United Kingdom Ends $17 Billion Electronic Medical Records Initiative

The Wall Street Journal on Sept 23, 2011 reported that the United Kingdom will scrap the entire electronic medical records (EMR) initiative that has been 9 years in the making with nearly 6.4 billion pounds already spent.

That action was hinted at back in August 2011 after a scathing parliamentary report stating the initiative to be wasteful and incapable of delivery.

I'm not surprised...

It's hard enough to get a group of doctors in one hospital to agree with a treatment plan let alone agree to a medical records system. The problem is exponentially more difficult when applying it to an entire country.

Physicians practice medicine differently... just like teachers have their own unique way of teaching kids. A method that may work for one doctor or teacher will not work for another. Even the method may change depending on how "busy" things are (teacher with a class of 5 kids versus 30 kids) so a doctor in a busy inner-city emergency room will have different flows and needs from an electronic medical records than a rural family practice with a sedate pace. Furthermore, the needs of a dermatologist is very different from a pediatrician. One can't expect a single EMR system to meet the needs of both perfectly just like one cannot expect a math teacher to use the same teaching methods as a singing teacher.

Forcing physicians to use a single standard electronic medical records without adapting to these realities is bound to fail no matter how much time, training, software, and hardware you throw at it.

A better alternative (my opinion), is to treat electronic medical records like the computers they reside on. There should be many different types of EMR systems just like there are MANY different types of computer models, speeds, makes, cost, sizes, etc.

However, unlike current EMR systems, in spite of who makes a computer and what operating system software it runs, it has standardized components... USB, Firewire, HDMI, VGA, BlueTooth, etc. as well as a universal communication medium called the "internet" that works with phones, computers, laptops, etc regardless of who makes it and what software it is on.

You would think that an EMR system given its digital essence would be able to easily communicate with other systems... but no... they don't communicate at all... which is why paper reports still exist... which are than scanned into the EMR.

Rather than the government (whether the United Kingdom or the United States) dictating what physicians must do and mandating EMR initiatives, I believe the money would be much better spent on mandating inter-operability and communication standards. The free market will create the best EMR systems and physicians will pick the one that best meets their need.

The other more insidious side of EMR is the over-reaching health goal mandates which means well, but runs into the same problem of applying standards to all physicians. Take "meaningful use" set by the Centers of Medicare and Medicaid Services (CMS). One of the core measures of meaningful use is adult weight-screening and follow-up.

Now as an ENT specialist, I see patients specifically for earwax. Why in the world would I want to perform a weight-screening when all I want to do (and what the patient only wants me to do) is get earwax out???

Makes no sense.

Does it to you???

Reference:
U.K. Scrapping National Health IT Network. InformationWeek Healthcare. Aug 4, 2011
U.K. Ends Health-Service IT Upgrade. Wall Street Journal. Sept 23, 2011

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At Home Laser Hair Removal That Works

Without going into TOO much detail of how I know this... I have personally observed that the TRIA Laser Home Removal System does work after observing its use and its effects over a 6 month period of time. And before anybody asks... no... I was not paid to write this nor did I get a free one to try. Rather, someone I am close to bought it off Amazon.com and I was a skeptic on-looker.

In any case, the caveat being that I know it works (admittedly anecdotal) as long as the hair is dark (ideally black or brown) on very light colored skin (ideally white).

The way laser hair removal works is that the laser beam is selectively absorbed by the hair follicle causing its death and destruction while preserving other skin structures. As such, the hair follicle needs to be as "different" a color to the skin around it in order for the laser to work. Otherwise, you end up burning the skin as well as the follicle. Depending on the laser used, different colored hair can be targeted on different colored skin. Because of this, the same laser can NOT be used for everybody.

In any case... back to the TRIA. This laser system ideally works best on dark colored hair on light colored skin. The greater the difference, the better it works; the best being black hair on white skin. In fact, the TRIA can't be used at all if you don't have the right hair/skin color combination (TRIA requires a skin check every time before use... unless you "pass," the device will not work).

There are only a few real differences between this laser system and that used in medical offices. 

