Drug and Disease Updates
Squeezing the Balloon: How New Technology Shifts the Workload
Tips for Tailoring EHR Systems to Existing Workflow
App of the Month for Nursing Students
FDA MedWatch Alerts
DocAlert® Messages: Editor's Pick
iOS App Update Available Now
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Epocrates® EHR: Get Started With a Special Offer
Future Physicians of America Survey
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We have written before about how learning doesn't stop just because you may not be in school anymore. There's always something new around the corner and figuring out the right balance of new technology and old, but reliable, tools can be tricky. Read this month's editorial from Dr. Kania to learn more.

Epocrates is always learning from our users and develops our apps and tools with your feedback in mind. Please tell us what you think at youropinion@epocrates.com or leave a review in the App StoreSM or Android™ Market.

The world of healthcare will continue to innovate and evolve and Epocrates is with you every step of the way.

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Clinical Editorial

Squeezing the Balloon: How New Technology Shifts the Workload
Stephen Kania, MD
VP Medical Information, Epocrates

Work faster, better, smarter. These are the promises of Electronic Health Records (EHRs), Computerized Physician Order Entry (CPOE) systems, and other new point-of-care technology. Does new technology always result in improved efficiency for clinicians? There is an often cited analogy describing what happens when squeezing a balloon: one part shrinks while another part expands. With new technology, administrative steps may be saved, intermediaries reduced, yet that sometimes means that physicians end up with an expanded work load. Tasks that were once the job of ward clerks, office staff, and other administrators are increasingly squeezed into the physician's workload. Choose a poor system, or implement a good system poorly, and busy clinicians may end up with more tasks than ever before.

Take e-prescribing for example: there is tremendous value in automated drug-drug/allergy/condition checking. However, in the past, I could scribble out a prescription on a pad in seconds. I never gave a thought to ensuring that a sig was expressed in available pill sizes and dose forms in order to be valid, or whether the number of puffs in an inhaler would last a month. If a patient needed a topical drug, I could get away with "apply as directed" and let the pharmacist figure out the details, without having to determine whether the 10-ounce tube or the 16-ounce jar was required to cover the affected area. Furthermore, I didn't have to ask the patient to which pharmacy or mail-order system they preferred me to route this prescription.

I used to count on my billing staff to ensure that the diagnostic code I chose was valid, including the correct number of digits. With an EHR, that job may now be mine. If I ordered a lab, that's the last I heard about it until the results came to my inbox. Now I run the risk of incessant transactional status updates like, "this lab order has been sent", "this lab order has been received" and "this lab order is pending".

Some added tasks truly benefit from clinical expertise and deserve to be shifted into the clinician's workflow. Examples include bringing judgment to bear on patient-specific clinical alerts and reminders as well as decision-making informed by fingertip access to libraries of contextually relevant reference content. Instead of waiting for the next office visit, EHRs permit real-time review of results, reports, and other patient data.

Designers of EHR and CPOE systems need to carefully consider how to avoid squeezing additional tasks into the clinician workload merely because clinicians are capable of performing them. If built well and deployed appropriately, systems can result in the very things we dream about – life-saving clinical alerts, timely tailored health-maintenance reminders, and easy access to information. Optimal systems will allow clinicians to squeeze more meaningful interactions with more patients into less time.

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Tips for Tailoring EHR Systems to Existing Workflow
Stephen Kania, MD
VP Medical Information, Epocrates

  1. Pick a customizable system. Identify a system that allows you to modulate, filter, and route various types of information for each member of the team.

  2. Set up the system to handle orders your way. Reduce clinicians' administrative task burden to allow them to focus more on clinical decision-making. Determine how drug, lab, imaging, and other orders will be enacted. Map out how pharmacy call-backs will be addressed, and how lab, imaging, and other results will be handled.

  3. Involve staff in patient data entry. Especially for new patients, arrange for office staff to collect demographic information, pharmacy preferences, and information from review-of-system (ROS) checklists. Better yet, use a secured patient portal so that patients can complete an ROS form from the convenience of home, rather than rushing to finish it in the waiting room.

  4. Carefully consider patient-clinician interactions. Just because your patients can securely email you directly does not mean that doing so is ideal for every practice. Some have found that few patients abuse this form of communication. However, it's worth considering whether office staff might serve as filters for some communications, as they do with phone calls today.

