So why don’t doctors introduce EHR’s?

Aside from the fact that in Australia we have very little variety when it comes to electronic health records, there seem to be two major factors: the expense and concerns about loss of productivity.

Fortunately, Studies from the USA show that while they do not increase turnover, the expense is made up in increased productivity.

Other concerns doctors have include their own lack of computer skills and the lack of technical support available. In parts of the USA, over 40% of doctors use electronic health records, but the average is said to be only 18%.

Despite their concerns, even the oldest of these doctors use email. So the idea of a web based EHR might not be so bad. This is where I begin to get excited: Practice Fusion is the first web based Software as a Service system is being offered free to doctors. It incorporates EHR, practice management, scheduling and other features (most specific to US based physicians).

Let’s hope we see something like it in Australia soon.

How Wired is your Medical Practice?

And does it matter? According the the Royal College of General Practitioners it does matter.

The best general practitioners offer “clear and precise” web sites and seek a patient’s consent before giving private patient information to other healthcare professionals, according to a newly released guide on good medical practice. In contrast, the “unacceptable GP” does not have a Web site or has one that is misleading or self-promoting, according to the 2008 edition of “Good Medical Practice of General Practitioners” by the Royal College of General Practitioners.

A good read for any GP, the guide has other interesting thoughts. For example “Patients value being able to talk to a doctor or nurse on the phone or consulting through email.” It also notes that while patients do not need to be examined on every occasion, GPs need to put themselves in a position to be able to identify an important problem if there was one.

Not only is IT important for good patient relations, it may decide whether you can attract younger doctors to follow in your footsteps. Ninety percent of medical students consider such system to be a key factor in where they choose to practice, according to a survey by San Mateo, CA-based medical research analyst firm Epocrates Inc. In the firm’s third annual “Future Physicians of America” survey, 62 percent of medical students considered an EHR system’s presence “very important,” and another 28 percent said the system was “important” in helping them choose a future practice.

The overall message is fairly clear. Now just how do I go about getting my 58 year old GP to change his ways??

Emerging Health 2.0 Tools

If you thought Medscape or Wikipedia were good, wait till you see what’s around the corner.

I’ve been blogging for some time about electronic or personal health records online such as those offered by Google and Microsoft. Interestingly, as I predicted, the uptake has been slow and many don’t seem interested in maintaining them. The major problem from my point of view – that of a soon to be doctor – is that these tools don’t add anything to the persons health improvement or healthcare system experience, and they certainly are of no great benefit to the treating doctor.

However there are many other Web 2.0 tools emerging that may help both doctors and consumers.

The first is Medpedia, a collaboration between major academic institutions and governmental agencies that aims to describe the entirety of current medical knowledge. Google has launched a wikipedia competitor called Knol. Now many are suggesting that sites like this could threaten the stranglehold that traditional medical journals have had on emerging information.

Wikis can cover nearly every topic. But accuracy and credibility problems may arise when topics are not moderated by subject matter experts. So these new health care sites address the accuracy issue with expert panels from every discipline who jury the content.

What makes these efforts particularly interesting is that, through a collaborative Web-based process, they attempt to distill and document the current best knowledge about any topic.

Related tools are also emerging for clinicians. WikiHealthCare is an interactive forum for health care professionals. Clinfowiki is devoted to clinical informatics. Then there is the Health 2.0 wiki, which has assembled information about that burgeoning sector, and a variety of knowledge, product and service exchanges:

Patients Like Me, Sermo, Carol where people can learn about a topic, or can contribute information that deepens the information readily available.

These tools are not just about information but are also beginning to analyse data. For example, Oncology Metrics aggregates clinical and administrative data across oncology practices, feeding the results back to the contributing practices to help them better understand and manage their practices.

These are all exciting developments. They will help us organize and maintain a unified knowledge base of the best current medical and health care information. If we can figure out how to link them with our EHR’s and PHR’s and in turn allow doctors to use them as practice management systems, we’ll have a real Web based healthcare system!

