$44k to use an EHR iPad App? OK!!

28 07 2011

This has been all over the web today, just thought I’d pass it along.

DrChrono is an EMR iPad app from DrChrono, Inc. that has generated a lot of buzz recently.  Any practitioner who uses it in their office may qualify for up to $44,000 in stimulus money under the HITECH Act (the idea being that EHR’s save a ton of money- invest a little to save a lot).

So aside from the headline-grabbing statement, is the app any good?

I signed up and have poked around a bit, it’s REALLY interesting.  Well laid out, easy to use.  There’s text to speech, the ability to add pictures, bill the encounter, look up CPT codes, and even integrate with your Google Calendar.  Pricing varies from FREE up to $799/month (which really isn’t that bad, relatively speaking).

When I signed up, “Pathologist” was one of the selection choices, but as it’s written now, it doesn’t much cater to pathologists, but it could be tweaked to be pretty useful at sign-out!  Right now, I’ll use it as a CPT/ICD-9 dictionary, but I’ll keep playing around with it to see what else it could be used for on the lab side of things.

Here is a link to the deal on the deal.

Here is a link to the app.





How to Save $$$ on Textbooks

24 08 2010

As a typical strapped-for-cash resident, I’m always looking for ways to save a couple bucks on textbooks.  I’ve posted previously about getting in on Amazon Prime with a .edu e-mail address, and, today, LifeHacker has a few more crowd-sourced tips on where to find cheap textbooks.  Some of the sites are familiar players.  Others, however, were new to me, so I thought I’d pass them along! From LH:

Chegg offers a nice compromise between buying the overpriced textbooks at your local bookstore and shopping for iffy-quality used books online. At Chegg you don’t purchase your books; you rent them for a semester. The Chegg discount, compared to retail prices, is anywhere from 30%-80% off, with most book rentals falling around the 50% mark. You rent them a semester, a quarter, or a 60-day rental window and then ship them back for free with a prepaid UPS label. You won’t be able to find books at pennies on the dollar like you can by scrounging for used or out-of-print editions elsewhere, but you do get a 30-day “any reason” return policy and free return shipping.

No one should be surprised to find out that Amazon has their hand in the textbook business. The book superstore originally offered textbooks mixed in with the rest of their book offerings, both new and discounted through their third-party marketplace. Now Amazon has a dedicated student/textbook section with enhanced textbook search and student-centric features. They even offer a free Amazon Prime membership to anyone with a valid student email address (even if you have an Amazon Prime account already, they will refund you the remaining balance and extend your Prime membership a year into the future). With careful shopping you can find textbooks anywhere from new with a slight discount to heavily-used and extremely discounted.

AbeBooks is a massive online marketplace for new, used, and rare books. They have a bustling textbook section with new and used books that average 50% off retail—we found quite a few books in our test searches that crept up in the 75-90% range, however. AbeBooks has a 30-day return policy and an easy-to-use sell-back program—plug in the ISBNs, print off a free mailing label, and ship them back for cash in your pocket.

Half.com, an eBay subsidiary, offers cheap media and books including textbooks. Like a giant used bookstore/record store equivalent of eBay, Half.com is a great place to find cheap textbooks. Low prices aside, one of the strong selling points for textbook shopping at Half.com is their Buying Wizard. Using the Buying Wizard you can search for the books you need and the wizard will search all the deals on Half.com to find you the best combination of prices and combined shipping to get your textbooks faster and cheaper.

BIGWORDS is the textbook website that put seller/shipping optimization on the map with their Multi-Item Price Optimization services. When you search for textbooks at BIGWORDS, they scan dozens of other textbook retailers and resellers to find you the absolute bargain basement prices. When the semester is over you can use the BIGWORDS engine in reverse to sell them all back or donate your textbooks through Better World Books to help fight illiteracy in developing nations.

So I did a quick search for ‘Rosai and Ackerman’s Surgical Pathology’ just to see how Pathology-resident-friendly each service could be, and I got some interesting results.

