Re: Replies to the Electronic Medical Records

Re: Replies to the Electronic Medical Records

Jim DeWees

3/1/2013

Hello Everyone,


Happy Friday!!!


Here is a summary of responses that I have gotten from my question about the
Electronice Medical Records (EMR) or EHR depending on how the wind blows
(Electronic Health Records).


But to clear up my question, I am only asking about how or IF we are being
required to somehow link up with some national database, or HOW this EMR is
working for the medical field, and if we are supposed to be doing this with
O&P facilities.

There was ONE person who made an assumption that I don't even own a computer
(I guess he didn't understand that somehow I am able to send and receive
emails). He told me to run to WalMart and buy a computer and to learn how
to work a computer (and that is the LAST place I would go for any of my
computers that I own). Well, for the record, I bought my first PC in 1985,
which cost me over $3000 (my brand new Honda Civic Si cost me just $7000
brand new that year. I have been on the leading edge of technology my
entire life.

My office DOES have electronic charting. I am the only practitioner, and I
do have the software to generate claims, schedule appointments, etc. I use
MediSoft in my office, it is relatively inexpensive and does everything I
need it to do for me. I can access it with my phone, my tablet, my laptop,
etc. (It is very secure, and password protected, and I am the only one with
access at this point).

BUT my question was if we were being required to somehow get our computer
information to link to some bigger system for this goal of having all of the
medical records available for everyone to access.

The replies were basically all stating that it is NOT being required yet for
us to be compliant in having our medical documentation linked to any
bigger government database or anything.

Most stated that they are doing electronic chart notes, and are converting
their offices to be paperless, and this all depended on the size of the
facilities, and number of practitioners, etc.

Some mentioned a few of the software packages available, by name, and some
had good things to say, others were not too thrilled with their software
they were using.

Nobody mentioned to me that this is being required of us YET, but most
mentioned that they can see the time coming where we will have to invest the
money to get linked to this bigger database, or have access to transfer
our data to other providers.

Thanks everyone for the responses, and the information. I can sleep now
knowing that WE are not required to do this at this point in time. But
hopefully when the time comes, there will be an easy fix to get my
software to communicate with the main database, or cloud or however it
is going to be handled.

Thanks, have a great weekend!

Jim DeWees, CP





> Date: Mon, 25 Feb 2013 17:50:54 -0500

-----Original Message-----
From: Cheryl Lewis
Sent: Thursday, February 28, 2013 3:39 PM
To: <Email Address Redacted>
Subject: [OANDP-L] Responses Perspiration with CROW

Thanks to all who responded - once again the esteemed members of this list
came through.

Below is a list of responses - I am planning to suggest the patient try the
Arrid X-Dry aerosol light application on a clean leg at night and then using
the x-static Coolmax AFO Socks during the day. I couldn't remember the
brand of Antiperspirant that is most effective - and someone suggested it
specifically. My patient is only 40y.o. , very cognitively aware and has no
skin issues so I think this will work well for her.

Here are the other suggestions:

try looking at knitrite, maybe give them a call. Usually they have items
like that which aren't in the catalogue as sales for that item are small.
Good luck




SmartKnit makes AFO-interface socks that wick moisture away from the skin.
Many insurances cover them (usually only 3 per side per year and Medicare
doesn't cover them).


I usually drill holes in both the anterior and posterior shells
to assist in air flow. The holes of course need to be placed so as not to
compromise orthosis strength. We also use long Coolmax socks that tend to
wick moisture away.


There have been many discussion about ventilation holes in CROWS. The air
flow is needed, but you certainly don’t want small rocks and debris falling
inside. Here in Arizona we do usually drill very small 1/8 holes....many
of them, to allow air flow. We have also suggested changing socks
regularly.

I use knit rite x-static socks with silver lining. You get the moisture
control and bacterial control. Sps carries them
-------------------------


My only suggestion is based on this same problem with my prosthetic
patients, that use silicone/gel liners... it may or may not be suitable
due to risk of skin breakdown with additional material in the CROW,
however I have had good success using either nappy liners, or breast
feeding pads. These don't stop the sweat, but act as a good wick to
absorb the moisture and are just disposed of once removed at the end of
the day (or more frequently if required).

