The downside of meaningful use

Meaningful use began as an initiative to use electronic health record’s throughout United States to improve quality, safety and efficiency of healthcare delivery and decrease health disparities. It was further intended to help engage patients in their healthcare and improve health care coordination.

Meaningful use initiatives include but are not limited to computerized order entry, electronic prescription prescribing, provider patients the ability to view online the health information, incorporate clinical lab tests and use of secure electronic messaging.

From a physician’s perspective, this has resulted in more use but less meeting. In the framework of meaningful use, the physician is treated as a secretary. He or she gets interrupted countless times throughout the day to enter orders that in the past were taken care of within the framework of good quality patient care by ward secretaries. Often the physician is attempting to provide high quality care such as patient or family education or attempting to work out a complex medical problem and they are interrupted to perform some menial task such as releasing an order for a straight cane for homegoing. These multiple interruptions add up to multiple hours in an average day. Each interruption results in logging back on the computer which takes multiple steps as a computer is never allowed to be left on when not attended.

On the rehabilitation unit, these meaningful use requirements including physician order entry are particularly disruptive. At the heart of Rehabilitation Medicine is a team concept. Although the Rehabilitation Physician is designated the team leader, Rehabilitation Medicine is a very collegial atmosphere in which all the team members from therapy, nutrition, nursing and allied health are all respected for their valuable input. They all have individual rolls and are empowered following our team discussions to act.

An analogy of the current situation would be a plant manager that had hundreds of employees reporting to him with tasks that needed to be done. These employees would report to the manager what needed to be done and the manager himself would have to perform the tasks while all of his employees waited for him to complete them. This is the situation that arises in the Hospital as a physician is bombarded with multiple request from multiple different disciplines to complete tasks that historically they would do themselves. They are simply the ones most qualified to properly complete these tasks.

Unfortunately, many of the meaningful use requirements, including physician order entry risk decreasing quality of patient care. The physician can get lost in the weeds and have all their time taken from high quality interactions.

Over time, hopefully the pendulum will swing back and we will achieve a better balance of physician time expectations, allowing him or her to truly have high-quality interactions with patients and their families


Five ways to read between the lines when it comes to food labels.

1. Watch out for terms such as “all natural” or “organic”. There are many naturally occurring seven says that are bad for you are even deadly. Heck, arsenic is naturally occurring. Some manipulation of food products, including better sanitation, have been actually good for us.

2. “Gluten-free” may not be best for you. Gluten is found in wheat and rye and some people have a severe sensitivity to it or even gluten enteropathy. If you’re cutting gluten from her diet unnecessarily however you may be missing out on the beneficial effects of multi grains, particularly fiber

3. “Fat free” me in fact be fattening. When fat is taken out of foods, other unhealthy substances are frequently added such as artificial ingredients chemical compounds and sugar fillers. These may trigger an insulin response which ironically causes your body to store fat.

4. “Sugar free” is also not healthy. Substitutes such as NutraSweet or saccharine should be avoided They have never been shown to lead to weight loss and have many potential side effects. Ideally, choose low sugar foods or a healthy sugar substitute such as Stevia

5. “Vitamin fortified” may be a smokescreen to distract you from the fact that the cereal you are eating is loaded with sugar and may have minimal fiber. A more healthy option is a multi grain high-fiber cereal that has some protein and is very low in sugar


Goodbye Trans Fat

Today the world health organization announced its plans to wipe out the use of trans fat from food by 2023

Trans fats were created by adding hydrogen to vegetable to make a solid . The most famous being Crisco. It had benefits of making foods taste more rich and creamy and extended their shelf life.

The negative side however is the fact that it greatly increased heart disease by increasing unhealthy cholesterol.

The move by the WHO is unprecedented and is a major public health victory.

This move reinforces commonsense nutrition advice. To be most healthy, avoid synthetic foods such as trans fats high fructose corn syrup or NutraSweet, just to name a few and eat healthy, Whole Foods


The importance of microbes.

I just posted an interesting article from BBC news entitled “Five Things You Might be Surprised Affect Weight”. In it they address the importance of microbes in our gut and the multitude of ways in which they impact out weight and our health.

Have you ever wondered why two people from the same family seem to eat approximately the same number of daily calories and one of them is significantly heavier? The answer may lie in the microbes that live deep in our gut. Every time you eat anything, you’re feeding hundreds of trillions of microbes. It is important that we have a very diverse range of microbes. The number one factor that affects the diversity of the microbes in our gut is fiber. It is very difficult in the American diet to eat as much fiber as recommended. Fiber is found in whole-grain cereals, fruits, vegetables, beans and nuts. You could also take extra fiber supplements through medication such as Metamucil or Benafiber. High-fiber diet supports the biodiversity in our guts and contribute to healthy microbe balance. With the hundreds of trillions of by microbes in our gut, we are truly more them then we are us!

It is important that we continue to exercise and keep moving. Also try to shift your eating more towards early in the day and consume your smallest meal in the evening. New science however reinforces the fact that we should eat a high-fiber diet with lots of fruits and vegetables for trillions of reasons.


Enter the blue zones

There is a fascinating book by author Dan Buettner called The Blue Zones. He went around the world and observed lifestyle and environmental factors that enabled people to live significantly longer in “blue zones” around the world.

He came up with nine key lessons.

1. Move naturally.

This doesn’t just mean gym activities. Rather move around your house work and yard when doing your daily activities.

2. Know your purpose.

Find your passion and reason for waking up in the morning.

3. Kick back.

Find ways to downshift and release stress in ways such as prayer or meditation.

4. Eat less.

Follow the 80% rule. Stop when you feel 80% full and eat more slowly and allow your satiety center in your brain to let you know that you’ve had enough

5. Eat less meat. Have a plant slant to your diet

6. Drink in moderation. It’s OK to have a glass of wine at five.Two or less for men and one or less per day for women

7. Have faith. Denomination doesn’t matter but attending faith based services four times a month does

8. Power of love.

Put family first. Commit to your partner and keep friends nd family close

9. Stay social.

Remain part of the right tribe

City and Community leaders need to take these recommendations to heart and work to create communities that allow its citizens to more easily follow these recommendations.