Physicians writing on KevinMD about the electronic record and artificial intelligence: what the record did to the visit and who it was built for, alert fatigue and pajama time, human and AI scribes and the minutes they actually save, ambient documentation and its audit risk, and what AI can do in clinical practice now, whether it will replace physicians, 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.

Electronic health records cannot replace a doctor who knows you

Health Technology
July 1, 2019

The introduction of electronic health records (EHRs) was accompanied by a great deal of fanfare. Such systems, which replace old paper-based charts in doctor’s offices and hospitals, were designed to make patient data more accurate, safer and more accessible. It was also claimed that they would make it easier for doctors and other health professionals to monitor medical care and ensure that guidelines were followed. The federal government was so …

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Electronic health records cannot replace a doctor who knows you

Why patients should read their medical notes

Physician
June 26, 2019

For centuries, doctors felt that their notes were their property, and none of the patients’ business. This attitude slowly shifted, and the Health Insurance Portability and Availability Act (HIPAA) of 1996 put into law the fact that patients must be allowed to review and get copies of their medical records. Despite this, access to records has remained a daunting task for many. A study done in 2017 of 83 hospitals, …

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Why patients should read their medical notes

When gender identity confuses the electronic health record

Physician
June 5, 2019

One little thing.

Somehow, with the changeover to the latest release of our electronic medical record, something happened to some of the demographic information on our patients. Suddenly, an enormous number of patients were now labeled as choosing not to disclose their gender.

When I first noticed this, it was flagged in bright yellow on the banner in a patient’s chart when I …

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When gender identity confuses the electronic health record

How non-video telehealth can be a cure for overprescribing antibiotics

Health Technology
May 15, 2019

When Dr. Fleming found penicillin mold in his Petri dishes in 1928, he had no idea of the impact he — and it — would have on global health. Penicillin and the antibiotic revolution that it triggered have saved countless lives and change world history.

Less than a century later, though, antibiotics occupy a space between savior and sinner. This complicated reputation is mostly due to how …

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How non-video telehealth can be a cure for overprescribing antibiotics

Electronic medical record interoperability is a total mess

Health Technology
May 14, 2019

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 …

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Electronic medical record interoperability is a total mess

It’s time to teach the elderly about computer safety

Physician
May 9, 2019

Medicare wants doctors to get patients on their computers. Doctors are required to set up computer portals to communicate with patients. These portals use two-factor identification and presume substantial computer literacy from patients in their late 70s or 80s.

Yet, there are limits. For many geriatric patients, a cell phone means a feature phone with gigantic numbers. If they have a computer, it …

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It’s time to teach the elderly about computer safety

AI in medicine: Separate hype from reality

Health Technology
May 1, 2019

As a physician trying to keep up with all the new information about artificial intelligence, I want to know how machine learning and deep learning are impacting medicine now and to separate the hype from reality. Here’s a look at some ways AI is being used successfully in health care and some ways it is not.

AI has been validated for use in interpreting medical scans, pathology slides, and reading electrocardiograms. …

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AI in medicine: Separate hype from reality

Digital health and artificial intelligence provide solutions to the global crisis in surgical care

Health Technology
May 1, 2019

In many countries around the world, women giving birth still face substantial risks to their own lives and that of their baby. Women travel for days to reach facilities that are understaffed, unsafe, and unequipped to provide life-saving surgical care. They are pushed into financial catastrophe as a result of paying for surgical care, if they are able to afford it all, and they return home with little support in …

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Digital health and artificial intelligence provide solutions to the global crisis in surgical care

Sorry doctors, you’re nothing special

Physician
April 25, 2019

When I was a child, I knew I would become a doctor. I liked science and taking care of people. We diagnose medical problems and prescribe treatment plans. Some of us perform surgeries and some focus on keeping you well. Despite this, I’m nothing special, and neither are you, my physician colleagues. Let me explain why by first taking a brief step back into the history of American health care.

Since …

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Sorry doctors, you’re nothing special

Death by 1,000 clicks: Where electronic health records went wrong

Health Technology
April 22, 2019

The pain radiated from the top of Annette Monachelli’s head, and it got worse when she changed positions. It didn’t feel like her usual migraine. The 47-year-old Vermont attorney turned innkeeper visited her local doctor at the Stowe Family Practice twice about the problem in late November 2012, but got little relief.

