iPad EMR Apps | A Guide to Electronic Medical Records - Software Advice Articles

Apple's iPad is making rounds in healthcare. Its ergonomic design, long battery life, and beautiful user interface (UI) gives other tablets a run for their money. Several reports indicate that the iPad is growing in popularity among physicians. As a result, more and more electronic medical record (EMR) vendors are releasing iPad-specific versions of their EMRs. Some offer native iPad EMRs; others offer web-browser access through the iPad. However, there is no perfect iPad EMR solution. Each type of deployment has it benefits and drawbacks. In this guide we review the three main iPad EMR options:

• Web-based EMRs. These systems are used through a web browser, and can therefore be accessed using the iPad's Safari browser. They are great for many reasons.
• Remote access EMRs. Most client/server, on-premise EMRs can be accessed from a remote system, including iPads, through utilities like Citrix. This isn't ideal, but it works.
• Native iPad EMRs. These are probably what you want most – a slick app developed just for the iPad – but the options are very limited so far. You might have to wait.

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http://www.softwareadvice.com/articles/medical/guide-to-ipad-electronic-medical-records-1052611/

Squandering Medicare’s Money - NYTimes.com

MEDICARE has suddenly taken center stage in American politics, with Democrats now trying to score an advantage from the unpopularity of the Republican plan to overhaul the government health insurance program. Apart from the politics, though, Medicare's financing challenges are worsening: this month, Medicare's trustees projected that the insurance program would become insolvent by 2024, five years earlier than previously estimated.

Much has been said about the growing gap between the program's spending and revenues — a gap that will widen as baby boomers retire — but little attention has been focused on a problem staring us in the face: Medicare spends a fortune each year on procedures that have no proven benefit and should not be covered. Examples abound:

• Medicare pays for routine screening colonoscopies in patients over 75 even though the United States Preventive Services Task Force, an independent panel of experts financed by the Department of Health and Human Services, advises against them (and against any colonoscopies for patients over 85), because it takes at least eight years to realize any benefits from the procedure. Moreover, colonoscopies carry risks of serious complications (like perforations) and often lead to further unnecessary procedures (like biopsies). In 2009, Medicare paid doctors more than $100 million for nearly 550,000 screening colonoscopies; around 40 percent were for patients over 75.

• The task force recommends against screening for prostate cancer in men 75 and older, and screening for cervical cancer in women 65 and older who have had a previous normal Pap smear, but Medicare spent more than $50 million in 2008 on such screenings, as well as additional money on unnecessary procedures that often follow.

• Two recent randomized trials found that patients receiving two popular procedures for vertebral fractures, kyphoplasty and vertebroplasty, experienced no more relief than those receiving a sham procedure. Besides being ineffective, these procedures carry considerable risks. Nevertheless, Medicare pays for 100,000 of these procedures a year, at a cost of around $1 billion.

• Multiple clinical trials have shown that cardiac stents are no more effective than drugs or lifestyle changes in preventing heart attacks or death. Although some studies have shown that stents provide short-term relief of chest pain, up to 30 percent of patients receiving stents have no chest pain to begin with, and thus derive no more benefit from this invasive procedure than from equally effective and far less expensive medicines. Risks associated with stent implantation, meanwhile, include exposure to radiation and to dyes that can damage the kidneys, and in rare cases, death from the stent itself. Yet one study estimated that Medicare spends $1.6 billion on drug-coated stents (the most common type of cardiac stents) annually.

• A recent study found that one-fifth of all implantable cardiac defibrillators were placed in patients who, according to clinical guidelines, will not benefit from them. But Medicare pays for them anyway, at a cost of $50,000 to $100,000 per device implantation.

The full extent of Medicare payments for procedures with no known benefit needs to be quantified. But the estimates are substantial. The chief actuary for Medicare estimates that 15 percent to 30 percent of health care expenditures are wasteful. Medicare spending exceeded $500 billion in 2010, suggesting that $75 billion to $150 billion could be cut without reducing needed services.

Why does Medicare spend so much for procedures and devices on patients who get no benefit and incur risks from them?

