Free iPad EHR / EMR Electronic Medical Records

Nov201122

Like many in neuroscience, I’ve been thinking about the consequences of traumatic brain injury in football. In thinking about this, I think I’ve figured out how American-style football will end. I’m putting the over/under at about 10 years.

The simple explanation of football is this: football is the optimal activity to put the maximum explosive energy a human can develop and deliver it to another human, pause, catch your breath, and do it again. Football is a game of inches, and so the ball is carried by huge, weight-lifting sprinters who hurl their 200+ pound frames at a line of huge, weight-lifting thugs who try to stop them cold. I am not anti-football: I played a little football in high school, I played full-pads, full contact intramural football while an undergraduate (an insurance company’s nightmare), and was a rugby player and coach as a graduate student. My own athletic skill was thuggery.

The problem with this is that repetitive shocks to the brain seem to create pathology in the brain of the protein tau. Athletes who engage in contact sports have a tendency to suffer from chronic traumatic encephalopathy (CTE), which is identified pathologically by finding dense tangles of tau. Dense tangles of tau have been found in boxers, football players, professional wrestlers, and soldiers. There is concern in hockey players and soccer players who head the ball. One researcher found tau tangles in 8 of 9 donated brains from former NFL players. This kind of accumulation of tau is associated with young-onset dementia, cognitive change, and mood disorders.

Here’s my scenario for how football ends: a late-teenager in or recently graduated from a private school dies in a car accident, killing himself and several friends. He played football. Pathological examination finds signs of CTE. (This happens.) His parents claim that early cognitive change resulted in his making the poor choices that resulted in his death, and that this cognitive change was a result of football, and specific techniques that were taught by the coach contributed. (A football player who later studied biomechanics told me that running with high knees imparts a rotational torque on the lineman’s head, rotational motion is most commonly responsible for sports-related concussions.) The school, fearing a huge court award, settles.

The insurance companies see the writing on the wall: our schools are taking healthy teens with developing brains and encouraging them to play a sport that subjects those brains to trauma, protecting them from abrasion but this and cut all coverage for football programs, fearing the future liability for past programs they covered. High school football collapses, then football at private universities. The NFL becomes like WWE — no real feeder program, with serious athletes being raised on other sports.

That’s it. It’s a simple story that probably happens many times a year. (The rate of motor vehicle-related death in the 15-19 age group is 25/100,000.) An ambulance-chasing attorney could read the paragraph above and set a google news alert, this post probably contains all the necessary scientific references to pursue a case. Alternatively, we could change football to make it less dangerous. Yes, it’s true that humans have been teaching their young males violence for millennia, but only for a couple of decades have we made a science of athletic performance that resulted in such huge, fast, and strong competitors. Evolution hasn’t kept up.

Nov201116

Jane Newman

3

Coal Miner’s Doctor?

Image from the History of Medicine (NLM)

Image courtesy of the U.S. National Library of Medicine

Occupational and Environmental Medicine is a specialty where physicians are responsible for the health of workers. While your average office cubicle dweller doesn’t usually think twice about workplace health hazards, those in mining, manufacturing, and the military have good reason to be concerned.

Typically an occupational health record and a medical record take two completely separate paths, and rarely does a practitioner get the benefit of being able to see both in the same system. As a patient’s work affects their health and vice-versa, this report proposes that an EMR also capture occupational health information. The Institute of Medicine, the Government’s most august body of academic physicians and policymakers just issued a report that examined the rationale and feasibility of incorporating occupational information in patients’ EHRs. Patient records and occupational health records typically exist in separate systems – probably because reimbursement systems differ. To unify these records would give a physician a full picture of the patients’ health, potentially making care more effective and lowering costs.

Though the most obvious place for an occupational health department is a health care setting, occupational health physicians can practice just about anywhere. Judging from a few recent listings on the American College of Occupational Medicine’s website, in addition to the usual suspects like large health systems, occupational health physicians are currently needed at the Harley Davidson Plant in Tomahawk WI, the Social Security Administration in Baltimore, MD, and SeaWorld. It seems that a physician who works at any of these atypical settings would benefit from an EMR that speaks specifically to the needs of these particular sets of patients. A diver at SeaWorld and a line worker at the Harley plant would benefit from a customized OnPatient experience when seeing an occupational health physician. Physicians who work in these environments also need to have their own set of efficiencies built into their workflow given the variety of environments they work in.

Nov201113

Daniel Kivatinos

1

iPad EHR Presented at Health 2.0 Conference

Every year the drchrono team has presented at the health 2.0 conference. This year I was able to show off some of our cool new ideas just implemented.