Discover and read the best of Twitter Threads about #ehr

Most recents (24)

NCI Pooled analysis (N=6.9K) of antiPD1/PDL1:
👉0.6% incidence CPI-related major cardiac AEs, 77% grade 3+
👉Almost half were myocarditis
👉 Twice as common w/ combos vs monotherapy & w/ CPI + targeted agent vs CPI + antiCTLA4…
👉Major cardiac AEs were mostly early events (1-2 months) occurring after median of 2 doses of CPI
👉1/4 of cases of myocarditis were fatal, all preceded by myositis 👀
👉Diverse clinical presentations so have high index of suspicion to diagnose & intervene early…
My commentary: It’s also concerning (& not surprising given what we know about pro-inflammatory metabolic syndrome as a cardiac risk fx) that markedly ⬆️ risk of MI has been reported in pts with multi-yr use of CPIs. I predict this follows a course much like HIV…
Read 6 tweets
Had an opportunity to visit few #MTIs in #KPK with the purpose to explore #PedsICU infrastructure & need assessment and collaboration for capacity building. 1/12
Overall basic infrastructure is there and the need is unmet. And there is a desire on ground to build this field of #Pediatrics which is encouraging. The management is excellent and there is an #EHR in place. All these make an excellent starting point. 2/12
We need to keep few facts in mind while embarking on this challenging and but truly rewarding journey of providing quality acute hospital care to #children in #KPK & #Pakistan 3/12
Read 13 tweets
I’ve been contacted 2x just this wk—1 IRL acquaintance & 1 person I know only via Twitter—after they got imaging results in portal before their dr. They DM’d w/ screenshots, panicked, asking for help. I’m 💯 for pt access to #EHR, but #CuresAct implementation needs a MAJOR reboot
Whenever I have expressed concern about #CuresAct, #advocacy often tells me it’s still better. But it def was not better for these folks, nor for me dropping everything to help ppl who aren’t my pts, whose records I lack, & whose drs I don’t even know, i.e., it’s bad care. 😔
And I’m always happy to help patients, genuinely. I actually started using Twitter to be able to report out from #SABCS17 (I think) for #advocacy. But I don’t like providing bad medical care, & this is a set-up for doing so. We need a systems fix so pts aren’t left hanging…
Read 4 tweets
We have a drug that protects from #HIV. True or False? #ph260720
My friend Steve texted me last year asking how he could convince his partner Ed to see a doctor.

Steve said, “Something weird is happening to him. He can’t walk, his speech is slurred, and his mood changes. He’s a totally different person.” #ph260720 #HIV
I asked him why Ed is reluctant to see doctors. Steve replied, “He has always hated seeing doctors because he feels judged by the health system.”

This is the story of Ed’s experience and how we could have prevented his death from #AIDS 8 weeks later. #ph260720 #providerbias
Read 18 tweets
Today’s medical adventure: patient goes to hospital’s outpatient infusion center. /1
Patient complies with intake procedure which takes 1 hour. This involves nurses doing required data entry for #EHR documentation. /2
Once intake completed, pharmacists is requested to bring up medicine. Waiting time for arrival of infusion drug after getting set-up is 1.5-2 hrs /3
Read 6 tweets
What if you or your doctor could accurately predict how long you had to live upon a new diagnosis of aggressive cancer (e.g. lung cancer or sarcoma)? I've faced that question both as a doctor and with a dearly beloved. On the one hand I know I would 1/ #ML #AI #mortality
do the utmost to beat the odds… and a gloomy prediction would be just another hurdle to overcome. On the other hand, a very accurate predictor of mortality upon diagnosis would be very useful: we might dispense w control arms in trials [at our peril] 2/
families and society might allocate resources/support accordingly, research might focus on why exceptional patients deviate markedly from the prediction… . Therefore a recent study by colleagues @HarvardDBMI @HarvardChanSPH @harvardmed on this prediction 3/
Read 8 tweets
I have found most non-technical explanations of FHIR (🔥) to be unsatisfactory. Key things to know are as follows… 1/🧵
FHIR (Fast Healthcare Interoperability Resources) defines a standard way to organize health data. By having a standard, a computer programmer can write an application (app) that requests data from a source location without having to ask anyone how the data are organized. 2/
This means that a computer application can be written once and work the same no matter which source (e.g., hospital) it requests data from. This is called interoperability. 3/
Read 13 tweets
1/ Good overview of challenges of doing “big data” health care research in US. For instance, nice description of basic pros and cons of insurance claims vs #EHR health care records

