Patients, Docs Don’t See Eye to Eye Regarding EMR Access

doctor viewing patient record on iPadSeptember 16, 2013 | Bernie Monegain – Editor

A new survey finds that with patient engagement efforts on the rise, a mounting number of U.S. citizens — 41 percent to be precise — are more privy to changing doctors based on their ability to gain online access to their own electronic medical records. Meanwhile, doctors remain skeptical of lending patients that type of unabridged EMR access.

The survey, of more than 9,000 people in nine countries, shows that only about a third of U.S. consumers (36 percent) currently have full access to their EMR, but more than half (57 percent) have taken ownership of their record by self-tracking their personal health information, including their health history (37 percent), physical activity (34 percent) and health indicators (33 percent), such as blood pressure and weight.

“The rise of meaningful use mandates and a growing trend of self-care among consumers is shifting the role of an EMR from a mere clinical repository to a platform for shared decision-making among consumers and doctors,” said Kaveh Safavi, MD, managing director of Accenture’s North America health business. “Just as consumers can self-manage most other aspects of their lives, they expect to take greater ownership of their medical care, and they are willing to switch to doctors who share their values and are willing to provide access to consumer records.”

Roughly four out of five consumers (84 percent) surveyed believe they should have full access to their electronic medical record while only a third of physicians (36 percent) share this belief. In contrast, the majority of U.S. doctors (65 percent) say patients should only have limited access to their records and that is what most individuals (63 percent) say they currently have.

“When consumers are part of the record-keeping process, it can increase their understanding of conditions, improve motivation and serve as a clear differentiator for clinical care,” added Safavi.

Accenture conducted an online survey of 9,015 adults ages 18 and older to assess consumer perceptions of their medical providers’ electronic capabilities across nine countries: Australia, Brazil, Canada, England, France, Germany, Singapore, Spain and the United States. The survey, which included 1,000 U.S. consumers, was fielded by Harris Interactive in July 2013. Where relevant, the survey compares select findings from the Accenture Doctors Survey to compare the doctor and consumer responses.

This article is based on original reporting from Healthcare IT News. 

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Dealing With Stress : How to Reduce Surgical Anxiety

hoard of surgeons creating surgical stressDo you Suffer from Surgical Anxiety?

Are you afraid of surgery? Does the idea of yourself, or a loved one, entering a surgical theatre set your heart racing? If so, you are not alone.

Surgical anxiety is a fear. A natural human response to something out of our own control. It is most usually triggered by fear of the result. That is, in most cases, the anxiety arises when a patient remains uneducated to the details of the surgery that they are facing. This leaves them to imagine what the possible worst-case scenarios could be, both during and after the planned surgery. For example, a patient facing a surgical operation which results in a cosmetic change to the body, such as a mastectomy, might worry how their body will look after such an operation.

Fear of the unknown can have a powerful impact on the mind.

That’s not to say this is always the case. Some people may find themselves suffering with anxiety because of a previous bad experience themselves, some suffer with a fear of different types of surgical instruments, such as needles, which is known as Trypanophobia. Patients with an already existing anxiety disorder may find themselves more susceptible to surgical anxiety too. The truth is that most people will find this type of anxiety increases as the surgery draws closer and that is a completely natural thing to happen.

How Surgical Anxiety Can Impact Your Physical Health
Regardless of the cause, its important that the patient seeks the correct treatment and doesn’t feel as though they must suffer in silence. If left ignored, surgical anxiety can affect your physical health, these extra problems combined with stress and sleepless nights will almost certainly reduce your ability to cope, making the anxiety worse.

The physical symptoms associated with surgical anxiety can stretch further than you may be aware, with some experiencing chest pains and/or a strong feeling of nausea along with an increased heart rate. If the physical symptoms increase, and the circle of anxiety is allowed to continue, you may even find yourself cancelling an important operation due to the added stress. This isn’t an ideal situation, because in the long run it is essential that any surgery planned by your doctor can proceed. In order to for this to happen, you will need to learn to control your anxiety, and this isn’t an easy task when under stress.