Chegg: Found, but unavailable at all outlets

Amazon: $375 new or $325 used + free shipping with Amazon Prime

Abe: $274 for “International Edition” + $9.99 shipping

Half: $488 new + ??? for shipping

BigWords: $233 for 130 day RENTAL + free shipping

Pretty interesting results, eh?  So it seems that AbeBooks is the clear victor in this case, but “International Version”??  I had never heard of such a thing.  When you mouse over it, it says the following: “The publishers of the international versions do not authorize the sale and distribution of international editions in the United States and Canada, and such the sale and distribution may violate the copyrights and trademarks of such publishers.”  Yikes!  However, there was an additional copy of the North American version for the same price right below it; still, interesting.  Also novel to me is this concept of textbook RENTAL offered by BigWords.  Could be useful for a particular project, paper or case, but to rent it for basically the price of purchasing it?!  Yea, I’m going to pass on that one.

Another tip I’ve used:  I subscribe to the Barnes&Noble and Borders email bacn (aka spam that you kind of want), and they will occasionally send out e-coupons for significant discounts on their products.  During my PGY-1 year, I was able to get Sternberg’s 2-volume set at 40% off using one of these coupons.  So I would suggest signing up for those as well.

Finally, ask your attendings!  I’ve gotten copies of Rosai, Kurman and Kjeldsberg from various attendings over the years for free!  Whether they were getting rid of books they didn’t use any more or they were updating to the most recent edition, I’ve often been the beneficiary of my bosses’ great collective generosity!

Do you have any great tips on getting a handle on textbooks on the cheap?  Please share them in the comments below!




Doctors Overwhelmingly Choose iPhone Over Blackberry

27 07 2010

[Via C|Net Health Tech]

C|Net’s Elizabeth Moore relays the recently released results of the 2010 Spyglass Consorting Group’s report entitled ‘Trends in Mobile Communications’.  The group’s first investigation in 2006 found that 59% of doctors were using smartphones at the time; the number now has grown to 94%, exceeding adoption by the general public.

The group also reports that doctors prefer the iPhone over the BlackBerry 44 to 25% (I’ll assume that the other 25% prefer Android), and that 78% are frustrated with “difficulties accessing and communicating with colleagues in a timely manner”.

I find these statistics puzzling, and I therefore pose the following:

  • Why were only iPhone and BlackBerry surveyed?  What about Windows Mobile? (it is still around, after all)  What about Android?
  • I am actually surprised that BlackBerry lost by such a margin.  If the question was: “Which do you prefer?”  Perhaps doctors own personal/private biases might have influenced their answer (aka I think the iPhone is cool, so I must prefer it).  Also, perhaps their own personal experiences have frustrated them.  At least at Albany Medical Center, all the Pathology staff have company issued BlackBerrys, and none of them have iPhones.  I’d imagine most people can easily find gripes with their current devices, and, at the same time, look at other devices through rose-colored glasses.
  • At AMC, the only way to access your email on a mobile phone is via BlackBerry server since Exchange and OWA is blocked by our stellar IT department.  So for this reason, I think a RIM device actually makes more sense than other smartphones.  I hate that I can’t get my e-mail on my phone (I currently am using a Sprint Evo 4G running Android 2.1).  So perhaps it’s just my institution, but BlackBerry certainly keeps you more connected here than any other platform.
  • Sure the iPhone is constantly featured in the news and on the blogs for its cool medically relevant apps (my blog is certainly no exception), but how many are actually useful in day-to-day practice?  Very few for a Pathologist, and perhaps a handful for clinical docs.
  • Finally, while I might have guessed that most MD’s are quite tech savvy at one point in my life, I’ve since found that not to be true.  They probably mirror that of the general public more closely than most people assume, and as such, are equally as susceptible to the excellent marketing campaign put forth by Apple, and, therefore, have a better opinion of their products.

Ultimately, it’s probably a combination of all of the above observations/extrapolations that resulted in the great divide in opinion.  Alternatively, the results could be skewed by sample selection or sample size (as the C|Net article alludes to).  Finally, perhaps the results are totally valid, and my suspicions are unfounded! haha.

As to the 87% of people dissatisfied with their ability to communicate overall, I feel that this number is much lower than it should be.  Perhaps some docs don’t even realize how much easier life could be with new and evolving technologies being used in daily practice.  I mean, beepers?  Really?!?  Sigh.

