Doctors being pushed to use electronic medical records Payment rewards, penalties tied to 2015 deadline August 16, 2010 | By Bob LaMendola Sun Sentinel Patient histories, growth charts, immunization logs and X-rays bulge from racks of color-coded file folders lining the walls at Pediatrics by the Sea in Delray Beach, where Dr. Karen Kuhns and a partner see 4,000 patients. But the two doctors have just ordered a new computer system to begin a paperless future, as the federal government is pushing the nation’s doctors and hospitals to do. New federal standards unveiled last month require doctors to start using electronic medical records routinely, including logging patients’ diagnoses and visits, ordering prescriptions, monitoring for drug interactions and making records accessible to other medical providers. Advocates say meeting the “meaningful use” standards will save lives, prevent errors, reduce waste and save money. To make it happen, Congress is wielding carrots and sticks. Doctors who use electronic record according to the standards by 2015 can collect as much as $64,000 each in federal stimulus funds to help them buy hardware and software. Those who don’t comply by that date will see their Medicare or Medicaid payments trimmed by one percent per year. Only about 20 percent of South Florida medical providers use electronic records now, experts said, and while many doctors are already making the change, some fear that older family physicians may one day close their practices rather than spend the money and time to go digital. “There is some opposition,” said Lisa K. Rawlins, executive director of the South Florida Regional Extension Center, a new nonprofit group that has an $8.5 million federal grant to help the local medical community make the transition. “We have a lot of challenges ahead of us. Our goal is to help 1,500 doctors” of the 10,000 active in South Florida, she said. Health care experts have estimated the cost of not having electronic medical records at nearly $78 billion a year. That includes the costs of sending lab results between hospitals and outside laboratories, needlessly duplicating medical procedures and shuttling paper charts among doctors. Just eliminating phone calls between doctors and pharmacists would save at least $2 billion each year, according to a 2005 study funded by the nonprofit research group Center for Information Technology Leadership. Instant access to information also could save lives. The first day Orlando Health hospital system launched its electronic records in 2001, a woman age 82 was rushed into the ER unconscious after a car accident. Before starting to treat her, doctors entered her name into their computer and found she was on the highest dose of blood thinners from an operation the week before. “If we hadn’t had that software, we surely would have killed this woman,” said Becky Cherney, president of the Florida Health Care Coalition in Orlando, who has held seminars for South Florida doctors about the switch to electronic records.
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Doctors being pushed to use electronic medical records
Payment rewards, penalties tied to 2015 deadline
August 16, 2010 | By Bob LaMendola
Sun Sentinel
Patient histories, growth charts, immunization logs and X-rays bulge from racks of color-coded
file folders lining the walls at Pediatrics by the Sea in Delray Beach, where Dr. Karen Kuhns and
a partner see 4,000 patients.
But the two doctors have just ordered a new computer system to begin a paperless future, as the
federal government is pushing the nation’s doctors and hospitals to do.
New federal standards unveiled last month require doctors to start using electronic medical
records routinely, including logging patients’ diagnoses and visits, ordering prescriptions,
monitoring for drug interactions and making records accessible to other medical providers.
Advocates say meeting the “meaningful use” standards will save lives, prevent errors, reduce
waste and save money.
To make it happen, Congress is wielding carrots and sticks. Doctors who use electronic record
according to the standards by 2015 can collect as much as $64,000 each in federal stimulus funds
to help them buy hardware and software. Those who don’t comply by that date will see their
Medicare or Medicaid payments trimmed by one percent per year.
Only about 20 percent of South Florida medical providers use electronic records now, experts
said, and while many doctors are already making the change, some fear that older family
physicians may one day close their practices rather than spend the money and time to go digital.
“There is some opposition,” said Lisa K. Rawlins, executive director of the South Florida
Regional Extension Center, a new nonprofit group that has an $8.5 million federal grant to help
the local medical community make the transition.
“We have a lot of challenges ahead of us. Our goal is to help 1,500 doctors” of the 10,000 active
in South Florida, she said.
Health care experts have estimated the cost of not having electronic medical records at nearly
$78 billion a year. That includes the costs of sending lab results between hospitals and outside
laboratories, needlessly duplicating medical procedures and shuttling paper charts among
doctors.
Just eliminating phone calls between doctors and pharmacists would save at least $2 billion each
year, according to a 2005 study funded by the nonprofit research group Center for Information
Technology Leadership.
