Electronic Medical Record Software

By Kent Pinkerton  |   Submitted On July 25, 2006

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As more medical providers in the United States are encouraged to maintain electronic patient medical records, the electronic medical record software industry has grown and evolved rapidly. Electronic medical record software can be described as having three key functional elements-- overall functionality, design and functional aspects that are important from a physician's standpoint, and aspects that are important from a patient's standpoint.
In terms of overall design, physicians can either purchase an entire software package or pick and choose from a menu and put together a customized package that meets their specific needs. While most software packages are flexible in terms of practice size, some are specially designed for very large or very small practices. The software may be physically located in the physician's office, or in a remote location accessed through the Internet. There may be different data entry options, such as via a keyboard, touchscreen, or voice.
From a practice's standpoint, there are many options available to optimize the functionality of electronic medical records software. Some programs allow for customized or summary views of medical information, and many allow records to be downloaded to portable devices. Many programs allow physicians to review and sign electronic reports.
Systems are available that interface with appointment scheduling and financial software, and support links to internal or external email. As concerns grow regarding the security of electronic data and remotely stored data in particular, software systems are becoming increasingly sophisticated in preventing unwanted access. Some offer multiple levels of password protection. More recently, systems that use voice recognition or biometrics for identification have been developed.
For practices that permit patient access to electronic medical records, software options are available to provide appointment reminders, access to medical information, and access to patient education material or links. Some systems provide automatic links to patients on materials and other information that is relevant to their condition.

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Medical Waiting Rooms Are No Joke

By Marilee Veniegas  |   Submitted On October 27, 2005

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Emailing your doctor may not be as bad as you think. Which scenario causes a patient less stress? The awkwardness of the waiting room verses sending a question to your doctor over email, the latter choice may be much easier to your psyche. Take for example the joke below I've been getting in my email inbox for ages:
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An 86-year-old man walked into a crowded doctor's waiting room. As he approached the desk, the receptionist said, "Yes sir, what are you seeing the doctor for today?""There's something wrong with my dick," he replied. The receptionist became irritated and said, "You shouldn't come into a crowded doctor's waiting room and say things like that."
"Why not, you asked me what was wrong and I told you," he said.
The receptionist replied, "You've obviously caused some embarrassment in this room full of people. You should have said there is something wrong with your ear or something and then discussed the problem further with the doctor in private."
The man replied, "You shouldn't ask people things in a room full of others, if the answer could embarrass anyone." The man walked out, waited several minutes and then re-entered.
The receptionist smiled smugly and asked, "Yes?"
"There's something wrong with my ear," he stated.
The receptionist nodded approvingly and smiled, knowing he had taken her advice. "And what is wrong with your ear, Sir?"
"I can't piss out of it," the man replied. The waiting room erupted in laughter.

- - - - - - - - - -Funny as this email joke about the elderly man's "ear-ache," may be, it mirrors the uncomfortable reality of most medical waiting rooms, pharmacies, and treatment clinics. Accessibility to one's healthcare provider online can be less stressful and a more practical means of contact for many patients. "People are often more comfortable talking to a computer than they are to a doctor," says Dr. Delbanco, a professor of medicine at the Harvard Medical School and the lead author of an article on doctors and e-mail in the current New England Journal of Medicine.(1) However, the convenience of emailing your doctor or clinic to ask your provider questions brings up a myriad of risks. As medicine and the internet have converged, concerns about protecting a patient's PHI (personal heath information) and EMRs (electronic medical records) have come to the fold.
HIPAA, the Health Insurance Portability & Accountability Act requires health care institutions to protect patient information. The Act outlines how this should happen, but does not make any firm recommendations about how to go about it. At the same time, strides are being made to make the electronic medical office a reality. "Office visits between patients and their doctors increasingly will take place not in person but over the Internet, through e-mail or even a video conference," Dr. Thomas Delbanco and Dr. Daniel Sands of Beth Israel Deaconess Medical Center stated in the April 2004 New England Journal of Medicine.(2) This means that seeking information online is now as common as dialing 411 a decade ago. From Drugstore.com to WebMD, the internet is where patients seek information on maladies to drug and herbal supplement information.
Patients aren't the only ones flocking to the net. Online use shows many within the medical field want to take accessing medical information a step further. Medical providers and patients alike wish to use the internet as a tool in their personal healthcare communications. According to Dr. Daniel Z. Sands, a primary care internist and Assistant Professor of Medicine at Harvard Medical School, "The internet will increasingly change patients' expectations of the clinicians, so that physicians will routinely need to offer services like e-messaging, instant messaging, video conferencing and other online services."(3)
Now is the opportune time for both patient and doctor to lay the ground work and find a balance in both patient's concerns over PHI and the immediacy of emailing their doctor. Looking towards the future of online healthcare means measures need to be put into place to protect a patient's privacy in order to securely implement the digital medical office.
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End Notes:
1.) Anahad O'Connor, "Take Two Aspirin, E-Mail Me Tomorrow," The New York Times, Section F; Column 5; Health & Fitness; LexisNexis 30 September 2005. 7.
2.) Liz Kowlaczyk, "Is Email The Future of Doctor-Patient Relations?," D2, The Boston Globe, LexisNexis, 27 April 2004.
3.) Dr. Daniel Z. Sands quoted in: Susannah Fox, Janna Quinney, Lee Rainie, "The Future of the Internet," Pew Internet and American Life Project, Published 4 January, 2005. 4.