Anyway, just some food for thought.  What are your opinions on this topic?  Is the a truly superior device/medical assistant?





PowerPoint: Tips to Giving a Better Presentation

21 07 2010

To be a pathologist is to be a teacher.   Whether it be giving resident lectures, conference presentations, tumor boards or even something as simple as in-house consults, we pathologists are constantly called on to share our knowledge with others.  One of the major vehicles for the delivery of said information is via PowerPoint (or maybe KeyNote if you are a Mac head, or maybe Open Office if you are a Linux hippie) presentations.  However, just because we are called on to teach, it does not mean that we are all GOOD at it.

As a PGY-4, I’ve basically been given PowerPoint presentations every day for… oh, say… the last 11 years.  I’ve seen every type of presenter/presentation over this time, and I’m sure you will all agree with me when I say that the success or failure of a lecture is almost more reliant on how dynamic the presenter is rather than how intriguing the content is.  I’ve seen the most boring, droll content be metamorphosed into vibrant memorable stories, and I’ve borne witness to the bastardization of  some of my most favorite topics.  Now, granted, not everyone is Steve Jobs, but there are a number of tips and tricks out there on how to improve on your presentations and your presentation skills.  I’ll link a couple of my favorite below:

And once you are done with your snazzy show, don’t forget to upload it to Slideshare.net so for all the world to see (aka steal slides from).

In the end, the more ammunition you have before you go into a fight, the better off you are.  There is no substitute for good preparation (someone once told me about the 7 P’s, and I think they are certainly relevant here).  Hopefully some of these links will help you the next time you have to give a talk.





Doctors are supposed to know everything, right?

18 06 2010

A friend of mine passed along an article from the New Yorker by Atul Gawande entitled ‘The Velluvial Matrix’.

As doctors, we all know what the Velluvial Matrix is, right?  I had to double-check, myself, but it turns out that it doesn’t exist.  The article is an enjoyable read for any physician; it’s one of those oh-my-gosh-that-totally-happens-to-me-all-the-time articles.

Excerpt:

Since I graduated from medical school, my family and friends have had their share of medical issues, just as you and your family will. And, inevitably, they turn to the medical graduate in the house for advice and explanation.

I remember one time when a friend came with a question. “You’re a doctor now,” he said. “So tell me: where exactly is the solar plexus?”

I was stumped. The information was not anywhere in the textbooks.

“I don’t know,” I finally confessed.

“What kind of doctor are you?” he said.

I didn’t feel much better equipped when my wife had two miscarriages, or when our first child was born with part of his aorta missing, or when my daughter had a fall and dislocated her elbow, and I failed to recognize it, or when my wife tore a ligament in her wrist that I’d never heard of—her velluvial matrix, I think it was.

This is a deeper, more fundamental problem than we acknowledge. The truth is that the volume and complexity of the knowledge that we need to master has grown exponentially beyond our capacity as individuals. Worse, the fear is that the knowledge has grown beyond our capacity as a society. When we talk about the uncontrollable explosion in the costs of health care in America, for instance—about the reality that we in medicine are gradually bankrupting the country—we’re not talking about a problem rooted in economics. We’re talking about a problem rooted in scientific complexity.

These sometimes awkward situations are especially common, I feel, for Pathologists, as we do not even have the day-to-day contact with patients that primary care docs do.  Heck, I have no idea where my ophthalmoscope is, and I currently use my stethoscope as a make-shift stud-finder!  Yet, as doctors, our friends and family definitely expect us to be the final answer on anything from rashes to cancer.  Of course, I’m not saying that I don’t remember *ANY* of my training- I can still answer some basic questions, or I at least know where I can go to get an answer, and I can still do a physical exam if I had to, but I feel that it’s pretty safe to say that other people greatly overestimate our memory banks.  [Note: For some reason, I feel like a magician that just showed the audience how he did his trick.]

When I first graduated medical school, empowered, I tried to be that endless fund of medical knowledge for anyone who had questions.  Now, as a fourth year resident, if there is a question I am not prepared to answer, I will tell people that they should see their doctor!  I guess that some people will think that that is a cop-out answer, but I think it is more a demonstration of learned temperance, such that by saying “I don’t know”, you are actually being more wise.

