Newborn Screening Requirements
Newborn screening for diseases and conditions is an emotionally and politically charged subject. For a variety of reasons, not all states mandate all available screening tests, and consequently many infants suffer irreparable handicaps.
States must decide if a test is reliable and readily available, if there are enough cases of the disease to make it worthwhile, and if treatments are available to make a difference with early detection/diagnosis. It is unfortunate when an infant is born with a detectible, treatable disease but suffers irreversible damage because the state in which the infant is born does not require a test for that disease.
The PKU test (for phenylketonuria) was designed in the late 1960s, and screening for congenital hypothyroidism was added in the 1970s. Since the development of mass spectrometry in the early 1990s, many more tests have been added to the options.
According to the U.S. National Newborn Screening and Genetic Resource Center, the PKU test is universally mandated in all states, along with tests for congenital hypothyroidism (CH), galactosemia (GALT), benign hyperphenylalaninemia (H-HPE), and hearing (HEAR). Many states additionally require testing for congenital adrenal hyperplasia (CAH), sickle cell disease (SS), maple syrup urine disease (MSUD), homocystinuria, biotinidase deficiency, and more.
Click on http://genes-r-us.uthscsa.edu/nbsdisorders.pdf for more information about newborn screening requirements in your state, or contact your state Department of Health. Also see the Wikipedia website, www.wikipedia.org, for more information about newborn screening (search Newborn Screening Tests).
Additional information and links about each of the above-listed tests and conditions can be found through a Wikipedia search and at the National Library of Medicine—National Institutes of Health website at www.nlm.nih.gov.
Converting to Electronic Medical Records Part II - The Disadvantages
In our last newsletter article on electronic medical records, we promised to discuss some disadvantages of EMRs, specifically problems with converting patient charts and medical records to EMR; costs, timeframes, and personnel hours; training for physicians, medical assistants, and other allied health professionals to learn new software; patient concerns; and confidentiality and sensitive information related to EMR.
These issues are the reasons only about 20% of all U.S. doctors are currently using EMRs. Probably the most cited reason is cost, including the initial outlay for the software ($20,000 on average), the cost of personnel training hours and conversion hours, support costs, and hardware costs. When the advantages and disadvantages are measured in less tangible benefits such as patient satisfaction, patient safety, and more efficient patient treatments, the initial outlay is even more difficult to balance on a comparison chart.
Some start-up costs, such as personnel training and conversion hours, are more difficult to assess, since we all learn at different rates. The slowing down of the day-to-day tasks while the software is being learned might mean that fewer patients are treated per day and longer days are required for medical assistants, physicians, and other healthcare workers. The best EMR software is that which is designed to be very simple and logical to use, yet is able to handle complex patient records and practice management systems.
Formally trained medical assistants have a distinct advantage over other allied health professionals, since computer training is included in our required curriculum. My students are required to have extensive Windows-based applications experience before entering the MA program, and then must take several other computerized courses (including EMR) while in the program.
Perhaps doctors face the most difficult challenges, as they no longer dictate or write progress notes, but rather must do their own data entry and transcribe their own reports. They need to access reports, test results, and other information, too, rather than relying on staff to give it to them.
Patient confidentiality has always been a concern with electronic medical records, but tracking who has been looking into a patient’s medical record is actually easier with electronic records than with paper records. As long as good security measures are in place, unauthorized access will be denied without passwords. Also, audit trails, sometimes called footprints, are proof of who has been into a patient’s record. The challenge is for access to be allowed for legitimate need and access to be denied for unauthorized use.
The good news is that recently federal regulations have been approved allowing hospitals to donate software to clinics and physician offices. Remember that President Bush set a 2014 goal date for all Americans to have an electronic patient record. This new federal regulation is a giant step in the right direction, and we will surely see a huge surge in EMR use in the next few years.
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