Marilee Veniegas is an alumni of the University of Washington she joined the Marketing team at Essential Security Software, Inc [http://www.essentialsecurity.com]. in 2005.

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Bias in Health Information: Understanding the Agendas

By Gary Cordingley  |   Submitted On October 23, 2005

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Writers of medical advice--including columnists, insurance companies, governmental agencies, medical organizations, drug companies and even practitioners--are all biased. They always have agendas. They all choose to write about certain topics and not others. They make choices about what to include in their articles, what to leave out and how to state their cases. They're all self-serving. They all have something to "sell," even when there is not an immediate cash-return.
Does that mean you should throw up your hands, say the hell with it, and never read or listen to another medical message? I don't think so, but in order to derive value from these messages, you sure as heck better understand the agendas of the people who created them. Or as the psychologists say, if you want to understand a behavior, you need to figure out what motivated it. Let's examine some advice-givers and their biases.
What motivates health columnists? Well, how about their continued employment, the needs of their publisher-employers, and the needs of the companies the publishers wish to attract as advertisers? It's not hard to imagine there are some subtle and not-so-subtle influences and incentives at play in framing the subject-matter and slant of the articles. Certainly, it's hard to attract the business of potential advertisers when you have written devastating critiques of their products.
Yet don't infer that you should ignore what the health columnists have to say. They provide a wonderful service in discussing health issues, the business of medicine and its practice. I personally enjoy reading the health columns of that great medical publication, The Wall Street Journal. In fact, I still distribute to my patients an excellent article about medication-overuse headaches that Tara Parker-Pope, one of their columnists, wrote years ago.
One of the odder chapters in the business of medicine is that certain insurance companies have positioned themselves as providers of health advice, particularly those companies paid by employers to manage their medication-benefit plans. I won't waste the reader's time in building a case that insurance companies have agendas and conflicts-of-interest in providing such advice. This should be self-evident.
Governmental agencies like the National Institutes of Health provide medical information which is generally reliable and useful, but influenced by the agency's understandable needs for self-promotion and self-preservation. The same holds true for medical organizations like the American Academy of Neurology (to which I belong) and big group-practices like the Mayo Clinic and Cleveland Clinic. The advice tendered by these medical organizations in their publications and web-pages is backed by their reputations, which they zealously protect. So you can be sure that the medical content is subjected to rigorous quality-control. And fortunately, although their messages are motivated by commercial needs, the linkages are obvious and easy for the consumer to take into account.
How about individual health practitioners? Giving advice is what they do for a living, so what's the issue? Well, in the U.S., at least, there is a genuine "medical marketplace" where competition reigns supreme. So when you need help with your health, each practitioner (including me!) would like to make the short-list of advisers whose opinions you trust and value.
Let's move on to the drug companies. In my opinion there is no medical information that is both as pervasive and biased as that created by drug companies. And in many cases the connection between the message and the drug company's name has been obscured or hidden, so the consumer doesn't even know to be wary.
I have written elsewhere about the comical turn of events in the "advice" that drug companies have provided to people with headaches. For many years the makers of sinus medications invested heavily in convincing people with headaches that most of them were due to sinus disease. But now that effective and lucrative drugs for migraine exist, companies are sinking even larger sums of money into the message that those headaches weren't due to sinus conditions after all. Instead, they've been due to migraine. This vignette illustrates the hazard in allowing marketing departments of drug companies to diagnose one's headaches.
Another hazard is in allowing drug companies to write the information-sheets that doctors hand patients at the ends of office visits. Every doctor gets buried in pamphlets that sales reps from drug companies leave at their offices. For years I actually looked at these things, trying to select the 30% that might be worth retaining and passing along to my patients. After a while, 30% seemed too optimistic, so I searched for the 20% that was worth keeping, and then the 10%...well, you get the idea. The pamphlets kept getting more biased and less useful. At one time the sales reps passed out some real gems that were genuinely helpful to patients and their families. But those days are gone.
So when it comes to medical advice, consider the source.
(C) 2005 by Gary Cordingley

Gary Cordingley, MD, PhD, is a clinical neurologist, teacher and researcher who works in Athens, Ohio. For more health-related articles see his website at: http://www.cordingleyneurology.com

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The History of Medical Alert Bracelets

By Richard Romando  |   Submitted On September 07, 2005

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The medical alert bracelet is a fairly recent phenomenon. Medical alert jewelry started with stainless steel tags that resembled dog tags, and although they were useful, their popularity never reached beyond people who absolutely wanted or needed to wear them.
Medical ID bracelets were initially available in stainless steel. Over the past decade or so, with people becoming more health-conscious and with more medical conditions being diagnosed, people began to want bracelets that they could actually enjoy wearing. While most people wouldn't enjoy advertising their medical condition, many wanted to discretely have their medical condition information available on their person in the event of an emergency.
Metallic designer bracelets have become increasingly popular in the 21st century. Available products are constantly evolving, and many of the bracelets don't even have rectangular engravable plates anymore. In fact, many designer ID bracelets allow medical information to be displayed on a shapely charm. These designer bracelets are a great way to almost account for medical factors with style. In this way, medical information is still available, but person can enjoy the look and style of their medical bracelet.
As of late, beaded medical bracelets have also become popular, bringing a new array of colors to the field. These lively bracelets are a highly customizable and attractive option for style-conscious medical patients.
Adding a new style to the highly functional accessory, beaded medical bracelets are produced with attractive designs and sold by several online medical vendors.

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