RxInformatics.com

Follow-up visits conducted via a secure Web site may result in similar clinical outcomes as in-person visits among patients with acne, according to a report in the April issue of Archives of Dermatology, one of the JAMA/Archives journals.

'Ensuring timely access to high-quality care is currently a challenge for the stressed U.S. health care system. Many specialities, including internal medicine, psychiatry and dermatology, are struggling to accommodate a growing demand for appointments owing to a critical shortage of health care providers,' the authors write as background information in the article. Dermatology, in particular, faces challenges such as an increase in skin cancer and a work force that is not equally distributed geographically. 'One potential solution to these issues may be the adoption of innovative, technology-enabled models of care delivery.'

'In this trial, delivering follow-up care to subjects with mild to moderate acne via office and online visits produced equivalent clinical outcomes by several different metrics,' the authors conclude. 'These findings suggest that dermatologists obtain sufficient information from digital images and survey responses to make appropriate management decisions in the treatment of acne. In addition, this model of care delivery was popular with both physicians and patients, likely owing to the convenience and/or time savings associated with e-visits.'

Although this article discusses follow-up care for a fairly benign condition - mild to moderate acne - it highlights the growing need for, and benefits of, telemedicine.

Health information technology: A new world for pharmacy

AUTHORS: Lisa Webster, BPharm, MS, and Rachelle F. Spiro, BPharm, FASCP

Activity Preview

This article provides a primer on Health Information Technology (HIT) for pharmacists, including the current state of HIT, future expectations, and strategies to ensure success.

Learning Objectives After participating in this activity, the pharmacist will be able: List at least five ways in which health information technology (HIT) is predicted to improve patient care. Provide at least five ways in which patient care might be at risk as a result of the adoption of HIT. Discuss six actions that pharmacists can take to help prevent patient harm related to the implementation and use of converging technologies. List four reasons for physician resistance to HIT implementation. Name six organizations involved in the development of HIT standards. State seven ways in which HIT is expected to benefit U.S. patients.

[note: free subscription required to access CPE activities]

Objective: To examine whether physicians' use of information technology (IT) was associated with better knowledge of drug costs.

 

Study Design/Methods: A 2007 statewide survey of 247 primary care physicians in Hawaii regarding IT use and self-reported knowledge of formularies, copayments, and retail prices.

 

Results: Approximately 8 in 10 physicians regularly used IT in clinical care: 60% Internet, 54% e-prescribing, 43% electronic health records (EHRs), and 37% personal digital assistants (PDAs). However, fewer than 1 in 5 often knew drug costs when prescribing, and more than 90% said lack of knowledge of formularies and copayments remained a barrier to considering drug costs for patients. In multivariate analyses adjusting for sex, practice size, years in practice, number of formularies, and use of clinical resources (eg, pharmacists), use of the Internet—but not e-prescribing, EHRs, or PDAs—was associated with physicians reporting slightly better knowledge of copayments (adjusted predicted percentage of 23% vs 11%; P = .04). No type of IT was associated with better knowledge of formularies or retail prices.

 

Conclusions: Despite high rates of IT use, there was only a modest association between physicians’ use of IT and better knowledge of drug costs. Future investments in health IT should consider how IT design can be improved to make it easier for physicians to access cost information at the point of care.

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...More

Very cool [free] new application for iPhone - and, eventually, for the iPad - that has built int medication safety information and reporting from ISMP.

Epocrates®, Inc., today announced its top-ranked clinical reference application for the iPhone® and iPod® touch devices will be customized for the new iPad™ computer tablet. The iPad is already receiving a warm reception from the healthcare industry with nearly 20 percent of clinicians expressing plans to purchase in an Epocrates survey conducted days after the Apple announcement.

