EHR’s need common language with multiple accents

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Going down the rabbit hole that is health care information exchange, we are often faced with a common question: Is the goal for health care interoperability to have all doctors and hospitals use the same, single electronic records system (EHR)? Would that be the easiest way to accomplish freedom of information movement and achieve all the benefits a robust system should possess (lack of testing and procedure duplication among providers, ease of global search, clinical decision support, etc)?

The answer is a resounding YES! That would be much easier. But it is also a meeker sounding no. Of course if everyone used the same records system, the world of health information exchange would be an easier place. Much like finding parts for your car would be simpler if there were only one brand, model and color of automobile. For the software engineers, it would be a level playing field with great ease of implementation. The loss would be to the clinicians — and ultimately to the patients.

Lack of differentiation in the user experience (UX) puts round pegs into square holes. Forcing a cardiologist to use the same system that works well for a chiropractor would be a detriment to  workflow. The patient encounter and data capture requirements are dramatically different. The importance of subsets of the examination and test tracking differ. The clinician would be slower and the quality of care would likely suffer. The patient would be worse off even as the data forest strengthens and aligns.

What is required is not the use of a single EHR but a single language of data interchange. Meaningful Use Stage 1 regulations brought us the CCD, Continuity of Care Document, which took steps to improve data flow exchange. However, we learned that the CCD isn’t really the complete problem solver it might appear to be. A lack of specificity and optional sections left holes in the dataflow.

The next step comes with Meaningful Use Stage 2: the Consolidated-Clinical Document Architecture (C-CDA); another positive push toward interoperability. This allows clinical summaries and consult notes in an easier to parse format with consistent headers. Still complex gaps in the translation and integration process that need to be ironed out, but closer to a universal language albeit colored with individual clinical accents.

The standards come down to restraints: force users to put as much information about a patient’s health into ones and zeros, checkboxes and pulldown menus and as little as possible into the once gold standard of clinical narrative. Think: fewer words, more structured data sets. Less creativity but easier sharing capabilities.

Overall, the system is moving in the right direction. There is much work to be done, which is exciting for those of us who want to help in the transition to full interoperability with the ultimate goal of increasing quality of health care while reducing costs and medical errors.

Dr. Brett Kinsler is an evidence based chiropractor in Rochester, NY and a certified healthcare technology specialist.

Peanut Butter in the Gas Tank

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People amaze me. Honestly, I am always surprised by many people’s consistent failure to leverage logic in a situation. Here’s an example: A patient had a lumber disc issue three years ago. After seeing several other practitioners, epidural steroid injections and physical therapy all failed to produce desirable results, a friend of the patient suggested he see me. A few properly directed treatments of flexion-distraction and long axis decompression went a long way to quickly dissipate this patient’s disc pain. We were both quite happy with his recovery.

Fast forward to now; three years later. The patient again comes to me with disc pain. When I asked when it began, the patient tells me it started 6 months ago and he went through physical therapy, medications and more injections before returning to me. I was stunned. Chiropractic treatment worked so well for his disc pain in the recent past, why would he not seek my help immediately after a similar flare up?

I equate this form of illogical thinking to putting peanut butter in one’s automobile gas tank. After all, the past hundred times I put gasoline in my car, it ran as it was intended. But this time, I am going to put peanut butter in the tank instead of gasoline hoping for a better result. Huh?

The old adage that people who do what they’ve always done will get what they have always gotten is usually used to illustrate the negative consequences of stagnation. However, if you are satisfied with the results of what you have done in the past, continuing with that same strategy just makes good sense.

 

Brett Kinsler is a chiropractor in Rochester who treats disc injuries in a way that works. If it didn’t work, he would do it a different way. 

Medical doctors as chiropractic patients

I saw a new patient this week in our chiropractic office in Rochester who is a medical professional. This is nothing novel as we have a lot of medical workers as patients. What was interesting however was this patient said she had asked her colleagues and none of them saw a chiropractor. Really? None of them? Surprising.