The TRIA's head is about 1/4 inch in size. The medical-grade laser head can be one inch or larger in size. What that means practically is that if you are using the TRIA for your leg, it'll take a long time and a lot of zaps due to the large surface area.

Also, the TRIA can only be used for about 15 minutes on the highest power before it shuts off for 2 reasons: It "overheats" and needs to cool down or runs out of battery and needs to be recharged. On that last point, you can only use it on battery power (which I suspect is due to safety reasons). After letting it cool/recharge overnight, it is ready to use again by the next day.

Medical-grade lasers do not have these limitations.

Finally, for those technically inclined, the TRIA uses a pulsed diode laser (same as a medical grade laser) with five intensity settings. The highest fluence available is 22 with a wavelength of 810nm, which is lower than what is available from a laser used in the clinic.

Regardless of medical-grade laser hair removal or TRIA, it does require repetitive sessions as the laser only kills follicles that are in the growth phase. Unfortunately, hair are in different phases at any given moment (there are 3 phases) and as such, it may take numerous sessions spaced 1-2 weeks apart over a few months before all hair follicles have entered into the growth phase and thus be able to be amenable to death by laser.

And unlike brain cells... hair follicles CAN come back from the dead and start producing hair again. Hard to say when or why this happens, but is likely due to hormonal factors. 

Overall, however, the TRIA can save you a lot of money (compared to getting it done by a physician) if you have the following characteristics:

1) Dark hair

2) Light skin

3) Patience (small laser head on large surface area takes a long time as well as the fact that a single session may need to be broken up over a few days due to device needing to recharge or cool overnight after about 15 minutes of use)

4) High pain threshold (even with a small head... it does hurt. And because it is a small head, there's a lot more zaps to cover the same surface area)

You can buy it on Amazon.com here.

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Cartoon Video of What Happens After Decision for Surgery Made

A very common question our practice gets from patients is what happens next after a decision is made to pursue surgery. What do or should they do next? What do we do?

Well, our office created a video cartoon to describe this somewhat intimidating process in a way that is understandable and benign.

Watch it here!

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Why Does Medical Science Keep Changing Its Mind???

I read with interest a blog post by Robert Krulwich of NPR fame on why there is so much public resistance to accept changes in truth with new scientific discoveries (some of which was new to even me)...

1) Triceratops with their beautifully placed 3 horns is actually the teenage dinosaur version of the adult Torosaurus (who had ugly asymmetric horns). Now... a decision had to be made regarding which name to stick with. Ultimately, "Triceratops" won out, perhaps because of the "Save the Triceratops" Facebook page???

2) The same unfortunately is not true for the Brontosaurus. It was clear that Apatosaurus is the same dinosaur and as such, the "Brontosaurus" name is no more much to the dismay of many lay public...

3) Pluto is no longer a planet... tell that to many elementary school children who are still being taught Pluto is the ninth planet in the solar system.

Well... guess what... The same is true in the ENT medical world... Here's a few of my favorites:

1) We all have FOUR tonsils... not two as many people think. The four tonsils are:

• Two palatine tonsils located in the back of the mouth
• Adenoid (aka, nasopharyngeal tonsil) which is located in the back of the nose
• Lingual tonsil which is located on the back of the tongue

2) The tongue is able to sense four different taste qualities -- sweet, bitter, sour, and salty. Now hold on... don't forget about umami (or savory added in 1985) which brings it up to five taste sensations... Oooops... there's now possibly a sixth simply called "calcium" which has been proposed in 2008 (but not official yet, but maybe soon).

3) How many sinus cavities are there? Most people are aware of the frontal, maxillary, ethmoid, and sphenoid sinus cavities. You ask an ENT that question and they'll probably answer the same... but if you press harder for other sinus cavities beyond those basic 4? You just might get them to start listing the agger nasi cell, onodi cell, haller cell, concha bullosa, etc.

For that matter, most people believe the nose is just an empty cavity that connects to the sinuses for drainage and allows breathing. Not so fast... The nose contains a midline wall called the septum that divides the nasal cavity left and right. Within each side, there are 3 sets of turbinate tissue (inferior, middle, and superior). For awhile, even in the ENT world, there's been debate whether the superior and even a supreme turbinate is present.