How to Reduce Surgical Anxiety
The most important part of dealing with surgical anxiety is to fully inform yourself of the procedure you are facing. Immerse yourself in information from others who have endured the same surgery that you are facing. Learn about any therapy that may be helpful for you afterwards. Ask to speak to your surgeon beforehand and don’t be afraid to ask any questions you may have regarding your surgery. The surgeon will be able to give you an idea of what exactly the procedure you are facing entails. By facing the facts head-on, and allowing yourself a better understanding, you will feel better informed as to what you can expect, and this will help to relieve some of your anxiety. Continue reading Dealing With Stress : How to Reduce Surgical Anxiety

Is There A Place For Chiropractic Care In Workers’ Compensation?

colorful x-ray illustration of spineSeptember 18, 2013 by 

Editor’s note: Acupuncture is also in the California Workers’ Comp Treatment Tables, and the following guidelines would seem to apply here, as well.
[Summary of California Workers’ Compensation Law Relating To Acupuncture Treatment]

Chiropractic care is an area of workers’ compensation medical treatment that often brings forth negative emotions by the employer. Any employer who has handled numerous workers compensation claims can recall the injured employee who had what seem like an endless number of visits to a chiropractor.

Inability to Limit Chiropractic Care Plagues Employers

Chiropractors differ from doctors as they do not perform surgical interventions, and in most jurisdictions are not allowed to prescribe medications. Chiropractic care, like acupuncture and massage, are healing arts. Chiropractic care focuses on the musculoskeletal system, with spinal manipulation being the primary medical service provided.

The issue that has plagued chiropractic care in the workers’ compensation system is the inability of many chiropractors and many employees to limit the medical treatment to what is needed, especially with employees who have had previous chiropractic care. Chiropractic care is a symbiotic relationship where both the chiropractor and the employee benefit. The chiropractor benefits from a steady stream of income from the workers’ compensation insurer. The employee benefits from feeling better, even if very temporary, following the chiropractic treatment. When either the employee or the chiropractor begins to abuse the workers’ compensation system by receiving treatment or by providing treatment that is no longer necessary, the negative emotions of the employer begin to come into play.

In response to the abuse of the workers’ compensation system, some states, for example California, have passed laws limiting the number of chiropractic visits an injured employee can have that are paid for by workers’ compensation. When a state limits the number of chiropractic visits to a set number, for example 24, and a disproportionate number of injured employees reach full recovery on the 24th visit, it reinforces the belief of employers who have a negative opinion of chiropractic care.

Chiropractor Should Provide Plan With Expected Number of Visits

Employers sometime begin to experience the negative emotions about chiropractic care too early because of previous episodes of chiropractic care abuse. While every injury is different and medical complications vary, there are some general boundaries that can be applied to chiropractic care. Following the initial visit, the chiropractor should be able to provide a treatment plan that will include the number of probable visits. In general:

• One month of treatment 8 to 10 visits
• One and ½ months of treatment 12 to 14 visits
• Two months of treatment 15 to 20 visits
• Three months of treatment 22 to 28 visits

If state law does not limit the number of chiropractic visits, and the chiropractor is treating the injured employee on a daily basis, or for more than three months, the employer should discuss the situation with the claims professional and with the nurse case manager. If the injured employee medical needs are severe to need daily care or if the care last more than 3 months, the medical care should be transferred to an orthopedic. Also, an independent medical evaluation is an option that should be considered. Continue reading Is There A Place For Chiropractic Care In Workers’ Compensation?

Can e-cigarettes be a public health victory?

hand holding an e-cigaretteJUSTIN BERK, MPH, MBA | MEDS | SEPTEMBER 12, 2013

Annoying mall vendors have been pushing what may be one of public health’s greatest accomplishments—and few have taken notice. Behind pillow pet stations and the candle stand, mall shoppers can find electronic cigarettes, or “vapes.” Often targeted at smokers wanting to quit, e-cigarettes offer many of the joys of smoking without one of its major components: smoke.

Smokeless cigarettes have become a hot product, with an estimated $1.7 billion in sales this year.  According to a recent article in the Journal of the American Medical Association, over 10% of smokers have tried e-cigarettes, and almost 5% have used them in the past month. Often marketed as smoking-cessation products, a small Italian study suggested that smokers do smoke fewer real cigarettes when given e-cigarettes.  A 2011 study in Addiction found that 77% of users used e-cigarettes for the purpose of smoking cessation and that 79% of users were afraid of relapse if they stopped using the e-cigarette. Their efficacy as a smoking cessation tool is still in question.

But for e-cigarettes to be a successful public health intervention, they do no not need to help smokers quit.

E-cigarettes need not be just a smoking cessation tool. Instead, their potential comes as a smoking maintenance tool that could greatly reduce individual and public health risks. Unlike other nicotine replacement therapies such as the patch or gum, e-cigarettes deliver the full smoking experience: as users put cigarettes to their lips, see a light when they inhale, and even receive a smoke-like “throat hit.”

