• Federal panel: stop prostate exams at 75 years of age.

Most oncologists already argue against treating most men in that age group for prostate cancer because they are more likely to die from some other cause than from their tumor. The new guidelines go one step further, saying, in effect, why test if the patient is unlikely to be treated? The guidelines, published in the Annals of Internal Medicine, are only recommendations, but they are relied on by many physicians in determining patient care. The recommendations could therefore trigger a decline in prostate cancer testing in the elderly. The recommendations provoked a backlash from some experts.

• So much for privacy concerns.  Apparently more UCLA Medical Center employees helped themselves to celebrities’ medical records.
• Can estrogens relieve psychosis in women with schizophrenia?

Schizophrenic women who get an estrogen patch along with their regular antipsychotic medications have fewer symptoms than women who get inactive placebo patches. The finding, from a four-week study of 102 women of childbearing age with schizophrenia, comes from Jayashri Kulkarni, MBBS, PhD, and colleagues at Monash University in Melbourne, Australia. During her psychiatric training, Kulkarni spoke with many schizophrenic women who kept telling her, “It’s my hormones, Doc.” They also told her, “No one takes any notice when I say that it’s to do with my hormones.” Kulkarni took notice. She and her colleagues have now completed a series of small studies showing that estrogen can be very effective in reducing symptoms such as delusions, hallucinations, and disordered thinking.

• What to the Democrats think of Obama’s message of healthcare reform?  Why, they’re all for it.
• Since 2000, the World Bank has spent over $1.6B to combat AIDS-related illness in Africa.  But is it enough?

It’s inevitable.  Electronic prescribing may be a early-adopter niche-driven tech blip on the EHR tableau, but it is here to stay; and the government is getting in on the act.  Medicare will now provide incentives for physicians who wish to incorporate this method of prescribing into their practices.  Makes sense.  The days of physicians getting a free pass on illegible prescriptions and healthcare’s expectations of working within this potentially dangerous construct are numbered — from a patient safety standpoint.  | LINK

• Presumptive Republican presidential nominee John McCain releases health records.
• Is there a role for a simple blood test in predicting cardiac risk in post-menopausal females taking estrogens?
• Panel: Those with hypertension should be monitoring their blood pressures at home regularly.

The advice was published online yesterday in the journal Hypertension, will be printed in the June issue of the Journal of Cardiovascular Nursing and comprises a joint statement from three medical organizations: the American Heart Association, American Society of Hypertension and the Preventive Cardiovascular Nurses’ Association.

The panel wrote that an increasing number of patients are measuring their blood pressure regularly at home, and although this practice has been endorsed by national and international guidelines, there are no detailed guidelines.

• More on the launch of Google Health.
• Florida’s governor and possible VP candidate, Charlie Crist, signs law giving that state’s uninsured “access” to healthcare with low-cost premiums.

Google Health was unveiled yesterday (google.com/health), and it’s the latest entrant into the increasingly crowded online personal health records marketplace.  When the product was in beta, its 1600 closed invitations were quickly snatched up, and anticipation only increased from there.  Like other services, say WebMD, Google hopes to capitalize eventually on the trend of increasingly seeking health information online, and the potential of Internet tools to help consumers manage their own health care and medical spending.

The user is completely in control with his/her own personal record, as allows the user can send personal information, into the clinic record or to pull information from the participating clinic’s records into the individual’s Google personal file.  Also, the healthcare consumer has the ability for his/her uploaded information to provide an online health profile and seek out second opinions with the click of a mouse. | LINK

• Mayor Bloomberg makes his case for NYC to use the electronic medical record to follow patients’ chronic medical conditions, and he is incentivizing providers who accept Medicare/Medicaid to buy in to it.
• There’s yet another use for corn.  Researchers are now seuqencing its genome.
• A new study suggests that a popular drug used to treat anemia in cancer patients may actually be increasing the risk of death in these patients.
• WaPo: Approximately 1 in 20 active tuberculosis cases does not respond to even the most aggressive of regimens.
• Want to take that newfangled DNA test?  If you want to be insured, read this first.

Anyone who works in healthcare knows the importance the electronic medical record.  As we get comfortably settled into the penultimate year of the first decade of the 21st century, there is virtually no disagreement among healthcare organizations on the vital function of a sound method for the transmission, storage, and retrieval of the secure electronic medical record.

Internet search giant Google knows this as well.  For the past year and a half, the company has been developing a standard for the Web-based personal health record.  Portability seems to be the key, and the prestigious Cleveland Clinic has wholly endorsed the company’s intentions.

