Month: January 2006

A Medical Education Digital Resource Library – FMDRL

Family Medicine Digital Resource Library  – now the 1.0 release is out – thanks to Dave Ross for the final push with programming. 

We still have many loose ends to clean up .. and some UI bits .. but we've been sitting on this release for a few months .. and Richard finally pushed us to just release it once and for all.

Version 1.1 will come in about 2 weeks.  I hope.

We lost our other programmer in a series of frustrating events that have taught me a bit about Federal grants.  We were awarded the grant in October, 2004 – but were notified of our award only weeks before.  It took some time for us to re-arrange things and get started on the work – as those of us involved had other things we were doing.  Can't just wait around for the grant and do nothing!

So we got the grant, cleaned up (I actually quit one of my jobs!) … and really got going by ~ February 2005.  While we were a few months behind .. we got the beta version of FMDRL up by the time of the STFM national meeting last May.

Trouble is that by the end of the "year 1" grant cycle, we hadn't finished all of the "year 1" development and so hadn't spent all of our development money.  So we asked for an extension of the year 1 development money – hoping they would respond promptly and we could keep the developers going.

But now it's three months later and we have heard nothing.

The programmer had to get another job – and now Dave's left by himself – with a lot to do .. and not much time to do it.

Maybe I'll have to stop in at NLM sometime soon to bother someone and get an answer!

RSS Reading Lists – Applications for healthcare?

Dave is on to something here.  Somehow I even think that OPML may have some remarkable applications in healthcare.

No kidding.  OPML and this "reading list" functionality is potentially very powerful well beyond blogging and information/news websites.  (I'm not sure "reading list" is the right term – as it is defines the technology with reference to one use of the technology, rather than what it is that the technology does — RSS isn't BSS – evel though blogs were the 1st use of the technology). How about AOPML – for Automated OPML?

Let's consider something that is (for some reason) pervasive in Health Information Technology:  templates.

Templates are tools that developers and "knowledge engineers" have developed to assist providers in the documentation of clinical encounters.

You would think that providers would LOVE templates .. as they diminish the amount of free-text entry:
I click on something and have long sentences of text automatically pasted into the record.

But it turns out that providers DON'T love these things .. because invariably .. someone else created them .. the sentences aren't quite what we want to express .. and:

  1. No template exists for "my toe hurts because I dropped a bowling ball on it 6 days ago." 
  2. Finding a particular text passage may require navingating a long tree of a template:
    1. Pain
      1. in extremity
        1. Lower Extremity
          1. foot
            1. toe
    2. Duration
      1. days
        1. 6
    3. Text
      1. "dropped a bowling ball on it."

Users like macros though … and oddly – I've even seen people use 3rd party macro tools that push free text into templates! 

So .. what if the template components were defind in OPML and editable by end-users in a good UI?  Might help .. especially if the template navigation/use implementation is

Ok … that's nice .. but how do I share my template components with others?  What if my "toe" template is really good?  Here's where the BOPML comes in .. as others can subscribe to my toe template .. and if I change it .. then they get my changes.

hmm ..

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MinuteClinics?

Bruce writes about MinuteClinics .. then Richard comments.

They are both right.

Quickie Clinics may threaten family physicians' business.    Sure ..

But is this bad?  Not necessarily.  Today I saw a child with a sore throat.  She lives 40 miles away.  Dad called the office and asked us to refer her to an urgent care clinic near their home.  The insurance rule is that we can refer to urgent care if we can't see her .. or if we are closed.  But not if we are open.  So we said no.  She needs to come in. 

So she comes in and the rapid strep is positive.  As I am writing the rx for her, I ask her if she has any allergies to medication.  She says "yes – Amoxicillin gives me a rash" (she's <10!) .. and dad nods.  The EMR warns me of an allergy to penicillins.  Everyone agrees.

So I write a prescription for something more appropriate (no — not azithro!) and schmooze a bit with her.  She tells me that "dad wants to get a new doctor — he is mad we had to drive all the way here."

I nod and say that I understand and that it's a long drive and there are lots of doctors near your new house and I bet that there are some nice doctors there.

Then dad says "yeh – I was frustrated with the drive.  But you held her in your hand when she was tiny and you have been with us all of this time – so I was grumbling during the drive down – but you walk through the door and it all falls away and then I remember why we still come here."

And of course he is talking about the connection between a physician and a family that we can't replace with wal-mart medicine – no matter how good it is.

Would she have gotten BAD care at the quickie medical clinic if there was one (and I was allowed to refer her there) .. no .. but I bet it's more likely that she would have gotten something like azithromycin rather than something more appropriate.

Why do free-standing urgent care facilities prescribe more gatifloxacin and azithrmoycin (and antibiotics in general) than we do?  Because PLEASING THE CUSTOMER is a primary focus of the visit.   Yet without an established relationship and trust – quick "this will make you better" prescriptions are more likely to be the name of the game.  Refusing an antibiotic for the negative rapid strep will be a challenge for these quickie clinics .. and I am much more concerned about THAT than I am about losing the business.

Another concern is how we would all coordinate care .. and how .. in the case that the kid and the dad forget about the allergy .. the minuteclinic can avoid harmful errors.  Do they call us and ask for an allergy list?  ugh .. this WOULD bug me.  I don't want to pay my staff to be fielding phone calls like this .. while others make money on rendering the care.

Very complicated.

And this is all too new to really understand.

Patients’ use of the Internet for Health Information

Family Medicine Patients' Use of the Internet for Health Information

"The physicians (n = 92) underestimate the proportion of their patients who used the Internet for health information"

Of course this is no surprise.  Physicians don't quite "get it" how much people use the Internet for information.

Another implication for the future is the need to train physicians and medical students about discussing information brought to the office visit by their patients. Both qualitative7,8 and quantitative9 studies have reported that physicians can feel challenged by the patient who brings in Internet information, leading to degradation of the patient-physician relationship.

'nuf said. 

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