Online Follow up for Hospitalized Patients

I'm excited about a new program that we started today at the University of Arkansas, using the eDoc technology and team in partnership with the UAMS physicians.

We give every patient being discharged from the hospital a free subscription to our service, with the encouragement for them (or their family) to log on and ask a question or get a clarification about their recent hospitalization or other health questions that may be concerning them.

I don't know about your experience but, around here, when patients leave the hospital, it is not that easy for them to get in touch with one of the doctors associated with the hospitalization to get questions answered, etc.

So, anyway, they log on, ask our team questions and, if it is straightforward and we're comfortable answering, we do. If it needs to be passed on to one of the doctors who took care of the patient, we do that.

We're doing a three month pilot, then we'll reassess and see how we want to proceed.

What do you think of this idea? Let me hear from you.

Electronic Records and Confidentiality

At UAMS, we recently did a survey asking employees if they used the University for their health care and, if not, why not. A signficant percentage indicated that they elected to go elsewhere because of concerns about confidentiality of records.

Recently, at another local hospital, following a tragic homicide of a news anchorwoman at a local TV station, 7 employees were fired because they accessed her records without authorization.

At UAMS our compliance/HIPAA office indicated that, when they do audits of our EMR, they routinely discover MANY episodes of unauthorized access to our electronic medical records.

Electronic records have so many advantages, but this is one of the challenges that needs to be addressed. Communication, clear policies, and accountability measures are all critical to keeping folks' noses out of records where they don't belong.

One thing needs to be said in clarification, though. In the "old days" when paper records were the rule, I'm absolutely sure that confidentiality was just as big an issue, but we had no way of knowing if someone looked at records without authorization. Nowadays, if someone accesses a digital record, it leaves an electronic "footprint" that can be easily traced to the perpetrator. So, it could be that this is simply a problem that we now have more information about and can do something about, rather than actually being a new problem that is due to the EMR. On the other hand, it is likely that some occurrences of unauthorized access would not have occurred in the "paper era" because electronic lurking involves different settings, technology and skill than finding a paper chart and looking at it.

Can electronic records be constructed that assure that their confidentiality will be maintained? Probably not. Can more be done to safeguard patient online records? Without a doubt, yes.

This is an issue that the public needs to become educated about and weigh in on. What do you think? Do the advantages of an EMR outweigh confidentiality concerns? How concerned are you about this? Does it affect where you go and who you see for medical care?

Let us hear from you on this...

What to be Sure to Eat if You are on a Diet

Most Americans are overweight, so dieting is very common. We all know that losing weight means eating less and burning more calories. As we eat less, what should we be sure to eat?

A study published in the Journal of Nutrition in early 2008 followed 130 overweight people on two types of diets. The control group reduced calories based on the traditional food pyramid, so they ate the right types of food. The study group ate a diet rich in protein and calcium, emphasizing lean meats and low-fat dairy products. Both groups lost comparable weight over 12 months. The group on the protein and calcium rich diet had stable bone mass while the control group had some loss in bone mass. The protein rich diet also helps with maintaining muscle mass.

So, if you plan to lose weight by any method, be sure to get protein at every meal, and pay attention to getting enough calcium, either from dairy products or through a supplement. Also take a multi-vitamin daily if you are eating less calories than you burn, and be sure there is vitamin D that is necessary for calcium absorption by the body. Also, get regular weight bearing exercise such as daily walking to help protect your bone mass.

Source: University of California, Berkeley Wellness Letter, December 2008

How Important is Chewing?

Everyone seems to be in a hurry these days. Meal times, especially breakfast and lunch, are rushed. "Wolf it down" seems more common than taking our time with eating. We often swallow food with minimal if any chewing. Is this ok? No!

Chewing our food is an important first step in digestion. Skip it and you may miss getting some of the nutrients in some of the best foods, like our vegetables. Chewing has an important role in eating and should not be skipped. What does chewing our food do?

• Chewing transforms transforms food into a form that is safer for swallowing.
• Saliva contains the digestive enzyme amylase that begins the process of breaking down food for digestion into our bodies.
• Grinding food with our teeth is important in preparing the food for later digestion in the intestine.
• Taking our time with eating through chewing our food helps us eat less and not gain as much weight.

Chewing is not optional! It is part of good nutrition practice. Think about how much time you spend with chewing. Being conscious of our chewing is a first step in keeping this essential part of digestion in proper perspective.

