Health Technology

Physicians writing on KevinMD about the technology in the exam room: the electronic record and what it did to the visit, meaningful use, alert fatigue, pajama time, human and AI scribes and whether they give time back, ambient documentation, telemedicine, and what AI can do in clinical practice now and who is responsible when it is wrong. Two maintained records draw on this archive: The electronic health record: what physicians say, in their own words and Artificial intelligence: what physicians say, in their own words.

Meaningful use: A view from the penalty box

Niran S. Al-Agba, MD

Health Technology

January 23, 2017

The Centers for Medicare and Medicaid Services (CMS) EHR Incentive Program — also known as meaningful use (MU) — initially provided incentives to accelerate the adoption of electronic health records (EHRs) to meet certified program requirements. Many physicians were mandated to change over to electronic records at the cost of tens of thousands of dollars. Electronic records have never been shown to improve patient care or outcomes with statistical significance, …

Why are Americans wary of advances in biotechnology?

Samir Shah

Health Technology

January 22, 2017

We are truly living in a remarkable era of biotechnological progress. Emerging nanotechnologies and immunotherapies offer the possibility of the targeted destruction of cancerous cells. 3-D printing of living cells is on the horizon, engendering the hope of a future with fully printed organs. And simultaneous advances in neuroscience and bioengineering have given rise to promising research and development of “electrocueticals” (neuromodulatory devices that may alleviate the symptoms …

Tech-savvy docs need to be on the forefront of EHR reform

David Mann, MD

Health Technology

December 27, 2016

I remember the disdain some of the EHR trainers had for their trainees back when our hospital system “went live” several years ago. Of course, this disdain was tempered by their knowledge that if docs weren’t so computer illiterate, or the user interfaces of the EHR systems weren’t so awful, or if the EHR software wasn’t so bug-ridden, their jobs wouldn’t exist.

So they soldiered bravely on, undaunted by grumpy old …

The communication revolution in health care may be doing more harm than good

Jim Schroeder, PhD

Health Technology

December 26, 2016

It happened again. Yesterday, I was charting on the recently launched streamlined version of our electronic health records and a new note popped up in the right lower corner of the screen:

“Welcome to (our new texting system). Now you can instantly and securely text about patient care with all of your colleagues.”

A few seconds later, a message popped up. “You have one unread message.” As with most other communication systems, …

Will technology destroy the art of medicine?

Suneel Dhand, MD

Health Technology

December 13, 2016

One of the topics that I write most about is the interaction of health care information technology with frontline clinical medicine, which I believe to be among the most critical issues facing the practice of medicine at the moment. With statistics now suggesting that doctors (and nurses) are spending an absolute minimal amount of their day engaging in direct patient care — some research suggesting as little as …

Enter the world of a physician entrepreneur

Gabe Charbonneau, MD and Alistair MacDonald, MD

Health Technology

December 11, 2016

One of my favorite things about being an entrepreneur is the people I’m privileged to meet and spend time with. This week I met a fellow Montana physician, Alistair MacDonald, who has started his own company. He’s created a product that automatically decreases the volume on music playing in the operating room if a patient’s vital signs are tanking. It seems like an important idea to me. He made some …

Be wary when a non-clinician talks about acute kidney injury

Joel Topf, MD

Health Technology

December 2, 2016

Acute kidney injury (AKI) is hard.

Things that seem like they should work often don’t. Just ask Perry Wilson.

And even the most predictable cases of AKI are resistant to intervention. Look at bypass surgery. We know days in advance the time and place the AKI will occur and despite that foreknowledge, like Cassandra, we are powerless to prevent the AKI. Same with contrast administration (or not). Same with AAA …

My dentist’s EHR system is better than mine. Here’s why.

Toni Brayer, MD

Health Technology

December 2, 2016

Imagine my surprise and delight when I saw my dentist this week for a check-up and found the electronic health record (EHR) to be both informative and patient friendly. As I sat in the dental chair, the large monitor screen was swung over in front of me, and my dentist was at my side going over it. The monitor was not a barrier; it was part of my exam. The …

Where does health care IT hurt? Everywhere.

John Halamka, MD

Health Technology

December 1, 2016

Over the past few months, I’ve been in England, China, Denmark, New Zealand and Canada.

Each of them is rethinking their health care IT strategy and is not entirely satisfied with past progress.

I’m often asked by senior government officials to help harmonize IT strategy at the country level. That — I can do.

I frequently say that health care IT issues are the same all over the world. Here are a few …

What will the Trump era bring to health IT?

John Halamka, MD

Health Technology

November 25, 2016

Many organizations have asked me to comment on the impact of the Trump presidency on health care and health care IT. I served the Bush administration for four years and the Obama administration for six years. I know that change in Washington happens incrementally. There is always an evolution, not a revolution, regardless of speechmaking hyperbole.

