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.

Why EHRs aren’t meaningful to doctors and hospitals

Health Technology
November 18, 2010

Electronic health record (EHR) advocates in Washington don’t seem to get it. They don’t seem to understand that hospitals and doctors aren’t rushing to install EHRs because many EHRs, despite the constant talk that EHRs are a prerequisite for good care. Caregivers are not walking the talk, because in their view, EHRs,

  • aren’t ready for prime time
  • slow productivity
  • decrease revenues,
  • show scant returns on investment
  • don’t talk to one …

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Why EHRs aren’t meaningful to doctors and hospitals

EMR is here to stay, which will be good for doctors and patients

Health Technology
November 17, 2010

The electronic medical record, the EMR, is upon us.

For those of us who learned medicine entirely with paper charts, some have enthusiastically embraced the EMR and some have refused, to the extent they can, to deal with it at all. But most of us have plowed ahead into learning how to use it as best we can. It seems to me that the degree of enthusiasm physicians show for the …

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EMR is here to stay, which will be good for doctors and patients

Understand your options before monitoring Internet use

Health Technology
November 10, 2010

As medical practices become more advanced, staff members gain improved access to the Internet during work hours. Cyber-slacking is a well-known problem in corporations; in fact, one study found that over thirty-five percent of employees admit to using the Internet for personal surfing at work.

The New York Times cited that twenty-five percent of Net use on work computers isn’t actually work-related. Although it is unknown how severe the problem is …

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Understand your options before monitoring Internet use

How EMRs are failing nurses

Health Technology
November 9, 2010

Among the litany of complaints about the (un)usability of EMRs, it’s easy to lose sight of the big picture. More than the poor design choices and overall ugliness of existing software, by far the single biggest failure of HIT companies is that none of them has yet to produce an EMR that nurses actually need.

There is a huge opportunity being wasted here. Other industries have been able to incorporate computers …

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How EMRs are failing nurses

Patient safety suffers when doctors are forced to learn multiple EMRs

Health Technology
November 9, 2010

As a new intern at a well-endowed medical institution, I was disappointed despite the flurry of excitement that comes with orientation. I was disappointed despite the brand new privilege to save lives and relieve human sufferings. And the disappointment was made clear to me over the past two days.

What has happened in the past two days? As I will be working at two separate hospitals, for the past two days …

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Patient safety suffers when doctors are forced to learn multiple EMRs

Physicians should establish rules with their patients before using a PHR

Health Technology
November 5, 2010

These days, it seems that for every consumer advocate out there who promotes the personal health record (PHR) as The Patient Empowerment Ubertool, there’s at least 10 physicians worried sick that the technology will further complicate their frazzled work lives.

The fear and loathing derives from an increasingly common and distinctly distasteful experience in which a patient presents the physician with a thumb-drive, computer disk or Web-link to a site containing …

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Physicians should establish rules with their patients before using a PHR

How health care could benefit if a company followed Apple

Health Technology
October 30, 2010

Health care workers throughout the country daily face the growing pains of the transition from paper charts to electronic medical systems. Not only are there frustrations within each system, every hospital seems to have selected a different EMR.  When I was a medical student at UCSD, I was exposed to 4 separate EMR’s (Epic, PCIS, CPRS, Centricity, etc) during my rotations at various San Diego hospitals.

In this Wild West era …

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How health care could benefit if a company followed Apple

EMR ROI depends on workflow improvements

Health Technology
October 23, 2010

Some of the toughest obstacles to EMR are the physician doubters.

These people say, “My charts are going to be on a computer.  So what?  All I know for sure is that it will take longer for me to finish my charts every day and we will have another component in fixed overhead.  Why this is a good idea?”

The concerns are valid.  When my practice chose to get EMR 6 years …

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EMR ROI depends on workflow improvements

Challenges facing patients adopting personal health records

Health Technology
October 14, 2010

by Kristina Fiore

They’re still there. Rows upon rows of number- and color-tagged manila charts, packed in so closely together that Fiore sometimes sticks to Fiori, or hides behind it.

None of my physicians has yet converted to electronic health records. I dream of the day when my PCP can pull up my chart on her iPad, accessing all of the important information (allergies, family history) before …

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Challenges facing patients adopting personal health records

Benefits of EMR outweigh the cost and learning curve

Health Technology
October 5, 2010

It’s hard to teach an old dog new tricks, but we can try.

To write or to type, that is the question. To boldly go (according to the latest statistics) where only a small few are going; that is the challenge. Actually, for everyone in the medical profession, the reality of the paper chart is slowly coming to a close.

