RCHC Community Project Abstracts

Back to subject search page or search by preceptor site The Decision To Transition: Paper Charts vs. Electronic Medical Records (EMR) Project Date: 9/7/2009 Choosing to switch from paper charts to electronic medical records (EMR) is a major decision, philosophically and financially, for physicians and clinics. This study attempted to compare and contrast the advantages and disadvantages of paper charts vs. EMR and to identify the attitudes that physicians in Grants Pass, OR have towards these two systems. The methodology for this study was qualitative and an interview approach was utilized. Four physicians were interviewed based upon their time spent using paper charts/EMR and their intention of transitioning to EMR. Physician concerns for transition to EMR included quality of patient care, financial stability, time efficiency and impact on quality of life. Recommendations from physicians currently using EMR were included for health care providers considering the transition from paper charts to EMR. Rural Medicine in the Digital Era Project Date: 8/3/2009 Electronic medical records have been heralded as a cornerstone in the effort to eliminate waste and mistakes in medicine. Yet even today only a quarter of practitioners use EMR. The rates may be even lower in rural areas where practices are generally smaller and run on tighter budgets. This study will help to understand the key barriers to EMR adoption among rural primary care practitioners. Data was collected through formal and informal interviews with providers in Klamath Falls, OR. Through these conversations it became clear that while all of the providers were considering EMR, there were three types of barriers to adoption including financial, investigational and personal barriers. Given these barriers a low cost subscription EMR designed specifically for primary care practitioners would likely be the most beneficial design to encourage adoption of EMR among rural PCPs. Challenges to providing psychiatric care in Florence, OR– Is telemedicine an option for the future? Project Date: 4/27/2009 Mental health resources are already lacking in rural communities and by mid 2009, the two visiting psychiatrists who come to Florence every week will phase out their practices there. With this drastic change in psychiatric services, alternatives need to be explored in order to adequately care for the mental health patients in Florence. Additionally, it is important to investigate why these psychiatrists are leaving and what difficulties they have faced trying to practice in a rural setting. Interviews with two psychiatrists who currently see patients in Florence were conducted and literature search on telepsychiatry was done. It was found that there are financial, logistical, political and geographical reasons that make the practice of psychiatry in Florence, Oregon difficult. The departing psychiatrists believed their absence from the challenging patient population in Florence will create great stress on primary care providers, be traumatic for patients, and cause difficulty for children in school. There is a growing body of literature that supports the use of telepsychiatry as equally reliable at diagnosing and treating a variety of mental health problems while keeping patients out of the hospital and being cost effective. It is also financially feasible from a reimbursement standpoint with the passage of senate bill 24 in Oregon as well as a good source for the education of primary care providers. Virtual Office Visits in Harney County - an assessment of attitudes and access to care Project Date: 3/16/2009 Access to health care is a growing concern in the United States that disproportionately affects those in rural areas already working to overcome barriers in physical access. Technology has the ability to bridge some of these physical gaps and may be particularly effective at increasing access in geographically isolated areas. Virtual office visits – the online interaction between patient and physician – may be one of these technologies. This study was designed to evaluate patient and physician attitudes toward virtual office visits in Harney County and to gather logistical information to assist in the eventual development of a pilot project. A standardized survey was developed and data was collected over a two week period. Physicians and office staff were interviewed and models for virtual office visits in other locations were reviewed. Overwhelmingly, patients and physicians expressed interest in piloting virtual office visits in Harney County and felt that this technology would improve access to health care and consequently would improve health outcomes. Several common concerns were also identified and problem-solving strategies were discussed. At the completion of the study, a document with compiled results of the survey, synthesized data from the interviews, and suggested options for pursuing a pilot project was presented to staff at the High Desert Medical Center. Reedsport Nutrition Information Site Project Date: 12/29/2008 Good nutrition is becoming rarer and rarer in Oregon as well as the nation, leading to troubling trends in obesity. The purpose of this project was to