2/ But the article has a prematurely triumphant tone at the beginning (and in the default Twitter tagline). N3C is great but limited, as the article does make clear
3/ And it’s not totally novel. But the novelty to me is that it’s

a non-“federated”* model

*not* run by for-profit companies,

so the data are accessible to the public for analysis

*this term is explained in article
Read 6 tweets
🧵1/ I find #COVIDvaccine focus groups like this fascinating. I was struck by the broad distrust of physicians in this group of reproductive-aged women...
🧵2/ I study this kind of population a lot in my #gynhealth work through #EHR medical systems data. As a social epidemiologist, it’s a cool population to study in EHR data bc so many have frequent contacts with the medical system through routine gyn and pregnancy care...
🧵 3/ So you really get a peek into a broad cross-section of the population, unlike other kinds of EHR research.
Read 9 tweets
When the #ACA was implemented: there was no mandate established to ensure that #emr #ehr electronic medical records could communicate and physicians could obtain medical records from #doctors caring for the same patients at other offices or hospitals. 1/
What ensued was that the government forces practices to an incur most of the cost of buying expensive electronic medical records and forced them to use them or incur more financial penalties. In retrospect those who did not use #emr and #ehr benefitted 2/
It became impossible to afford an #emr #ehr in a private practice
costs include:
1. Computers
2. Network maintenance
3. Wi-Fi
4. Back-up systems
5. #emr #ehr Licenses
6. Cost of repairs
7. Reduction of time with patients
8. Increase typing-dictating time
9. Longer notes 3/
Read 6 tweets
@ThinkingAboutV @nanopore The applied omics market based on #NGS technology is still an incipient market if we compare it to more established #diagnostics markets. But we are not far away from a point in time where every newborn's genome is ...
@ThinkingAboutV @nanopore ... sequenced at high quality (long reads, maybe with PCR-free including epigenome marks), and kept as an #EHR in the health system for future use. From then onwards, there will be recurrent #LiquidBiopsy assays, maybe once a year, to screen for a multitude of conditions.
@ThinkingAboutV @nanopore From 40-45 yo onwards, mainly cancer screening of healthy individuals, based on a #MachineLearning cancer classifier such as shown already by @GrailBio / $GH and others, but also other classifiers will come soon, such as #epigenomic profiling of #Neurodegenerative conditions, ...
Read 7 tweets
#MedTwitter showed me the dark side of this, of all times, during a #pandemic. Turns out some who are employed in supposed #SciComm actually stalk patients on behalf of doctors & administrators. Sadly, #bullying patients has gone from "just" in hospitals to dark web.
There is a type of doctor, not all, who believes self a "victim" of patients.. "I am a victim" is used to do mental gymnastics to "justify" #bullying patients who seek answers, report error or harm, initiate lawsuits.

Yes, there is too much litigation. But this is America.
#Tweetiatrician training is for #advocacy on #vaccines #VaccinesWork #VaccinesSaveLives

This has been our lane for well over a decade. As long as I've been a pediatrician we've been using every form of #communication and #SciComm, the sillier the better…
Read 9 tweets
Those who:
do not touch patients & never have
who maintain no clinical licenses
who feel free of any commitment to #ethics

are put in charge, by administrators, to control, often via fear & shame, clinicians.

This harms on many levels.
It is anti-#safetyculture.
We have lost >500,000 Americans to #COVID19 alone. Preventable deaths. These are mostly the marginalized, vulnerable.

