THREE years ago I presented before this Association a paper in which it was shown that the subsequent death t rate in patients operated on for duodenal ulcer was not greater than that of the general population of similar age and sex, but that it was three times as great in patients operated on for gastric ulcer. It is well known that gastric ulcer is a more serious disease in every respect than duodenal ulcer: because of th6 disability from the symptoms it produces, the danger from these symptoms, the less response to medical regime, and the greater risk and the less satisfactory results of surgical treatment. The fact that the subsequent death rate in patients successfully operated on for gastric ulcer proved to be three times the death rate of a similar group of the general population, prompted me to make further investigation, the results of which I desire to place before the Association.During a period of fifteen years, prior to January, I92I, I280 patients with gastric ulcer were operated on in the Mayo Clinic. In this series, I95 deaths occurred following satisfactory recovery from the operation. I have endeavored by every possible means to ascertain the causes of these deaths. The information obtained by a review of case histories, by correspondence, by reexamination, or by further operation shows very clearly that the most important single factor influencing the life expectancy of patients operated on for gastric ulcer is gastric cancer. The exact number of deaths due to gastric cancer cannot be ascertained, but it easily constitutes the most common cause of death. There is, moreover, little doubt that many of the deaths for which no cause was given were due to cancer. Exclusive of these, there were seventy-five deaths from gastric cancer, which comprise about 40 per cent. of the total number of deaths, and the remainder in which the cause is known are, with few exceptions, due to causes independent of the stomach. Gastric cancer, then, may well be regarded as the factor most worthy of consideration, necessitating a review of the pre-operative history of the patient, the character of the gross lesion found at operation, the microscopic picture of the lesion, and the operative method used in dealing with the lesion.Patients who subsequently died of gastric cancer may be divided into two groups, those in whom the lesion was not removed, and those in whom the lesion was removed. In the first group there is a striking similarity in the description of the lesions found at operation, all conform more or less to the following operative record: " Large ulcer of posterior wall, adherent to
H ealth information technology (HIT), the secure transmission and management of health information, is relatively new. Despite its availability, acceptance and use of HIT in the United States has been slow and lags behind many industrialized countries.1 Forces within the current environment-rising health care expenditures, high adverse event rates, and government and private initiatives-are increasing the speed of acceptance of HIT. Challenges to the adoption of HIT in the United States have included the high costs of the technology, general resistance to change, misaligned incentives, and the fractured payment system. Believing that HIT will improve the quality and safety of health care, President George W. Bush set a goal for most Americans to have an electronic health record (EHR) by 2014.2 The Centers for Medicare & Medicaid Services (CMS) has followed through on this directive by instituting programs aimed at increasing the adoption and use of HIT, starting with e-prescribing and EHR.■■ Benefits of HIT Increased use of HIT can benefit all members of the health care system: patients, payers, prescribers, physicians, office staff, and pharmacies.3 While one particular technology may provide a more apparent benefit to a particular segment, the overall improvement in patient care that can be realized affects all stakeholders in the process. Improvements in Quality of CareData drive the measurement of quality in health care. Collecting data can be cumbersome in a paper and pencil world. Capturing information electronically is a major asset of HIT and facilitates quality measurement. Data that are mined through HIT applications provide continuous feedback to providers and plans and are an invaluable tool for guiding future care decisions.E-prescribing E-prescribing uses technology to allow prescribers to electronically transmit prescriptions. The intent of this technology is to reduce medication errors and improve patient care by eliminating the need for interpreting handwritten prescriptions. 4 Through the increased use of e-prescribing, physicians have the benefit of receiving real-time formulary, drug-drug and drugallergy information as well as a history of drugs dispensed for the patient. The elimination of handwriting interpretation decreases medication error rates and reduces communication time between pharmacies and office staff. Payers are better able to promote increased utilization of generic and preferred brand drugs, as well as avoid costs resulting from adverse drug events. However, , notably e-prescribing and electronic health records (EHR), have the potential to improve the quality of care, reduce medication errors and adverse events, and decrease overall health care utilization and costs. However, the United States continues to lag behind other countries in the adoption and use of HIT.OBJECTIVE: To review the various issues surrounding the implementation of HIT in the United States and potential drivers that will influence the use of e-prescribing and EHR.SUMMARY: The United States has been slow t...
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