Discover and read the best of Twitter Threads about #EHR
Most recents (24)
š New today! š In @JAMANetworkOpen, with @NateApathy, @Bruce_Landon, and @SusanEdgman we use #EHR data to characterize roles & activities of physicians vs. Advance Practice Providers in primary care vs. medical vs. surgical specialties
jamanetwork.com/journals/jamanā¦
jamanetwork.com/journals/jamanā¦
While traditional team-based care models have suggested that physicians would see more new patients and APPs see patients in follow-up, we find that primary care APPs actually see a GREATER proportion of new visits than APPs 
We also show notable differences in EHR use patterns between physicians and APPs across specialty types.
In total, in primary care, physicians are spending MORE daily and weekly time on the EHR than APPs. This is reversed for medical & surgical specialties.
In total, in primary care, physicians are spending MORE daily and weekly time on the EHR than APPs. This is reversed for medical & surgical specialties.
Why do people have persistent hypertension? Turns out there are many reasons; we developed a taxonomy to classify them so they can be addressed, based on #EHR data. @yuan_lu1 @CircOutcomes @SpatzErica @YaleMed @YaleCardiology #bloodpressure @AHAScience ahajournals.org/doi/abs/10.116ā¦
@yuan_lu1 @CircOutcomes @SpatzErica @YaleMed @YaleCardiology @AHAScience Several years ago @yuan_lu1 and I introduced the concept of persistent hypertension to describe people with many measures of elevated #bloodpressure; a more encompassing term than resistant hypertension, which was about not responding to drugs. @amjmed sciencedirect.com/science/articlā¦
@yuan_lu1 @CircOutcomes @SpatzErica @YaleMed @YaleCardiology @AHAScience @amjmed We wrote that persistent hypertension was a condition of repetitive measures of above-goal elevated blood pressure over a period of time (eg, 6 mos), and drug resistance was just one of many causes. And many causes were related to missed opportunities in the care pathways.
Speaker Alejandra Pablos shares her story #KeepAleFree and encourages others to do so too through @AbortionStories. She says her story of fighting deportation, being detained and says that fighting for abortion rights are an intuitive extension of her goals and values.
#SFP2022
#SFP2022
Dr. Perritt @Reprorightsdoc encourages the audience to center on their own positionality. We focus on disclosures in medicine, but positionality - where we grew up, who we are, how the world sees us - are probably more important in framing our actions.
#SFP2022
#SFP2022
Day 2. Starting on pitfalls in leveraging EHR by Stephanie HYLAND @ESICM #criticalcare #ehr #datascience #ai #LIVES2022
This problem is mainly for ML engineers who may not have talked to domain expert or clinicians / end users.
Pitfall 1 : sampling bias
"whos included in the analysis"
"who in your EHR"?
- e.g., - COVID prediction dataset where missing all blood tests were removed, but this missingess has a meaning. Thus not generalisable.
e.g., yesterday I mentioned about females < 6% of sample popn
"whos included in the analysis"
"who in your EHR"?
- e.g., - COVID prediction dataset where missing all blood tests were removed, but this missingess has a meaning. Thus not generalisable.
e.g., yesterday I mentioned about females < 6% of sample popn
What % of #EHR text is directly duplicated from a prior note?
6 yrs
100+ mil notes
33 B words
192 B characters
Duplicated text ā¬ļø from 33% in 2015 to 54% in 2020
Blocking copy forward is not the answer. We must reimagine #documentation
jamanetwork.com/journals/jamanā¦
6 yrs
100+ mil notes
33 B words
192 B characters
Duplicated text ā¬ļø from 33% in 2015 to 54% in 2020
Blocking copy forward is not the answer. We must reimagine #documentation
jamanetwork.com/journals/jamanā¦
Also - we (the authors) paid out of pocket to publish this piece on @JAMANetworkOpen so that it would not be behind a paywall. We need more resources (aka funds!) for open academic research šš½
Documentation burden directly impacts #burnout for clinicians as well and it does so disproportionately between disciplines & gender
