October 2022

October 25, 2022

If Socrates were alive today, his message of “know thyself” could be expounded upon to include the importance of knowing the details of your medical healthcare journey.

When you visit a medical provider one of the first things you encounter is a series of questions, typically asked by a nurse or medical assistant, regarding your health. They want to obtain your current health information as well as past medical history, a list of all medications you are currently taking and any you are allergic to before you ever see the provider. The answers to these questions may seem easy to deliver, however, the recollections you have about your complete healthcare history may contain gaps in information that could be critical to the care you receive. One misconception is that your provider already knows every aspect of your healthcare journey and can access it easily.

After several urgent care trips and visits to my regular provider over a period of 7 months resulting in an inconclusive diagnosis, I ended up in the emergency room. I had to provide blood and urine specimen samples, as well as receive a CT scan to determine the cause of the symptoms I was experiencing. A few hours and a surgical consultation later, a diagnosis was made and I was able to return home with a couple of prescriptions and medical directives to follow in order to heal and feel better.

This recent hospital ER visit happened to be within the same health system as my general practitioner, therefore a note was sent internally to my provider through the health system’s unified electronic health records (EHRs) for a follow-up. But what happens if you go to a hospital that isn’t within the same health system as your regular provider or they don’t utilize an EHR system? Is the medical information from that visit automatically sent to your provider another way? The answer is most often, no. What if you don’t have a general practitioner, how are you able to obtain all the detailed information you may need the next time you see a doctor?

These are common inquiries most of us are faced with and end up having to navigate ourselves without knowing exactly where to begin when records depicting our healthcare journey are needed. Doctors also face a risk in treating patients without the benefit of knowing complete medical record history, and patients can experience financial hardships for repeat and concurrent tests when doctors lack visibility into recent care.

Knowing the importance of getting test and scan results into the hands of my general practitioner, I requested that my test results and any medical notes be sent to my internist, as well as my specialty physician. A couple of weeks following my ER visit, I had my annual OB/GYN appointment and my provider was able to view the CT scan and immediately identified the root cause of all the symptomatic issues that had been overlooked by previous providers, including in the Emergency Department.

After my first urgent care visit, months prior to landing in the ER, not resulting in me feeling better, I began a hard copy medical journal. I recorded my symptoms in detail, along with herbal supplements, and over-the-counter (OTC) medications, as well as identifying specific information about prescriptions I had taken. I also was sure to note specific dates to create a timeline and included physical activities I took part in or refrained from due to symptoms or pain. I knew something was not “right” in my body, but I didn’t know what the cause was. Many times we have an intuitive sense that something is wrong, but trying to describe or decipher that notion can be difficult. The journal began to tell a story. This information along with the CT scan being sent to my OB/GYN was key in accurately identifying the problem.

My story isn’t unique; many individuals have similar stories. In today’s environment of seeing multiple providers—dermatologists, OB/GYNs, internists, etc. that may not be within the same health system, it’s vital to take charge of your medical information. There are several ways to organize this information. Johns Hopkins Medicine has shared methods for organizing your medical records and The Office of the National Coordinator for Health Information Technology (ONC) provides A Guide to Getting & Using Your Health Records as a helpful resource on how to obtain your medical information from providers and health systems.

There are a variety of personal benefits that stem from having all your medical information yourself. Your medical history can also benefit your children as they may have genetic or familial predispositions identifying the importance of receiving early scans and engaging preventative measures otherwise unknown. This article by Guava Health explains the 10 benefits of tracking your medical history and the advantages of keeping a detailed record of your healthcare. This will help you and your loved ones share vital information about your health with any provider you may see.

But how do you keep track of your health information? By the time you are in your 50s or older, you’ve likely garnered a mountain of personal medical information! Your current health provider may offer a patient portal where you and your provider(s) can log information and share communication. There are also free apps and digital storage platforms, such as Care Passport. The best way to begin is to jot down on paper what you remember. As you begin this process you will likely start to recall additional timelines throughout your life that will help in creating your healthcare map.

As health systems and medical labs nationwide recognize the importance of shared information, hc1 is playing an integral role in enhancing patient care by transforming lab data into personalized healthcare insights®, helping to connect siloed data within health systems, hospitals and labs to help the right patient gets the right test and the right prescription at the right time. For more information visit hc1.com.

