John Halamka, MD
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Latest articles
Health technology
With the Department of Justice announcement of the $155 million dollar eClinicalWorks settlement (including personal liability for the CEO, CMO and COO), many stakeholders are wondering what’s next for EHRs. Clearly, the industry is in a state of transition. eCW…
With the Department of Justice announcement of the $155 million dollar eClinicalWorks settlement (including personal liability for the CEO, CMO and COO), many stakeholders are wondering what’s next for EHRs.
Clearly, the industry is in a state of transition. eCW will be distracted by its 5-year corporate integrity agreement. AthenaHealth will have to focus on the activist investors at Elliott …
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The future of EHR: Here are 5 predictions
Health technology
At HIMSS, I listened carefully to payers, providers, patients, developers and researchers. Below is a distillation of what I heard from thousands of stakeholders. It is not partisan and does not criticize the work of any person in industry, government…
At HIMSS, I listened carefully to payers, providers, patients, developers and researchers. Below is a distillation of what I heard from thousands of stakeholders.
It is not partisan and does not criticize the work of any person in industry, government or academia. It reflects the lessons learned from the past 20 years of health care IT implementation and policy making. Knowing where we are now and where we want to be, …
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10 crucial guidelines for health care IT
Health technology
As I've listened to the confirmation hearings for cabinet nominees, I’ve realized that no one with health care IT expertise has been identified by the transition team. I continue to ask all my colleagues about any contact they’ve had with…
As I’ve listened to the confirmation hearings for cabinet nominees, I’ve realized that no one with health care IT expertise has been identified by the transition team. I continue to ask all my colleagues about any contact they’ve had with anyone advising the new administration. So far, no one has been asked anything by anyone related to health care IT.
At this early time in the administration, it’s important to offer …
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5 health care IT tips for President Trump
Health technology
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…
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 …
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Where does health care IT hurt? Everywhere.
Health technology
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…
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 …
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What will the Trump era bring to health IT?
Health technology
Recently, the American Medical Association CEO called digital health care products modern day "snake oil." As a provider and a technologist, I think we need a deeper dive to understand the issues, avoiding the kind of hyperbole that’s so common…
Recently, the American Medical Association CEO called digital health care products modern day “snake oil.”
As a provider and a technologist, I think we need a deeper dive to understand the issues, avoiding the kind of hyperbole that’s so common in politics today.
Paul B. Batalden, MD, Senior Fellow, Institute for Healthcare Improvement (IHI), once said “Every system is perfectly designed to get the results it gets.”
Let’s take …
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Is health IT modern day snake oil?
Health technology
When my father died three years ago, my comments at his funeral noted that the greatest aspiration any of us can have is to make a difference in the world. My father’s life made a difference. I’m always self-critical and…
When my father died three years ago, my comments at his funeral noted that the greatest aspiration any of us can have is to make a difference in the world. My father’s life made a difference.
I’m always self-critical and analyzing my own life. I moved to Boston 20 years ago this month. In those 20 years of service to Beth Israel Deaconess Medical Center (BIDMC), Harvard, numerous federal organizations, …
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Where will health IT innovation come from?
Health technology
Over the past several years I’ve written about the inadequate state of clinical documentation, which is largely unchanged since the days of Osler, (except for a bit more structure introduced by Larry Weed in the 1970s) and was created for…
Over the past several years I’ve written about the inadequate state of clinical documentation, which is largely unchanged since the days of Osler, (except for a bit more structure introduced by Larry Weed in the 1970s) and was created for billing/legal purposes not for care coordination.
One of the most frequent complaints in my email box these days is a sense that the current record is filled with data, but little knowledge and …
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Ebola forces us to rethink how we document in the EMR
Health technology
Over the past few months, Beth Israel Deaconess Medical Center (BIDMC) has been exploring the use of wearable computing. In the emergency department we’ve been evaluating an early unit of Google Glass, a high tech pair of glasses that includes…
Over the past few months, Beth Israel Deaconess Medical Center (BIDMC) has been exploring the use of wearable computing.
In the emergency department we’ve been evaluating an early unit of Google Glass, a high tech pair of glasses that includes a video camera, video screen, speaker, microphone, touch pad, and motion sensor.
We have been able to access our internal web-based ED dashboard on Glass, in a secure manner that ensures all …
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The logistics behind Google Glass in the ER
Health technology
Over the next few months, Jacob Reider will serve as the interim National Coordinator for Health Information Technology (ONC) while the search continues for Farzad Mostashari’s permanent replacement. What advice would I give to the next national coordinator? David Blumenthal…
Over the next few months, Jacob Reider will serve as the interim National Coordinator for Health Information Technology (ONC) while the search continues for Farzad Mostashari’s permanent replacement.
What advice would I give to the next national coordinator?
David Blumenthal led the ONC during a period of remarkable regulatory change and expanding budgets. He was the right person for the “regulatory era.”
Farzad Mostashari led ONC during a period of implementation when resources peaked, grants were …
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Advice to the next national coordinator for health IT
Physician voices
Now that Labor Day has come and gone, I’ve thought about the months ahead and the major challenges I’ll face. 1. Mergers and acquisitions. Health care in the US is not a system of care, it’s a disconnected collection of…
Now that Labor Day has come and gone, I’ve thought about the months ahead and the major challenges I’ll face.
