Where does doctor stop and computer begin? Who is in charge? Do we care? Are these silly, academic questions from some sci-fi future or is it an onrushing tomorrow?
Consider:
Where does the doctor stop and computer begin?
Right now, there are two patients in every room. One is made with flesh, bones, and blood. One is made with a monitor, a mouse, and a keyboard.
Both demand my time.
Both demand my concentration.
A little over two weeks ago I wrote the short story “Please Choose One.” I posted it online. The response it generated exceeded anything I could …
To health IT: You are the ones who can save us
I am a clinician and a clinical trialist. Medical research in some form or another (performing it, consuming it, reviewing it, editing it, etc.) occupies much of my time. Therefore, you can imagine my excitement while watching Apple’s product announcement when they introduced a new open source software platform called ResearchKit. Apple states ResearchKit could “revolutionize medical studies, potentially transforming medicine forever.”
ResearchKit allows clinical researchers to have data about various diseases …
Apple’s ResearchKit has problems. Can they be fixed?
The world of health care will likely look very different in a decade, owing to a variety of diverse factors including; medical breakthroughs, political reform and not least of all the tremendous advances in technology that are occurring at breathtaking pace. The traditional model of the doctor-patient interaction will also continue to change dramatically (as it already has over the last several years). The days of an unchecked paternalistic relationship …
Why we need less virtual medicine
As all kinds of information are being collected about every aspect of our lives, the data generated at this exorbitant rate can lead to advancements in research and health care. That is the idea behind big data” and it’s disruptive benefits for the health care industry. The term encompasses a searchable vast data collection for relative information in order to quickly identify trends. Like all other disruptive innovations, the focus …
Data-based medicine: The end of evidence-based medicine?
Andy McAfee is the associate director of the Center for Digital Business at MIT’s Sloan School of Management. He is also coauthor (with his MIT colleague Erik Brynjolfsson) of the 2014 book, The Second Machine Age: Work, Progress, and Prosperity in a Time of Brilliant Technologies, one of my favorite books on technology. While he sits squarely in the camp of “technology optimists,” he is thoughtful, appreciates the downsides of IT, and …
What does a technology optimist think about the future of health care?
Please choose one:
The three words blink in front of me on the computer screen.
Please choose one:
Patient is-
☐Male ☐Female
I click FEMALE.
I watch as the auto-template feature fills in the paragraph for me based on my choices.
Patient #879302045
Patient is: 38-year-old female status post motor vehicle accident. Please acknowledge you have reviewed her allergies, medications, and past medical history.
I click YES.
Have you counseled her about smoking cessation?
I click NO.
A little, animated icon of a …
Despite the well-known rollout problems for hospitals and clinics across the nation, there are many palpable and welcome advantages to using electronic health records.
Chief among these are the ability to access the chart from anywhere, rapidly search for information needed, and reducing the centuries-old problem of illegible doctors’ handwriting. But with the good comes the bad, and in these still relatively early stages of health care information technology adoption — …
How can we make the EMR note more legible? Here are some ideas.
The other day I ordered a CT scan with contrast on a patient with an apparent mass on his neck. I explained about the need to get a blood test to make sure his kidneys could handle the iodine contrast. Because our lab was closed, I had to print a requisition for him to bring to the hospital lab.
Printing a requisition from our EMR is a multi-step process that involves …
Today’s EMRs: Extra work with uncertain benefits
As our medical system attempts to evolve to better deal with the modern epidemics of lifestyle-driven chronic disease, much time and attention is being placed on the clinical models for prevention. Rightly so, and various viable models are popping up with names like lifestyle medicine, preventative medicine, and functional medicine.
But one area that is hardly addressed is the payment structure and business model of the practices. Are there structures that …
Emerging health care models for innovators
First off, this is the first time I have typed an official response to a blog post: “Dear health IT: Please understand our frustrations.” You might think, hey aren’t you a millennial, shouldn’t you be blogging non-stop? Like doing everything from my taxes to baking with my smartphone? No, not really; besides residency doesn’t make it very feasible either.
Yet, the need to respond to Dr. Leap’s blog post was …
The cumbersome EHR: It’s time to implement solutions
Remember the Latin phrase “Primum non nocere”? It means “First, do no harm.” Most of us physicians committed to it when reciting the Hippocratic Oath, back when we were first embarking on our careers in medicine.
Sadly, today’s technology threatens this sacred physician-patient relationship. Electronic health records (EHRs), although much-needed, have created perverse, unintended consequences for the patient experience.
To be clear, EHRs are inherently good. They’re the backbone of better-coordinated care, …
The documentation solution your patients want you to adopt
It has been quite a year. Between 3 main hospitals, 2 major medical institutions and 3 major healthcare networks, our practice has been on 3 different echocardiographic reading platforms, 3 ECG reading platforms, and 8 different electronic health record systems including 4 instances of Epic alone. I am typically enthusiastic to a fault about new technologies and, time after time, have rushed in, often where angels feared to tread. I …
Today’s EHRs: No doctor left behind
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Meaningful. Having a serious, important, or useful quality.
You know this word because you want it to define your life. Nearly all of us, at some point, will seek a more meaningful existence. Most wish our jobs were that way too.
Meaningless. Having no purpose or reason. Ouch. We don’t want anything to do with that. Meaningless makes us question what in the …
The sad, tragic road to meaningful use
I just deposited a check into my bank account by photographing the check with my iPhone and zapping it through cyberspace. I realize this is ho hum to the under 35 crowd. Soon, there won’t be any paper checks as the entire transaction will occur electronically. As a member of the over 35 crowd (plus 20 years), I am wowed by this process. I remember being astonished when my kids …
Mobile health: Just because we can do it doesn’t mean we should
Dear health IT staff,
I know that, on many levels, physicians must be the absolute banes of your existence. We are grumpy and resistant to change. And some of us are still confused by graphing calculators, much less complex modern computer systems. We call you because we forgot our passwords, then because we forgot the new passwords. We call because the system …
Dear health IT: Please understand our frustrations
Of the nearly 100 people I interviewed for my upcoming book, John Halmaka was one of the most fascinating. Halamka is CIO of Beth Israel Deaconess Medical Center and a national leader in health IT policy. He also runs a family farm, on which he raises ducks, alpacas and llamas. His penchant for black mock turtlenecks, along with his brilliance and quirkiness, raise inevitable comparisons to Steve Jobs. I interviewed him …
The marriage between technology and medicine: An interview with John Halamka
Citing slow load times, confusing menu structure, and overall frustration with the user interface, St. Barnaby’s Hospital has announced that the old electronic health record (EHR) will be replaced with a new state of the art binder-based system, in which a so-called “paper chart” is kept for each patient.
The new …
Hospital replaces EHR with new, efficient “paper chart” system
It was 11:47 p.m. That meant that I had 13 minutes to reach my pre-set goal of “activity” that the fitness tracker on my wrist had been registering throughout the day. If I met the goal, I would get a “trophy” on the accompanying app. I probably looked pretty funny bouncing around my living room doing a squat here and a sit-up there, punching a pretend opponent, and running in …
What a medical student learned from using a fitness band
Most readers know that an EMR (electronic medical record) is the back-end software that runs a health care organization. EMRs have been around for a while. Recently most large hospitals and health systems have begun building out the patient-facing version of their EMR; allowing patients to communicate electronically with their doctors, refill prescriptions, schedule appointments, and view clinical information.
I’ve written at length about the differences between B2B software and B2C …
Patient portals and EMRs: Each requires a different skillset
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