to the old form of note writing or order writing which includes a blank piece of progress note paper, or a blank order form.  The old records follow a similar format.

Medical programs should PULL the diagnosis and relevant medical history FROM the medical document.  Our current format allows a diagnosis to drive a note.  I believe the note should actually drive actions.  It should automatically develop billing codes, diagnoses, as well as order & fax prescriptions and set up follow appointments.

For example:

1.  Hypertension
           - well controlled, will refill HCTZ 25mg daily for another year
           - recheck BMP in 2 weeks
           - follow-up in 6 months

Is all one would need to drive billing, diagnoses, prescriptions, labs, and follow-up for this patient encounter.

Filed under  //   clinical   document   informatics   medical   web 10.0  

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July 25, 2008

ePocrates for iPhone (medical app) critique

Overall I have been impressed with ePocrates for the iPhone.  It is an application I have been waiting for for some time.

However three annoyances have popped up:

1.  It takes a few taps to get to the app in the first place (as it does for any application on the iPhone).
      - A shortcut, or hotkey to go right to ePocrates would be great 

2.  The program takes 5 to 10 seconds to load before I can tap on the blank query spot to type in my drug name.
     -  The default load when loading ePocrates should already be with the keypad pulled up, waiting for you to enter the drug name.
     -  My colleagues using the old PDA are able to load drug info much faster than me.

3.  I do not get reception for my cell phone in the place where I see many of my new patients:  The emergency department.
     - The hospital should give free, fast, and unlimited wifi access to its employees.

Filed under  //   design   efficiency   ePocrates   iphone   medical   Medicine  

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July 16, 2008

My Daily Reading Habits

 
Here are my daily reading habits:
 
1.  Wake up to iphone alarm, read my daily horoscope on iGoogle.
 
Today's example:
 
"You may be tempted to keep an important bit of information to yourself today, but it will only stir up insecurities in those around you. It's better to be straightforward and just tell it like it is. Anything that is currently withheld -- by you or by anyone else -- will come out into the open anyhow and can create a lot more trouble when it does. Honesty is really the best policy."
 
I applied this when I presented my patient from earlier this month to my colleagues, the patient with a large hemorrhagic pericardial effusion. 
 
 
2.  Listen to Medical Podcasts on the way to & from work.
 
Today's example:  Advances in Cardiovascular Medicine series, one hour on lipid/cholesterol management.
 
 
3.  Read my favorite bloggers on Google Reader RSS feeds.
 
Today's Example: Jay, Joshua, Michael, Gina
 
 
4.  Doing some research on a case report.
 
 
5.  Usually prior to falling asleep in bed, reading about one chapter in a book about personal growth.
 
Today's Example:  Depak Chopra's book, The Third Jesus.

Filed under  //   Chopra   google   iphone   medical   Michael Hyatt   recommended   web 2.0  

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July 13, 2008

ePocrates and post MI care

I have had ePocrates on my iPhone for about 24 hrs.  It has been a dream so far.  I havent had any patient interactions, as it is my day of the week off.

However, I have been quite impressed with the formulary function.  I have been able to quickly see which of the frequently prescribed medications are on the Madison formulary.

I will run in to this clinical situation many times in the next month on the cardiology ward:

A patient with no known history enters the hospital emergently due to an acute myocardial infarction (heart attack).  They have previously not taken any medication.  If all goes well, they will be discharged in 3-4 days on multiple new medicaitons, including:

Aspirin (generic, over the counter)
B-blocker (metoprolol tartrate or carvedilol are both covered on the Target 4$ Program)
Ace-inhibitor (lisinopril is covered)
Statin (simvastatin and atorvastatin are most commonly used, but quite expensive).  Pravastatin and Lovastatin are covered, but not as well studied.
Plavix, or clopidogrel: very expensive still.  There was a lawsuit back in 2007 to keep it under patent.
Fish Oil, or omega 3 fatty acids

If on-patent drugs are prescribed, this can be quite expensive quite quickly.

Filed under  //   cardiology   clinical   clinical informatics   Clinical support systems   ePocrates   iphone   medical   Medicine  

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July 12, 2008

DB's Medical Rants

I rediscovered DB's Medical Rants, a medical blog.

His posts seem more relevant to me at this this time in my training.

One quote on his sidebar stuck out to me specifically:

"Anyone can make the simple complicated. Creativity is making the complicated simple." - Charles Mingus

Filed under  //   blog   medical   Medicine   quote   simplicity  

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