There was a time when the medical profession eschewed chiropractors but as the literature changed and (the better) chiropractors focused on science over superstition, those tables have turned. Still, when the occasional medical doctor or registered nurse questions the clinical veracity of what we do, I like to remind them of several important points:

First, these is no evidence of excess risk of vertebrobasilar artery (VBA) stroke from chiropractic care compared to medical treatment. None. This is not an opinion. We can point to the studies, back it up with research and factual evidence.

Second, recent studies show that patients with low back pain and neck pain do not add to overall medical spending seeing a chiropractor versus other types of medical care. This is based on a survey of 12,000 respondents. In fact, seeing a chiropractor results in a 20-40% decrease of costs in lower back pain compared to MD treatment.

Third, there are many clinical reviews of spinal manipulation for low back pain and it has been shown to be more effective in the short term for many cases and probably the most effective treatment for chronic low back pain patients.

Fourth, patients like seeing a chiropractor over most other health care treatments and isn’t having a compliant patient who is happy half the journey toward recovery?

I also remind my physician and medical worker patients that in our practice, we limit our focus to neuromusculoskeletal issues and treat with a biomechanical focus. That means no magic, no chanting, no candles. Just well evidenced, science based treatments that are worthy of their referrals.

The real question is why don’t more medical doctors, PAs and nurses refer appropriate patients to responsible chiropractors and see them for their own back and neck pain?

Dr. Brett Kinsler is a practicing chiropractor in Rochester, NY. Our practice is evidence based and spine focused.

 

 

Do you do the RHIO?

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Perhaps you’ve heard the term before. Perhaps not. RHIO (ree-yo) stands for Regional Health Information Organization and is a way for multiple providers and health care organizations to share data in a common way. The goal is to facilitate rapid and standardized exchange of patient information. Our office joined the Rochester RHIO which gives us access to the hospitals, laboratories and radiology centers in a 13 county region.

From the first day, our patients noticed the benefit. We were able to quickly obtain lab results that were ordered by another doctor, get imaging results from years back and check on the discharge instructions from a recent emergency department visit. All with minimal interruption to our office workflow. All of these things were obtainable in the past but each required a separate phone call from a staff member and, when a patient couldn’t recall exactly which lab or center performed their test, often multiple calls were needed.

It is easy to see that RHIOs should help in reduction of test duplication, decrease staff hours in tracking down results and providing patients safer care but transferring allergies and medical history to each provider. The organization in the Rochester area has no cost to providers (including chiropractors) but your mileage may vary.

It’s not without it’s weaknesses. Currently, the Rochester RHIO doesn’t have accurate patient insurance information and individual providers cannot upload data. So, if we write a report for a patient from our chiropractic office and discuss the treatments we delivered for a herniated disc, for example, there is no way for us as an individual provider to submit that to the system. Yet. For the moment, we are consumers of the data and not producers. This is a weakness but I imagine it won’t be for long.

If you are a medical doctor or chiropractor in the Rochester, NY area, I strongly urge you to contact our local RHIO (http://www.grrhio.org/) and if you are a practitioner in another part of New York State, you can check this clickable map to see if there is a RHIO you can join in your region: http://www.health.ny.gov/technology/projects/regions/

Wondering if there is a RHIO in your state? Check with the local hospital’s IT or HIM (Health Information Management) department. They should know if there is a current network or one in the planning stages. The transfer of health information across multiple organizations is one of the most important aspects of healthcare and one that benefits providers, patients, hospitals and the communities.

 

Dr. Brett Kinsler is a chiropractor in Rochester, NY and a certified healthcare technology specialist.

Randy Ferrance, DC MD, bridging the gap between chiropractic and medicine

Podcast with chiropractor medical doctor who bridges the gap between the two professions

Dr. Randy Ferrance is a medical physician who was a practicing chiropractor when he entered medical school. Raised in an evangelical chiropractic family, he wasn’t vaccinated as a child. He speaks on bridging the gap from chiropractic to medicine, on his experiences making the transition from chiropractic to medicine and on how chiropractors can best develop working relationships with medical doctors.

