Medical Record Doesn’t Always Reflect Medications Patient Actually Taking

MedicalResearch.com Interview with:
"Portable Information station, nurse, computer, hand wipes, 9th floor, Virginia Mason Hospital, Seattle, Washington, USA" by Wonderlane is licensed under CC BY 2.0Timothy Ryan PhD

This work was performed while Dr. Ryan was at
Precera Biosciences, 393 Nichol Mill Lane
Frankluin, Tennessee 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: The study design is quite simple.  We measured medication concentrations in patients, then compared empirically detected medications with prescribed medications in each patient’s medical record.  We used this information to estimate how many prescribed medications patients had actually taken and how often they took medications that were not in their medical record.  The later comparison is a particularly novel measure of the number and types of medications taken by patients unbeknownst to healthcare providers who use the medical record as a guide to patient care.

Further, the test was performed in blood and not urine, so we could obtain an estimate of how often patients were in range for medications that they did take – at least for medications where the therapeutic range for blood concentrations are well established.

In sum, we found that patients do not take all of their medications, the medical records are not an accurate indicator of the medications that patients ingest, and that even when taken as prescribed, medications are often out of therapeutic range.  The majority of out-of-range medications were present at subtherapeutic levels.  Continue reading

Even in Intensive Care, Health Care Costs Are Factor For Both Patients and Clinicians

MedicalResearch.com Interview with:

Deborah D. Gordon, MBA Mossavar-Rahmani Center for Business and Government Harvard Kennedy School Cambridge, Massachusetts

Deborah  Gordon

Deborah D. Gordon, MBA
Mossavar-Rahmani Center for Business and Government
Harvard Kennedy School
Cambridge, Massachusetts

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Against the backdrop of rising health care costs, and the increasing share of those costs that consumers bear, studies show people are interested in finding health care cost information and engaging with their providers on issues of cost.

We were interested in learning to what extent, if any, discussion or consideration of cost would be documented in electronic health records.

Using machine learning techniques to extract data from unstructured notes, we examined 46,146 narrative clinical notes from ICU admissions. We found that approximately 4% of admissions had at least one note with financially relevant content. That financial content included documentation of cost as a barrier to adhering to treatment prior to admission, and as a consideration in treatment and discharge planning.    Continue reading

What Types of Health Care Records Are Breached?

MedicalResearch.com Interview with:

Thomas McCoy, M.D. Assistant Professor of Psychiatry Massachusetts General Hospital Psychiatry Massachusetts General Hospital

Dr. McCoy

Thomas McCoy, M.D.
Assistant Professor of Psychiatry
Massachusetts General Hospital
Psychiatry
Massachusetts General Hospital

MedicalResearch.com: What is the background for this study?

 Response: Big data has the potential to transform how we care for patients but comes with risks of big breaches. My co-author and I use health records in our research and we wanted to better understand the risks that these data might pose to our patients.

MedicalResearch.com:? What are the main findings? 

Response: The majority of breaches are of health care providers whereas the majority of breached records are from health plans. The three largest breaches account for the over half of records breached.

MedicalResearch.com: What should readers take away from your report?

Response: This study doesn’t speak to any particular solution; rather, it speaks to the aspects of the system that are most often breached: In 2017 it was hacking or IT incidents and networked servers. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: This study speaks to the aspects of the system that are most often breached: In 2017 it was hacking or IT incidents and networked servers; however, much is left to be learned about the specific mechanisms and consequences of these events.

MedicalResearch.com: Is there anything else you would like to add?

Response: Large healthcare datasets present a means of transformational discovery but also come with real risks of large scale disclosure. 

Disclosures: Dr. McCoy reports unrelated grants from The Stanley Center at The Broad Institute, Brain and Behavior Research Foundation, and Telefonica Alpha. Dr. Perlis reports unrelated grants from the National Human Genome Research Institute, National Institute of Mental Health, and Telefonica Alpha; serves on the scientific advisory board for Perfect Health, Genomind, and Psy Therapeutics; and consults to RID Ventures. Dr. Perlis is an editor of JAMA Network Open.