What am I doing in Massachusetts? I’m staying the course, continuing …

A revolution is needed to fix what’s wrong with EMRs

Diane W. Shannon, MD, MPH

Health Technology

November 19, 2016

During the Q&A period after a presentation I gave recently on understanding and preventing physician burnout, a physician in the audience voiced her vehement objections to the current electronic health record (EHR) with a simple statement: “We need a revolution.”

In a few words, she described her frustrations with the EHR. “It is meaningless — full of fields that we cut and paste from other fields. There are an ever-growing number …

Leave my patients’ health data alone!

Linda Girgis, MD

Health Technology

November 17, 2016

The patient looked angry and I felt his frustration. His voice was rising, “Why is the chart 54 pages long? My son has only been here five times!” In the olden, pre-electronic health record days, chances are the chart would most likely have been less than 10 pages. However, since the government takeover of medical records, this is no longer the case. When the government rolled out its meaningful use …

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Leave my patients’ health data alone!

Sharing your personal health data? Don’t be scared!

Joseph Kvedar, MD

Health Technology

November 17, 2016

I recently had the opportunity to join Boston news media veteran, Dan Rea, on his AM radio program, Nightside with Dan Rea. It was a one-hour call-in program and an eye-opening experience for me. Dan and I chatted about connected health and how it can truly disrupt care delivery and put the individual at the center of their own health. Then Dan opened the lines to …

5 obstacles to texting patients

Joseph Kvedar, MD

Health Technology

November 1, 2016

The business value of medication adherence tools is coming into focus. For years, I remarked that, while we could create a case for why adherence was the right thing to do, we had great difficulty creating the right financial incentives to move these programs from curiosity to scale. That is changing now with the collision in the marketplace of new payment models and exorbitantly priced pharmaceutical products.

The poster child for …

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5 obstacles to texting patients

A letter to health care technologists

Suneel Dhand, MD

Health Technology

October 31, 2016

Dear health care technologist or regulator,

The world of health care is changing exponentially. Speaking as one the nation’s over 800,000 physicians, I can confidently say that most of us understand the fact that the current health care system is unsustainable, and can’t carry on as is. There are many potential solutions to explore, and everyone in health care needs to try to come together in an attempt to address these …

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A letter to health care technologists

A go-live prayer for those with new EMR systems

Edwin Leap, MD

Health Technology

October 26, 2016

Some dear friends of mine, at Busy Community Hospital, are having a momentous day. Today is the “go-live” for their brand new, shiny EMR.

For those of you outside the hallowed, creaky halls of medicine, this EMR is one of the most widely used electronic medical records systems in America. It’s big, it’s expensive, it captures lots of data, integrates ERs, hospitals, clinics, labs and everything else. (Probably your cat’s shot records too.)

The problem …

Current EMR systems are terrible. (Apple, save us!)

Hans Duvefelt, MD

Health Technology

October 26, 2016

“Then it’s me and my machine
For the rest of the morning,
For the rest of the afternoon
And the rest of my life.”
– James Taylor, “Millworker”

It’s Friday afternoon, 4:30. I am sitting in front of my computer. My last patient is gone, my prescriptions are done, my messages answered, my office charges submitted and my office notes completed. Now, it’s time to tackle the incoming laboratory results.

Opening up the list of completed …

One device slows down health care. Get rid of it.

Suneel Dhand, MD

Health Technology

October 25, 2016

The mouse is a piece of technology that we’ve all got very used to working with over the last couple of decades. They actually go back longer than we might expect — the British Royal Navy first used a version of the mouse in the 1940s. With the personal computing revolution of the 1990s, they entered almost every single American household. Go back ten years, and nobody could have imagined …

Speech recognition errors in the ER. It’s a problem.

Skeptical Scalpel, MD

Health Technology

October 17, 2016

Speech recognition errors occurred in 71 percent of emergency department notes, and 21.1 percent of notes with errors were judged as critical with potential implications for patient care says a recent study in the International Journal of Medical Informatics.

Investigators looked at a random sample of 100 dictated notes and found 128 errors or 1.3 errors per note.

More than half of the errors were ascribed to speaker mispronunciation. Although …

The time doctors and nurses spend with EHRs is a national disgrace

Suneel Dhand, MD

Health Technology

October 10, 2016

I enjoy being a physician. I really enjoy being a physician. Although much of my blog is focused on areas where we need to improve health care, with a particular recent focus on the burdens of information technology, that does not take away from the fact that I do really love my job as a doctor.

I’ve received a lot of supportive correspondence regarding my views on how electronic medical records …