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The attack ads proliferate in Nevada. I try to mute them, but it's hard to avoid. Seems to me most of the attack ads are put up by Dems and I make it a policy to vote for the other candidate if I see an attack ad. The Miller-Laxalt campaign is pretty nasty. But, it extends down to the city council level as I received a robocall from candidate Cafferata attacking candidate Duerr, which makes me instantly want to vote for Duerr (this is a nonpartisan race). I check them out on their websites and elsewhere to see if either of them are worth voting for. We have None Of The Above here in Nevada and I sometimes exercise that option. In the primary for governor, there were a couple of Dems and they both lost to NOTA. Flores was the second best in that primary, but has no chance against Sandoval, but it was interesting that NOTA won.
But we have the International Classification of Disease (ICD-9, soon to be ICD-10) which lists many "diseases." It breaks down subtitles under the "diseases" into minutiae. It classifies "substance abuse" as a disease and under that it includes "alcohol abuse" and "drug abuse," which is further broken down into what drug. It codifies accidents and injuries and includes how the person was injured such as falling off a swing in a playground or being kicked by a horse. So, the reason the CDC takes on "diseases" such as obesity, smoking and gun injuries is that they are classified as "diseases." So, "public health" has been expanded to include anything that can happen to somebody indoors or outdoors. The CDC, then, thinks that it is the nanny state and can advocate, by spending money on TV advertising, that we stop smoking, stop drinking sugary beverages, etc. It then doesn't spend money on such things as research into a vaccine (or vaccines) for hemorrhagic fevers (of which there are several besides Ebola). When ICD-10 comes out next year, CDC will have even more minutiae to be concerned about that will be classified as a disease.
It's your tax dollar at work. The hospital will collect from Medicaid.
You are able to add a correction to your records if you find an inaccuracy, although I'm not sure who will read it since some records are voluminous and more cumbersome to handle and locate data than in a paper record. That's why you should have a copy of pertinent records that you keep with you.
You're absolutely right, Dr. Zinj. Think of how the IPAB will use the expanded data under ICD-10 to keep track of more minutiae in medical records and decide whether to pay based on cost/benefit analysis. I'm sure you have read Dr. Ezekiel Emanuel's Lancet article in 2009 about the Complete Lives System.
It is so important for you, as a patient, to have copies of your medical records (at least, the pertinent parts) which you keep in your possession. I've been in hospitals a lot both for myself and for my family members and have used the record that I have to point out to the doctor what was there before, particularly because I have not always gone to the same hospital. For example, I had an EKG done in southern California when I had chest pain and when I followed up back at home I had a copy of it which the doctor was glad to have and copied it for their own records. Don't rely on the electronic record. Know what is in it. You have the right to read your record (for a fee).
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.
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