"By optimizing our software for the iPad, we are capitalizing on the larger screen real estate and interactivity provided by this sophisticated device. We are committed to providing the most productive experience at the point of care, keeping physicians informed and focused on the patient rather than searching for answers," said Rose Crane, chief executive officer of Epocrates. "We are continuing to explore the advanced capabilities of the iPad and ways it can help Epocrates address the evolving healthcare technology needs."

In addition to announcing its engineers are using Apple's SDK to optimize Epocrates' offerings for the iPad, Epocrates surveyed more than 350 clinicians to gauge their interest in the new tablet. Findings include:

• Nine percent of survey respondents plan to buy the iPad when it was immediately available,
• Another 13 percent plan to buy it within the year,
• Thirty-eight percent of respondents expressed interest in the iPad with the request of more information to solidify their purchase decision.

I suspect that we'll see a lot of uptake by providers, however, I wonder if our health-systems' IT infrastructures are ready for the demand?

Nintendo Co. and Apple Inc. are helping drugmakers find new ways to get their products to customers as health-policy changes and new technologies force them to move beyond traditional marketing methods, audit firm Ernst & Young said in a report today.

Bayer AG, Germany’s biggest pharmaceutical company, has hooked its Didget glucometer to Nintendo’s video-gaming devices to encourage children with diabetes to monitor their blood sugar regularly. Johnson & Johnson is working with Apple to create an iPhone application that allows patients to upload and share their glucometer data.

Once again, another great opportunity for informatics pharmacists - and other clinicians - to help meet the needs of industry while making sure these types of projects are beneficial to unmet patient needs.

But for doctors treating patients with chronic diseases, text messaging can be an invaluable tool, according to Johns Hopkins Children’s Center pediatrician Delphine Robotham. “For better or worse, this technology is here,” she said, “and sending a text to a patient’s cell phone about an upcoming appointment or a test, or simply to remind them to take their meds, is a great example of how we can harness new communication technology for a greater good.”

Research has shown that up to half of patients may fail to take their daily medication properly, with forgetting being a top reason for nonadherence so, at least in some cases, a text reminder may be all that a patient needs, added Robotham, who has encouraged the use of appropriate texting among pediatricians at Johns Hopkins.

Several recent studies have looked at use of SMS (short message service, or text messaging) in a medical context, Robotham notes. For example, one study involving children with diabetes showed improved blood glucose testing rates among those using it. These children were also more likely to share their blood glucose test readings with their doctor’s office. In another study, patients on immunosuppressive drugs after a liver transplant had improved medication adherence. The liver study detected measurable clinical benefits from text messaging: Acute liver rejection episodes dropped dramatically as a result of better medication adherence. Chronic conditions that require daily medication, such as HIV, asthma and TB, or daily testing, such as diabetes, are great candidates for “SMS therapy,” Robotham said.

HITSP Chair Dr. John Halamka: “The iPad comes closer to my requirements than other devices on the market. However, the ideal clinical device would include a camera for clinical photography and video teleconferencing. Entering data via the touch screen with gloved hands may be challenging on a capacitance touch screen. Holding the iPad with one hand means hunt and peck typing with the remaining hand. The device is a bit large for a white coat pocket, may be hard to disinfect, and may not be tolerant of dropping onto a hospital floor. I look forward to trying one to validate these assumptions. My general impression is that it is not perfect for healthcare, but it is closer than other devices I’ve tried.” More (John D. Halamka, MD, MS is CIO of the Beth Israel Deaconess Medical Center, CIO and Dean for Technology at Harvard Medical School, Chairman of the New England Health Electronic Data Interchange Network (NEHEN), CEO of MA-SHARE, Chair of the US Healthcare Information Technology Standards Panel (HITSP), and a practicing emergency physician.)

Mountain View-based El Camino Hospital Vice Chief of Clinical Operations, Cheryl Reinking: “You could use this [iPad] in the operating room, when you need to document things quickly, or in the lab,” Reinking told the SF Chronicle. “Physicians could use the device at the bedside to make notes, or use it as a reference for medications. It could be an amazing tool.” More