The More Downs than Ups of Electronic Medical Records

11 10 2012

Hark back to the thought processes of the 1970s and 80s when the ‘bad’ science fiction movies were filled with technology, robots, were taking over the world from the humans who created them.  This is the sensation that I got from the Oct 8, 2012 article in the New York Times, “The Ups and Downs of Electronic Medical Records” by Milt Freudnheim.

While the title suggests that the article will speak to both the benefits and issues with electronic medical records, the author was much more heavy handed with the downfalls.  The article was fairly gloom and doom about the whole situation.

Don’t get me wrong, I realize that there are definitely bugs to be worked out and that it looks like it will take time to work them out, but downplaying the potential benefits to patients and doctors alike of this new technology is not the answer.  In this case, where neither the software manufacturers, nor doctors, nor patients really have an idea of when and how the technology can really be beneficial, or if it will turn out to be a detriment to patient healthcare, it is much better to present both sides of the argument and let people make their own informed decisions.

The first portion of the article really emphasizes that currently, unfamiliarity with the software systems is bogging down the system, and this is probably true, but wasn’t that also the case with the first computers, where there absolutely was a steep learning curve.  Fortunately, now computers are a staple in everyday life and are making lives much easier and more productive.  This is also emphasized in another article in the NYT on the same date, “Redefining Medicine With Apps and iPads,” by Katie Hafner.  Nurses and doctors alike will likely have to go through hours of training and overcome the habits learned over years on the job and professional training of writing everything down on paper, but benefits may eventually outweigh the problems that are currently being brought to light.

In the middle portion of the article, several good points are brought up about the current state of technology. Dr. Scot M. Silverstein raises a good argument, that indeed testing technology in a live hospital setting is probably not a good idea, much less ethically correct.  This is why there are simulators and even training tools, where a mock system with imaginary patients could be used in training to practice using the system, and where hospital administrators and doctors could determine whether the system that is being tested is correct for the hospital it’s being used in.

Cross talk between systems and apps is also brought up, until either a universal system is created to be used in all medical institutions, or a set of systems are designed to infallibly speak to each other, without translational issues, institutions are going to have to implement safety measures to ensure that what a computer system is transmitting, is indeed correct.  Medical professionals are still going to have to use common sense and not just rely on technology.

The industry will definitely have to design new safety measures to handle these new standard operating procedures in order to protect the patient and ensure the highest standard of care.   This is not new, and new safety measures are being implemented daily, but with technology a new kind of safety measure will have to be created.  People have to be willing to learn and evolve with technology, not let these ‘new fangled electronic gadgets’ stymie them completely.

In the last part of the article, I thought one quote was particularly amusing.  Dr. Scott A. Monteith is quoted saying:

“the diagnosing process can include ‘looking at six pieces of paper,’ he said. ‘We cannot do that on a monitor.  It really affects how we think.’”

I have no idea how old this doctor is, but the quote reminds me of some of the previous generations’ attitudes about technology, that just because it is not the way ‘it’s always been done’ that it can’t be correct.  I’m not sure how much exposure he has to technology, but there are ways to have multiple monitors linked together, to where indeed you can look at 6 documents at one time.  Granted, you can’t read them all at one time, just like with paper, you have to read one at a time, but you can get the same effect as laying them all out on a table to analyze trends and similarities, having them all visible on 2 or 3 monitors that are linked together.

One character in this story, Ms. Burger, president of the California Nurses Association, also brought up an interesting issue, stating:

“‘The problem is each patient is an individual, we need the ability to change that care plan, based on age and sex and other factors.’”

She is absolutely correct, that the software being used to enter records, diagnoses, and order medications should not be plug and chug with just a few options based on standard of care.  Medical professionals should have the freedom to use their expertise and previous experience to treat patients with drugs and treatments that they feel will be the most successful for each individual, as she stated correctly that “each patient is an individual.”

While this paragraph in the story was supposed to bring up more issues about the current state of technology when it comes to electronic medical records, I’d like to bring up the possibility of benefits in the future.  Personalized medicine is thought to be the wave of the future, using individual genetics to customize treatment.  While genetic sequencing is still on the expensive side, the price is steadily dropping and eventually we will probably have a sequence for everyone in their medical records.  This could allow a software system to analyze the sequence and give the doctor or nurse warnings about patient sensitivities to drugs or an idea about which drugs will be effective based only on comparison of genetic sequence or even epigenetics.  Cross referencing previous treatments, genetic sequence, and available treatments via software, could allow for each patient to be treated even further as an individual, making unique treatment plan design much quicker, without some of the trial and error.  For example, current genetic analyses, such as from the website 23andme.com shows when patients have a higher likelyhood of being sensitive to the drug Warfarin, an anticoagulant, even before being treated with the drug and finding out the ‘old fashioned way’ that there could be an issue with sensitivity.  It could allow medical professionals to change drugs or adjust dosages based on the way the patient metabolizes the drug, all found via genetic analysis.

