Dear health IT staff,
I know that, on many levels, physicians must be the absolute banes of your existence. We are grumpy and resistant to change. And some of us are still confused by graphing calculators, much less complex modern computer systems. We call you because we forgot our passwords, then because we forgot the new passwords. We call because the system …
Dear health IT: Please understand our frustrations
Of the nearly 100 people I interviewed for my upcoming book, John Halmaka was one of the most fascinating. Halamka is CIO of Beth Israel Deaconess Medical Center and a national leader in health IT policy. He also runs a family farm, on which he raises ducks, alpacas and llamas. His penchant for black mock turtlenecks, along with his brilliance and quirkiness, raise inevitable comparisons to Steve Jobs. I interviewed him …
The marriage between technology and medicine: An interview with John Halamka
Citing slow load times, confusing menu structure, and overall frustration with the user interface, St. Barnaby’s Hospital has announced that the old electronic health record (EHR) will be replaced with a new state of the art binder-based system, in which a so-called “paper chart” is kept for each patient.
The new …
Hospital replaces EHR with new, efficient “paper chart” system
Most readers know that an EMR (electronic medical record) is the back-end software that runs a health care organization. EMRs have been around for a while. Recently most large hospitals and health systems have begun building out the patient-facing version of their EMR; allowing patients to communicate electronically with their doctors, refill prescriptions, schedule appointments, and view clinical information.
I’ve written at length about the differences between B2B software and B2C …
Patient portals and EMRs: Each requires a different skillset
I think it’s fair to say that digital health is warming up. And not just in one area. The sheer number and variety of trends are almost as impressive as the heat trajectory itself. The scientist in me can’t help but make the connection to water molecules in a glass — there may be many of them, but not all have enough kinetic energy to ascend beyond their liquid state. …
Digital health in 2015: What’s hot and what’s not?
Happy 2015! Health care in the United States continues to change faster than any of us can keep pace with and this shows no signs of slowing down. Having written a lot in 2014 on a variety of different topics, I wanted to focus on my own 5 wishes for hospital care this New Year. A lot of you may think that what you’re about to read sounds like wishful …
5 health care wishes for the New Year
If you delve into the personal stories of health IT innovators, most journeys rest on their personal interaction with the health care system on behalf of themselves, a parent, a child, or perhaps a sibling. Just a few weeks ago, I had a small interaction with the health care system that confirmed many of the impressions I have developed of providers’ strengths and weaknesses.
There’s no way to start except with …
How health IT fails transgender patients
While the electronic medical record (EMR) has advantages, it also has introduced liability risks. EMRs can lead to lawsuits or result in a weak defense by casting the physician in an unfavorable light.
For example, examine these exchanges in a recent malpractice trial:
EMRs can hurt physicians during lawsuits. Here’s how.
One of my patients got admitted this past week. As a new attending, this is still an unpleasant experience. Have I failed? Is there more I could have done to prevent this? I have to say that this particular case wasn’t shocking. The patient hadn’t been doing well lately, and I wasn’t surprised when I got the message that they were on the way to the emergency room.
Due to our …
Primary care is a story of misaligned incentives
On a 12-hour shift in the hospital, I recently spent a mere hour with patients, with the rest glued to a computer screen, to the “iPatient.” When a patient comes to the hospital, speaking to them has become an afterthought to reading extensive medical records, physical exam findings from the emergency room, and synthesizing laboratory data. I, as a millennial doctor, have been on the cusp of this shift. My …
Do electronic records change the way doctors think?
It is a heart pounding, head spinning, edge of your seat page-turner; the sort of rare saga that takes your breath away as it changes you, forever. It hints at a radically different future, a completely new world a few years away, which will disrupt the lives of every man, woman, and child. Available now, from the National Coordinator for Health Information Technology (ONC), Office of the Secretary, United States …
Health IT will radically transform medicine. Is it for the better?
Doctors and hospitals often exist in a universe parallel to the consumers, patients, and caregivers they serve, a prominent chief medical information officer told me last week. In one world, clinicians and health care providers continue to implement the electronic health records systems they’ve adopted over the past several years, respond to financial incentives for meaningful use, and re-engineer workflows to manage the business of health care under constrained reimbursement.
In …
A lot has been written about how awful electronic health record (EHR) systems are. They are overwrought, overengineered, dreadfully dull baroque systems with awkward user interfaces that look like they were designed in the early 1990s. They make it too easy to cut and paste data to meet billing level requirements, documenting patient care that never happened and creating multipage mega-notes, full of words signifying exactly nothing.
They have multitudes of …
EHRs: It’s time to start from scratch
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As I watch the business world’s fascination with the electronic medical record (EMR) and all of the big data that it accumulates, I see more and more processes codified and treatment pathways carefully honed. Only one small thing remains until the computer can tell doctors how to behave based on the developed algorithms: To turn free text in the patient chart …
Who needs doctors at all if care is reduced to point and click?
I once wrote about the communication difficulties caused by electronic medical records systems. The response on Twitter ranged from sentiments including everything from “right on, sister” to “greedy doctors are only complaining about EMRs because of their price tag.” The disconnect between policy wonk’s (and EMR vendor’s) belief in the transformative power of EMRs and exasperated clinician users of these products is jaw-dropping. Physicians are often labeled as obstinate dinosaurs, blocking progress, while policy wonks …
What happens to medical notes today’s EMRs
A common complaint regarding the use of electronic medical records (EMRs) is that physicians spend the majority of their time with a patient “tinkering” on a computer rather than interacting with the patient.
Use of EMRs is now mandatory in the U.S., creating many advantages: Patient information can be more easily shared in a secure environment, there are no lost files or …
Medical scribes are a solution to click overload
An article from the JAMA has been gnawing at my consciousness for the last couple of weeks. Dr. Prashant Kaul and colleagues out of the University of North Carolina reviewed records from hospitals in the state of California from 2008 through 2011, looking for patients who had been hospitalized with heart attacks. Specifically, they were looking for patients with ST elevation …
Why does treating heart attacks cost so much money?
The job of a nurse has changed dramatically over the last couple of decades. I’ve witnessed these changes at close quarters and heard feedback from nurses in several different hospitals. The biggest change undoubtedly is the interaction with information technology and the move away from paper charting.
The theory behind this push, which is part of the federal government’s meaningful use policy, …
3 ways to make health IT work better for nurses
By the time the next decade rolls in there will be no paper charts. There will probably still be paper floating around in various capacities, but there will be no one charting on paper. The term “charting” itself may become obsolete, like yonder or popinjay. The term EHR, which is what replaces the paper chart, won’t last either because it doesn’t …
EMRs remove the soul of the medical record. So, what’s next?
In recent months, Silicon Valley has surpassed Hollywood as America’s home for high-profile split ups.
Last month, computer security giant Symantec announced its intentions to split in two. And three days before that, HP announced plans to divide up into parts. In September, eBay announced its intention to spin off PayPal.
With enough twists and turns to fill a screenplay, the tech industry’s recent split-up saga raises a …
Silicon Valley breakups: Are there lessons for health care?
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