This is absolutely correct. I work with multiple different EMRs and this is the problem inherent to them all - they exist as proprietary siloes of information waiting to be printed out and sent on to the next user. There is little to no mandated backend interfacing.

oh - i see what you did there ...

at what point does a decision tree automated algorithm actually lay hands on a patient? in my specialty, the differential diagnosis for "lower abdominal pain" cannot be narrowed without a physical examination.

evidence based medicine does have its place, and i think that we, as physicians should do our best to make sure our practice (using both local and national standards) is evidence based. however, as noted above in the pulse ox comment, sometimes current practice cannot be overcome by EBM. another example is continuous fetal heart rate monitoring in labor. no study has ever shown that continuous monitoring is better than intermittent monitoring in preventing adverse outcomes (such as cerebral palsy). every study has shown the continuous fetal monitoring increases the cesarean section rate. so , we use an intervention that confers no benefit and may increase the risk for harm. why? ask the plaintiff's bar ...

is your suggestion that obstetricians would prefer to have unhealthy patients so we have "something to do"? i get reimbursed the same regardless of a patient's risk status. besides, i am pretty sure that most of the information texted by this program is readily available to the patient at her routine visits.

true, but the texting app asks for LMP not EDC (estimated date of confinement). gestational age is determined from EDC (when it is known and confirmed) not by LMP.

unfortunately, not all pregnancies are dated by the first date of the last menstrual period (LMP). first date of LMP roughly assumes regularly occurring 28 day cycles with ovulation/conception occurring around day 14. not all cycles are regular or 28 days in length. a significant number of pregnancies are dated by first trimester ultrasound.

where is the american college of obstetrics and gynecology or the american academy of pediatrics (you know, the national bodies whose members actually take care of these ladies and their babies)?

here you go -- http://wattsupwiththat.files.wordpress.com/2009/06/mcgartland-carlin-epa-memo.jpg

While Dr. Stamler's supposition is interesting, I would like to see the data and not an AP or Time magazine story. A search of "JS Stamler" on Pubmed shows 183 papers - 30 of which as first author and almost all dealing with NO. I would guess that he is probably an authority on NO. But that in and of itself does not mean that he is an authority on transfusion medicine, trauma care, surgery, or the like. I am interested to see which variables were controlled, what the power of the study was, and in what fashion data were obtained. The article and abstract are not yet up at the PNAS website.