The EHRs have limited capability to record information on patients' cancer history, and clinicians are not provided with actionable recommendations for follow-up care.
Primary care medicine is currently not able to meet the healthcare needs of cancer survivors, despite a long effort by the medical establishment to move long-term survivorship care out of the specialist's realm, according to a new Rutgers study.
The study, published in JAMA Internal Medicine, examined 12 advanced primary care practices selected from a national registry of workforce innovators; not one had a comprehensive survivorship care program in place.
According to the National Cancer Institute, there are 15.5 million cancer survivors in the United States, a number expected to reach 20.3 million by 2026. The vast majority of these patients are seen in primary care practices.
The researchers, who over nearly two years spent 10–12 days observing each of the practices (based in Colorado, Illinois, Maine, New York, Pennsylvania, and Washington) and interviewing clinicians and administrators, identified several barriers to integrating survivorship care into primary medicine.
It found that no distinct clinical category for clinicians to identify cancer survivors exists. EHRs used in primary care practices have limited capability to record information on patients' cancer history, and clinicians are not provided with actionable recommendations for follow-up care.
Medical records sometimes are lost as patients change clinicians over the years, leaving patients to report their cancer histories to their primary care doctors.
In addition to these issues, primary care physicians are concerned about their knowledge gaps in cancer care and the need to monitor changing information in oncology.
Those findings are based on a multisite retrospective study of nearly 173,000 emergency department visits. The study showed significant differences in patient priority levels using e-triage and ESI.
For example, out of the more than 65% of visits triaged to ESI Level 3, e-triage identified about 10%, or more than 14,000, Level 3 patients who may have benefitted from being assigned to a more critical priority level, such as Level 1 or 2.
These patients were at least five times more likely to experience a critical outcome, such as death, admission to the ICU, or emergency surgery, and were two times more likely to be admitted to the hospital.
The e-triage tool was also able to increase the number of patients assigned to a lower priority level, such as Level 4 or 5, to help minimize the occurrence of low-acuity patients waiting and overusing scarce resources.
The e-triage tool uses an algorithm to predict patient outcomes based on a systems engineering approach and advanced machine learning methods to identify relationships between predictive data and patient outcomes. The tool is also designed to provide decision support to clinicians.
CVS Caremark program will include limiting to seven days the supply of opioids dispensed for certain acute prescriptions for patients who are new to therapy.
CVS Health says it’s enhancing its enterprise-wide initiatives supporting safe drug disposal, utilization management of pain medications, and funding for treatment and recovery programs.
CVS Caremark will roll out an enhanced opioid utilization management approach for all commercial, health plan, employer, and Medicaid clients as of February 1, 2018 unless the client chooses to opt out.
This program will include limiting to seven days the supply of opioids dispensed for certain acute prescriptions for patients who are new to therapy; limiting the daily dosage of opioids dispensed based on the strength of the opioid; and requiring the use of immediate-release formulations of opioids before extended-release opioids are dispensed.
CVS Pharmacy locations will also strengthen counseling for patients filling an opioid prescription with a safe opioid use education program highlighting opioid safety and the dangers of addiction. This clinical program will educate patients about the guideline for opioid prescribing published by the CDC.
Pharmacists will counsel patients about the risk of dependence and addiction tied to duration of opioid use, the importance of keeping medications secure in the home and methods of proper disposal of unused medication.
It’s also expanding its kiosk disposal locations.
In related news, Walgreens has launched the “#ItEndsWithUs” campaign to educate teens nationwide on the opioid epidemic. The campaign is helmed by actor Brandon Larracuente, who lost a close friend to the opioid epidemic.
The #ItEndsWithUs campaign aims to provide teens with resources and positive steps they can take in their community, which are all available at the #ItEndsWithUs hub at walgreens.com/itendswithus. The campaign also promotes the drugstores’ safe medication disposal kiosks.
Certain pharmacists can free access to patient-specific medication history data.
