The Malaysian Insider :: Features

Copying common in electronic medical records

Posted: 08 Jan 2013 07:38 AM PST

COLUMBUS, Jan 8 — Most doctors copy and paste old, potentially out-of-date information into patients' electronic records, according to a US study looking at a shortcut that some experts fear could lead to miscommunication and medical errors.

Experts suggested that copying signifies a shift in how doctors use notes, away from being a means of communication among fellow healthcare providers and toward being a barrage of data to document billing. — AFP pic

"The electronic medical record was meant to make the process of documentation easier, but I think it's perpetuated copying," said lead author Daryl Thornton, assistant professor at Case Western Reserve University School of Medicine.

Electronic health records have been touted as having the potential to transform patient data from indecipherable scribbles into easy-to-read, searchable standardized documents that could be shared among hospital staffers and a patient's various other health care providers.

Many electronic record keeping systems allow text to be copied and pasted from previous notes and other documents, a shortcut that could help time-crunched doctors but that could also cause mistakes to be passed along or medical records to become indecipherable, critics argue.

To see how much information in patient records came from copying, Thornton's team, in a study published in Critical Care Medicine, examined 2,068 electronic patient progress reports created by 62 residents and 11 attending physicians in the intensive care unit of a Cleveland, Ohio hospital.

Progress notes are typically shared among doctors, nurses and other hospital staff and are meant to document the progression of a patient's tests and treatments.

Using plagiarism-detection software, the researchers analyzed five months' worth of progress notes for 135 patients.

They found that 82 per cent of residents' notes and 74 per cent of attending physicians' notes included 20 per cent or more copied and pasted material from the patients' records.

Thornton and his colleagues did not examine what motivated physicians and residents to copy and paste, or whether the shortcut affected patient care.

But in one case, a patient left the ICU and was readmitted a couple of days later. The patient's medical record included so much copied and pasted information that the new team of doctors wasn't able to decipher the original diagnosis. In the end, the team called the physicians who originally diagnosed the patient.

"What tends to get missing is the narrative — what's the patient's story?" said Michael Barr, senior vice president in the Division of Medical Practice, Professionalism and Quality at the American College of Physicians. Barr was not involved in the study. — Reuters

Debt may influence young doctors’ career plans

Posted: 08 Jan 2013 07:32 AM PST

A study finds that the average paediatric resident doctor's debt increased 34 per cent between 2006 and 2010. — AFP pic

NEW YORK, Jan 8— Paediatricians-in-training are more likely to plan to go into primary care, rather than a speciality field, if they have lots of debt from college and medical school, according to a US study.

Researchers publishing in Pediatrics also found that the average paediatric resident doctor's debt increased 34 per cent between 2006 and 2010.

That suggests financial considerations may keep young doctors out of medical specialities, they said, especially those fields that aren't known for paying well but still require extra training.

"(The debt) keeps climbing, and it doesn't seem like there's an end," said Mary Pat Frintner, the study's lead author, from the American Academy of Pediatrics (AAP).

"There are multiple factors that (affect) a paediatrician's career decisions, and debt is just one part of that," she told Reuters Health. "Since there's no end in sight to the rise in debt, that relationship may become more important in the future."

The findings also hint that rising debt, due to increases in medical school tuition, is not what's driving young doctors away from primary care, as many people have suggested, according to one health economist.

The new data collected by the AAP are based on five years of surveys of young doctors finishing their residencies, the training that follows medical school. The study included about 2,700 pediatric residents.

Close to three-quarters of the responders had debt from school. The average graduating resident's debt increased from US$104,000 (RM316,000) in 2006 to US$139,000 in 2010.

Forty-three per cent of residents had career plans requiring further subspecialty training, such as in paediatric cardiology or adolescent medicine. The rest planned to go straight into primary care or hospital medicine.

Frintner and her colleagues found residents with at least US$51,000 in debt were about 50 per cent more likely to be planning a primary care or hospitalist career than those who owed less or no money.

Women and residents with children were also less apt to be seeking further speciality training before entering the workforce, the research team said.

Peter Bach, at Memorial Sloan-Kettering Cancer Center in New York, said that residents with more debt may come from more disadvantaged backgrounds, which might influence the type of medicine they want to practice. So the link between debt and career plans might not be cause-and-effect, he told Reuters Health.

So far, there hasn't been a spike in the number of paediatric residents pursuing primary care careers rather than becoming specialists, Frintner said. In fact, there's still concern there may be too few primary care doctors, at least in some parts of the United States.

Increasing debt may create or worsen other shortages by discouraging young doctors from pursuing speciality training in fields that aren't particularly lucrative, such as adolescent medicine, the researchers said.

Amitabh Chandra, an economist and health policy researcher from Harvard University, said the findings go against conventional wisdom that debt is one concern driving medical students to specialities and away from lower-paying primary care jobs - and that raising salaries for fields that need more doctors may be a more effective strategy than focusing on debt. — Reuters

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Selasa, 8 Januari 2013

The Malaysian Insider :: Features

The Malaysian Insider :: Features

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