The Momdocs project is moving along a bit.  We originally built it because we use an Emr with not-so-good prenatal module. A few years ago, this company lost out to GE in a bidding war for Logician.  The plan, of course, was to throw their old EMR in the trash and use Logician.    Now there are rumors again about this company in the market for another EMR … I wonder if these rumors have any basis …

Anyway …  Momdocs was an effort to make a perinatal record that didn't take forever to manage.  The Misys EMR simply can't build a record that the hospitals would accept.  So we were filling out the ACOG sheets by hand — transcribing them from the EMR when our patients were approaching delivery.   It's too bad that we had to create another home-grown solution, but momdocs – like everything else we've built – is user-focused.  

The residency program is using it more and more, and I've not had much feedback … so I guess that means they like it.

You can try it too … log in with username:demo and password demo.  Looks like Barney Rubble is overdue.  We'll need to induce him soon.

Office Work

If we think about what physicians do, the physician-patient interaction is what springs to mind first.  

But … we do other things too …  how much else?

We've had our home-grown messaging system in place for about 18 months now, and I just did a little analysis of some of the data in the system.   We use the system for phone messages and patient – initiated e-mails.   When a patient calls with a question, a message is generated to the nurse or physician.  It's much better than paper messages – which we outlawed in the summer of 2002.   An average of 71 messages were generated in the system per day.  We have 2.5 physicians (2.0 until 11/03) and 2 nurses.  The 2.5  physicians received an average of 42 messages a day  — so about 15 messages per physician.

Some messages are just FYI:  patient calls and nurse gives advice, sends FYI to physician.

Other messages represent work to be done — either calling a patient or calling a physicians or (ugh) calling an insurance company.  This varies, but I find that when I call home with my ETA for dinner, if I have more than 10 items in my "in" box, It'll be more than 40 minutes to get home (I live about 90 seconds from the office).

The other work we do is review labs and make calls or send messages based on the lab results.  Our labs are scanned in to our "in" box as well.  In the same timeframe, we have scanned 42,562 pages — about 170 per day (about 70 per physician per day).  Reviewing these takes time too.

When we did this work in the paper world, it was all represented by a pile of paper on the desk.  Now we can quantify how much work this represents, and perhaps we can figure out how much time to expect this to take — which would ultimately determine how we budget our time and human resources.

.. no wonder I'm up so late …


Access ePocrates Rx Online for free during the month of February, 2004..

Click here:

epocrates is a staple of physician practice in 2004.  Like most physicians – I use it many times every day.  Our nurses have started to use the desktop version (web-based) and it's one of the three or four applications always open on their desktop. 

"normal humans" can take a look at it too … as the free trial is open to everyone.

CME and Medlogs

A month or so ago, I discussed (via e-mail of course) an idea with Enoch.  Here goes:  Develop a mechanism for providing Continuing Medical Education credit to physician readers of medical weblogs.  I suppose that nurses and NPs/PAs could do the same .. and I'm happy to help with that .. but our inital idea was to focus on the physicians.  Dr Bob already offers CME on his weblog, but it's a challenge to follow the path toward that credit .. and since he's an Internist – he can't offer AAFP credit – which is important to me (and my family physician colleagues).

Here's my proposal … now that we're nearly ready to begin working on it.   We'll change a bit to highlight Medical weblogs that provide CME. 

Huh? … ok .. here's goes …

We identify 12 medical weblogs that qualify as high quality sources of medical information that would qualify as CME.  Sure .. if we have more than 12 .. that's ok, I suppose.  We'll need to form a core group of us to determine some criteria for inclusion  Pennie?  Bob? Enoch? Steve? …

  • We make sure that these weblogs meet the ACCME's ciriteria for web-based CME
  • We define the GNOME for the learning experience
    • Goals:  what we hope the learner will accomplish
    • Needs: What do they need to reach these goals
    • Methods:  How will we do this
    • Objectives: What are the measurable events that we can track on the way toward the goals?
    • Evaluation:  How will we evaluate what the learner has learned .. and whether our process was implemented properly.
  • We identify 12 medical weblog authors who will volunteer to be responsible for a given month of the year.   Each volunteer would review all 12 weblogs every (week? 2 weeks? month?) and would develop a quiz that would test the participant's learning – and survey the particiant on the quality of the CME activity.
    • We've got quiz-making software here at AMC, so it won't be too hard to get the feedback and quiz done every month.
    • Splitting this up among 12 people will minimize the work we have to do individually.
    • We'll need to do some work on this end to file the appropriate paperwork to be able to grant CME credit. 

Please post feedback to this post and/or send me a message if you would like to volunteer to be an author/collaborator. 


Early common infections may play a protective role in the aetiology of childhood leukaemia

This British Journal of Cancer paper suggests that childhood infections may prevent leukemia. 

The study was deigned to determine risks .. so we can't really draw any conculsions about prevention.  But it's an interesting idea.  We'll keep our ears open …

… and it seems intuitively related to the literature on allergies .. and the observation that the cleaner we live … the more likely we are to develop allergies. 


Popular Entries

A few notes today …

  • Aside from the entries in which I mention not-to-be-mentioned body parts, this post from nearly two years ago is one of the most linked-to posts I've written.  I like it too.  Kinda poetic, eh?  .. and if you ask "" what Jacob Reider is … the answer comes from this post.  I now know what I am .. or at least what I'm doing! 
  • I have a heckler now that my wife  has found the weblog.  Sorry … Cerumen = "ear wax"
  • Jacob's famous chicken surprise .. goog and good for you.
    • Handful of frozen chicken breast strips.  Get a 5 pound bag at BJ's or Costco for $10 
    • Plop into hot cast-iron skillet .. fire on at med-hi
    • Splash of Olive Oil
    • ok … another splash of Olive oil
    • Blob of mild salsa …
    • Splash of V8 juice
    • 2 oinions – sliced well.
    • Get the onions UNDER the chicken now … cover and cook for about 15 minutes.  As Maura always said … "Chicken is not like a burger … you don't need to flip it"


Coldfusion Weblog

CFBlog v.005 is Dave's next big hit.  It's built on Mach II.

Here's a spec-on-a-napkin (the best kind)

  • Imports Radio and MovableType
  • Generates RSS 2.0
  • Won't Generate Atom (just to spite them!)
  • Tackback
  • Searching
  • Multiple Blogs
  • Multiple Authors
  • "easy" mode with layout templates, etc (like Radio or TypePad)
  • "hard" mode with customizable tags .. this will require basic coldfusion skills.
  • Support for static or dynamic page generation
  • RSS subscription (supporting the creation of mini-aggregators)
  • Make breakfast
  • WYSIWYG editing for posts and comments
  • Spam-proof comments
  • Support for categories