Studies have not yet shown that e-cigarettes are healthier than tobacco cigarettes, since longitudinal studies of this kind are years down the line. But e-cigarettes lack the major carcinogens in tobacco cigarettes, which come not from nicotine but from other toxins. Most e-cigarettes use liquid cartridges with very few ingredients: water, nicotine, flavoring, and propylene glycol. Should these cartridges be shown to have toxic effects, they are likely to be orders of magnitude less severe than those of traditional tobacco cigarettes. Continue reading Can e-cigarettes be a public health victory?

Text Messaging Cuts New Diabetes Cases by Almost 40%

Lisa Nainggolan    Sep 12, 2013

health app for smart phone illustrationA new study conducted in southeast India has shown that sending text messages via mobile telephone seems to be an effective way of preventing the development of type 2 diabetes in at-risk men. Those who received the short messaging service (SMS), which consisted of 2 to 3 messages sent twice a week for around 2 years, were 36% less likely to develop diabetes.The findings were reported online in Lancet Diabetes and Endocrinology by Ambady Ramachandran, MD, of India Diabetes Research Foundation, Chennai, India, and colleagues.

“This is one of the first studies in the world to show that mobile technology can have an impact on clinical outcomes; it’s concrete evidence to show we could prevent diabetes,” Dr. Ramachandran told Medscape Medical News.

And senior author Desmond Johnston, FMedSci, from Imperial College London, United Kingdom, said: “We’ve known for years that you can prevent type 2 diabetes by modifying your lifestyle, but the problem is how to support people to do that. Frequent personal contact with a doctor is effective, but it’s very costly to provide. We’ve shown that you can achieve similar results using mobile phone messaging, which is a very low-cost solution.”

And he added in the Imperial College statement, “We plan to carry out more studies in other populations, but there’s no reason why this strategy shouldn’t work anywhere else in the world.”

Caroline Free, MD, of the London School of Hygiene and Tropical Medicine, agrees. “If the results of this trial are replicated in other settings, mobile phone messaging could be a practical and affordable way to deliver lifestyle advice to delay or prevent the onset of type 2 diabetes in many different populations,” she writes in an accompanying editorial.

Texts Cheap and Easy; Computer-Generated

Dr. Ramachandran said that it has been proven that primary prevention works in type 2 diabetes, for example, in studies in Finland and in the US Diabetes Prevention Program (DPP) and the Indian Diabetes Prevention Program (IDPP). But these trials were “labor intensive” and therefore costly, he explained. “We wanted to see whether we could use a cost-effective method of motivating people to change their lifestyle.”

Continue reading Text Messaging Cuts New Diabetes Cases by Almost 40%

Job Stress Blamed for Sizeable Proportion of Depression

Caroline Cassels       Sep 11, 2013

The costs of job stress graphicNegative working conditions, including low job satisfaction, little control, and a lack of appreciation by employers, are responsible for a sizeable proportion of depression in middle-aged adults, new research suggests.

Investigators at the University of Michigan Institute for Social Research in Ann Arbor found that workers with a higher total “negative working conditions” score also had higher scores for depressive symptoms.

In workers with the total highest scores, negative working conditions accounted for about one third of the standard deviation in depressive symptoms, a “substantial difference,” according to investigators.

“These findings add to the growing body of evidence that employment is an important source of divergence in mental health across midlife,” the researchers, led by Sarah A. Burgard, PhD, write.

The study is published in the September issue of the Journal of Occupational and Environmental Medicine.

Novel Methodology

Previous longitudinal studies of negative working conditions have tended to use a single exposure indicator, such as job strain. However, the investigators note that although this methodology has predicted health outcomes in a large number of populations, it may not capture the full range of negative conditions individuals experience on the job.

For the study, the researchers analyzed the relationship between a large number of working conditions and depressive symptoms on the basis of 4 waves of data collection during a period of 15 years in 1889 US workers aged 25 years and older.

The workers were asked about all working conditions, including job satisfaction, work/life balance, conflicting demands, and whether they felt appreciated for their work.

Researchers created a “novel” summary score of negative working conditions that encompassed all available working condition measures and examined the link between this score and depressive symptoms.

“Our measurement strategy can capture a wider range of experiences that workers face on the job, while not requiring the same set of items to be fielded in each wave of a survey,” the authors write.

The investigators found that workers with higher total negative working conditions scores also had the highest scores for depressive symptoms, as measured by the Center of Epidemiological Studies–Depression scale (CES-D).

For workers with the highest total scores, negative working conditions accounted for about one third of the standard deviation in depressive symptoms, “a substantial difference,” according to the authors.