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Lorri Markum is the marketing manager for hc1 Insights and has over two decades of corporate and nonprofit marketing leadership experience. Lorri specializes in B2B marketing and is SEO Certified. A graduate of Ball State University with a degree in psychology, digital communications and storytelling. For the past 25 years, Lorri has been a professional commercial photographer and photojournalist in the music industry. Before joining hc1 she served as the marketing manager for a nonprofit healthcare organization, serving 40 counties throughout Indiana.

October 11, 2022

Laboratory testing plays a decisive role in the early detection, diagnosis and treatment of disease in patients and is the single highest-volume medical activity performed in the U.S., with more than 7 billion tests conducted annually, according to the American Clinical Laboratory Association. Test orders aren’t always perfect, however. Often, a duplicate or unnecessary test is ordered or a needed test is omitted, which can negatively impact the quality of care a patient receives.

Lab Stewardship has emerged as a strategy to assure quality in laboratory medicine to provide the right test for the right patient at the right time. The American Association for Clinical Chemistry (AACC) refers to lab stewardship as correctly ordering, retrieving and interpreting lab results. Errors in these three aspects of the total testing process are the culprits for most diagnostic errors and are the cause of the majority of significant patient harm in malpractice litigations.

On September 21, 2022, Quest Diagnostics, in collaboration with hc1, hosted a virtual webinar on the importance of Lab Stewardship entitled How to Close Gaps in Care by Maximizing the Power of Laboratory Stewardship Solutions.

Experts, Donna D. Cooper, MS, MBA, Sr. Director, Health Systems Product Solutions, Quest Diagnostics and James Haarbauer, MS, Sr. Business Intelligence Consultant, hc1, shared their lab stewardship strategies for hospitals and health systems including:

The 4 basic elements of an effective Laboratory Stewardship program
Key criteria when building a Laboratory Stewardship Committee
3 ways lab stewardship solutions improve patient care and outcomes
How to identify low-impact versus high-impact interventions

“Lab stewardship is the opportunity to manage hospital and laboratory resources in a way that provides optimal information to clinicians while reducing costs to patients, hospitals, and health systems,” said Cooper, “Effective committees need a balance of three qualities in order to be successful–Influencers, Informers and Doers.”

Cooper went on to provide details on how to form a solid lab stewardship committee and the importance of governance, intervention, and pipeline from a granular approach. “Getting the right people at the table is critical to the success of any Lab Stewardship Committee,” said Cooper.

Lab Stewardship also requires lab data insights that can be cumbersome to interpret in identifying areas of concern for the health systems they support. However, “the burden of deciphering lab data can be removed from the medical and lab leadership with just an LIS connection––health systems can begin using hc1 dashboards to identify the greatest improvement opportunities by test, location and provider,” said Haarbauer.

Quest Lab Stewardship powered by hc1 empowers health systems to maximize the utility of their laboratories with intuitive analytics and advisory services that provide actionable insights into laboratory testing trends that can identify missed opportunities to deliver the right test to the right patient at the right time.

One of the questions posed by attendees during the webinar’s question and answer session was whether it is easy to access the lab stewardship platform. Cooper explained, “There are two ways to access the lab stewardship platform in a system. Quest offers tiered access through the Reference Platform to allow users to see data on any test that is sent through Quest. The Enterprise Platform allows users to establish an interface with hc1 and will be able to enter data for all in-house testing as well as testing sent to Quest or any laboratory so users will have a full picture of all testing information.”

To learn more in-depth information that was shared, you can view the webinar on-demand by clicking here.

October 6, 2022

Changes in seasons often accompany changes in diet, environment and behavior. Such changes can have a cascading effect on health, particularly for people who take prescription medication. Precision prescribing recognizes that every person has a unique combination of genetic, environmental and behavioral factors that will determine how specific medications will work for them.

The term pharmacokinetics describes how drugs move through the body—how they are absorbed, metabolized and eliminated. Pharmacodynamics describes how the drug affects the body. Food-drug interactions are how foods change a drug’s pharmacokinetics and pharmacodynamics. These changes can reduce the medication’s effectiveness or lead to adverse events. The impact of these changes can be difficult to predict because of the many factors involved: how much time elapses between eating and taking medication, the nutritional content of the food, and the amount of food eaten. Age, sex and genetics also affect how a person metabolizes food and medication.

