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One-Third of Physicians Miss Electronic Test Results

Thu, 20 Feb 2025 14:50:18 GMT

March 6, 2013

In a new survey, nearly 30 percent of primary care practitioners said they missed test results sent via an electronic health record notification system.

By Erin Hicks, Everyday Health Staff Writer

MONDAY, March 4, 2013 — Patients might assume that their doctors are keeping close track of their health records, but a new survey shows a large percentage of physicians are missing important electronic alerts , possibly due to the fact they receive too many notifications to reliably keep track of.

Researchers surveyed 2,590 primary care practitioners in the Veterans Affairs (VA) system from June to November 2010. In the survey, almost 30 percent of the doctors reported missing test results posted through an electronic health records (EHR) system.

The survey found that the median number of alerts the doctors received was 63 per day. Eighty-six percent of the doctors perceived the number of alerts to be excessive, and almost 70 percent reported they were receiving more alerts than they could effectively manage, according to a research letter by Hardeep Singh, MD, MPH of the Michael E. DeBakey Veterans Affairs Medical Center in Houston, published online in the Journal of the American Medical Association .

This number didn’t surprise Tejal Gandhi, MD, MPH, associate professor of medicine at Harvard Medical School, who was not involved in the survey.

“I think we have a long way to go to figure out the best ways to alert providers about important test results,” Dr. Gandhi says.

If doctors are not receiving timely information about medical tests, it could potentially mean serious consequences for all patients, she adds, not just those in the VA system.

“There could be serious consequences if it is an important test result and the doctor misses it — for example, leading to a missed or delayed diagnosis of some condition," says Gandhi.

She mentions workload issues, over-alerting, and useability as some of the factors that could be contributing to doctors missing test results.

“Doctors are getting so many alerts it's interrupting their workflow, and they may be blowing by them because they’re trying to do something else,” Gandhi says.

When it comes to useability, according to Gandhi, “In general, health records [systems] don’t do a great job of making sure important things stand out more than lesser important things. That contributes to missing important alerts."

She suggests different ways of triaging alerts could help physicians more easily flag the ones they know they need to look at. “There may be some better strategies, for example, [assigning] one person whose job it is to look at these alerts might be better than having doctors have to manage these alerts in addition to everything else that goes on in their clinic,” she says.

Overall, Electronic Notifications Better Than Paper

Despite the problems with EHRs, Gandhi says electronic records and notifications are better than the paper systems doctors used in the past (and that some still use) in which papers could get lost very easily.

"This is an interesting time because it's right when so many people are adopting these electronic health records. It’s an early time for many hospitals to adopt these systems, so I’m hopeful things will get better as more studies come out and more vendors work to improve their products," she says.

Diana Warner, MS, RHIA, CHPS, FAHIMA, Director of HIM Practice Excellence at the American Health Information Management Association, helped roll out an EHR system at the University of Minnesota Physicians. She said physicians were frustrated with the number of alerts they got at first, so she helped manage which alerts the doctors got and which ones could be turned off.

For those who work in hospitals, Warner recommends putting together a clinical support group to look at how alerts are set up, and change the settings to suit the practice or contact the EHR vendor to tailor alerts to the specialty or even to specific physicians.

“One thing hospitals should do is have evidence-based alerts. They need to make sure there is evidence behind the need to have certain types of alerts,” Warner says.

How Patients Can Protect Themselves

EHR systems have backup in some cases, since some labs still call patients in situations where it's urgent that they get certain test results. But in many cases, patients can’t count on labs, pharmacies, or doctors to stay on top of their medical tests and history. The best thing patients can do for themselves is to be engaged in their own healthcare. If you have a medical test, call your doctor's office to get the results if you don't hear from them within a reasonable time.

"They [patients] need to understand what their allergies are, what medications they are taking, and if they are getting a new medication, what it’s for or how it interacts with other medications. You can’t rely on your pharmacy or your primary care physician,” says Warner.

“If you’re unclear about anything, ask. Don’t just assume your doctor knows what they are doing. They are human too, whether it’s on paper or in the electronic world, patients still need to take the reins and be in charge of their own healthcare.”

CREDIT: Rick Gomez/Corbis

Anger Is Fast Trigger for Heart Attack or Stroke

Thu, 20 Feb 2025 14:44:02 GMT

April 7, 2014

A flash of anger may send the body down a path ending in a heart attack or stroke, a systematic review showed.

Although relatively few studies have explored the link between short bouts of anger and cardiovascular events in the hours immediately following the outburst, the evidence is consistent in showing a direct relationship, according to Murray Mittleman, DrPH , of the Harvard School of Public Health, and colleagues.

But it's not clear how substantial the risk is, the researchers reported online in the European Heart Journal .

"The relative risks estimated in this meta-analysis indicate that there is a higher risk of cardiovascular events after outbursts of anger among individuals at risk of a cardiovascular event, but because each episode may be infrequent and the effect period is transient, the net absolute impact on disease burden is extremely low," they wrote. "However, with increasing frequency of anger episodes, these transient effects may accumulate, leading to a larger clinical impact."

Several smaller studies have examined the link between anger and cardiovascular health, but Mittleman and colleagues set out to explore the consistency of the association. A review of the literature turned up nine independent case-crossover studies conducted in the U.S., Sweden, England, Israel, and the Netherlands.

Outcomes included myocardial infarction, acute coronary syndromes, stroke, and ventricular arrhythmia in the 2 hours following angry outbursts.

In pooled results of four of the studies, the risk of MI or acute coronary syndrome was 4.74-fold higher in the hours after an outburst (95% CI 2.50-8.99). In pooled results of two studies, the risk of ischemic stroke was not significantly elevated (incidence rate ratio 3.62, 95% CI 0.82-16.08).

