Just the other day, while I was in the middle of seeing a morning schedule full of patients, I opened one patient’s chart and was thrilled to see a whole bunch of new icons in Chart Review in the electronic health record that I had never seen before.
These apparently indicate office visits and other health care encounters with outside providers.
Sometime during …
Electronic medical record interoperability is a total mess
I think the time has come for us all to do a little more than put our 2 cents in.
Our health care system is a mess, and while many of us fighting in the trenches and taking care of patients are working to make things better (despite the best efforts of much of the rest of the system), the challenges and …
What do we want our health care system to look like?
Every day, as we care for our patients, we are placed in a unique position, where we are armed with the world of literature, randomized controlled trials, society recommendations, national screening and practice guidelines, and more, working to prompt us to try and do what’s best for each patient in a vast array of clinical situations.
And patients come to us armed …
What do we do when guidelines come crashing into the real world?
Apocryphal story from residency:
On morning rounds in the critical care unit, the post-call resident starts to present a complicated patient admitted overnight with chest pain, and after the first bits of the history have been presented, the wise old cardiology attending turns to the gathered medical students who are just starting their first clinical rotation and asks them what they …
What if EMRs can never capture the clinical experience?
Once again, we find ourselves stuck between a rock and a hard place.
Increasingly, providers are being pressured to improve access for our patients, which we certainly think is a good thing. We want our patients to come in, whether it’s for their annual physicals, for ongoing routine management of their chronic health conditions, or for acute issues best handled in the …
Why increasing patient volume won’t work
To do the math right, you have to get your numerator and denominator correct, or else things just don’t work.
Recently, in the midst of a large patient safety and quality improvement project trying to bridge gaps in breast cancer screening among our patients, we discovered that one of the large databases of patients who were attributed to us contained innumerable …
How one insurer’s mistake wrecked a practice’s quality score
Several patients seen in our practice recently were significantly and dramatically transformed by the electronic health record (EHR). And not in a good way.
Take, for instance, the patient whose outside chart was reviewed when she showed up in our office for a follow-up appointment after an emergency department visit.
The notes from the emergency department providers, including a scribe and the …
The problem with abbreviations in the medical record
86 minutes.
That’s what I found when I added up how late patients were through a single practice session earlier in the week.
Some patients arrived on time, and some a few minutes early, but the average was about 8 minutes late, ranging up to one patient who showed up an hour and 12 minutes after their scheduled appointment time.
The reason I …
Patient care suffers when you squeeze patients into a tight schedule
How do we change the way we think about taking care of patients, particularly when it comes to not the individual patient sitting in front of us, but a whole population of patients just like them (or somewhat like them)?
In our practice, we have been struggling with how to best do population health, trying to find the best ways to …
To do population health right, think about individuals
5,177.
That’s the current number of “cc’ed charts” as of this morning in my electronic health record in-basket.
While it might sound like a lot, this is not at all an unusual accumulation, partly due to the fact that I receive a notation every time a patient at our practice gets a flu shot, and also every time one of my patients or …
Electronic health records: Separating the signal from the noise
“Sorry Dr. Pelzman, just one exam room today.”
This is how our medical technician greeted me as I arrived for my Wednesday morning practice session earlier this week, with a full panel of patients on the schedule set to see me over the next few hours.
Most of them were my own patients, well known to me, but a few were new patients who had been referred by colleagues in our institution, …
Asking primary care clinicians to work harder isn’t a solution
What do our patients really want from us?
When a patient calls up to schedule an appointment, or sends us a message through the patient portal, or calls our front desk staff to leave a message, what is it that they’re looking for?
I think, more than anything else, our patients are looking to us as health care providers to be able to be there for them, to address their health needs …
A smarter EMR will make visits more patient-focused
At a quality and patient safety meeting recently, one of the departments was presenting their annual report on all they have done, reviewing progress that has been made around several quality and patient safety initiatives.
One of their project centered on efforts to decrease an incredibly high no-show rate.
Coupled with their desire to avoid overbooking appointments, the problem has compromised patient access, both for their own established patients and for new …
How can we reduce the no-show rate in primary care?
Nearly a quarter of a century ago (good heavens, I can hardly believe I have to say that!), when I was just starting out as a junior faculty attending, I remember one of my mentors taking me to the hospital with him on morning rounds to see all of his patients who were admitted to the hospital.
He was an eminent cardiologist, incredibly gifted and well-respected, and we walked the wards …
We need to make better use of the health team and technology
Sometimes things go just the way you want them to, and sometimes they don’t.
Compare and contrast the case of two different patients, and how things went trying to get them the care they needed.
The first patient, let’s call him Mr. Smith, called up one day last week with a brand-new symptom, which after a phone call was ultimately determined to be disturbing enough that he was offered a same-day appointment.
After …
When physicians order tests: a tale of 2 patients
Earlier this week, I was pleased to learn that my practice had achieved a statistically significant increase in box clicking.
In reviewing data from our accountable care organization, graphs were shown to us demonstrating improved compliance with several of the measures that they’ve instituted institution-wide for the purpose of reporting back to Medicare on how well we are taking care of our patients.
One of these measures is the ever popular “falls …
Clicking checkboxes doesn’t meaningfully improve care
So many moving parts.
Just last week, a patient I’ve cared for over 20 years came to see me, and she was despondent over a number of issues.
First and foremost was that her partner of over 60 years has had progressive dementia, and finally things got so bad that he had to be transferred to a long-term care facility, no longer safely able to be cared for at home despite all …
Health care has too many moving parts
This was the end-of-the-hallway conversation with an elderly patient after wrapping up a recent office visit, as we walked away from the exam room toward the front desk to schedule her follow-up appointment, and she realized that we were “celebrating” 20 years together.
I met her when she was admitted as an inpatient when I was on service as a junior attending just starting out, and after going home she came …
It’s time for an army of people to help take care of our patients
It’s that time of year again.
The start of a new academic year, marked by the arrival of a brand-new class of interns starting out in their training.
Clutching their freshly-minted medical degrees, they appear so ready, so anxious, so excited, so eager to learn.
Now it’s our job to make sure they stay this way.
(Have I written this column before? Every year …)
We need to make sure we have a world where …
Making the world a better place for new medical interns
As we all know, the time around discharge from the hospital is a tricky one.
In more ways than one can imagine, patients are in a delicate state, judged by those caring for them to no longer be sick enough to need to remain in the hospital, but possibly not quite completely ready to be fully back in the community, on their own at home.
Over the past few years, there have …
A better way to handle patient handoffs from the hospital
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