Ok, so I’m a big geek and super excited about Apple’s new iPhone they just announced; is it just me, or are we getting close to the tricorder era already? (Yes, I’m a Star Trek nerd, too.)

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Doctors, nurses, med students, patients, we should be embarrassed.

Welcome 2007. You can email, send instant messages, order airline tickets in seconds, track that airplane as it flies across the globe, manage your calendar, work on documents and spreadsheets in real time with your friends and colleagues, even read newspapers from around the freaking globe. But our computerized medical records (or whatever you want to call them) can’t even print out labs in the right order. This is, in a word, ridonkulous. Hospitals and clinics should demand more. The big medical record makers should provide more. Their interfaces, truly, look like they’re from 1990.

I have spent a little over a year in hospitals, working as an upcoming doctor, and I’ve seen 8 completely different electronic medical records. (This is working at only 4 different hospitals.) Some are better than others, some are definitely worse than others. The government’s own Veterans’ Hospital’s CPRS software is probably the best, and honestly leaves much to be desired. (This is what it looks like.)

Over the year I’ve tried to collect ideas about the best features (and worst) of these different systems, and I’ve put them all together in something I call (for lack of better): the GMR (Grahamazon Medical Record). It’s an interface only–doesn’t actually save patient data (yet!)–but sadly, I think it’s lightyears ahead of what I’ve seen (and I live in Silicon Valley). It’s mainly a proof of concept–that this could be done, and can be done. (Note: It works in all modern browsers: IE7, Firefox, Safari.)

I’ve put together a screencast that walks you through some of the features. Watch it, and then play around with the interface. My goals, basically:

1. Make the software work for you, not the other way around. I see many of my attendings bewildered when trying to figure out basic tasks on current systems.
2. Make it make sense. Chemistry panels should come out in the right order. Information should be easy to find and accessible. Information that needs to be known quickly in an emergency should be easily displayed.
3. Don’t act like a medical record. Act like a one-stop shop for getting hospital work done. Be context sensitive. Don’t make me call the operator to find out who’s on call. If a lab isn’t being processed, show me who to call for that lab.
4. Be legible, and easy to process. I see too many people having to squint and strain to read their monitor.

Note: This is obviously not optimized code for efficiency, it’s my hacking-so-it-works Web 2.0 interface. It could definitely be improved, but it’s a start.

Feedback, as always, is appreciated. (Oh–forgot to mention in the video–you can easily access any of the tabs by doing “Ctrl+letter” on a Mac or “Alt+Letter” on a PC, using the underlined letter.)

(Special thanks to Maria and Nick for their feedback!)

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Okay KevinMD and Socialized Medicine, I’ll bite. (They quote Ontario’s deputy Health Minister.) His version, and then mine, with changes in bold.

Canada:

“[O]ur system could be much better. It lags behind the best international standards in waiting times and availability of new technology and drugs. Our medical staff are overworked and stressed. We seem to lurch from crisis to crisis with constant government attempts at micromanagement, punctuated with cutbacks and bailouts.

It is time for a different approach: less government, not more. Our current problems are caused by the failure of a rigid, centralized control system that inevitably follows from single-source funding. In the absence of economic user fees, paid directly to service providers, central funding leads to shortages and rationing as a means of cost control. We see the results in unacceptable waiting times and lack of adequate services. The current shortage of trained medical staff is the result of botched government decisions in the name of cost control. As a result, a significant number of people do not have a family doctor.

The way we fund health care rules out any market forces or signals that might improve efficiency. We provide free coverage for minor services to all, including the most affluent, so we don’t have enough funds for timely cancer treatments and catastrophic drug plans. This creates the ultimate two-tier system where the more affluent can pay for drugs and travel to the United States, while those of more modest means are denied service.

US:

[O]ur system could be much better. It lags behind the best international standards in access to care, infant mortality, life expectancy, and equity. Our medical staff are overworked and stressed. We seem to lurch from crisis to crisis with constant double-digit increases in annual insurance costs, and government attempts at patchwork reform, punctuated with cutbacks and bailouts.

