Post

How to get URL link on X (Twitter) App

On the Twitter thread, click on or icon on the bottom
Click again on or Share Via icon
Click on Copy Link to Tweet
Paste it above and click "Unroll Thread"!
More info at Twitter Help

Benoy Shah MD

Jan 6, 2022 • 8 tweets • 3 min read • Read on X

Scrolly

Electronic patient records (EPR) - I've seen some negative tweets recently about how cumbersome they can be...but EPR is here to stay so it's important to get them right

I'm fortunate to work somewhere with the most amazing EPR set-up...check it out!

A brief 🧵...

Our hospital's IT team have built 1 program from which we get all these options:

E-documents (clinic letters, memos etc)
Blood results
X-rays / scans
Drug chart
Request tests (bloods, imaging, micro, everything)
Link to primary care records
Observations (for in-patients)

There's so much more there too..."Outpatients" allows us to see what we have booked for upcoming clinics including procedural clinic lists like stress echo.

EDMS has the scanned records after hospital admissions

There's even a direct link to UpToDate!

Clicking on e-documents brings up the various specialities that letters are categorised by...and if you click on one division like 'Medicine', you can see the breakdown...so you know instantly where to look to find the letters you need

This is what the menu looks like...you can see if the document is a clinic letter, a MDT meeting entry, a record of a phone call with the patient, a GP referral, a test result (e.g. TTE or TOE) etc...so you can usually find what you want pretty quickly!

The eQuest system allows you to request almost any test, request a specialty consult from another team and also view requests already placed on the system, to avoid repetition / duplication

I know this is a rather unusual thread compared to my normal ones, but I see my wife struggle with her hospital's IT system - literally pulling her hair out at how clunky and difficult it is to navigate - and I realise that getting this right really impacts our working lives!

@UHSDigital

I've never met any of the @UHSDigital team, but a BIG thank-you from me (and I suspect almost everyone that works here) for a truly special IT system that definitely aids efficiency and facilitates patient care

Interested to hear experiences of others with EPR systems...

• • •

Missing some Tweet in this thread? You can try to force a refresh

This Thread may be Removed Anytime!

Twitter may remove this content at anytime! Save it as PDF for later use!

More from @dr_benoy_n_shah

Benoy Shah MD

@dr_benoy_n_shah

Apr 29, 2025

Superb medical student on placement
Keen, energetic, friendly, smart
She wants to go into neurosurgery

I thought I'd better give her some advice
After what my wife went through in her training
I thought the advice was for the future
Little did I realise it had already started

What I had planned on saying:

You're going to receive a lot of unsolicited advice about your intended career

Most of it will be from men

Most will mean well, but will suggest a 'more family-friendly' career choice

Yet, even whilst a student, the 'advice' has started:

'Neurosurgery, are you sure?'
'It's very long & arduous training'
'It's not the most family friendly career'
'You might feel like that now, but in 10yrs you'll probably regret it'
'It's harder to find a partner when you're working all the time'
'GP is a better choice for balance'

Read 9 tweets

Benoy Shah MD

@dr_benoy_n_shah

Mar 17, 2025

**CASE OF THE MONTH**

Female, mid 20s
Fit & healthy
No CVS risk factors
Only 💊 is COC pill

Experiences central chest pain during sport (exertion), not happened before

Recently has been well, no coryzal or other symptoms

Here is admission ECG

First troponin I is 358ng/L (normal <18)
Second troponin I is 409ng/L

Here is chest x-ray, initially thought of as (and subsequently reported as) normal

Transthoracic echocardiogram is entirely normal

Normal LV & RV size & systolic function
No effusions
No masses
No valve disease

What would you do next?

Vote in next message...

Read 11 tweets

Benoy Shah MD

@dr_benoy_n_shah

Dec 15, 2024

Another nice example recently of the importance of a systematic approach to assessment of mitral regurgitation during TOE

Indication was known MR, assess suitability for TEER

Mid oesophageal 4Ch & 5Ch views...wondering if we have the right patient! No real MR to see...

The segmentation approach in the bicommisural view is a very reliable and easy-to-do method

Start at the lateral side of the valve with X-plane (Philips) / MultiD (GE) and you have A1-P1 coaptation on the right side...do this with 2D only & then with colour Doppler too

Then move to the middle of the valve with your cursor, cutting through A2 in bicomm view so you see A2-P2 coaptation on the right side

Still no MR!

Read 8 tweets

Benoy Shah MD

@dr_benoy_n_shah

Oct 30, 2024

Deep dive on #EARLYTAVR from ##TCT2024

Lots already said & discussed

It takes time to read the paper, read the supplementary appendix, analyse the results, think about them etc!

Some thoughts...🧵

On Sunday I wrote a thread about asymptomatic severe AS and what we knew already from RECOVERY & AVATAR RCTs and what the guidelines currently advocate

Here's the 🧵 in case you missed it

https://x.com/dr_benoy_n_shah/status/1850645694698135554?t=TAVDsW79WuDguZBGOutVBg&s=19

EARLY TAVR
Asymptomatic severe AS patients recruited between March '17 - Dec '21

75 sites across 🇺🇲 and 🇨🇦

Asymptomatic status confirmed by negative treadmill test in 90.6%
(Remaining 9.4% unable to do test, relied on detailed physician history)

That's a good % that did ETT 👏

Read 29 tweets

Benoy Shah MD

@dr_benoy_n_shah

Oct 27, 2024

Tomorrow - Oct 28th - we learn the results of 3 landmark randomised studies in patients with aortic stenosis (AS)

Results of EARLY-TAVR, EVOLVED & TAVR UNLOAD will be unveiled at #TCT2024 in a Joint LBCT Session with #NEJM

These could well be practice-changing studies...

A 🧵

#TCT2024
The first 2 RCTS - EARLY TAVR & EVOLVED - concern the management of asymptomatic severe aortic stenosis (ASAS for this 🧵)

Currently, ASAS (with normal LV function) is not a Class I indication for valve intervention in either 🇪🇺 or 🇺🇲 VHD guidelines

##TCT2024
There have been 2 RCTs of early intervention (surgery) vs routine care, aka 'watchful waiting'

It's worth reminding ourselves briefly of these studies, as the background is important in understanding EARLY TAVR in the right context

Read 21 tweets

Benoy Shah MD

@dr_benoy_n_shah

Mar 17, 2024

*Mitral valve assessment by TTE*

Transthoracic echocardiography (TTE), when performed with care and diligence, can reveal a lot about the valve. TOE isn't necessary in all cases to determine leaflet pathology.

A worked example below:

In the PLAX view, you can assess the scallops of the leaflets

In a true PLAX view with aortic valve clearly visible, you mostly see the A2-P2 interface. Here, you can see a clear & large prolapse of the posterior leaflet

If you tilt upwards towards the PLAX RV outflow (pulmonary valve) view you see mostly the A1-P1 interface

Here, you can see the valve looks slightly different & no prolapse is seen