Tag Archives: standards

HHS Report on Pain Mgmt Best Practices – part 3

Draft Report on Pain Management Best Practices | HHS.gov – Dec 2018

This document is so long and so detailed that I spent hours working it over to add my own voluminous commentary.

I posted the second, most significant part yesterday, HHS Report on Pain Mgmt Best Practices – part 2, and the first part the day before: HHS Report on Pain Mgmt Best Practices – part 1.  

This is the third and final part of my series, and covers the middle of the document, starting where I left off in the second part detailing interventional procedures. Continue reading

HHS Report on Pain Mgmt Best Practices – part 2

Draft Report on Pain Management Best Practices | HHS.gov – Dec 2018

This document is so long and so detailed that I spent hours working it over to add my own voluminous commentary. I posted the first part yesterday: HHS Report on Pain Mgmt Best Practices – part 1.

Below is the second part, covering more about opioid medication with all its “risk” and then the final, most significant section, covering the problems and errors of the CDC Opioid Prescribing Guidelines:

2.2.1 Risk Assessment  Continue reading

HHS Report on Pain Mgmt Best Practices – part 1

This seems like the first good news in a while: a government agency admitting that most opioid overdoses are from illicit fentanyl. The report also documents the downsides of non-opioid medications and highlights the predicament of pain patients.

Draft Report on Pain Management Best Practices | HHS.gov

This document is so long and detailed that I spent hours picking it over to find the critical pieces and add my own commentary. It’s far from perfect, but still a welcome change from the usual PROPaganda – and I choose to celebrate.

Here’s the first part:   Continue reading

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