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

How physicians can endure the trauma of a malpractice lawsuit

Physician
September 11, 2010

Several clients have endured the trauma of malpractice law suits, Medicare audits and stinging accusations or criticisms from patients or colleagues that leave them reeling.

These clients have shared feelings of:

  • shame
  • despair
  • depression
  • loss of self-worth
  • disillusionment
  • confusion
  • hurt
  • defeat

Oddly enough, one of the least common feelings they’re able to get in touch with is anger.

Maybe it’s because my clients are self-selected, and many tend to be goal-oriented strivers with a perfectionistic streak. They were, as was I, …

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How physicians can endure the trauma of a malpractice lawsuit

Primary care needs more than 15 minutes for patients

Physician
September 10, 2010

Psychotherapy appointments have traditionally lasted 50 minutes with 10 minutes for paperwork. This has lead to the expression, “the 50-minute hour”.

More recently there has been talk of incorporating psychotherapy techniques in brief visits in primary care. The provoking title “The Fifteen Minute Hour” is from a book about addressing the emotional aspects of disease in primary care during brief appointments. The title and the concept seem relevant to much of …

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Primary care needs more than 15 minutes for patients

How doctors can cope with stress

Physician
September 10, 2010

by Walter van den Broek, MD, PhD

Often I ask my residents that if you can’t take care of yourself, how do you expect to take care of your patients?

Or in another way: the only difference between God and a doctor is that God knows he’s not a doctor. These sound like cliches but there is some truth in them. In short, doctors are just ordinary people …

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How doctors can cope with stress

Contraceptive pill prices have a huge price range

Conditions and Diseases
September 10, 2010

Do you know that the price of a contraceptive pill in Chicago pharmacies varies from $9 (Trinessa, aka generic Tricyclen, at Target pharmacy) to $84 (Loestrin 24 at Kmart pharmacy) a month? That means, over the course of the year, depending on what pill you take and where you shop, you could drop as little as $84 or — let me get my calculator here — $1008! These prices are if you pay out …

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Contraceptive pill prices have a huge price range

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

What is an adequate trial of an antidepressant?

Conditions and Diseases
September 10, 2010

Since there are many antidepressants with varying dosage ranges, and many more degrees of variations between individual responses to particular antidepressants, psychiatrists have been unable to agree upon an operational definition of an “adequate trial” of an antidepressant.

However, it’s worth looking at some guidelines.

A 2003 study from the Journal of American Medical Association found that only 21.7% of Americans diagnosed with depression received “minimally adequate treatment” in the past 12 …

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What is an adequate trial of an antidepressant?

Chronic disease and using social media for health

Social Media in Medicine
September 9, 2010

Speaking to the senior staff of the National Library of Medicine recently was like going before the best kind of murder board.

Picture it: 30 of the nation’s smartest health information mavens around a polished conference room table, asking me sharp questions, suggesting new lines of inquiry, and offering their own insights. In other words, heaven.

Our jumping-off point was the Pew Internet Project’s latest research on internet penetration, mobile use, and …

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Chronic disease and using social media for health

Bringing a friend or family member on doctor’s appointments

Patient
September 9, 2010

by Diana E. Lee

Most of the resources I’ve read about how to prepare for a doctor’s appointment recommend bringing a loved one with you so that person can help you remember what the doctor said and make sure you get your questions and concerns addressed.

But when I read Paula Kamen’s book All in My Head: An Epic Quest to Cure an Unrelenting, Totally Unreasonable and …

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Bringing a friend or family member on doctor’s appointments

Working with industry requires building a culture of trust

Health Policy
September 9, 2010

Howard Brody, a family physician, recently wrote an article in the Annals of Family Medicine discussing, “Professional Medical Organizations and Commercial Conflicts of Interest: Ethical Issues.”

The article focused on how AAFP has “recently been criticized for accepting a large corporate donation from Coca-Cola to fund patient education and materials on obesity prevention,” and how this money has been called a “conflict of interest.” To that effect, Dr. Brody defines such …

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Working with industry requires building a culture of trust

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

Why are most physicians writing their prescriptions by hand?

Health Policy
September 8, 2010

Is the pen mightier than the PC?