These findings, the investigators note, underscore the importance of the “role of good jobs in enhancing worker productivity and reducing the costs of depression for workers, their families, and healthcare systems.”

The authors have disclosed no relevant financial relationships.

J Occup Env Med. 2013;55:1007-1014. Full article

Implementing Health Reform: Reporting Requirements For Employer And Minimum Essential Coverage

Read the full analysis of two Affordable Care Act IRS reporting regulations on the Health Affairs Blog.

September 7th, 2013 

On September 5, 2013, the Internal Revenue Service issued proposed rules intended to implement key reporting requirements of the Affordable Care Act.  One rule would require insurers, self-insured employers, government-sponsored programs, and entities that provide minimum essential coverage to report information on this coverage to the IRS and to covered individuals.  This rule will be referred to as the “6055 Rule” and implements section 6055 of the Internal Revenue Code, created by section 1502 of the ACA.

The second rule would require large employers to report to the IRS and to their employees information regarding the health care coverage they offer to full-time employees.  This rule will be referred to as the “6056 Rule” because it implements section IRC Section 6056, created by ACA section 1514.

The IRS also issued a press release describing the proposed rules.

The purposes of the reporting requirements.  These reporting requirements serve distinct purposes under the ACA.  The 6056  large-employer reporting requirement is necessary to determine whether large employers are complying with the employer responsibility requirement of the ACA; it will also help identify individuals who are ineligible for premium tax credits because they have been offered coverage by their employer, as well as individuals who meet the individual responsibility requirement because they have employee coverage.  The 6055 minimum-essential-coverage reporting requirement will assist the IRS in determining whether individuals are complying with the ACA’s individual responsibility requirement, and also whether they are eligible for premium tax credits because they lack minimum essential coverage.

The absence of these rules was the reason given by the IRS for delaying the employer mandate until 2015.  The IRS is encouraging voluntary reporting by employers and insurers subject to the requirements for 2014 and should have no trouble getting the final rules in place for mandatory reporting in 2015.

Continue reading Implementing Health Reform: Reporting Requirements For Employer And Minimum Essential Coverage

Infographic – The Most Common Workplace Injuries

The infographic shown gives an insight in the most common workplace injuries, the top ten most dangerous jobs, workplace accidents and distribution of injury cases. All in which can be avoided if accommodated with safety gear and equipment.

If you would like a complimentary ergonomic analysis of your job site, workspace or office, performed by our Physical Therapist, Ed Donahue, just give us a call at (805) 614-9000.

allsafetysupplies_infographics_450Written by the staff of Global Stores Group LLC, a leading provider of essential safety supplies to businesses of all kinds.

Benefits of Stay at Work & Return to Work Programs

August 29, 2013 by 

If these benefits sound good to you, read on! 1.No lost days or fewer lost days. 2. Higher productivity.Return to Work for healthy workers, healthy business3. Higher employee morale as the employee sees the employer as trying to maintain  employee’s income level. 4. Higher profit for the employer.  The doctors and staff at Central Coast Industrial Care are fully trained to assist you and your employees with a Return to Work Program.

Employers frequently do not grasp the true cost of workers’ compensation.  Many employers mistakenly think that the cost of workers’ compensation insurance is the amount of premium paid to the work comp insurer, or if self-insured, the amount paid out in medical and indemnity benefits.  These are the direct cost of work-related injuries.  The indirect cost of on-the-job injuries is estimated to be three times the direct cost.

Return to Work Brings Employee Back During Medical Recovery

 The loss of productivity is the primary indirect cost employers incur due to a job injury related absence.  However, employers frequently continue to incur the cost of health insurance, accruing time for vacations / sick days and other employee benefits while the employee is off work.  Overtime hours paid to other employees to make up part of the loss of productivity or time training a temporary or permanent replacement for the injured worker is also a part of the indirect cost.

Returns to work programs are designed to have the injured employee brought back to work during the employee’s medical recovery process.  More and more companies are altering their return to work programs to include stay at work, a policy where all but the most critically injured employees are given modified duties, or even a totally new and different job to do immediately following the initial medical visit.

With a stay at work program, the employer’s workers’ compensation coordinator is on the phone contacting the medical provider during the time the injured employee is traveling from the accident scene to the medical provider.  The medical provider is advised that the employer will provide the employee with modified duty within any medical restrictions including providing total sedentary work if needed.  The work comp coordinator also requests the employee’s work restrictions to be provided immediately following the employee’s first medical visit for the injury.

Continue reading Benefits of Stay at Work & Return to Work Programs