Instant access to information also could save lives. The first day Orlando Health hospital system
launched its electronic records in 2001, a woman age 82 was rushed into the ER unconscious
after a car accident. Before starting to treat her, doctors entered her name into their computer and
found she was on the highest dose of blood thinners from an operation the week before.
“If we hadn’t had that software, we surely would have killed this woman,” said Becky Cherney,
president of the Florida Health Care Coalition in Orlando, who has held seminars for South
Florida doctors about the switch to electronic records.
Cherney’s group has spent a decade linking local hospitals and doctors to a Central Florida
database of millions of patients, the kind needed for emergency rooms to quickly learn about
patients who had never been to that hospital. The database is due to come online this fall for a
one-year pilot study.
Rawlins’ group is working to create a similar system linking hospitals and doctors in its turf,
which runs from Broward County to Key West but may soon expand to Palm Beach County and
several counties to the north.
A patient database could greatly benefit public health, too, said Alan Spitzer, a neonatal
researcher at Pediatrix Medical Group in Sunrise. Keeping track of how many children are
injured in accidents such as pool drownings or head injuries can alert doctors to troubling trends
in real time.
But the cost of purchasing and maintaining the systems is steep, and health care providers said
the stimulus grants will not always offset the full cost.
Kuhns and her partner will probably break even, or better. They chose to buy a simple $6,000
system of laptops or tablet computers for entering data, which then gets stored by an online
service costing several hundred dollars a month.
In contrast, Delray Beach family physician Dr. James Byrnes said he went bigger last year,
buying a powerful in-house system of portable computers and a server for $38,000, plus $22,000
in staff training and $1,000 a month for data storage. His maximum grant would be $44,000.
“For four or five years, it’s going to cost me money. But in the long run it’s worth it,” Byrnes
said. “I can document better with my records. It’s better for the patients. I can get paid better
[because] I can prove what I did. And for the health system into the future, it’s definitely a good
idea.”
Hospitals can expect to collect tens of millions each in stimulus funds to help pay for their record
systems, Rawlins said. Some hospitals have said that may only cover part of their costs.
Not everyone is on board with the changes.
Some primary-care physicians worry that electronic records will create more work – such as
filling out a questionnaire about each patient and clicking boxes on computer forms — and take
away time that should be spent face to face with the patient.
“Once you learn it, it might be faster. But not at the beginning,” Kuhns said.
“A lot of the doctors are being dragged into it against their will,” said Hollywood surgeon Dr.
Arthur Palamara, who supports electronic records but says the systems are “not ready for prime
time.”
Some physicians have voiced concerns over whether the systems can protect patients’ privacy.
Others worry that the systems they buy today will be outdated in a few years and will have to be
replaced, or that the data services endorsed by the government may not survive.
Still, doctors are embracing the change.
“This is a big undertaking for a small office like ours,” Kuhns said, “but it’s the right way to go.”
Make doctor visits by smart phone or web cam
September 10, 2010 | By Bob LaMendola
Sun Sentinel
Your smart phone is now a doctor’s office. And before long, you may be checking your blood
pressure, heart rate and throat at home while the physician watches online.
Last month, a Boca Raton company launched a service that lets you consult one of its physicians
via smart phone or web cam if you can’t see your regular doctor. It’s just one of many new ways
you can take charge of your health with technology, by seeing your medical records online,
creating your own medical chart, and communicating more thoroughly with the doctor.
Driving the trend is the federal government, which is pushing medicine to abandon paper records
and go electronic. Experts say E-records are saving money for you and the nation by reducing
duplicate tests and wasteful treatments, as well as preventing needless errors.
E-record systems urge doctors to order drugs recommended for your condition, remind them and
you it’s time for preventive screenings, and eliminate lost medical files. At home, you can look
up your cholesterol scores and refill prescriptions.
Most importantly, electronic records someday will give any doctor instant access to your full
medical file at critical moments.
No one knows better than Lisa Rawlins, executive director of South Florida Regional Extension
Center. Her agency has an $8.5 million federal grant to create an electronic records network
linking local hospitals and as many local doctors as possible.
But she also knows about the issue first-hand. Rawlins in 2005 was diagnosed in Jacksonville
with a benign brain tumor. To get a second opinion, she copied her medical chart into a
keychain-sized computer memory device, and took it to a Boston specialist. He found a rare form
of cancer in her head and neck.
Her hometown doctors called the cancer untreatable and gave her three to 12 months to live.
Back she went to Boston, where she received an intense type of radiation that beat the cancer.
