There was a hole in the wall of our bathroom that was a painful reminder of a bad encounter with a plumber. Yes, that hole has been there about a year, and it has been on my to d0 list for the duration, daring me to show if I inherited any of the fix it genes I got from my father. Why not hire someone to come fix it? I …
The ultimate DIY project: Create your own EMR
I first picked up an ultrasound transducer 17 months ago, at an emergency medicine ultrasound course at Harvard University. I had just barely heard about using ultrasound as a clinical tool and was vaguely interested. The course was 3 days long and cost a little under $700 and changed my life forever and made me a better doctor.
Emergency physicians have embraced the …
Bedside ultrasound tips for the general internist
A guest column by the American College of Physicians, exclusive to KevinMD.com.
English is the international language of medicine, according to many. Regardless of whether that is true, what is becoming increasingly clear is that English is the second language of medical documentation. For those of you who blame EHRs for this, the replacement of English by something else started …
English is the second language of medical documentation
As a physician, I experience first-hand the impact that internal communication at a hospital—both good and bad—has on patient care.
If I am able to quickly access clinical systems, analyze patient information and collaborate with colleagues, I can diagnose and interact with the patient much more efficiently and effectively. Conversely, breakdowns and inefficiencies in the communications process can inhibit the delivery of quality patient care by bogging down workflows, creating delays …
The impact of outdated communications technologies in healthcare
With the announcement that the FDA granted 510(k) approval for the AliveCor EKG case for the iPhone 4/4S, the device became available to “licensed U.S. medical professionals and prescribed patients to record, display, store, and transfer single-channel electrocardiogram (ECG) rhythms.”
While this sounds nice, how, exactly, does one become a prescribed patient? Once a doctor prescribes such a device, what are his responsibilities? Does …
The legal risks of prescribing the AliveCor ECG
I would like now to delve into what I consider critical elements of patient-centric care. They all involve technology to various extents.
1. There must be buy-in from providers. I am including payers, healthcare systems as well as clinical providers in this category. While I realize that much of healthcare is devoted to satisfying legal and regulatory mandates, there is great opportunity to improve the care experience (and dare I say …
5 critical elements of patient-centric care
“Hey doctor, what do you think about this product/solution/service?”
These days, I look at a lot of websites describing some kind of product or solution related to the healthcare of older adults. Sometimes it’s because I have a clinical problem I’m trying to solve. (Can any of these sleep gadgets provide data — sleep latency, nighttime awakenings, total sleep time — on my elderly patient’s sleep complaints?)
In other cases, it’s because …
Questions to ask when considering new medical technology
There are an estimated 15,000 medical apps presently on the market and is expected to grow 25% per year according to one study. There are issues which are common in the development of these apps and other categories of apps. However, some technical and non-technical issues are unique to the sector. As someone who does not design apps, …
5 reasons why mobile health apps fail
On my birthday several weeks ago, I was lucky to get an iPad Mini from my husband. I already have an iPad and have shared my experience. In fact, we gave all of our residents iPads (one of them contacted Steve Jobs and got a response), and documented an improvement in efficiency on the wards. So why the Mini? What is …
Using the iPad Mini in the hospital: One doctor’s experience
As medicine moves forward in its most technologically advanced era yet, we continue to struggle with basic concepts such as record keeping. The medical record is vital to the care of the patient. It tells the story of each patient’s journey through the medical system. The idea of centralizing all pertinent medical information is, in theory, a step in the right direction. In utopia, there would be one medical record …
What are the biggest issues with EMR today?
Everybody has a shadow. Although as a small child you may have tried, you cannot separate yourself from your shadow no matter what you do. Electronic medical records may be the first tiny step on the road to attaching yet another indivisible part to your persona, a “panoramic, high-definition, relatively comprehensive view of a patient that doctors can use to assess and manage disease”, and this, in the words of …
Striking the balance between the public good and patient privacy
Many doctors are now getting into movie production and making videos that are loaded onto YouTube. These videos are effective in attracting new patients and educating your existing patients. There are a few guidelines that you can use to create an effective script for each of your videos. These scripts can be loaded onto your computer in a PowerPoint format and will serve as poor man’s teleprompter to assist in …
How to create YouTube videos for patient education
Does your doctor use a computer in the exam room? Some people think that computers are a great way to keep track of patient information. Others see some advantage, but problems in the implementation. There are also a few Luddites who oppose this change simply on principle. I’ve had good experiences, and bad experiences, and believe we have a long way to go before computers are as helpful as they could be.
There …
Computers in the exam room: Good and bad setups
In the old days, bullying used to consist of name calling or physical aggression from someone in a position of power over another, typically from a roughly similarly aged peer group. The bullying could be mild such as occasional name calling and having one’s books knocked down when walking in the hallway. This does not mean the effects of the bullying were mild but comparatively speaking, this is generally not …
Impersonal communication on the Internet fuels cyberbullying
I’ve had the luck to attend medical school in the city of San Francisco during what will be looked back on as the start of transformational change in our health care system. My growing interest in technology and new business models as the disruptive forces behind this change, as well as marriage to a technology entrepreneur, has me frequently rubbing elbows with movers and shakers in the digital health space. …
A guide for entrepreneurs to get a doctor’s attention
iPads have been introduced into medical education mostly during the pre-clinical years. I’d like to share my experience using an iPad during my clinical year. I’ve found it to be exceedingly useful and versatile.
I have an entire medical library in my pocket. With the touch of a button I can pull up essential texts such as Harrison’s Principles of Internal Medicine or William’s Endocrinology. I get these books and …
How a medical student uses an iPad for patient care and education
Could a complete stranger receive your echocardiogram results in the mail?
Could a homeless guy in Boston end up with your labs in his shopping cart?
Is it possible that your medical records were sold on eBay?
Yes. Yes. And yes.
On February 24, 2011, Massachusetts General Hospital was fined $1 million dollars by the federal government when an employee inadvertently left a stack of papers on the subway. These documents contained the …
Properly delete electronic medical records, or face fines
Clinical content refers to the various checklists, documents, and forms that address an area of medicine when using an EHR. For example, a pediatric practice would be interested in documentation tools for a newborn visit. Not all EHRs have clinical content for all areas of medicine. For example, some EHRs have clinical content for internal medicine, but lack the details needed for dermatology or cardiology.
A disturbing number of practices …
Practices have failed to analyze the clinical content of their EHR
I was asked recently to predict the practice of medicine in 20 years. After stating that any such prediction is massively speculative, I indulged because it is massively fun.
I am persuaded by Clayton Christensen’s arguments in The Innovator’s Prescription that healthcare will go the way of other massively disrupted industries, wherein healthcare will follow the arc of decentralization.
Using the music industry as an example, the arc begins …
What medicine will be like 20 years from now
Joe Frisch is a staff scientist at the SLAC National Accelerator Laboratory at Stanford University. Dr. Frisch writes: “I wonder when we will start seeing really addictive games banned? I don’t know what makes games addictive though. Angry birds is a mystery to me – there is no ongoing story line, you don’t really gain any abilities as the game …
Angry Birds: A psychiatrist explains the addicition
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