provide an easily accessible resource that contained information on good nutrition and had tools for self-evaluation. It was decided the best medium for this project would be a website. Clinicians could then provide the site address to patients interested in nutrition or those struggling with being overweight or obese. Further, patients who benefitted from the site could refer friends as well, increasing the target population to all residents of the county and beyond. The interactive nature of the site was aimed at making it more personal than a handout and thus serving as a personal nutrition consultation. As a consolidated source of information, its utility is hoped to be greater than other sources on the web that may contain each of its individual aspects. Pediatric Telephone Medical Care Project Date: 12/29/2008 Since its invention in 1876, the telephone has been used as a tool for delivering health care. The first recorded use of the telephone in pediatric practice was reported in The Lancet in 1879, describing the evaluation of an infant with croup using the newly developed telephone (Melzer et al. 2006). As the future of patient care continues to improve, the addition of telephonic medical care to the health clinic is now on the forefront of interest and debate. The opportunity for parents to call into the clinic with their child’s symptoms, speak with a physician, and receive counsel and treatment over the phone, may not only save time, but may extend care to a greater number of families. For many reasons, the pediatricians at the North Bend Medical Center are interested in establishing a telephone medical service to further extend pediatric care to their community. To better assess their current patients’ interest in such a service, we provided a survey to the parents of visiting patients that assesses the number of children, the number of visits, the number of phone calls, the length of travel time, their interest in speaking with a medical assistant or physician, and their willingness to pay out of pocket for telephone services. When asked to assess, on a scale of 1 to 5, their interest in speaking with a physician over the phone about their child’s medical needs, 88.2% marked interest levels between 3 and 5. . Of all those who took the survey, 63.5% of parents would be willing to pay for telephone medical care if their insurance does not cover it. Telephone medical care is about extending health care to a greater rural pediatric population. Its about saving families the anxiety and time that accompany last minute appointments, and helping those who cannot afford an office visit receive care from their pediatrician. Though the implementation of this service may be months in the making, forward strides are being made to increase pediatric services. Implementation of Personal Health Records in a Rural Community Project Date: 12/29/2008 The term "patient-centered care" is an often-used catch phrase in family medicine. This approach includes core values such as information sharing, participation and collaboration. Stemming from these ideas, interest in the development of personal health records (PHR's) has been a recent hot topic in the world of Health Information Technology. PHR's are a patient-directed tool that may help to deliver integrated, portable, interoperable, patient-centered care. They have many projected benefits especially in rural communities. These benefits include reaching out to areas of unmet need, helping to protect isolated communities, empowering patients and enlarging the "virtual" healthcare network. However, significant risks and barriers to implementation exist and these must be further defined, analyzed and accounted for before PHR's can become a reality. As such, with this project I sought to develop a thorough understanding of OHR's and analyze the risks, benefits and barriers to implementation in a rural community. Overall, PHR's have many potential benefits but implementation will require overcoming many barriers (financial, logistical, and technical) and carry significant security risks to all parties involved. Evidence-Based Medicine in Coquille, Oregon Project Date: 10/13/2008 Coquille physicians have no subscriptions to evidence-based medicine resources, and report no use of such resources in their daily practice. They routinely see 30-40 patients per day in clinic, and often must simultaneously cover ER call at the local hospital. Thus it is very difficult for Coquille physicians to remain abreast of new medical developments and current evidence-based guidelines. The goal of this project was to teach Coquille physicians how to use and incorporate into their practice a continuously updated evidence-based medicine resource: ACP PIER, via the Stat!Ref online library. As part of this project, I used a questionnaire to identify the types of resources physicians utilize to keep up with new medical information, registered all seven Coquille physicians for OHSU library barcodes in order to access off-campus OHSU resources for Oregon licensed physicians (which includes Stat!Ref), created a handout detailing how to use these resources, and taught each physician how to use these resources and how they could be incorporated into