The article goes on to talk about health care reform, etc., etc. but the first half is quite enjoyable and thought-provoking.





Atypical Mycobacteria Masquerading in the CNS

12 04 2010

Below is a case report I was invloved with in which the patient was found to have a Mycobacterium haemophilum brain abscess.  Interesting case!

Atypical Mycobacteria Masquerading in the CNS





Follow The 1x Objective on Twitter

11 03 2010

https://twitter.com/1xObjective

There’s just so much news that comes down the pipes, that it becomes hard if not impossible to keep up here on the blog, especially when I’m on service months.  Also, sometimes there are stories that are interesting, but not necessarily blog-worthy.  So I’ve decided to start a augment this site with a companion Twitter Blog (http://twitter.com/1xObjective).

Basically the Twitter feed will just contain links to stories I think are interesting or relevant to Medicine (and specifically Pathology) in the digital age.

So please stay tuned and hit that follow button!





New York: Get a flu shot, or get fired.

15 10 2009

I’m not sure if this kind of mandate has been rolled out across the country, but here in New York, we were told, up front, that the entire hospital staff was required to get a flu shot this year (and the swine flu shot as well when it comes out) OR face termination.  Fired over a flu shot?  I thought Cleveland Clinic’s anti-smoking policy was pushing it…

There have already been talks of protests and law suits here in Albany.  Personally, I’m indifferent, but I guess I can see their point- being forced into doing something they otherwise would not have done, but is it worth a law suit?  Probably not.

I’ve heard a few different explanations for dissent.  Perhaps the most interesting reasoning I’ve heard is this- because the flu shot is offered for free or reduced cost by the drug companies, the companies are protected from litigation if a patient is injured as a direct result of the vaccination.  Another question to be asked would be, “Does the punishment fit the crime?”  Is termination the proper penalty for not receiving a shot?  They require house staff to be up to date on their vaccinations, after all.  So is that any different?  I suppose.  Can you fire an employee for poor hygiene?  Either of my examples could perceivably place patients at risk, but it’s not clear to me that either of these would be enforced.  Finally, do ALL employees really need the shot, even those with no patient contact?  As a pathologist, I did ask myself that question.  Sure we have some patient contact, and we surely have contact with other employees that do have contact with patients, so I suppose the idea is to cover all your bases and just vaccinate everyone.

In the end, it seems clear to me that the New York State government has gotten swept up in the media craze surrounding the H1N1 virus, which, as a concept is sad, but in practice is probably better for everyone in the long run.  I do wonder, however, if we will be required to get our flu shots next year too… ;)





Albany Medical Center’s CEO Defends the Public Option

7 10 2009

barba

Below is a link to the mp3 of an interview with Albany Medical Center’s CEO Jim Barba in which he defends Obama’s Public Option proposal.  The interview originally aired on Siena College’s WVCR Radio Station.

I thought it was a very interesting perspective, and is yet another health professional coming out in support of the public option.  Interesting!

He goes on to talk about the viability of a single-payer system as well (waters far too murky for me).

I guess when I’ve thought about health care reform, I had never really imagined that the CEO of a hospital would support a single-payer system…  A public option? Sure, but not single payer.  He does make an interesting argument, however.

Definitely worth a listen!

AMC CEO Supports Public Option





New Font: DNA.

16 09 2009

Forget 10 pt fonts… this is 10nm! Using PCR and some complicated techniques, researchers at BYU have developed a way to string DNA together in complex branching patterns in a deliberate manner.  The potential utility has to do with nanotechnology, but the proof of concept is pretty nifty in and of itself! Check out the press release here.

Abstract: “Designs for DNA origami have previously been limited by the size of the available single-stranded genomes for scaffolds. Here we present a straightforward method for the production of scaffold strands having various lengths, using polymerase chain reaction amplification followed by strand separation via streptavidin-coated magnetic beads. We have applied this approach in assembling several distinct DNA nanostructures that have thin (10 nm) features and branching points, making them potentially useful templates for nanowires in complex electronic circuitry.”

[via MedGadget]








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