One reason is that Medicare's reimbursement procedures are not sophisticated enough to track the appropriateness of the care provided. Medicare delegates its claims administration to private local contractors based on how quickly and cheaply they can process claims.

These contractors have few incentives to audit the taxpayer dollars they are paying out, and even if they wanted to, they would need information often not available on the claim form. For example, a claims administrator, processing a claim for a screening colonoscopy, does not know when the patient's last colonoscopy was, or whether there was a new clinical reason for repeating it. While this information is available, finding it would require extra steps, and there are no incentives to do so.

Moreover, denying payment after a procedure is performed invites the wrath of both patient and physician. Medicare and private insurers are also keen to avoid situations that could be viewed as telling doctors how to practice medicine — even if such advice is in the patient's best interest. The political sensitivity of limiting services based on age, for example, was illustrated by the uproar over the Preventive Services Task Force's findingtwo years ago that women in their 40s do not benefit from routine mammography.

Another factor is the shocking chasm between Medicare coverage and clinical evidence. Our medical culture is such that if the choice is between doing a test and not doing one, it is considered better care to do the test. So while Medicare is obligated to follow the task force's recommendations to cover new preventive services, it has no similar mandate to deny coverage for services for which the task force has found no benefit.

Changing the system would be relatively easy administratively, but would require a firm commitment to determining whether tests and procedures truly benefit patients before performing them. Unfortunately, in a political environment in which doctors providing end-of-life counseling are called death panels, and in which powerful constituencies seek to preserve an ever-increasing array of procedures and device sales, this solution remains hidden in plain view.

Of course, doctors, with the consent of their patients, should be free to provide whatever care they agree is appropriate. But when the procedure arising from that judgment, however well intentioned, is not supported by evidence, the nation's taxpayers should have no obligation to pay for it.

Rita F. Redberg, a cardiologist, is a professor of medicine at the University of California, San Francisco, and the editor of Archives of Internal Medicine.

http://www.nytimes.com/2011/05/26/opinion/26redberg.html?_r=1&nl=todaysheadlines&emc=tha212

Sleep-deprived doctor problem needs strategy - Health - CBC News

The problem of drowsy doctors may get worse, a medical journal editorial warns.

Last year, researchers reported higher rates of surgical complications if a surgeon had less than six hours of sleep the night before.

"The problem may only be getting worse," Drs. Noni MacDonald, Paul Hébert, Ken Flegel and Matthew Stanbrook wrote in an editorial in Tuesday's issue of the Canadian Medical Association Journal.

Doctors themselves are part of the problem of sleep deprivation in medicine, a medical journal editorial says. iStock

Medical care is more complex, as patients with life-threatening conditions now survive thanks to medical innovations, drugs and technologies that weren't an option in past decades, the editorial noted.

The greater complexity at both the bedside and in the operating room not only affects surgeons but also doctors who stay up all night assisting at a birth or dealing with a patient in crisis, they said.

"We doctors ourselves are part of this problem," the editorial said. "We need to shift our professional culture. Long periods on call should not be accepted as routine or a source of pride. Instead, we must admit that working while impaired from sleep deprivation is neither normal nor acceptable."

A previous study suggested that sleep deprivation from an overnight call can cause a similar degree of impairment in judgment and motor performance as having a blood alcohol level above 0.05 per cent.

But solving the problem could be costly. A U.S. study in 2009 estimated it would take a 71 per cent increase in the physician workforce and a 174 per cent jump in the number of residents to apply the aviation industry's strategy of restricting work hours to ease fatigue in the medical system.

Some hospitals, departments and practices have used innovative strategies such as:

• Adopting strict policies on going home after call.
• Refraining from booking procedures or clinics the day after call.
• Reorganizing schedules to allow for more coverage by doctors.
• Moving to shift work.

