Vinod Chacko

The adoption of Electronic Medical Records (EMR)is increasing every year even though the rate of adoption is slow. MEDLINE is adding thousands of new citations every day. It may be possible to enrich an EMR system with relevant information from NLM resources. During my elective at NLM I was assigned to evaluate the preliminary stages in designing and building a system, which automatically augment a patient's EMR with pertinent information from NLM resources. Clinical informatics experiments using content from real EMR is necessary to achieve the ultimate goal of automatic augmentation of the EMR with MEDLINE.

Takotsubo cardiomyopathy, also called transient left ventricular apical ballooning or "broken heart syndrome", is a cardiac condition that mimics the clinical presentation of acute coronary syndrome but without any evidence of obstructive atherosclerotic coronary artery disease. An episode of intense emotional or physiologic stress, serving as the nidus for a catecholamine surge, has been reported prior to presentation and is presumed to be the triggering factor playing the pathogenic role. We report a unique case of Takotsubo cardiomyopathy without any known precipitating factors. After reviewing multiple case reports and review articles, the evidence supporting a "catecholamine surge" is empirically plausible; however, our case calls this theory into question. The "aborted MI" hypothesis is more convincing as an all-inclusive nidus for the pathogenesis and clinical presentation described in Takotsubo syndrome. More detailed studies and research are ne...

Reliable communication of patient information among physicians during shift changes is an important patient safety parameter. The Joint Commission on Accreditation of Healthcare Organizations [JCAHO] recognized the pitfalls in hand off communications by including standardized hand-offs as a National Patient Safety Goals. We are presenting an electronic application called eHand-offs to address this problem in our residency program. Residents can use this application to hand-off patient information during admissions, transfers, and discharges. eHand-offs also functions as a surveillance tool for administrators to track patient hand offs, ensuring added patient safety and enhancing resident supervision and training.

Missed hand-offs and breakdowns in verbal and written communications are key sources of medical injury and thus major concerns in the delivery of safe patient care. The Joint Commission on Accreditation of Healthcare Organizations [JCAHO] has recognized these pitfalls and added this as a new requirement in the National Patient Safety Goals. We designed an electronic application called eHand-offs to standardize and supervise communications among medical residents about patient information during admissions, transfers, and discharges. eHand-offs also functions as a surveillance tool for administrators to track patient hand-offs, ensuring added patient safety and enhancing resident supervision and training. With this background, a national survey of program directors of internal medicine residencies was conducted to get a national consensus about hand-off communication. It was concluded from the survey that standardization and tracking of hand-off data using an electronic, secure, and standardized software application, will help improve continuity of care, reduce medical errors and improve resident supervision and training. A secure software application with face-to-face communication is preferred as the handoff method of choice by our respondents.