This is absolutely correct. I work with multiple different EMRs and this is the problem inherent to them all - they exist as proprietary siloes of information waiting to be printed out and sent on to the next user. There is little to no mandated backend interfacing.
at what point does a decision tree automated algorithm actually lay hands on a patient? in my specialty, the differential diagnosis for "lower abdominal pain" cannot be narrowed without a physical examination.
evidence based medicine does have its place, and i think that we, as physicians should do our best to make sure our practice (using both local and national standards) is evidence based. however, as noted above in the pulse ox comment, sometimes current practice cannot be overcome by EBM. another example is continuous fetal heart rate monitoring in labor. no study has ever shown that continuous monitoring is better than intermittent monitoring in preventing adverse outcomes (such as cerebral palsy). every study has shown the continuous fetal monitoring increases the cesarean section rate. so , we use an intervention that confers no benefit and may increase the risk for harm. why? ask the plaintiff's bar...
is your suggestion that obstetricians would prefer to have unhealthy patients so we have "something to do"? i get reimbursed the same regardless of a patient's risk status. besides, i am pretty sure that most of the information texted by this program is readily available to the patient at her routine visits.
true, but the texting app asks for LMP not EDC (estimated date of confinement). gestational age is determined from EDC (when it is known and confirmed) not by LMP.
unfortunately, not all pregnancies are dated by the first date of the last menstrual period (LMP). first date of LMP roughly assumes regularly occurring 28 day cycles with ovulation/conception occurring around day 14. not all cycles are regular or 28 days in length. a significant number of pregnancies are dated by first trimester ultrasound.
where is the american college of obstetrics and gynecology or the american academy of pediatrics (you know, the national bodies whose members actually take care of these ladies and their babies)?
While Dr. Stamler's supposition is interesting, I would like to see the data and not an AP or Time magazine story. A search of "JS Stamler" on Pubmed shows 183 papers - 30 of which as first author and almost all dealing with NO. I would guess that he is probably an authority on NO. But that in and of itself does not mean that he is an authority on transfusion medicine, trauma care, surgery, or the like. I am interested to see which variables were controlled, what the power of the study was, and in what fashion data were obtained. The article and abstract are not yet up at the PNAS website.
from the ruling (linked elsewhere in this thread):
Perez admitted that he possessed and "collected" child
pornography. He was able to direct the officers searching his
home to compact discs that contained child pornography. At least
one such compact disc had file folders labeled "kiddie porn." The
Attorney General's office reviewed only a portion of the
approximately 4000 compact discs seized from Perez, and still
found an estimated 2500 images of child pornography. so, no, he did not accidentally download some kiddie porn unattended. they guy ADMITTED to possession of the illegal files. he was trying to get off (no pun intended) on a technicality.
from the appellate court's decision:
After the officers searched Perez's room, in
which they located compact discs containing child pornography,
Perez, who was present during the search, directed the officers
to storage bins in the garage, where more such compact discs were
found. In total, approximately 4000 compact discs containing
thousands of images of child pornography were seized by the
officers.
4000 CDs of child porn. he was guilty as hell. he even led the officers to more of it in the garage. he was basically trying to have the results of the search thrown out as "fruits of the poisoned tree" from an illegal search. it seems to me more than enough probable cause to search the residence was documented.
This basically explains what happened. Anyone who reads it and continues to claim anything from "the Airport hack didn't exist" to "Maynor and Ellch faked the demo" is, frankly,to use your language, a raging tool.
referring to someone as a "tool" and then linking to george ou's blog is rich indeed.
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This is absolutely correct. I work with multiple different EMRs and this is the problem inherent to them all - they exist as proprietary siloes of information waiting to be printed out and sent on to the next user. There is little to no mandated backend interfacing.
When is this arriving for the ps3?
oh - i see what you did there ...
evidence based medicine does have its place, and i think that we, as physicians should do our best to make sure our practice (using both local and national standards) is evidence based. however, as noted above in the pulse ox comment, sometimes current practice cannot be overcome by EBM. another example is continuous fetal heart rate monitoring in labor. no study has ever shown that continuous monitoring is better than intermittent monitoring in preventing adverse outcomes (such as cerebral palsy). every study has shown the continuous fetal monitoring increases the cesarean section rate. so , we use an intervention that confers no benefit and may increase the risk for harm. why? ask the plaintiff's bar ...
is your suggestion that obstetricians would prefer to have unhealthy patients so we have "something to do"? i get reimbursed the same regardless of a patient's risk status. besides, i am pretty sure that most of the information texted by this program is readily available to the patient at her routine visits.
true, but the texting app asks for LMP not EDC (estimated date of confinement). gestational age is determined from EDC (when it is known and confirmed) not by LMP.
unfortunately, not all pregnancies are dated by the first date of the last menstrual period (LMP). first date of LMP roughly assumes regularly occurring 28 day cycles with ovulation/conception occurring around day 14. not all cycles are regular or 28 days in length. a significant number of pregnancies are dated by first trimester ultrasound.
where is the american college of obstetrics and gynecology or the american academy of pediatrics (you know, the national bodies whose members actually take care of these ladies and their babies)?
here you go -- http://wattsupwiththat.files.wordpress.com/2009/06/mcgartland-carlin-epa-memo.jpg
While Dr. Stamler's supposition is interesting, I would like to see the data and not an AP or Time magazine story. A search of "JS Stamler" on Pubmed shows 183 papers - 30 of which as first author and almost all dealing with NO. I would guess that he is probably an authority on NO. But that in and of itself does not mean that he is an authority on transfusion medicine, trauma care, surgery, or the like. I am interested to see which variables were controlled, what the power of the study was, and in what fashion data were obtained. The article and abstract are not yet up at the PNAS website.
oh, so you've been to Kowloon as well.
4000 CDs of child porn. he was guilty as hell. he even led the officers to more of it in the garage. he was basically trying to have the results of the search thrown out as "fruits of the poisoned tree" from an illegal search. it seems to me more than enough probable cause to search the residence was documented.
referring to someone as a "tool" and then linking to george ou's blog is rich indeed.