http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=8151275&as=33379 Most Recent Submissions from AndySchumanMD on Modern Medicine Community Wed, 18 Jul 2012 18:48:13 GMT Wed, 18 Jul 2012 18:48:13 GMT modmedadmin@advanstar.com (ModernMedicine) modmedadmin@advanstar.com (ModernMedicine) KickApps Feed Builder 2012-07-18T18:48:13Z 34 http://community.modernmedicine.com/service/searchEverything.kickAction?as=33379&includeVideo=on&includeAudio=on&includePhoto=on&includeBlog=on&sortType=recent 0 http://community.modernmedicine.com/_Dollars-and-Common-ense/blog/6232791/33379.html Most physicians don’t chose to discuss politics at work with partners, staff or parents and our silence, unfortunately needs to be broken.  In the past we have modified our practices to accommodate innumerable annoying, yet tolerable government mandates like OSHA regulations, CLIA ’88 requirements among others.  Now the Affordable Health Care Act, recently upheld by the Supreme Court, promises to intrude and radically transform our daily practice of medicine.  If the Affordable Health Care Act is successful in transitioning many insured patients to state Medicaid insurance, many pediatric private practices will be forced to close.  As I’ve said before nobody has asked or involved physicians in changing our health care system.       It comes down to dollars and common sense! Time to break the silence and talk it up so that once quiet physicians and patients start writing our representative and effecting change via the ballot box.   Eighty-three percent of American physicians have considered leaving their practices over President Barack Obama’s health care reform law, according to a survey released by the Doctor Patient Medical Association.  According to founder Katheryn Serkes, “Doctors clearly understand what Washington does not — that a piece of paper that says you are ‘covered’ by insurance or ‘enrolled’ in Medicare or Medicaid does not translate to actual medical care when doctors can’t afford to see patients at the lowball payments, and patients have to jump through government and insurance company bureaucratic hoops,”   Perhaps Donald Trump said it best…   We're going to be "gifted" with a health care plan we are forced to purchase and fined if we don't, which purportedly covers at least ten million more people, without adding a single new doctor, but provides for 16,000 new IRS agents, written by a committee whose chairman says he doesn't understand it, passed by a Congress who didn't read it but exempted themselves from it, and signed by a President who smokes, with funding administered by a treasury chief who didn't pay his taxes, for which we'll be taxed for four years before any benefits take effect, by a government who has already bankrupted Social Security and Medicare, all to be overseen by a Surgeon General who is obese, and financed by a country that is broke!!!! Most physicians don’t chose to discuss politics at work with partners, staff or parents and our silence, unfortunately needs to be broken.  In the past we have modified our practices to accommodate innumerable annoying, yet tolerable government mandates like OSHA regulations, CLIA ’88 requirements among others.  Now the Affordable Health Care Act, recently upheld by the Supreme Court, promises to intrude and radically transform our daily practice of medicine.  If the Affordable Health Care Act is successful in transitioning many insured patients to state Medicaid insurance, many pediatric private practices will be forced to close.  As I’ve said before nobody has asked or involved physicians in changing our health care system.       It comes down to dollars and common sense! Time to break the silence and talk it up so that once quiet physicians and patients start writing our representative and effecting change via the ballot box.   Eighty-three percent of American physicians have considered leaving their practices over President Barack Obama’s health care reform law, according to a survey released by the Doctor Patient Medical Association.  According to founder Katheryn Serkes, “Doctors clearly understand what Washington does not — that a piece of paper that says you are ‘covered’ by insurance or ‘enrolled’ in Medicare or Medicaid does not translate to actual medical care when doctors can’t afford to see patients at the lowball payments, and patients have to jump through government and insurance company bureaucratic hoops,”   Perhaps Donald Trump said it best…   We're going to be "gifted" with a health care plan we are forced to purchase and fined if we don't, which purportedly covers at least ten million more people, without adding a single new doctor, but provides for 16,000 new IRS agents, written by a committee whose chairman says he doesn't understand it, passed by a Congress who didn't read it but exempted themselves from it, and signed by a President who smokes, with funding administered by a treasury chief who didn't pay his taxes, for which we'll be taxed for four years before any benefits take effect, by a government who has already bankrupted Social Security and Medicare, all to be overseen by a Surgeon General who is obese, and financed by a country that is broke!!!! Fri, 03 Aug 2012 12:47:05 GMT http://community.modernmedicine.com/_Dollars-and-Common-ense/blog/6232791/33379.html AndySchumanMD 2012-07-18T18:48:13Z Modern Medicine Community Most physicians don’t chose to discuss politics at work with partners, staff or parents and our silence, unfortunately needs to be broken.  In the past we have modified our practices to accommodate innumerable annoying, yet tolerable government mandates like OSHA regulations, CLIA ’88 requirements among others.  Now the Affordable Health Care Act, recently upheld by the Supreme Court, promises to intrude and radically transform our daily practice of medicine.  If the Affordable Health Care Act is successful in transitioning many insured patients to state Medicaid insurance, many pediatric private practices will be forced to close.  As I’ve said before nobody has asked or involved physicians in changing our health care system.       It comes down to dollars and common sense! Time to break the silence and talk it up so that once quiet physicians and patients start writing our representative and effecting change via the ballot box.   Eighty-three percent of American physicians have considered leaving their practices over President Barack Obama’s health care reform law, according to a survey released by the Doctor Patient Medical Association.  According to founder Katheryn Serkes, “Doctors clearly understand what Washington does not — that a piece of paper that says you are ‘covered’ by insurance or ‘enrolled’ in Medicare or Medicaid does not translate to actual medical care when doctors can’t afford to see patients at the lowball payments, and patients have to jump through government and insurance company bureaucratic hoops,”   Perhaps Donald Trump said it best…   We're going to be "gifted" with a health care plan we are forced to purchase and fined if we don't, which purportedly covers at least ten million more people, without adding a single new doctor, but provides for 16,000 new IRS agents, written by a committee whose chairman says he doesn't understand it, passed by a Congress who didn't read it but exempted themselves from it, and signed by a President who smokes, with funding administered by a treasury chief who didn't pay his taxes, for which we'll be taxed for four years before any benefits take effect, by a government who has already bankrupted Social Security and Medicare, all to be overseen by a Surgeon General who is obese, and financed by a country that is broke!!!! nonadult false Dollars and Common $ense! text blog 784 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=8151275&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_4147077_33379_8151275_ap_160X120.jpg false 0 0 6232791 8151275 Member 0 http://community.modernmedicine.com/_New-recommendations-for-neonatal-sepsis/blog/6076993/33379.html In this month’s issue of Pediatrics there is an article that all pediatricians who care for newborns should review (Management of Neonates With Suspected or Proven Early-Onset Bacterial Sepsis PEDIATRICS Vol. 129 No. 5 May 1, 2012  pp. 1006 -1015).  For years the rational approach to the newborn at risk for sepsis has been debated and many different practice recommendations have been proposed over the last decade.  This latest article from the American Academy of Pediatrics (AAP) Committee on Infant and Fetus is most helpful as the latest data is reviewed and a series of 3 algorithms is provided which will prove invaluable when pediatricians are faced with the all too common clinical dilemma – what to do with well appearing term or preterm who are born with risk factors for sepsis??   The first algorithm deals with infants less than 37 weeks gestation with risk factors for sepsis. Such Infants should have a blood culture at birth, a CBC with or without a CRP at 6 to 12 hours of age, and started on broad spectrum antibiotics.  Lumbar punctures should be performed on infants with a positive blood culture, clinical signs of sepsis, or poor clinical response to therapy.  Antibiotics are continued for 48 hours if the blood culture is negative, the infant is clinically well and follow up labs are normal. However in the setting of a clinically well infant, if follow up labs are abnormal, then antibiotics are continued if the mother received antibiotics prior to delivery. Algorithm 2 is similar to the first except that it deals with term infants (> 37 weeks gestation) exposed to suspected maternal chorioamnionitis.  Management is the same as in the first algorithm. Algorithm 3 deals with term infants over 37 weeks gestation born with risk factors for sepsis. Risk factors include rupture of membranes over 18 hours, and inadequate intrapartum prophylaxis when a mother is Group B strep positive or her GBS status is unknown.  If babies are clinically well, they should have labs performed as in the first 2 algorithms - but not started on antibiotics. If labs are abnormal then a blood culture should be done, and antibiotics still withheld while the baby is observed for 48 hours and remains clinically well. These new algorithms will soon be adopted by nurseries across the country and should simplify management of at risk newborns considerably. Thank you AAP for these new recommendations.  In this month’s issue of Pediatrics there is an article that all pediatricians who care for newborns should review (Management of Neonates With Suspected or Proven Early-Onset Bacterial Sepsis PEDIATRICS Vol. 129 No. 5 May 1, 2012  pp. 1006 -1015).  For years the rational approach to the newborn at risk for sepsis has been debated and many different practice recommendations have been proposed over the last decade.  This latest article from the American Academy of Pediatrics (AAP) Committee on Infant and Fetus is most helpful as the latest data is reviewed and a series of 3 algorithms is provided which will prove invaluable when pediatricians are faced with the all too common clinical dilemma – what to do with well appearing term or preterm who are born with risk factors for sepsis??   The first algorithm deals with infants less than 37 weeks gestation with risk factors for sepsis. Such Infants should have a blood culture at birth, a CBC with or without a CRP at 6 to 12 hours of age, and started on broad spectrum antibiotics.  Lumbar punctures should be performed on infants with a positive blood culture, clinical signs of sepsis, or poor clinical response to therapy.  Antibiotics are continued for 48 hours if the blood culture is negative, the infant is clinically well and follow up labs are normal. However in the setting of a clinically well infant, if follow up labs are abnormal, then antibiotics are continued if the mother received antibiotics prior to delivery. Algorithm 2 is similar to the first except that it deals with term infants (> 37 weeks gestation) exposed to suspected maternal chorioamnionitis.  Management is the same as in the first algorithm. Algorithm 3 deals with term infants over 37 weeks gestation born with risk factors for sepsis. Risk factors include rupture of membranes over 18 hours, and inadequate intrapartum prophylaxis when a mother is Group B strep positive or her GBS status is unknown.  If babies are clinically well, they should have labs performed as in the first 2 algorithms - but not started on antibiotics. If labs are abnormal then a blood culture should be done, and antibiotics still withheld while the baby is observed for 48 hours and remains clinically well. These new algorithms will soon be adopted by nurseries across the country and should simplify management of at risk newborns considerably. Thank you AAP for these new recommendations.  Mon, 11 Jun 2012 16:08:34 GMT http://community.modernmedicine.com/_New-recommendations-for-neonatal-sepsis/blog/6076993/33379.html AndySchumanMD 2012-05-14T11:47:05Z Pediatrics Modern Medicine Community In this month’s issue of Pediatrics there is an article that all pediatricians who care for newborns should review (Management of Neonates With Suspected or Proven Early-Onset Bacterial Sepsis PEDIATRICS Vol. 129 No. 5 May 1, 2012  pp. 1006 -1015).  For years the rational approach to the newborn at risk for sepsis has been debated and many different practice recommendations have been proposed over the last decade.  This latest article from the American Academy of Pediatrics (AAP) Committee on Infant and Fetus is most helpful as the latest data is reviewed and a series of 3 algorithms is provided which will prove invaluable when pediatricians are faced with the all too common clinical dilemma – what to do with well appearing term or preterm who are born with risk factors for sepsis??   The first algorithm deals with infants less than 37 weeks gestation with risk factors for sepsis. Such Infants should have a blood culture at birth, a CBC with or without a CRP at 6 to 12 hours of age, and started on broad spectrum antibiotics.  Lumbar punctures should be performed on infants with a positive blood culture, clinical signs of sepsis, or poor clinical response to therapy.  Antibiotics are continued for 48 hours if the blood culture is negative, the infant is clinically well and follow up labs are normal. However in the setting of a clinically well infant, if follow up labs are abnormal, then antibiotics are continued if the mother received antibiotics prior to delivery. Algorithm 2 is similar to the first except that it deals with term infants (> 37 weeks gestation) exposed to suspected maternal chorioamnionitis.  Management is the same as in the first algorithm. Algorithm 3 deals with term infants over 37 weeks gestation born with risk factors for sepsis. Risk factors include rupture of membranes over 18 hours, and inadequate intrapartum prophylaxis when a mother is Group B strep positive or her GBS status is unknown.  If babies are clinically well, they should have labs performed as in the first 2 algorithms - but not started on antibiotics. If labs are abnormal then a blood culture should be done, and antibiotics still withheld while the baby is observed for 48 hours and remains clinically well. These new algorithms will soon be adopted by nurseries across the country and should simplify management of at risk newborns considerably. Thank you AAP for these new recommendations.  pediatrics nonadult false New recommendations for neonatal sepsis text blog pediatrics 1448 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=8151275&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_4147077_33379_8151275_ap_160X120.jpg false 0 Pediatrics 0 6076993 8151275 Member 0 http://community.modernmedicine.com/_Pediatricians-and-the-bottom-line/blog/6006233/33379.html   There are two general models of pediatric care delivery and accordingly two related models of pediatrician compensation.  There are pediatricians in independent private practice who are compensated according to the amount of revenue the provider generates, once overhead costs are factored in.  In contrast there are pediatricians who are employed by hospitals and multispecialty clinics and are compensated by the “work relative value units” (wRVUs) a pediatrician generates.    In private practice, physicians are well aware of the cost of operating a business. If the insurance companies are slow to pay, partners are subject to no or reduced paychecks depending on the practice’s cash reserves.   In this model motivated partners are always looking for ways to improve efficiency, reduce costs, attract patients to the practice and find ways to see more patients.   They are also well aware that the service we provide has significant “value” and generally will not tolerate patients who consistently no show, or who do not pay their bills. Such practices often limit their payer mix to restrict the numbers of patients with government insurance as reimbursements are typically extremely poor.  They even may be tempted to do more in office testing or provide new services, if those services generate revenue for the practice. Physicians must be mindful to practice quality medicine and to do appropriate testing for patients. They should not be tempted to “do more tests” to boost the practices bottom line.    In contrast employed physicians are not financially motivated by practice revenue.  Physician compensation is set by the number of patients seen, the complexity of patient problems, and often by the quality of care provided as measured by certain agreed upon practice metrics.    Employed physicians are blinded to the overhead of their employer. In this model practices are rarely motivated to innovate to provide cutting edge services, often do not restrict access to those with government insurance and have a very liberal no show policy.   Given the turbulent economy, many small independent pediatric practices have folded, and physicians used to the first model of compensation, now find themselves employed by hospitals or clinics.  Many tell me they miss the autonomy that private practice provides, but welcome the financial security they now find as an employee.  As I’ve said before small independent pediatric practices are the perfect medical home for complex patients. It is a shame that government insurance compensates physicians so poorly many private practices cannot afford to participate.  The solution for many of our healthcare woes is simple.  Pay a reasonable fee to pediatricians for caring for our most needy patients. Medicare rates would suffice.  As a consequence, private practice medicine would survive and patients will receive better care!       There are two general models of pediatric care delivery and accordingly two related models of pediatrician compensation.  There are pediatricians in independent private practice who are compensated according to the amount of revenue the provider generates, once overhead costs are factored in.  In contrast there are pediatricians who are employed by hospitals and multispecialty clinics and are compensated by the “work relative value units” (wRVUs) a pediatrician generates.    In private practice, physicians are well aware of the cost of operating a business. If the insurance companies are slow to pay, partners are subject to no or reduced paychecks depending on the practice’s cash reserves.   In this model motivated partners are always looking for ways to improve efficiency, reduce costs, attract patients to the practice and find ways to see more patients.   They are also well aware that the service we provide has significant “value” and generally will not tolerate patients who consistently no show, or who do not pay their bills. Such practices often limit their payer mix to restrict the numbers of patients with government insurance as reimbursements are typically extremely poor.  They even may be tempted to do more in office testing or provide new services, if those services generate revenue for the practice. Physicians must be mindful to practice quality medicine and to do appropriate testing for patients. They should not be tempted to “do more tests” to boost the practices bottom line.    In contrast employed physicians are not financially motivated by practice revenue.  Physician compensation is set by the number of patients seen, the complexity of patient problems, and often by the quality of care provided as measured by certain agreed upon practice metrics.    Employed physicians are blinded to the overhead of their employer. In this model practices are rarely motivated to innovate to provide cutting edge services, often do not restrict access to those with government insurance and have a very liberal no show policy.   Given the turbulent economy, many small independent pediatric practices have folded, and physicians used to the first model of compensation, now find themselves employed by hospitals or clinics.  Many tell me they miss the autonomy that private practice provides, but welcome the financial security they now find as an employee.  As I’ve said before small independent pediatric practices are the perfect medical home for complex patients. It is a shame that government insurance compensates physicians so poorly many private practices cannot afford to participate.  The solution for many of our healthcare woes is simple.  Pay a reasonable fee to pediatricians for caring for our most needy patients. Medicare rates would suffice.  As a consequence, private practice medicine would survive and patients will receive better care!     Mon, 11 Jun 2012 20:13:24 GMT http://community.modernmedicine.com/_Pediatricians-and-the-bottom-line/blog/6006233/33379.html AndySchumanMD 2012-04-23T14:34:50Z Pediatrics Modern Medicine Community   There are two general models of pediatric care delivery and accordingly two related models of pediatrician compensation.  There are pediatricians in independent private practice who are compensated according to the amount of revenue the provider generates, once overhead costs are factored in.  In contrast there are pediatricians who are employed by hospitals and multispecialty clinics and are compensated by the “work relative value units” (wRVUs) a pediatrician generates.    In private practice, physicians are well aware of the cost of operating a business. If the insurance companies are slow to pay, partners are subject to no or reduced paychecks depending on the practice’s cash reserves.   In this model motivated partners are always looking for ways to improve efficiency, reduce costs, attract patients to the practice and find ways to see more patients.   They are also well aware that the service we provide has significant “value” and generally will not tolerate patients who consistently no show, or who do not pay their bills. Such practices often limit their payer mix to restrict the numbers of patients with government insurance as reimbursements are typically extremely poor.  They even may be tempted to do more in office testing or provide new services, if those services generate revenue for the practice. Physicians must be mindful to practice quality medicine and to do appropriate testing for patients. They should not be tempted to “do more tests” to boost the practices bottom line.    In contrast employed physicians are not financially motivated by practice revenue.  Physician compensation is set by the number of patients seen, the complexity of patient problems, and often by the quality of care provided as measured by certain agreed upon practice metrics.    