Some other potential benefits that went unmentioned in this article include eliminating the need for double procedures, decreasing the likelihood of being prescribed drugs that interact badly from two different medical institutions, and decreasing the likelihood of drug addicts being able to play the system and obtain multiple prescriptions for the same drug.  All of these benefits require rapid sharing of information between institutions and likely not be implemented or seen for awhile, though the potential is striking.

The lack of need for double procedures, like imaging, blood work, etc would allow patients to be protected from unneeded radiation exposure or more needle pricks if referred from one institution to the next, instead of repeat procedures to get the same results, all the image scans and blood work reports could be rapidly and easily passed from one place to the next (think inter-institutional e-mail) or accessed in a universal system.

Prescription records that are widely accessible to pharmacy, hospital, and doctor alike, with safety measures in place, like the little pop-ups in gmail that remind you that you have not added an attachment if in your e-mail it says ‘see attached,’ doctors could be quickly warned if he/she is about to prescribe a drug that is known to interact with another drug the patient is already on.  A similar system could warn doctors/pharmacies that a prescription for opioids or other addictive drugs have already been prescribed.

While there are many kinks in the development of this technology to still be worked out, I think there is more promise than what this article would have you believe.  It is still really early in the game, but as technology gets better and professionals become more familiar with the options, I think this is the future of medicine and how information will be shared.  The majority of the issues presented are valid and should be taken into consideration and it may be a little early for universal implementation, but I think this industry lends more hope for the future than a need to toss it all out the window and start from scratch, as the tone of this article would lead you to believe.

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Building a Career: From bugs to belly buttons – Guest Speaker Dr. Holly Menninger

30 09 2012

If you want an example of a person using multiple life experiences (aka jobs), all of which were not “perfect,” to lead you to a great job/career that makes it all worth it, then Dr. Holly Menninger is the example for you.  She was invited as a guest speaker on Tuesday, September 25th, 2012 to our ENG 520 class as the Director of Public Science for the Your Wild Life project.  As part of her job as director, she gets to enthusiastically engage the public, introducing them to glorious scientific knowledge, write, record podcasts, and play with bugs, all of which are passions developed over the beginnings of her career.

What at glance would seem a haphazard transition from Ph.D. in entomology, appearances on CNN (as a bug publicist), to work in science policy, to creating a weekend science radio show/podcast (on a volunteer basis), all have their purpose in allowing Dr. Holly to succeed in her current role as Director of Public Science.  She exudes a passion for bugs, which began early, as she would tell it, but 17-year and 13-year cicadas emerging from the ground to “do their thing” is what launched the transition from pure interest in studying these creatures, to interest in public education of scientific phenomena.  Creating a buzz (pardon the pun) around the emergence of “giant bugs” that make a lot of racket and that could be perceived as the beginning of the apocalypse, if the public was not educated about the natural life cycle of these bugs, was invigorating.  Her excitement about the topic, vicinity to major news outlets, and the fact that her PI was doing Good Morning America the same morning, allowed her to be the perfect “bug guru” for 6 episodes on CNN.  This first major exposure to public, mainstream education was trial by fire for Dr. Holly and from her comments, it seems that this is how she learned the most about how to be the interviewer and interviewee.  A relatively brief stent as a science policy liaison with a side project as a science radio show host showed her that absolutely wanted to follow her passion, educating the public, rather than dealing with the paperwork mess of policy for a career.   Thus the transition into the Your Wild Life project, where she can play with bugs, create podcasts, educate the public, and use the information she gleaned from the science policy job to really influence the lives of the public around Raleigh, and the rest of the country, investigating microbiomes that are a little closer to home than we’d like to imagine, bugs in our homes, bacteria in our belly buttons, and not to mention what lives in our armpits!

She and her comrades strive to make bugs a little less yucky and a lot more educational and exciting for young scientists and other inquiring minds.  The projects they are working on engage citizen scientists to investigate and sample for themselves and contribute to the pool of samples from urban and suburban local areas.  The Your Wild Life team strives to “Explore the biodiversity that lives on us, in us and around us,” so if your game, the participation information is on the groups’ website, yourwildlife.org

The theme of class was interviewing skills for the interviewer and interviewee, as our class is a mix of scientists in the making and Technical Communications students, so we will all probably be on both sides of the coin at one point in our careers or another.  To address this theme, along with telling her wonderfully inspiring story, she gave us tips about being both the interviewer and the interviewee, which I will summarize below:

For the interviewee:

  • Focus on the 5 P’s: Prior Practice Prevents Poor Performance

Think about your main message when approached about an interview, take five minutes to organize your thoughts and get your talking points together.  If you know ahead of time that your story or research is likely to make headlines, do a little preparation to be sure you deftly cover appropriate issues and give the most factual information possible.

