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Travel data was not considered a high priority until now, so most likely Epic (and other EMR systems) didn't automatically put a red flag on it. People who program the system have to be told what the providers want. Right now, travel data is a high priority so the programmers jumped in there and changed the screens to grab that data and put it in a priority setting, or flag it in red, or put it in capital letters. The trouble is, there's only so much room on a page and you can't make the typeface so small that nobody can read it, so sometimes important data is on a second page and the doctor or nurse has to actually scroll to read the whole thing, which is something that sometimes doesn't happen. Now that travel data has been flagged, maybe the providers will look at it, although we all know that patients lie so just because travel data is priority doesn't mean what the providers read is true. A patient might lie if he thinks he won't get treated if he tells the triage nurse the truth.
Sure. You're absolutely right. And they haven't even instituted the minutiae of ICD-10 with 140,000 codes detailing practically everything and making it possible to assign a value to those codes (they do it now with ICD-9, but there's only 40,000 codes there) and have some criteria for deciding whether to pay for that code under Medicare/Medicaid. ICD-10 has been postponed for a year. Coincidentally (or not), the IPAB (new board under ACA that will assign values and decide the cost/benefit of payments) has also been postponed for a year. Maybe there's an election to get past first?
This really shouldn't be a surprise. I worked for many years with the effort to go electronic (ending in 1995 when I moved out of the job I was in) and have worked with electronic records up until 2007. I have not seen a great advantage to the electronic record, especially if the power goes off. Any medical record is only as good as the people who use it. First, they have to enter the data and then somebody has to read the data. Whether it's electronic or paper, this is still is still true. Scrolling through multiple screens to try to read the data takes time and most people I've talked to hate the electronic systems because you have to search to find what you want. Obama wanted EMR so that info could be shared everywhere (privacy issues?) but, as Michelle points out, Epic doesn't want to handle data from other people's systems; they prefer to try to have a monopoly (a so-called integrated system, universally accessible). What Obama proved to me was that he knew near to nothing about electronic medical records because he mandated that this be done within five years (it's now overdue). The cost is high (but the govt subsidizes physicians, hospitals and clinics in the implementation) and there's no guarantee that the data is any better or more accurate than on paper, or that it's accessible all around the town (it's not). So, hospitals have to prove they are engaging in "meaningful use" of the EMR (more waste paper and regulatory compliance costs). The EMR is not a useless pursuit, but it's overrated both in terms of accuracy and accessibility.
In response to:

Dr. Emanuel's Death Wish

Dot462 Wrote: Oct 07, 2014 2:03 PM
We have to remember that old Ezekiel wrote the Lancet article in 2009 that outlined the Complete Lives System, a method of applying cost/benefit analysis to health care rationing. The N.I.C.E. system in the U.K. applies cost/benefit analysis to decide whether to pay for certain procedures/treatments for persons who are not going to be able to contribute to society. Old Ezekiel has been a main advisor to Obama in development of the ACA. Obama pushed off by a year implementation of the Independent Payment Advisory Board, which probably will be using cost/benefit analysis to decide with greater specificity what treatments/procedures are appropriate for Medicare/Medicaid to pay for. I am looking forward to the day when Old Ezekiel decides he's lived long enough and he goes out in the snow without clothes on and waits to freeze to death. They say you just go to sleep.
In response to:

