With the national push toward electronic medical records, there have been active efforts to upgrade clinical data and systems software. At some institutions, an effect of this transition is the migration from the traditional voice dictation systems or paper clinic notes to a typed electronic record.

A recent study at the University of Toronto Faculty of Medicine sought to evaluate the overall quality of electronic discharge summaries (EDS) compared to their traditional dictated counterparts. The measure for quality was based on a 100-point visual analogue scale rating the satisfaction of primary care physicians (PCPs) who receive the discharge summaries. Other endpoints studied included the satisfaction of house officers using either system (again, using a 100-point visual analogue scale), adverse outcomes after discharge (combined emergency department visits, readmissions, and death), and patient understanding of the discharge details.

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There are veritable reasons to be concerned about the swine flu (H1N1 virus). We would not want to repeat the SARS outbreak of 2003, or worse, the 1918 Spanish flu pandemic that killed 50 million people. It is nevertheless interesting that although the avian flu (H5N1 virus) has been in the news for several years, it has not gained the same traction that the swine flu has had in just a few days. Some may attribute the rapid dissemination of information (and fear) to social networking technologies and the boisterous media. xkcd has even produced a humrous and satirical comic to illustrate this effect.

I nevertheless agree that we need to maintain a high degree of caution and vigilance with the swine flu. While Twitter and related technologies may generate more mass hysteria than necessary, they have also extended useful and up-to-date news to the public. @CDCemergency is an example of a great Twitter resource to follow CDC updates on the issue. I have also embedded a Google Map below that tracks reported swine flu cases.

View H1N1 Swine Flu in a larger map

• The pink tags are suspected cases.
• The purple tags are confirmed cases.
• The yellow tags are negative cases.
• Deaths lack a dot in the tag.

You can monitor whether your state or city has been affected. Now, I don my N95 mask and lock myself in the basement until Twitter says the swine flu pandemic has passed. [Disclaimer: the last sentence was a joke]

The “New and Interesting” series is a new feature of [On The Wards], and will comprise periodic compilations of select research findings, news articles, and random tidbits in bullet-point format.

• Development of long-acting local anesthetic with minimal toxicity (PNAS) – researchers at the Children’s Hospital of Boston develop a controlled release form of saxitoxin, which can provide prolonged nerve blockade with minimal systemic and local toxicity.

• Low adoption rate of electronic health record systems in US hospitals (NEJM) – despite wide agreement that electronic medical records would benefit health care institutions, the adoption rate is strikingly low.

• Valsartan does not prevent recurrence of atrial fibrillation (NEJM)

The Medpedia Project recently announced the public launch of its namesake project: Medpedia, an online medical encyclopedia based on the Wikipedia model for collaborative content creation. It aims to become a “repository of up-to-date unbiased medical information, contributed and maintained by health experts around the world, and freely available to everyone”.

At the surface, the project appears like a medical version of Wikipedia. There are however several nuances that distinguish it from the latter, and could lead to greater acceptance within the medical community as a credible source of information, such as with the prevalent use of UpToDate.

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Fox News broadcasted today a brief report on a surgical chief resident using Twitter during an operation. The “delicate operation removing a cancerous tumor from a kidney” occurred at a hospital in Detroit (Michigan). No additional details were provided. This leaves us with a few interesting questions:

• Were these personal or professional tweets?
• What type of information was transmitted?
• What had the surgical team hoped to achieve?
• Was the patient aware that this activity had occurred?
• What about the attending physician supervising/performing the operation?

The reporter had discussed this incident with a Fox News medical contributor, Dr. Jennifer Ashen, who is also a surgeon. She first clarified that it was probably not the chief resident–but an intern or other resident–who would be tweeting. The chief resident would probably have been assisting with the operation. She then stated that there were advantages and disadvantages of using Twitter in this case. When asked by the reporter to state an advantage, Dr. Ashen was unfortunately unclear or unable to provide a convincing response.

I believe there may be interesting and potentially useful applications for real-time microblogging in future surgical cases, but so far there have been no compelling uses in this arena. But just as Dr. Ashen had mentioned, we would first have to hash out the privacy and medico-legal issues.