It is time for a different approach: less fragmentation and corporate control, not more. Our current problems are caused by the failure of a patchwork, ridiculously administratively wasteful system that inevitably follows from employee health benefits as a fluke from World War II. In the absence of access to prevention and primary care, patchwork funding leads to shortages and rationing as a means of cost control. We see the results in unacceptable deaths from lack of health insurance and undue suffering of those without–and sometimes with–health insurance. * As a result [of no health insurance and poor incentives for medical students to go into primary care], a significant number of people do not have a family doctor.

The way we fund health care rules out any public health or prevention efforts or signals that might improve efficiency. We provide free coverage for emergency services to all, including the most affluent, so we don’t have enough funds to prevent disease and illness before it becomes more serious; often even the insured end up owing tens of thousands of dollars for timely cancer treatments and catastrophic drug plans. This creates the ultimate two-tier system where the more affluent have access to health care without risk of bankruptcy, while those of more modest means are asked to weigh the decision between medical care and bankruptcy or severe financial difficulty.

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Aetiology is questioning the intelligence of Brits for the fact that “More than a quarter of [British] people believe that fate alone will determine whether they get cancer, not their lifestyle choices”.

Brits, here I come to the rescue–I agree. Fate causes cancer. (Aetiology’s Tara Smith is an assistant professor of epidemiology, which may have clouded her views on this one–that’s what statistics and population studies will do to you!)

If you look at groups of people, you can easily say that smoking increases your risk of many, many cancers. And other lifestyle choices definitely increase your risk of cancer. But look what I said–increased risk. Not guarantee. Not all smokers develop lung cancer, not all smokers develop emphysema. Not all obese people develop diabetes, and not all people who develop diabetes are obese.

You can say that X increases your risk of cancer by 99%, but when you go down to the individual level, that individual has to either develop cancer or NOT develop cancer. We can’t say which smokers will get cancer and which won’t, only that they’re more likely to. There’s still random chance–if you want to call it fate, so be it–that gives people cancer.

So there you are, Brits, you’re right.

If you want to reduce your risk of cancer, heart disease, and other big killers, prevention is the key, and lifestyle changes can do a lot. But we want to accurate for the individual, we don’t know who will get cancer. Is this an argument for patients to keep smoking, and playing Russian roulette with their bodies? Of course not. Maybe someday we’ll be able to tell which people will get cancer, but we definitely can’t now.

(Update: Orac agrees! I’m flattered!)

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This is just hideous. Grotesque. Please, do not let anyone play with fireworks.

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Echocardiograms are being posted to YouTube–what a great way to learn! (Okay, it’s a start–I still need some orientation and arrows myself, but it’ll happen!)

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… because I will never trust malicious teenagers.

a nice section of EKGs, but I will never, ever, ever, ever, ever use it for anything remotely related to patient care. I don’t care if it ends up having the top 10 results for my query on Google. I don’t trust wikis.

I know everyone says that if you screw with a Wikipedia page, within the next hour, it will be edited back to the correct information, so that at any time, 99.9% of pages are accurate. However, I will never use a source that is immediately edittable by anyone at any time. I screwed with Ask Dr. Wiki’s Aortic Stenosis page, and it still lists one of my causes: Tricuspid Aortic Valve (it should be Bicuspid Aortic Valve). I don’t care if 99.9% of the time Dr. Wiki is correct. If the time that I’m using it is when it’s inaccurate, that’s a big problem.

It’s one thing to provide basic health information geared toward patients that can provide free, almost-always-accurate education to patients, but it’s another to try to provide it to physicians.

See also: Ganfyd, which requires proof of being a physician in Canada, the UK, New Zealand, or Australia. (But if you really wanted to mess with it, it wouldn’t be that hard.)

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From the Snarky-Comment-Slash-Breaking-Medical-Studies Department:

My governor broke his femur. I was going to recommend that he go back on the anabolic steroids, as they help bone mass (corticosteroids hurt bone mass and cause osteoporosis), but then I saw that stomach acid reducers (proton pump inhibitors like Nexium, Protonix, and Omeprazole) can cause decreased calcium absorption. Maybe the poor guy just has bad heartburn. And that I can empathize with.

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