their daily practice of medicine. Inpatient Hospital Resources in Astoria, OR: Development of a Patient Library Project Date: 10/13/2008 Patient education is a critical part of effective healthcare delivery. Although patient education begins with healthcare workers, it must be reinforced by other modalities including pamphlets, books and the internet. This study aided in the completion of a patient library for inpatients at Columbia Memorial Hospital in Astoria, OR. The design was consisted of observation of patient care and exploration of current resources at CMH, meetings with the Stewards, data collection of population demographics and inpatient diagnosis. To aid in its completion, this project consisted of (1) Instructions of how to access WebMD for a novice computer user; (2) Pamphlets for the most common inpatient admissions at Columbia Memorial Hospital; (3) Development of a handout of patient friendly websites. These resources, including the internet, are cost-effective teaching tools. Increasing patient education will hopefully translate to increased compliance, improved patient-physician relationships, and greater patient autonomy. The Effectiveness of Patient Education in the Total Health Community Clinic: A Media-Based Approach Project Date: 2/11/2008 Patient education is a key component of preventative medicine and is necessary to providing comprehensive patient care. This student attempted to identify the effectiveness of patient education efforts in Monmouth, Oregon family practice clinic. The design included observation of patient education methods currently in use in the clinic and an analysis of the effectiveness of those methods over the course of four weeks. In addition, patient interviews were conducted to both assess the effectiveness of patient education methods currently in use and to discuss methods for improvement. New methods for educating patients were then employed and their effectiveness measured via observation and patient feedback. These included patient educational videos presented in the waiting area as well as patient handouts. In addition, a patient-accessible computer with learning tutorials was proposed to clinic administrators and approved for implementation. The changes achieved in this project enhanced patient education and increased satisfaction with the clinic waiting room experience, as many patients felt that their waiting time was more valuably used. Effect Of Computer-Based Patient Record System On Patient Satisfaction In Eugene, Oregon. Project Date: 2/11/2008 Background and objectives: Computer-based patient record system is being increasingly implemented in physician offices. Implementation of electronic medical record changes the work process during the patient encounters. Studies have identified that physicians are concerned about electronic medical record utilization in the exam room negatively impacting physician-patient relations, leading to diminished patient satisfaction. The objective of this study was to determine the effect of computer-based patient record system in the examination room on patient satisfaction one year after implementation of the electronic medical record system when the physician is proficient at utilizing the EMR. The other objective was to determine patient satisfaction with web-based services, particularly secure messaging, lab result reporting, and medication refill requests, and confidentiality. Methods: A survey was given to 50 patients at the end of the visit at a family medicine physician’s clinic in Eugene, Oregon. The survey assessed the following factors: overall patient satisfaction, patient’s perception of the doctor’s proficiency, effect of computers in the exam room, patient satisfaction with patient web portal system, and patient’s concern about the confidentiality. Results: Majority (84% to 86%) of those surveyed rated computers in the exam room as very or somewhat positive in all five aspects of physician-patient communications. 83% to 100% of those who used the web-based services rated the four aspects as very satisfied. Discussion: This study showed that at 1 year after implementation of the electronic medical record system, CBPR in the exam room had a positive effect on all five aspects of physician-patient communications. Majority of the patients were very satisfied with the web services, which is consistent with other studies and adds to the existing data. Use of email in a rural family practice setting: a strategy to meet increasing demand on limited health care resources in John Day, Oregon. Project Date: 2/11/2008 The challenges created by physician shortages in rural communities require creative solutions that maximize available resources. Previous studies have demonstrated that Internet technology such as email, electronic medication refills, and web consults has the potential to improve efficiency and increase productivity among family practice clinics. It has also been shown that a majority of patients use the Internet and are interested in electronic communication with their physician. This study attempted to determine the number of patients in a family practice clinic in rural John Day, Oregon that have access to the Internet and are receptive to