Drug and Disease
Heat stroke
Food allergy
Parasomnias in children
Abnormal Pap smear
Electrical injury
Snake bites
Preoperative cardiac risk assessment
Vitamin B12 deficiency
drug updates
Arthritis Hot
(methyl salicylate/ menthol topical)
azelastine nasal (first-time generic for Astelin)
Bengay Arthritis Formula(methyl salicylate/menthol topical)
Bengay Cold Therapy(menthol topical)
Bengay Greaseless (methyl salicylate/menthol topical)
Bengay Ultra Strength Cream (methyl salicylate/camphor/menthol topical)
budesonide (first-time generic for Entocort EC)
Capzasin Quick Relief Gel (capsaicin/menthol topical)
Corifact (factor XIII concentrate (human))
Dificid (fidaxomicin)
Flexall Ultra Plus (methyl salicylate/camphor/menthol topical)
Fungicure Maximum Strength Liquid
(undecylenic acid topical)
Icy Hot Balm (methyl salicylate/ menthol topical)
Icy Hot Cream (methyl salicylate/ menthol topical)
Icy Hot Naturals (menthol topical)
Icy Hot Stick (methyl salicylate/ menthol topical)
Infergen (interferon alfacon-1)
Orabloc (articaine/epinephrine)
Orsythia (levonorgestrel/ethinyl estradiol)
Rezira (hydrocodone/pseudoephedrine)
Salonpas Air (methyl salicylate/ camphor/menthol topical)
Salonpas Arthritis Pain (methyl salicylate/ menthol topical)
Salonpas Gel (methyl salicylate/ menthol topical)
Salonpas Hot (capsaicin topical)
Salonpas Pain Relief Patch (methyl salicylate/menthol topical)
Salonpas Pain Relieving Patch (methyl salicylate/camphor/menthol topical)
Salonsip Aqua-Patch (menthol topical)
Syeda (drospirenone/ethinyl estradiol)
Trianex (triamcinolone topical)
Tylenol Precise (methyl salicylate/ menthol topical)
Xarelto (rivaroxaban)
Zutripro (hydrocodone/chlorpheniramine/ pseudoephedrine)
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  1. Invest in support. A little upfront investment in tailoring the system to your needs will likely pay off in the long run. Consider some hands-on guidance to get your team up to speed, in order to ensure workload shifts do not become burdensome to clinicians.


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FDA Medwatch Safety Alerts

Prescription drugs: Diflucan (fluconazole): Long-term, high-dose use in pregnancy and risk of birth defects, Chantix (varenicline): Risk of certain cardiovascular adverse events, Tamiflu (oseltamivir) oral suspension: Concentration change (6 mg/mL), Oral Osteoporosis Drugs (bisphosphonates): Update on potential esophageal cancer risk, Zyvox (linezolid): Serious CNS reactions in those on certain psychiatric medications, Multaq (dronedarone): Increased risk of death or serious cardiovascular events, Nulojix (belatacept): Risk of posttransplant lymphoproliferative disorder and PML, Vasopressin Injection: Multiple-dose vials shelf-life potency, Methylene Blue: Serious CNS reactions in those on certain psychiatric medications, American Regent Injectable Products: Visible particulates

OTC products: Undeclared Drug Ingredients in Slim Forte products: Slimming Capsules, Slimming Coffee, Botanical Slimming Soft Gel,  Slimming/Double Power Slimming Capsules

Medical devices: Surgical Mesh: Complications from transvaginal placement, CardioGen-82 PET Scan: Increased radiation exposure, Arrow International NextStep Antegrade Chronic Hemodialysis Catheter: Stylet breakage/separation, GE Healthcare Vital Signs Hygroscopic Condenser Humidifier Device: Occlusion may prevent O2 flow, GEM Premier 4000 PAK Cartridges: Inaccurate results, Global Focus Marketing & Distribution Silencer  S2200 Centrifuge: Biohazardous materials may be released

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Epocrates® EHR: Get Started With a Special Offer

As the clinical editorial above shares, it's important to find an EHR that is well built ... and that's exactly what Epocrates has done. Epocrates is proud to announce the launch of Epocrates EHR—the system designed with physician input specifically for small practices!

We are offering an Early EHR Adopter Special to help our valued users transition to electronic health records. Start using Epocrates EHR for just $179/month—a savings of over 55% compared to the regular subscription rate of $359/month (price is per paid seat and will change to $359/month on April 1, 2012). We believe you’ll find our all-inclusive, transparent pricing, simple purchase process, and the intuitive nature of our EHR to be just what you’d expect from Epocrates. Don’t miss your chance to take advantage of this offer.

Call 1-877-423-4980 or visit www.epocratesehr.com for more details or to purchase.



App of the Month for Nursing Students

Saunders Q & A Review for the NCLEX-RN® Examination, Vol. 1* provides 1,000+ practice questions true to exam format, conveniently on your iPhone®. Create a customized quiz with questions from any or all available content areas, read rationales for all answer choices, and track your success. This helpful app is the first in a series of five.

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*Copyright © 2011 Epocrates, Inc. All app content © Saunder's, Inc., an imprint of Elsevier, Inc.



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iOS App Update Available Now

Visit the App Store to update your Epocrates app to the latest version, featuring new EssentialPoints® mobile detail programs to keep you current on medical topics such as disease states, therapeutic areas, and treatment options. 


DocAlert Messages: Editor's Pick
Anne Meneghetti, MD
Director, Clinical Communications, Epocrates

US doctors identify top five activities that can be reduced

Roehr, B

[Excerpts] [Free full-text PDF]

Doctors in the US could cut back on many common medical activities, such as imaging and routine antibiotics, without adversely affecting patient care to save substantial costs, says a survey by the National Physicians Alliance.

On the basis of the survey findings, the National Physicians Alliance issued the following recommendations for family medicine:

Don't do imaging for lower back pain within the first six weeks unless red flags are present
Don't routinely prescribe antibiotics for acute mild to moderate sinusitis unless symptoms—which must include purulent nasal secretions and maxillary pain, or facial or dental tenderness to percussion—last for seven days, or symptoms worsen after initial clinical improvement
Don't order annual electrocardiograms or any other cardiac screening for asymptomatic, low risk patients
Don't perform Pap smear tests on patients younger than 21 years or in women post hysterectomy for benign disease
Don’t use DEXA screening for osteoporosis in women younger than 65 years or men under 70 years with no risk factors.


[National Physician’s Alliance Blog: The Top 5: Better Care for Less Health Care $]

© 2011 BMJ Publishing Group Ltd. BMJ 2011; 342:d3345


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