When it comes to prescribing, it appears so. A new report from the Center for Studying Health System Change finds that most physicians write their RX scripts by hand, despite financial incentives for physicians to adopt electronic prescribing. Even those who have e-RX systems do not always use them, and when they do, they may not to use the features that were …

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Why are most physicians writing their prescriptions by hand?

Alzheimer’s disease needs better preventive strategies and treatments

Conditions and Diseases
September 8, 2010

The Alzheimer’s Association sponsors a journal titled Alzheimer’s & Dementia.  In the March 2010 issue, they provide a report on facts and figures related to Alzheimer’s disease (AD).

I’m a sucker for data so I spent some time going through the manuscript and here are some of the things that stood out to me:

Ninety (90) drugs are under investigation using human volunteers in the U.S. to slow or stop …

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Alzheimer’s disease needs better preventive strategies and treatments

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Forgiveness shaped by the stories of people’s lives

Patient
September 8, 2010

If you had asked me what I thought forgiveness was when I was a young adult, I probably would have said that it is something you do for others—others who have wronged you in some way, to give them a break and let them know that you are no longer angry or upset with them.

As I’ve matured emotionally over the years, my view of forgiveness has evolved significantly. Some of …

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Forgiveness shaped by the stories of people’s lives

Anecdotal accounts of patient experiences with local physicians

Patient
September 8, 2010

by Liz O’Brien

A long time ago — when managed care-style employee healthcare benefits were a new thing — we worker bees learned we might have to throw our old family doc under the bus.

We were given a booklet of providers on the network panel, and if the faithful retainer who had served our family for years wasn’t on that list, it was sayonara — unless we …

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Anecdotal accounts of patient experiences with local physicians

Improve patient safety and cut costs with clinical pharmacists

Patient
September 8, 2010

by Emmanuel King, MD

What if you could improve patient safety, cut costs, broaden your medical knowledge and find 20% more time in your workday?  On October 1, 2010, that is just what we can expect when clinical pharmacists move from the back room to the bedside in ten general medical units at the Hospital of the University of Pennsylvania.

As we all know, medications play an intensely complex and ever-growing …

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Improve patient safety and cut costs with clinical pharmacists

Empathy is still at the heart of medicine

Physician
September 7, 2010

Treat the patient, not the disease.

Care more particularly for the individual patient than for the especial features of the disease.
— William Osler

We enter medical school eager to help the sick and the dying. Over the years this golden objective is transmuted into the base lead of disease-specific diagnostics and therapeutics. Our absorption in the strangeness of the manifestations of a remarkable pathophysiological process may distract us from its impact on …

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Empathy is still at the heart of medicine

Why are hearing aids so expensive, and reading glasses so cheap?

Conditions and Diseases
September 7, 2010

I am currently 53 years old, but I recently found an imperfection in my near-vision.  I was probably laboring for a year or so before caving in: purchasing reading glasses. I am using them right now and they have made all the difference.

In the space of a few months, I went from no reading glasses to seven pairs. I bought all seven online together as a package recently, for the …

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Why are hearing aids so expensive, and reading glasses so cheap?

Some MRI places have good quality machines, others are obsolete

Conditions and Diseases
September 7, 2010

“Dave” showed up at my office last week with neck pain, worsening weakness in his arms and legs, and changes in his bladder control. All signs pointed to something gone bad in his neck.

His internist had already thought of this, because he’d ordered the appropriate MRIs. And they’d all been read as normal, leaving me without a cause.

Here is where the problem began. Everything about Dave’s exam and story pointed …

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Some MRI places have good quality machines, others are obsolete

Cosmetic foot surgery can have serious downsides

Physician
September 7, 2010

How far will some women go to fit into high heels? The menu of services at Beverly Hills Aesthetic Foot Surgery in Studio City, Calif., provides a clue.

There’s the trademarked “Cinderella Procedure”—a preventive bunion correction that makes feet narrower. The clinic also offers the “Perfect 10! Aesthetic Toe Shortening” that invisibly trims toes that hang over the end of sandals or have to be crushed into tight shoes. There’s also …

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Cosmetic foot surgery can have serious downsides

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