Either document measurable work to save lives, or get out of the way and out of budgets that could be used to save lives.
I’ve seen SO much over the years, in the name of #compliance consulting to siphon off money to block &, ultimately, harm.

No this does not save money.
It harms families.
It monetizes coded racism.

There are a multitude of such vendors & consultants.…
Read 16 tweets
Kicking off the Year in Review for #PICUQI and #PedsICU #MedEd #CCC50 Search strategy included a review of ALL tables of contents of major pediatric and critical care journals, PUBMED search, key collaborative search, asking on @twitter and discussion with experts in the fields.
First up, discussion of #PICUQI #CCC50.
First up by @ndean75, “The Late Rescue Collaborative: Reducing non-ICU arrests” in @PedCritCareMed Dean & colleagues saw decreased rates of non-ICU arrests & increased participation through @AAP #MOCPart4. #PICUQI #CCC50…
Read 24 tweets
@MParshleyMD @adamIMdoc @InduPartha @primarycarechat @ACPinternists Urgent need to provide MORE time for ambulatory visits. Us ambulatory specialists have all felt the time crunch of seeing complex patient w/ 5-10 issues (or more) in 15-20 minutes. NOT good #PatientCare. NOT #PatientSafety. Thread 🧵 1 @ACPinternists #IMProud
@MParshleyMD @adamIMdoc @InduPartha @primarycarechat @ACPinternists We need major payment reform so reimbursements & physician “productivity” is NOT volume-centered based on number of visit encounters. THAT drives ambulatory schedules to have visits that are far too short to maximize numbers of visits. Thread 🧵 2 @ACPinternists #IMProud
@MParshleyMD @adamIMdoc @InduPartha @primarycarechat @ACPinternists Focus on value of care, NOT number of visits. Have flexibility of visit lengths based on appropriateness for care complexity. Get rid of “one size fits all” 15-20 minute visits. Simple 1 issue visit ok for that. Complex multi-problems-NOT ok w/ that. Threads 🧵 3 @ACPinternists
Read 6 tweets
1/ @AmerMedicalAssn⁩ submitted comments to ⁦@CMSGov⁩ regarding a NPRM on provider burden reduction and #priorauthorization:

The NPRM cited #OurAMA prior authorization survey data and grassroots website
2/ The rule proposes policies to help make the prior authorization process more efficient and transparent.

The NPRM would require #Medicaid, CHIP, and federally facilitated health exchange plans to:

•Support technology that would convey #priorauthorization requirements
3/ The NPRM would also require impacted payers to:

•Automate the exchange of supporting clinical data from physicians’ #EHR workflow

•Publicly report data on #priorauthorization programs and comply with processing timeframes
Read 8 tweets
Dear #MedTwitter please, please, if you are a licensed medical professional and/or in school to be, do NOT delete your tweets or comply with anyone telling you to do so. It will harm you far more than leaving them up and explaining. Nothing is ever deleted. Can be used in court.
When I was at Harvard Med School and at an esteemed children's hospital, a case against an esteemed professor, that NO lawyer would touch cuz this was someone who had WRITTEN the textbooks and trained every expert, was won ..based on "a document was deleted" - creating suspicion
"Sunlight is the best disinfectant" you will hear me say OVER and OVER - wins & losses *should* be on data/standards but unfortunately wins & losses are in the court of public opinion. So be reliable, credible, and trustworthy. Transparency is one way to achieve that reputation.
Read 64 tweets
Israel is now a population-scale lab to one of the greatest experiments. It is going to be very interesting few months from a scientific perspective.
A thread!
As of yesterday, >10% (~1M) of the population got the first dose of the @BioNTech_Group vaccine (~half of 60+ already got it).