emailing with their doctor. Methods included a survey and informal interview of a convenience sample of patients at the clinic about their use of the Internet and attitude toward using this medium to interact with their doctor. Information about gender, age, and place of residence was also recorded. Fifty-nine percent of patients sampled did not use the Internet and were not interested in any form of Internet technology to communicate with their physician. This attitude was found entirely among elderly patients who cited their inability to navigate the web and lack of understanding of its potential benefits as reasons for not using the Internet. This survey showed that patients in John Day do not have enough interest and fluency in Internet technology to make this form of communication a viable option at this time. “WI I ” TA S T I C : T H E I N T ROD U C T ION OF A NOV E L V I D EO G A M E CON SOL E I N TO A N U R S I N G HOM E Project Date: 12/31/2007 For nursing homes, the maintenance of physical activity is often an important, if not primary goal of day to day activities. It is commonly believed that lack of physical exercise will lead to exacerbation of co-morbid conditions and general overall decline. In many commercial nursing homes, this is primarily accomplished through group exercise as well as formal physical and occupational therapy.; each of these approaches has their limitations. The purpose of this project was to provide a qualitative analysis of the introduction of a novel video game console concept developed by Nintendo called the “Wii.” This console is unique in that it is one of the first to be introduced into the mass market that implements the use of physical interactive technology into game play. This task was accomplished through two general introductory sessions and two case study sessions with nursing home patients. Qualitative observations and analysis are reported with recommendations for follow studies that could be performed using a quantitative approach. Establishing a web home for the Strawberry Wilderness Community Clinic Project Date: 7/2/2007 Internet usage in rural areas is rapidly increasing. As this occurs, more and more rural businesses are establishing online web presences, allowing them to interact with current customers and reach potential new ones. In the health care arena, the ability to attract patients is limited by physical distance, but the Internet can also be used to disseminate important information both about the clinic and about the health care provided. This project is designed to establish a web home for the Strawberry Wilderness Community Clinic, for which patients will be able to find out information about the services provided by the clinic, common health problems and procedures performed, and interact with clinic staff by email or by phone. Telecommunications Technology and Medicine in Burns, Oregon Project Date: 1/1/2007 Telemedicine uses telecommunications technology for medical diagnosis, follow up, and therapeutic purposes when distance separates the patient from their doctor. It is ideal, in concept, for patients who live in rural ares, and are forced to travel long distances to see specialists typically centered in urban areas. Studies show that setting up this remote interaction is possible, but there is little evidence that is is an efficient and cost effective means of delivering care. High Desert Medical Center in Burns, Oregon was given equipment through various grants to set up telemedicine services, but little has been done in terms of implementing it into a useable practice. An analysis of the benefits of and barriers to creating a lasting operational telemedicine service was undertaken to help guide future efforts. A survey of patient opinion was performed, and a newsletter article was drafted to educate the public about telemedicine. Transforming Rural Primary Care: Electronic Medical Records (EMR) in Coos Bay, Oregon Project Date: 2/13/2006 EMR has advantages over paper-only charting systems in accuracy, speed, portability, and information retrieval and sharing. Yet it is costly to initiate and introduces its own set of possibilities for error, to include digital security breach and computer “crash.” In any case, EMR is not widely used in the United States, with estimates ranging from 7-33% of primary care clinicians. However, it is being used in the continuity clinics of 46% of Family Practice residency programs. The Bay Clinic Internal Medicine practice in rural Coos Bay, Oregon, is transitioning to partial EMR from a paper-only system. It plans to uniformly implement EMR within one to three years, and interface with the pending internet-based EMR of Bay Area Hospital. Bay Clinic is one of the sites for a required Rural Medicine clerkship for third-year medical students from Oregon Health & Science University (OHSU), in Portland. Study observations are made using the “PRAXIS Version 3.2” EMR by Infor-Med Medical Information Systems, Inc., between February 15 and March 15, 2006. The medical student used the EMR for every patient encounter, primarily to chart. One internist used the EMR for roughly 50% of his patient encounters on a given day, primarily to chart. A second internist used the