Citation:

McCoy TH, Perlis RH. Temporal Trends and Characteristics of Reportable Health Data Breaches, 2010-2017. JAMA. 2018;320(12):1282–1284. doi:10.1001/jama.2018.9222

 

Sep 28, 2018 @ 11:22 am

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Medical Notes Using Speech Recognition: Less Than Perfect

MedicalResearch.com Interview with:

Li Zhou, MD, PhD, FACMI Associate Professor of Medicine Division of General Internal Medicine and Primary Care Brigham and Women’s Hospital, Harvard Medical School Somerville, MA 02145

Dr. Li Zhou

Li Zhou, MD, PhD, FACMI
Associate Professor of Medicine
Division of General Internal Medicine and Primary Care
Brigham and Women’s Hospital, Harvard Medical School
Somerville, MA 02145

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Documentation is one of the most time-consuming and costly aspects of electronic health record (EHR) use.

Speech recognition (SR) technology, the automatic translation of voice to text, has been increasingly adopted to help clinicians complete their documentation in an efficient and cost-effective manner. One way in which SR can assist this process is commonly known as “back-end” SR, in which the clinician dictates into the telephone, the recorded audio is automatically transcribed to text by an speech recognition engine, and the text is edited by a professional medical transcriptionist and sent back to the EHR for the clinician to review and sign.

In this study, we analyzed errors at different processing stages of clinical documents collected from 2 health care institutions using the same back-end SR vendor. We defined a comprehensive schema to systematically classify and analyze these errors, focusing particularly on clinically significant errors (errors that could plausibly affect a patient’s future care). We found an average of 7 errors per 100 words in raw  speech recognition transcriptions, and about 6% of those errors were clinically significant. 96.3% of the raw speech recognition transcriptions evaluated contained at least one error, and 63.6% had at least one clinically significant error. However, the rate of errors fell significantly after review by a medical transcriptionist, and it fell further still after the clinician reviewed the edited transcript.

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Despite Promise, EMRs Have Not Reduced Administrative or Billing Expenses

Barak Richman JD, PhD Bartlett Professor of Law and Business Administration Duke University

Prof. Barak Richman

MedicalResearch.com Interview with:
Barak Richman JD, PhD
Bartlett Professor of Law and Business Administration
Duke University 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: The US not only has the highest health care costs in the world, we have the highest administrative costs in the world. If we can reduce non-value added costs like the ones we document, we can make substantial changes in the affordability of health care without having to resort to more draconian policy solutions.

Our paper finds that administrative costs remain high, even after the adoption of electronic health records.  Billing costs, for example, constituted 25.2% of professional revenue for ED departments and 14.5% of revenue for primary care visits.  The other numbers are captured below.

Administrative Costs Still High With EHRs

Administrative Costs Still High With EHRs

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Study Finds Patients Equally Likely To Fill Paper vs Electronic Prescriptions

MedicalResearch.com Interview with:

Shannon Toohey, MD, MAEd Associate Residency Director, Emergency Medicine Assistant Clinical Professor, Emergency Medicine University of California, Irvine Editor-in-Chief Journal of Education and Teaching in Emergency Medicine

Dr. Toohey

Shannon Toohey, MD, MAEd
Associate Residency Director, Emergency Medicine
Assistant Clinical Professor, Emergency Medicine
University of California, Irvine
Editor-in-Chief
Journal of Education and Teaching in Emergency Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Electronic prescriptions (e-prescriptions) are now the predominant form of prescription used in the US. Concern has been raised that this form of prescription may be more difficult for emergency department (ED) patients to utilize than traditional printed prescriptions, given the unplanned nature of most ED visits at all times of day.

While there are disincentives for physicians who choose not to use them, many emergency physicians are still concerned that it could decrease compliance in their patients.
This study evaluated prescription compliance in insured patients at a single center. In our studied population, we found that patients were as equally likely to fill paper and e-Prescriptions.

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Timicoin First Mobile Platform to Deploy Blockchain Technology to Store and Access Medical Records

MedicalResearch.com Interview with:
http://www.timicoin.io/Will Lowe, Timicoin CEO

Mr. Lower discusses the first cryptocurrency blockchain mobile platform for storing medical records that can be safely accessed from anywhere.

