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Using Information Technology To Transfer Knowledge: A Medical Institution Steps Up to the Plate

Robert Badgett, MD; and Cynthia Mulrow, MD, MSc, Deputy Editor
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Ann Intern Med. 2005;142(3):220-221. doi:10.7326/0003-4819-142-3-200502010-00016
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In this issue, Jain and colleagues (1) display the power of information technology (IT) to facilitate communication about important health care information. The information was Merck's withdrawal of rofecoxib at 9:00 a.m. on 30 September 2004—one of the largest drug recalls in modern history—and the power on display was the speed and specificity of electronic communications. Within 90 minutes of Merck's initial press release about the withdrawal, staff at the Cleveland Clinic Foundation began querying databases stored in their electronic medical record (EMR) to identify patients with active rofecoxib prescriptions and their providers. Within 7 hours, they deactivated prescriptions in the EMR and notified providers via e-mail. Within 22 hours, they sent letters about the withdrawal to all 11 699 patients with rofecoxib prescriptions.

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EMRs in Fly-Over Country
Posted on January 31, 2005
S. Germain Cassiere
No Affiliation
Conflict of Interest: None Declared

Before going too gaga over Cleveland Clinic's IT department, perhaps the Annals' editorialists need to ponder if anyone else, without high grade academic or institutional affiliations, is also on the cutting edge of high tech patient care interactions. Well the answer is a resounding yes. Those of us in fly-over country, aka the IM trenches, also use high tech to do similar feats as described by the Cleveland Clinic.

In fact this physician has been using his own, home programmed, semi- EMR since 1994 and has found all patients prescribed recalled drugs since that time,ie., Propulsid, Redux, Rezulin Baycol, and now Vioxx. Found them all in less than 15 seconds. Patients called and alerted of said recall. Obviously not the impressive numbers demonstrated by CC, but typically in the 100-150 range. The nightmare of pulling 2-3K charts and searching each one would rival any Stephen King adventure.

My story is not unique as there are probably hundreds of other physicians, of all genres, who have fashioned similar IT products to keep track of their patient's most vital data. It is to all those docs, practicing in the trenches, that your editorial plaudits should also be directed. Their care of their patients is also first rate and cutting edge.

Conflict of Interest:

None declared

Medical Information Technology
Posted on February 4, 2005
Joseph H. Goldberger
Yavapai Regional Medical Center
Conflict of Interest: None Declared

I read this editorial with great interest. In light of the current political climate, especially referring to the State of the Union Address, it seems as though the EMR and EHR are now on the radar screen. As a solo practioner, I have been evaluating the prospect of selecting an EMR for my practice. The cost of this project is closing in on $50,000! I run a very efficient practice and calculate a 5 year program just to break even on the investment. None the less, I plan on going through with the purchase because I believe very strongly in the benefits the electronic record will bring. I have great concerns about the entire connectivity issue, and see a long road ahead for this problem. David Brailler, M.D. has been appointed by the Bush Administration to spearhead the push to an electronic healthcare transformation, and as a harbinger, Congress withheld the monies initially granted to get this off the ground. The investment in information technology will be in the 100's of billions of dollars, and even getting access to millions of dollars is going to be a struggle. The point made in the editorial about institutional responsibility to this technology is very true, but I believe the endeavor will require a committment on the part of all participants to make this a reality.

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