Ultimately, licensing, accreditation, insurance and governments need to establish standards on minimum uninterrupted sleep hours and best practices, they concluded.

http://www.cbc.ca/news/health/story/2011/05/24/sleep-deprivation-doctors.html

Without A Prevention Plan, All Nursing Home & Hospital Patients Remain At Risk For Developing Pressure Ulcers

Pressure ulcers are indeed preventable in the overwhelming majority of circumstances. The key is to identify patients who are at risk quickly after their admission to a medical facility and timely– and effectively implement preventative measures such as regular pressure relief and ensuring patients remain clean and dry.

Medicare has determined that pressure ulcers are indeed preventable and hospitals may no longer seek reimbursement for patients who develop pressure ulcers during a hospitalization.

While Medicare's assignment of pressure ulcers to its list of never events remains an important development for patient safety, the fact remains that pressure ulcers are indeed a significant problem for many patients and result in many families seeking answers regarding medical care and legal options.

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http://www.bedsorefaq.com/without-a-prevention-plan-all-nursing-home-hospital-patients-remain-at-risk-for-developing-pressure-ulcers/

Alternative medicine: Think yourself better | The Economist

ON MAY 29th Edzard Ernst, the world's first professor of complementary medicine, will step down after 18 years in his post at the Peninsula Medical School, in south-west England. Despite his job title (and the initial hopes of some purveyors of non-mainstream treatments), Dr Ernst is no breathless promoter of snake oil. Instead, he and his research group have pioneered the rigorous study of everything from acupuncture and crystal healing to Reiki channelling and herbal remedies.

Alternative medicine is big business. Since it is largely unregulated, reliable statistics are hard to come by. The market in Britain alone, however, is believed to be worth around £210m ($340m), with one in five adults thought to be consumers, and some treatments (particularly homeopathy) available from the National Health Service. Around the world, according to an estimate made in 2008, the industry's value is about $60 billion.

Over the years Dr Ernst and his group have run clinical trials and published over 160 meta-analyses of other studies. (Meta-analysis is a statistical technique for extracting information from lots of small trials that are not, by themselves, statistically reliable.) His findings are stark. According to his "Guide to Complementary and Alternative Medicine", around 95% of the treatments he and his colleagues examined—in fields as diverse as acupuncture, herbal medicine, homeopathy and reflexology—are statistically indistinguishable from placebo treatments. In only 5% of cases was there either a clear benefit above and beyond a placebo (there is, for instance, evidence suggesting that St John's Wort, a herbal remedy, can help with mild depression), or even just a hint that something interesting was happening to suggest that further research might be warranted.

It was, at times, a lonely experience. Money was hard to come by. Practitioners of alternative medicine became increasingly reluctant to co-operate as the negative results piled up (a row in 2005 with an alternative-medicine lobby group founded by Prince Charles did not help), while traditional medical-research bodies saw investigations into things like Ayurvedic healing as a waste of time.

Yet Dr Ernst believes his work helps address a serious public-health problem. He points out that conventional medicines must be shown to be both safe and efficacious before they can be licensed for sale. That is rarely true of alternative treatments, which rely on a mixture of appeals to tradition and to the "natural" wholesomeness of their products to reassure consumers. That explains why, for instance, some homeopaths can market treatments for malaria, despite a lack of evidence to suggest that such treatments work, or why some chiropractors can claim to cure infertility.

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http://www.economist.com/node/18710090

Need Therapy? A Good Man Is Hard to Find - NYTimes.com

Between unresolved family conflicts, relationship struggles and his mixed-race identity, James Puckett had enough on his mind in college that he sought professional help. But after bouncing from one therapist to another, he still felt stuck.

"They were all female, and they did give me some comfort," said Mr. Puckett, 30, who works for a domestic-abuse program in Wisconsin. "But I was getting the same rhetoric about changing my behavior without any challenge to see the bigger picture of what was behind these very male coping reactions, like putting your hand through a wall."

He decided to seek out a male therapist instead, and found that there were few of them. "I'm just glad I ended up with the person I did," said Mr. Puckett, who is no longer in therapy, "because for me it made all the difference."

Researchers began tracking the "feminization" of mental health care more than a generation ago, when women started to outnumber men in fields like psychology and counseling. Today the takeover is almost complete.