MedicalResearch.com: What is the background for this announcement? Would you briefly explain what is meant by blockchain technology?  How does  it allow for more efficient storage and transmittal of encrypted medical records?

Response: We do not store the data on any cloud storage to avoid any threat to data security and server overhead for data processing as well as to avoid temporary potential data unavailability.

When a certain kind of data is queried by the consumer, our cloud engine first passes on the query to each of the providers (our gateway applications that are running on their node) and see if there are enough query results, it shows a sample to the consumer and if consumer decides to pay, it creates a Blockchain channel between the providers and the consumer that queried the data and all the provider nodes propagate the queried data onto that channel.

So a common trust is built between the nodes and the consumer on that Blockchain channel and the shared query stays there as the trust builder. Then the consumer can anytime access the data needed from that blockchain channel.  Continue reading

Physicians Overwhelmed by Messaging From Electronic Medical Records

MedicalResearch.com Interview with:
“Computer” by FullCodePress is licensed under CC BY 2.0Matilda W. Nicholas,
 MD, PhD
Duke Dermatology
Durham, North Carolina

MedicalResearch.com: What is the background for this study?

Response: I have found many physicians overwhelmed by the electronic messaging feature in Electronic Health Record systems (EHRs). I found there was very little published about this phenomenon, particularly for specialists. So, we set out to take a look at the volume and effect these systems have. 

MedicalResearch.com: What are the main findings?

 Response: We found that, on average, clinicians receive 3.24 messages per patient visit, for an average of about 50 messages per full day of clinic. The number of messages also correlated with poor reported work life balance for dermatologists. Continue reading

Patients Prefer Doctors Who Face Them Rather Than Computer Screen

MedicalResearch.com Interview with:
Dr. Ali Haider, MBBS MD

Assistant Professor, Department of Palliative Care and Rehabilitation Medicine
Division of Cancer Medicine
The University of Texas MD Anderson Cancer Center
Houston, TX 

MedicalResearch.com: What is the background for this study?

Response: Patients with chronic and serious illnesses such as cancer often experience high physical and psychosocial symptoms. Recent studies have reported association of physicians’ examination room computer use with less face to face interactions and eye contact. It’s important for the clinicians to look for certain physical cues to better understand the well being of their patients. Therefore we conducted this randomized clinical trial to understand patients perception of physicians compassion, communication skills and professionalism with and without the use of examination room computer.

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Billing Data May Not Accurately Represent In-Hospital Cardiac Arrests

MedicalResearch.com Interview with:

Rohan Khera MD Division of Cardiology University of Texas Southwestern Medical Center Texas 

Dr. Khera

Rohan Khera MD
Division of Cardiology
University of Texas Southwestern Medical Center
Texas 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: An increasing number of studies have used administrative claims (or billing) data to study in-hospital cardiac arrest with the goal of understanding differences in incidence and outcomes at hospitals that are not part of quality improvement initiatives like the American Heart Association’s Get With The Guidelines-Resuscitation (AHA’s GWTG-Resuscitation). These studies have important implications for health policies and determining targets for interventions for improving the care of patients with this cardiac arrest, where only in 1 in 5 patient survive the hospitalization.

Therefore, in our study, we evaluated the validity of such an approach. We used data from 56,678 patients in AHA’s GWTG-Resuscitation with a confirmed in-hospital cardiac arrest, which were linked to Medicare claims data. We found:

(1)  While most prior studies have used a diagnosis or procedure code alone to identify cases of in-hospital cardiac arrest, we found that the majority of confirmed cases in a national registry (AHA’s GWTG-Resuscitation) would not be captured using either administrative data strategy.

(2)  Survival rates using administrative data to identify cases from the same reference population varied markedly and were 52% higher (28.4% vs. 18.7%) when using diagnosis codes alone to identify in-hospital cardiac arrest.

(3)  There was large hospital variation in documenting diagnosis or procedure codes for patients with in-hospital cardiac arrest, which would have consequences for using administrative data to examine hospital-level variation in cardiac arrest incidence or survival, or conducting single-center studies to validate this administrative approach.

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What Do Patients Value About Reading Their Electronic Medical Record Notes?