  • Stick to no more than three talking points, which emphasize your main message.

Too much information can oftentimes detract and distract from the message that you really want to convey.  The “triangle method” was how Dr. Holly presented graphically the 3 points and a main message mantra.

  • Ask the “Why me?” question.

Knowing why you are a person of interest to be interviewed and what spurred interest in the subject can give you a great head start into knowing what information will be relevant to the interviewer and what may allow you to make the most positive and pertinent press about the issue.

  • Get your facts straight.

Probably the most important tip for the interviewee, this is the way to gain good exposure as an expert, if you misspeak or fudge information because you don’t know the answer, the journalist may not come to you again, because you’re not a reliable source.  The best policy would be to say you don’t know (if you don’t), look up the information, and get back to the interviewer later.  I’m sure most scientists and science writers value accurate reporting of facts at a later time, rather than a quick, inaccurate quotation.  Good punchy facts can also potentially make powerful quotes, so doing your homework and being prepared can make a big difference in getting your message across.

  • Take journalists into the field, it can add ambiance to a story.

There is nothing better than firsthand experience to lend a little spark to a story, not to mention providing photo ops or sound clips.  Dr. Holly’s example of taking a journalist literally into the field, a field of cicadas, surely contributed to later reporting.  She described what the cicadas were like at their time of emergence and that the researchers and journalist were literally shouting at each other to be heard over the din of the bugs chorusing.  What kind of journalist wouldn’t mention that in a story?

  •  Misquotation will happen, just roll with it.

Take the instances of misquotation, which inevitably happen in the transfer of information (think about the childhood game of telephone), something might be misheard or misinterpreted, as a learning experience.  Think about how you could have described it so that the interviewer, next time will fully understand.

You can also use your resources to correct or explain the misquote, linking to the story in your personal blog allows you space to fully explain a statement and communicate why it was wrong or out of context.

We also discussed the fact that if you do get interviewed, it is likely that at some points a quote you provide will not make it past the cutting room floor, don’t take it as a slight; there are absolutely word limits to be made.  Also, it may have been your information that provided the appropriate background to make the story come alive, so use interviews as times to educate, rather than expect big quotations to come out of it.  Being polite and approachable regardless of whether you get a quote or not, may lead to journalists coming back in the future or referring colleagues just because you are a good source.

For the interviewer:

  • There is a fine line between knowing enough to ask intelligent, relevant questions and knowing too much, where questions are too in-depth and you lose the audience.

Most of the time, writing stories and interviewing on subjects that are foreign to you can be easier than subjects that you are intimate with.  Taking a broad base view is more appealing to people who know nothing about a topic, they’re more likely to be able to understand the story if you get at the big picture; whereas,  if you’re already an expert in the field, you make hone in on questions and details that fly way over the head of a lay audience.

  • Send questions ahead of time.

This tip definitely comes with caveats, if you’re trying to catch time sensitive information or get off the cuff comments about a controversial topic, then spontaneous interview is probably the better bet.  However, if you have the freedom to send them ahead of time, then you can have an interviewee that is prepared with great facts and potential quotes.

  • Have more questions prepared than you know you’ll be able to ask.

Nothing is worse than running out of material before the interview is supposed to be over, so being over prepared is key.  Also, feel free to go off script and ask questions that delve in deeper to answers that the interviewee has given, it can give depth to a story and take it somewhere you hadn’t expected.  It also shows you’re listening, which moves us into the next tip.

  •  Listen to the guest.

Is the answer interesting?  Are there any follow-up questions that would be great to fill out your story? Do you need clarification?  Did they actually answer the questions?  These are all questions that couldn’t be answered on the spot if you aren’t actively listening and engaged in what they are saying.  You may also get more passion from the interviewee if you listen rather than robotically go through your list of questions.

  • If the interview doesn’t work out, go to idea #2.

Some people just aren’t naturally enthusiastic or willing to answer questions in an open format, so if you get an interviewee that is a dud, be polite, but don’t be afraid to scrap the material.

Sometimes, you can bring people out of their shells to open up if you ask things unrelated to the core of your interview, ask them about a picture on your desk, or art on the wall, or what their interests are; getting them to loosened up and more comfortable with a more neutral topic can make the flow of the interview better.  And hey, you may learn something fun about the person to throw into your story.

  • Embrace the long, extended, pause.

If there is a lull in conversation or a question than stumps the interviewee, don’t feel the need to fill the void.  Oftentimes, people become uncomfortable with this pause and begin to talk freely just to end it.  This may lead to unsolicited, interesting stories, as well as tidbits of information that the interviewee might have not meant to reveal.