Men earn only one in five of all master's degrees awarded in psychology, down from half in the 1970s. They account for less than 10 percent of social workers under the age of 34, according to a recent survey. And their numbers have dwindled among professional counselors — to 10 percent of the American Counseling Association's membership today from 30 percent in 1982 — and appear to be declining among marriage and family therapists.

Some college psychology programs cannot even attract male applicants, much less students. And at many therapists' conferences, attendees with salt-and-pepper beards wander the hallways as lonely as peaceniks at a gun fair.

The result, many therapists argue, is that the profession is at risk of losing its appeal for a large group of sufferers — most of them men — who would like to receive therapy but prefer to start with a male therapist.

"There's a way in which a guy grows up that he knows some things that women don't know, and vice versa," said David Moultrup, a psychotherapist in Belmont, Mass. "But that male viewpoint has been so devalued in the course of empowering little girls for the past 40 or 50 years that it is now all but lost in talk therapy. Society needs to have the choice, and the choice is being taken away."

The reasons for the shift are economic as well as cultural, most people in these professions agree. Managed care took a bite out of therapists' incomes in the 1990s. Psychiatry, the most male-dominated corner of therapy, increasingly turned to drug treatments. And as women entered the work force in greater numbers, they proved to be more drawn to the talking cure than men — in giving the treatment as well as in receiving it.

"Usually women get blamed when a profession loses status, but in this case the trend started first, and men just evacuated," said Dorothy Cantor, a former president of American Psychological Association who conducted a landmark study of gender and psychology in 1995. "Women moved up into the field and took their place."

The impact of this gender switch on the value of therapy is negligible, studies suggest. A good therapist is a good therapist, male or female, and a mediocre one is a mediocre one. Shared experience may even be an impediment, in some cases: therapists often caution students against assuming that they have special insight into person's problems just because they have something in common.

Still, perception is all important when it comes to seeking help for the very first time. In a recent study among 266 college men, Ronald F. Levant, a psychologist at the University of Akron, found that a man's willingness to seek therapy was directly related to how strongly he agreed with traditionally male assumptions, like "I can usually handle whatever comes my way." Such a man on the fence about seeking treatment could be discouraged by the prospect of talking to a woman.

"Many men like this believe that only another man can help them, and it doesn't matter whether that's true or not," Dr. Levant said. "What's important is what the client believes."

Both male therapists and men who have been in treatment agree that there are certain topics that — at least initially, all things being equal — are best discussed within gender. Sex is one, they say. And some men are far less ashamed about affairs when speaking to another man.

Aggression is another. Many men grow up in a world of hostile body language and real physical violence that is almost entirely invisible to women. A bar fight that sounds traumatic to a female therapist may be no more than a good night out for a man. Likewise, a stare-down in the sandbox that looks vanishingly trivial from a distance may lie like a poisoned well in the stream of the unconscious.

In some men's groups he used to run, Dr. Levant passed out index cards and had each participant write down the one thing he was most ashamed of, that he was reluctant to admit to himself, much less to anyone else. "I would get things like, 'I backed down from a fight in junior high school,' " he said, "and these were mostly middle-aged, married guys."

In just the past few years, psychologists have identified a number of issues that are, in effect, male versions of the gender-identity issues that so many mothers face in the work force: the self-doubt of being a stay-at-home father, the tension between being a provider and being a father, even male post-partum depression.

"In the same way that there is something very personal about being a mother, something very important to female identity, the experience of fathering is also very powerful," said Aaron Rochlen, a psychologist at the University of Texas, Austin. "And some men, I think, prefer to talk about that — the joy of being a father, the stress, how it's impacting them — with a therapist who's had the same experience," from the same point of view.

If they can find one, that is. "I remember when I started training, I looked around and realized that for the first time in my life, I was an endangered minority," said Ryan McKelley, a psychologist at the University of Wisconsin, La Crosse. "Now I tell my male students, if you're interested in clinical care, you can write your own ticket. You'll be hired immediately."

http://www.nytimes.com/2011/05/22/health/22therapists.html?pagewanted=print