MedicalResearch.com Interview with:
Macda Gerard
M.D. Candidate | Class of 2021
Wayne State University School of Medicine

MedicalResearch.com: What is the background for this study?

Response: As electronic health records proliferate, patients are increasingly asking for their health information but little is known about how patients use that information or whether they encounter errors in their records. This comes at a time when we’re learning that understanding the patient and family experience, especially what is most valued in exchanges between doctors and patients is important and has many benefits. To learn more, we developed a formal mechanism for patients to provide feedback on what they like about accessing the information in their health records and to inform their clinical team about things like inaccuracies and perceived errors. So that’s the gap we tried to fill.

The patient feedback tool is linked to the visit note in the electronic health record (EHR), and it’s part of a quality improvement initiative aimed at improving safety and learning what motivates patients to engage with their health information on the patient portal. Over the 12-month pilot period, 260 patients and care partners provided feedback using the OpenNotes patient feedback tool. Nearly all respondents found the tool to be valuable and about 70 percent provided additional information regarding what they liked about their notes and the feedback process.

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Clinicians Multitask on Electronic Health Records 30% of Visit Time with Patients

MedicalResearch.com Interview with:

Neda Ratanawongsa, MD, MPH Associate Chief Health Informatics Officer for Ambulatory Services, San Francisco Health Network Associate Professor, Division of General Internal Medicine UCSF Center for Vulnerable Populations Physician, Richard H. Fine People's Clinic (RHPC) Zuckerberg San Francisco General Hospital San Francisco, CA 94110 

Dr. Ratanawongsa

Neda Ratanawongsa, MD, MPH
Associate Chief Health Informatics Officer for Ambulatory Services, San Francisco Health Network
Associate Professor, Division of General Internal Medicine
UCSF Center for Vulnerable Populations
Physician, Richard H. Fine People’s Clinic (RHPC)
Zuckerberg San Francisco General Hospital
San Francisco, CA 94110

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: U.S. federal incentives allowed many safety net healthcare systems to afford fully functional electronic health record systems (EHRs). Although EHRs can help clinicians provide care to vulnerable populations, clinicians may struggle with managing the EHR workload, particularly in resource-limited settings. In addition, clinicians’ use of EHRs during clinic visits may affect how they communicate with patients.

There are two forms of EHR use during clinic visits.  Clinicians can multitask, for example, by ordering laboratory tests while chatting with a patient about baseball.  However, like distracted driving, using EHRs while talking with increases risks – in this case, the risk of errors in patient-provider communication or in the EHR task. Alternatively, clinicians can use EHRs in complete silence, which may be appropriate for high-risk tasks like prescribing insulin. However, silence during visits has been associated with lower patient satisfaction and less patient-centered communication.

So we studied how primary and specialty care clinicians used EHRs during visits with English- and Spanish-speaking patients in a safety net system with an EHR certified for Centers for Medicare & Medicaid Services meaningful use incentive programs. We found that multitasking EHR use was more common than silent EHR use (median of 30.5% vs. 4.6% of visit time). Focused patient-clinician talk comprised one-third of visit time.

We also examined the transitions into and out of silent EHR use. Sometimes clinicians explicitly stated a need to focus on the EHR, but at times, clinicians drifted into silence without warning. Patients played a role in breaking silent EHR use, either by introducing small talk or by bringing up their health concerns.

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EHRs Can Facilitate Rapid Detection and Treatment of Sepsis

MedicalResearch.com Interview with:

Faheem Guirgis MD  Assistant Professor of Emergency Medicine Department of Emergency Medicine Division of Research UF Health Jacksonville

Dr. Guirgis

Faheem Guirgis MD
Assistant Professor of Emergency Medicine
Department of Emergency Medicine
Division of Research
UF Health Jacksonville

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Sepsis is quite prevalent among hospitals and the incidence is increasing. It is a life-threatening disease that can lead to poor outcomes if patients are not recognized and treated promptly. We recognized that our institution needed a strategic approach to the problem of sepsis, therefore the Sepsis Committee was created with the goal of creating a comprehensive sepsis program.