One study evaluated intracranial hemorrhage and showed that the risk was higher in the hour after a bout of anger (IRR 6.30, 95% CI 1.59-24.90).

Two studies had ventricular arrhythmia in patients with implantable cardioverter-defibrillators as an outcome, although the results could not be combined because of differences in the measurement of anger, study design, and hazard periods. One showed that risk was significantly higher in the 15 minutes after an outburst (IRR 1.83, 95% CI 1.05-3.19) and the other showed that the risk was higher in the hour after the angry episode (IRR 3.20, 95% CI 1.80-5.69).

Mittleman and colleagues noted that the magnitude of increased risks was higher for individuals who had a greater cardiovascular risk initially.

For MI/acute coronary syndrome, for example, "the absolute impact of one episode of anger per month is only one excess cardiovascular event per 10,000 individuals per year at low (5%) 10-year cardiovascular risk and four excess cardiovascular events per 10,000 individuals per year at high (20%) 10-year cardiovascular risk," they wrote.

In an accompanying editorial, Suzanne Arnold, MD, of Saint Luke's Mid America Heart Institute in Kansas City, Mo., and colleagues discussed some of the potential mechanisms tying anger to cardiovascular events.

"Mediated through increases in circulating catecholamines, increased myocardial oxygen demand, coronary vasospasm, and increased platelet aggregability, anger can cause transient ischemia, disruption of vulnerable plaques, and increased thrombotic potential," they wrote. "These changes can then result in myocardial or cerebral ischemia or malignant arrhythmias."

They pointed out that the review was limited by the small number of available studies and the significant heterogeneity between them, but said that the findings highlight the consistency of results linking acute anger and increased cardiovascular risk.

"However, how to move forward in reducing the burden of these risk factors in patients and, hopefully, its impact on cardiovascular health is still in question," they wrote. "Given the lessons we have learned from trying to treat depression after MI, treating anger in isolation is unlikely to be impactful. Instead, a broader and more comprehensive approach to treating acute and chronic mental stress, and its associated psychological stressors, is likely to be needed to heal a hostile heart."

Mittleman and colleagues noted in their paper that studies of medications -- including beta-blockers and selective serotonin reuptake inhibitors -- have not shown substantial benefits, and said that psychological interventions might help.

In an email to MedPage Today, Redford Williams, MD , of Duke University, said that beta-blockers could ease some of the negative consequences of angry outbursts but that their use would be limited by side effects. He agreed the psychological interventions might be worthwhile.

"Behavioral interventions that train folks to reduce angry outbursts and/or the accompanying physiological arousal could be an effective means of reducing the health damage associated with angry outbursts," he said, backing that up with three prior studies.

The first showed that a group-based psychosocial intervention designed to reduce stress cut mortality among women with coronary heart disease .

The second demonstrated that cognitive behavioral therapy with a focus on stress management lowered the risk of recurrent cardiovascular events in men and women with established coronary heart disease.

And the final paper cited by Williams showed that a psychosocial skills training workshop reduced anger levels and the size of the increases in blood pressure and heart rate that accompanied the recall of situations that made men who had undergone CABG angry.

Extremely Sophisticated Virus Mimics Your Behavior

Thu, 20 Feb 2025 14:38:08 GMT

July 29, 2015

There's a new type of malware that cybersecurity pros are calling "Hammertoss." This one is pretty advanced, because it can effectively hide in network traffic.

It's so hard to spot because it mimics your behavior, even checking Twitter or accessing your cloud on your schedule. Hackers can also send new commands to the virus hidden in images.

Lucky for most of us, this virus is only being used against high-profile targets like government officials and celebrities, but it's still just as frightening for the rest of us.

The hackers use social media and email accounts to weave their way through your server undetected, slowly checking one system and then another without raising any suspicion.

Many of the targets from the same group who launched this virus, MiniDuke, are United States and Western European government agencies and political organizations. This specific type of targeting makes analysts think that they are after classified political information to expose to the public.

“We ... think Hammertoss is only leveraged against critical targets,” Jen Weedon, manager of threat intelligence at FireEye, explained to ThreatPost. “The actors seem selective in using it versus other tools that are deployed more widely.”

This is not the first time MiniDuke has tried to take down targets with a virus like this. In February 2013, the hacking group aimed at political figures in Austria, Belgium, France, Germany, Hungary, Netherlands, Spain, Ukraine and the United States.

We'll keep you updated on the Hammertoss virus as we learn more about how to find it and eliminate it.

New Detection for Early Signs of Heart Disease Saves Two Brothers

Thu, 20 Feb 2025 14:36:36 GMT

Nov. 2, 2015

LAFAYETTE, Ind. (WLFI) — The new Coronary Calcium CT Scan detects early signs of heart disease.

Seventy-one-year-old Mike Crumly and 63-year-old Marty Crumly, are the oldest and youngest brothers of four siblings. Both men decided to get the new Coronary Calcium CT Scan, which detects early signs of a heart attack and helps prevent long-term heart issues.

They were surprised when they learned that their results were almost identical. As a result, they both underwent open heart surgery in the same week.

“A $49 heart scan that I can say today, and I’ll say it every day, that it probably saved our lives,” said Mike and Marty.

This new scan shows if a patient has calcium in their coronary arteries and whether there is a plaque buildup. This method of early detection is much faster and can lower the chances of patients having a heart attack.

“This will lower the chances of heart-related diseases, in the intermediate to long-term issues. If both Mike and Marty wouldn’t have done this test, they probably wouldn’t know that,” said Dr. Hoque, a cardiologist at IU Health Arnett.

Like most brothers, Mike and Marty enjoy friendly competition, but they never thought they would be fighting for their lives together.

Since the surgery, they enjoy going to rehab together. They are also encouraging everyone to get the new Coronary Calcium CT Scan.