Tag Archives: standards

Automating clinical decisions with predictive analytics

Automating clinical decisions with predictive analytics – Twitter discussion from Terri A Lewis, PhD @tal7291

This is Dr. Lewis’ take on how Appriss is using the electronic health record (EHR) of pain patients to automatically calculate an “opioid risk score” and guide the doctor to prescribe less and/or add a naloxone prescription. (see EHR tool to assess patient risks for opioid abuse)

This kind of automated standardization flies in the face of the supposed intention to individualize treatments. Unfortunately, such personalized care is expensive, while standardization is cheap.

Allow me to point out the obvious. Med records are far too inconsistent, messy, wrong, incomplete for this to be a valid, reliable tool upon which to make clinical decisions that involve predictive analytics. JUST SAY NO.   Continue reading

EHR tool to assess patient risks for opioid abuse

EHR tool to assess patient risks for opioid abuse – Joseph Goedert – October 23,  2018

Electronic health record vendor eClinicalWorks has built a new software module, embedded in the EHR system, to help clinicians assess a patient’s risk for opioid misuse.

The Opioid Risk Tool module will be included in the vendor’s next upgrade in January 2019. The software includes clinical decision support that estimates a patient’s risk and provides suggestions for prescribing alternatives to opioids or opioid antagonists, which block the effects of opioids.

So it seems this system would never suggest continued opioid therapy, no matter what the patient’s situation.   Continue reading

A Measured Approach to Pain

A Measured Approach to Pain: Tools to Help Patients and Doctors – Elisa Friedlander – Sep 01, 2016

There’s one question I’ve been asked more than any other in my adult life. On a recent visit to the emergency room, I heard it once again.

My pain was so intense I could hardly tolerate the standard intake procedures: getting my blood pressure taken and explaining why I was there was beyond me. When I told the admitting nurse about my symptoms, she followed up with those overly familiar words.

“What’s your pain level on a scale of 1-10?”   Continue reading

Who Else Would Put Up with This?

Who Else Would Put Up with This? – by Fred N. Pelzman, MD August 24, 2018

Those checkbox forms would never fly in other professions.

Can you imagine lawyers, or bankers, or almost any other profession, allowing this to happen to them?

I’m writing about the standardization efforts that the makers of electronic health records are trying to institute for us as we try and build a record of what took place between us and our patients.

Make no mistake, standardization is driven by profit-seeking cost-cutting.   Continue reading

Four Clusters of Chronic Pain Patients Identified

Chronic pain patients can be classified into four groups: Clustering-based discriminant analysis of psychometric data from 4665 patients referred to a multidisciplinary pain centre (a SQRP study) – free full-text article /PMC5805304/ – PLoS One, Feb. 2018

This the first study I’ve seen that begins to address the wide variety of “pain patients” that suffer from so many varieties of “chronic pain”. We are NOT a uniform group.

The major findings of the study were that the four groups/clusters were identified, which had the following characteristics:   Continue reading

Has patient-centered care gone too far?

Has patient-centered care gone too far? – Ali Rafiq, MD | Physician | April 28, 2018

This article makes the good point that a metric-driven push to provide all kinds of patient-centered amenities in medical settings is far from optimal. The patient is not always right.

The first week of residency of any program is usually comprised of several orientation sessions in which the new interns are introduced to various important aspects of the residency program. One of the sessions regarding patient safety and quality though caught my eye. It was the introduction of the STEEEP model of health care.

It came across as a clever acronym that stood for safe, timely, effective, efficient, equitable and patient-centered (STEEEP) care — a motto that was supposed to be shared by all employees of the hospital.   Continue reading

Individualizing Pain Treatment: Start with Gender?

Individualizing Pain Treatment: Start with Gender? – ASPS 2018

When evaluating a new patient with pain, doctors may first think about the location of the pain, the potential mechanism, the severity or the age of the patient.

Inna Belfer, MD, PhD, has another idea: first, consider gender. “The approach to the patient should be individualized, first of all, based on sex, then age,” said Dr. Belfer, health scientist administrator at the National Institutes of Health (NIH) Office of the Director.

This seems so obvious to me that I’m surprised it’s worth an expert’s time to write about it.   Continue reading

CDC Admits It Screwed Up Counting Opioids

The CDC Quietly Admits It Screwed Up Counting Opioid Pills | American Council on Science and Health – By Josh Bloom — March 19, 2018

Here’s another take-down of the CDC’s corrupt counting:

Here’s the title of an opinion piece in the April issue of the American Journal of Public Health, which was published by four authors at the CDC: Quantifying the Epidemic of Prescription Opioid Overdose Death

(See previous post: CDC Over-Counting Rx Opioid Overdose DeathsContinue reading

Boston Pain Care Functional Pain Scale

I finally found a pain scale that relates to levels of functionality, not sensation.

I’ve always self-rated my pain by how much it interrupts me, if I can override the interrupts and still write or if I have to stop and lie down, or if I’m so consumed by some pain I can only lay unmoving with gritted teeth waiting for my pain medication to take effect (that can be over an hour sometimes).   Continue reading