Rise Seen in Medical Efforts to Treat the Very Old

When Hazel Homer was 99, more than one doctor advised that there was little to be done about her failing heart except wait for it to fail a final time. But Mrs. Homer was not interested in waiting to die of what many would call old age. Now, at 104, her heart is still ticking, thanks to a specialized pacemaker and defibrillator that synchronizes her heartbeat and can administer a slight shock to revive her if her heart falters. Her operation, a month before her 100th birthday, reflects what some doctors are hailing as a new frontier in medicine: successful surgery for centenarians. But others say that such aggressive treatment for what are euphemistically known as the late elderly can be wasteful and barbaric, warning that the rush to test the limits of technology can give patients false hope and compound their health challenges with surgical complications. “She’s just a peek into the future,” said Dr. Steven M. Greenberg, a Long Island cardiologist who performed Mrs. Homer’s surgery, for which the average Medicare reimbursement at the time was $35,000. Data is hard to come by, since people over 75 are scarcely represented in clinical trials, but several geriatricians said that procedures that two decades ago were seldom considered for people in their 90s are now increasingly commonplace. They include hip and knee replacement, cataract surgery, heart valve replacement, bypass operations, pacemaker implantation and treatment for slow-growing cancers that afflict areas like the prostate.

Please click on the link below to read the New York Times article:

http://www.nytimes.com/2008/07/18/health/18old.html?_r=1&hp=&adxnnl=1&oref=slogin&adxnnlx=1216988142-vY0R2nOz7hzfR9dQ7QFevA#

For more information on defending medical malpractice and nursing home matters in Florida contact Howard Citron at The Citron Law Firm, P.A. – www.citronlegal.com.

Cost, Workflow Disruption Blamed for Slow E-Prescribing Adoption Rate

Prescribe drugs electronically? Chances are, you don’t. More than 35 million electronic prescriptions were issued nationwide in 2007, but only 6 percent of doctors wrote them, according to a study released in June by a group made up of healthcare organizations and microchip maker Intel Corp. The report, “Electronic Prescribing: Becoming Mainstream Practice,” was published by the eHealth Initiative and the Center for Improving Medication Management, which includes representatives from Intel, the American Academy of Family Physicians, Humana Inc., the Medical Group Management Association, and SureScripts, an e-prescribing software maker. The study shows that 35,000 doctors were actively e-prescribing last year, but those physicians wrote only 2 percent of all prescriptions issued in the year. The Center estimates that by the end of 2008, there will be at least 85,000 active e-prescribers. “E-prescribing works, and its benefits for many stakeholders are proven,” Kate Berry, executive director of the Center, said in a press release from the group. “However, education, incentives, and implementation assistance are needed.” The top obstacle to widespread adoption is cost to doctors, according to the report. Investing in more hardware and software, and confusion over whether to integrate the system into their practices’ EHR or buy a stand-alone e-prescribing system make most doctors want to hold on to their paper pads. Workflow disruption is another major stumbling block, the study shows. The Center offered recommendations to encourage wider use of e-prescriptions, which its backers claim will reduce errors and improve efficiency by speeding renewals.

Recommendations in the report include:

• Incentives should be developed by federal and state governments, payers, employers, health plans, and health systems to encourage adoption.
• Termination of the DEA ban on e-prescribing of controlled substances, which accounts for about 20 percent the market. (Less than a month after the study’s release, the DEA was already moving to repeal the ban.)
• Create a public-private e-prescribing advisory body, made up of diverse stakeholders across every sector of health care, to accelerate the effective use of e-prescribing.

Please click on the link below to read the Medical Economics article:

http://medicaleconomics.modernmedicine.com/memag/InfoTech+Bulletin/E-prescribing/ArticleStandard/Article/detail/528195?contextCategoryId=44149

For more information on defending medical malpractice and nursing home matters in Florida contact Howard Citron at The Citron Law Firm, P.A. – www.citronlegal.com.