
Statins are a mess: we need better data, and shared decision making - MaysonL
http://www.bmj.com/content/348/bmj.g3306/rr/759401
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cko
"We need better data; better dissemination of that data; and better
communication of that data, in ways that help people make decisions which
reflect their wishes."

This is where I think good EMR software can make a difference - in gathering
and organizing data. The quantitative data like lab values are probably stored
electronically, but the clinical assessments are still scribbles on paper.
Most of the physician notes are in SOAP format (Subjective Objective
Assessment Plan), and many require educated guesses to decipher (I'm a
pharmacist so I have to make these guesses daily). This alone makes data very
difficult to gather. You can't do a SELECT * query on this stuff. Every time I
call a doctor's office, they'll put me on hold for some time while they flip
through a patient's chart. Combine that with the fact that there are multiple
clinicians working on the same patient, each with their own set of medical
records, the cardiologist might not know what the endocrinologist is doing.
Also almost every medical institution uses fax machines. It's 2014. Fax
machines should not exist. So the first step to better data is better data-
gathering.

Prescribing can also be a mess. Evidence-based medicine means there are
standards for diagnosing and treating. For example, if a patient was recently
diagnosed with Type 2 Diabetes, there is a certain protocol on what to
prescribe, with considerations based on a patient's status (say, kidney
function). I think this is medicine equivalent of idiomatic programming
constructs - just as "cowboy coding" is frowned upon, medicine shouldn't be
like House MD. But I frequently see patients being started on non-standard
regimens. So not only are standards difficult to come by, sometimes they are
not even being followed - and this too compounds the difficulty in gathering
good data.

Relating to dissemination of data: My aunt was recently diagnosed with non
small-cell lung cancer. The first step was surgery. Her next option was
infusions of chemotherapy. She didn't consult me on this matter, but I dug up
some studies, and it appears that if she chose chemo it'd increase her 5-year
survival rate by 5%. Currently based on her staging it's 50%. Granted, aside
from profound hair loss, one seizure, and likely adverse hematologic effects,
I don't observe any other damage, but I wonder if she would have made the
choice to do chemo if she knew about that 5%.

Side note: I wish I hadn't been so lazy in pharmacy school and really put in
the effort to learn how to code. I remember opening up K&R a few times half-
heartedly and not getting past the first three pages. Learning this stuff by
myself is an uphill battle, even given the wealth of documentation out there.
Most of pharmacy school was just "memorize and regurgitate" \- once you got
past Organic Chem it was all smooth sailing. Progress is super-slow, because I
give up frequently, only to pick myself up the next day to start again. It's
only my vision of better medical software that keeps me going.