Surescripts and Allscripts are expanding the scope of service available in the wake of the hurricanes over the past several weeks to provide free access to patient-specific medication history data for pharmacists in Alabama, Florida, Georgia, North Carolina, and South Carolina for a limited time.
Once users have been authorized, they will need to obtain patient consent to see a 12-month view of a patient's medication history. Prescribers who do not already use medication history data through their EHR software can also download the free, cloud-based application to gain access.
Surescripts and Allscripts have both participated in similar initiatives in response to previous storms. In 2005, Surescripts participated in a public-private initiative to build an online database to provide pharmacies and clinicians access to patients' prescription histories and allergies in the wake of Hurricane Katrina.
Allscripts also played a role in Katrina relief efforts by offering the ePrescribe solution to clinicians caring for patients affected by the disaster.
Seventy-nine percent of seniors do not have easy access to their EMRs.
A HealthMine survey revealed that 57% of Medicare health plan members aged 65+ said they are unsure if their health plan offers telemedicine; another 31% say that telemedicine is not offered by their plan.
In addition, 79% of seniors do not have easy access to their EMRs.
Medicare plan members also revealed their communication preferences. The survey found that 48% prefer to communicate with their plan via voice/phone, 31% prefer digital communication, and 21% prefer snail mail.
Health information exchanges are beginning to show their promised value to the healthcare system, according to University of Notre Dame research.
Information technology investments in healthcare lead to significant spending reductions, potentially in the billions of dollars, according to research from the University of Notre Dame.
Health information exchanges (HIE) are beginning to show their promised value to the healthcare system, according to the research, which is forthcoming inInformation Systems Research.
“We find significant spending reductions in health care markets that have established operational HIEs, with an average savings of $139 per Medicare beneficiary per year (1.4 percent decrease),” one of the authors, Idris Adjerid, a professor at Notre Dame’s Mendoza College of Business, said in a statement.
“This equals a $3.12 billion annual reduction in spending if HIEs were to be implemented nationally in 2015 (the most recent year complete Medicare spending data was available).”
Many HIEs were created because hospitals needed ways to exchange medical data that were more efficient than photocopying, mailing, or faxing records. The research shows that when HIEs appear in regional markets, massive cost savings follow. Because of that, there is long-standing interest in implementing HIEs nationally.
The researchers collected annual data from a seven-year period (2003 through 2009) to compare average Medicare spending per beneficiary (adjusted for regional variation in age, race, and gender) in healthcare markets with an operational HIE relative to those without an operational HIE.
They analyzed these data using advanced econometric models that accounted for factors such as healthcare delivery infrastructure, regional hospital quality, health IT adoption, patient demographics, and economic factors.
Researchers showed that the drone successfully transported human blood samples during the three-hour flight.
Successfully transporting biological samples is sometimes hampered by Mother Nature thanks to factors like hot weather, long distances, and rough terrain.
Enter drones, which Johns Hopkins researchers just showed can successfully transport human blood samples across 161 miles of Arizona desert, setting a new delivery distance record in the process.
The drone flight was three-hours long, and throughout, an on-board payload system designed by the Johns Hopkins team maintained temperature control, ensuring the samples were viable for laboratory analysis after landing, according to a report of the findings, published in the American Journal of Clinical Pathology.
"We expect that in many cases, drone transport will be the quickest, safest and most efficient option to deliver some biological samples to a laboratory from rural or urban settings," Timothy Amukele, M.D., Ph.D., assistant professor of pathology at the Johns Hopkins University School of Medicine and the paper's senior author, said in a statement.
Other research earlier this year reached a similar conclusion: A JAMA study showed that a drone hauling an automated external defibrillator drastically reduced emergency response times by an average of 16 minutes for simulated out-of-hospital cardiac arrest cases.
The Johns Hopkins research team wanted to determine the stability of biological samples after a long drone flight, and studied 84 chemistry and hematology samples from 21 adults.