The take home message here is that science constantly evolves and is never quite the universal truth people think it is. It is ever-evolving and changing... just like the iPhone or your computer's microchip.

However, it is not as bad as it used to be... After all, people believed the earth to be flat and that the sun rotated around the earth for centuries... to think or say otherwise resulted in scientists being even executed or arrested!

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How a Grizzly Bear Can Help Patients

Scientists recently figured out exactly what happens to a bear when they hibernate... For SIX to SEVEN MONTHS...

- Their metabolism decreases by 75%. The breathing and heart-rate also decreases
- Their body temperature stays the same
- They do not produce urine or feces
- They do not eat or drink
- Bone strength remains the same
- Their muscle mass and strength remains the same

Now, lets take a look at humans, especially those who are bedridden in a hospital in the intensive care unit. Over a matter of days:

- Muscle mass and strength starts to decrease
- We still produce urine and feces
- We develop bed-sores
- We still require water and food
- Our bones start to weaken
- Our metabolism also decreases, but at the detriment of all other body functions

If somehow we can translate what a hibernating bear does to human beings, that would be amazing in terms of healthcare cost savings AND patient well-being. Imagine being put into a hibernating state while doctors cure your cancer or you recover from surgery or a major illness. Imagine paramedics inducing a hibernating state in a major trauma victim of a motor vehicle accident.

Once your illness, surgery, cancer, or whatever has been cured, you "wake" from your hibernation fully functional without any deterioration in muscle/bone mass or strength. You would literally be able to wake up and go home as if you just woke from a nice long sleep.

From a hospital standpoint, the cost-savings would be enormous. No need for feeding such hibernating patients. The entire field of physical therapy and orthopedics would be dramatically reduced given bones would be stronger with less risk of fractures.

Hibernation would be a natural sleep as opposed to anesthesia which is more akin to a coma.

In terms of ENT, adults can theoretically elect to go into a hibernating state after a tonsillectomy so they would not have to experience the horrible pain that lasts for 2-3 weeks.

Read more about the amazing hibernating bear on NPR news here.

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Santa Claus, A Sick Patient Needing Medical Care

ENT Journal published in December 2003, a humorous paper on Santa Claus as a patient with numerous medical problems. Given it is Christmas Eve, it is probably worth revisiting the article which lists among his many medical problems:

• Allergies to woodwork (sawdust and varnish) and materials used in preparing teddy bears, dolls, and other gilts.
• Asthma exacerbated by reindeer exposure as well as the hay and straw in the stable which makes his nose run
• His symptoms get worse when he leaves the North Pole where there is no pollen to regions of the Earth where vegetation and pollen are plentiful, especially in the Southern Hemisphere where it is summer.
• Going down chimney's irritates the eyes and his nose resulting in sneezing fits. Probably carcinogenic as well.
• Santa is considerably overweight, and his cheeks appear quite ruddy suggesting high blood pressure.
• Probably has type 2 diabetes exacerbated by milk and cookies left for him in millions of homes.
• He smokes a pipe putting him at increased risk of oral, throat, and lung cancer

Merry Christmas!

Suggest you leave for Santa a glass of water and a low-calorie, low-salt granola bar instead of milk and cookies tonight!

Read the full article here.

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Dr. Chris Chang Mentioned in a Medical Blog

Dr. Chris Chang and his blog was mentioned in an article in another medical blog "Dr. John M" on December 14, 2010.

"---One of the best ways to know something well is to teach it. Dr Chris Chang from the blog of the Fauquir ENT Consultants of Virginia writes about why he keeps a blog. His first reason is that it keeps him highly informed. No doubt about that. Could we bloggers get some CME credit, please?"

 Click here to read the whole story!

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Physician Marketing Using Groupon

For those not in the know, Groupon is a website that offers coupons and other savings on local merchandise and services. Groupon also has recently rejected a takeover bid by Google.

I recently encountered this amazing deal on Groupon offered by an ENT colleague, Dr. Ghaheri:

"$149 for Four Laser Hair-Removal Treatments at The Center for Aesthetic Medicine at The Oregon Clinic (Up to $1,000 Value)"

I wonder if such marketing and medical discount offerings like this will become the future. Clearly, procedures and other types of medical treatments that are not covered by insurance will be applicable.

