On Monday March 30, 2015 our Greenway PrimeSuite electronic health record had a system-wide failure at the level of the Edgemed Computer service center in New York State. It meant that I was back to using pencil and paper to interview patients and record the answers and physical findings.
With much trepidation, I began seeing patients with two sheets of white blank …
I temporarily went back to paper records. And it wasn’t so bad.
A guest column by the American College of Physicians, exclusive to KevinMD.com.
So far, 2015 has been a busy year for reflecting on the use of electronic health records (EHRs). CMS just released its proposed rules for meaningful use stage 3. One might say that “MU 3” supports the belief that the sequel is never …
A recent piece in the New York Times profiled a young man with a remarkable medical history, and an equally remarkable approach to sharing it. I think it raises some profound issues regarding the self-monitoring movement and the “ownership” of patients’ health information, both of which have the potential to change our traditional practices in a big way.
The guy — Steven Keating — is not your average Joe. He is a …
Is it time to surrender control of the medical record?
I drank the Kool-Aid early. We installed our first EHR in 1996 with me doing the lion’s share of pushing and pulling. While I’d ultimately turn my back on this passion, I had a number of notable accomplishments before walking down my road to Damascus.
What does real meaningful use of an electronic record look like? Not like this.
The nightmare sickens me. A small child trusts a man to protect her, take care of her, and shield her from harm. The man, for incomprehensible and useless reasons, neglects her unto death. For me, when I think of Germanwings flight 9525, I am haunted by the photo of a single tiny girl, taken in the last days of life; the obliteration of that perfect life’s potential. Waste, tragedy, evil.
In the …
As the doctor exits, what does it mean for the humanity left behind?
On March 20, 2015 the stars aligned to produce four simultaneous events that will never again coincide during the life of human civilization. The first three, the vernal equinox, a total solar eclipse and a new supermoon, were brought to us by the stars themselves, and the fourth one was thrown out there by the government. The regulations for meaningful use stage 3 were finally published. Meaningful use of electronic health …
What does meaningful use stage 3 mean to you?
Sometimes, after crafting an important or complex plan of care with a patient, I say: “Let me type all this into the computer so that, in case I run into that big bull moose up on Vaillancourt Hill on my way home tonight, the next doctor who sees you will know what we were thinking today.”
Patients sometimes squirm or laugh nervously at that, but then they usually indicate understanding and …
With the EMR, you have to work backwards from the superbill
As medical providers, we recognize the value and importance of emergency medical identification (EMI), especially for our patients who live with chronic medical conditions, such as diabetes, epilepsy, and severe allergies. Of particular concern are those who may require emergency care during a time when they are unable to communicate, but how often do we address this topic with our patients, and do they really listen?
Health care professionals have long recommended that such patients obtain emergency medical identification, such as MedicAlert jewelry (bracelet, …
Access your emergency medical identification via smartphone
Where does doctor stop and computer begin? Who is in charge? Do we care? Are these silly, academic questions from some sci-fi future or is it an onrushing tomorrow?
Consider:
Where does the doctor stop and computer begin?
Right now, there are two patients in every room. One is made with flesh, bones, and blood. One is made with a monitor, a mouse, and a keyboard.
Both demand my time.
Both demand my concentration.
A little over two weeks ago I wrote the short story “Please Choose One.” I posted it online. The response it generated exceeded anything I …
To health IT: You are the ones who can save us
I am a clinician and a clinical trialist. Medical research in some form or another (performing it, consuming it, reviewing it, editing it, etc.) occupies much of my time. Therefore, you can imagine my excitement while watching Apple’s product announcement when they introduced a new open source software platform called ResearchKit. Apple states ResearchKit could “revolutionize medical studies, potentially transforming medicine forever.”
ResearchKit allows clinical researchers to have data about various diseases …
Apple’s ResearchKit has problems. Can they be fixed?
Andy McAfee is the associate director of the Center for Digital Business at MIT’s Sloan School of Management. He is also coauthor (with his MIT colleague Erik Brynjolfsson) of the 2014 book, The Second Machine Age: Work, Progress, and Prosperity in a Time of Brilliant Technologies, one of my favorite books on technology. While he sits squarely in the camp of “technology optimists,” he is thoughtful, appreciates the downsides of IT, and …
What does a technology optimist think about the future of health care?
I have a unique perspective as a physician. Having traveled to many hospitals in the past two years, working as a locums emergency physician, I can comment on a variety of issues with a reasonable amount of experience.
One of those issues is EMR, or electronic medical records. I have spent plenty of time writing about this in the past, and I …
Pay doctors and nurses for the time they spend charting
ADVERTISEMENT
Please choose one:
The three words blink in front of me on the computer screen.
Please choose one:
Patient is-
☐Male ☐Female
I click FEMALE.
I watch as the auto-template feature fills in the paragraph for me based on my choices.
Patient #879302045
Patient is: 38-year-old female status post motor vehicle accident. Please acknowledge you have reviewed her allergies, medications, and past medical history.
I click YES.
Have you counseled her about smoking cessation?
I click NO.
A little, animated icon of a …
Despite the well-known rollout problems for hospitals and clinics across the nation, there are many palpable and welcome advantages to using electronic health records.
Chief among these are the ability to access the chart from anywhere, rapidly search for information needed, and reducing the centuries-old problem of illegible doctors’ handwriting. But with the good comes the bad, and in these still relatively early stages of health care information technology adoption — …
How can we make the EMR note more legible? Here are some ideas.
The other day I ordered a CT scan with contrast on a patient with an apparent mass on his neck. I explained about the need to get a blood test to make sure his kidneys could handle the iodine contrast. Because our lab was closed, I had to print a requisition for him to bring to the hospital lab.
Printing a requisition from our EMR is a multi-step process that involves …
Today’s EMRs: Extra work with uncertain benefits
First off, this is the first time I have typed an official response to a blog post: “Dear health IT: Please understand our frustrations.” You might think, hey aren’t you a millennial, shouldn’t you be blogging non-stop? Like doing everything from my taxes to baking with my smartphone? No, not really; besides residency doesn’t make it very feasible either.
Yet, the need to respond to Dr. Leap’s blog post was …
The cumbersome EHR: It’s time to implement solutions
Remember the Latin phrase “Primum non nocere”? It means “First, do no harm.” Most of us physicians committed to it when reciting the Hippocratic Oath, back when we were first embarking on our careers in medicine.
Sadly, today’s technology threatens this sacred physician-patient relationship. Electronic health records (EHRs), although much-needed, have created perverse, unintended consequences for the patient experience.
To be clear, EHRs are inherently good. They’re the backbone of better-coordinated care, …
The documentation solution your patients want you to adopt
It has been quite a year. Between 3 main hospitals, 2 major medical institutions and 3 major healthcare networks, our practice has been on 3 different echocardiographic reading platforms, 3 ECG reading platforms, and 8 different electronic health record systems including 4 instances of Epic alone. I am typically enthusiastic to a fault about new technologies and, time after time, have rushed in, often where angels feared to tread. I …
Today’s EHRs: No doctor left behind
Meaningful. Having a serious, important, or useful quality.
You know this word because you want it to define your life. Nearly all of us, at some point, will seek a more meaningful existence. Most wish our jobs were that way too.
Meaningless. Having no purpose or reason. Ouch. We don’t want anything to do with that. Meaningless makes us question what in the …
The sad, tragic road to meaningful use
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