“There is no document of civilization which is not at the same time a document of barbarism.”
– Walter Benjamin, Theses on the Philosophy of History
It is 1940, and the Nazi horror is bearing down on Europe. France has fallen, and refugees are streaming out, fleeing to safety through neutral states and America. Walter Benjamin, a Jew, and a German philosopher, joins a small group being guided through southern Spain with …
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The metric, the dialectic, and the chart electric
When I began my tenure at the University of Florida, the departure of a colleague left a very large inflammatory bowel disease practice that involved a lot of work both in and outside of clinic, just as the electronic healthcare record became mandatory. One unanticipated consequence of EHR is that physicians have to review everything before it is final in a patient’s chart. Thus, I spent countless hours in the EHR …
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10 signs that you may need a scribe
Computerized physician order entry (CPOE) is something that every physician up and down the country will be familiar with. For anyone non-medical reading this, it’s the process by which physician orders are now placed in nearly all U.S. hospitals. As little as five years ago, most hospitals were still using pen and paper to place medication, laboratory, radiology and all other orders. Being able to do this now by computer …
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This is what CPOE apps should look like
This week is Physicians Week, and this is one in a series of interviews with members of the physician community that are bringing a variety of ideas and networks together in order to improve the relationships between physicians and between physicians and their patients.
Dr. Colm Murphy is a cardiologist and the founder of a tech company that is about building a community of physicians in order for them to help …
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The physician as a health care innovator
Technology has been moving at a lightning pace the past two decades. Technological advancements have crept into every facet of life, from HD screens that now blare ads at us at gas station pumps to disruptive start-ups like Netflix, Airbnb, and Uber, which have rocked entire industries, the air of change is inescapable. The medical field, on the other hand, remains in many ways the same as it has been …
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Medicine is stuck in the dark ages. Here’s why.
The current American climate seems to champion those outside the establishment and eschew the experience of career professionals. Medicine, like politics, has not been immune to the rise of populism. There exists a growing distrust of traditional medical institutions and a movement to concede medical expertise to the public, particularly evidenced by the development of platforms that crowdsource diagnosis. While online medical crowdsourcing is trendy and has received nearly universal …
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The dangers of inexpert diagnosis from a noisy crowd
The SOAP note isn’t what it used to be. And what it has become needs to be scrapped, because it has made the office practice of medicine cumbersome and unsafe.
In simpler times, when medical records were written by and for doctors, the SOAP note represented a significant leap forward in expanding and organizing office notes and also notes from emergency rooms and walk-in clinics. Before that notes sometimes only documented …
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EMRs are dangerous. Let’s change that.
One of the topics I write most about and have also done a considerable amount of consulting work on is improving and optimizing health care information technology. I hate to say it, but after a few years of doing this, I’m starting to despair a little from what I’m seeing. It’s a question I never thought I’d ask: But will health care IT ever really get to where it should …
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3 reasons why health care IT will always be terrible
In 1949, my maternal grandparents left everything and everyone they knew — a happy family, a comfortable home, a thriving medical practice — to travel further across the Earth than any of their family ever had before, to come through Ellis Island, and to trek to the Mayo Clinic so my grandfather could become a pioneering anesthesiologist.
Twenty-one of my aunts, uncles, and cousins have since followed in their footsteps and …
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Immigrants make America great
Compare the following two versions of the same medical history:
Version 1
CC: chest pain
Mr. Smith is a 57-year-old white man who comes into the office today for the first time with a complaint of chest pain. He states he has been in generally good health in the past, though he has smoked about 40 pack-years and admits to not exercising much, other than occasional games of golf. He has trouble keeping …
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What’s better: Narrative medical histories or checkboxes?
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
Another year passed by, and I was going to write about my wishes for the New Year as a hospital doctor. But then, remembered that I did something very similar a couple of years ago. I went back and read over my wishes and found that they are identical to my wishes now! That’s not to say we haven’t made some great progress but — as anyone in health care …
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My top 5 wishes for health care in 2017
The Centers for Medicare and Medicaid Services (CMS) EHR Incentive Program — also known as meaningful use (MU) — initially provided incentives to accelerate the adoption of electronic health records (EHRs) to meet certified program requirements. Many physicians were mandated to change over to electronic records at the cost of tens of thousands of dollars. Electronic records have never been shown to improve patient care or outcomes with statistical significance, …
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Meaningful use: A view from the penalty box
Anyone with a computer or smartphone is well aware of the incessant alerts that flash across the screen, often accompanied by a beep or exclamation point. The alert may be for an upcoming appointment, a reminder of an acquaintance’s birthday — or a just-announced sale at your favorite online retailer.
How many of these alerts are really important? It’s easy to ignore a media news flash — but what if you …
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EMR alert fatigue: Can we learn from the aviation industry?
The notion began early in computer science class during Jason’s freshman year. The professor had noticed a certain elegance and zeal in his work and suggested medicine. That was in the days of the giants when clinicians were tied to such clunky programs as meaningful use and PQRS. In this antiquated milieu, Jason cut his teeth on basic health care architecture.
In those prehistoric years, there still remained a bias toward …
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The data was suffering. And it cleaved at this doctor’s soul.
I remember the disdain some of the EHR trainers had for their trainees back when our hospital system “went live” several years ago. Of course, this disdain was tempered by their knowledge that if docs weren’t so computer illiterate, or the user interfaces of the EHR systems weren’t so awful, or if the EHR software wasn’t so bug-ridden, their jobs wouldn’t exist.
So they soldiered bravely on, undaunted by grumpy old …
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Tech-savvy docs need to be on the forefront of EHR reform
It happened again. Yesterday, I was charting on the recently launched streamlined version of our electronic health records and a new note popped up in the right lower corner of the screen:
“Welcome to (our new texting system). Now you can instantly and securely text about patient care with all of your colleagues.”
A few seconds later, a message popped up. “You have one unread message.” As with most other communication systems, …
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The communication revolution in health care may be doing more harm than good
Customer service is all the rage these days in most facets of our lives. America leads the world in this area (however much of the public here take it for granted). I’ve traveled all over the world, and the concept of customer service in many other parts of the globe, including highly advanced and prosperous other Western nations, still leaves a lot to be desired. It’s always reassuring to know …
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Physicians take note: Get personal with your patients
One of the topics that I write most about is the interaction of health care information technology with frontline clinical medicine, which I believe to be among the most critical issues facing the practice of medicine at the moment. With statistics now suggesting that doctors (and nurses) are spending an absolute minimal amount of their day engaging in direct patient care — some research suggesting as little …
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Will technology destroy the art of medicine?