Does Dr. Ferrance experience prejudice for being a chiropractor/medical doctor? Yes…but it’s not from whom you’d think.

Interview conducted with Dr. Brett L. Kinsler.

Get the podcast here or look for OnTheOtherHand Podcast on iTunes.

This podcast episode was sponsored by XSite Pro website design and management software. The software I use for my own office website.  Try their software with a 30 day money back guarantee.

YouTube Video Promo for the On The Other Hand Podcast

I keep being told that in order to maximize our exposure with the podcast, we need to also have some video. I produced this video promo in order to let more people know about the project in which we help to uncover more scientific, ethical, intelligent people in chiropractic, alternative medicine and health care.

Edzard Ernst, CAM Critic, Talks with Dr. Brett Kinsler on Chiropractic and Bias

Book by Edzard Ernst complementary and alternative medicine

Professor Edzard Ernst, MD, PhD, FRCP, FRCP holds the Laing Chair in Complementary Medicine at the Peninsula Medical School, University of Exeter and is the Editor-in-Chief of two medical journals. He has also been seen as a major public opponent of chiropractic and alternative medicine. He has devoted most of his career to publishing articles that are critical of complementary and alternative medicine….an unbelievable number of papers. Like 1500 or so. He’s been especially critical of chiropractic and, in the opinion of many researchers, has glossed over important research and exaggerated results. To me, what’s most interesting about Ernst is that he claims objectivity and lack of agenda. This podcast asks some tough questions of Prof. Ernst.

You can get the podcast episode on iTunes by searching the podcast section for “On The Other Hand” or you can just click here.

Thanks to this episode’s sponsor: Audible.com, the audiobook company. Get a free audiobook download just by trying their service free for 14 days.

Freezing Cold Electrodes? Not Anymore!

I live and practice chiropractic in Rochester, NY right smack in the middle of the upstate New York snow belt. And I know it’s hard for you to believe but it does get a tad bit chilly around here…even in the winter time. Seriously.  Now, on occasion in our office, we use some electric modalities with patients (electric muscle stimulation, interferential, etc.) and one thing always bothered me. Generally, when we choose to use one of these modalities, it is because of overly tight muscles or splinting (settle down there Ben Franklin, we can talk about the research in another post). And regardless of whether we used the sticky electrodes or the 3 x 5″ carbon electrodes that were sprayed with water (my economical preference), patients always jumped just a bit from the cold electrodes. This seemed counter-productive — especially when we are talking about people who are in pain and spasm and shouldn’t be exposed to a shock that makes them jump at all.

Several times per day, I would hear myself say, “Sorry, these are going to be a bit cold.”
To which the patient would respond, “Arrrrrgh! Holy crap, is that cold!”

Not the greatest strategy for patient comfort, retention and bedside manner.

So five years ago, I decided to take it as a personal challenge to solve the problem of the freezing cold carbon electrodes. First, I tried heating the water in the spray bottles we used. I got a desktop coffee cup heater and rested the spray bottle on that. I also tried ultrasound gel warmers and a few other strategies. No help. The water stayed warm but once the water hit the air, it was almost as cold as without heating it. And keep in mind, 72 degree room temperature water is awfully chilly to a 98.6 degree body.

After several experiments I determined that the only way to consistently deliver comfortably toasty electrodes to the patient would be to actually heat the electrodes. Then, once the water hit them, they would still feel warm. But how? We have a microwave in the office but this seemed like a terrible idea for the degradation of the carbon. I was also afraid it would become uncomfortably hot and perhaps even cause burns. Another idea was to dunk them in a hydrocollator but I didn’t have one in every treatment room and had no intention of buying a bunch of hot water tanks at $250 a pop. Not to mention the space they take up and the horrible prospect of a kid turning his arm into soup. It also made the electrodes really wet and patients didn’t dig that too much.

The perfect solution would be something that I could rest the electrodes on and keep them at a safe, steady temperature.  It would need to be small, be able to stay on all day without over heating and be safe around little patients’ little fingers.

