Better Care From Docs With Electronic Records?

Does your doctor have an electronic health record (EHR)? Do you have a complete personal record of your medical history? I don’t and I am sure you don’t either. It’s kind of absurd that there’s probably more sophisticated technology at your local fast food joint or car wash than there is at your doctors office.

Why should you care about electronic health records? Because they reduce errors (think prevention of medication interactions and duplicate medical tests) and they provide a complete picture from all your different care providers in one place where all your docs – and you – can see “what’s up” with your health. Basically, it makes doctors do their job better. Peachy.

A national survey found that electronic records were used in less than 9 percent of small offices with one to three doctors, where nearly half of the country’s doctors practice medicine.

82 percent of those using such electronic records said they improved the quality of clinical decisions, 86 percent said they helped in avoiding medication errors and 85 percent said they improved the delivery of preventative care

So, why doesn’t every doctor’s office have EHRs already? Well, the national survey says that some just aren’t happy with the solutions and other just don’t see the incentives for doing so. The cost to implement is high and during the transition they would see fewer patients, possibly cutting their income in half.

Dr. Paul Feldan, one of three doctors in a primary care practice in Mount Laurel, N.J., considered investing in electronic health records, and decided against it. The initial cost of upgrading the office’s personal computers, buying new software and obtaining technical support to make the shift would be $15,000 to $20,000 a doctor, he estimated. Then, during the time-consuming conversion from paper to computer records, the practice would be able to see far fewer patients, perhaps doubling the cost.

I feel your pain, docs, but come on. What about doing this because it is the right thing to do? Isn’t health care about CARE and doing it the best way possible? I can understand the bitterness… those who benefit financially are not the ones who pay for the records. But what price can you put on better care?

Private and government insurers and hospitals can save money as a result of less paper handling, lower administration expenses and fewer unnecessary lab tests when they are connected to electronic health records in doctors’ offices. Still, it is mainly doctors who bear the burden making the initial investment.

This is just another sign that our health care system is completely shattered and it needs an “extreme makeover”.

There is a new 5-year pilot program about to start through medicare that will give “incentives” for docs to go paperless.

The government took a step in that direction last week, announcing a $150 million Medicare project that will offer doctors incentives to move from paper to electronic patient records. The program is intended to help up to 1,200 small practices in 12 cities and states make the conversion.

Individual doctors will be offered up to $58,000 over the five-year span of the project, which is intended to test the impact of incentives on the spread of electronic health records. Further programs across the country are planned.

Good. Maybe in another 10-12 years my trail of medical encounters will be as comprehensive as my social network map on Facebook and LinkedIn. (grin)

Mobile Motivation: Using Your Cell Phone To Get Healthy

If you are looking for a free service and online community that will send you motivating text messages – or even nag you about diet and exercise – you may want to look at Wellphone.

What’s interesting to me about this is that it was my research project for my nutrition degree. I conducted focus groups on the use of text messages to improve nutrition behaviors. I can tell you from my research, that these health-conscious people were open to the idea, but they wanted full control over how often they’d receive the messages and the types of messages they’d receive. They also had a beef about “a computer telling me what to do”. They wanted a real person reviewing their health status and sending personalized messages.

I personally don’t think people need to be told “don’t forget to workout today” or “avoid junk food”, but a reminder like “you’re doing yoga tonight after work so pack your clothes” might help. I also think that if people could receive a text message that would teach them a diet tidbit that it would be beneficial “snacking may help to curb overeating at your next meal. grab a piece of fruit like an apple or a banana as an afternooon snack.”

They have an interesting feature that lets users look up a gym when they are traveling… although most business travelers use the hotel gym.

Hard to say where this is going, but there are possibilities. I particularly would like to see dietitians and trainers on the other end. I think the “killer ap” is where the user completes a health assessment and based on the outcome goals are set (e.g. tailoring) and then the text messages and online support are generated from these outcomes and goals.

What do you think? Would you use a service like this? Anyone willing to try and blog about it for me? Let me know!

Low Income Mothers Prefer Nutrition Education Via Websites

Robert Wood Johnson Foundation reported the outcomes of a recent study that examined the efficacy of print, web and games to deliver nutrition education to low-income mother.

The internet won.

To determine the best method for providing nutrition education, Michigan State University researchers presented 155 low-income mothers with nutrition information in a pamphlet, via an interactive computer game and on a Web site. They found that participants paid more attention to and better comprehended information on the Web site compared with the other modalities. In addition, they were more likely to return to the Web site for additional information.

View the study

I guess this bodes well for the USDA’s efforts to enhance MyPryamid website with online personalization features and the new podcast launch.

Safer Food With RFID and Online Food Traceability?