On Line Interactions Can be Better than those in the Doctor's Office

It is sometimes said that contacting a physician online, especially one that doesn't provide your ongoing primary care, is an "iffy" proposition at best. And, truthfully, if you require lab tests, x rays, an exam or a procedure, that is certainly true.

However, for many problems, the most important need a patient has is to exchange meaningful information about the condition at hand and have a clear plan about how to address it. For example, whether a specialty referral or a particular procedure or medication is needed, just to name a few of the many examples.

But, consider the possibility that, for certain situations, on line interaction may actually be superior to in 0ffice care! I have been amazed at the number of times that clients using eDoc have said that our physicians have been even more helpful for their situation than their own doctor has been after several office visits. How could this be?

On line dialogue, both for the physician and the patient, provides a much more relaxed environment to think about a response to a question or problem. There is no embarassment and, consequently, often more comfort in sharing unpleasant or personal details about symptoms. If a physician is "pretty sure" how to answer a question, but is unclear on some of the details, he has plenty of time to consult a text or a web site and review a situation briefly before he responds. Patients then have an unlimited opportunity to clarify issues or respond back to physicians' questions.

Finally, physicians have an incredible treasure chest of web sites and resources called the internet that they can use to enhance their responses with patient education materials. So, in the end, many online episodes result in a patient who is more fully informed and more satisfied with their plan than they might be following one or more brief in office visits with their physician.

So, if you have not been sure that online health is for you, try logging on and asking one of the eDocs a question.

You'll be glad you did.

Next time, I'll discuss the debate about independent research v. consulting with a physician online to answer your questions...

Let me know if you have comments or questions.

Nutritional Quality Index - How Well Do You Know Your Foods?

In the supermarket, we have the greatest choices of foods in the history of mankind. Eating well can be an overwelming challenge. Most of us like variety in our foods, and we have that luxury. But making good food choices regularly is quite a challenge with so many factors to think about.

At Yale University's Griffin Prevention Research Center, an Overall Nutritional Quality Index has been developed with scores of 1 to 100 based on the nutrients, vitamins, sugar and salt, and the overall impact of foods on blood pressure and other health concerns like clogging blood vessels. The quality index will begin appearing on many food labels and at many stores. Look for it. The scores are available at: www.onqi.org. Here are some highlights.

Foods that rated a perfect 100 are: broccoli, blueberries, orange and green beans. Pinapple and radish get a 99. Summer squash (98), apple (96), green cabbage (96), and tomato (96) are among the others at the top of this food chain.

Near the bottom are: popsicle and soda both rating a 1, saltine crackers, bacon, and apple pie rating a 2, milk chocolate a 3 (very sorry), cheese puffs a 4, hot dog a 5, salami a 7 and white bread a 9. These are commonly eaten foods that can easily be eliminated from a diet. You will lose weight too.

Some interesting foods in the middle are: unbuttered, unsalted popcorn (69), 2% milk (55), pasta (50), New York strip steak (44), bagel (23) and salted dry roasted peanuts at 21.

Eating healthy is a big challenge but we know more about our foods than ever before. Nutritional knowledge is out there for us to make healthy choices. I hope this information helps you and your family live a healthier life.

I Have Diverticuli in my Colon, What Can I Eat?

Now that more adults are getting colonoscopies, more of us are finding out that we have diverticuli in our colon. A diverticulum is a pouch, like a small cave, coming out of the lining of our colon. It is common for adults over 40 to have them. If they become inflammed or infected, this is call diverticulitis. Stool may become trapped in the diverticulum and over time cause an infection, sometimes very serious if there is a ruture of the diverticulum causing the infection to spread in the abdomen (peritonitis).

It is generally felt that a lack of regular fiber in the diet causes these diverticuli to form. This has has never been clearly proven. It is clear that daily use of fiber, especially grain fiber like that in high fiber cereals, keeps the stool moving and helps avoid stool getting trapped in the diverticuli causing an infection.

There has been a belief, even a medical recommendation, that people with diverticuli should avoid certain foods such as nuts, corn, popcorn and berries, thinking that these foods might get trapped in the diverticuli and cause an infection. This is rational thinking but has never been proven. To the relief of us that have diverticuli, and I found out I do at my colonoscopy, a study has now shown that these foods to not present any risk to people with diverticuli. In a study of over 47,000 men, intake of these foods had no association with developing diverticulitis.

So, I will continue to eat my high fiber cereal, fruits and vegetables every day. I will continue to enjoy nuts, corn and berries since I love them, and will feel free to order popcorn at the movies. Isn't it nice when medical science helps us enjoy life a little more!