Employed physicians are blinded to the overhead of their employer. In this model practices are rarely motivated to innovate to provide cutting edge services, often do not restrict access to those with government insurance and have a very liberal no show policy.   Given the turbulent economy, many small independent pediatric practices have folded, and physicians used to the first model of compensation, now find themselves employed by hospitals or clinics.  Many tell me they miss the autonomy that private practice provides, but welcome the financial security they now find as an employee.  As I’ve said before small independent pediatric practices are the perfect medical home for complex patients. It is a shame that government insurance compensates physicians so poorly many private practices cannot afford to participate.  The solution for many of our healthcare woes is simple.  Pay a reasonable fee to pediatricians for caring for our most needy patients. Medicare rates would suffice.  As a consequence, private practice medicine would survive and patients will receive better care!     pediatrics nonadult false Pediatricians and the bottom line text blog pediatrics 718 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=8151275&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_4147077_33379_8151275_ap_160X120.jpg false 0 Pediatrics 0 6006233 8151275 Member 0 http://community.modernmedicine.com/_Pediatricians-and-the-bottom-line/blog/5871479/33379.html Pediatricians and the bottom line   There are two general models of pediatric care delivery and accordingly two related models of pediatrician compensation.  There are pediatricians in independent private practice who are compensated according to the amount of revenue the provider generates, once overhead costs are factored in.  In contrast there are pediatricians who are employed by hospitals and multispecialty clinics and are compensated by the “work relative value units” (wRVUs) a pediatrician generates.    In private practice, physicians are well aware of the cost of operating a business. If the insurance companies are slow to pay, partners are subject to no or reduced paychecks depending on the practice’s cash reserves.   In this model motivated partners are always looking for ways to improve efficiency, reduce costs, attract patients to the practice and find ways to see more patients.   They are also well aware that the service we provide has significant “value” and generally will not tolerate patients who consistently no show, or who do not pay their bills. Such practices often limit their payer mix to restrict the numbers of patients with government insurance as reimbursements are typically extremely poor.  They even may be tempted to do more in office testing or provide new services, if those services generate revenue for the practice. Physicians must be mindful to practice quality medicine and to do appropriate testing for patients. They should not be tempted to “do more tests” to boost the practices bottom line.    In contrast employed physicians are not financially motivated by practice revenue.  Physician compensation is set by the number of patients seen, the complexity of patient problems, and often by the quality of care provided as measured by certain agreed upon practice metrics.    Employed physicians are blinded to the overhead of their employer. In this model practices are rarely motivated to innovate to provide cutting edge services, often do not restrict access to those with government insurance and have a very liberal no show policy.   Given the turbulent economy, many small independent pediatric practices have folded, and physicians used to the first model of compensation, now find themselves employed by hospitals or clinics.  Many tell me they miss the autonomy that private practice provides, but welcome the financial security they now find as an employee.  As I’ve said before small independent pediatric practices are the perfect medical home for complex patients. It is a shame that government insurance compensates physicians so poorly many private practices cannot afford to participate.  The solution for many of our healthcare woes is simple.  Pay a reasonable fee to pediatricians for caring for our most needy patients. Medicare rates would suffice.  As a consequence, private practice medicine would survive and patients will receive better care!   Pediatricians and the bottom line   There are two general models of pediatric care delivery and accordingly two related models of pediatrician compensation.  There are pediatricians in independent private practice who are compensated according to the amount of revenue the provider generates, once overhead costs are factored in.  In contrast there are pediatricians who are employed by hospitals and multispecialty clinics and are compensated by the “work relative value units” (wRVUs) a pediatrician generates.    In private practice, physicians are well aware of the cost of operating a business. If the insurance companies are slow to pay, partners are subject to no or reduced paychecks depending on the practice’s cash reserves.   In this model motivated partners are always looking for ways to improve efficiency, reduce costs, attract patients to the practice and find ways to see more patients.   They are also well aware that the service we provide has significant “value” and generally will not tolerate patients who consistently no show, or who do not pay their bills. Such practices often limit their payer mix to restrict the numbers of patients with government insurance as reimbursements are typically extremely poor.  They even may be tempted to do more in office testing or provide new services, if those services generate revenue for the practice. Physicians must be mindful to practice quality medicine and to do appropriate testing for patients. They should not be tempted to “do more tests” to boost the practices bottom line.    In contrast employed physicians are not financially motivated by practice revenue.  Physician compensation is set by the number of patients seen, the complexity of patient problems, and often by the quality of care provided as measured by certain agreed upon practice metrics.    Employed physicians are blinded to the overhead of their employer. In this model practices are rarely motivated to innovate to provide cutting edge services, often do not restrict access to those with government insurance and have a very liberal no show policy.   Given the turbulent economy, many small independent pediatric practices have folded, and physicians used to the first model of compensation, now find themselves employed by hospitals or clinics.  Many tell me they miss the autonomy that private practice provides, but welcome the financial security they now find as an employee.  As I’ve said before small independent pediatric practices are the perfect medical home for complex patients. It is a shame that government insurance compensates physicians so poorly many private practices cannot afford to participate.  The solution for many of our healthcare woes is simple.  Pay a reasonable fee to pediatricians for caring for our most needy patients. Medicare rates would suffice.  As a consequence, private practice medicine would survive and patients will receive better care!   Mon, 11 Jun 2012 16:13:25 GMT http://community.modernmedicine.com/_Pediatricians-and-the-bottom-line/blog/5871479/33379.html AndySchumanMD 2012-03-17T11:50:44Z Pediatrics Modern Medicine Community Pediatricians and the bottom line   There are two general models of pediatric care delivery and accordingly two related models of pediatrician compensation.  There are pediatricians in independent private practice who are compensated according to the amount of revenue the provider generates, once overhead costs are factored in.  In contrast there are pediatricians who are employed by hospitals and multispecialty clinics and are compensated by the “work relative value units” (wRVUs) a pediatrician generates.    In private practice, physicians are well aware of the cost of operating a business. If the insurance companies are slow to pay, partners are subject to no or reduced paychecks depending on the practice’s cash reserves.   In this model motivated partners are always looking for ways to improve efficiency, reduce costs, attract patients to the practice and find ways to see more patients.   They are also well aware that the service we provide has significant “value” and generally will not tolerate patients who consistently no show, or who do not pay their bills. Such practices often limit their payer mix to restrict the numbers of patients with government insurance as reimbursements are typically extremely poor.  They even may be tempted to do more in office testing or provide new services, if those services generate revenue for the practice. Physicians must be mindful to practice quality medicine and to do appropriate testing for patients. They should not be tempted to “do more tests” to boost the practices bottom line.    In contrast employed physicians are not financially motivated by practice revenue.  Physician compensation is set by the number of patients seen, the complexity of patient problems, and often by the quality of care provided as measured by certain agreed upon practice metrics.    Employed physicians are blinded to the overhead of their employer. In this model practices are rarely motivated to innovate to provide cutting edge services, often do not restrict access to those with government insurance and have a very liberal no show policy.   Given the turbulent economy, many small independent pediatric practices have folded, and physicians used to the first model of compensation, now find themselves employed by hospitals or clinics.  Many tell me they miss the autonomy that private practice provides, but welcome the financial security they now find as an employee.  As I’ve said before small independent pediatric practices are the perfect medical home for complex patients. It is a shame that government insurance compensates physicians so poorly many private practices cannot afford to participate.  The solution for many of our healthcare woes is simple.  Pay a reasonable fee to pediatricians for caring for our most needy patients. Medicare rates would suffice.  As a consequence, private practice medicine would survive and patients will receive better care!   pediatrics nonadult false Pediatricians and the bottom line text blog pediatrics 662 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=8151275&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_4147077_33379_8151275_ap_160X120.jpg false 0 Pediatrics 0 5871479 8151275 Member 0 http://community.modernmedicine.com/_Medicaid-Health-Care-Dollars-spent-unwisely/blog/5712198/33379.html Approximately 50 million Americans have Medicaid and Medicaid health insurance for children reimburse pediatricians only a third of what commercial insurance reimburses for the same care.  As the ranks of Medicaid insured swell, this inequity threatens to drive private practice pediatricians out of business at they can no longer afford practice overhead, malpractice insurance and provide employee healthcare.  Obamacare has invested staggering amounts of money to provide services for the “uninsured” (those whose jobs don’t provide insurance). A wiser investment of funds should have involved bolstering the Medicaid reimbursements to physicians. Small or mid-size private pediatric practices have provided ideal "medical homes" for their patient for years. In private practice pediatrics, patients have virtually unlimited access to their primary care physicians and relatively few access overburdened Emergency Rooms needlessly. Presently only Federally Qualified Health Centers receive adequate compensation on par with that provided by private payers (from the Fed) for services provided to those with Medicaid. Just as easily those outside of the FQHC system should have access to improved reimbursement by demonstrating that they can provide services on par with FQHC Health Centers. Medicaid patients should also learn to value their health coverage by paying an income adjusted co-payment necessary to access care. With healthcare at the crossroads it frustrates most physicians to see that the government "fix" as always  ignores the most obvious, and unfortunately is always the "path not taken!" Approximately 50 million Americans have Medicaid and Medicaid health insurance for children reimburse pediatricians only a third of what commercial insurance reimburses for the same care.  As the ranks of Medicaid insured swell, this inequity threatens to drive private practice pediatricians out of business at they can no longer afford practice overhead, malpractice insurance and provide employee healthcare.  Obamacare has invested staggering amounts of money to provide services for the “uninsured” (those whose jobs don’t provide insurance). A wiser investment of funds should have involved bolstering the Medicaid reimbursements to physicians. Small or mid-size private pediatric practices have provided ideal "medical homes" for their patient for years. In private practice pediatrics, patients have virtually unlimited access to their primary care physicians and relatively few access overburdened Emergency Rooms needlessly. Presently only Federally Qualified Health Centers receive adequate compensation on par with that provided by private payers (from the Fed) for services provided to those with Medicaid. Just as easily those outside of the FQHC system should have access to improved reimbursement by demonstrating that they can provide services on par with FQHC Health Centers. Medicaid patients should also learn to value their health coverage by paying an income adjusted co-payment necessary to access care. With healthcare at the crossroads it frustrates most physicians to see that the government "fix" as always  ignores the most obvious, and unfortunately is always the "path not taken!" Thu, 23 Feb 2012 21:38:12 GMT http://community.modernmedicine.com/_Medicaid-Health-Care-Dollars-spent-unwisely/blog/5712198/33379.html AndySchumanMD 2012-01-15T21:16:11Z Pediatrics Modern Medicine Community Approximately 50 million Americans have Medicaid and Medicaid health insurance for children reimburse pediatricians only a third of what commercial insurance reimburses for the same care.  As the ranks of Medicaid insured swell, this inequity threatens to drive private practice pediatricians out of business at they can no longer afford practice overhead, malpractice insurance and provide employee healthcare.  Obamacare has invested staggering amounts of money to provide services for the “uninsured” (those whose jobs don’t provide insurance). A wiser investment of funds should have involved bolstering the Medicaid reimbursements to physicians. Small or mid-size private pediatric practices have provided ideal "medical homes" for their patient for years. In private practice pediatrics, patients have virtually unlimited access to their primary care physicians and relatively few access overburdened Emergency Rooms needlessly. Presently only Federally Qualified Health Centers receive adequate compensation on par with that provided by private payers (from the Fed) for services provided to those with Medicaid. Just as easily those outside of the FQHC system should have access to improved reimbursement by demonstrating that they can provide services on par with FQHC Health Centers. Medicaid patients should also learn to value their health coverage by paying an income adjusted co-payment necessary to access care. With healthcare at the crossroads it frustrates most physicians to see that the government "fix" as always  ignores the most obvious, and unfortunately is always the "path not taken!" pediatrics nonadult false Medicaid Health Care: Dollars spent unwisely text blog pediatrics 911 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=8151275&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_4147077_33379_8151275_ap_160X120.jpg false 0 Pediatrics 0 5712198 8151275 Member 0 http://community.modernmedicine.com/_Game-Changing-Technologies/blog/5650470/33379.html This month’s “Best new products for Pediatricians” article feature a varied selection of devices and technologies that may improve your pediatric practice. Among these are three devices so innovative I’ve described them as “potentially” game changing technologies. The first is the Pronto 7 from Masimo Corporation that performs pulse oximetry in addition to a transcutaneous hemoglobin measurement.  It’s use is limited to children 3 and older because of probe size, but if its accuracy is substantiated in clinical studies, it will be the first device capable of screening for anemia that does not required a finger stick or venipuncture specimen. In the near future technologic improvements in the Pronto 7 are likely to enable the device to screen children as young as one year of age, when we typically screen for anemia. The second device is a needlefree injection system from Pharmajet Inc.  It uses a spring mechanism to force vaccines through a small orifice at high velocity, achieving a depth of penetration equivalent to that achieved by a standard syringe needle. I’m told that, while not pain free, it is less painful than a standard injection, and would be welcome by our young patients who overwhelmingly are needlephobic. It also will eliminate the threat of needlestick injuries as well as the problem of disposing of syringe needles.   Lastly Becton Dickinson Diagnostics is the first company to introduce a rapid office immunoassay that uses a “reader” to improve the accuracy of results that used to depend on visual inspection of a test strip or cartridge. As detailed in the article, while these technologies are very exciting and may change the way we practice office pediatrics. We eagerly await clinical studies that validate their use.  [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] This month’s “Best new products for Pediatricians” article feature a varied selection of devices and technologies that may improve your pediatric practice. Among these are three devices so innovative I’ve described them as “potentially” game changing technologies. The first is the Pronto 7 from Masimo Corporation that performs pulse oximetry in addition to a transcutaneous hemoglobin measurement.  It’s use is limited to children 3 and older because of probe size, but if its accuracy is substantiated in clinical studies, it will be the first device capable of screening for anemia that does not required a finger stick or venipuncture specimen. In the near future technologic improvements in the Pronto 7 are likely to enable the device to screen children as young as one year of age, when we typically screen for anemia. The second device is a needlefree injection system from Pharmajet Inc.  It uses a spring mechanism to force vaccines through a small orifice at high velocity, achieving a depth of penetration equivalent to that achieved by a standard syringe needle. I’m told that, while not pain free, it is less painful than a standard injection, and would be welcome by our young patients who overwhelmingly are needlephobic. It also will eliminate the threat of needlestick injuries as well as the problem of disposing of syringe needles.   Lastly Becton Dickinson Diagnostics is the first company to introduce a rapid office immunoassay that uses a “reader” to improve the accuracy of results that used to depend on visual inspection of a test strip or cartridge. As detailed in the article, while these technologies are very exciting and may change the way we practice office pediatrics. We eagerly await clinical studies that validate their use.  [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Fri, 16 Dec 2011 21:52:37 GMT http://community.modernmedicine.com/_Game-Changing-Technologies/blog/5650470/33379.html AndySchumanMD 2011-12-16T19:51:50Z Pediatrics Modern Medicine Community This month’s “Best new products for Pediatricians” article feature a varied selection of devices and technologies that may improve your pediatric practice. Among these are three devices so innovative I’ve described them as “potentially” game changing technologies. The first is the Pronto 7 from Masimo Corporation that performs pulse oximetry in addition to a transcutaneous hemoglobin measurement.  It’s use is limited to children 3 and older because of probe size, but if its accuracy is substantiated in clinical studies, it will be the first device capable of screening for anemia that does not required a finger stick or venipuncture specimen. In the near future technologic improvements in the Pronto 7 are likely to enable the device to screen children as young as one year of age, when we typically screen for anemia. The second device is a needlefree injection system from Pharmajet Inc.  It uses a spring mechanism to force vaccines through a small orifice at high velocity, achieving a depth of penetration equivalent to that achieved by a standard syringe needle. I’m told that, while not pain free, it is less painful than a standard injection, and would be welcome by our young patients who overwhelmingly are needlephobic. It also will eliminate the threat of needlestick injuries as well as the problem of disposing of syringe needles.   Lastly Becton Dickinson Diagnostics is the first company to introduce a rapid office immunoassay that uses a “reader” to improve the accuracy of results that used to depend on visual inspection of a test strip or cartridge. As detailed in the article, while these technologies are very exciting and may change the way we practice office pediatrics. We eagerly await clinical studies that validate their use.  [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] pediatrics nonadult false Game Changing Technologies... text blog pediatrics 640 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=8151275&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_4147077_33379_8151275_ap_160X120.jpg false 0 Pediatrics 0 5650470 8151275 Member 0 http://community.modernmedicine.com/_Medical-Apps-for-This-and-That-/blog/5477300/33379.html In this month’s issue of Contemporary Pediatrics I present a brief overview of the many applications available to pediatricians that can make our smartphones and tablets an indispensable medical tool. It’s hard to believe that the iPhone was introduced to the world just 4 short years ago with the iTunes application store following just one year later.  No matter what you do as a pediatrician, you can often do it better (and often faster) with a mobile device at hand.   I use Epocrates to quickly look up drug dosages, check insurance formularies, and check for drug interactions. When I have a question about pediatric infectious disease I load the AAP’s 2009 Report of the Committee on Infectious Disease via Unbound Medicine’s “Pediatric Central”.   And when I need to know something fast I call upon my UpToDate or Medscape applications.  And when I’m in the mood I will read the digital version of Contemporary Pediatrics, Medical Economics, or the latest issue of AAP News or Pediatrics. It’s not only healthcare providers who are benefiting by mobile technology, but our patients are as well.  Today I saw one of my autistic patients who previously used an expensive ($8000) and heavy communication device called a Dynavox,  which has been replaced with a lightweight iPad2 running a program called  Proloquo2Go—at a fraction of the cost.   