We developed a system for sepsis recognition and rapid care delivery that would work in any area of the hospital. We found that we reduced overall mortality from sepsis, the number of patients requiring mechanical ventilation, intensive care unit length and overall hospital length of stay, and the charges to the patient by approximately $7000 per patient.

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Large Teaching Hospitals Face Greater Risk of Data Breaches

MedicalResearch.com Interview with:

Ge Bai, PhD, CPA Assistant Professor The Johns Hopkins Carey Business School Washington, DC 20036

Dr. Ge Bai

Ge Bai, PhD, CPA
Assistant Professor
The Johns Hopkins Carey Business School
Washington, DC 20036


MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We examined the hospital data breaches between 2009 and 2016 and found that larger hospitals and hospitals that have a major teaching mission have a higher risk of data breaches.

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Computerized Clinical Decision Support Systems Can Reduce Rate of Venous Thromboembolism

MedicalResearch.com Interview with:
Zachary Borabm, Research fellow

Hansjörg Wyss Department of Plastic Surgery
NYU Langone Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Recent studies have shown that health care providers perform poorly in risk stratifying their patients for venous thromboembolism (VTE) which leads to inadequate VTE prophylaxis delivery, especially in surgical patients. Computerized Clinical Decision Support Systems (CCDSSs) are programs integrated into an electronic health record that have the power to aid health care providers. Using a meta-analysis study technique we were able to pool data from 11 studies, including 156,366 patients that either had CCDSSs intervention or routine care without CCDSSs.

Our main outcome measures were the rate of prophylaxis for VTE and the rate of actual VTE events. We found that CCDSSs increased the rate of VTE prophylaxis (odds ratio 2.35, p<0.001) and decreased the risk of VTE events (risk ratio 0.78, p<0.001).

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Loopback Analytics Uses Predictive Analytics To Close The Loop In Health Care Data

MedicalResearch.com Interview with: Neil Smiley CEO of Loopback Analytics

Neil Smiley

MedicalResearch.com Interview with:
Neil Smiley
CEO of Loopback Analytics

MedicalResearch.com: What is the background for Loopback Analytics? What are the problems Loopback Analytics is attempting to mitigate?

Response: Loopback Analytics (Loopback) is a Software-as-a-Service company that provides event-driven population health management. Founded in 2009, Loopback integrates and manages diverse data sources to support predictive analytics and intervention solutions to address health reform reimbursement challenges with the goal of achieving the Triple Aim – better care, better health and lower costs.

Loopback enabled intervention solutions address key challenges associated with value-based care, such as reducing avoidable hospitalizations, high emergency department utilization, medication adherence and optimization of post-acute care networks.

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Drop in Adverse Drug Events Linked to Meaningful Use of Electronic Records

MedicalResearch.com Interview with:
Michael Furukawa, Ph.D.

Senior Economist
Agency for Healthcare Research and Quality 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Despite some progress, patient safety remains a serious concern in U.S. health care delivery, particularly in acute care hospitals. In part to support safety improvement, the Health Information Technology for Economic and Clinical Health (HITECH) Act promoted widespread adoption and use of certified electronic health record technology. To meet Meaningful Use (MU) requirements in the law, hospitals are required to adopt specific capabilities, such as computerized physician order entry, which are expected to reduce errors and promote safer care.

We found that, after the HITECH Act was made law, the occurrence of in-hospital adverse drug events (ADEs) declined significantly from 2010 to 2013, a decline of 19%. Hospital adoption of medication-related MU capabilities was associated with 11% lower odds of ADEs occurring, but the effects did not vary by the number of years of experience with these capabilities. Interoperability capability was associated with 19% lower odds of adverse drug events occurring. Greater exposure to MU capabilities explained about one-fifth of the observed reduction in ADEs.

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Cedars-Sinai Study Will Address How Doctors Communicate With Patients About Chronic Pain

MedicalResearch.com Interview with:
Michelle S. Keller, MPH, PhD Candidate

Health Policy and Management
Cedars-Sinai
Los Angeles CA 90048

MedicalResearch.com: What is the background for this new funding award?

Response: Research shows that treating and managing chronic pain is tough, and it can be hard for patients and their physicians to be on the same page. Chronic pain touches so many facets of people’s lives—relationships, mental health, sleep, work—that treating it in a 15-minute visit can lead to a lot of frustration and disappointment.