“If I didn’t do all that, I would be dead today,” Rawlins said.
Last year, after moving to Broward County, part of her jawbone died as a result of the radiation.
A new CT scan showed she needed surgery. She saw three surgeons; each asked for another CT
that would have exposed her to more radiation. She talked them out of it by showing the results
of the new scan on her portable memory stick.
“Having the records was the key thing for me,” Rawlins said. “The entity that suffers the most
from the lack of communication and duplication due to [paper] records is the patient. The doctors
don’t. People should be paying attention to electronic medical records.”
E-records are far from perfect. Very few health providers have them yet. Many experts worry
about security and privacy, and the new systems have spawned new types of mistakes.
In the meantime, the technology keeps changing. Here are the latest:
InteractiveMD of Boca Raton last month launched a service in Florida that lets members visit the
doctor via smart phones or computers. A few others do this, too, and big players like General
Electric, Intel and Cisco are developing systems, so expect to hear more.
You need only a web cam and standard broadband or 4G wireless connection, said company
spokesman Alex Price. A company staff doctor talks to you and reads your online medical chart
to diagnose you, then either suggests a treatment, prescribes a drug, sends you to the ER or
insists you see your regular doctor.
Jump in cases of RSV leave children wheezing
Babies, chronically ill most at risk from lung virus
November 21, 2011 | By Bob LaMendola
Sun Sentinel
An outbreak of a little-known but potentially serious lung infection called RSV is clogging the
lungs and airways of South Florida babies and young children.
Emergency rooms, pediatricians and the federal Centers for Disease Control and Prevention
report a surge of respiratory syncytial (sin-SISH-uhl) virus in recent weeks. CDC tracking shows
that 25 percent of RSV lab tests were positive in Florida in the week of Nov. 12, an unusually
high figure indicating an outbreak.
No one counts RSV cases, but the CDC estimates that 1.5 million children need medical
attention for RSV each year and up to 125,000 are hospitalized.
In healthy children and adults, RSV acts like a simple cold, doctors said. But in vulnerable
babies and adults with weak immunity, RSV can clog the airways with mucus and damage the
lungs. There's no vaccine or cure.
"Right now I have three patients in my emergency room who are RSV positive. That's just in the
past three hours," said Dr. Guillermo Salazar, an emergency physician at tax-assisted Joe
DiMaggio Children's Hospital in Hollywood.
Most of the nation gets RSV from November through March, but the tropical southern half of
Florida is the exception, with cases peaking in winter but continuing virtually year-round.
RSV spreads from person to person in droplets from sneezes, coughs and saliva. Children in day
care are prime carriers of RSV, but adults and older children also can infect little ones, said Dr.
Margaret Gorensek, a pediatric infectious disease specialist in Fort Lauderdale.
Premature babies, who often are born with underdeveloped lungs, are most vulnerable.
"Some of these preemies are cute and chubby, and people want to touch them. They shouldn't do
that," said Dr. Ana Hernandez-Puga, medical director of primary care at Children's Diagnostic
and Treatment Center in Fort Lauderdale. "They're already fighting to develop appropriately, and
now they have to fight this bug that can take over their lungs."
Babies with RSV typically wheeze as with asthma, and breathe two or three times as fast as
normal. They may breathe so fast they can't eat, which makes them dehydrated and weak, Puga
said. Or, they may try to eat, throw up and breathe it in, further damaging their lungs.
Kristen and Pavan Kapur, the parents of twins in Boynton Beach, watched RSV take their year-
old daughter Kya in March, after an eight-week fight. A leukemia patient, little Kya had a weak
In late 2009, two Tennessee women were killed and a man critically injured as they drove away
from a George clinic in Fort Lauderdale. Their car was hit by a train and oxycodone pills were
strewn all over the scene, leading Chris George to berate the victims during a cell phone call. “You got to be an idiot to get hit by a train,” he told a manager.
“They showed a callous disregard for their patients, including not caring whether they lived or
died,” said Wifredo Ferrer, U.S. Attorney for South Florida.
Officials said the brothers used violence in their business.
They threatened operators of other clinics. They had staffers vandalize buildings and cars of
competitors or people who opposed them.
The brothers and aides kidnapped and handcuffed a man they thought had stolen $50,000 from
them, the indictment said. They threw him on the ground, and while trying to get him to talk, Jeff
George fired a bullet next to his head, the indictment said.