There are dozens of programs designed to improve the life quality of our patients with disabilities.  Some are designed to entertain patients, others to improve their ability to communicate with others, and still others designed to teach.   For a wonderful firsthand account of one parent’s experience using an iPad with her autistic son visit http://www.blogher.com/ipad-nearmiracle-my-son-autism.   The discussion also features nicely detailed descriptions of his favorite applications. I expect that in the near future we will hand tablets to parents when they check in for a visit.  Tablets will let them register for our practice, fill out child development questionnaires, and read our latest e-newsletter, sign their HIPAA form, or watch a video about immunizations.  Wonderful stuff indeed.  [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] In this month’s issue of Contemporary Pediatrics I present a brief overview of the many applications available to pediatricians that can make our smartphones and tablets an indispensable medical tool. It’s hard to believe that the iPhone was introduced to the world just 4 short years ago with the iTunes application store following just one year later.  No matter what you do as a pediatrician, you can often do it better (and often faster) with a mobile device at hand.   I use Epocrates to quickly look up drug dosages, check insurance formularies, and check for drug interactions. When I have a question about pediatric infectious disease I load the AAP’s 2009 Report of the Committee on Infectious Disease via Unbound Medicine’s “Pediatric Central”.   And when I need to know something fast I call upon my UpToDate or Medscape applications.  And when I’m in the mood I will read the digital version of Contemporary Pediatrics, Medical Economics, or the latest issue of AAP News or Pediatrics. It’s not only healthcare providers who are benefiting by mobile technology, but our patients are as well.  Today I saw one of my autistic patients who previously used an expensive ($8000) and heavy communication device called a Dynavox,  which has been replaced with a lightweight iPad2 running a program called  Proloquo2Go—at a fraction of the cost.   There are dozens of programs designed to improve the life quality of our patients with disabilities.  Some are designed to entertain patients, others to improve their ability to communicate with others, and still others designed to teach.   For a wonderful firsthand account of one parent’s experience using an iPad with her autistic son visit http://www.blogher.com/ipad-nearmiracle-my-son-autism.   The discussion also features nicely detailed descriptions of his favorite applications. I expect that in the near future we will hand tablets to parents when they check in for a visit.  Tablets will let them register for our practice, fill out child development questionnaires, and read our latest e-newsletter, sign their HIPAA form, or watch a video about immunizations.  Wonderful stuff indeed.  [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Mon, 21 Nov 2011 16:54:47 GMT http://community.modernmedicine.com/_Medical-Apps-for-This-and-That-/blog/5477300/33379.html AndySchumanMD 2011-11-16T01:16:21Z Pediatrics Modern Medicine Community In this month’s issue of Contemporary Pediatrics I present a brief overview of the many applications available to pediatricians that can make our smartphones and tablets an indispensable medical tool. It’s hard to believe that the iPhone was introduced to the world just 4 short years ago with the iTunes application store following just one year later.  No matter what you do as a pediatrician, you can often do it better (and often faster) with a mobile device at hand.   I use Epocrates to quickly look up drug dosages, check insurance formularies, and check for drug interactions. When I have a question about pediatric infectious disease I load the AAP’s 2009 Report of the Committee on Infectious Disease via Unbound Medicine’s “Pediatric Central”.   And when I need to know something fast I call upon my UpToDate or Medscape applications.  And when I’m in the mood I will read the digital version of Contemporary Pediatrics, Medical Economics, or the latest issue of AAP News or Pediatrics. It’s not only healthcare providers who are benefiting by mobile technology, but our patients are as well.  Today I saw one of my autistic patients who previously used an expensive ($8000) and heavy communication device called a Dynavox,  which has been replaced with a lightweight iPad2 running a program called  Proloquo2Go—at a fraction of the cost.   There are dozens of programs designed to improve the life quality of our patients with disabilities.  Some are designed to entertain patients, others to improve their ability to communicate with others, and still others designed to teach.   For a wonderful firsthand account of one parent’s experience using an iPad with her autistic son visit http://www.blogher.com/ipad-nearmiracle-my-son-autism.   The discussion also features nicely detailed descriptions of his favorite applications. I expect that in the near future we will hand tablets to parents when they check in for a visit.  Tablets will let them register for our practice, fill out child development questionnaires, and read our latest e-newsletter, sign their HIPAA form, or watch a video about immunizations.  Wonderful stuff indeed.  [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] pediatrics nonadult false Medical Apps for This and That ..... text blog pediatrics 889 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=8151275&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_4147077_33379_8151275_ap_160X120.jpg false 0 Pediatrics 0 5477300 8151275 Member 0 http://community.modernmedicine.com/_Thank-you-Steve-Jobs/blog/5290629/33379.html We recently lost Steve Jobs, one of the most productive innovators of our era.  Steve Jobs was an inspiration for millions who admired his ability to create, speculate, work hard, and live a meaningful life. Much has been written recently about his life and times.  He was publicly quiet, but known for being a tyrant at times with employees. While we all are familiar with his creativity, and enjoyed the products he and Apple gave us, I for one was unfamiliar with the depth of his wisdom and spirit until my wife showed me a YouTube video of his commencement address to the 2005 graduating class at Stanford University.  The video is well worth your time. You will be inspired by his ability to respond to, and rebound from, hardships, and would be well advised to take his advice—to acknowledge that we have a limited life and we should be spend it pursuing our dreams, not someone else's. He concluded the address with the admonition taken from the last issue of the “whole earth catalog”—that we should stay hungry and stay foolish.      Our long-term patients, those we have helped nurture from infancy into adolescence often look to their pediatricians for wisdom and advice, especially when they hit hard times as we all do.  One should point to Steve Jobs as a good example how one is able to react to and deal with adversity.   He was also a good example for those of us who labor in the trenches, caring for patients. There is a joy to be gleaned from every patient interaction; we just need to be wise enough to appreciate them.  If we stop complaining and start appreciating each parent, patient, and colleague we will Stay hungry and stay foolish. We recently lost Steve Jobs, one of the most productive innovators of our era.  Steve Jobs was an inspiration for millions who admired his ability to create, speculate, work hard, and live a meaningful life. Much has been written recently about his life and times.  He was publicly quiet, but known for being a tyrant at times with employees. While we all are familiar with his creativity, and enjoyed the products he and Apple gave us, I for one was unfamiliar with the depth of his wisdom and spirit until my wife showed me a YouTube video of his commencement address to the 2005 graduating class at Stanford University.  The video is well worth your time. You will be inspired by his ability to respond to, and rebound from, hardships, and would be well advised to take his advice—to acknowledge that we have a limited life and we should be spend it pursuing our dreams, not someone else's. He concluded the address with the admonition taken from the last issue of the “whole earth catalog”—that we should stay hungry and stay foolish.      Our long-term patients, those we have helped nurture from infancy into adolescence often look to their pediatricians for wisdom and advice, especially when they hit hard times as we all do.  One should point to Steve Jobs as a good example how one is able to react to and deal with adversity.   He was also a good example for those of us who labor in the trenches, caring for patients. There is a joy to be gleaned from every patient interaction; we just need to be wise enough to appreciate them.  If we stop complaining and start appreciating each parent, patient, and colleague we will Stay hungry and stay foolish. Thu, 13 Oct 2011 19:28:45 GMT http://community.modernmedicine.com/_Thank-you-Steve-Jobs/blog/5290629/33379.html AndySchumanMD 2011-10-13T00:21:30Z Pediatrics Modern Medicine Community We recently lost Steve Jobs, one of the most productive innovators of our era.  Steve Jobs was an inspiration for millions who admired his ability to create, speculate, work hard, and live a meaningful life. Much has been written recently about his life and times.  He was publicly quiet, but known for being a tyrant at times with employees. While we all are familiar with his creativity, and enjoyed the products he and Apple gave us, I for one was unfamiliar with the depth of his wisdom and spirit until my wife showed me a YouTube video of his commencement address to the 2005 graduating class at Stanford University.  The video is well worth your time. You will be inspired by his ability to respond to, and rebound from, hardships, and would be well advised to take his advice—to acknowledge that we have a limited life and we should be spend it pursuing our dreams, not someone else's. He concluded the address with the admonition taken from the last issue of the “whole earth catalog”—that we should stay hungry and stay foolish.      Our long-term patients, those we have helped nurture from infancy into adolescence often look to their pediatricians for wisdom and advice, especially when they hit hard times as we all do.  One should point to Steve Jobs as a good example how one is able to react to and deal with adversity.   He was also a good example for those of us who labor in the trenches, caring for patients. There is a joy to be gleaned from every patient interaction; we just need to be wise enough to appreciate them.  If we stop complaining and start appreciating each parent, patient, and colleague we will Stay hungry and stay foolish. pediatrics, steve jobs nonadult false Thank you Steve Jobs.... text blog pediatrics,steve jobs 521 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=8151275&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_4147077_33379_8151275_ap_160X120.jpg false 0 Pediatrics 0 5290629 8151275 Member 0 http://community.modernmedicine.com/_Government-and-Healthcare-Can-oil-and-water-ever-mix/blog/5116204/33379.html As I prepare a series of lectures that I will present at the AAP’s National Conference next month, I am puzzled and conflicted when considering the question “what role should the government play in pediatric medical care?” In hindsight, the involvement of the government has been both beneficial as well as an enormance hindrance. The Food and Drug Administration (FDA) and the Centers for Disease Control (CDC) have been of enormous benefit in improving and advancing American healthcare throughout the years. The FDA obviously plays a pivotal role in assuring the safety of medicines and medical devices, and the CDC has been a diligent watchdog when it comes to limiting the spread of diseases, encouraging vaccination, and educating physicians and the general public. These organizations have done so well by involving our best and brightest physicians, who are mindful of physician’s credo “to do no harm.” But when the legislative branch intrudes into the daily practice of medicine, the track record is not so good. The Medicaid and Medicare health programs have failed to provide reasonable healthcare to our elderly and low-income families, and both have unfairly compensated physicians, especially those in primary care. In case anyone hasn’t noticed, the ranks of America’s uninsured grew this month to exceed 50 million and the numbers of private practice primary physicians (who have always provided the best “medical home” for patients) are reducing at a scarily rapid rate. Rather than fix problems, the legislature has chosen to reinvent the broken wheel, to the dismay of physicians and patients, who are now bracing for possible worsening circumstances. In the past legislators have meant well. OSHA regulations do protect healthcare professionals in the workplace. CLIA’88 reforms was intended to protect patients from medical errors and unscrupulous physicians, but had the effect of impeding innovation, and contributing to the rising cost of healthcare. The latest “American Healthcare Act” continues this trend of unneeded, and unwanted intrusion into the doctor and patient relationship. Overlooking its impact on insurance coverage (which will be significant, unless changes are implemented soon), it’s effect on encouraging (ie “forcing”) physicians to implement not ready for primetime electronic health records, has been disturbing. To qualify for substantial stimulus dollars (especially valued in this economy), Medicare providers and primary care providers who have at least 20% Medicaid volume, must acquire government approved EHRs and begin to use them meaningfully with the next year. This assumes an erroneous assumption, that EHR will improve the quality of medical care we provide. Many physicians tell me that so far, their “meaningful” EHRs have reduced their productivity by as much as 30 %, while frustrating staff and drastically increasing the rate of carpal tunnel syndrome from daily “clickitis” that is associated with many of the government approve products. Please President Obama, and Mr. Legislator, let doctors alone to make these important decisions! As I prepare a series of lectures that I will present at the AAP’s National Conference next month, I am puzzled and conflicted when considering the question “what role should the government play in pediatric medical care?” In hindsight, the involvement of the government has been both beneficial as well as an enormance hindrance. The Food and Drug Administration (FDA) and the Centers for Disease Control (CDC) have been of enormous benefit in improving and advancing American healthcare throughout the years. The FDA obviously plays a pivotal role in assuring the safety of medicines and medical devices, and the CDC has been a diligent watchdog when it comes to limiting the spread of diseases, encouraging vaccination, and educating physicians and the general public. These organizations have done so well by involving our best and brightest physicians, who are mindful of physician’s credo “to do no harm.” But when the legislative branch intrudes into the daily practice of medicine, the track record is not so good. The Medicaid and Medicare health programs have failed to provide reasonable healthcare to our elderly and low-income families, and both have unfairly compensated physicians, especially those in primary care. In case anyone hasn’t noticed, the ranks of America’s uninsured grew this month to exceed 50 million and the numbers of private practice primary physicians (who have always provided the best “medical home” for patients) are reducing at a scarily rapid rate. Rather than fix problems, the legislature has chosen to reinvent the broken wheel, to the dismay of physicians and patients, who are now bracing for possible worsening circumstances. In the past legislators have meant well. OSHA regulations do protect healthcare professionals in the workplace. CLIA’88 reforms was intended to protect patients from medical errors and unscrupulous physicians, but had the effect of impeding innovation, and contributing to the rising cost of healthcare. The latest “American Healthcare Act” continues this trend of unneeded, and unwanted intrusion into the doctor and patient relationship. Overlooking its impact on insurance coverage (which will be significant, unless changes are implemented soon), it’s effect on encouraging (ie “forcing”) physicians to implement not ready for primetime electronic health records, has been disturbing. To qualify for substantial stimulus dollars (especially valued in this economy), Medicare providers and primary care providers who have at least 20% Medicaid volume, must acquire government approved EHRs and begin to use them meaningfully with the next year. This assumes an erroneous assumption, that EHR will improve the quality of medical care we provide. Many physicians tell me that so far, their “meaningful” EHRs have reduced their productivity by as much as 30 %, while frustrating staff and drastically increasing the rate of carpal tunnel syndrome from daily “clickitis” that is associated with many of the government approve products. Please President Obama, and Mr. Legislator, let doctors alone to make these important decisions! Tue, 27 Sep 2011 20:59:26 GMT http://community.modernmedicine.com/_Government-and-Healthcare-Can-oil-and-water-ever-mix/blog/5116204/33379.html AndySchumanMD 2011-09-15T21:55:56Z Pediatrics Modern Medicine Community As I prepare a series of lectures that I will present at the AAP’s National Conference next month, I am puzzled and conflicted when considering the question “what role should the government play in pediatric medical care?” In hindsight, the involvement of the government has been both beneficial as well as an enormance hindrance. The Food and Drug Administration (FDA) and the Centers for Disease Control (CDC) have been of enormous benefit in improving and advancing American healthcare throughout the years. The FDA obviously plays a pivotal role in assuring the safety of medicines and medical devices, and the CDC has been a diligent watchdog when it comes to limiting the spread of diseases, encouraging vaccination, and educating physicians and the general public. These organizations have done so well by involving our best and brightest physicians, who are mindful of physician’s credo “to do no harm.” But when the legislative branch intrudes into the daily practice of medicine, the track record is not so good. The Medicaid and Medicare health programs have failed to provide reasonable healthcare to our elderly and low-income families, and both have unfairly compensated physicians, especially those in primary care. In case anyone hasn’t noticed, the ranks of America’s uninsured grew this month to exceed 50 million and the numbers of private practice primary physicians (who have always provided the best “medical home” for patients) are reducing at a scarily rapid rate. Rather than fix problems, the legislature has chosen to reinvent the broken wheel, to the dismay of physicians and patients, who are now bracing for possible worsening circumstances. In the past legislators have meant well. OSHA regulations do protect healthcare professionals in the workplace. CLIA’88 reforms was intended to protect patients from medical errors and unscrupulous physicians, but had the effect of impeding innovation, and contributing to the rising cost of healthcare. The latest “American Healthcare Act” continues this trend of unneeded, and unwanted intrusion into the doctor and patient relationship. Overlooking its impact on insurance coverage (which will be significant, unless changes are implemented soon), it’s effect on encouraging (ie “forcing”) physicians to implement not ready for primetime electronic health records, has been disturbing. To qualify for substantial stimulus dollars (especially valued in this economy), Medicare providers and primary care providers who have at least 20% Medicaid volume, must acquire government approved EHRs and begin to use them meaningfully with the next year. This assumes an erroneous assumption, that EHR will improve the quality of medical care we provide. Many physicians tell me that so far, their “meaningful” EHRs have reduced their productivity by as much as 30 %, while frustrating staff and drastically increasing the rate of carpal tunnel syndrome from daily “clickitis” that is associated with many of the government approve products. Please President Obama, and Mr. Legislator, let doctors alone to make these important decisions! care, ehrs, healthcare, pediatrics, primary, reform nonadult false Government and Healthcare: Can oil and water ever mix? text blog care,ehrs,healthcare,pediatrics,primary,reform 634 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=8151275&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_4147077_33379_8151275_ap_160X120.jpg false 0 Pediatrics 0 5116204 8151275 Member 0 http://community.modernmedicine.com/_New-AAP-Section-on-Therapeutics-and-Technology/blog/5045859/33379.html I am pleased to have been invited to join the Executive Committee of the AAP’s new provision Section on Advances in Therapeutics and Technology, identified by the acronym PSATT. The Academy’s newest section was developed to advance pediatric health through collaboration, communication and education relating to the discovery and development of therapeutics and technology—and their successful translation into pediatric practice. Among its stated goals is to explore the research and development process and make recommendations that will improve quality, safety, understanding as technologies are integrated into practice. Additionally it will endeavor to improve communication and relationships between AAP members and industry, academia and government agencies. As pediatricians, we are challenged to deliver efficient, cost effective care to our patients. Despite the economic downturn we must be able to assimilate the newest “reliable” technologies into the daily practice of pediatric medicine. I think PSATT has the ability to facilitate and speed technologic improvement of pediatric care by educating its members and fostering dialogs between government agencies, researches, industry - and general pediatricians always looking for the “next best thing”. The PSATT membership is over 200 with the majority of members coming from pediatricians employed by the government, and industry. I’d like to see a good representation from pediatricians like myself who work in the “trenches” of pediatric medicine, either in private practice or pediatric clinics. I will be presenting a lecture on Gadgets and Gizmos for Pediatric Practice at the National AAP Conference in Boston (October 17, 2011) and I’d like to invite everyone to attend and learn more about the new AAP section. See you there! I am pleased to have been invited to join the Executive Committee of the AAP’s new provision Section on Advances in Therapeutics and Technology, identified by the acronym PSATT. The Academy’s newest section was developed to advance pediatric health through collaboration, communication and education relating