The digital age is moving forward at lightning speed.

But can you teach …

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Benefits of EMR outweigh the cost and learning curve

Why doctors need an EHR, and why they should buy it now

Health Technology
October 3, 2010

The regulators have completed their work. CMS has defined how you should use technology in your practice or hospital (Meaningful Use) and technical requirements for EHRs have been finalized.

Centers for Medicare & Medicaid Services (CMS) and Office of the National Coordinator for Health IT (ONC) have removed all ambiguity regarding Government financial assistance to those purchasing EHRs, and ONC certified EHRs will start appearing shortly.

A national network of federally funded …

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Why doctors need an EHR, and why they should buy it now

Coping with the culture clash between nurses and IT

Health Technology
October 1, 2010

by John Rossheim

IT professionals are great at coming up with nifty tools for bringing clinical data to clinicians – as long as nurses are willing to memorize lots of byzantine paths to that information.

Nurses are dedicated to providing direct care for their patients and advocating for them in every way – as long as it doesn’t mean having to adapt to ever-changing computer systems.

These two stereotypes …

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Coping with the culture clash between nurses and IT

Why health IT usability matters to patients

Health Technology
September 24, 2010

It’s widely rumored that a health IT industry executive was unhappy about suggestions that systems have to be usable in the eyes of employees who use them while caring for us. (Us. The patients. Your mother.)

According to the rumor, the exec said, “Over my dead body.” As if he ran the agency.

Whether or not the rumor’s true it’s not funny. So when I was asked to represent the patient perspective …

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Why health IT usability matters to patients

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Converting paper charts to electronic medical records tips

Health Technology
September 24, 2010

We are a little over two years into our electronic medical records implementation at the time of this writing. Since we have been performing a gradual rollout, the entire process has been relatively uneventful. Most of the credit for this goes to our chief information officer (technospeak for the head of our IT department) and our practice administrator.

One of the biggest challenges we have been facing is how to convert …

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Converting paper charts to electronic medical records tips

Physicians deserve to be compensated for time spent on email

Health Technology
September 24, 2010

Dr. Wes, a blogging cardiologist, posted a follow-up to his recent post on e-mail correspondence between physicians and patients.

The majority of emails he receives tend to be for very simple things like checking a lab result.

Current EMRs don’t make reviewing and sharing lab values efficient. Dr. Wes writes:

[O]ur current model of the electronic medical record sending every single result to our inbasket, even though it contains …

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Physicians deserve to be compensated for time spent on email

Powerful examples of using the iPad on the wards

Health Technology
September 16, 2010

I recently completed a two week tour of duty on the wards in July with new residents, interns, and students.

Attending (serving as the supervising doctor for the team of residents, interns and students) in July can be challenging, but also one of the most rewarding clinical experiences as a faculty member.  The interns and residents are eager to learn and your teaching may have a more lasting impact as the residents …

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Powerful examples of using the iPad on the wards

10 tips for troubleshooting complex EHR infrastructure problems

Health Technology
September 11, 2010

I recently joined my team while troubleshooting a complex infrastructure problem affecting our community EHR hosting private cloud.

From years of experience doing this, here are my lessons learned.

1. Once the problem is identified, the first step is to ascertain the scope. Call the users to determine what they are experiencing. Test the application or infrastructure yourself. Do not trust the monitoring tools if they indicate all is well but the …

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10 tips for troubleshooting complex EHR infrastructure problems

Beyond the final Medicare and Medicaid EHR incentive rules

Health Technology
September 10, 2010

by David C. Kibbe, MD, MBA and Brian Klepper, PhD

Finally, we have a Final Rule on the Medicare and Medicaid EHR incentive programs.

The rules and criteria are simpler and more flexible, and the measures easier to compute. But they are still an “all or nothing” proposition for physicians, who will have to meet all of the objectives and measures to receive any incentive payment. Doctors …

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Beyond the final Medicare and Medicaid EHR incentive rules

Physician resistance to EMR and why CPT should be replaced

Health Technology
September 9, 2010

After 5 successful years with electronic medical records (EMR), I am convinced that the promise of EMR to improve physician practices and to improve the health care system is real.

If that is true, why is adoption of EMR currently limited to only 5-10% of medical practices?  Why is there so much resistance?  As folks who work in heath care IT so often ask, why don’t doctors “get it?”  I don’t …

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Physician resistance to EMR and why CPT should be replaced

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