When the indictment was released Tuesday, Chris George was in jail on charges of illegally
having two shotguns and a handgun at his house in violation of his past felony conviction. He’s
being held without bond.
All those arrested this week are pleading not guilty and have not commented. In the past, the
brothers’ lawyers have said they were running a legitimate business for patients truly in pain,
with commonly used dosages prescribed by licensed doctors.
“They made a profit,” attorney James Eisenberg said last year. “They used that profit to buy a
house. That’s what we all do.”
Authorities say this week’s arrests on top of three other major busts, tougher state laws and
continued police heat have slowed South Florida’s pain clinics – but not stopped them.
“I think we’re making significant advances,” said Palm Beach State Attorney Michael
McAuliffe. “I don’t think we’re quite to the end of the story yet.”
Some OB-GYNs in South Florida Turn Away Obese Women
May 17, 2011| By Bob LaMendola
Sun Sentinel
In a nation with 93 million obese people, a few ob-gyn doctors in South Florida now refuse to
see otherwise healthy women solely because they are overweight.
Fifteen obstetrics-gynecology practices out of 105 polled by the Sun Sentinel said they have set
weight cut-offs for new patients starting at 200 pounds or based on measures of obesity — and
turn down women who are heavier.
Some of the doctors said the main reason was their exam tables or other equipment can’t handle
people over a certain weight. But at least six said they were trying to avoid obese patients
because they have a higher risk of complications.
“People don’t realize the risk we’re taking by taking care of these patients,” said Dr. Albert
Triana, whose two-physician practice in South Miami declines patients classified as obese.
“There’s more risk of something going wrong and more risk of getting sued. Everything is more
complicated with an obese patient in GYN surgeries and in [pregnancies].”
Plantation ob-gyn partners Jeffrey Solomon and Isabel Otero-Echandi turn down any woman
weighing more than 250 pounds.
Solomon and Otero don’t want to begin seeing heavy women and then have to send them to
specialists if they later develop problems, said their office manager, who asked not to be named.
The two doctors, like several of the others with weight cutoffs, declined to comment.
“This is not a high-risk practice,” the office manager said. “They are not experts in obesity.”
Turning down overweight people is not illegal for doctors, but the policy worried leaders of
Physician groups, medical ethics experts and advocates for the obese, all of whom said it violates
the spirit of the medical profession.
“If I had that policy, I wouldn’t have a practice. I’d lose half my patients,” said Dr. Maureen
Whelihan, a West Palm Beach ob-gyn. “We never turn down anyone. We would see them, and if
we had to, we would refer them to a specialist.”
Leaders of eight local, state and national medical associations said they had never heard of
doctors turning away patients solely because of weight. Several said obese people with no other
health issues do not need special treatment.
“No doctor should be unable to treat patients just because they are heavy,” said Dr. Bruce
Zafran, a Coral Springs ob-gyn.
So far, the weight cutoffs have been enacted only by South Florida ob-gyns, who have long
complained of high numbers of lawsuits after difficult births and high rates for medical-
malpractice insurance. More than half go without coverage.
Ob-gyns for years have declined to see pregnant women who are overweight, typically sending
them to specialists. It’s new for them to turn down overweight women who are not pregnant,
physician groups said.
Several ob-gyn offices said their ultrasound machines do not give good images of internal
anatomy in obese women, making it harder to diagnose some medical problems.
The Plantation office manager said weight limits are not uncommon at offices owned, like hers,
by the Coconut Grove medical services company VitalMD.
VitalMD treasurer Kerry Kuhn, an ob-gyn in Coral Springs, said he was unaware of his doctors
setting weight limits, adding the company has nothing to do with doctor decisions.
“This is individual choice by a doctor,” Kuhn said. “Doctors know who they want to treat.”
Physicians, like any business, can decline service to whomever they choose for any reason —
including personality conflicts — as long as it’s not discriminatory. The American Medical
Association advises doctors that they cannot reject patients because of race, gender, sexual
orientation or infectious diseases.
Doctors also are allowed to drop patients, if they believe they lack the medical skills to properly
treat them. They must send notices and refer them to other doctors.
But decisions about patients typically are made after assessing the individual’s condition during
an exam, not by ruling out an entire group, said Dr. Robert Yelverton, a board member of the
Florida Obstetric and Gynecologic Society. He said he would discourage physicians from
excluding the obese.
“Do I think it’s a good policy? No,” Yelverton said. “Overweight people need doctors. I don’t
know where a patient in that situation would go if every practice had that policy.”