For example... here are some medical treatments/services I am considering to discount on Groupon:

1) Injection snoreplasty for snoring
2) Botox injections for facial wrinkles
3) Hearing services and products including hearing aids
etc

Click here to check out Groupon and create an account!

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Making Twitter Work for a Specialty Medical Practice (Like ENT)

I've been asked by a few ENT colleagues how I got Twitter to work for my practice and how in the world I managed to get more than a few dozen followers.

I've been at it for about 1 year now (up to 355 followers @FauquierENT) and here are a few tips to making it work for a medical practice... Just an opinion... And it may not apply to everyone...

• When you tweet something, always back it up with a useful link to a webpage using a link shortner like bit.ly or goo.gl.
• Tweet about topics that the LAY-PERSON would find interesting. Twittering about "Outcomes of Vascularized Bone Graft Reconstruction of the Mandible in Bisphosphonate-Related Osteonecrosis of the Jaws" is NOT going to garner you fans even if you personally as an ENT find it riveting reading. An example of a good tweet I recently posted is "Do Cell Phone Makers Secretly Know Cell Phones May Cause Health Problems? http://ht.ly/3bBUZ"
• Follow people you find interesting. They will follow you back typically and their followers will slowly start to follow you. Given I twitter about ENT topics, I make it a point to follow ALL otolaryngologists, respected medical journalists, and health related newspapers.
• Write a blog and use twitter to "advertise" your blog article.
• ADVERTISE on your website that you have a twitter account.
• Be active with tweets. Potential followers will not be that excited to follow you if you have something interesting to say only once every few weeks.
• IF you come across something interesting in a medical journal, tweet it, and support it with a link.

So there you have it... Now go sign up with twitter and don't forget to follow my tweets!

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Fauquier ENT Blog Now Published on the Kindle

We are pleased to report that our blog is now published on the Kindle! As many readers may already be aware, the Kindle is the top-selling e-book reader sold by Amazon.com. Click hereto subscribe to our blog on the Kindle!

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New Video Produced on Using MediTech EMR on the iPad!

Our office has been instrumental in bringing the Apple iPad to Fauquier Hospital allowing physicians to access MediTech.

In order for physicians to see how MediTech can be accessed and used on the iPad, our office has created a YouTube video tutorial. Not only is MediTech shown, but also PACS. This video has been added to our YouTube channel.

Please note that this video is in REAL-TIME. It has not been speeded up. The system we are using is Citrix Version XanApp 5 and MediTech Client/Server v5.6.4 PP13.

Watch the video on YouTube here or below.

Related iPad and MediTech Blog Articles:
6/12/10 iPad Use In the Medical Clinic and/or Hospital For the Surgeon Doctor
6/19/10 The Perfect Computer for Healthcare and Electronic Medical Records
9/8/10 Dr. Chang Featured in Magazine Article on Using iPad with MediTech EMR
9/20/10 UPDATE: iPad and MediTech Electronic Medical / Health Records
10/12/10 UPDATE #2: iPad and MediTech Electronic Medical / Health Records

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Pediatric ENT Care of Warrenton, Virginia (Fauquier County)

Recently, there has been some confusion regarding whether our office deals with adults only or do we see kids as well... Strangely enough, we also get asked by parents whether our office sees adults when seeing a pediatric patient.

To clear up any confusion, our office does see kids AND adults... starting from birth to the elderly.

Dr. Chang who joined the office in October 2005, was named one of America's Top Physicians by the Consumer's Research Council of America in 2008 as well as a Northern Virginia Top Doctor for 2011 (to be published in February 2011).

Some common problems and procedures for which Dr. Chang sees kids specifically include:

- Tongue Tie Release (starting from ONE DAY OLD!)
- Tonsillectomy
- Adenoidectomy
- Sinus Surgery starting with adolescents
- Ear Tube placement
- Hearing Loss
- Nasal Obstruction
- Nasal Congestion
- Snotty Nose
- Speech Delay
AND many other issues...