Half of the samples were held stationary in a car at the airfield that had active cooling to maintain their target temperature. The other samples were flown for three hours in a contained temperature-controlled chamber in the drone.
After the flight, all samples were transported 62 miles by car to the Mayo Clinic in Scottsdale, Arizona. They were then tested for common chemistry and hematology tests.
Flown and not-flown samples showed similar results for red blood cell, white blood cell, and platelet counts and sodium levels, among other results.
Statistically significant but small differences were seen in glucose and potassium levels, which also show variation in standard transport methods (e.g. automobile transport). These differences were due to chemical degradation from slightly warmer temperature in the not-flown samples.
The flown samples were also cooler: They had an average temperature of 24.8°C (76.6°F), compared with 27.3°C (81.1°F) for the samples that weren’t flown.
"Drones can operate where there are no roads, and overcome conditions that disable wheeled vehicles, traffic and other logistical inefficiencies that are the enemy of improved, timely patient diagnoses and care," Amukele said. "Drones are likely to be the 21st century's best medical sample delivery system."
The research team previously studied the impact of drone transportation on the chemical, hematological, and microbial makeup of drone-flown blood samples over distances up to 20 miles, and found that none were negatively affected.
The team plans further and larger studies in the United States and overseas.
The findings challenge the use of claims data for sepsis surveillance.
New research led by investigators at Brigham and Women's Hospital estimates the current United States burden of sepsis and trends using clinical data from the EHR systems of a large number of diverse hospitals.
The findings, published in JAMA, challenge the use of claims data for sepsis surveillance and suggest that clinical surveillance using EHR data provides more objective estimates of sepsis incidence and outcomes, the researchers said.
The research team developed a new strategy to track sepsis incidence and outcomes using electronic clinical data instead of insurance claims. Sepsis was identified if a patient had concurrent indicators of infection and organ dysfunction.
The researchers applied this definition to EHR data from nearly 3 million patients admitted to 409 U.S. hospitals in 2014; they found that sepsis was present in 6% of all hospitalizations and in more than one in three hospitalizations that ended in death.
These data were used to project the total burden of sepsis in hospitalized patients in 2014. They estimated that there were approximately 1.7 million sepsis cases nationwide in 2014, of whom 270,000 died.
In addition, the researchers assessed whether sepsis incidence and outcomes have been changing over time.
In contrast to prior claims-based estimates, they found no significant changes in adult sepsis incidence or in the combined outcome of hospital death or discharge to hospice between 2009 and 2014.
Researchers found that physicians spent 5.9 hours of an 11.4-hour workday in the EHR.
Primary care physicians spend more than half of their workday interacting with EHRs during and after clinic hours, according to research in the Annals of Family Medicine.
The study, Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations, from the University of Wisconsin and the AMA, is based on data from EHR event logs and confirmed by direct observation data.
Researchers found that physicians spent 355 minutes (5.9 hours) of an 11.4-hour workday in the EHR, including 269 minutes (4.5 hours) during clinic hours and 86 minutes (1.4 hours) after hours.
Almost half of their total EHR time per day (44%) was devoted to clerical tasks, and an additional 84 minutes per day (24%) was spent managing the inbox.
Time spent on EHR activities differed by time of day on weekdays and weekends, with weekend EHR work peaking around 10:00 a.m. and 10:00 p.m.
They also found that documentation took 84 minutes and order entry took 43 minutes. The authors note that an increased EHR workload can contribute to physician burnout.
Congress is back in session and the effort to fix Obamacare is not dead yet. Two proposals were expected Wednesday and the chasm between them could not be wider.
On Wednesday Sens. Bill Cassidy (R-LA) and Lindsey Graham (R-SC) and colleagues announced their plan. Sen. Rand Paul(R-KY) said Monday that it would “probably” be worse than doing nothing at all on the health law.
Sen. Bernie Sanders (I-V) has a bill of his own, detailing a single-payer system for the nation. He wrote an Op-Ed piece in the New York Times Wednesday, ahead of releasing his single payer bill.