to the discovery and development of therapeutics and technology—and their successful translation into pediatric practice. Among its stated goals is to explore the research and development process and make recommendations that will improve quality, safety, understanding as technologies are integrated into practice. Additionally it will endeavor to improve communication and relationships between AAP members and industry, academia and government agencies. As pediatricians, we are challenged to deliver efficient, cost effective care to our patients. Despite the economic downturn we must be able to assimilate the newest “reliable” technologies into the daily practice of pediatric medicine. I think PSATT has the ability to facilitate and speed technologic improvement of pediatric care by educating its members and fostering dialogs between government agencies, researches, industry - and general pediatricians always looking for the “next best thing”. The PSATT membership is over 200 with the majority of members coming from pediatricians employed by the government, and industry. I’d like to see a good representation from pediatricians like myself who work in the “trenches” of pediatric medicine, either in private practice or pediatric clinics. I will be presenting a lecture on Gadgets and Gizmos for Pediatric Practice at the National AAP Conference in Boston (October 17, 2011) and I’d like to invite everyone to attend and learn more about the new AAP section. See you there! Tue, 23 Aug 2011 19:27:27 GMT http://community.modernmedicine.com/_New-AAP-Section-on-Therapeutics-and-Technology/blog/5045859/33379.html AndySchumanMD 2011-08-18T20:11:24Z Pediatrics Modern Medicine Community I am pleased to have been invited to join the Executive Committee of the AAP’s new provision Section on Advances in Therapeutics and Technology, identified by the acronym PSATT. The Academy’s newest section was developed to advance pediatric health through collaboration, communication and education relating to the discovery and development of therapeutics and technology—and their successful translation into pediatric practice. Among its stated goals is to explore the research and development process and make recommendations that will improve quality, safety, understanding as technologies are integrated into practice. Additionally it will endeavor to improve communication and relationships between AAP members and industry, academia and government agencies. As pediatricians, we are challenged to deliver efficient, cost effective care to our patients. Despite the economic downturn we must be able to assimilate the newest “reliable” technologies into the daily practice of pediatric medicine. I think PSATT has the ability to facilitate and speed technologic improvement of pediatric care by educating its members and fostering dialogs between government agencies, researches, industry - and general pediatricians always looking for the “next best thing”. The PSATT membership is over 200 with the majority of members coming from pediatricians employed by the government, and industry. I’d like to see a good representation from pediatricians like myself who work in the “trenches” of pediatric medicine, either in private practice or pediatric clinics. I will be presenting a lecture on Gadgets and Gizmos for Pediatric Practice at the National AAP Conference in Boston (October 17, 2011) and I’d like to invite everyone to attend and learn more about the new AAP section. See you there! pediatrics, psatt, technology, therapeutics nonadult false New AAP Section on Therapeutics and Technology! text blog pediatrics,psatt,technology,therapeutics 514 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=8151275&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_4147077_33379_8151275_ap_160X120.jpg false 0 Pediatrics 0 5045859 8151275 Member 0 http://community.modernmedicine.com/_The-Point-of-Point-of-Care-Testing/blog/4846674/33379.html In this month’s issue of Contemporary Pediatrics I have an article on “Point of Care Tests” (POCT) in the pediatric office. It’s a brief update on the rules and regulations surrounding Clia ’88 waivered tests in the office, and includes several suggestions for improving the quality and quantity of labs that you perform. Over the years, POCT testing has gotten simpler, faster, and more accurate, and providers and patients have benefited enormously from improvements in technology. Rapid strep tests years ago were based on latex agglutination technology and were difficult to interpret; now the majority of rapid tests are immunoassays with sensitivities and specificities well above 90%, in practice, that make them very useful in general pediatric practice. Most practices also perform urine dipsticks, rapid flu tests during respiratory disease season, and many also perform hemoglobin screening. The above are high volume tests that are inexpensive both to provider and patient to make them worth performing. Other tests, mono tests for example, although inexpensive and helpful, are used too infrequently to include in the standard office repertoire of rapid tests. There are other “niche” POCTs including lead screening, hemoglobin A1C tests, and chemistries that could be considered by some large practices or pediatricians that manage certain type of patients (obese, inner city, etc.). The whole point of “Point of Care” is that results are available at the time of the office visit. This facilitates workflow as results available during a visit. Thus, one can treat anemia or a strep infection expeditiously. This is much better than needing to call a patient with a result from a lab, call a pharmacy to order a medication, and then update your office note. Look for some new POCTs in my year end "Best New Products for Pediatrics" article at the end of the year! In this month’s issue of Contemporary Pediatrics I have an article on “Point of Care Tests” (POCT) in the pediatric office. It’s a brief update on the rules and regulations surrounding Clia ’88 waivered tests in the office, and includes several suggestions for improving the quality and quantity of labs that you perform. Over the years, POCT testing has gotten simpler, faster, and more accurate, and providers and patients have benefited enormously from improvements in technology. Rapid strep tests years ago were based on latex agglutination technology and were difficult to interpret; now the majority of rapid tests are immunoassays with sensitivities and specificities well above 90%, in practice, that make them very useful in general pediatric practice. Most practices also perform urine dipsticks, rapid flu tests during respiratory disease season, and many also perform hemoglobin screening. The above are high volume tests that are inexpensive both to provider and patient to make them worth performing. Other tests, mono tests for example, although inexpensive and helpful, are used too infrequently to include in the standard office repertoire of rapid tests. There are other “niche” POCTs including lead screening, hemoglobin A1C tests, and chemistries that could be considered by some large practices or pediatricians that manage certain type of patients (obese, inner city, etc.). The whole point of “Point of Care” is that results are available at the time of the office visit. This facilitates workflow as results available during a visit. Thus, one can treat anemia or a strep infection expeditiously. This is much better than needing to call a patient with a result from a lab, call a pharmacy to order a medication, and then update your office note. Look for some new POCTs in my year end "Best New Products for Pediatrics" article at the end of the year! Wed, 27 Jul 2011 12:59:33 GMT http://community.modernmedicine.com/_The-Point-of-Point-of-Care-Testing/blog/4846674/33379.html AndySchumanMD 2011-07-13T14:44:17Z Pediatrics Modern Medicine Community In this month’s issue of Contemporary Pediatrics I have an article on “Point of Care Tests” (POCT) in the pediatric office. It’s a brief update on the rules and regulations surrounding Clia ’88 waivered tests in the office, and includes several suggestions for improving the quality and quantity of labs that you perform. Over the years, POCT testing has gotten simpler, faster, and more accurate, and providers and patients have benefited enormously from improvements in technology. Rapid strep tests years ago were based on latex agglutination technology and were difficult to interpret; now the majority of rapid tests are immunoassays with sensitivities and specificities well above 90%, in practice, that make them very useful in general pediatric practice. Most practices also perform urine dipsticks, rapid flu tests during respiratory disease season, and many also perform hemoglobin screening. The above are high volume tests that are inexpensive both to provider and patient to make them worth performing. Other tests, mono tests for example, although inexpensive and helpful, are used too infrequently to include in the standard office repertoire of rapid tests. There are other “niche” POCTs including lead screening, hemoglobin A1C tests, and chemistries that could be considered by some large practices or pediatricians that manage certain type of patients (obese, inner city, etc.). The whole point of “Point of Care” is that results are available at the time of the office visit. This facilitates workflow as results available during a visit. Thus, one can treat anemia or a strep infection expeditiously. This is much better than needing to call a patient with a result from a lab, call a pharmacy to order a medication, and then update your office note. Look for some new POCTs in my year end "Best New Products for Pediatrics" article at the end of the year! pediatrics, poct, point of care tests nonadult false The Point of “Point of Care” Testing text blog pediatrics,poct,point of care tests 533 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=8151275&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_4147077_33379_8151275_ap_160X120.jpg false 0 Pediatrics 0 4846674 8151275 Member 0 http://community.modernmedicine.com/_Patient-Web-Portals/blog/4106139/33379.html One of the best features of “enterprise” level Electronic Health Records (EHRs) is that they usually integrate a patient’s electronic record with a web based “patient portal”.  I recently activated my own patient portal and needless to say I was very impressed.   Enrollment is easy.  Following a physician visit an established patient is issued an activation code which one uses to establish an online account.  Alternatively one can request an activation code from the portal’s web page and usually the activation code is sent via email within 24 hours once the information is verified.   Parents can access records of children under 12 – those over 12 establish their own private accounts and can give permission to parents to view the account if so desired When you enter the portal lots of useful information is readily available.   Listed are your current medications, summaries of recent visits, your immunizations, allergies, and health forms.  You can also message your provider, request medication refills, and even request an "e-visit" where you communicate with either the nursing staff or provider to see if an office visit is warranted.  One can request a referral, make an appointment and search an online library of information about medical issues.  Lab tests and imaging results are available as well, along with comments made by the patient’s provider. This is wonderful and will only get better.   Obviously we need to make a concerted effort to get patients enrolled.  The patient portal will significantly improve office workflow, cut down on phone tag, reduce the use of letters, reduce costs, and most likely make office visits more meaningful as many patients may be able to get adequate information about medical condition that would prevent visits for minor conditions.  From a pediatricians perspective I see an eventual development of sections of patient portals that permit screening for ADHD, developmental issues, and depression to name a few.  It is also a wonderful opportunity to integrate topic related videos, podcasts, and even offer web based classes or support groups.   Great stuff indeed. One of the best features of “enterprise” level Electronic Health Records (EHRs) is that they usually integrate a patient’s electronic record with a web based “patient portal”.  I recently activated my own patient portal and needless to say I was very impressed.   Enrollment is easy.  Following a physician visit an established patient is issued an activation code which one uses to establish an online account.  Alternatively one can request an activation code from the portal’s web page and usually the activation code is sent via email within 24 hours once the information is verified.   Parents can access records of children under 12 – those over 12 establish their own private accounts and can give permission to parents to view the account if so desired When you enter the portal lots of useful information is readily available.   Listed are your current medications, summaries of recent visits, your immunizations, allergies, and health forms.  You can also message your provider, request medication refills, and even request an "e-visit" where you communicate with either the nursing staff or provider to see if an office visit is warranted.  One can request a referral, make an appointment and search an online library of information about medical issues.  Lab tests and imaging results are available as well, along with comments made by the patient’s provider. This is wonderful and will only get better.   Obviously we need to make a concerted effort to get patients enrolled.  The patient portal will significantly improve office workflow, cut down on phone tag, reduce the use of letters, reduce costs, and most likely make office visits more meaningful as many patients may be able to get adequate information about medical condition that would prevent visits for minor conditions.  From a pediatricians perspective I see an eventual development of sections of patient portals that permit screening for ADHD, developmental issues, and depression to name a few.  It is also a wonderful opportunity to integrate topic related videos, podcasts, and even offer web based classes or support groups.   Great stuff indeed. Fri, 17 Jun 2011 19:35:29 GMT http://community.modernmedicine.com/_Patient-Web-Portals/blog/4106139/33379.html AndySchumanMD 2011-06-15T12:04:22Z Modern Medicine Community One of the best features of “enterprise” level Electronic Health Records (EHRs) is that they usually integrate a patient’s electronic record with a web based “patient portal”.  I recently activated my own patient portal and needless to say I was very impressed.   Enrollment is easy.  Following a physician visit an established patient is issued an activation code which one uses to establish an online account.  Alternatively one can request an activation code from the portal’s web page and usually the activation code is sent via email within 24 hours once the information is verified.   Parents can access records of children under 12 – those over 12 establish their own private accounts and can give permission to parents to view the account if so desired When you enter the portal lots of useful information is readily available.   Listed are your current medications, summaries of recent visits, your immunizations, allergies, and health forms.  You can also message your provider, request medication refills, and even request an "e-visit" where you communicate with either the nursing staff or provider to see if an office visit is warranted.  One can request a referral, make an appointment and search an online library of information about medical issues.  Lab tests and imaging results are available as well, along with comments made by the patient’s provider. This is wonderful and will only get better.   Obviously we need to make a concerted effort to get patients enrolled.  The patient portal will significantly improve office workflow, cut down on phone tag, reduce the use of letters, reduce costs, and most likely make office visits more meaningful as many patients may be able to get adequate information about medical condition that would prevent visits for minor conditions.  From a pediatricians perspective I see an eventual development of sections of patient portals that permit screening for ADHD, developmental issues, and depression to name a few.  It is also a wonderful opportunity to integrate topic related videos, podcasts, and even offer web based classes or support groups.   Great stuff indeed. ehrs, patient, portals nonadult false Patient Web Portals text blog ehrs,patient,portals 379 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=8151275&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_4147077_33379_8151275_ap_160X120.jpg false 0 0 4106139 8151275 Member 0 http://community.modernmedicine.com/_Pediatrics-and-34Googly-Eyes34/blog/3620083/33379.html Strange title for a blog eh? The first time I encountered the expression “googly eyes” in pediatrics was when a mother of a child with albinism used the term to describe her child’s nystagmus.  I have since used the expression to describe this sign to parents.  The second significant encounter with “googly eyes” was when I watched one of the funniest Saturday Night Live skits about a shy gardener who puts googly eyes on plants to avoid intimidation (Christopher Walken at his best). I then began to notice that when I became aware of certain issues relating to medical care and medical bureaucracy—I expressed my exasperation with the situation by rolling my eyes—it was unavoidable and involuntary, and my frustration manifested itself silently with “googly eyes”. Now I pay close attention to which situations provoke a personal googly eyed response.   There are many I’m sure you can relate to. Here are some of my favorites: Trying to order a CT or MRI study on a patient for workup of a patient with worsening HA.  To get approval by the insurance company I need to either admit the patient to the hospital or discuss the necessity of this test with a radiologist designated by the insurance company (who no doubt gets a commission for every request he/she denies). Needing to try 3 ADHD meds on a child before using the one drug with the highest likelihood of success and then needing to call an insurance company or fill out forms to request this—like I have nothing better to do with my time. Filling out long forms and prescriptions to get WIC to cover a specialty formula for a baby with prematurity or formula intolerance. The necessity of a child who needs psychiatric admission to an inpatient facility to show up at an ED to get medically cleared for admission never knowing if a bed is available. Having to literally help a patient “shop” for a specialist because not all participate in Medicaid. Having to track down stat labs which the lab puts in mistakenly as “routine”. Trying to track down a parent who provides the wrong contact phone number or has his/her phone disconnected. When a parent continually “no shows” for appointments when they have kids with significant medical problems. When a parent ignores your advice and follows that recommended by the child’s grandparents. When parents who are new to your practice forget to get the old medical records. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Strange title for a blog eh? The first time I encountered the expression “googly eyes” in pediatrics was when a mother of a child with albinism used the term to describe her child’s nystagmus.  I have since used the expression to describe this sign to parents.  The second significant encounter with “googly eyes” was when I watched one of the funniest Saturday Night Live skits about a shy gardener who puts googly eyes on plants to avoid intimidation (Christopher Walken at his best). I then began to notice that when I became aware of certain issues relating to medical care and medical bureaucracy—I expressed my exasperation with the situation by rolling my eyes—it was unavoidable and involuntary, and my frustration manifested itself silently with “googly eyes”. Now I pay close attention to which situations provoke a personal googly eyed response.   There are many I’m sure you can relate to. Here are some of my favorites: Trying to order a CT or MRI study on a patient for workup of a patient with worsening HA.  To get approval by the insurance company I need to either admit the patient to the hospital or discuss the necessity of this test with a radiologist designated by the insurance company (who no doubt gets a commission for every request he/she denies). Needing to try 3 ADHD meds on a child before using the one drug with the highest likelihood of success and then needing to call an insurance company or fill out forms to request this—like I have nothing better to do with my time. Filling out long forms and prescriptions to get WIC to cover a specialty formula for a baby with prematurity or formula intolerance. The necessity of a child who needs psychiatric admission to an inpatient facility to show up at an ED to get medically cleared for admission never knowing if a bed is available. Having to literally help a patient “shop” for a specialist because not all participate in Medicaid. Having to track down stat labs which the lab puts in mistakenly as “routine”. Trying to track down a parent who provides the wrong contact phone number or has his/her phone disconnected. When a parent continually “no shows” for appointments when they have kids with significant medical problems. When a parent ignores your advice and follows that recommended by the child’s grandparents. When parents who are new to your practice forget to get the old medical records. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Wed, 18 May 2011 20:14:28 GMT http://community.modernmedicine.com/_Pediatrics-and-34Googly-Eyes34/blog/3620083/33379.html AndySchumanMD 2011-05-16T14:40:09Z Pediatrics Modern Medicine Community Strange title for a blog eh? The first time I encountered the expression “googly eyes” in pediatrics was when a mother of a child with albinism used the term to describe her child’s nystagmus.  I have since used the expression to describe this sign to parents.  The second significant encounter with “googly eyes” was when I watched one of the funniest Saturday Night Live skits about a shy gardener who puts googly eyes on plants to avoid intimidation (Christopher Walken at his best). I then began to notice that when I became aware of certain issues relating to medical care and medical bureaucracy—I expressed my exasperation with the situation by rolling my eyes—it was unavoidable and involuntary, and my frustration manifested itself silently with “googly eyes”. Now I pay close attention to which situations provoke a personal googly eyed response.   There are many I’m sure you can relate to. Here are some of my favorites: Trying to order a CT or MRI study on a patient for workup of a patient with worsening HA.  