In the unlikeliest of places, I actually found it! A small, thin, flat heating element that stayed at 100 degrees Fahrenheit. No more, no less. The device is meant to be kept on all day long with no danger of overheating. You can turn them off at night and they warm up quickly in the mornings. They are safe to touch. They don’t wear out the electrodes and they cost under 15 bucks!

I bought four of them and they have been in constant service for 5 years.  None have failed. None have caused patient burns. And best of all, there have been no chilly electrodes.  I can use them with the carbon or the sticky ‘trodes.  I sandwich the paper-thin heater between two pairs of electrodes and usually toss a package of stickies on top.  Now patients say, “Ohh, that’s nice and toasty. Like a spa.”

I can live with that.  Bring it on, Winter! I’m ready for ya, Tough Guy!

I searched around since the store I initially got these heaters no longer carries them but I just located them online for a great price! The exact model and brand I have been using can be found here in case you are interested in getting some for yourself.  Yes, it takes you to a pet store website.  No, that is not a mistake.

Too bad you have to get them online, though. I really enjoyed the horrific look I got from the checkout girl when I first purchased mine when her eyes widened and she asked, “Exactly how many cobra snakes do you own?!?”

You will miss that conversation and the wide-eyed checkout girl but you won’t miss your patients cringing from your formerly cold electrodes.

Let me know how it works out for you.

Link to get the “Electrode Heaters” I use.

Is Warren Hammer a Fasciaist?

Fascia is the newest focus in manual medicine. Those fibrous sheets that surround muscle are proving to be the link to all sorts of musculoskeletal problems. In this podcast episode, I interviewed one of the foremost experts on soft tissue manipulation who is bringing some groundbreaking techniques on fascial manipulation to the United States for the first time.

Excited about his recent work with well-known Italian physical therapist Luigi Stecco, Dr. Warren Hammer brings his 50 year experience in chiropractic and soft tissue procedures to his candid talk with me on our On The Other Hand podcast.

The episode can be found on iTunes or here.

Think you know all about chiropractors? Think again.

 

Interview published on the On The Other Hand podcast series by Rochester, NY chiropractor Dr. Brett L. Kinsler.

Tom Hyde, DC is Sports Chiropractic.

Photo of Tom Hyde, DC

Dr. Tom Hyde co-developed Functional and Kinetic Treatment with Rehabilitation, Provocation and Motion (FAKTR-PM).

Tom Hyde, DC has had so many accomplishments and he discusses several of them in an episode of our podcast including how he helped to incorporate chiropractors into the world of professional sports.  Hyde talks about how the barriers were broken to get chiropractic services to Olympic athletes, how he became the chiropractic physician for the Miami Dolphins and he discusses the procedure he co-developed, called FAKTR-PM.

FAKTR-PM stands for “Functional And Kinetic Treatment with Rehabilitation, Provocation and Motion.” It was developed to help speed recovery from chronic musculoskeletal pain syndromes and has also been shown to work extremely well on acute musculoskeletal/fascial conditions.

In 1987, Tom Hyde became the first chiropractor to be accepted to the volunteer program for chiropractors at the United States Olympic Training Center, in Colorado Springs, Colorado, and was subsequently selected to serve as the official chiropractor for the 1987 Pan American Games. In 2001, Hyde was inducted to the Hall of Fame of the Sports Council of the American Chiropractic Association.  In 2002, he was named “Sports Chiropractor of the Year” by the Florida Chiropractic Association Sports Injury Council.  He was named “Person of the Year” by Dynamic Chiropractic in 2009.

He is an avid mountain climber and will soon be going to Kilimanjaro for the 3rd time.  He invited podcast listeners to join him on the climb.

His website www.faktr-pm.com will be changed in January 2011 to www.faktr.com

Find the podcast and show notes at OnTheOtherHand.podbean.com or look for us on iTunes.

 

Functional and Kinetic Treatment with Rehabilitation, Provocation and Motion (FAKTR-PM).

Photo of Tom Hyde, DC

Dr. Tom Hyde co-developed Functional and Kinetic Treatment with Rehabilitation, Provocation and Motion (FAKTR-PM).

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