In the evolution of the electronic health record, this represents a major step.  The flow of information across the Internet is all about (secure) interaction of a personalized nature — the democratization of that data.  Nothing benefits the patient-as-consumer ethic more than giving the consumer the power to take control over this aspect of his or her healthcare.  As healthcare organizations continue to realize that protecting the personalized information of their greatest resources, the patients, is a priority; the delivery of healthcare becomes safer, more efficient, and cheaper.  Once again, Google is at the forefront of this critical piece of 21st century medicine. | LINK

House Speaker Nancy Pelosi announces healthcare initiatives for the upcoming legislative session, and they don’t include any significant inroads into issues of expanding general healthcare access.

Pelosi has talked of allocating more money for medical research, creating a common electronic medical record and spending more to repair aging highways and bridges.

Really, should we expect anything more? | LINK

It started out as an inspired effort by Gov Schwarzenegger to insure all of California’s neediest patients.  But, just like fellow Republican Rudy Giuliani’s Florida primary meltdown last night, the gov’s hopes for subsidizing the healthcare for every one of his state’s residents is about to implode.

Based upon a similar model of taxpayer subsidy, mandated employer contribution, and forced patient participation employed in Massachusetts, the Schwarzenegger administration’s plan for universal coverage seems to be collapsing under the weight of a severe state budget deficit from which it seemingly cannot overcome in the short term.

That essentially means that were the plan to pass the state Senate (unlikely next week), the prime mode of subsidy would have to come from the people his version of universal healthcare was supposed to help – the working Californian. 

But for some, the numbers did not add up.  “I just came to the conclusion that the working people are going to end up paying for it,” said Senator Leland Yee, Democrat of San Francisco, who announced his opposition before a committee meeting last Wednesday. “There’s control for everybody else — the employers are protected and the insurance industry. The only group that’s vulnerable is the working people.”  Asked to surmise its odds of passage on Monday, Mr. Yee was blunt. “I wouldn’t bet 5 cents on it,” he said.

It will be interesting to see in next week’s California exit polls on Super Tuesday if this issue resonates enough influence the Democratic votes in Barack Obama’s favor, where he continues to trail Hillary. | LINK

The use of the electronic medical record (EMR) and its importance in the practice of 21st century medicine cannot be overstated enough.  Whereas the original intent was the push toward a “paperless” and efficient mode for the storage, retrieval, and transport of medical information, once early adopters quickly accepted its use, EMR has radically redefined the logistics of medical practice and its standard of care in this country.

Enter the field of medical and scientific research, specifically disease surveillance in the public health sphere.  Researchers from the Indiana University School of Medicine have found that automated electronic medical laboratory reporting (ELR) improves both the completeness and timeliness of disease surveillance, significantly bettering the odds of stopping the spread of disease.

It pays for healthcare organizations to adopt, adapt, and promote the use of the electronic record as not only an indispensable efficiency for healthcare organizations, but also as a necessary element in health maintenance and disease prevention for the good of the public. | LINK

With all of the hype surrounding the push to the electronic health record (EHR) in the healthcare organization of the 21st century, it’s still hard to believe that there are still practicing groups which are entirely paper-run.  The Department of Health & Human Services is initiating a pilot project to woo the non-believers (or the lazy) to the benefits of practicing medicine with EHR support.

Under the program, physicians will receive additional Medicare payments for completing certain tasks online, such as ordering prescriptions and recording laboratory test results. Physicians who use the electronic system most often for major tasks and obtain the best scores in an annual evaluation will receive the highest payments. Medicare reimbursements could increase by several thousand dollars for participating physicians.

This move may be a little premature, especially since EHR is not standardized among different organizations.  Without knowing absolute quality parameters which EHR is touted to produce, how will the federal government see a return on investment?  And when?  Perhaps with the money that was supposed to go toward SCHIP expansion, we may already have a partial answer. | LINK

Kaiser Permanente just released the findings of a study which sought a higher quality of care with respect to patient outcomes in those members who were diagnosed  with osteoporosis.  The healthcare organization realizes that the number of deaths from which this disorder may play a role could be prevented provided that close followup and secondary prevention could be implemented.  The organization surmised that if the treating clinician had immediate access to crucial patient data in electronic form, then prevention, and subsequently optimal patient care, would result.  According to initial trial results, it has.

This study of 3,588 women shows that an outreach program targeted to patients with a previous fracture meant there was an improvement from 13.4 percent to 44 percent of patients being evaluated and/or treated for osteoporosis. Osteoporosis management is the receipt of a bone mineral density (BMD) measurement or osteoporosis medication in the six months after a fracture. If widely implemented, this approach could substantially improve the secondary prevention of osteoporosis, according to the study authors.

The motivation for this trial was also corroboration from the standpoint of clinical treatment guidelines from the National Center for Quality Improvement, not to mention the high probability for future funding of similar research incentives for Kaiser.