Obama Hopes to Boost Number of Health Care Professionals Using Electronic Medical Records

Both former President George W. Bush and President Obama have endorsed the goal of having electronic health records in wide-spread use by 2014, just five years from now. But previous efforts to introduce electronic patient records into the health care system have not gone far.

According to a report released by the New England Journal of Medicine in 2008, 83% of physicians polled had no electronic patient records whatsoever and 13% had a very basic system. Only 4% had fully functional systems.

Percentage of Physicians Using Electronic Patient Health Records

From a survey of 2,758 U.S. physicians conducted Sept. 2007 - March 2008

In addition to the problem of providing physicians with point of care terminals and devices that can be used to enter patient data and information, there is the further problem of inter-connecting multiple electronic patient records from different health care centers as well as physician offices. Recent health care privacy legilation in the form of HIPAA privacy requirements also complicate the intoduction of electronic patient records.

I remember sponsoring research into this area while at Digital Equipment Corp. in the early '90s. There was alot of enthusiasm for this in many quarters then, but not much progress has been made in the the 18 years since. Two weeks ago House Democrats introduced a fiscal-stimulus bill that includes $20 billion for health-care information technology. While a good start, given the long time that electronic health care records have taken to make this minor a penetration into the market, and given the ultimate cost of having full-fledged, inter-connected electronic patient records, it seems that greater sums and a longer time frame than 5 years will be required to generate the desired results.

Update (2/25/09): Although little formal research has been done into the effects of medical information technology on patient outcomes, a study just published in the "Archives of Internal Medecine" points to improved outcomes for patients where medical decision support systems are used. The study, led by Dr. Ruben Amarasingham, found that "hospitals with automated notes and records, order entry, and clinical decision support had fewer complications, lower mortality rates, and lower costs."

"For all medical conditions studied, a 10-point increase in the automation of notes and records was associated with a 15% decrease in the adjusted odds of fatal hospitalizations (0.85; 95% confidence interval, 0.74-0.97). Higher scores in order entry were associated with 9% and 55% decreases in the adjusted odds of death for myocardial infarction and coronary artery bypass graft procedures, respectively. For all causes of hospitalization, higher scores in decision support were associated with a 16% decrease in the adjusted odds of complications (0.84; 95% confidence interval, 0.79-0.90). Higher scores on test results, order entry, and decision support were associated with lower costs for all hospital admissions (–$110, –$132, and –$538, respectively; P < .05)."

In an editorial in this same issue of Archives of Internal Medicine, Dr. David Bates cites studies which show a potential $88 billion in savings over ten years were health information technology (HIT) to be adopted broadly.

Number of Ambulances in New Dehli, India

According to the government, there are 35 working public ambulances with life-saving equipment to serve the needs of a population of over 14 million in New Dehli, India. This greatly contributes to the loss of life during terrorist attacks when the "golden hour" turns into the "golden four hours".

By way of contrast, there were 1,363,893 ambulance runs in New York City in 2007 (population est. 8,274,527), over 3300 per day, with an average response time of 8 minutes and 13 seconds throughout all five boroughs.

Ambulance Runs and Incidents New York City 2007

Source: FDNY

Circumcision Rates of Newborns Drop Dramatically Worldwide, Except in the US

Circumcision rates of newborns worldwide has dropped dramatically since World War II, except in the US where the rate has dropped from 64 percent of newborn males to 57 percent of newborn males. Doctors fear this is a serious public health issue since circumcision defends against many forms of sexually transmitted diseases, including HIV/AIDS. Arguments against the procedure include fear of desensitization of the penis, which doctors claim has never been demonstrated clinically.

Rates of Newborn Circumcision Have Dropped Dramatically Since WWII, Except in the US

Source: NewScientist, "Cut!", July 19-25, 2008

Female genital circumcision (mutilation) showed a drop from 35% to 20% in Ghana at the War Memorial Hospital from 1995 to 2003.

Prevalence of FGM among mothers delivering at the WMH (1996–2003)

Ghana Med J. 2006 September; 40(3): 87–92.

The WHO says that 3 million girls a year undergo female genital mutilation (FGM) in Africa.

"Prevalence of female genital cutting in Upper Egypt: 6 years after enforcement of prohibition law."

The objective of this study was to evaluate the prevalence of female genital cutting (FGC) in Upper Egypt, after 6 years of putting prohibition law into action. A total number of 3730 girls between the ages of 10-14 years were recruited to participate in this study. They were mainly preparatory school students (three urban and three rural areas). Social workers interviewed them as to whether they had undergone circumcision within the last 6 years or not. Subsequently, a questionnaire was sent to parents of girls who were positive for circumcision as to the circumstances surrounding the procedure. The prohibition law of FGC seems not to have altered the prevalence of this procedure. The majority of girls (84.9%) had had circumcision within the last 6 years with high prevalence in rural areas (92.5%). Circumcision was done for a combination of reasons, according to parents, with high rates of non-medical personnel participation (64.15%). This study's results indicate that the practice of FGC in Upper Egypt remains high despite enforcement of law. Extensive efforts are needed both to revise public awareness and to change attitudes regarding FGC.

PMID: 18348787 [PubMed - indexed for MEDLINE]

Employer Health Care Insurance Costs Trend - up 5% in 2008

Employer health care insurance cost trends continued their upward march in 2008, rising an average of 5% from 2007. This is a far cry from the 13% to 14% increases of five years ago, but it still makes employer paid health care one of the greatest benefits to employees in the US. The costs for family coverage in 1999 were an average of $5,900. In 2008 family health care insurance coverage averaged $13,000, an increase of 54% in nine years. But employers and employees are paying more for less, because today's insurance packages come with much higher deductibles, in some cases as much as $1,000 or more per year.

Estimated Average Annual Premiums of Employer Sponsored Health Benefits

Source: WSJ

Trends in Alzheimer's Disease

Nearly 30 million people worldwide suffer from Alzheimer's disease today. By 2050 that is expected to grow over 3 fold to top 100 million people.

Worldwide Prevalence of Alzheimer's Disease
2008 - 2050

Update: The percentage of Americans over the age 85 with Alzheimer's is 42%, an astoundingly large figure.

Age of Onset of Alzheimer's in the US