EMR for every patient encounter: to chart, set clinical reminders, e-mail staff, write clinic letters, and print prescriptions and patient handouts. Both internists increased their average number of patients evaluated per day by about 25% (self-report), as compared to their practices when using paper only. We do not believe that using computers in the exam room diminished provider-patient interaction. Future studies may focus on the quality of this interaction, and of charting in general, as influenced by EMR. We anticipate that using EMR at this rural site will continue to benefit rotating medical students in learning practice guidelines and workflow efficiency. Medical Information Researched via the Internet by Patients in Astoria, Oregon: To surf or not to surf...that is the question Project Date: 2/13/2006 The Internet has become a vast resource of medical knowledge for patients all across the United States. This study sought to characterize the level of Internet use with respect to acquiring medical information in an Astoria, Oregon family practice clinic. The study design was based on three individual components: First observational data obtained from patient interactions, second qualitative and quantitative data obtained from patient surveys and finally anecdotal evidence from interviews with physicians. The results indicated a high percentage of patients acquiring information from the Internet. Review of current literature validated our conclusion further quantifying the types of information obtained and the results of acquiring such information. Given the possibility of negative outcomes as a result of false information, a patient brochure was designed to help physicians educate patients on how to obtain credible information on the Internet with the inclusion of disease specific sites. Nuclear Medicine in Reedsport, OR. Myth or Reality? Project Date: 1/2/2006 As the needs for nuclear studies are expanding in Reedsport, Oregon, the Lower Umpqua Hospital wants to introduce a gamma camera to be a part of their imaging facility. Being a small 22-bed critical access hospital for the area of 8,000 people puts certain financial restrictions on the scope of services the hospital can provide. Mainly a feasibility analysis for implementation of radionuclide studies into the hospital operations, this project attempts to evaluate the needs of the community and financial viability of the new imaging service. The potential barriers to entry, ways to mitigate them, and functional advantages of the hospital were explored. The analysis confirmed the immediate needs of the community for nuclear studies and supported the far-reaching plans to expand the scope of hospital services in the future. Pro-forma financial statements based on the realistic assumptions showed potential ability to break even on operations but inability to get any direct return on investment. The findings were shared with the hospital administration, staff of the radiology department, and physicians from the Dunes Family Health Care clinic. A pro-forma spreadsheet for profitability analysis was created for the hospital administration. Further research on how to make it profitable is suggested. Educating The Population Through The Media Project Date: 4/25/2005 The project was suggested by my preceptor, Dr. Tom Fitzpatrick. It involves getting basic medical information out to the population of Burns by publishing a weekly column in the local newspaper. Contact was made with Toni Siegner, a local reporter, to coordinate the publication. An initial article was written, but this proved to be too long; the newspaper wanted the publication to be limited to between 150 and 300 words. Several articles were then written, which met the expectations of the newspaper. As of the end of the rotation, one article had appeared in the paper (an introductory article) and another was to appear in the paper on Sunday, May 29 (two days after the end of the rotation). Three more articles are in reserve, and Dr. Fitzpatrick will submit them for the following weeks. Follow up of this project can be undertaken by any student who goes to Burns; it would involve writing comprehensive, concise, interesting articles on healthcare subjects not yet covered. The Use Of Handheld Computers In Clinical Practice: A Comparison Between Urban And Rural Settings. Project Date: 8/13/2001 This study attempted to elucidate the prevalence of handheld computers in primary care practices as well as physician perceptions surrounding the utility of these increasingly common devices. The design is a cross-sectional study conducted with surveys completed by telephone and personal interview. 21 physicians in Ontario, OR and the surrounding area were surveyed, including primary care specialties such as family practice, internal medicine, pediatrics, emergency medicine, and OB/GYN. 29% of physicians used handheld computers in their practice and the average number of years in practice was 9.33. Physicians from both urban and rural settings ranked the importance of handheld computer features very similarly, and the results provide guidelines for furture handheld software and hardware development. Back to subject search page or search by preceptor site