From Pumpkin Spice Lattes and Oktoberfest Märzens to Halloween candy and Thanksgiving dishes, favorite fall foods interact with drugs in different ways:

Licorice. Before breaking into bags of black licorice this Halloween, you may want to check with your doctor, particularly if you are pregnant or older than 40. Commonly used in herbal remedies as well as candy, licorice contains glycyrrhizin, which can lower potassium. Licorice also can raise cortisol levels. These physiological effects mean that licorice doesn’t mix well with medications for high blood pressure or cardiovascular diseases, such as ACE inhibitors or diuretics. Combining such medication and licorice can lead to irregular heart rhythms.
Grapefruit. Ruby Red grapefruit season starts in November, and this fruit’s sour kick can be just the ticket when your body needs a vitamin C boost. Yet grapefruit also blocks the CYP3A4 enzyme from metabolizing drugs in the small intestine, causing too much of the drug to be in your body. The affected drugs include some statins, some high blood pressure medication, some anti-anxiety drugs, and some corticosteroids. With some antihistamines, grapefruit prevents absorption of the drug, thus lowering the drug’s effectiveness. Grapefruit interactions are typically highlighted on a prescription’s warning label or the box containing over-the-counter medications.
Cruciferous vegetables: Thanksgiving feasts have moved beyond green bean casserole to make room for roasted Brussels sprouts and mashed cauliflower, and rightly so. These vegetables from the Brassica botanical family are low in calories, high in fiber, and packed with nutrients, such as Vitamin K. What makes them different from other vegetables is that they contain glucosinolates, compounds that show promise in reducing cancer and cardiovascular disease risk and are the cause of their pungent odor and somewhat bitter taste.

These typically beneficial qualities can work against specific medications, however. Warfarin is a blood thinner used to prevent blood clots; whereas, Vitamin K helps make blood clotting proteins. Drastically increasing your intake of, say, kale chips or green smoothies could interfere with warfarin’s effectiveness. Cruciferous vegetables also increase the activity of the CYP1A2 enzyme, an enzyme involved in drug metabolism. As more drugs are developed that are metabolized via this enzyme, more research will be needed to determine how diets high in cruciferous vegetables might affect the effectiveness of those drugs.

Aged cheeses and meat. Charcuterie boards are not your friend if you take any of the class of drugs known as monoamine oxidase inhibitors (MAOI). MAOIs are prescribed to treat depression and Parkinson’s disease. As the name suggests, they block monoamine oxidase, an enzyme that breaks down tyramine. Our bodies use tyramine to control blood pressure, and foods such as cheddar cheese, salami and pickles are full of it. If you are taking medication that prevents tyramine from being broken down while ingesting more tyramine, you are likely to end up with too much tyramine, and too much tyramine can cause dangerous blood pressure spikes.

Beer, wine and liquor. Alcohol is a drug that depresses the central nervous system and can damage the liver. These effects can be increased to dangerous levels when alcohol is combined with medications that have similar effects, such as sedatives and pain relievers. For example, you may become extremely drowsy if you drink alcohol while taking medication to deal with autumn ragweed allergies. Another bad combination is alcohol and acetaminophen, which are both metabolized by the CYP2E1 enzyme and together can lead to liver toxicity.
Coffee. As the weather gets chillier and the days get shorter, you might pour yourself multiple mugs of coffee to stay warm and awake. Coffee contains caffeine, a stimulant, which gives coffee its bitter taste and has many different pharmacokinetic interactions with prescription drugs. Coffee interferes with drug absorption by changing stomach acid levels, for example, and interferes with drug excretion by increasing urine volume.

Food-drug interactions are one of many patient data points providers have to take into account to create effective treatment plans. Patients will try to make themselves feel better before they ever set foot in a doctor’s office, so patient encounters should include questions about over-the-counter medications, herbal supplements, and diet changes in addition to medical history and current symptoms.

To learn how hc1 can help your healthcare organization ensure that patients get the right tests and the right prescriptions no matter the season, request a demo!

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