1. Mergers and acquisitions. Health care in the US is not a system of care, it’s a disconnected collection of hospitals, clinics, pharmacies, labs, and imaging centers. As the Affordable Care Act rolls out, many accountable care organizations are realizing that the only way to survive is to create “systemness” through mergers, …
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What keeps this hospital CIO up at night
Health technology
I recently had the opportunity to test Google Glass. It’s basically an Android smartphone (without the cellular transmitter) capable of running Android apps, built into a pair of glasses. The small prism “screen” displays video at half HD resolution. The…
I recently had the opportunity to test Google Glass.
It’s basically an Android smartphone (without the cellular transmitter) capable of running Android apps, built into a pair of glasses. The small prism “screen” displays video at half HD resolution. The sound features use bone conduction, so only the wearer can hear audio output. It has a motion sensitive accelerometer for gestural commands. …
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5 ways Google Glass can be used in a hospital
Health technology
In the Boston marketplace, Partners Healthcare is is replacing 30 years of self developed software with Epic. Boston Medical Center is replacing Eclipsys (Allscripts) with Epic. Lahey Clinic is replacing Meditech/Allscripts with Epic. Cambridge Health Alliance and Atrius already run…
In the Boston marketplace, Partners Healthcare is is replacing 30 years of self developed software with Epic. Boston Medical Center is replacing Eclipsys (Allscripts) with Epic. Lahey Clinic is replacing Meditech/Allscripts with Epic. Cambridge Health Alliance and Atrius already run Epic. Rumors abound that others are in Eastern Massachusetts are considering Epic. Why has Epic gained such momentum over the past few years?
Watching the implementations around me, …
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Boston hospitals go Epic: Hear from a holdout
Physician voices
Recently, my family and the hospital care team have been guided by my father's healthcare proxy to avoid painful, invasive, or aggressive care at time when his multiple medical issues have combined to make his health decline irreversible. The healthcare…
Recently, my family and the hospital care team have been guided by my father’s healthcare proxy to avoid painful, invasive, or aggressive care at time when his multiple medical issues have combined to make his health decline irreversible.
The healthcare proxy was extremely clear and enabled us to finalize the do not resuscitate and do not intubate orders. We agreed to stop monitoring and stop all medications except …
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Comfort care goes beyond DNR orders
Health technology
Earlier this year, my team presented a list of risks to the Compliance, Audit and Risk Committee at BIDMC. Here's my list of top risks for 2012: 1. Old Internet browsers. Many vended clinical applications require specific versions of older…
Earlier this year, my team presented a list of risks to the Compliance, Audit and Risk Committee at BIDMC. Here’s my list of top risks for 2012:
1. Old Internet browsers. Many vended clinical applications require specific versions of older browsers such as Internet Explorer 6, which are known to have security flaws. We’ve worked diligently to eliminate, upgrade or replace applications with browser specificity. At this point we …
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What keeps a hospital CIO up at night
Health technology
The Internet can be a swamp of hackers, crackers, and hucksters attacking your systems for fun, profit and fraud. Defending your data and applications against this onslaught is a cold war, requiring constant escalation of new techniques against an ever…
The Internet can be a swamp of hackers, crackers, and hucksters attacking your systems for fun, profit and fraud. Defending your data and applications against this onslaught is a cold war, requiring constant escalation of new techniques against an ever increasing offense.
Clinicians are mobile people. They work in ambulatory offices, hospitals, skilled nursing facilities, on the road, and at home. They have desktops, laptops, tablets, iPhones and iPads. Ideally …
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Protecting health apps on the web from the evils of the Internet
Health technology
In a meeting with senior management at Harvard Medical School, one of our leaders asked, "What is our cloud strategy?" My answer to this is simple. The public cloud (defined as the rapid provisioning and de-provisioning of CPU cycles, software…
In a meeting with senior management at Harvard Medical School, one of our leaders asked, “What is our cloud strategy?”
My answer to this is simple. The public cloud (defined as the rapid provisioning and de-provisioning of CPU cycles, software licenses, and storage) is good for many things, such as web hosting or non-critical applications that do not contain patient or confidential information.
At Harvard Medical …
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Public and private cloud computing at a hospital
Health technology
I'm often asked how healthcare reform will impact IT planning and implementation over the next few years. First, some background. The Patient Protection and Affordable Care Act (HR 3590) and Health Care and Education Reconciliation Act (HR 4872) were passed…
I’m often asked how healthcare reform will impact IT planning and implementation over the next few years.
First, some background. The Patient Protection and Affordable Care Act (HR 3590) and Health Care and Education Reconciliation Act (HR 4872) were passed to address several problems with healthcare in the US. We’re spending 17% of our …
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Top IT implications of healthcare reform
Drugs and prescribing
Recently, I spent a few days in California when both my parents ended up in the hospital with different issues. They're home, settled and doing well at this point. Just as when I first wrote about experiencing healthcare with my…
Recently, I spent a few days in California when both my parents ended up in the hospital with different issues. They’re home, settled and doing well at this point.
Just as when I first wrote about experiencing healthcare with my family, there are important lessons to learn about this trip.
As we strive to achieve meaningful use and create health information exchange in the US, the …
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Medication lists need to be shared in a meaningful way
Health technology
As State Health Information Exchanges and Federal efforts (NHIN Connect/NHIN Direct) implement the data sharing technology that will enable all providers in the country to achieve Meaningful Use Stage 1, I'm often asked "but when will this healthcare information exchange…
As State Health Information Exchanges and Federal efforts (NHIN Connect/NHIN Direct) implement the data sharing technology that will enable all providers in the country to achieve Meaningful Use Stage 1, I’m often asked “but when will this healthcare information exchange technology be able to retrieve all my records from everywhere when I’m lying unconscious in the Emergency Department and cannot give a history?”
Here are …
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What meaningful use stage 1 will mean to patients
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