@evebmd and I talked about this with @DIVURGENT @ShaneDanaher & @trentrosenbloom @techguy
podcasts.apple.com/us/podcast/heaā¦
@evebmd and I talked about this with @DIVURGENT @ShaneDanaher & @trentrosenbloom @techguy
podcasts.apple.com/us/podcast/heaā¦
1 of 10 /Do you use an electronic health record? Did anyone ever teach you how to document #allergies? šCheck our this #EHR allergy documentation guidance #medtwitter #idtwitter #AIMedEd @EricMacyMD @AutumnGuyer @allisoncramsey @vumc_cdsi_rsch @JACIInPractice
2 of 10/We are excited to announce that the adverse reaction to drugs biologics and latex (ARDBL) committee of the @AAAAI_org has an #inpress workgroup report on allergy documentation in the EHR. jaci-inpractice.org/article/S2213-ā¦
3 of 10/ In this article: current state of allergy #ehr documentation, definitions, reconfigurations, and recommendationsāļø#bestpractices in documentation for #penicillin allergy āļøwhat to include and what not to include in the allergy list
ACC & @American_Heart released a šreport outlining key data elements & definitions for #ChestPain & acute myocardial infarction (#MI) based on the 2021 ACC/AHA Chest Pain Guideline. Takeš Points inš§µBelow ā¬ļø #cvAMI #ClinicalGuidelines #JACC @JACCJournals
@American_Heart @JACCJournals 1ā£ The #ACCClinicalDoc presents a clinical lexicon of data elements related to #ChestPain & #cvAMI, in context of how the terms are used in the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR #ClinicalGuideline for the Evaluation and Diagnosis of Chest Pain: bit.ly/3CIBldf
2ā£ This lexicon follows the plans contained in the new #chestpain guideline and NOT all conceivable types and causes of chest pain are considered here. #ClinicalGuidelines @JACCJournals
#OncTwitter
NCI Pooled analysis (N=6.9K) of antiPD1/PDL1:
š0.6% incidence CPI-related major cardiac AEs, 77% grade 3+
šAlmost half were myocarditis
š Twice as common w/ combos vs monotherapy & w/ CPI + targeted agent vs CPI + antiCTLA4ā¦
#ImmunoOnc
ascopubs.org/doi/full/10.12ā¦
NCI Pooled analysis (N=6.9K) of antiPD1/PDL1:
š0.6% incidence CPI-related major cardiac AEs, 77% grade 3+
šAlmost half were myocarditis
š Twice as common w/ combos vs monotherapy & w/ CPI + targeted agent vs CPI + antiCTLA4ā¦
#ImmunoOnc
ascopubs.org/doi/full/10.12ā¦
#OncTwitter
šMajor cardiac AEs were mostly early events (1-2 months) occurring after median of 2 doses of CPI
š1/4 of cases of myocarditis were fatal, all preceded by myositis š
šDiverse clinical presentations so have high index of suspicion to diagnose & intervene earlyā¦
šMajor cardiac AEs were mostly early events (1-2 months) occurring after median of 2 doses of CPI
š1/4 of cases of myocarditis were fatal, all preceded by myositis š
šDiverse clinical presentations so have high index of suspicion to diagnose & intervene earlyā¦
#OncTwitter
My commentary: Itās also concerning (& not surprising given what we know about pro-inflammatory metabolic syndrome as a cardiac risk fx) that markedly ā¬ļø risk of MI has been reported in pts with multi-yr use of CPIs. I predict this follows a course much like HIVā¦
My commentary: Itās also concerning (& not surprising given what we know about pro-inflammatory metabolic syndrome as a cardiac risk fx) that markedly ā¬ļø risk of MI has been reported in pts with multi-yr use of CPIs. I predict this follows a course much like HIVā¦
Had an opportunity to visit few #MTIs in #KPK with the purpose to explore #PedsICU infrastructure & need assessment and collaboration for capacity building. 1/12
Overall basic infrastructure is there and the need is unmet. And there is a desire on ground to build this field of #Pediatrics which is encouraging. The management is excellent and there is an #EHR in place. All these make an excellent starting point. 2/12
Iāve been contacted 2x just this wkā1 IRL acquaintance & 1 person I know only via Twitterāafter they got imaging results in portal before their dr. They DMād w/ screenshots, panicked, asking for help. Iām šÆ for pt access to #EHR, but #CuresAct implementation needs a MAJOR reboot
My friend Steve texted me last year asking how he could convince his partner Ed to see a doctor.