______________

I really feel blessed to have been able to be present in class during these guest lectures.  The science writing community is so open and willing to share great advice and life lessons with newcomers, which you don’t find in many other fields.  I’m sure this information will be of great use in the future, especially when it comes to writing our first formal pieces, which will require extensive interviews.  I also am glad Dr. Holly shared the information about being an interviewee; I will be more than prepared to give an interview, if my research ever sparks a news frenzy.





Starting Things Off Write – Guest Speaker: Bora Zivkovic

24 09 2012

A little background into this post before diving in:  I am taking ENG 520 Science Writing for the Media, taught by David Kroll.  The class is about how to write articles about science for the general media, so that lay audiences can gain insight into the goings on of the scientific community.  Bora Zivkovic was the first guest speaker invited to talk with our class, our assignment to prepare for his visit was to read several of his blog entries, which I have linked to periodically through my reflection.  The format of the visit was a very open ended interview, which allowed the majority of the class to have their questions answered about science writing, blogs, writing formats, job opportunities, and personal anecdotes.  I really gained a lot from his visit, most importantly, that I can be a science writer.  Below is my formal reflection on his visit.

I’ll admit when I first heard that we’d be blogging, hearing from bloggers, and reading blogs I was a bit nervous.  I had the general impression that blogging was for those so bold as to put personal diaries online, so once I began reading, I was quite surprised to see people using it to communicate knowledge, parse out thought processes, and critically analyze publications from mass media to scientific journals.  I think my original fears came from my parents’ and school teaches’ ardent lectures about taking care not to reveal too much on the internet, as this could be dangerous.

In some cases they are right, there is no way that I’m going to be publishing addresses, social security numbers, etc online, but then I’ve  also begun to wonder if not having enough online is also a  bad thing.  Could you lose out on potential opportunities that shameless self promotion and publication of a reasonable synthesis of scientific ideas could present?  Would it be better for potential employers to have an idea about your capability and personality beforehand? Bora Zivkovic’s answer to both of these questions would most certainly be yes.  His straightforward, stream of conscious, write until you’re done explaining, style is informative, creative and admirable.  He’s taken off with a new trend, well new since the 20th century, and adapted it to current technology, evolving as the world of science journalism evolves and helping to stand tradition on its head.  I greatly enjoyed our class’ opportunity to discuss with him the ins and outs of his journey in scientific writing and here I muse on some of the topics he brought up.

Bora very deftly describes that the idea that the mass media is 1. the end all be all in news authority and 2. completely accurate in their reporting is crazy, you have journalists with no expertise in science translating it for lay audiences, which definitely has the potential to turn out very badly.  As he realized the potential in blogs early on, he’s helped to popularize the modern outlets for writing, which has allowed for a style of writing and reporting to return that was lost for a blip in the timeline of the earth, aka the 20th century.  By sharing everything and hashing out ideas in mass, with everyone contributing thoughts and critique, this may help a lot of the bogus science to be brought to light, and for the progression of discovery to move at a faster clip.

Bora also brought up the need to be extremely critical when you’re reading, as even in peer reviewed journals, garbage has a tendency to get shoved through the cracks.  With this thought in mind, blogs are an excellent way to discuss the latest science news and publications, getting multiple points of view from a variety of sources, via the comments section, to hash out what is good science and what is hogwash.  One of his suggestions was very insightful, in that you can use a blog as a think tank to work out new ideas, but I’m not too sure this will catch one with prominent scientists too quickly, as most are very protective of new ideas that could be stolen.  I also wonder about how I will personally be able to handle some of the critiques that come from allowing writing to be available to the masses, especially in light of the recent ENCODE circus.  Bora’s thoughts on the matter were helpful in my musings over this matter; he talked about “attacking ideas not people,” a way to critique someone’s writing without bashing it, which can also be used in the reverse, take to heart the content of the criticism, but taking the criticism personal.  Keeping this in mind will allow me to use critiques from the public to grow as a new science writer, rather than shrink back away from my thoughts and principles.

I very much appreciated his openness about how he got some of his jobs; the stories were comical and incredible at the same time.  Who knew you could get a job via blog post? It just goes to show that indeed, having an online presence and a loyal readership can get you pretty far on the job front.  Based on some of Bora’s comments it seems expertise and trust from your readers is absolutely developed over time, along with deftly placed links to resources that can verify your thought processes and resource; this should definitely be kept in mind if you want to science write for a career.  However, if you’ve got a creative streak and an ability to integrate other disciplines with science topics, then you may catch the Blog Father’s eye and be on the fast track to notoriety.  Bora tries to promote and encourage new science writers through mentoring and opportunities to post your work on sites like Scientific American, where he is currently an editor and blog community facilitator; he may also tweet up a storm about a post if he likes it enough.  This attitude of encouragement seems to permeate the science writer blogosphere with veterans promoting newbie’s work; the key to success according to Bora, it’s all about just getting your stuff out there for other curious minds to find.