While vaccine distribution is spectacular, covid19 cases raise fast. On top of that, we already have confirmed community transmission of the b.1.1.7🇬🇧🦠 Image
Israel is going to be the first country wide battling ground between the vaccine and the virus. And it is one of the best places to watch such a battle:
- Israel is among the top 10 countries with tests/capita
- Every citizen is part of one of four HMOs. All have #EHR. Image
Read 5 tweets
If you are NOT a clinician with DIRECT patient contact or other frontline service worker (janitor, delivery person, receptionist checking in patients F2F) and offered a vaccine, do the RIGHT thing and step back in line. #HealthcareHeroes needs to be more than a hashtag.
This is NOT okay.

#HealthcareHeroes my foot.

Actions > words

Trainees doing intubation daily should not have to protest to be heard that their LIVES are at risk as compared to administrators or non F2F care doctors.
I posted on #LinkedIn because, frankly, no administrator really follows #MedTwitter apart from “gotcha” policing to discipline or fire a whistleblower clinician.

This is unacceptable.

Admin before F2F care trainee?

Momma grizzly mode activated.…
Read 14 tweets
Being in survival mode b/c of undertreated pain makes me feel apathetic. I would benefit from CBT, but won’t do it b/c ins. coverage req. a dx. code, and THAT would add a psych dx to my #EHR. R/N MDs are using a psych dx to justify taking pts pain meds away. I can’t risk it. #ipp
This makes me think about the evidence that shows a mulitimodal, psychosocial approach works best. I wonder if they know I’d be choosing massage therapy over $ UDTs. But I don’t have that choice. I’d be choosing CBT, but I don’t have that choice. @VanilaSingh @BethDarnall
$600 a year with private insurance is what I spend on having my pee tested. Imagine how many massage and CBT sessions I could have for that. If some of these barriers would be lifted, patients could then have the freedom to self-manage.
Read 6 tweets
In 2016 I was working on a fascinating @SEIresearch project with the goal of increasing the number of women seeking medical care for their pregnancies and deliveries in rurlal #Kenya. I dove down a rabbit hole looking into #electronichealthrecords #EHR and published a..
quickly forgotten conference paper for @NairobiIW and @uonbi. "From paper to data: taking medical health
records into the future". Here are the notes for interested twitterers...
1) A robust health care infrastructure is crucial for protecting public health, particularly during crises such as epidemics, civil wars and disasters. This has never been clearer than it is right now.
Read 14 tweets
Jumping from the #LEADatStanfordMed Diversity and Inclusion Forum to the @StanfordWellMD Physician #Wellness Forum... Today, we'll be doing a journal club!

#doctorsarehumanstoo #whatdoctorslooklike
On the first paper:
820 physicians and 57 leaders took the survey
As an aside, there are more men than women in #leadership positions in this study.

Burnout score, professional fulfillment score, self valuation score among leaders, and their wellness scores.

Role model effect. No associations between leaders' scores of burnout, professional fulfillment and self-valuation with the same outcomes for those who they supervised.

Sleep impairment, however, shows an association.
Read 13 tweets
#covid19 #deaths in India & other nations, here I explain several ways to have reliable estimates. Of all range of estimates, the probability of deaths being actually lower should not be ignored. In the absence of data, if undercounting is possible, so is over-attribution 1 of N
First, deaths due to #COVID19 are far lower compared to other reasons. @DMavalankar and Dr Divya Nair explain why we should not focus too much on India’s COVID-19 #Mortality and not loose focus on deaths due to other Diseases.… 2 of N
Second , as Prof K Srinath Reddy of @thePHFI explained here, a sharp spike in home deaths over a long period is also not likely to go unnoticed.… 3 of N
Read 5 tweets
Excited to share new preprint "Phenotypic signatures in clinical data enable systematic identification of patients for genetic testing" led by @MorleyTheodore and with @NancyGenetics @lisa_bastarache @lhan111 @jonmorra8…
Genetic testing is the standard path to a diagnosis for people with a rare disease yet many who should receive a genetic test still do not or do so after years of diagnostic odyssey.
There are thousands of characterized genetic diseases with unique combinations of symptoms. However, many share a particular pattern of having multiple rare phenotypes often spanning organ systems.
Read 10 tweets

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