Steve said, āSomething weird is happening to him. He canāt walk, his speech is slurred, and his mood changes. Heās a totally different person.ā #ph260720 #HIV
Steve said, āSomething weird is happening to him. He canāt walk, his speech is slurred, and his mood changes. Heās a totally different person.ā #ph260720 #HIV
I asked him why Ed is reluctant to see doctors. Steve replied, āHe has always hated seeing doctors because he feels judged by the health system.ā
This is the story of Edās experience and how we could have prevented his death from #AIDS 8 weeks later. #ph260720 #providerbias
This is the story of Edās experience and how we could have prevented his death from #AIDS 8 weeks later. #ph260720 #providerbias
Todayās medical adventure: patient goes to hospitalās outpatient infusion center. /1
Patient complies with intake procedure which takes 1 hour. This involves nurses doing required data entry for #EHR documentation. /2
Once intake completed, pharmacists is requested to bring up medicine. Waiting time for arrival of infusion drug after getting set-up is 1.5-2 hrs /3
What if you or your doctor could accurately predict how long you had to live upon a new diagnosis of aggressive cancer (e.g. lung cancer or sarcoma)? I've faced that question both as a doctor and with a dearly beloved. On the one hand I know I would 1/ #ML #AI #mortality
do the utmost to beat the odds forward.com/scribe/470514/ā¦ and a gloomy prediction would be just another hurdle to overcome. On the other hand, a very accurate predictor of mortality upon diagnosis would be very useful: we might dispense w control arms in trials [at our peril] 2/
families and society might allocate resources/support accordingly, research might focus on why exceptional patients deviate markedly from the prediction dbmi.hms.harvard.edu/news/most-poweā¦ . Therefore a recent study by colleagues @HarvardDBMI @HarvardChanSPH @harvardmed on this prediction 3/
I have found most non-technical explanations of FHIR (š„) to be unsatisfactory. Key things to know are as followsā¦ 1/š§µ
FHIR (Fast Healthcare Interoperability Resources) defines a standard way to organize health data. By having a standard, a computer programmer can write an application (app) that requests data from a source location without having to ask anyone how the data are organized. 2/
This means that a computer application can be written once and work the same no matter which source (e.g., hospital) it requests data from. This is called interoperability. 3/
1/ Good overview of challenges of doing ābig dataā health care research in US. For instance, nice description of basic pros and cons of insurance claims vs #EHR health care records
HT @ABatemanHouseā© technologyreview.com/2021/06/21/102ā¦
HT @ABatemanHouseā© technologyreview.com/2021/06/21/102ā¦
2/ But the article has a prematurely triumphant tone at the beginning (and in the default Twitter tagline). N3C is great but limited, as the article does make clear
3/ And itās not totally novel. But the novelty to me is that itās
a non-āfederatedā* model
*not* run by for-profit companies,
so the data are accessible to the public for analysis
*this term is explained in article
a non-āfederatedā* model
*not* run by for-profit companies,
so the data are accessible to the public for analysis
*this term is explained in article
š§µ1/ I find #COVIDvaccine focus groups like this fascinating. I was struck by the broad distrust of physicians in this group of reproductive-aged women...
š§µ2/ I study this kind of population a lot in my #gynhealth work through #EHR medical systems data. As a social epidemiologist, itās a cool population to study in EHR data bc so many have frequent contacts with the medical system through routine gyn and pregnancy care...
š§µ 3/ So you really get a peek into a broad cross-section of the population, unlike other kinds of EHR research.
When the #ACA was implemented: there was no mandate established to ensure that #emr #ehr electronic medical records could communicate and physicians could obtain medical records from #doctors caring for the same patients at other offices or hospitals. 1/
@ThinkingAboutV @nanopore The applied omics market based on #NGS technology is still an incipient market if we compare it to more established #diagnostics markets. But we are not far away from a point in time where every newborn's genome is ...
@ThinkingAboutV @nanopore ... sequenced at high quality (long reads, maybe with PCR-free including epigenome marks), and kept as an #EHR in the health system for future use. From then onwards, there will be recurrent #LiquidBiopsy assays, maybe once a year, to screen for a multitude of conditions.
@ThinkingAboutV @nanopore From 40-45 yo onwards, mainly cancer screening of healthy individuals, based on a #MachineLearning cancer classifier such as shown already by @GrailBio / $GH and others, but also other classifiers will come soon, such as #epigenomic profiling of #Neurodegenerative conditions, ...
#MedTwitter showed me the dark side of this, of all times, during a #pandemic. Turns out some who are employed in supposed #SciComm actually stalk patients on behalf of doctors & administrators. Sadly, #bullying patients has gone from "just" in hospitals to dark web.
There is a type of doctor, not all, who believes self a "victim" of patients.. "I am a victim" is used to do mental gymnastics to "justify" #bullying patients who seek answers, report error or harm, initiate lawsuits.
Yes, there is too much litigation. But this is America.
Yes, there is too much litigation. But this is America.
#Tweetiatrician training is for #advocacy on #vaccines #VaccinesWork #VaccinesSaveLives
This has been our lane for well over a decade. As long as I've been a pediatrician we've been using every form of #communication and #SciComm, the sillier the better
pediatrics.aappublications.org/content/141/1_ā¦
This has been our lane for well over a decade. As long as I've been a pediatrician we've been using every form of #communication and #SciComm, the sillier the better
pediatrics.aappublications.org/content/141/1_ā¦
Those who:
do not touch patients & never have
who maintain no clinical licenses
who feel free of any commitment to #ethics
are put in charge, by administrators, to control, often via fear & shame, clinicians.
