Daffy Duck for President

In the heated election season I thought it would be a nice break to remind ourselves of our constitutional form of government via a humorous civics lesson from Bugs Bunny.



Daffy Duck for President is a children's book, published by Warner Bros. and the United States Postal Service in 1997 to coincide with the release of the first Bugs Bunny U.S. postage stamp. The book was written and illustrated by Chuck Jones, edited by Charles Carney, and art directed by Allen Helbig. It was Jones' last published book before his death in 2002.

In 2004, Warner Bros. released a four-minute animated short of the same name based on the book. The film was produced by Tony Cervone, Spike Brandt, and Linda M. Steiner. It was considered for a 2005 Academy Award for Best Animated Short.

Doctors Using Electronic Health Records Provide Higher Quality Healthcare

The use of electronic health records is linked to significantly higher quality care, according to a new study¹ by Lisa Kern and her team, from the Health Information Technology Evaluation Collaborative in the US. Their work appears online in the Journal of General Internal Medicine, published by Springer.

Electronic health records (EHRs) have become a priority in the US, with federal incentives for 'meaningful' use of EHRs. Meaningful use entails tracking and improving specific patient outcomes, as well as gathering and storing information.

Kern and colleagues examined the effect of EHRs on ambulatory care quality in a community-based setting, by comparing the performance of physicians using either EHRs or paper records. They assessed performance on nine specific quality measures for a total of 466 primary care physicians with 74,618 patients, from private practices in the Hudson Valley region of New York.

The quality measures included: eye exams, hemoglobin testing, cholesterol testing, renal function testing for patients with diabetes, colorectal cancer screening, chlamydia screening, breast cancer screening, testing for children with sore throat, and treatment for children with upper respiratory infections.

Approximately half of the physicians studied used EHRs, while the others used paper records. Overall, physicians using EHRs provided higher rates of needed care than physicians using paper, and for four measures in particular: hemoglobin testing in diabetes, breast cancer screening, chlamydia screening, and colorectal cancer screening.

The specific quality measures included in this study are highly relevant to national discussions. Of the seven quality measures expected to be affected by EHRs, all seven are included as clinical quality measures in the federal meaningful use program. There has been little evidence previously that using EHRs actually improves quality for these measures.

This study took place in a community with multiple payers. This is in contrast to integrated delivery systems, such as Kaiser Permanente, Geisinger, and the Veterans Administration, all of which have seen quality improvements with the implementation of health information technology. Most health care is delivered in “open” rather than integrated systems, thus increasing the potential generalizability of this study.

The authors conclude: "We found that EHR use is associated with higher quality ambulatory care in a multi-payer community with concerted efforts to support EHR implementation. In contrast to several recent national and statewide studies, which found no effect of EHR use, this study's finding is consistent with national efforts to promote meaningful use of EHRs."

1: Kern LM et al (2012). Electronic health records and ambulatory quality of care. Journal of General Internal Medicine; DOI 10.1007/s11606-012-2237-8

Study: Exercise as a Vital Sign Improves Patient Care

Exercise is now a “vital sign” for all Kaiser Permanente members. While they have their weight, height and blood pressure measured before a doctor visit, patients are asked how often they exercise so that doctors can follow up.

A Kaiser Permanente study 'Initial Validation of an Exercise “Vital Sign” in Electronic Medical Records' published in the journal Medicine & Science in Sports & Exercise examined the electronic health records of 1,793,385 Kaiser Permanente Southern California patients ages 18 and older from April 2010 to March 2011 and found that 86 percent of all eligible patients had an exercise vital sign in their record. Of those patients who had an exercise record, one third were meeting national guidelines for physical activity, and two thirds were not meeting guidelines. Of those not meeting guidelines, one third were not exercising at all.

“There is no better indicator of a person’s health and longevity than the minutes per week of activity a patient engages in,” said Robert E. Sallis, M.D., one of the authors. Kaiser Permanente began using the exercise vital sign in October 2009. Patients at Kaiser are routinely asked questions about their usual daily levels of activity and are assigned a minutes-per-week value based on their answer. Using a regression model, this study demonstrated that a greater disease burden increased the likelihood of physical inactivity among the sample patient population. As expected, researchers also found lower activity levels among patients who were older, obese or members of ethnic minorities.

"Embedding questions about physical activity in the electronic medical record provides an opportunity to counsel millions of patients during routine medical care regarding the importance of physical activity for health," said study lead author Karen J. Coleman, PhD, of the Kaiser Permanente Southern California Department of Research & Evaluation. "In addition, the Exercise Vital Sign has the potential to provide information about the relationship between exercise and health care utilization, cost and chronic disease that has not been previously available."

Check out the video below featuring Dr. Jed Weissberg, Senior Vice President for Hospitals, Quality, and Care Delivery.

"…The medical assistant asks the patient, ‘How many days a week do you exercise, and on those days, how many minutes do you exercise? So that is adding exercise to the set of vital signs, just like we added cigarette smoking as a vital sign so that it could be right up there at the top of the medical information for the doctor to engage in a discussion with the patient."

Living by Numbers: Wired Health Conference

I am now at the WIRED Health Conference, which is being simulcast in a free live-feed at www.wiredhealthconference.com. The WIRED Health Conference will be an exploration of the challenges and opportunities of data-driven medicine. This is going to be a great launching point for me to head to San Francisco for Strata Rx (more on that in a later post ;-)

I'd encourage you to watch the live feed, follow along on the Twitter hashtag #WIREDhealth and check out the Living By Numbers: A Wired E-Book. This is just the start of what promises to be an awesome event!

The agenda includes:

KEYNOTE SPEAKER ASHTON EATON
Gold Medalist, Olympic Decathlon World Record Holder, Decathlon and Heptathlon

KEYNOTE SPEAKER MICHAEL GRAVES
Founding Partner, Michael Graves & Associates/Michael Graves Design Group

KEYNOTE SPEAKER CRAIG VENTER
Founder, Chairman & President, J. Craig Venter Institute; CEO & President, Synthetic Genomics

KEYNOTE SPEAKER STEPHEN WOLFRAM
President & CEO, Wolfram Research

YOU CAN NOW WATCH THE ARCHIVE OF THE EVENT HERE