Margalit Gur-Arie

Margalit Gur-Arie is founder, BizMed. She blogs at On Health Care Tech & Policy.

EMRs cannot fix the financial and physical health of the nation

Tech

March 9, 2013

Somewhere between the 20th century bank ATM and the 25th century Tricorder, lays the EMR that we should have today. Somewhere between the government-designed meaningful use EMR and the holographic doctor in Star Trek, there should be a long stretch of disposable trial-and-error cycles of technology, changing and morphing from good to better to magical. For this to happen, we must release the EMR from its balls and chains.

We must …

How pushing the Triple Aim ignores doctors and their patients

Margalit Gur-Arie

Policy

February 9, 2013

Better Care for Individuals, Better Health for Populations, and Lower Per Capita Costs
–ihi.org

If you stop to think about the holy grail of health care reform, also known as the Triple Aim, it sounds like a grand challenge involving wizardry or wishful thinking or worse, propaganda for the masses, particularly the last part. It’s like attempting to build a better driving machine, with better fuel efficiency at lower cost. …

Is consolidation the answer to healthcare’s fragmentation problem?

Margalit Gur-Arie

Policy

January 29, 2013

Adam Smith would disagree, Karl Marx would be appalled, and heck even Milton Friedman and Ayn Rand would be raising objections. But for some peculiar reason, there are enough contemporary lesser economic minds scattered throughout the entire philosophical spectrum, that are advocating for, and enabling the execution of, a government induced transition of our health care system to an oligopoly model …

Computers are meaningless in health care without computable data

Margalit Gur-Arie

Tech

January 12, 2013

If this were a business concerned with bottom lines, cash flows and sustainability, this would be a good time to begin planning one of those posh executive retreats to evaluate current strategy. People would be feverishly working on pulling data for PowerPoint presentations, summarizing market research and deciding whether to select the vegetarian meal or not. If this were a better …

The EHR user interface and my personal moment of Zen

Margalit Gur-Arie

Tech

December 2, 2012

Every time someone publishes an article or a paper or a blog post that has anything remotely to do with electronic health records (EHR), there is usually a flurry of reactions in the comments section, now available in most publications, and these always include at least half a dozen anonymous statements, usually from clinicians, decrying the current state of EHR software, best summed up by a commenter on THCB: “It …

The futile attempt to provide cheaper care to poor people

Margalit Gur-Arie

Policy

November 20, 2012

Wherever health care reformation and transformation is discussed, sooner or later the imperative of patient engagement is sure to materialize. Patients, it seems, are no longer content to be passive spectators while care is administered to them, and instead are demanding to be active participants in their own health care decisions. Gone are the paternalistic days of doctor knows best, replaced by informed and educated patients on an equal footing …

Stop penalizing doctors for effectively using EHRs

Margalit Gur-Arie

Tech

October 31, 2012

The health care crowd is abuzz with the New York Times revelation that Medicare billing rates seem to have increased by billions of dollars in parallel with increased adoption of EHR technologies for both hospitals and ambulatory services. The culprit for this unexpected increase is the measly E&M code.

Evaluation and Management (E&M) is the portion of a medical visit where the doctor listens to your description of …

Why venture capitalists shouldn’t try to solve health care

Margalit Gur-Arie

Tech

October 24, 2012

I recently wrote a post about the clueless, but endearing, enthusiasm of technology people as applied to solving the health care problem.

Dr. Davis Liu published a post describing the vision of Vinod Khosla, the famed venture capital maven, of replacing doctors with machines. It turns out that Mr. Khosla wrote a series of three articles at the beginning of the year in a technology …

Health IT: We can fix health care, and we know exactly how to do it

Margalit Gur-Arie

Tech

September 27, 2012

High tech people are very enthusiastic people. We are optimistic, confident and creative and if I may be allowed to say so, really, really smart. We start out by saying “Hello World!” not “Hi, I’m Jack or Jane”. We hail the entire Universe and assume it knows who we are, or that it will soon find out, because the sky is not the limit and we are going to change …