Our hope is that by arming patients and clinicians with evidence-based tools, we can help foster a better dialogue about what is ultimately important to patients, how to achieve fully functional lives while managing chronic pain. We’re testing two different types of communication tools: electronic health record alerts pointing physicians to guidelines when they write opioid prescriptions and patient portal-based tools that can help patients prepare for visits and become active, engaged partners in their care.

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Is Trust in Mental Health Clinicians Affected Among Patients Who Access Clinical Notes Online?

MedicalResearch.com Interview with:

Steven K. Dobscha, M.D. Professor, Department of Psychiatry, OHSU Director, VAPORHCS Center to Improve Veteran Involvement in Care Oregon Health & Science University

Dr. Dobscha

Steven K. Dobscha, M.D.
Professor, Department of Psychiatry, OHSU
Director, VAPORHCS Center to Improve Veteran Involvement in Care
Oregon Health & Science University

MedicalResearch.com: What is the background for this study? 

Response: Several health care systems across the United States now offer patients online access to all of their clinical notes (sometimes referred to as progress notes) through electronic health record portals; this type of access has been referred to as OpenNotes (see www.opennotes.org for more information on the national OpenNotes initiative). Veterans have been able to use OpenNotes in the Veterans Health Care (VHA) system since 2013. However, some individuals have expressed concern that online access to clinical notes related to mental health could cause some patient harms.

We are conducting a VA-funded research project with several objectives:
1) to examine benefits and unintended negative consequences of OpenNotes use as perceived by veterans receiving VHA mental health care and by VHA mental health clinicians, and
2) to develop and evaluate brief web-based courses designed to help veterans and clinicians use OpenNotes in ways that optimize Veteran-clinician collaboration and minimize unintended consequences.

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Medical Residents Spend More Time Working on Electronic Medical Records than With Patients

MedicalResearch.com Interview with:
Dresse Nathalie Wenger

Cheffe de clinique
FMH médecine interne
Département de Médecine Interne
CHUV – Lausanne 

MedicalResearch.com: What is the background for this study?

Response: The structure of a residents’ working day dramatically changed during the last decades (limitation of working hours per week, wide implementation of electronic medical records (EMR), and growing volume of clinical data and administrative tasks), especially in internal medicine with increasing complexity of patients. Electronic Medical Records (EMR) have some positive effects but negative effects have been also described ie more time writing notes, more administrative works, and less time for communication between physicians and patients.

Few time motion studies have been published about the resident’s working day in Internal Medicine: the impact of the computer, and what really do the residents do during their work, especially the time spent with the patient versus the computer, as now the EMRs are widely implemented. Previous studies have been mostly performed in the US, so we decided to conduct one observational and objective study in Europe.

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Many CT Scans Can Be Avoided During ER Evaluation of Head Trauma

MedicalResearch.com Interview with:

Adam L. Sharp MD MS Research Scientist/Emergency Physician Kaiser Permanente Southern California Kaiser Permanente Research Department of Research & Evaluation Pasadena, CA 91101

Dr. Adam Sharp

Adam L. Sharp MD MS
Research Scientist/Emergency Physician
Kaiser Permanente Southern California
Kaiser Permanente Research
Department of Research & Evaluation
Pasadena, CA 91101

MedicalResearch.com: What is the background for this study?

Response: Millions of head computed tomography (CT) scans are ordered annually in U.S. emergency Departments (EDs), but the extent of avoidable imaging is poorly defined. Ensuring appropriate use is important to ensure patient outcomes and limited resources are optimized. A large number of stake holders have highlighted the need to reduce “unnecessary” CT scanning as part of their recommendations for the Choosing Wisely campaign. However, despite calls for improved stewardship, the extent of avoidable CT use among adults with minor trauma in community EDs is not known.

The Canadian CT Head Rule (CCHR) is perhaps the most studied of many validated decision instruments designed to assist providers in evaluating patients with minor head trauma. This study aims to describe the scope of overuse of CT imaging by ED providers in cases where application of the CCHR could have avoided imaging.