Two months later, Monachelli was dead of a brain aneurysm, a condition that, despite the symptoms and the appointments, …

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Death by 1,000 clicks: Where electronic health records went wrong

Could patients be their own scribes?

Health Technology
April 11, 2019

One day while on shift in the emergency department, I looked out into the waiting room at the dozens of people waiting to be seen.  Many had been waiting for hours. Some looked bored. Others appeared agitated by the long wait time. One thing that nearly all of them had in common, though, was the presence of a smartphone within arms reach.  I wondered, rather than spending their time mindlessly …

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Could patients be their own scribes?

A physician’s secret to restore joy in the exam room

Physician
March 27, 2019

As someone who has been in the medical field for nearly ten years, I have had the opportunity to follow many physicians. I started off shadowing physicians, standing behind them as they would speak to patients in their rooms.

Now, as a resident physician, I spend hours and hours each week in the clinic seeing my own patients. Every week, I read about burnout and how it affects fellow physicians deal …

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A physician’s secret to restore joy in the exam room

Carefully consider every aspect of the integration of AI into health care

Health Technology
March 23, 2019

AI, artificial intelligence, is all the rage right now in medical news media. And this has many practicing physicians, even medical students, concerned. Will AI make diagnose heavy specialties such as dermatology and radiology obsolete? Can AI give rise to new medical specialties? How many tasks traditionally done by doctors will now be handled by AI?

I believe that there is a right to be worried. We do not have any …

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Carefully consider every aspect of the integration of AI into health care

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Knowing how artificial intelligence works empowers clinicians to be at the forefront of using it

Health Technology
March 22, 2019

Physicians and other health care professionals are uniquely suited to understand artificial intelligence. They’ve studied or routinely use mathematics, data analysis, and algorithms. They comprehend pattern recognition, decision trees, rules-based systems, and statistics. These are the very components of AI.  Perhaps the only thing our premed and medical training didn’t teach us was how to code. But we understand how coding is done. Add to this our training in how …

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Knowing how artificial intelligence works empowers clinicians to be at the forefront of using it

Will blockchain become the coin of the medical realm?

Health Technology
March 18, 2019

First, there was Bitcoin, a cryptocurrency that utilizes blockchain, a decentralized system of data collection and transactions that we are told will defy hacking. (Wasn’t the Titanic said to be unsinkable?) We read that cryptocurrency and other blockchain functions will be a societal gamechanger, much like the internet was when Al Gore invented it some years ago.

My state of Ohio will now accept Bitcoin as payment for commercial taxes.

And, of …

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Will blockchain become the coin of the medical realm?

What if EMRs can never capture the clinical experience?

Health Technology
March 11, 2019

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 …

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What if EMRs can never capture the clinical experience?

The truth about artificial intelligence in medicine

Health Technology
March 10, 2019

For many months, artificial intelligence has been in my peripheral vision, just sitting there, ignored by me because it seemed too far in the future to be interesting now.

And then, there were all these terms — Big Data, machine learning, data science — which circled the subject and, frankly, gave me a bit of a headache.

Artificial intelligence is upon us, unleashed and unbridled in its ability to transform the world. …

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The truth about artificial intelligence in medicine

How telemedicine can help patients and solve physician burnout

Health Technology
March 6, 2019

I have been practicing telemedicine successfully for four years. In 2015, I had to beg doctors to work in telemedicine. Because so many doctors were wary of it, I started to get licensed in multiple states, and now, I have 15 state licenses. Well, what a difference a few years makes. Now, in 2019, I get six to seven Linkedin, Facebook, and Instagram messages a week from physicians asking …

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How telemedicine can help patients and solve physician burnout

What physicians can learn from anthropologists

Health Technology
March 3, 2019

Since the passing of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, it has been said that health tech would dramatically revolutionize health care and the patient experience. Advocates have claimed time and time again that it would advance disease diagnosis capabilities, improve patient outcomes, and increase patient satisfaction. Belief in this narrative can be seen in the sharp increase in health tech investments, with …

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What physicians can learn from anthropologists

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