Our office has even created videos on a few common pediatric procedures including tonsillectomy, adenoidectomy, earwax removal, ear tubes placement. Watch the video below on tonsillectomy.

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Fauquier Hospital MediTech Now Accessible on the Mac (As Well As iPad, Windows PC, iPhone, etc)!

Can I just express how totally excited and grateful I am to Fauquier Hospital Information Technology Department for upgrading their Citrix server?!! I can now access the hospital's MediTech EMR from anywhere using not only Windows PC, but also the iPad and Mac platforms as well!!! Even the iPhone, though the screen is a bit small...

GREAT job and appreciate how responsive the department as a whole has been!

Thank you! Especially given I'm a Mac person.

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UPDATE #2: iPad and MediTech Electronic Medical / Health Records

This blog article is a continuation of prior blogs (6/12/10 and 9/20/10) I wrote on the use of the iPad with Meditech.

Since June 12, 2010 when I first wrote about my experiences of using the iPad with my hospital's Meditech EMR system, a LOT has happened...

First, the hospital has upgraded its Citrix infrastructure to allow iPad (as well as Mac) connectivity to the hospital's MediTech EMR using the Citrix Receiver app (free in iTunes). I reported this back in 9/20/10.

Since than, the hospital has done a remarkable job optimizing and speeding up the connectivity to the point where using MediTech on the iPad is JUST AS FAST as using it on a hospital networked desktop. Of course, the iPad needs WiFi access to achieve these speeds.

Furthermore, I can now access PACS directly via Citrix Receiver app on my iPad rather than going through MediTech which is just great!

My only complaint now (which may not be possible to address with current Citrix software) is the initial prolonged time it takes to get to the MediTech logon screen. After that, speed is quite zippy.

From my conversations with individuals in the know, the next step would be to create a "MediTech" app on the iPad, rather than going thru Citrix Receiver app.

Obviously, one way of doing this is if MediTech creates a native application for the iPad which does not appear to be likely anytime in the near future.

A more likely solution that may be achievable in the next few months is to create a "virtual" MediTech iPad app using Citrix as the engine "under-the-hood". This is an active area of development and I am optimistic that such a virtual MediTech iPad app will soon be available.

Related iPad and MediTech Blog Articles:
6/12/10 iPad Use In the Medical Clinic and/or Hospital For the Surgeon Doctor
6/19/10 The Perfect Computer for Healthcare and Electronic Medical Records
9/8/10 Dr. Chang Featured in Magazine Article on Using iPad with MediTech EMR
9/20/10 UPDATE: iPad and MediTech Electronic Medical / Health Records
10/25/10 New Video Produced on Using MediTech on the iPad!

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Cocaine As A Medically Approved Medication

Many people are already aware that marijuana is now legal in some states in the US with a medical prescription.

What many people may not realize is that cocaine is also used in medical care, especially in the ENT world.

Cocaine is one of the most potent anesthetic AND vasoconstrictor. These two characteristics make it an ideal medication for use during sinus surgery as well as any nasal procedure where bleeding and pain may be an issue.

Many physicians will use cocaine to help stop nosebleeds (I do not).

Many surgeons use cocaine during sinus surgery to minimize post-operative pain as well as minimize intra-operative bleeding. Use of cocaine also significantly decreases risk of nosebleeds after sinus surgery as well as minimize need for nasal packing.

Cocaine when used for illegal recreational purposes by snorting puts a person at risk for septal perforation due to its vasoconstrictor properties. In essence, the cocaine puts a chemical tourniquet on the blood supply to the septum leading to mucosal necrosis and eventual perforation. Afrin does the same thing, but on a much smaller scale.

Before anybody asks... Cocaine is NEVER prescribed to a patient. It is only ever used in a hospital/office setting and heavily controlled under lock and key. (It is never used in our office.)

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Mutter Medical Museum of the Odd, Strange, and Bizarre

In the spirit of Halloween that is coming up soon, I thought to share with everyone a FASCINATING museum located in Philadelphia, PA. The museum's full name is "Mütter Museum of College of Physicians of Philadelphia" and contains a fascinating collection of the bizarre aspect of medical sciences. Many of the exhibits are real and not for the faint of heart.