Secondarily, we sought to describe the extent to which avoidable CTs, if averted, would have resulted in “missed” intracranial hemorrhages requiring a neurosurgical intervention.

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Thyroid Care Collaborative Improves Adoption of Thyroid Cancer Clinical Guidelines

MedicalResearch.com Interview with:

Ilya Likhterov, MD Assistant Professor, Otolaryngology Icahn School of Medicine at Mount Sinai

Dr. Ilya Likhterov

Ilya Likhterov, MD
Assistant Professor, Otolaryngology
Icahn School of Medicine at Mount Sinai

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: As our understanding of thyroid cancer improves, the way these patients are diagnosed and treated is changing. It is difficult for clinicians to incorporate every individual scientific study into their practice. These studies are numerous and the results can be conflicting.

To address this difficulty, organizations such as the American Thyroid Association (ATA) create summary recommendations that account for the latest research and translate it into a format that is easily usable for physicians. Such clinical practice guidelines are available not just for thyroid cancer care, but in many other fields. The difficulty however, is how to ensure that clinicians have access to the guidelines and incorporate the recommendations into their practice.

There are a number of barriers to actually using the guidelines in practice, and we attempt to identify strategies on how to overcome these.

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Familial Hypercholesterolemia Diagnosed Through EHR and Genetics Data

MedicalResearch.com Interview with:

Michael F. Murray MD Geisinger Health System Danville, PA 17822

Dr. Michael Murray

Michael F. Murray MD
Geisinger Health System
Danville, PA 17822

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The DiscovEHR cohort was formed as a result of a research collaboration between Geisinger Health System and Regeneron Pharmaceuticals. There are over 50,000 patient participants in the cohort who have volunteered to have their de-identified genomic sequence data linked to their de-identified EHR data for research purposes. We report in this paper findings around the identification of 229 individuals (1:256) with pathogenic or likely pathogenic variants in one of the three genes (LDLR, APOB, PCSK9) associated with Familial Hypercholesterolemia (FH). The study found that these individuals are unlikely to carry a diagnosis of FH and are at risk for early coronary artery disease.

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Patients Prefer Online Portal To Receive Skin Biopsy Results

MedicalResearch.com Interview with:

sophia-akhiyatSophia Akhiyat
M.D. Candidate, Class of 2017
The George Washington University School of Medicine and Health Sciences
METEOR Fellowship

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Our study was inspired by one of Choudhry et al,1 in which patients’ preferences for skin biopsy result disclosure was surveyed at melanoma clinics affiliated with several academic institutions. We sought to broaden participant inclusion criteria by evaluating patients’ preferences at a general dermatology clinic at an academic center.

Our findings support that the highest ranked patient-preferred method for receiving skin biopsy results was through an online portal. Patients also reported that the most important factors when selecting a modality for communication were the amount of information given and time available to discuss results. We also observed a relationship between a younger patient age range and online portal experience as well as a preference for biopsy notification via online portal.

1Choudhry A, Hong J, Chong K, et al. Patients’ Preferences for Biopsy Result Notification in an Era of Electronic Messaging Methods. JAMA Dermatol. 2015;151(5):513-521.

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Default Settings in Electronic Records Can Facilitate Over-Prescribing

MedicalResearch.com Interview with:

Jashvant Poeran MD PhD Assistant Professor Dept. of Population Health Science & Policy Icahn School of Medicine at Mount Sinai New York, NY

Dr. Jashvant Poeran

Jashvant Poeran MD PhD
Assistant Professor
Dept. of Population Health Science & Policy
Icahn School of Medicine at Mount Sinai
New York, NY

MedicalResearch.com: What is the background for this study?

Response: Falls are an important patient safety issue among elderly patients and may lead to extended hospitalization and patient harm. Particularly important in elderly patients are high risk drugs such as sleep medications which are known to increase fall risk and should be dosed lower in elderly patients.

In this study we looked at patients aged 65 years or older who fell during hospitalization. We found that in 62%, patients had been given at least one high risk medication that was linked to fall risk, within 24 hours before their fall. Interestingly, we found that also a substantial proportion of these medications were given at doses higher than generally recommended for elderly patients.

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