This harms on many levels.
It is anti-#safetyculture.
#MedTwitter
do not touch patients & never have
who maintain no clinical licenses
who feel free of any commitment to #ethics
are put in charge, by administrators, to control, often via fear & shame, clinicians.
This harms on many levels.
It is anti-#safetyculture.
#MedTwitter
We have lost >500,000 Americans to #COVID19 alone. Preventable deaths. These are mostly the marginalized, vulnerable.
Either document measurable work to save lives, or get out of the way and out of budgets that could be used to save lives.
Either document measurable work to save lives, or get out of the way and out of budgets that could be used to save lives.
Iāve seen SO much over the years, in the name of #compliance consulting to siphon off money to block &, ultimately, harm.
No this does not save money.
It harms families.
It monetizes coded racism.
There are a multitude of such vendors & consultants.
governing.com/topics/health-ā¦
No this does not save money.
It harms families.
It monetizes coded racism.
There are a multitude of such vendors & consultants.
governing.com/topics/health-ā¦
Kicking off the Year in Review for #PICUQI and #PedsICU #MedEd #CCC50 Search strategy included a review of ALL tables of contents of major pediatric and critical care journals, PUBMED search, key collaborative search, asking on @twitter and discussion with experts in the fields.
First up by @ndean75, āThe Late Rescue Collaborative: Reducing non-ICU arrestsā in @PedCritCareMed Dean & colleagues saw decreased rates of non-ICU arrests & increased participation through @AAP #MOCPart4. #PICUQI #CCC50
journals.lww.com/pccmjournal/Fuā¦
journals.lww.com/pccmjournal/Fuā¦
@MParshleyMD @adamIMdoc @InduPartha @primarycarechat @ACPinternists Urgent need to provide MORE time for ambulatory visits. Us ambulatory specialists have all felt the time crunch of seeing complex patient w/ 5-10 issues (or more) in 15-20 minutes. NOT good #PatientCare. NOT #PatientSafety. Thread š§µ 1 @ACPinternists #IMProud
@MParshleyMD @adamIMdoc @InduPartha @primarycarechat @ACPinternists We need major payment reform so reimbursements & physician āproductivityā is NOT volume-centered based on number of visit encounters. THAT drives ambulatory schedules to have visits that are far too short to maximize numbers of visits. Thread š§µ 2 @ACPinternists #IMProud
@MParshleyMD @adamIMdoc @InduPartha @primarycarechat @ACPinternists Focus on value of care, NOT number of visits. Have flexibility of visit lengths based on appropriateness for care complexity. Get rid of āone size fits allā 15-20 minute visits. Simple 1 issue visit ok for that. Complex multi-problems-NOT ok w/ that. Threads š§µ 3 @ACPinternists
1/ ā¦@AmerMedicalAssnā© submitted comments to ā¦@CMSGovā© regarding a NPRM on provider burden reduction and #priorauthorization: tinyurl.com/y5ebobkf
The NPRM cited #OurAMA prior authorization survey data and grassroots website FixPriorAuth.org
The NPRM cited #OurAMA prior authorization survey data and grassroots website FixPriorAuth.org
2/ The rule proposes policies to help make the prior authorization process more efficient and transparent.
The NPRM would require #Medicaid, CHIP, and federally facilitated health exchange plans to:
ā¢Support technology that would convey #priorauthorization requirements
The NPRM would require #Medicaid, CHIP, and federally facilitated health exchange plans to:
ā¢Support technology that would convey #priorauthorization requirements
3/ The NPRM would also require impacted payers to:
ā¢Automate the exchange of supporting clinical data from physiciansā #EHR workflow
ā¢Publicly report data on #priorauthorization programs and comply with processing timeframes
ā¢Automate the exchange of supporting clinical data from physiciansā #EHR workflow
ā¢Publicly report data on #priorauthorization programs and comply with processing timeframes
Dear #MedTwitter please, please, if you are a licensed medical professional and/or in school to be, do NOT delete your tweets or comply with anyone telling you to do so. It will harm you far more than leaving them up and explaining. Nothing is ever deleted. Can be used in court.
When I was at Harvard Med School and at an esteemed children's hospital, a case against an esteemed professor, that NO lawyer would touch cuz this was someone who had WRITTEN the textbooks and trained every expert, was won ..based on "a document was deleted" - creating suspicion
"Sunlight is the best disinfectant" you will hear me say OVER and OVER - wins & losses *should* be on data/standards but unfortunately wins & losses are in the court of public opinion. So be reliable, credible, and trustworthy. Transparency is one way to achieve that reputation.
