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A National Database on Advanced Directives? Great Idea.

Posted on December 5, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

An oldish post from the Healthcare Blog had me thinking about EMRs, advance directives and national patient IDs this week. John Maa, assistant professor of surgery at UCSF, writes about a case early in his career where:
– an 85 year old woman called 911, and was brought into the ER around noon with severe abdominal pain. She was delirious and could provide her medical history
– attempts to contact her family and friends were unsuccessful
– she had some serious problems that needed immediate attention, and two surgeons documented the need for her to be taken to the operating room for “life threatening emergency situation”. She underwent a six-hour surgery, was intubated, her kidneys were recovering.
– Her children arrived at about 10 pm, and asked for withdrawal of support. Amid all the back-and-forth, and threats of legal action etc, the hospital went with the family’s wishes and withdrew support. The woman died soon after.

For Maa, this was a formative experience of sorts, happening in his second month of internship. He says he still thinks about the case.

The ethics of the situation notwithstanding (and there’s more in Maa’s post that I’m not going into), from an EMR/EHR perspective – a unique patient ID that identifies each patient and an EMR that captured the woman’s advanced directive would have really helped. As commenter John Ballard states in the discussion following Maa’s post:

“One more illustration underscoring the importance of comprehensive advance directives, properly executed and easily accessible. Why such a document is not routinely a part of medical records is an ongoing mystery to me.

Advance directives — properly executed — should be required by all insurance plans as well as Medicare/Medicaid for beneficiaries. They should expire and be subject to renewal every five years to allow for changes in the person’s health, medical advances or discoveries and changes of opinion (not to mention the passing of designated agents)”

Another commenter says “What we need is a federal mandate for advance directives and a federally run advance directive database that can be accessed from any computer.” Indeed.

Healthcare During and After 9/11

Posted on September 11, 2011 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

If you’re interested in reading a more personal post about 9/11, you can check out this post I did on EMR and HIPAA about teaching the new generation about 9/11.

As I’ve watched the various news stories, documentaries and memorials about 9/11, this 60 Minutes news story about a doctor caring for 9/11 survivors was incredibly fascinating. Turns out, he set up a free clinic for the survivors and also started doing interviews with these people so that their stories would be recorded for others to hear. If you didn’t see it, you should watch it below.

The opening to the 60 Minutes video had me wondering about how healthcare dealt with all the injuries in the aftermath of September 11th. It seems like so many angles of September 11th have been covered, I can’t remember ever seeing the stories of hospitals and other doctors trying to treat the influx of patients that no doubt overwhelmed their doors. If you know of some, I’d love to see them.

Maybe that’s not such a terrible thing that the focus hasn’t been on the healthcare stories. Maybe it’s better that we focus on the heroes who lost their lives that day. Although, I’m sure we’re going to hear more and more healthcare related stories about 9/11 illnesses as time passes. Too bad we don’t have an integrated EMR with HIE that could help to track all those that were exposed to the gases and dust that were found at ground zero. That might help their cause since the 9/11 First Responders bill is only for the next 5 years.

John Halamka also has a post up about the impact of 9/11 on Healthcare IT. He concludes that “Disaster recovery, security, and emergency support efforts will continue, inspired by the memories of those who perished 10 years ago.”