The future of primary care?

While in Australia we are busy debating the potential role of physicians assistants, a company in the USA is about to deploy them in their thousands in shopping centers across the country with only ‘telemedical’ oversight by a physician.

NuPhysicia LLC, a private medical services company, has a large telemedicine program based at the University of Texas Medical Branch at Galveston. The clinics will operate under the name “Walk-In Telemedicine Health Care” in order to help ensure that people understand they are not being seen by a doctor in person.

How does it actually work? Basically, paramedics welcome and examine patients using medical devices such as an electronic stethoscope to listen to the heart, or other scopes that can see down the throat or in the ears – all of which is relayed back to a doctor. Acording to their press release: “the physician sees and hears everything live and in real time,” said Glenn G. Hammack, president of NuPhysicia. “The physician performs the exam as if he or she was in the room with the patient.”

Hammack said the program replaces the care typically provided by nurse practitioners at retail clinics. “Our alliance takes that care a step further, bringing new levels of service, convenience and value to the retail health-care setting through interactive physician visits.”

Already in the USA, many doctors offer more varied modes of patient interaction such as basic email or telemedical consultations. With electronic health records now taking off one can envisage a time when all 4 modes merge into one seamless package.

So where is Australia in all this? And will our medical groups oppose such models of primary care on the grounds of patient safety?

Certainly many will say the USA’s health system is not one to compare ourselves to – but that doesn’t discount the potential value of these novel technologies.

Attitude is everything – almost!

Yes indeed. And today I collected a spray worthy of HG Nelson today when I questioned the value of some of my rotations through specialties in hospital this year. My colleague, who’s level of motivation no one would question, certainly put it to me.

A recent blog by Linda Calabresi had the same message, referring particularly to students ‘GP experience’. While reflecting on the joy the overflowed from WYD pilgrims recently in Sydney, she asked herself why there was not more demand for GP training positions and why many GP’s highlight the trials and tribulations of their practice.

I personally believe much of it is cultural, meaning that traditionally general practice was not for the most talented and thus it has always had a dirty name – even amongst GP’s themselves.

Fortunately, I am fairly confident that most of my medical school cohort are convinced that, for all the weaknesses of GP’s, they are equally as talented in the pursuit of their profession – when they do it well. What matters then is having the attitude to do it well from the outset.

Future of Pharma Part 4

I think I’ve already written official parts 1-3. But this post focuses on R and D strategies that are already emerging amongst the big wigs.

On the scale of blockbuster to personalized medicine we already know which direction we are heading in. As our genetic testing is not quite up to testing every single patient, companies aren’t yet individualising drugs. but we are already seeing a shift towards a host of new therapies that will have higher efficacy in smaller groups.

This strategy also means easier approval, and more secure financial futures as bis bucks won’t suddenly be lost when patents expire or approvals fail. A quote from a Deloitte’s report:

While typical blockbuster efficacy rates range from 35 – 75 percent, genotyped market segments and biomarker-assessed responses promise treatments with significantly higher efficacy rates, possibly approaching 100 percent.

A critical determinant of financial success for these new entrants will be ownership of the genotype–biomarker combination that identifies high-efficacy treatments for a particular patient–disease state. Whether determined upfront, as in the case of Genentech’s (DNA) Herceptin® or Imclone’s (IMCL) Erbitux®, or retroactively in the case of Sanofi’s (SNY) Clipidogrel, this knowledge permits the evaluation of current and potential products to identify and fill possible treatment gaps.

Deloitte’s also expects collaborative ventures between biotech, such as Merck & Co., Eli Lilly & Co. and Pfizer Inc. who are teaming up to create new drug-discovery methods, hopefully saveing them large sums by reducing the failure rate of clinical trials.

The three companies, normally archrivals, and Boston venture-capital firm PureTech Ventures LLC have launched Enlight Biosciences LLC, which aims to speed the way drugs are found and developed. In particular they are looking at ways to better cross the blood brain barrier.