To get approval by the insurance company I need to either admit the patient to the hospital or discuss the necessity of this test with a radiologist designated by the insurance company (who no doubt gets a commission for every request he/she denies). Needing to try 3 ADHD meds on a child before using the one drug with the highest likelihood of success and then needing to call an insurance company or fill out forms to request this—like I have nothing better to do with my time. Filling out long forms and prescriptions to get WIC to cover a specialty formula for a baby with prematurity or formula intolerance. The necessity of a child who needs psychiatric admission to an inpatient facility to show up at an ED to get medically cleared for admission never knowing if a bed is available. Having to literally help a patient “shop” for a specialist because not all participate in Medicaid. Having to track down stat labs which the lab puts in mistakenly as “routine”. Trying to track down a parent who provides the wrong contact phone number or has his/her phone disconnected. When a parent continually “no shows” for appointments when they have kids with significant medical problems. When a parent ignores your advice and follows that recommended by the child’s grandparents. When parents who are new to your practice forget to get the old medical records. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] care, pediatrics, primary nonadult false Pediatrics and "Googly Eyes" text blog care,pediatrics,primary 507 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=8151275&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_4147077_33379_8151275_ap_160X120.jpg false 0 Pediatrics 0 3620083 8151275 Member 0 http://community.modernmedicine.com/_EHRs-A-Tale-of-Two-Clinics/blog/3467428/33379.html Many of my previous blogs have focused on the electronic healthcare record. I was an early adopter (at least among my pediatric colleagues) when it came to EHRs, and have been writing about their potential for years. I am admittedly very opinionated regarding their benefits, as well as their shortcomings. This month I have an interesting tale to tell of the recent experiences of two of my close friends who, over the past few weeks, have participated in radically different EHR “transitions”. Friend number one works at a clinic affiliated with a medical center that, after months of preparation, just went live with a multimillion dollar “Enterprise” level EHR. To prepare for the transition, all medical and support staff attended many hours of classroom training where they practiced with the new system. When the day of change arrived, things did not go well. Despite all the planning and preparation, staff had difficulty navigating the EHR, writing notes, ordering labs, x-rays and diagnostic tests, and communicating with each other. The reason for the difficulties was due to the complicated nature of the EHR itself as the interface is not intuitive, with hundreds of buttons (many unlabeled) and navigation is unwieldy in that lots of typing and mouse maneuvering is needed for what should require just a few clicks or keystrokes. Surely the situation will improve with time, but my friend seriously thinks that his productivity will never be on par with what it was before the transition. He tells me he is now considering an early retirement. In contrast, friend number 2 works in a community clinic that used a “borrowed” EHR for over a year. Unfortunately, funding did not materialize for the facility’s own EHR. With just over a month’s notice the clinic went from an EHR back to a paper charting system. The hardest part of this backward transition was the time spent in printing information from the EHR to be included in the paper record, and assembling the charts themselves. Now physicians dictate their notes, or write or type notes to be included in the paper charts. My friend likes the change as this transition has actually made him more productive. There are downsides of course, as all prescriptions are now hand written. It is also a chore to maintain accurate problem and medication lists, and some physician’s handwriting borders on legibility. He is impressed by how easy it is just to flip through recent notes in a paper record—much more user friendly than any EHR system he has ever used! What does the above say about the current state of EHRs? Clearly when it comes to EHRs, more is not better and administrators need to involve physicians in the EHR acquisition process. One should also not assume that a million dollar EHR is superior to one costing thousands. Sadly most of our current EHRs still can’t compete with paper charting systems in terms of usability, and most EHRs unfortunately negatively impact productivity. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Many of my previous blogs have focused on the electronic healthcare record. I was an early adopter (at least among my pediatric colleagues) when it came to EHRs, and have been writing about their potential for years. I am admittedly very opinionated regarding their benefits, as well as their shortcomings. This month I have an interesting tale to tell of the recent experiences of two of my close friends who, over the past few weeks, have participated in radically different EHR “transitions”. Friend number one works at a clinic affiliated with a medical center that, after months of preparation, just went live with a multimillion dollar “Enterprise” level EHR. To prepare for the transition, all medical and support staff attended many hours of classroom training where they practiced with the new system. When the day of change arrived, things did not go well. Despite all the planning and preparation, staff had difficulty navigating the EHR, writing notes, ordering labs, x-rays and diagnostic tests, and communicating with each other. The reason for the difficulties was due to the complicated nature of the EHR itself as the interface is not intuitive, with hundreds of buttons (many unlabeled) and navigation is unwieldy in that lots of typing and mouse maneuvering is needed for what should require just a few clicks or keystrokes. Surely the situation will improve with time, but my friend seriously thinks that his productivity will never be on par with what it was before the transition. He tells me he is now considering an early retirement. In contrast, friend number 2 works in a community clinic that used a “borrowed” EHR for over a year. Unfortunately, funding did not materialize for the facility’s own EHR. With just over a month’s notice the clinic went from an EHR back to a paper charting system. The hardest part of this backward transition was the time spent in printing information from the EHR to be included in the paper record, and assembling the charts themselves. Now physicians dictate their notes, or write or type notes to be included in the paper charts. My friend likes the change as this transition has actually made him more productive. There are downsides of course, as all prescriptions are now hand written. It is also a chore to maintain accurate problem and medication lists, and some physician’s handwriting borders on legibility. He is impressed by how easy it is just to flip through recent notes in a paper record—much more user friendly than any EHR system he has ever used! What does the above say about the current state of EHRs? Clearly when it comes to EHRs, more is not better and administrators need to involve physicians in the EHR acquisition process. One should also not assume that a million dollar EHR is superior to one costing thousands. Sadly most of our current EHRs still can’t compete with paper charting systems in terms of usability, and most EHRs unfortunately negatively impact productivity. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] Fri, 29 Apr 2011 15:50:52 GMT http://community.modernmedicine.com/_EHRs-A-Tale-of-Two-Clinics/blog/3467428/33379.html AndySchumanMD 2011-04-16T11:28:05Z Pediatrics Modern Medicine Community Many of my previous blogs have focused on the electronic healthcare record. I was an early adopter (at least among my pediatric colleagues) when it came to EHRs, and have been writing about their potential for years. I am admittedly very opinionated regarding their benefits, as well as their shortcomings. This month I have an interesting tale to tell of the recent experiences of two of my close friends who, over the past few weeks, have participated in radically different EHR “transitions”. Friend number one works at a clinic affiliated with a medical center that, after months of preparation, just went live with a multimillion dollar “Enterprise” level EHR. To prepare for the transition, all medical and support staff attended many hours of classroom training where they practiced with the new system. When the day of change arrived, things did not go well. Despite all the planning and preparation, staff had difficulty navigating the EHR, writing notes, ordering labs, x-rays and diagnostic tests, and communicating with each other. The reason for the difficulties was due to the complicated nature of the EHR itself as the interface is not intuitive, with hundreds of buttons (many unlabeled) and navigation is unwieldy in that lots of typing and mouse maneuvering is needed for what should require just a few clicks or keystrokes. Surely the situation will improve with time, but my friend seriously thinks that his productivity will never be on par with what it was before the transition. He tells me he is now considering an early retirement. In contrast, friend number 2 works in a community clinic that used a “borrowed” EHR for over a year. Unfortunately, funding did not materialize for the facility’s own EHR. With just over a month’s notice the clinic went from an EHR back to a paper charting system. The hardest part of this backward transition was the time spent in printing information from the EHR to be included in the paper record, and assembling the charts themselves. Now physicians dictate their notes, or write or type notes to be included in the paper charts. My friend likes the change as this transition has actually made him more productive. There are downsides of course, as all prescriptions are now hand written. It is also a chore to maintain accurate problem and medication lists, and some physician’s handwriting borders on legibility. He is impressed by how easy it is just to flip through recent notes in a paper record—much more user friendly than any EHR system he has ever used! What does the above say about the current state of EHRs? Clearly when it comes to EHRs, more is not better and administrators need to involve physicians in the EHR acquisition process. One should also not assume that a million dollar EHR is superior to one costing thousands. Sadly most of our current EHRs still can’t compete with paper charting systems in terms of usability, and most EHRs unfortunately negatively impact productivity. [Editor’s Note: Do you have any thoughts to share on this topic? Please Log in to use the Comment box below.] care, ehrs, emrs, pediatrics, primary nonadult false EHRs: A Tale of Two Clinics text blog care,ehrs,emrs,pediatrics,primary 554 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=8151275&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_4147077_33379_8151275_ap_160X120.jpg false 0 Pediatrics 0 3467428 8151275 Member 0 http://community.modernmedicine.com/_Outpatient-Management-of-Bronchiolitis-Art-Vs-Science/blog/3384582/33379.html As Julia McMillan MD, Editor-in-Chief of Contemporary Pediatrics, noted in her February 2011 editorial, despite decades of research medical science has produced little effective therapies for bronchiolitis, the most common viral respiratory tract infection affecting infants and children. The article on bronchiolitis in the same issue highlights diagnostic and treatment options, and discusses in detail some promising studies suggesting that nebulized hypertonic saline may prove to have some benefit in bronchiolitis management. It is interesting that most articles discussing bronchiolitis have focused on inpatient management of severe disease. Those of us who practice in pediatric offices and clinics see infants with bronchiolitis frequently, yet only a small fraction of those we see get admitted to the hospital for more aggressive management. The question arises: are the outpatient measures implemented by pediatricians of any value in improving the symptoms of bronchiolitis and at some level instrumental in preventing hospitalization? We’d like to think that our interventions do make a difference but, according to the literature, the only thing that works is supportive care with fluids and humidified oxygen. These are not very exciting interventions after decades of research. In the office environment when we evaluate an infant with clinical symptoms of bronchiolitis, we take into account predisposing factors that would make the child a good candidate for hospitalization, such as prematurity, congenital heart disease, or bronchopulmonary dysplasia. We evaluate hydration status via history and exam, and evaluate work of breathing and oxygenation with pulse oximetry. We also try to determine if we are seeing the infant early in the course of the disease (therefore perhaps at risk for getting worse) or late in the course of the disease (and likely improving) Most routine “wheezing” infants with worrisome oxygen saturation readings typically get a trial of nebulized albuterol (or racemic epinephrine). If I were to generalize, those who improve with nebulization don’t get hospitalized while those who don’t improve are considered potential candidates for hospitalization. The majority of infants presenting with bronchiolitis don’t require hospitalization. Mildly ill infants are treated with oral hydration and mist, while moderately ill infants get sent home with nebulizers. I prescribe antibiotics if a secondary bacterial pneumonia is suspected or an otitis media is seen on exam. I am guilty of using steroids in an infant with bronchiolitis who clinically responds to nebulized albuterol, despite the studies that indicate these are of little value. In so many ways this large subset of infants acts like older children with reactive airway disease. When I see these patients in follow up, usually the next day, I am amazed by how many of my patients have dramatically improved. I find it hard to believe that the child would have improved so strikingly without the interventions I implemented. What it comes down to is this: like many of my colleagues, as long as my therapeutics pose little risk of harm I most likely will continue my current practice, until such time that medical research succeeds in finding an oral antiviral that cures bronchiolitis. I suspect that we may have long to wait! As Julia McMillan MD, Editor-in-Chief of Contemporary Pediatrics, noted in her February 2011 editorial, despite decades of research medical science has produced little effective therapies for bronchiolitis, the most common viral respiratory tract infection affecting infants and children. The article on bronchiolitis in the same issue highlights diagnostic and treatment options, and discusses in detail some promising studies suggesting that nebulized hypertonic saline may prove to have some benefit in bronchiolitis management. It is interesting that most articles discussing bronchiolitis have focused on inpatient management of severe disease. Those of us who practice in pediatric offices and clinics see infants with bronchiolitis frequently, yet only a small fraction of those we see get admitted to the hospital for more aggressive management. The question arises: are the outpatient measures implemented by pediatricians of any value in improving the symptoms of bronchiolitis and at some level instrumental in preventing hospitalization? We’d like to think that our interventions do make a difference but, according to the literature, the only thing that works is supportive care with fluids and humidified oxygen. These are not very exciting interventions after decades of research. In the office environment when we evaluate an infant with clinical symptoms of bronchiolitis, we take into account predisposing factors that would make the child a good candidate for hospitalization, such as prematurity, congenital heart disease, or bronchopulmonary dysplasia. We evaluate hydration status via history and exam, and evaluate work of breathing and oxygenation with pulse oximetry. We also try to determine if we are seeing the infant early in the course of the disease (therefore perhaps at risk for getting worse) or late in the course of the disease (and likely improving) Most routine “wheezing” infants with worrisome oxygen saturation readings typically get a trial of nebulized albuterol (or racemic epinephrine). If I were to generalize, those who improve with nebulization don’t get hospitalized while those who don’t improve are considered potential candidates for hospitalization. The majority of infants presenting with bronchiolitis don’t require hospitalization. Mildly ill infants are treated with oral hydration and mist, while moderately ill infants get sent home with nebulizers. I prescribe antibiotics if a secondary bacterial pneumonia is suspected or an otitis media is seen on exam. I am guilty of using steroids in an infant with bronchiolitis who clinically responds to nebulized albuterol, despite the studies that indicate these are of little value. In so many ways this large subset of infants acts like older children with reactive airway disease. When I see these patients in follow up, usually the next day, I am amazed by how many of my patients have dramatically improved. I find it hard to believe that the child would have improved so strikingly without the interventions I implemented. What it comes down to is this: like many of my colleagues, as long as my therapeutics pose little risk of harm I most likely will continue my current practice, until such time that medical research succeeds in finding an oral antiviral that cures bronchiolitis. I suspect that we may have long to wait! Wed, 16 Mar 2011 15:40:11 GMT http://community.modernmedicine.com/_Outpatient-Management-of-Bronchiolitis-Art-Vs-Science/blog/3384582/33379.html AndySchumanMD 2011-03-13T22:55:22Z Pediatrics Modern Medicine Community As Julia McMillan MD, Editor-in-Chief of Contemporary Pediatrics, noted in her February 2011 editorial, despite decades of research medical science has produced little effective therapies for bronchiolitis, the most common viral respiratory tract infection affecting infants and children. The article on bronchiolitis in the same issue highlights diagnostic and treatment options, and discusses in detail some promising studies suggesting that nebulized hypertonic saline may prove to have some benefit in bronchiolitis management. It is interesting that most articles discussing bronchiolitis have focused on inpatient management of severe disease. Those of us who practice in pediatric offices and clinics see infants with bronchiolitis frequently, yet only a small fraction of those we see get admitted to the hospital for more aggressive management. The question arises: are the outpatient measures implemented by pediatricians of any value in improving the symptoms of bronchiolitis and at some level instrumental in preventing hospitalization? We’d like to think that our interventions do make a difference but, according to the literature, the only thing that works is supportive care with fluids and humidified oxygen. These are not very exciting interventions after decades of research. In the office environment when we evaluate an infant with clinical symptoms of bronchiolitis, we take into account predisposing factors that would make the child a good candidate for hospitalization, such as prematurity, congenital heart disease, or bronchopulmonary dysplasia. We evaluate hydration status via history and exam, and evaluate work of breathing and oxygenation with pulse oximetry. We also try to determine if we are seeing the infant early in the course of the disease (therefore perhaps at risk for getting worse) or late in the course of the disease (and likely improving) Most routine “wheezing” infants with worrisome oxygen saturation readings typically get a trial of nebulized albuterol (or racemic epinephrine). If I were to generalize, those who improve with nebulization don’t get hospitalized while those who don’t improve are considered potential candidates for hospitalization. The majority of infants presenting with bronchiolitis don’t require hospitalization. Mildly ill infants are treated with oral hydration and mist, while moderately ill infants get sent home with nebulizers. I prescribe antibiotics if a secondary bacterial pneumonia is suspected or an otitis media is seen on exam. I am guilty of using steroids in an infant with bronchiolitis who clinically responds to nebulized albuterol, despite the studies that indicate these are of little value. In so many ways this large subset of infants acts like older children with reactive airway disease. When I see these patients in follow up, usually the next day, I am amazed by how many of my patients have dramatically improved. I find it hard to believe that the child would have improved so strikingly without the interventions I implemented. What it comes down to is this: like many of my colleagues, as long as my therapeutics pose little risk of harm I most likely will continue my current practice, until such time that medical research succeeds in finding an oral antiviral that cures bronchiolitis. I suspect that we may have long to wait! bronchiolitis, pediatrics nonadult false Outpatient Management of Bronchiolitis: Art Vs. Science text blog bronchiolitis,pediatrics 450 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=8151275&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_4147077_33379_8151275_ap_160X120.jpg false 1 Pediatrics 0 3384582 8151275 Member 0 http://community.modernmedicine.com/_So-many-clicks-and-so-little-time/blog/3316104/33379.html Last month I expressed my belief that physicians should revise the way we document patient visits. An astute reader (astute because he agreed with me) commented that he spends more time on documenting patients’ visits in his EMR, to justify the level of service provided, than he actually spends talking with the parents and examining the child. A friend told me that he recently spent many hours in training to prepare for the roll-out of a new “state of the art” enterprise EMR his organization will soon implement. He told me that while the EMR is extremely comprehensive, it is also very complicated—with hundreds of icons, links, and buttons. To complete a patient visit his nursing staff must spend considerable time verifying medications, allergies, diagnoses, problem lists, recording family and past medical history, and entering the patient’s vital signs. Physicians must document the history of present illness, order labs and diagnostic tests, write prescriptions, referrals, prepare handouts, arrange for follow up visits, and bill for the visit by assigning an appropriate level of service. By his estimate a typical visit would require no less than 75 to 100 mouse clicks even using integrated macros and templates, and will take perhaps twice as long as it does with his current “basic” EMR. With the new EMR - If he sees twenty patients a day, that’s at minimum 1000 mouse clicks. Just thinking about this makes my fingers hurt….  