From Food Quality News:

An internet-based interface that allows food processors to see which country every ingredient has come from and each process a product goes through in the factory is set to significantly overhaul food chain traceability.

The Northern Ireland-based venture TraceAssured launched its online traceability initiative last week, promising to cut out many of the time-consuming headaches faced by food makers who identify a problem in the supply chain.

Dr Ken Baird, chairman of the company, says the system offers information on the entire food chain, from farm to fork, within minutes, compared with hours or days required in current traceability systems.

“It uses a novel approach as it traces containers instead of batches. Each container has a barcode, which can in the future be replaced by a RFID chip,” he explained to FoodProductionDaily.com.

I believe this type of web-based tracing system backed by RFID is the best chance to help improve the safety of our food supply. Considering the state of food safety (a la melamine, lead, e. coli in the last year) and the process for handling recalls in the U.S. one thing is clear: it’s time get smarter about where our food has been.

Where Technology and Healthcare Collide

The top dawgs from Intel, Microsoft, and Google will present at a seminar sponsored by the National Cancer Institute (NCI) on December 10. My hunch is this will be focused on personal health records and electronic health records. Can’t make it to Bethesda? Check out the webcast!

Bridging the Gap between Behavioral Science and Consumer Health Technologies

December 10th, 2007
Bethesda, Maryland

We live in a period of unparalleled scientific and technologic opportunity. The pace at which we accumulate new knowledge and engineer advanced systems has never been so great, and it is making possible unprecedented opportunities to accelerate progress in healthcare and healthcare delivery. As we work to take full advantage of these evolving opportunities, it is increasingly important to integrate research, science, and technology as effectively as possible.

In that vein, we invite you to attend the NCI-sponsored meeting, “The Future: Consumer Health Information Technology,” where leaders from three of the largest Information Technology (IT) companies will discuss how they see consumer technologies changing the face of healthcare, healthcare delivery, and personal health management.

Looking to the future, learn how connective technologies can enable the delivery of timely, tailored, scalable health solutions to a broad range of consumers, and explore how such novel applications may speed the translation and dissemination of research into routine, representative practice.

INDUSTRY REPRESENTATIVES:

BERN SHEN Intel Digital Health, Chief Healthcare Strategist, Strategic Partnerships, Digital Health Care

ADAM BOSWORTH, Google Health, Former Director

BILL CROUNSE, Microsoft, Director Worldwide Health

This meeting will also be Web cast at http://videocast.nih.gov/summary.asp?live=6327

Enroll in “Guide to Health” Weight Management Trial

This is cool… I studied the use of technology to improve nutrition behaviors in my “health behavior and psychology” class at Johns Hopkins. I found several studies that had evidence to support efficacy of an internet-based program to help people change behaviors (ala weight management). 

Here’s a trial you can get in on now, for free, if you are not physically active. It includes weekly coaching online as well. I assume there will be some type of assessment completed and a tailored program will be created (but that is a guess). 

Psychologists in Virginia Tech’s College of Science have developed a free Internet health program that helps people make permanent lifestyle changes to improve their health.

“Most Americans know they should eat better and be more physically active,” said Richard Winett, director of the university’s Center for Research in Health Behavior. “What most don’t know is that they don’t have to make drastic life changes to do it. Making just a few key changes can have big health benefits.”

The new program, called “Guide-to-Health” provides the skills, support, and information people need to increase physical activity, eat more nutritiously, and prevent weight gain. The program is based on National Institutes of Health (NIH)-supported research conducted by Winett and his team on women and men from diverse backgrounds.

Winett said many otherwise healthy adults gain about two pounds each year, so people who are normal weight at age 30 can become overweight or even obese by the time they are 50. For an ever-growing number of mid-life adults, the signs of inactivity and gradual weight gain show up as higher blood pressure, higher “bad” cholesterol, more body fat, and a condition known as pre-diabetes.

“Left alone, these symptoms can become chronic diseases, can shorten your life and can make the years you have to live less enjoyable,” he said.

The health focus favored by many scientists now is what is called “weight stabilization,” which includes making selective changes in eating and adding more physical activity. But while the needed changes are small, they are often difficult to make and stick with.

“To make these critical changes in nutrition and physical activity, most people need to develop skills and have support over a long period of time,” Winett said. “In fact, probably the best way to make these changes is to have your own personal program and coach. Fortunately, there are now ways to provide a personal program to many people through technology and the Internet.”

The goal of the “Guide-to-Health” program is the help people make healthy changes a permanent lifestyle. The program is designed to see how well a state-of-the-art Internet program helps people reach this goal and improve their health.

