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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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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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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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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Electronic Records Can Provide Real World Evidence On Treatments of Type 2 Diabetes

MedicalResearch.com Interview with:

Lee Kallenbach, PhD, MPH Principal Investigator Practice Fusion

Dr. Lee Kallenbach

Lee Kallenbach, PhD, MPH
Principal Investigator
Practice Fusion

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

Response: Clinical inertia, or the tendency for patients and providers to continue using the same course of treatment even when clinical markers may suggest that treatment intensification is necessary, is an ongoing factor that can contribute to inadequate diabetes care. This is especially true when the treatment intensification may involve a switch from an oral medication to an injectable medication. It is less challenging for a patient to take a pill than it is to give themselves a shot.

Even with all the new diabetes treatments available, clinical inertia is still common among patients with uncontrolled type 2 diabetes (T2D). To further understand the extent of clinical inertia among patients with T2D, the study assessed treatment intensification patterns and associated demographic and clinical characteristics for patients with uncontrolled T2D who were already taking two or more oral anti-diabetes medications.

The study consisted of a retrospective observational analysis leveraging data from Practice Fusion’s de-identified clinical database, which includes more than 38 million records, representing 6.7 percent of all practices across the United States.1 Using a cohort of 25,365 de-identified records, we studied the care given by providers in independent practices to patients in need of intensifying their antidiabetic therapy for managing T2D. To our knowledge, this is one of the largest real world evidence (RWE) studies of T2D that has leveraged a de-identified clinical database from an electronic health record (EHR) platform.

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EHRs Can Help Identify Patients Who May Benefit From HIV PrEP Medications

MedicalResearch.com Interview with:

Douglas Krakower, MD Infectious Disease Division Beth Israel Deaconess Medical Center Boston, MA,

Dr. Douglas Krakower

Douglas Krakower, MD
Infectious Disease Division
Beth Israel Deaconess Medical Center
Boston, MA,

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

Response: There are 45,000 new HIV infections in the US annually, so effective HIV prevention strategies are needed. HIV pre-exposure prophylaxis (PrEP), whereby a person who is HIV-uninfected uses an HIV treatment medication on a daily basis to protect themselves from becoming infected with HIV, is over 90% effective when taken with high adherence. The Centers for Disease Control and Prevention estimates that there are 1.2 million Americans who are likely to benefit from using PrEP. However, only 80,000 persons have been prescribed PrEP. One of the barriers to implementing PrEP is that clinicians face challenges with identifying persons who are most likely to benefit from PrEP, given infrequent sexual health history assessments during routine clinical care. We thus sought to develop an automated algorithm that uses structured data from electronic health records (EHRs) to identify patients who are most likely to benefit from using PrEP. Our methods included extracting potentially relevant EHR data for patients with incident HIV and without HIV from nearly a decade of EHR data from a large ambulatory practice in Massachusetts. We then used machine learning algorithms to predict HIV infection in those with incident HIV and those without HIV. We found that some algorithms could offer clinically useful predictive power to identify persons who were more likely to become infected with HIV as compared to controls. When we applied these algorithms to the general population and identified a subset of about 1% of the population with risk scores above an inflection point in the total distribution of risk scores; these persons may be appropriate for HIV testing and/or discussions about PrEP.

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Machine Learning and Free-Text Analysis of Notes Improves Patient Identification

MedicalResearch.com Interview with:

Saul Blecker, MD, MHS Department of Population Health New York University Langone School of Medicine, New York, NY 10016

Dr. Saul Blecker,

Saul Blecker, MD, MHS
Department of Population Health
New York University Langone School of Medicine,
New York, NY 10016

Saul.Blecker@nyumc.org

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

Response: The identification of conditions or diseases in the electronic health record (EHR) is critical in clinical practice, for quality improvement, and for clinical interventions. Today, a disease such as heart failure is typically identified in real-time using a “problem list”, i.e., a list of conditions for each patient that is maintained by his or her providers, or using simple rules drawn from structured data. In this study, we examined the comparative benefit of using more sophisticated approaches for identifying hospitalized patients with heart failure.

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Electronic Health Records Linked To Only Slightly Better Medical Care

Jonathan R. Enriquez, MD Assistant Professor of Medicine Division of Cardiology University of Missouri- Kansas City Director, Coronary Care Unit Truman Medical Center

Dr. Enriquez

MedicalResearch.com Interview with:
Jonathan R. Enriquez, MD
Assistant Professor of Medicine
Division of Cardiology
University of Missouri- Kansas City
Director, Coronary Care Unit
Truman Medical Center 

Medical Research: What is the background for this study?

Dr. Enriquez:  

  • In 2009, U.S. legislation appropriated tens of billions of dollars to promote the use of electronic health records (EHRs).
  • Approximately 4 million hospitalizations for cardiovascular diagnoses occur annually in the U.S., which are more hospitalizations than for any other category of disease.  Therefore, evaluating the use of EHRs in these settings can help us understand how to best optimize the care and outcomes of a huge set of patients.

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