Ebola and Obama

Dot462 Wrote: Oct 07, 2014 1:40 PM
Thank you, Dr. Sowell. Looks to me like the reason many people no longer trust what govt officials have to say stems from the many lies that have been told by agency officials like the ones from the IRS, the State dept on Benghazi, etc. When Dr. Frieden tells us he's "100% sure" that nobody can get Ebola from sitting next to someone on an airplane he is flying in the face of infection control measures. Who would trust such a doctor? Nobody knows how the NBC photographer got it; he wasn't engaging in direct patient care, was he? Even the CDC website says that Ebola can live on surfaces for hours and even days. Letting people fly in here from Liberia and Sierra Leone is bad infection control. Airlines are also at fault because they are putting their passengers at risk when they allow people to fly on their planes who have been in west Africa within 21 days. People will lie in order to get out of west Africa and come to the U.S. where medical treatment is better. This epidemic may approach 10,000 cases by the end of October; it is hard to control if people can fly in here with west Africa stamps on their passports.
The trouble is that there is no really effective treatment for Ebola other than supportive care. We don't have a vaccine. I'm sure that is being worked on, but vaccines don't just hop on the market overnight. I read there's a shortage of IV fluids, which is the main supportive care because of the fluid losses experienced by victims. Pain control is also a factor as a thrashing patient can spread droplets all around them. I guess it's time to buy stock in companies that make PPE and other companies that make IV fluids and morphine.
What has to happen if what you desire can come to pass is that the airlines decide on their own to screen passengers, not depending on natives of the countries involved. I've read that some of these so-called screeners can't even read a digital scanning thermometer. What'll probably happen is that airlines (to protect themselves) will stop picking up passengers in those countries. That might happen if the epidemic spreads to tens of thousands, which WHO said could happen in a worse-case scenario. Passengers need to be screened out prior to boarding in those countries. By the time people get to the U.S., it's too late.
It might be airborne, but what we do know for sure is that it lives for hours or even days on surfaces (It says so on the CDC website). It obviously is transmitted by even infinitesimal contact with bodily fluids of a victim. It can enter the human through a cut or through contact with mucous membranes (like cleaning up after somebody who is sick and, even though wearing PPE, touching eyes or mouth). You do not have to have direct contact with the victim, but you do have to have direct contact with the droplets. Masks don't help with viruses as they are too small to be filtered. That's why the PPE of people working with Ebola victims is head-to-toe plastic suits with self-contained air. That's why Ebola victims who have come to the U.S. are put in negative-pressure rooms and treated like a Level 4 biohazard. But, we only have a limited number of isolation rooms with negative pressure so if an epidemic ever really got going here there wouldn't be enough rooms to treat the victims.
Wait...only a crazy person would infect themselves with Ebola and then travel to the U.S. to spread it. Wait...there are crazy people who want to do harm to the U.S. and are suicidal. Is it too farfetched to think somebody might do that? How many people could such a person infect? Nobody knows. Fortunately, Ebola is quick to incapacitate its victims, making it difficult for them to walk around spreading it. Dr. Freidan of the CDC says he's "100% sure" that you can't get Ebola from sitting next to somebody on an airplane. Really! 100% sure! It's tough to be 100% sure of anything but one thing we do know is that politicians (even politicians who are incidentally doctors) don't want to scare people. But, maybe people need to be scared. I recommend reading Clancy's book Executive Orders (although it's a biowar scenario, not a straight epidemic). The Hot Zone is a true story of Ebola Reston (an airborne form of Ebola) which infected monkeys from the Philippines which were brought to Reston, Virginia, for research. The more people become infected with Ebola Zaire, the more opportunity for it to mutate.
In response to:

Harry Reid: Public Enemy No. 1

Dot462 Wrote: Oct 05, 2014 3:46 PM
But, a large part of the Nevada populace is on some sort of govt dole and they don't bite the hand that feeds. Another large part are union members (although they ought to know better) that reflexively vote Dem. Another part is some big business owners and operators who want their own kind of handouts from D.C. They were afraid that if Reid was ousted they would lose their power position in the Senate. There are also quite a few RINOs here, unfortunately. Some voters in the state are libertine, but there are a lot of others who don't use the services of the prostitutes or participate in the gambling halls.
In response to:

Harry Reid: Public Enemy No. 1

Dot462 Wrote: Oct 05, 2014 3:41 PM
Unfortunately, the Repub party here is so fractured that they'll be lucky to be able to elect any Repubs. The fight has been going on well before the old guard Repubs refused to support Sharron Angle (who would have been a better Senator by far than Reid). But, he enjoys strong union support and big business interests don't want to give up his power in the Senate. But, I will vote for Repubs (even though I don't agree with a lot of what some say) because Dems are worse. It's sad to be in a position like that, voting for the lesser of evils, but right now that's where it is.
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