“There are quite a number of Internet health programs available but few have all the features of the program we have developed, and few have been really tested to see how well they work over the long-term,” Winett said.

“Guide-to-Health” is a free program. Participants must be 18-64 years of age, not physically active, and have access to the Internet. After qualifying, completing initial assessments, and enrolling in the program, participants will receive a free pedometer and scale. Individuals will then access the “Guide-to-Health” program online every week for 18 months. Weekly online coaching will take about 10-20 minutes. Two additional assessments will be given during the project.

To learn more about the “Guide-to-Health’ program, or to register, visit http://www.guide-to-health.info/.

Visit the Center for Research in Health Behavior at http://www.psyc.vt.edu/centers/crhb/

A Personalized Supplement Based on Your DNA

Have you heard of nutrigenomics yet? If not, you will. Check this out. I learned about this at a food and nutrition conference. You can have a DNA test done (for the low, low price of $495.00) and then have a custom supplement made for you based on 4 DNA markers (for the low, low price of $99 a month). 

 The company is called Salugen and they currently market DNA-customized nutritional solutions under three brands, GenoTrim(TM) for weight management (http://www.genotrim.com/), SpaGen (TM) for optimal health and wellness (http://www.spagen.com/) and Haveos(TM) for substance abuse attenuation.

I learned a small amount about GenoTrim at the conference. Here is an excerpt from an e-mail they sent me after they swiped my badge. At the end of the post, I offer my own thoughts.

[start]

 We appreciate your interest in GenoTrim™, the first nutrigenomics product to support weight management efforts through a DNA test and customized, genetically-guided nutritional supplements. 

As promised, we invite you to review the clinical studies supporting GenoTrim, as posted on our website, http://www.dnasoa.com/2006/programs.html#si.  We test five genes that influence weight and would be happy to discuss possible genetic variations and their respective influences:

•  Dopamine D2 Receptor (Sweet Tooth Gene™)
• Serotonin 2A Receptor (Nervous Eating Gene™)
• PPAR-Gamma (Fat Regulator Gene™)
• Leptin OB (Obesity Risk Gene™)
• MTHFR (New Cell Gene™)

GenoTrim addresses underlying genetic factors that affect weight by nourishing your body instead of starving it.  GenoTrim supplements contain the right ingredients in the right amounts for your patients.  Best of all, GenoTrim is not a medication but a natural, nutritional supplement.  Salugen, the creator of GenoTrim, was recently awarded the Bronze Award by the Natural Products Association.  The ingredients in GenoTrim are not only natural, they are only purchased from within the United States.  The efficacy of the ingredients is not just tested once, as now required by the Food & Drug Administration, but three times. You know your patients are getting the highest quality supplements on the market, made just for them.  Our Published Safety and Efficacy of Key Ingredients document is also posted on our website.

GenoTrim is not a “magic pill”. GenoTrim complements healthy eating and regular exercise for a more complete weight management program.  We encourage our own GenoTrim clients to see professional assistance through dietitians, nutritionists, fitness experts and support groups to ensure an integrated, overall healthy approach to managing their weight. 

 [end]

So could it be true? Could a supplement customized for individuals really help end struggles with weight or is it just another gimick. You decide. Review the clinical trials. Personally, I think its too early to tell. Here are some of my concerns.

Disclaimer: I did a quick skim of the trials, not an extensive review. I’m hoping some of my smart friends, colleagues or strangers will review them and contribute their thoughts.

• Trials were short duration and small, size designed for rapid results. But what about long term efficacy? Will a person gain weight again if they go off the supplement?
• Not published in big name journals, unsure of their reputation and credibility among a larger community.
• This report explains the supplements that are included and its basically vitamins and minerals in run of the mill vitamins (and food of course). Anyone heard of vitamin C, chromium picolonate, and folate? This could be good news, right? The stuff shouldn’t kill ya. But if there is nothing new, then why does this work?  

Finally, what concerns me the most about this is me. I don’t know enough about nutrigenomics to really make sound judgements, but I am committed to learning more. I bought a book by a PhD/RD Ruth Debusk on the nutrition and genetics connection.

I will say this… I always want to have an open mind to all the possibilities out there. Weight management is complex and there has got to be more out there than what we know know about behavior and calorie balance. I have been active my entire life. I’m talking yoga, distance running (including a marathon), weight training… etc. I have a degree in nutrition so I have that part covered. I eat well MOST of the time. (Anyone who knows me will tell you I have an enormous sweet tooth.) And still after all that, my BMI is borderline overweight. As much controversy that surrounds the BMI, that’s still the standard tool. We haven’t been able to come up with anything better. Is personalized nutrition the answer. Is there a future for nutrigenomics? I don’t know, but I look forward to watching it unfold.