So given the current state of the art EMRs there seems to be an inverse relationship between the number of clicks that must be used to document in an EMR and the ease with which an EMR can be used to document a visit. I think most of us would gladly sacrifice EMR capability for ease of use. Why? We relish “simplicity”. We like devices with few, clearly labeled buttons, and eschew those whose interfaces are complex and confusing. The reward for simplicity has always been improvement in time management, which in the physician office translates into quality time spent with patients and less time in front of a computer. Last month I expressed my belief that physicians should revise the way we document patient visits. An astute reader (astute because he agreed with me) commented that he spends more time on documenting patients’ visits in his EMR, to justify the level of service provided, than he actually spends talking with the parents and examining the child. A friend told me that he recently spent many hours in training to prepare for the roll-out of a new “state of the art” enterprise EMR his organization will soon implement. He told me that while the EMR is extremely comprehensive, it is also very complicated—with hundreds of icons, links, and buttons. To complete a patient visit his nursing staff must spend considerable time verifying medications, allergies, diagnoses, problem lists, recording family and past medical history, and entering the patient’s vital signs. Physicians must document the history of present illness, order labs and diagnostic tests, write prescriptions, referrals, prepare handouts, arrange for follow up visits, and bill for the visit by assigning an appropriate level of service. By his estimate a typical visit would require no less than 75 to 100 mouse clicks even using integrated macros and templates, and will take perhaps twice as long as it does with his current “basic” EMR. With the new EMR - If he sees twenty patients a day, that’s at minimum 1000 mouse clicks. Just thinking about this makes my fingers hurt….  So given the current state of the art EMRs there seems to be an inverse relationship between the number of clicks that must be used to document in an EMR and the ease with which an EMR can be used to document a visit. I think most of us would gladly sacrifice EMR capability for ease of use. Why? We relish “simplicity”. We like devices with few, clearly labeled buttons, and eschew those whose interfaces are complex and confusing. The reward for simplicity has always been improvement in time management, which in the physician office translates into quality time spent with patients and less time in front of a computer. Wed, 23 Feb 2011 15:59:49 GMT http://community.modernmedicine.com/_So-many-clicks-and-so-little-time/blog/3316104/33379.html AndySchumanMD 2011-02-16T04:28:38Z Pediatrics Modern Medicine Community Last month I expressed my belief that physicians should revise the way we document patient visits. An astute reader (astute because he agreed with me) commented that he spends more time on documenting patients’ visits in his EMR, to justify the level of service provided, than he actually spends talking with the parents and examining the child. A friend told me that he recently spent many hours in training to prepare for the roll-out of a new “state of the art” enterprise EMR his organization will soon implement. He told me that while the EMR is extremely comprehensive, it is also very complicated—with hundreds of icons, links, and buttons. To complete a patient visit his nursing staff must spend considerable time verifying medications, allergies, diagnoses, problem lists, recording family and past medical history, and entering the patient’s vital signs. Physicians must document the history of present illness, order labs and diagnostic tests, write prescriptions, referrals, prepare handouts, arrange for follow up visits, and bill for the visit by assigning an appropriate level of service. By his estimate a typical visit would require no less than 75 to 100 mouse clicks even using integrated macros and templates, and will take perhaps twice as long as it does with his current “basic” EMR. With the new EMR - If he sees twenty patients a day, that’s at minimum 1000 mouse clicks. Just thinking about this makes my fingers hurt….  So given the current state of the art EMRs there seems to be an inverse relationship between the number of clicks that must be used to document in an EMR and the ease with which an EMR can be used to document a visit. I think most of us would gladly sacrifice EMR capability for ease of use. Why? We relish “simplicity”. We like devices with few, clearly labeled buttons, and eschew those whose interfaces are complex and confusing. The reward for simplicity has always been improvement in time management, which in the physician office translates into quality time spent with patients and less time in front of a computer. emr, pediatrics nonadult false “So many clicks, and so little time….” text blog emr,pediatrics 496 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=8151275&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_4147077_33379_8151275_ap_160X120.jpg false 0 Pediatrics 0 3316104 8151275 Member 0 http://community.modernmedicine.com/_Time-to-Rethink-Physician-Documentation/blog/3239718/33379.html As I work in several different medical “environments,” I have an opportunity to use a variety of different electronic healthcare records on a daily basis. Compared to the day when we used paper charts in our clinics, productivity is down, physician charts (when completed) are legible and often quite detailed, and the chatter of providers talking to patients and each other has been replaced by the soft clicking of keyboards. Clearly EHR adaptation has been a mixed bag. When I used paper charts in clinic before we adopted an EHR, we migrated from SOAP notes to a modified checklist SOAP note that expedited the completion of provider documentation. Generally these kept our notes brief, problem focused, and were only as long as they needed to be. Prescriptions were completed by hand and given to patients, and a super bill provided to the patient facilitated checkout, rescheduling, specialist referrals, diagnostic studies, and billing. EHRs are undoubtedly better at organizing information, generating problem lists, and tracking medications than paper charts, but these need to be maintained. And while we always assumed EHRs would eliminate medical errors, the legibility errors have been replaced with other types of significant medical errors. It is easy to document in the wrong record, generate incorrect scripts, enter inaccurate lab values, and write dangerous medical orders with computer systems. These problems are compounded by the fact that we have a long way to go before the medical care system has completely converted to a digital system. By this I mean we straddle an “analog” (paper based) and digital (computer based) medical information system. We use our computers to generate paper prescriptions, lab orders, referral requests, etc. which takes time and adds more opportunities to generate errors. While we are waiting for the standardization of all medical electronic communication perhaps the best thing we can do is rethink how we need to document medical encounters and perfect a new type of medical record. We need to eliminate insurance compensation based on documentation and one based on diagnosis and time. We need to have EHRs that facilitate corroboration of medications, past and family history and demographic information and reviews of systems. This should be done by the patient while he or she is waiting to be seen, with the information confirmed by nurses or medical assistants when the patient if prepared to be seen by the physician. >When a patient interacts with a physician, time is only spent on discussing the reasons for the visit with only pertinent positives and negatives recorded, perhaps organized in a checklist, minimizing usage of text. By evolving a new way to document medical encounters we can achieve those things that EHRs were designed to do—speed visits, improve accuracy, reduce medical errors, and enhance patient satisfaction.  As I work in several different medical “environments,” I have an opportunity to use a variety of different electronic healthcare records on a daily basis. Compared to the day when we used paper charts in our clinics, productivity is down, physician charts (when completed) are legible and often quite detailed, and the chatter of providers talking to patients and each other has been replaced by the soft clicking of keyboards. Clearly EHR adaptation has been a mixed bag. When I used paper charts in clinic before we adopted an EHR, we migrated from SOAP notes to a modified checklist SOAP note that expedited the completion of provider documentation. Generally these kept our notes brief, problem focused, and were only as long as they needed to be. Prescriptions were completed by hand and given to patients, and a super bill provided to the patient facilitated checkout, rescheduling, specialist referrals, diagnostic studies, and billing. EHRs are undoubtedly better at organizing information, generating problem lists, and tracking medications than paper charts, but these need to be maintained. And while we always assumed EHRs would eliminate medical errors, the legibility errors have been replaced with other types of significant medical errors. It is easy to document in the wrong record, generate incorrect scripts, enter inaccurate lab values, and write dangerous medical orders with computer systems. These problems are compounded by the fact that we have a long way to go before the medical care system has completely converted to a digital system. By this I mean we straddle an “analog” (paper based) and digital (computer based) medical information system. We use our computers to generate paper prescriptions, lab orders, referral requests, etc. which takes time and adds more opportunities to generate errors. While we are waiting for the standardization of all medical electronic communication perhaps the best thing we can do is rethink how we need to document medical encounters and perfect a new type of medical record. We need to eliminate insurance compensation based on documentation and one based on diagnosis and time. We need to have EHRs that facilitate corroboration of medications, past and family history and demographic information and reviews of systems. This should be done by the patient while he or she is waiting to be seen, with the information confirmed by nurses or medical assistants when the patient if prepared to be seen by the physician. >When a patient interacts with a physician, time is only spent on discussing the reasons for the visit with only pertinent positives and negatives recorded, perhaps organized in a checklist, minimizing usage of text. By evolving a new way to document medical encounters we can achieve those things that EHRs were designed to do—speed visits, improve accuracy, reduce medical errors, and enhance patient satisfaction.  Thu, 20 Jan 2011 17:47:39 GMT http://community.modernmedicine.com/_Time-to-Rethink-Physician-Documentation/blog/3239718/33379.html AndySchumanMD 2011-01-14T18:34:10Z Modern Medicine Community As I work in several different medical “environments,” I have an opportunity to use a variety of different electronic healthcare records on a daily basis. Compared to the day when we used paper charts in our clinics, productivity is down, physician charts (when completed) are legible and often quite detailed, and the chatter of providers talking to patients and each other has been replaced by the soft clicking of keyboards. Clearly EHR adaptation has been a mixed bag. When I used paper charts in clinic before we adopted an EHR, we migrated from SOAP notes to a modified checklist SOAP note that expedited the completion of provider documentation. Generally these kept our notes brief, problem focused, and were only as long as they needed to be. Prescriptions were completed by hand and given to patients, and a super bill provided to the patient facilitated checkout, rescheduling, specialist referrals, diagnostic studies, and billing. EHRs are undoubtedly better at organizing information, generating problem lists, and tracking medications than paper charts, but these need to be maintained. And while we always assumed EHRs would eliminate medical errors, the legibility errors have been replaced with other types of significant medical errors. It is easy to document in the wrong record, generate incorrect scripts, enter inaccurate lab values, and write dangerous medical orders with computer systems. These problems are compounded by the fact that we have a long way to go before the medical care system has completely converted to a digital system. By this I mean we straddle an “analog” (paper based) and digital (computer based) medical information system. We use our computers to generate paper prescriptions, lab orders, referral requests, etc. which takes time and adds more opportunities to generate errors. While we are waiting for the standardization of all medical electronic communication perhaps the best thing we can do is rethink how we need to document medical encounters and perfect a new type of medical record. We need to eliminate insurance compensation based on documentation and one based on diagnosis and time. We need to have EHRs that facilitate corroboration of medications, past and family history and demographic information and reviews of systems. This should be done by the patient while he or she is waiting to be seen, with the information confirmed by nurses or medical assistants when the patient if prepared to be seen by the physician. >When a patient interacts with a physician, time is only spent on discussing the reasons for the visit with only pertinent positives and negatives recorded, perhaps organized in a checklist, minimizing usage of text. By evolving a new way to document medical encounters we can achieve those things that EHRs were designed to do—speed visits, improve accuracy, reduce medical errors, and enhance patient satisfaction.  nonadult false Time to Rethink Physician Documentation? text blog 521 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=8151275&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_4147077_33379_8151275_ap_160X120.jpg false 2 0 3239718 8151275 Member 0 http://community.modernmedicine.com/_A-Mans-Got-to-Know-His-Limitations/blog/3093773/33379.html   Pediatricians come in all shapes and sizes and vary considerably in our knowledge base and clinical capabilities. We come out of residency with core competencies and continue to hone our diagnostic and therapeutic abilities over the course of our careers. Pediatricians have a unique and challenging avocation where there is always “on the job training”. Perhaps the most important concept we all eventually learn is reflected in the immortal words of Harry Callahan in Magnum Force who reflected “A man’s got to know his limitations!”  What this means for pediatricians is that we each need to determine our level of comfort when confronted with diagnostic dilemmas, and know when (and how) to ask for assistance. That assistance may come from a simple conversation with colleagues, a phone call to a consultant, or an expedited referral to a pediatric specialist. We also know how to evaluate options when they vary in regards to patient management.  The pediatricians I most respect are those who are not embarrassed to admit to a patient that "they do not know" the diagnosis - but can facilitate the best care by expediting referral to the appropriate specialist. The most book-smart pediatricians are not necessarily the best doctors.  Pediatricians need to be humble enough to admit that they make mistakes – but wise enough to be able to learn from them. Throughout our careers we learn from lectures, mentors, reading, and investigation. I always read consultant notes carefully because this is how I am made aware of current diagnostic criteria and therapeutic modalities.   I’ve learned over time that experience is the best teacher of all, and we should strive to learn at least “one new thing” every day. By recognizing and acknowledging our limitations, we provide our patients with the best care, and are given opportunities to become better pediatricians, one referral at a time.        Pediatricians come in all shapes and sizes and vary considerably in our knowledge base and clinical capabilities. We come out of residency with core competencies and continue to hone our diagnostic and therapeutic abilities over the course of our careers. Pediatricians have a unique and challenging avocation where there is always “on the job training”. Perhaps the most important concept we all eventually learn is reflected in the immortal words of Harry Callahan in Magnum Force who reflected “A man’s got to know his limitations!”  What this means for pediatricians is that we each need to determine our level of comfort when confronted with diagnostic dilemmas, and know when (and how) to ask for assistance. That assistance may come from a simple conversation with colleagues, a phone call to a consultant, or an expedited referral to a pediatric specialist. We also know how to evaluate options when they vary in regards to patient management.  The pediatricians I most respect are those who are not embarrassed to admit to a patient that "they do not know" the diagnosis - but can facilitate the best care by expediting referral to the appropriate specialist. The most book-smart pediatricians are not necessarily the best doctors.  Pediatricians need to be humble enough to admit that they make mistakes – but wise enough to be able to learn from them. Throughout our careers we learn from lectures, mentors, reading, and investigation. I always read consultant notes carefully because this is how I am made aware of current diagnostic criteria and therapeutic modalities.   I’ve learned over time that experience is the best teacher of all, and we should strive to learn at least “one new thing” every day. By recognizing and acknowledging our limitations, we provide our patients with the best care, and are given opportunities to become better pediatricians, one referral at a time.      Wed, 15 Dec 2010 20:47:23 GMT http://community.modernmedicine.com/_A-Mans-Got-to-Know-His-Limitations/blog/3093773/33379.html AndySchumanMD 2010-12-13T11:37:25Z Modern Medicine Community   Pediatricians come in all shapes and sizes and vary considerably in our knowledge base and clinical capabilities. We come out of residency with core competencies and continue to hone our diagnostic and therapeutic abilities over the course of our careers. Pediatricians have a unique and challenging avocation where there is always “on the job training”. Perhaps the most important concept we all eventually learn is reflected in the immortal words of Harry Callahan in Magnum Force who reflected “A man’s got to know his limitations!”  What this means for pediatricians is that we each need to determine our level of comfort when confronted with diagnostic dilemmas, and know when (and how) to ask for assistance. That assistance may come from a simple conversation with colleagues, a phone call to a consultant, or an expedited referral to a pediatric specialist. We also know how to evaluate options when they vary in regards to patient management.  The pediatricians I most respect are those who are not embarrassed to admit to a patient that "they do not know" the diagnosis - but can facilitate the best care by expediting referral to the appropriate specialist. The most book-smart pediatricians are not necessarily the best doctors.  Pediatricians need to be humble enough to admit that they make mistakes – but wise enough to be able to learn from them. Throughout our careers we learn from lectures, mentors, reading, and investigation. I always read consultant notes carefully because this is how I am made aware of current diagnostic criteria and therapeutic modalities.   I’ve learned over time that experience is the best teacher of all, and we should strive to learn at least “one new thing” every day. By recognizing and acknowledging our limitations, we provide our patients with the best care, and are given opportunities to become better pediatricians, one referral at a time.      nonadult false "A Man's Got to Know His Limitations!" text blog 261 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=8151275&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_4147077_33379_8151275_ap_160X120.jpg false 0 0 3093773 8151275 Member 0 http://community.modernmedicine.com/_New-Resuscitation-Guidelines/blog/2966817/33379.html In this month’s issue of Contemporary Pediatrics I detail some of the changes in the latest American Heart Association (AHA) guidelines for pediatric resuscitation.  Every five years, after the AHA reviews new research studies from around the world, the current guidelines change to reflect our current understanding of resuscitation science.  This year the changes are substantial, and will require pediatricians and nurses to learn new concepts and skills and be prepared to put them into practice. Of particular note is that the new Pediatric Basic and Advanced Life Support guidelines continue to emphasize the importance of chest compressions, and this time around we have a new sequence of resuscitation that begins with compressions, followed by opening the airway and administering rescue breaths.  Compressions are given at a rate of 100 compressions per minute or faster, and there are new recommendations regarding the depth of compressions.   Pediatricians who regularly attend newborn deliveries will need to become familiar with a number of new recommendations.  Firstly we bulb suction secretions from the airway only if there is airway obstruction, term babies are resuscitated initially with room air, and oxygen administration is guided by pulse oximetry rather than color.  Additional recommendations include delayed cord clamping and consideration of hypothermia for the management of newborns with birth asphyxia. As in the past it will take training, patience and practice to become facile with the new recommendations.  The Pediatric Advanced Life Support (PALS) and Neonatal Resuscitation Courses (NRP) are updating their textbooks and media resources and will begin teaching the new guidelines next year. In the meanwhile you might consider developing a plan for your office or hospital that will help transition providers in adopting the new recommendations.    In this month’s issue of Contemporary Pediatrics I detail some of the changes in the latest American Heart Association (AHA) guidelines for pediatric resuscitation.  Every five years, after the AHA reviews new research studies from around the world, the current guidelines change to reflect our current understanding of resuscitation science.  This year the changes are substantial, and will require pediatricians and nurses to learn new concepts and skills and be prepared to put them into practice. Of particular note is that the new Pediatric Basic and Advanced Life Support guidelines continue to emphasize the importance of chest compressions, and this time around we have a new sequence of resuscitation that begins with compressions, followed by opening the airway and administering rescue breaths.  Compressions are given at a rate of 100 compressions per minute or faster, and there are new recommendations regarding the depth of compressions.   Pediatricians who regularly attend newborn deliveries will need to become familiar with a number of new recommendations.  Firstly we bulb suction secretions from the airway only if there is airway obstruction, term babies are resuscitated initially with room air, and oxygen administration is guided by pulse oximetry rather than color.  