It’s Not About The Box Improving Care at Group Health with People, Process and Technology

December 5, 2008

Smartphrase of the week

Filed under: After Visit Summary,Smartphrases — Tags: — Matt Handley @ 2:01 pm

The informatics team has been trying to figure out a way to collect and share smartphrases (see prior blog entry here).  There are some changes that we will explore for future releases of Epic, but in the meantime we are going to try a simple way of collect and share smartphrases – it isn’t very exciting, but it is a start.

We are going to solicit favorite phrases through the CIS newsletter email and collect them here – we will come up with some small inducement (Starbucks cards, etc) to see if we can get some coming in.

I will start with my favorite for responding to patients’ questions about supplements – it follows.  My naming convention uses “PM” for patient messages – anything that goes directly to patients (in patient instructions for the AVS or in secure messaging).

Smartphrase “PMSUPPLEMENTS” below…..

Thanks for asking – I think that a healthy skepticism about any advertisement is a good idea – and that is especially the case with nutriceuticals like ***.

This may all be information that you already have/know, but some background about supplements:
1.  There are no standards for manufacture for any supplements – and independent testing of products have shown that they commonly do not have the advertised ingredients, and have not uncommonly had pesticides of other contaminates (best source is  For instance, a recent study of Ayurvedic medicines (traditional Indian remedies) found that 20% of products manufactured in the US contained dangerous levels of heavy metals.
2.  There is almost no regulation about what they can claim – they do not need anything more than a testimonial to claim effectiveness.  Given that in carefully controlled studies of problems like fatigue up to 40% of patients taking a placebo report improvement, it is clearly not enough to have someone take a product and feel better to be sure that there is any benefit to the supplement.
3.  There is no system for collecting safety data about these products.  While several are clearly harmful (like ephedra), it has taken many years to get them removed from the market.
4.  To the extent that they work, they are drugs (defined as substances that are ingested to change the structure or function of the body).  They just come in unregulated doses without clear safety data.

November 13, 2008

What is the best way to share Smartphrases?

Filed under: Smartphrases — Tags: — Matt Handley @ 4:29 pm

At recent medical staff meetings and some other forums there has been a lot of interest in having the ability to share Smartphrases.  The Epic tool that supports individual innovation is the Smartphrase.  When people share best practices, one of the coins of the realm is the smartphrase.  So when one of my colleagues has a great way to explain a new clinical topic to their patients – I want to take advantage of their expertice in my own practice.  One of the great things about being in a large and innovative medical group is that we all don’t have to do it from scratch.

Unfortunately, Epic doesn’t have an easy way to do this.  The informatics team is working on the technology side (do we have a searchable database? a wiki? a blog?), but we have some other ideas to consider.

Do we want to just have a mosh pit?  Do we just throw everyone’s favorites into a searchable bin, or should we consider some vetting (some might be a bit more eivdence based vs clinical hunch, some written in plain language and some in medical jargon)?

We would love to hear from you about what you want in sharing Smartphrases.  We are considering the technical options (and have queries to other Epic customers to see what others are doing).  What we need from all of you is some discussion about what you want to get from a tool.

Thanks in advance for joining the conversation – just leave a comment on the blog.

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