Of course, I should mention that they have a number of exhibits related to ENT... including one of all the foreign bodies removed from the ear, nose, airway, etc.

Even as a physician who was bored with "The Bodies" exhibit, I am STILL fascinated by what I see in this museum.

Go check it out!

Here are a few images, but more can be found on Google Images.

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UPDATE: iPad and MediTech Electronic Medical / Health Records

Ever since I wrote my initial impressions of using the iPad with Meditech EMR on June 12, 2010, that blog article has received almost a thousand hits since that time, averaging about 20 hits per day. I've even been featured in Meditech news.

Also in the interval period, I have received numerous inquiries from health systems all over North America using MediTech regarding more specifics on how the iPad is used/incorporated into MediTech EMR.  Due to this interest, I've decided to write an update regarding what is going on since that initial blog article...

SO... I no longer need to use LogMeIn in order to access MediTech. Since then, Fauquier Hospital has upgraded their Citrix infrastructure so I now use a Citrix Receiver app (free in iTunes) to access MediTech.

Things are of course much faster, but still not quite as fast as I would like it to be. Currently, the hospital and I are working to resolve some of the speed issues seen. McKesson PACS (radiology imaging software) also is on the drawing board for direct Citrix access rather than going through MediTech which would also be welcome.

I recently heard from a confidential and utterly reliable source that MediTech has been asked to create a native app for the iPad (thus avoiding Citrix altogether), but the company at this time has politely declined to develop such an app that would hugely improve the user experience and most likely speed.

I would encourage all MediTech users to contact MediTech directly and demand/request that such a native iPad app be developed which would be immensely beneficial and strongly desired. Otherwise, alternative 3rd party software like Citrix will have to be used along with its inherent handicaps.

Click here to view MediTech's contact information.

Related iPad and MediTech Blog Articles:
6/12/10 iPad Use In the Medical Clinic and/or Hospital For the Surgeon Doctor
6/19/10 The Perfect Computer for Healthcare and Electronic Medical Records
9/8/10 Dr. Chang Featured in Magazine Article on Using iPad with MediTech EMR
10/12/10 UPDATE #2: iPad and MediTech Electronic Medical / Health Records
10/25/10 New Video Produced on Using MediTech on the iPad!

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Using The Internet To Radically Misdiagnose Your Children (Humor)

Saw this from The Onion, published June 2, 2006 (Issue 42; 22)... Though this was meant to be humorous from the folks at The Onion, it does happen unfortunately...

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Dr. Chang Featured in Magazine Article on Using iPad with MediTech EMR

On Sept 8, 2010, a story was published in MediTech Magazine regarding how Dr. Chang has piloted the use of the Apple iPad with MediTech electronic medical records used in Fauquier Hospital.

Click here to read the story (pdf document).

Related iPad and MediTech Blog Articles:
6/12/10 iPad Use In the Medical Clinic and/or Hospital For the Surgeon Doctor
6/19/10 The Perfect Computer for Healthcare and Electronic Medical Records
9/20/10 UPDATE: iPad and MediTech Electronic Medical / Health Records
10/12/10 UPDATE #2: iPad and MediTech Electronic Medical / Health Records
10/25/10 New Video Produced on Using MediTech on the iPad!

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Fauquier Hospital Medical Directory WebApp Created

A new mobile phone WebApp has been created specifically for cell phones called "Fauquier Med". It provides a listing of all the physicians on staff at Fauquier Hospital broken down by last name, specialty, and practice group. Commonly used hospital numbers are also listed.

The WebApp was created specifically for the iPhone, though other mobile smartphone users (Blackberry and Google Android) should also be able to use without difficulty.

Directions to add to at least your iPhone is shown below. Hope patients and physicians find this useful!

Step 1: Open Safari.
Step 2: Type in the Address Bar: www.FauquierHealth.mobi The WebApp will now load up.
Step 3: The WebApp will now load up. Click on the “+” sign on the bottom.
Step 4: Click on the button “Add to Home Screen”
Step 5: Click on the “Add” button.
Step 6: You now have the WebApp on your application screen!

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