The AMA and the ob-gyn group declined to comment on doctors setting weight limits. A
spokesman for the Obesity Action Coalition in Tampa said the restrictions sound like
discrimination.
“This completely goes against the principles of being a doctor,” James Zervios said. “Health care
professionals are there to help individuals improve their quality of health, not stigmatize them
according to their weight.”
Florida Wants to Ban ‘Legal Weed’
Sept. 16, 2010 | By Bob LaMendola
Sun Sentinel
Florida officials want to ban so-called “legal weed,” packs of herbs treated with chemicals that
mimic the high of marijuana and have sent a rising number of smokers to emergency rooms.
The herbs are sold as incense in head shops and hookah bars under brand names such as K2 and
Spice. They’ve become popular in the past year among teens and young adults who want legal
substitutes for pot.
Doctors said some legal weed smokers have been stricken by short-lived yet potentially serious
side effects, such as racing heartbeat, high blood pressure, agitation, panic attacks, severe
vomiting and occasionally fevers as high as 106.
“We’ve seen a couple really bad things,” said Richard Weisman, director of the Florida Poison
Information Center at the University of Miami. “If you had asked about this at this time last year,
we wouldn’t have known what you were talking about.”
The Miami poison center logged about 50 cases of side effects from legal weed, none before
May. Florida’s other centers in Tampa and Jacksonville reported a few cases each. Nationally,
1,259 cases have been reported so far this year compared to 14 last year, said the American
Association of Poison Control Centers.
Although no one’s tracking the severity of illnesses caused by legal weed in Florida, a check of
news reports shows a 17-year-old girl was found unresponsive on the ground and hospitalized in
June near Tallahassee after smoking K2. Officials in Iowa contend that K2 may have contributed
to a teen’s suicide.
Florida’s drug control director, Bruce Grant, said he and the state Drug Policy Advisory Council
will ask the Legislature next year to add synthetic marijuana products to the state’s list of illegal
drugs — as at least 11 other states have done.
“They are psychoactive and intoxicating, and they are a risk if you use them and drive,” Grant
said. “Law enforcement knows this is an issue, but their hands are tied.”
Those who sell and smoke legal weed say authorities are overreacting to rare problems with
products they call generally harmless.
“We’ve heard nothing bad about it whatsoever,” said Jay Work, who sells Spice at Grateful J’s
Deadhead Shops in Margate and Boca Raton. “It’s an incense. It’s labeled as not for human
consumption. What people do with it after they leave, I don’t know. It’s like inhaling [cleaning
spray] for your computer. People abuse a lot of things. You can’t ban everything.”
Carlos, a Tamarac student who asked that his full name not be used, said he smoked legal weed
items called Mr. Nice Guy and Blaze after he was arrested for pot possession.
“It’s just as good as regular marijuana, and it’s cheaper, too, and it’s legal,” said Carlos, who was
sent by a drug court to the Starting Place treatment center in Plantation. “I like it a lot. I can
control it, and I can moderate it. I would like it to stay legal.”
The weed products abound on the Internet, along with at least one online petition urging
government officials not to ban it.
Legal herbs for smoking have been around for decades, but a new generation came out a few
years ago using synthetic cannabinoids called JWH 018, CP 4797 and HU-210, developed in labs
to imitate THC, the active ingredient in pot.
Makers spray the chemicals on herbs and sell them under brand names such as Zohai, Jamaican
Gold Bud, Orange Krush, Black Magic, Serenity Now, California Dreams, Armageddon, King
Krypto, Spike 99 and Bombay Blue. Officials worry because there’s no control over what’s
really in the products.
K2 and Spice are the most common. They caught on in Europe, then spread to the United States.
They’re not cheap. K2 sells for $30 to $35 for a three-gram packet, or $170 an ounce.
A few South Florida head shops stopped selling K2 after incidents earlier in the year led to bans
in Kansas, Kentucky, North Dakota and eight other states. The U.S. Drug Enforcement
Administration calls K2 a “drug of concern” but has not banned it.
Because few blood tests can detect legal weed, it is catching on with people trying to kick
addictions to other drugs, said Kevin Bandy, adolescent outpatient coordinator at the Hanley
Center treatment program in West Palm Beach. The Starting Place has the same problem, Chief
Executive Joel Kaufman said.
“I have seen this drug be a complicating factor for people trying to get clean, trying to get sober,”
Bandy said. “It will be hard to control. If they ban one of these, they’ll just change the name and