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The CMG Voice

Amazon Care is here. You have been warned.

Posted Monday, October 14, 2019 by Tyler Goldberg-Hoss

The online retailer Amazon is getting into health care. Recently it announced the launching of Amazon Care, health care for (at least for now) Amazon employees and their families in the Seattle area.

As expected, health care offered by Amazon is expected to be both technologically friendly and convenient.

With regard to the technology part, the initial contact with a provider appears to be through your phone or computer. Through a specific app, a patient can have a virtual visit with a nurse, doctor, or nurse practitioner. This can be a live chat, or actual face to face video. If that’s not enough, the patient can then schedule a nurse to come to the patient’s home.

Prescriptions will be convenient as well, with delivery likely available in a similar way as everything else one purchases from Amazon is.

It remains to be seen exactly what Amazon Care will look like, particularly when/if it is offered to the public at large. With more and more patients, which providers will offer care remotely? Will the doctors be local themselves, or in another state (or country)? What happens when the patient really needs to see a doctor but is only offered a visit by a nurse? What if specialty care is needed? Which actual brick and mortar facilities will partner with Amazon (or be created by Amazon) for heart surgery, for example?

And what about data? Certainly, one way in which Amazon is successful is by gathering and organizing large amounts of data on its customers. What kind of health data will Amazon collect from its health care patients? How will they use that? What safeguards to privacy will there be?

This was always coming, of course. Now that it is here, it remains to be seen is whether and to what extent health care is different being run by a tech company.

Click here to check out Amazon Care for yourself.

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New prostate cancer test promises fewer false positives, more accuracy in detecting cancer that needs treatment.

Posted Thursday, October 10, 2019 by Tyler Goldberg-Hoss

Readers of this blog are aware that the standard of care regarding prostate cancer screening and testing has been evolving in the last few years, from 2015 to 2017.

As of 2018, the guidelines recommended that men ages 70 and older do not undergo screening for prostate cancer, and men 55-69 have a discussion with their doctors about the potential benefits and risks (including unnecessary biopsies after false positive PSA test results).

Now, researchers are hopeful a new blood test will be more accurate in diagnosing aggressive prostate cancer necessitating treatment.

The Journal of Urology published the findings of this recent study, which looked at the efficacy of a new test combined with the old PSA test, and found that it is more than 90% accurate at diagnosing cancer that needs treatment.

This is potentially big news, since one big reason why the guidelines did not recommend prostate cancer screening was because the PSA test alone resulted in so many false positives. Further, even when the PSA test was positive and accurate, not all prostate cancers require treatment, particularly slow growing ones.

Validation studies need to be completed before the test is ready to be used on patients, and this is estimated to take 3-5 years. After that, hopefully the standard of care, as reflected in updated guidelines, will be to use this new test and screen for what really matters: aggressive cancer that needs treatment.

You can read more on this new test here:

New prostate cancer blood test could reduce biopsies

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The Correct Way Doctors Can Use Blood Pressure Management Guidelines in Clinical Practice

Posted Monday, October 7, 2019 by Morgan Cartwright

In an editorial interview with cardiology fellow Martin van Zyl at the Mayo Clinic, he describes how doctors can best put guidelines on managing blood pressure into practice. He lays out a number of steps which doctors may use to effectively implement blood guidelines that are not always easy to adopt clinically. The steps include:

  1. Obtaining Accurate Measurements – Part of this includes automated measuring devices which takes multiple blood pressure measurements and then averages them in order to get a more accurate assessment. There is also the use of out-of-office blood pressure measurements to provide further measurements so the patient’s blood pressure is not only being read in a one-time office visit.

  2. Managing the Newly Diagnosed Patient – Once a patient is diagnosed, it’s important to come to decisions about how to manage that patient. This could include medication management, lifestyle management, or a combination of both. It’s imperative to truly assess the patient’s history and the cause behind the diagnosis.

  3. Systems Based Approach – The electronic medical record provides a significant advantage to doctors in tracking and managing patient’s medical conditions. Medical organizations need to be keen to use these records to help identify, track, and manage patients.

