"Arriving on track 134, the Health Train Express bound for Everywhere, USA. Stand back please, and have your boarding pass ready. This train is a local and will stop at HMO haven,DRG depot, P4P pitstop, JCAH junction, Copay Circle, H&P Place, EMR Exit, and points beyond!"
The train is late, and overloaded, 
standing room only and passengers hanging out the windows, on the roof, and swinging from the doors. The engine speeds by the platform and the cars smoothly glide to a halt.
Track 134 is a new 'high speed" mag-lev train,
with very limited service, since the infrastructure of new technology, magnetic lev cars and rails are not yet put into place. America has talked about this new technology for over 25 years, and there has been little progress.
You board this special health train on your way to work, and have a seat, awaiting your destination......as you work on your laptop, fiddle with your PDA and/or take SMS and phone calls on your IPOD, or new G1 phone, the train leaves the station gliding smoothly on a cushion of air.
As you pick up speed and pass by roads, overpasses, crossings, and small towns now vacant from migration to city centers, suddenly, you are distracted by:
Ding, Ding..... go the strings of my heart
Dr. Wes began this scenario for me in his blog today
* Ding Ding * You get a best practice alert!
Have a patient without an mammogram in the last year?
*Ding Ding* You get a best practice alert!
Haven't had your colostomy and over age 50?
*Ding Ding* You get a best practice alert!
Haven't counselled you patient about their smoking each year?
* Ding Ding * You get a best practice alert!
Haven't had your cholesterol checked?
* Ding Ding * You get a best practice alert!
Didn't screen your patient over 18 for depression?
* Ding Ding * You get a best practice alert!
Didn't know that there 134 potential alerts for 2008?
*Ding Ding * You clearly need a best practice alert!
DING DING GO THE STRINGS OF MY HEART (be patient while this loads (Chuck Berry)
"Best Practice Alerts" are computer algorithms triggered from diagnosis codes.
"Best Practice Alerts" are an Electronic Medical Record's (EMR) means to assure that the "voluntary" Physicians Quality Reporting Initiative is undertaken. Never mind that failing to comply means certain discrimination between physicians. Just remember, it's voluntary! Really.
"Best Practice Alerts" force doctors to cross tacit specialty treatment boundaries and risk alientating referral doctors.
"Best Practice Alerts" drive testing and procedures, and therefore costs, to our health care system.
"Best Practice Alerts" are encouraged by those with a stake in health care.
"Best Practice Alerts" remove judgement from medical care in favor of mandates.
"Best Practice Alerts" are disruptive to doctor-patient interactions, consuming precious clinic time as "why" or "why not" must accompany each alert response.
"Best Practice Alerts" have not been shown to improve patient outcomes over more conventional care.
So how, then, are we to assume such alerts represent "Best Practice?"image credit: Google images
Theme Song from Father Knows Best....opens in player, be patient while it downloads. (click on photo)
Well, it's simple: because 
Father knows best.
-Wes
Dr Wes......you are brilliant!! And thanks!!
photo credit: Dr Wes blog photo