Like I said, this may or may not be suitable, just a thought.


I have made multiple crow walker boots for our veterans. Some have been
for patients that have profound lymphedema. Substantial body fluids
weep with the compression of the crow. To prevent / reduce the foot from
the constant exposure to moisture, the veteran is supplied with multiple
synthetic sock ply. The synthetic socks don't soak up moisture but wick
it through the gapping of the fabric weave. Multiple layers of socks are
eventually added to accommodate the volume change. These synthetic socks
are often purchased through Cascade or SPS.

Secondly, drain holes had to be drilled through the bottom of the boot,
and the I had to fenestrate the remainder of the boot to allow for the
air flow pumping effect, you previously mentioned. The bottom of the
boot is usually quite thick, preventing moisture from coming up into the
boot when ambulating through a shallow puddle.

Hope this helps.
Look into swiftwick at swiftwick.com ask for John, he is very knowledgeable.
They have wicking products for amputees and regular socks that work well. I
have a real sweater patient and they helped and I actually use the socks
myself and no problems with sweat.
Good luck.
-------------------------------
Try cabellas for long sox

Hey,
I have tried drilling wholes all over the front and back. This helps some
but I have not found that it completely fixes the problem. Please let me
know if you here anything better.
I tried calling your office just now and found you will be only open after I
have to leave.
My thoughts on the situation you describe would be using wicking socks.
Have you contacted Vittoria Phoenix? They have some wicking socks. 519 426
0046
Orthoactive on Schoolhouse Rd in Coquitlam BC might also have what you need.
Another Pedorthist I would talk to would be Phil Watson. He is at
Ambulatory Footwear near Hamilton. Quite simply that man has been a help to
many of us.


Try the SmartKnit seamless AFO socks from KnitRite. I've had several patient
report improvement when using them. Good Luck

Does anyone have suggestions for perspiration inside a CROW? I have several
patients who are experiencing extreme sweating even in winter weather - I am
concerned for when it warms up! I have suggested they change their socks
frequently and to take off the front of the boot if they are not walking.
For the most severe case I suggested trying clinical strength
anti-perspirant on the leg to stop the sweat ( I have some reservations
about this but the problem is severe!)

I know eventually the sweating should calm down once the leg gets
acclimated to the warmth and I know that added holes will prevent the
airflow pumping effect when walking - I am wondering if there are any
specific design changes people have tried to improve the situation?

Does anyone have a source for long wicking socks or any other
suggestions?

As always, the feedback from the members of this list is very much
appreciated! I will post responses anonymously.
At minimum, use the silver fiber socks from Knit rite to reduce bacterial
growth inside the boot.

Also the anti perspirant, make sure its non-scented
Knit Rite AFO Socks
You might try a silver sock inside the walker .pulled up and over the top.
Silver helps with bacteria and fungus but is also thermal dynamic. The x
static version is also very good at wicking moisture up and out of the
walker.
there are individuals interested in hygroscopic interfacing. I can try and
get them in touch with you if you wish.
Perspiration is an ever growing problem for Amputee's as we use more and
more non-breathable interfaces and the amputee's are becoming more and more
active. You're right, usually, this reduces with acclamation though not
always. Use of anti-perspirants is a concern and I usually advise my
patients not to put the anti-perspirant directly on their residuum; but on
their hands first then on the residuum and to use it the night before so
that it has a chance to work. Alps has developed an anti-perspirant for use
under their liners that seems to work and can be obtained through Orto-ped.
Here is a link to Knit-Rite who make a Neuropathic Boot Interface which may
be what you're looking for,
<URL Redacted>
There is an article in the December 2012 edition on pages 40-42. It deals
with 3 different methods for amputee/socket sweating that applies the same
to an orthosis user. We are the ones promoting Alum as a solution, since it
is the cheapest and for us the most beneficial. The use of socks made of
Coolmax will also minimize the sweat and odor issues.



Cheryl Lewis BSc(HK), CO(c)
Certified Orthotist
Owner, CK Ortho Inc
Ph 519-436-9670

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