Additional recommendations include delayed cord clamping and consideration of hypothermia for the management of newborns with birth asphyxia. As in the past it will take training, patience and practice to become facile with the new recommendations.  The Pediatric Advanced Life Support (PALS) and Neonatal Resuscitation Courses (NRP) are updating their textbooks and media resources and will begin teaching the new guidelines next year. In the meanwhile you might consider developing a plan for your office or hospital that will help transition providers in adopting the new recommendations.    Wed, 24 Nov 2010 17:54:38 GMT http://community.modernmedicine.com/_New-Resuscitation-Guidelines/blog/2966817/33379.html AndySchumanMD 2010-11-14T11:35:38Z Pediatrics Modern Medicine Community In this month’s issue of Contemporary Pediatrics I detail some of the changes in the latest American Heart Association (AHA) guidelines for pediatric resuscitation.  Every five years, after the AHA reviews new research studies from around the world, the current guidelines change to reflect our current understanding of resuscitation science.  This year the changes are substantial, and will require pediatricians and nurses to learn new concepts and skills and be prepared to put them into practice. Of particular note is that the new Pediatric Basic and Advanced Life Support guidelines continue to emphasize the importance of chest compressions, and this time around we have a new sequence of resuscitation that begins with compressions, followed by opening the airway and administering rescue breaths.  Compressions are given at a rate of 100 compressions per minute or faster, and there are new recommendations regarding the depth of compressions.   Pediatricians who regularly attend newborn deliveries will need to become familiar with a number of new recommendations.  Firstly we bulb suction secretions from the airway only if there is airway obstruction, term babies are resuscitated initially with room air, and oxygen administration is guided by pulse oximetry rather than color.  Additional recommendations include delayed cord clamping and consideration of hypothermia for the management of newborns with birth asphyxia. As in the past it will take training, patience and practice to become facile with the new recommendations.  The Pediatric Advanced Life Support (PALS) and Neonatal Resuscitation Courses (NRP) are updating their textbooks and media resources and will begin teaching the new guidelines next year. In the meanwhile you might consider developing a plan for your office or hospital that will help transition providers in adopting the new recommendations.    advanced life support, guidelines, neonatal resuscitation courses, nrp, pals, pediatrics, resuscitation nonadult false New Resuscitation Guidelines text blog advanced life support,guidelines,neonatal resuscitation courses,nrp,pals,pediatrics,resuscitation 466 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=8151275&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_4147077_33379_8151275_ap_160X120.jpg false 0 Pediatrics 0 2966817 8151275 Member 0 http://community.modernmedicine.com/_Dont-I-know-you-In-Praise-of-Pediatricians/blog/2758313/33379.html There are about 60,000 doctors in the United States who currently have dedicated themselves to practicing pediatric medicine. We practice our craft quietly, humbly, with little recognition from our colleagues in other specialties. In the hierarchy of medical practitioners, we will never receive the professional stature of the brain or cardiac surgeon, and many specialists earn much more than we do. Few of us appear regularly on television as guests, and few if any television dramas have featured pediatricians as a main character. There are no trading cards featuring noted pediatricians, and only a tiny minority of my patients tell me they’d like to grow up to be a pediatrician. Yet, despite the fact that I will never be a role model, or become rich or famous—I am always grateful that I chose to become a pediatrician. As a “blue collar” physician, every day I attempt to improve the lives of children and their families, often in very subtle ways. Giving vaccines to prevent devastating illnesses, building the confidence of a first time mother dealing with colic, listening closely to the tribulations of a troubled teen, are all things we do every day, each day, and we do them very, very well. We coordinate the care of patients with complex medical problems, guiding them to needed specialists, and facilitating access to required community services. We get to work with good people—our nurses and office staff, who share our dedication to a higher cause, all expecting little praise except the thank-you from patients after their visits, or the occasional thank-you card from a parent or child that we post on the wall. Every day is different, with different challenges, and all days, with rare exception, are “good” days. It is a job that is its own reward because we get to touch the lives of so many children in a positive way, and this makes pediatrics one of the best medical careers I can think of. I am reminded of this when I checkout at a supermarket and the young man or women at the register looking puzzled remarks “I know you”, and then comes the expression of enlightenment after learning that I was their pediatrician. It just doesn’t get any better than that!    There are about 60,000 doctors in the United States who currently have dedicated themselves to practicing pediatric medicine. We practice our craft quietly, humbly, with little recognition from our colleagues in other specialties. In the hierarchy of medical practitioners, we will never receive the professional stature of the brain or cardiac surgeon, and many specialists earn much more than we do. Few of us appear regularly on television as guests, and few if any television dramas have featured pediatricians as a main character. There are no trading cards featuring noted pediatricians, and only a tiny minority of my patients tell me they’d like to grow up to be a pediatrician. Yet, despite the fact that I will never be a role model, or become rich or famous—I am always grateful that I chose to become a pediatrician. As a “blue collar” physician, every day I attempt to improve the lives of children and their families, often in very subtle ways. Giving vaccines to prevent devastating illnesses, building the confidence of a first time mother dealing with colic, listening closely to the tribulations of a troubled teen, are all things we do every day, each day, and we do them very, very well. We coordinate the care of patients with complex medical problems, guiding them to needed specialists, and facilitating access to required community services. We get to work with good people—our nurses and office staff, who share our dedication to a higher cause, all expecting little praise except the thank-you from patients after their visits, or the occasional thank-you card from a parent or child that we post on the wall. Every day is different, with different challenges, and all days, with rare exception, are “good” days. It is a job that is its own reward because we get to touch the lives of so many children in a positive way, and this makes pediatrics one of the best medical careers I can think of. I am reminded of this when I checkout at a supermarket and the young man or women at the register looking puzzled remarks “I know you”, and then comes the expression of enlightenment after learning that I was their pediatrician. It just doesn’t get any better than that!    Wed, 20 Oct 2010 23:52:25 GMT http://community.modernmedicine.com/_Dont-I-know-you-In-Praise-of-Pediatricians/blog/2758313/33379.html AndySchumanMD 2010-10-18T03:36:08Z Pediatrics Modern Medicine Community There are about 60,000 doctors in the United States who currently have dedicated themselves to practicing pediatric medicine. We practice our craft quietly, humbly, with little recognition from our colleagues in other specialties. In the hierarchy of medical practitioners, we will never receive the professional stature of the brain or cardiac surgeon, and many specialists earn much more than we do. Few of us appear regularly on television as guests, and few if any television dramas have featured pediatricians as a main character. There are no trading cards featuring noted pediatricians, and only a tiny minority of my patients tell me they’d like to grow up to be a pediatrician. Yet, despite the fact that I will never be a role model, or become rich or famous—I am always grateful that I chose to become a pediatrician. As a “blue collar” physician, every day I attempt to improve the lives of children and their families, often in very subtle ways. Giving vaccines to prevent devastating illnesses, building the confidence of a first time mother dealing with colic, listening closely to the tribulations of a troubled teen, are all things we do every day, each day, and we do them very, very well. We coordinate the care of patients with complex medical problems, guiding them to needed specialists, and facilitating access to required community services. We get to work with good people—our nurses and office staff, who share our dedication to a higher cause, all expecting little praise except the thank-you from patients after their visits, or the occasional thank-you card from a parent or child that we post on the wall. Every day is different, with different challenges, and all days, with rare exception, are “good” days. It is a job that is its own reward because we get to touch the lives of so many children in a positive way, and this makes pediatrics one of the best medical careers I can think of. I am reminded of this when I checkout at a supermarket and the young man or women at the register looking puzzled remarks “I know you”, and then comes the expression of enlightenment after learning that I was their pediatrician. It just doesn’t get any better than that!    pediatrics, practice rewards, viewpoint nonadult false “Don’t I know you?” - In Praise of Pediatricians text blog pediatrics,practice rewards,viewpoint 279 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=8151275&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_4147077_33379_8151275_ap_160X120.jpg false 0 Pediatrics 0 2758313 8151275 Member 0 http://community.modernmedicine.com/_Healthcare-Reform-the-Medical-Home-and-the-Small-Pediatric-Practice/blog/2646902/33379.html   I’ve had the privilege of being a pediatrician for almost 30 years.  During this time you and I have seen many changes in pediatric practice, not all of them for the better.  We’ve gone from a fee for service payment system to one where primary care physicians receive pennies on the dollar payment from private and government insurance programs.   The recently passed healthcare legislation may be the last nail in the coffin and may assure that small private practices will not survive to see 2020.   It would be a shame at many levels. First and foremost, with all the emphasis on the “medical home” model highlighted by the American Academy of Pediatrics, I can tell you from my own 19 year experience in private practice that the small pediatric practice is the ideal model for the medical home initiative.  We don’t need to reinvent the wheel, as a properly run small pediatric practice is the best “medical home”!   My patients always had excellent access to medical care including specialty care, inpatient care, and  had no problems communicating their concerns to caring physicians and staff.  Patients could always see their primary care physician for same day appointments when needed.   Even the most efficient large practices are at a severe disadvantage when it comes to caring for the individual patient and perhaps it time we all acknowledge this.   Insurance payment strategies have just about killed “home care” and now the few home care companies around have home phototherapy equipment gathering dust in backrooms.  Those of us who used home care appropriately know to this day that home care saved significant amounts of money for patients as well as insurance companies. The economic crisis is having the effect of swelling the ranks of the uninsured and is accelerating the transition away from the small private pediatric practice.    What is perhaps most difficult for pediatricians like myself is to watch all these changes, while not having the ability to focus our representatives  (government and the AAP) on solving a problem that is at its face, quite easy to solve.  We just need to go back to basics and assure that small private pediatrics practices not only survive, but thrive!       I’ve had the privilege of being a pediatrician for almost 30 years.  During this time you and I have seen many changes in pediatric practice, not all of them for the better.  We’ve gone from a fee for service payment system to one where primary care physicians receive pennies on the dollar payment from private and government insurance programs.   The recently passed healthcare legislation may be the last nail in the coffin and may assure that small private practices will not survive to see 2020.   It would be a shame at many levels. First and foremost, with all the emphasis on the “medical home” model highlighted by the American Academy of Pediatrics, I can tell you from my own 19 year experience in private practice that the small pediatric practice is the ideal model for the medical home initiative.  We don’t need to reinvent the wheel, as a properly run small pediatric practice is the best “medical home”!   My patients always had excellent access to medical care including specialty care, inpatient care, and  had no problems communicating their concerns to caring physicians and staff.  Patients could always see their primary care physician for same day appointments when needed.   Even the most efficient large practices are at a severe disadvantage when it comes to caring for the individual patient and perhaps it time we all acknowledge this.   Insurance payment strategies have just about killed “home care” and now the few home care companies around have home phototherapy equipment gathering dust in backrooms.  Those of us who used home care appropriately know to this day that home care saved significant amounts of money for patients as well as insurance companies. The economic crisis is having the effect of swelling the ranks of the uninsured and is accelerating the transition away from the small private pediatric practice.    What is perhaps most difficult for pediatricians like myself is to watch all these changes, while not having the ability to focus our representatives  (government and the AAP) on solving a problem that is at its face, quite easy to solve.  We just need to go back to basics and assure that small private pediatrics practices not only survive, but thrive!     Tue, 21 Sep 2010 20:21:03 GMT http://community.modernmedicine.com/_Healthcare-Reform-the-Medical-Home-and-the-Small-Pediatric-Practice/blog/2646902/33379.html AndySchumanMD 2010-09-14T12:25:30Z Pediatrics Modern Medicine Community   I’ve had the privilege of being a pediatrician for almost 30 years.  During this time you and I have seen many changes in pediatric practice, not all of them for the better.  We’ve gone from a fee for service payment system to one where primary care physicians receive pennies on the dollar payment from private and government insurance programs.   The recently passed healthcare legislation may be the last nail in the coffin and may assure that small private practices will not survive to see 2020.   It would be a shame at many levels. First and foremost, with all the emphasis on the “medical home” model highlighted by the American Academy of Pediatrics, I can tell you from my own 19 year experience in private practice that the small pediatric practice is the ideal model for the medical home initiative.  We don’t need to reinvent the wheel, as a properly run small pediatric practice is the best “medical home”!   My patients always had excellent access to medical care including specialty care, inpatient care, and  had no problems communicating their concerns to caring physicians and staff.  Patients could always see their primary care physician for same day appointments when needed.   Even the most efficient large practices are at a severe disadvantage when it comes to caring for the individual patient and perhaps it time we all acknowledge this.   Insurance payment strategies have just about killed “home care” and now the few home care companies around have home phototherapy equipment gathering dust in backrooms.  Those of us who used home care appropriately know to this day that home care saved significant amounts of money for patients as well as insurance companies. The economic crisis is having the effect of swelling the ranks of the uninsured and is accelerating the transition away from the small private pediatric practice.    What is perhaps most difficult for pediatricians like myself is to watch all these changes, while not having the ability to focus our representatives  (government and the AAP) on solving a problem that is at its face, quite easy to solve.  We just need to go back to basics and assure that small private pediatrics practices not only survive, but thrive!     pediatrics nonadult false Healthcare Reform, the Medical Home, and the Small Pediatric Practice text blog pediatrics 257 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=8151275&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_4147077_33379_8151275_ap_160X120.jpg false 0 Pediatrics 0 2646902 8151275 Member 0 http://community.modernmedicine.com/_Computer-Assisted-Auscultation-and-Sports-Exams/blog/2552667/33379.html I recently authored an article (Contemporary Pediatrics, August 2010) detailing a new and exciting technology for pediatric practice – Computer Assisted Auscultation (CAA).  Please see the article re: how this technology uses a new digital stethoscope that communicates with software to help identify significant murmurs in children that may warrant further investigation. In my view CAA may eventually play an important role when used in conjunction with the pre-participation sports exam. The American Heart Association and American Academy of Pediatrics recommend that at such exams pediatricians take a thorough family history looking for a history of significant heart disease or sudden death due to cardiac disease as well as a patient history to identify patients with a history of chest pain, palpitations, or syncope.  The exam should include documentation of blood pressure and auscultation in both the supine and standing position. The reason for this is that the most common cause of sudden cardiac death (SCD) among young athletes in the United States is Hypertrophic Cardiomyopathy (HCM). While 60% of HCM patients have no murmurs, the remainder have obstruction to blood flow from the left ventricle and have an associated systolic murmur which increases in intensity when a patient moves from the supine to standing position. Unfortunately pre-sports screening is often performed without the benefit of pre-sports screening questionnaires recommended by the American Heart Association. Additionally pediatricians rarely examine patients in both the supine and standing position during pre-sports exams, and the majority of sports teams physicians are orthopedists with little training or experience with auscultation. A recent pilot study has shown that CAA may have potential utility in helping screen patients who may have the obstructive form of HCM, by identifying patients with systolic murmurs with grade 3 intensities which are louder when the patient is repositioned from supine to standing. An advantage of CAA is that it can be performed by medical assistants or nurses, and results can be reviewed by physicians upon completion. Because results are digital they can also be shared via the Internet so a second opinion can be solicited from pediatric cardiologists to see if a referral is appropriate. I recently authored an article (Contemporary Pediatrics, August 2010) detailing a new and exciting technology for pediatric practice – Computer Assisted Auscultation (CAA).  Please see the article re: how this technology uses a new digital stethoscope that communicates with software to help identify significant murmurs in children that may warrant further investigation. In my view CAA may eventually play an important role when used in conjunction with the pre-participation sports exam. The American Heart Association and American Academy of Pediatrics recommend that at such exams pediatricians take a thorough family history looking for a history of significant heart disease or sudden death due to cardiac disease as well as a patient history to identify patients with a history of chest pain, palpitations, or syncope.  The exam should include documentation of blood pressure and auscultation in both the supine and standing position. The reason for this is that the most common cause of sudden cardiac death (SCD) among young athletes in the United States is Hypertrophic Cardiomyopathy (HCM). While 60% of HCM patients have no murmurs, the remainder have obstruction to blood flow from the left ventricle and have an associated systolic murmur which increases in intensity when a patient moves from the supine to standing position. Unfortunately pre-sports screening is often performed without the benefit of pre-sports screening questionnaires recommended by the American Heart Association. Additionally pediatricians rarely examine patients in both the supine and standing position during pre-sports exams, and the majority of sports teams physicians are orthopedists with little training or experience with auscultation. A recent pilot study has shown that CAA may have potential utility in helping screen patients who may have the obstructive form of HCM, by identifying patients with systolic murmurs with grade 3 intensities which are louder when the patient is repositioned from supine to standing. An advantage of CAA is that it can be performed by medical assistants or nurses, and results can be reviewed by physicians upon completion. Because results are digital they can also be shared via the Internet so a second opinion can be solicited from pediatric cardiologists to see if a referral is appropriate. Fri, 13 Aug 2010 20:45:45 GMT http://community.modernmedicine.com/_Computer-Assisted-Auscultation-and-Sports-Exams/blog/2552667/33379.html AndySchumanMD 2010-08-13T09:16:06Z Pediatrics Modern Medicine Community I recently authored an article (Contemporary Pediatrics, August 2010) detailing a new and exciting technology for pediatric practice – Computer Assisted Auscultation (CAA).  Please see the article re: how this technology uses a new digital stethoscope that communicates with software to help identify significant murmurs in children that may warrant further investigation. In my view CAA may eventually play an important role when used in conjunction with the pre-participation sports exam. The American Heart Association and American Academy of Pediatrics recommend that at such exams pediatricians take a thorough family history looking for a history of significant heart disease or sudden death due to cardiac disease as well as a patient history to identify patients with a history of chest pain, palpitations, or syncope.  