Docnotes

AAFP Monograph - Aging

The AAFP sends out mongraphs every few months.  I often glance at them and then pile them up in my study so taht I can r"ead them later"  .. (so that I can throw them away the next time I tidy up).

They're all on line ... so today's copy: Aging and Health Issues: The Family Physician's Role is going right into the recycling.  It looks interesting .... and ther are several useful screening tools:

• Folstein MMSE
• Michigan Alcoholism Screening Test - Geriatric Version (MAST-G)
• ADL self-maintenance scale
• Instrumental Activities of Daily Living Scale (IADLS)

Now I'll never lose it ...  and the office stays clean!

CCR vs EHR

Since it's not released yet - I don't know what the CCR is .. and it's likely that you don't either.  Ideally, this effort will get combined with the HL7 EHR project.  MRI has a little review of CCR and an explanation about what it isn't: an EHR.

EMR Selection - More

Thanks to all who have taken a look at the survey pilot.  I'm impressed with the response so far .. but not many have suggestions for additional (or corrected) questions.  I'd like to make the survey ~ 20 questions so that we capture a reasonable amount of data - but at the same time it would be very quick to take.

I've pulled together some interesting resources on usability:

• Himss EMR vendor selection paper
• 1999 AMIA paper
• JMJ EMR workflow "white paper"
• Usability.com - usability glossary
• COMPETE EMR vendor slection process (PDF)  (powerpoint)
• Peter Ziemkowski's 1999 paper on EMR usability
• Integrimed's EMR evaluation matrix paper has some usability references - but is a good example of how usability isn't adequately measured in such evalutations.
• Jakob Nielsen's useit.com 
• Maryland's Human-Computer Interaction Lab
• IBM has some interesting papers on usability - and they've got some great posters that can be used to remind us that "computing is about people, not machines."  IBM's User-Centered Design principles are also a good summary of what we should expect from our vendors.
• An essay on medical errors and usability.
• FDA:  Human Factors in Medical Device Design
• David Gaba's 1995 paper: Human Error in Medicine

EMR Usability

We're still struggling with our EMR .. and beginning (again) the process of reviwing alternatives. 

When I read EMR evaluations, I'm often struck by the absence of usability studies.  While the vendors have lots of feature "bullets" ... usability remains largely unmeasured and hard to compare.

I'm thinking of creating a survey to capture a few important usability metrics.

Something like this pilot survey ... but with more questions.

I'm trying to think of what the questions should be.  Pelase leave comments if you have suggestsions for very simple questions .. and please do fill out the pilot survey and give me feedback about that too. 

Thyroid Masses

More from down under:  eMJA: 6: Thyroid nodules and thyroid cancer  -- a nice review article on these relatively common conditions.

Sandifer Syndrome

Ok .. so I hadn't heard of this syndrome, but I've now seen a case (or what I think is a case .. we'll see if the specialists agree) .. and I think it's a good one to know about.  Here's an article with a good summary of some typical findings .. and here's a good review article on it.

 

Shared decision-making

An article in Biomed Central looks at whether Japanese Patients want to participate in shared decision-making with their physicians. It's an interesting paper - and deserves a quick read - but I wonder what cultural diffrerences influenced the results.

NAPCI news

The NAPCI - News page is a great resource for recent news that is relevant to primary care / information technology.  RSS coming soon?  We'll see.

Will Mothers Discuss Parenting Stress and Depressive Symptoms With Their Child’s Pediatrician?

Pediatrics -- Abstracts: Heneghan et al. 113 (3): 460 Conclusion: Mothers are aware that their own emotional health has consequences for their children. Although many mothers experienced lacks in their social support systems, many are reluctant to discuss parenting stress and depressive symptoms with their child's pediatrician because of mistrust and fear of judgment. Mothers are, however, generally receptive to the idea of open communication with their pediatricians and are interested in receiving supportive written communication about parenting stress and depressive symptoms from pediatricians. These qualitative data are valuable in developing an intervention to help pediatricians assist mothers at risk.

This is an interesting paper from many standpoints - and surprises me little.  Comunication between a child's physician and parents is essential to the health of the family.  Pediatricians are ill-positioned for this task relative to family physicians.  I'm occasionally asked by parents why they should bring their child to a family physician rather than a pediatrician.  Because we have a relationship with the parents - family physicians are simply better positioned to build and maintain a relationship with them as separate people (rather than as extensions of the children).  Parents' fear of being judged would, I expect, be less in this scenario. 

HINARI - Health InterNetwork

Health Internetwork The Health InterNetwork was created to bridge the "digital divide" in health, ensuring that relevant information - and the technologies to deliver it - are widely available and effectively used by health personnel: professionals, researchers and scientists, and policy makers. Launched by the Secretary General of the United Nations in September 2000 and led by the World Health Organization, the Health InterNetwork has brought together public and private partners under the principle of ensuring equitable access to health information.

There is an article in this week's NEJM:

A total of 1043 institutions in 100 countries (of a total of 113 eligible countries) have registered for the program. Institutions in countries with a per-capita gross national product (GNP) of less than $1,000 receive free access to the journals (see Table). Institutions in countries with a per-capita GNP of $1,000 to $3,000 pay $1,000 per year. These institutions include national universities, professional schools, research institutes, teaching hospitals, and government offices.

I can remember when my grandfather John J Sampson died, we bundled up old JAMA and NEJM issues and shipped them off to Nicragua.  The Health InterNetwork project is a great example of how technology can have a tangible impact on the health of thousands (?millions?) of people.