These three types of considerations in the management of blood pressure based on the guidelines is an incredibly useful and dynamic way to manage patient care. Guidelines are implemented for a reason. The more that doctors are able to implement guidelines in their clinical practice, the better health care they will provide.

You can read more about this here: Best Practices for Measuring and Managing Blood Pressure

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Nursing homes are excellent breeding grounds for candida auris superbug

Posted Wednesday, October 2, 2019 by Carl-Erich Kruse

Hospitals may not be the most fertile breeding ground for the dangerous candida auris fungus after all: it turns out that dubious distinction may belong to nursing homes. The causes are multiple, but some of the primary reasons include: vulnerable, ill patients, in close confines, amidst staff passing frequently among the multiple patients and pathogens, and substandard implementation of protocols to curtail their spread.

Nursing homes already see a higher incidence of antibiotic resistant pathogens than hospitals. Matt Richtel and Andrew Jacobs of the New York Times recently reported on the omissions that unnecessarily exposed nursing home patients to further spread of this deadly fungus. While New York law requires a sign outside the rooms of patients carrying c. auris requiring visitors wear gloves, a mask, and a gown, the entreaties often went ignored.

While hand hygiene is well known to be the simplest way to prevent the spread of germs, many facilities lack even hand sanitizers outside of patient rooms. The result is an increased likelihood that spores will travel with a visitor to the room of another patient.

While the candida auris superbug is notoriously difficult to eradicate, systemic failures to implement proper infection control protocols invite outbreaks of these pathogens. And doing so in nursing homes puts the most vulnerable members of our community at unnecessary risk. And tragically the results are can be devastating.

You may be familiar with cases regarding the the proliferation of this fungus around the world and how difficult it truly is to eradicate. Because the fungus is so difficult to eradicate, best practices tend to focus on efforts to prevent its spread. Yet, when medical facilities fail to make even minimal hygienic efforts, these providers are not even approaching the minimum standard of care to protect their patients.

Read the article here: Nursing Homes are Breeding Ground for Fatal Fungus

Read our prior coverage regarding candida auris here: Fungus Superbug Now “Serious Global Threat”

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Hidden Errors in Electronic Health Records May Lead to Devastating Injuries

Posted Thursday, September 26, 2019 by Carl-Erich Kruse

Many of us can appreciate that medical records are, largely, transitioning from handwritten records to electronic medical record. The benefits of an electronic health record (EHR) are multiple. Nevertheless, they may not be the panacea that they’ve been expected to be. Recent studies from Kaiser Health News and The Doctors Company Insurer illustrate the cost of EHR errors.

Kaiser Health News, earlier this year, published an article regarding some of the difficulties of electronic records. These include system design issues, technology failures, and user error. As a practical matter, that meant glitchy systems where each repair led to further errors, critical orders lost, and even prescriptions were affected. In the Kaiser article, these errors piled up into a substantial settlement between the EHR contractor and the provider (in that case, the United States government).

Aside from the obvious risk of injury, what does that mean for you (particularly if you are a medical negligence victim)? One line we hear from providers is “I ordered the [critical imaging study] but the patient simply did not follow up.” This is a version of the nearly ubiquitous “patient’s fault” defense. The truth, it turns out, may be that the order was never transmitted, was never processed by the EHR, or simply disappeared. So, while the patient did absolutely nothing wrong, they are being doubly victimized here. That means that sometimes the error is scarier than the superficial explanation defendants will fall back on.

And, a recent article based on reports from the Doctors Company, one of the leading insurers of doctors in the US, shows that the number of EHR claims is increasing. While the number of claims closed regarding EHRs represented less than 2% of claims closed over the study period, the number of claims tripled from 7 in 2010 to an average of 22.5 in 2017-2018. Notably, in most of the EHR related claims the systems errors were a contributing factor to the claim rather than the primary factor. That said, the Doctors Company acknowledged that near universal adoption of EHR will likely lead to more EHR related claims.

So, some medical errors may be assigned to more than the treating provider. The problems, however, may lie deeper and behind the shroud of the EHR. And the true story may be below the surface of the medical records, and only by crawling through the EHR can we learn why our clients were injured.

Read the Kaiser Health News Article here.

Read the article about the Doctors Company here.

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