The exam should include documentation of blood pressure and auscultation in both the supine and standing position. The reason for this is that the most common cause of sudden cardiac death (SCD) among young athletes in the United States is Hypertrophic Cardiomyopathy (HCM). While 60% of HCM patients have no murmurs, the remainder have obstruction to blood flow from the left ventricle and have an associated systolic murmur which increases in intensity when a patient moves from the supine to standing position. Unfortunately pre-sports screening is often performed without the benefit of pre-sports screening questionnaires recommended by the American Heart Association. Additionally pediatricians rarely examine patients in both the supine and standing position during pre-sports exams, and the majority of sports teams physicians are orthopedists with little training or experience with auscultation. A recent pilot study has shown that CAA may have potential utility in helping screen patients who may have the obstructive form of HCM, by identifying patients with systolic murmurs with grade 3 intensities which are louder when the patient is repositioned from supine to standing. An advantage of CAA is that it can be performed by medical assistants or nurses, and results can be reviewed by physicians upon completion. Because results are digital they can also be shared via the Internet so a second opinion can be solicited from pediatric cardiologists to see if a referral is appropriate. caa, computer assisted auscultation, pediatrics, sports exam, sudden cardiac death nonadult false Computer Assisted Auscultation and Sports Exams text blog caa,computer assisted auscultation,pediatrics,sports exam,sudden cardiac death 324 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=8151275&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_4147077_33379_8151275_ap_160X120.jpg false 0 Pediatrics 0 2552667 8151275 Member 0 http://community.modernmedicine.com/_Can-we-get-guidance-from-guidelines/blog/2454652/33379.html As long I practice pediatrics I plan to read every new practice guideline and clinical policy that AAP will produce. I may however choose not follow a guideline that seems contrary to common sense or is disputed by experts. As explained in my postscript in the June 2010 issue of Contemporary Pediatrics - many studies have shown that only a minority of physicians follow clinical guidelines. For years, physicians continue to criticize guidelines for lacking scientific evidence, not considering costs of recommended care and not taking into account patient preferences. Many physicians adopt a common-sense rather than an evidence-based approach to medical care that is embodied in Loeb’s laws of medicine, which state simply (1) If what you’re doing is working, continue to do it, and (2) If what you're doing is not working, then stop doing it. I would speculate that most pediatricians continue to treat children with acute otitis media with antibiotics despite the AAP’s advice that antibiotics in most cases are not necessary to achieve a cure. Many neonatologists I know do not follow the AAP guidelines from 2002 regarding babies born to mothers colonized with Group B strep. Many suggest that we do not obtain CBCs and blood cultures on babies at risk, recommending instead that we follow them clinically with frequent observation and vital signs. By not following guidelines – are we not good pediatricians and are placing our patients at risk? In the past pediatricians followed recommended clinical practices that were standards in their time and were recommended by experts - until they were proven not to have merit. No one today uses subcutaneous epinephrine to treat asthma, or screen premature infants with respiratory distress with surface and gastric aspirate cultures. We don’t follow levels in premature babies on caffeine for apnea, and we rarely use prophylactic antibiotics to prevent recurrence of otitis media. So history tells us that medicine has never been and will never be “cookbook,” and clinicians must decide on the merit of current guidelines which may or may not survive the test of time. As long I practice pediatrics I plan to read every new practice guideline and clinical policy that AAP will produce. I may however choose not follow a guideline that seems contrary to common sense or is disputed by experts. As explained in my postscript in the June 2010 issue of Contemporary Pediatrics - many studies have shown that only a minority of physicians follow clinical guidelines. For years, physicians continue to criticize guidelines for lacking scientific evidence, not considering costs of recommended care and not taking into account patient preferences. Many physicians adopt a common-sense rather than an evidence-based approach to medical care that is embodied in Loeb’s laws of medicine, which state simply (1) If what you’re doing is working, continue to do it, and (2) If what you're doing is not working, then stop doing it. I would speculate that most pediatricians continue to treat children with acute otitis media with antibiotics despite the AAP’s advice that antibiotics in most cases are not necessary to achieve a cure. Many neonatologists I know do not follow the AAP guidelines from 2002 regarding babies born to mothers colonized with Group B strep. Many suggest that we do not obtain CBCs and blood cultures on babies at risk, recommending instead that we follow them clinically with frequent observation and vital signs. By not following guidelines – are we not good pediatricians and are placing our patients at risk? In the past pediatricians followed recommended clinical practices that were standards in their time and were recommended by experts - until they were proven not to have merit. No one today uses subcutaneous epinephrine to treat asthma, or screen premature infants with respiratory distress with surface and gastric aspirate cultures. We don’t follow levels in premature babies on caffeine for apnea, and we rarely use prophylactic antibiotics to prevent recurrence of otitis media. So history tells us that medicine has never been and will never be “cookbook,” and clinicians must decide on the merit of current guidelines which may or may not survive the test of time. Tue, 13 Jul 2010 19:21:30 GMT http://community.modernmedicine.com/_Can-we-get-guidance-from-guidelines/blog/2454652/33379.html AndySchumanMD 2010-07-13T10:32:01Z Pediatrics Modern Medicine Community As long I practice pediatrics I plan to read every new practice guideline and clinical policy that AAP will produce. I may however choose not follow a guideline that seems contrary to common sense or is disputed by experts. As explained in my postscript in the June 2010 issue of Contemporary Pediatrics - many studies have shown that only a minority of physicians follow clinical guidelines. For years, physicians continue to criticize guidelines for lacking scientific evidence, not considering costs of recommended care and not taking into account patient preferences. Many physicians adopt a common-sense rather than an evidence-based approach to medical care that is embodied in Loeb’s laws of medicine, which state simply (1) If what you’re doing is working, continue to do it, and (2) If what you're doing is not working, then stop doing it. I would speculate that most pediatricians continue to treat children with acute otitis media with antibiotics despite the AAP’s advice that antibiotics in most cases are not necessary to achieve a cure. Many neonatologists I know do not follow the AAP guidelines from 2002 regarding babies born to mothers colonized with Group B strep. Many suggest that we do not obtain CBCs and blood cultures on babies at risk, recommending instead that we follow them clinically with frequent observation and vital signs. By not following guidelines – are we not good pediatricians and are placing our patients at risk? In the past pediatricians followed recommended clinical practices that were standards in their time and were recommended by experts - until they were proven not to have merit. No one today uses subcutaneous epinephrine to treat asthma, or screen premature infants with respiratory distress with surface and gastric aspirate cultures. We don’t follow levels in premature babies on caffeine for apnea, and we rarely use prophylactic antibiotics to prevent recurrence of otitis media. So history tells us that medicine has never been and will never be “cookbook,” and clinicians must decide on the merit of current guidelines which may or may not survive the test of time. aap, american academy of pediatrics, common sense, evidence-based medicine, guidelines, pediatrics nonadult false Can we get guidance from guidelines? text blog aap,american academy of pediatrics,common sense,evidence-based medicine,guidelines,pediatrics 379 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=8151275&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_4147077_33379_8151275_ap_160X120.jpg false 0 Pediatrics 0 2454652 8151275 Member 0 http://community.modernmedicine.com/_Keep-on-Dancing/blog/2402815/33379.html I recently attended yet another coding conference for primary care physicians presented to facilitate accurate coding of patient services so that our documentation of medical visits justifies the billing codes we submit to insurance companies for payment. These conferences frustrate the heck out of me because they rekindle feelings of distrust and dislike of insurance companies that I forever struggle to repress.It comes down to one basic principle of primary care pediatrics. We (pediatricians) want to get paid appropriately for services we provide. They (the insurance companies) want to pay us as little as possible for the services we provide. Not only do we provide medical services at a considerable discount to insured patients, but we must battle daily with the insurance companies to keep our revenue stream flowing.So we are forced to "dance the daily dance of documentation" so that we perform well should our practice undergo an insurance audit. The audit is the opportunity for insurance to reclaim monies from practices for "inappropriate charges."And so pediatricians, rather than spend as much time as we would like with patients, spend an inordinate amount of time struggling with their EMRs to produce lengthy, detailed notes replete with details that are often irrelevant to patient care, but are certain to survive the scrutiny of an auditor.As a result, pediatricians can see fewer patients per day--reducing our cash flow even further. If we were to begin the process of truly improving healthcare in a meaningful way, our professional organizations would begin the process of wresting several aspects of control away from the insurance companies and placing them into the hands of physicians where they rightfully belong.If this were to come to pass, our patients would receive better care, and we would be less vulnerable to eye strain and carpal tunnel syndrome. Until that happens, I'm afraid we must keep on dancing.... I recently attended yet another coding conference for primary care physicians presented to facilitate accurate coding of patient services so that our documentation of medical visits justifies the billing codes we submit to insurance companies for payment. These conferences frustrate the heck out of me because they rekindle feelings of distrust and dislike of insurance companies that I forever struggle to repress.It comes down to one basic principle of primary care pediatrics. We (pediatricians) want to get paid appropriately for services we provide. They (the insurance companies) want to pay us as little as possible for the services we provide. Not only do we provide medical services at a considerable discount to insured patients, but we must battle daily with the insurance companies to keep our revenue stream flowing.So we are forced to "dance the daily dance of documentation" so that we perform well should our practice undergo an insurance audit. The audit is the opportunity for insurance to reclaim monies from practices for "inappropriate charges."And so pediatricians, rather than spend as much time as we would like with patients, spend an inordinate amount of time struggling with their EMRs to produce lengthy, detailed notes replete with details that are often irrelevant to patient care, but are certain to survive the scrutiny of an auditor.As a result, pediatricians can see fewer patients per day--reducing our cash flow even further. If we were to begin the process of truly improving healthcare in a meaningful way, our professional organizations would begin the process of wresting several aspects of control away from the insurance companies and placing them into the hands of physicians where they rightfully belong.If this were to come to pass, our patients would receive better care, and we would be less vulnerable to eye strain and carpal tunnel syndrome. Until that happens, I'm afraid we must keep on dancing.... Mon, 21 Jun 2010 14:14:47 GMT http://community.modernmedicine.com/_Keep-on-Dancing/blog/2402815/33379.html AndySchumanMD 2010-06-18T20:07:03Z Pediatrics Modern Medicine Community I recently attended yet another coding conference for primary care physicians presented to facilitate accurate coding of patient services so that our documentation of medical visits justifies the billing codes we submit to insurance companies for payment. These conferences frustrate the heck out of me because they rekindle feelings of distrust and dislike of insurance companies that I forever struggle to repress.It comes down to one basic principle of primary care pediatrics. We (pediatricians) want to get paid appropriately for services we provide. They (the insurance companies) want to pay us as little as possible for the services we provide. Not only do we provide medical services at a considerable discount to insured patients, but we must battle daily with the insurance companies to keep our revenue stream flowing.So we are forced to "dance the daily dance of documentation" so that we perform well should our practice undergo an insurance audit. The audit is the opportunity for insurance to reclaim monies from practices for "inappropriate charges."And so pediatricians, rather than spend as much time as we would like with patients, spend an inordinate amount of time struggling with their EMRs to produce lengthy, detailed notes replete with details that are often irrelevant to patient care, but are certain to survive the scrutiny of an auditor.As a result, pediatricians can see fewer patients per day--reducing our cash flow even further. If we were to begin the process of truly improving healthcare in a meaningful way, our professional organizations would begin the process of wresting several aspects of control away from the insurance companies and placing them into the hands of physicians where they rightfully belong.If this were to come to pass, our patients would receive better care, and we would be less vulnerable to eye strain and carpal tunnel syndrome. Until that happens, I'm afraid we must keep on dancing.... healthcare reform, medical insurance, pediatrics nonadult false Keep on Dancing text blog healthcare reform,medical insurance,pediatrics 321 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=8151275&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_4147077_33379_8151275_ap_160X120.jpg false 0 Pediatrics 0 2402815 8151275 Member 0 http://community.modernmedicine.com/_iPad-initial-thoughts/blog/2335869/33379.html In a previous blog, I expounded on the impact that mobile computing has had on medical practice and contemplated what effect Apple's new iPad may have on the way you and I perform many of our daily activities. As of this writing, Apple has sold more than 1 million iPads in less than one month's time. Undoubtedly, I will include a discussion of the iPad in my next annual tech products review in Contemporary Pediatrics, but I thought I'd give you some first impressions, which may convince the undecided to either "wait and see" or join us early adopters in buying a "first generation" device.First and foremost, the iPad is well constructed and is very nimble. Applications load quickly, the wireless connection is easy to set up, and surfing the Web is a joy because of the iPad's generous screen size. The touch navigation is a nice substitute for a mouse, and the interface is very responsive. Where the device excels is in providing media--music, movies videos, and reading. The iPad's Kindle application displays books in color (although the Kindle itself can only display graphics in shades of grey). I have a dozen or so pediatric texts that look amazingly good on the iPad. To date, Apple's iBooks offerings are quite lean and no medical reference books are available.There are very few iPad-only medical applications, although one can use any of the existing iPhone medical applications. These unfortunately are displayed in their iPhone-size format and look pixilated when viewed in zoom mode. I'm sure many medical applications will be developed for the iPad, given its expected enormous customer base among physicians. I will tell you that it's nice to browse the digital edition of Contemporary Pediatrics using the iPad (the digital edition can be accessed by going to www.contemporarypediatrics.com/digital). It really creates a magazine-like experience.Where the iPad falls short is productivity. The on-screen keyboard is very difficult to use for extended typing. It's adequate for responding to emails, but I would not write a long document without using the keyboard docking station, which is a $70 accessory. I would welcome a handwriting recognition application, but an adequate substitute for typing is provided by the Dragon Naturally Speaking voice recognition typing program, which is surprisingly accurate.These are my first impressions. I like the device, have been using it frequently, and look forward to more and more dedicated medical applications being released in the weeks and months to come. In a previous blog, I expounded on the impact that mobile computing has had on medical practice and contemplated what effect Apple's new iPad may have on the way you and I perform many of our daily activities. As of this writing, Apple has sold more than 1 million iPads in less than one month's time. Undoubtedly, I will include a discussion of the iPad in my next annual tech products review in Contemporary Pediatrics, but I thought I'd give you some first impressions, which may convince the undecided to either "wait and see" or join us early adopters in buying a "first generation" device.First and foremost, the iPad is well constructed and is very nimble. Applications load quickly, the wireless connection is easy to set up, and surfing the Web is a joy because of the iPad's generous screen size. The touch navigation is a nice substitute for a mouse, and the interface is very responsive. Where the device excels is in providing media--music, movies videos, and reading. The iPad's Kindle application displays books in color (although the Kindle itself can only display graphics in shades of grey). I have a dozen or so pediatric texts that look amazingly good on the iPad. To date, Apple's iBooks offerings are quite lean and no medical reference books are available.There are very few iPad-only medical applications, although one can use any of the existing iPhone medical applications. These unfortunately are displayed in their iPhone-size format and look pixilated when viewed in zoom mode. I'm sure many medical applications will be developed for the iPad, given its expected enormous customer base among physicians. I will tell you that it's nice to browse the digital edition of Contemporary Pediatrics using the iPad (the digital edition can be accessed by going to www.contemporarypediatrics.com/digital). It really creates a magazine-like experience.Where the iPad falls short is productivity. The on-screen keyboard is very difficult to use for extended typing. It's adequate for responding to emails, but I would not write a long document without using the keyboard docking station, which is a $70 accessory. I would welcome a handwriting recognition application, but an adequate substitute for typing is provided by the Dragon Naturally Speaking voice recognition typing program, which is surprisingly accurate.These are my first impressions. I like the device, have been using it frequently, and look forward to more and more dedicated medical applications being released in the weeks and months to come. Thu, 13 May 2010 17:19:50 GMT http://community.modernmedicine.com/_iPad-initial-thoughts/blog/2335869/33379.html AndySchumanMD 2010-05-13T00:12:35Z Modern Medicine Community In a previous blog, I expounded on the impact that mobile computing has had on medical practice and contemplated what effect Apple's new iPad may have on the way you and I perform many of our daily activities. As of this writing, Apple has sold more than 1 million iPads in less than one month's time. Undoubtedly, I will include a discussion of the iPad in my next annual tech products review in Contemporary Pediatrics, but I thought I'd give you some first impressions, which may convince the undecided to either "wait and see" or join us early adopters in buying a "first generation" device.First and foremost, the iPad is well constructed and is very nimble. Applications load quickly, the wireless connection is easy to set up, and surfing the Web is a joy because of the iPad's generous screen size. The touch navigation is a nice substitute for a mouse, and the interface is very responsive. Where the device excels is in providing media--music, movies videos, and reading. The iPad's Kindle application displays books in color (although the Kindle itself can only display graphics in shades of grey). I have a dozen or so pediatric texts that look amazingly good on the iPad. To date, Apple's iBooks offerings are quite lean and no medical reference books are available.There are very few iPad-only medical applications, although one can use any of the existing iPhone medical applications. These unfortunately are displayed in their iPhone-size format and look pixilated when viewed in zoom mode. I'm sure many medical applications will be developed for the iPad, given its expected enormous customer base among physicians. I will tell you that it's nice to browse the digital edition of Contemporary Pediatrics using the iPad (the digital edition can be accessed by going to www.contemporarypediatrics.com/digital). It really creates a magazine-like experience.Where the iPad falls short is productivity. The on-screen keyboard is very difficult to use for extended typing. It's adequate for responding to emails, but I would not write a long document without using the keyboard docking station, which is a $70 accessory. I would welcome a handwriting recognition application, but an adequate substitute for typing is provided by the Dragon Naturally Speaking voice recognition typing program, which is surprisingly accurate.These are my first impressions. I like the device, have been using it frequently, and look forward to more and more dedicated medical applications being released in the weeks and months to come. nonadult false iPad, initial thoughts text blog 396 0 0.0 http://community.modernmedicine.com/service/displayKickPlace.kickAction?u=8151275&as=33379 http://media.kickstatic.com/kickapps/images/33379/photos/PHOTO_4147077_33379_8151275_ap_160X120.jpg false 0 0 2335869 8151275 Member 0