It's summertime, summertime Sum-sum-summertime Summertime, summertime Sum-sum-summertime Summertime, summertime Sum-sum-summertime Summertime, summertime Sum-sum-summertime Summerti-i-me ......
(Feller and Jameson, The Jamies 1958)
Yeah. Summertime. I love it here in the Rockies. Unfortunately, so do a whole lotta folks who take summertime activities in directions God never intended. Which means sum-sum-summertime is a busy one for those of us who treat trauma victims --- motorcyclists riding without helmets, mountain bikers going "endo," and toxic mixtures of ethanol, testosterone, and high-horsepower vehicles keep us hopping. Our group has lost two members this year, meaning that this summer is busier than most for me. Which means, in the end, no sum-sum-summertime blogging lately.
Time to make amends. Let's chat a bit about electronic medical records. Really! It will be fun! Exciting! A real waste of your next 4 minutes!
A wide policy net was cast in January by the federal government regarding the potential for physicians and to get some of the "stimulus" money as (partial) reimbursement for purchasing EHR systems. The kicker came with the phrase "meaningful use" --- in other words, physicians would have to demonstrate that they were using their EHR to a meaningful extent in order to be eligible to receive funds. What, exactly, does "meaningful use" mean?
Some framework was put into place in mid-June when the meaningful use workgroup of the HIT Policy Committee released its initial recommendations for a definition of "meaningful use" of electronic health records. 22 specific objectives for EHRs to be qualified by 2011, including:
- Allow patients to access clinical information;
- Comply with state and federal privacy, security and data sharing regulations;
- Document patient progress and provide clinical summaries;
- Exchange critical information with other care providers;
- Implement drug interaction safeguards;
- Send patient reminders about follow-up and preventive care;
- Submit immunization and laboratory data to relevant public health registries; and
- Use computerized physician order entry systems to transmit prescriptions.
Allow patients to access clinical information
I'll give an example; this is not a real patient, but is similar to many folks that I see.
- 59 year old lady
- History of stage I left breast cancer, treated with breast conservation therapy
- HTN, on Altace
- Mild glucose intolerance
- Family history of breast cancer, hypertension, diabetes and diabetes-related renal failure
- Status post cholecystectomy, TAH/BSO, and appendectomy
- Normal screening colonoscopy 18 months ago
- Referred to surgeon by nurse practitioner in gynecologist's office for evaluation of an abnormal mammogram. The mammogram reads "indeterminate cluster of microcalcifications in the 5 to 6 o'clock position of the left breast, seen only in MLO view; recommend 6 month interval diagnostic mammograms and ultrasound."
My little brother got an electrical engineering degree and mechanical engineering degree in college. Smart as a whip, even if he is a bit of a doofus. And even though he works in software now, I suspect he could make his way around an electrical wiring diagram in his sleep. But does he know what "indeterminate cluster of microcalcifications in the 5 to 6 o'clock position of the left breast, seen only in MLO view" means? Just as I can't make heads or tails of a microchip diagram, I wouldn't expect him to understand what a mammogram result means. It's in a different language, for all intents and purposes. And I wouldn't expect that he would understand that an abnormal mammographic finding in a breast that has been treated with breast conservation therapy for carcinoma is something that probably deserves a little more investigation than awaiting a 6 month follow-up study.
So, I have decided to drop this whole surgery gig and open up a new business venture. I'm going to publish a series of helpful little books designed to let patients navigate arcane medical jargon.
- Surgical Diagnoses and Treatments For Dummies
- Cardiology For Dummies
- Pediatric Terminology For Dummies