Striking the balance between the public good and patient privacy

Margalit Gur-Arie

Tech

September 6, 2012

Everybody has a shadow. Although as a small child you may have tried, you cannot separate yourself from your shadow no matter what you do. Electronic medical records may be the first tiny step on the road to attaching yet another indivisible part to your persona, a “panoramic, high-definition, relatively comprehensive view of a patient that doctors can use to assess and manage disease”, and this, in the words of …

How adopting an EHR is like treating cancer

Margalit Gur-Arie

Tech

January 31, 2012

EHRs are not ready for prime time. EHR benefits are questionable and there are documented instances where patients’ deaths were directly attributed to an EHR. EHRs are cumbersome and slow. They are unnecessarily complex and built on very old technology. The people who build EHRs have no concern for the end user and therefore EHR usability is pretty abysmal. And EHRs are expensive to buy and expensive to maintain, not …

Tips for doctors looking for the right EHR

Margalit Gur-Arie

Tech

September 3, 2011

Here we are going to talk about the second stage of shopping for an EHR. We are going to assume that you did your homework, defined your goals and constraints and prepared a comprehensive list of requirements for an EHR (if you have not done so already, go back and read part 1).

To continue our car shopping analogy, we are now ready to go kick some tires, and …

How shopping for an EHR is like buying a car

Margalit Gur-Arie

Tech

June 10, 2011

So you’ve been hearing all about the recent EHR buzz and decided to give it a try.

Whether you are convinced that electronic records are the way to go, or you have reached a point where you are willing to give it a try, the first thing to do is buy one of those EHRs. You may be staring at a glossy brochure or website featuring a distinguished silver-haired doctor …

EHR and the solo primary care physician

Margalit Gur-Arie

Tech

March 25, 2011

Recently, I went to see a doctor about an EHR. Dr. Greene (not his real name) is a typical solo primary care physician in a typical small town in the typical middle of nowhere. Four hours from the closest airport and miles and miles of winding roads, cow pastures and corn …

Read more…

EHR and the solo primary care physician

EHR data is currently ill suited for clinical research

Margalit Gur-Arie

Tech

January 20, 2011

One of the most promising uses of Electronic Health Records (EHR) is research.

As EHRs become more and more widespread and the clinical data previously held in silos of paper charts becomes fluid, exchangeable and duly collected, large clinical repositories should emerge and be made available to those engaged in research, presumably medical research. The results of such research are expected to help us identify cost effective therapies, health care trends …

Trust your life records to an unnamed chain of software vendors

Margalit Gur-Arie

Tech

November 21, 2010

Every day millions of Americans and billions of people around the globe are routinely accepting colorful pieces of paper in return for their labor and placing those hard earned possessions in modern glass buildings whose owners they do not know.

It took a few hundred years to change how business transactions are conducted, but today, there is very little apprehension about depositing one’s wealth in a bank. Public trust in both …

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

Margalit Gur-Arie

Tech

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 …

Computerized Physician Order Entry (CPOE) affects patient safety

Margalit Gur-Arie

Tech

August 29, 2010

Recently, yet another alarming Computerized Physician Order Entry (CPOE) study made headlines.

According to Healthcare IT News, The Leapfrog Group, a staunch advocate of CPOE, is now sounding the alarm on untested CPOE as their new study “points to jeopardy to patients when using health IT.” Up until now we had inconclusive studies pointing to increased and also decreased mortality in one hospital or another following CPOE implementation, but …

Should we worry about physician privacy in the EHR era?

Margalit Gur-Arie

Tech

July 28, 2010

As we move to electronic health records (EHR), the debates over security and privacy are becoming more frequent and more poignant.

We of course have HIPAA laws on the books and Office of the National Coordinator for Health Information Technology (ONC) has a Tiger team assembled to recommend privacy and security policies to Secretary Sebelius.

CIOs and entire IT departments are all focused on protecting the privacy of patients and their Personal …

How EMR and EHR systems can kill patients

Margalit Gur-Arie

Tech

June 29, 2010

Back in the times when EHRs were just EMRs, they had a very simple and humble mission.

The software was supposed to help providers of health care services better manage their business. EMRs were supposed to help physicians adhere to CMS documentation rules, automate patient flow management and get rid of all the mountains of paper floating around a typical medical office or hospital. It was assumed that EMR software will …

Margalit Gur-Arie

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