Health IT and AI in Medicine

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 medical records fail in data analytics

Alexandra S. Brown, MD

Health Technology

October 23, 2014

Over the past 5 to 10 years, hospitals and physician offices have been in a mad dash to implement electronic health records (EHRs) in order to meet governmental regulatory requirements. Now that most projects are either complete or well on their way, what are we doing with all of the data that EHRs promised to generate?

From my experience as a physician at a large academic medical center with one of …

Quantified health and the great digital divide

Kevin R. Stone, MD

Physician

October 21, 2014

Go into any hospital today and notice that between every great nurse and patient sits a computer terminal. The quantified health movement has created the great digital divide, between the patient and everyone else.

The nurse of old used to actually touch the patient. No more. Now, they wheel in a computer console, sit down and record the digital output of the wired up patient, every vital sign, every drug order or …

The EHR report card 2014: Has it gotten better?

Yul Ejnes, MD

Health Technology

October 16, 2014

A guest column by the American College of Physicians, exclusive to KevinMD.com.

A little over two years ago in this blog, my “EHR report card” evaluated the effect of the electronic health record (EHR) on my practice. I thought it would be interesting to see how things have changed. As in 2012, I will not identify …

A physician’s EMR wish list

Tal Raviv, MD

Health Technology

October 12, 2014

In their current form, most (if not all) EHRs kind of stink. I don’t speak from direct experience, as I’ve held off buying and implementing a system to date. But I’ve never heard any of my colleagues say they love — or even really like — their EHRs, and I’ve asked many. The most ardent supporters state that they’ve gotten used to their systems (usually after years of tribulations) and …

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A physician’s EMR wish list

Think your medical data is secure? Think again.

David Mann, MD

Health Technology

October 11, 2014

With the recent discovery of the ShellShock vulnerability affecting a large number of computers, the question comes up again: How secure is medical data? Thanks to the federally mandated push to transfer medical data from paper charts to computer databases, most if not all of this data is now fertile ground for hackers. As pointed out in this article medical data is more valuable to hackers than stolen credit cards. …

Who is blocking EMR interoperability? You are.

Margalit Gur-Arie

Health Technology

October 7, 2014

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The Senate Appropriations Committee has defined a new transgression perpetrated in the committee’s expert opinion by vendors of certified EHRs, as well as “eligible hospitals or providers.” Since the committee has no data or evidence of any kind that this transgression is actually occurring, it requires the Office of the National Coordinator for Health Information Technology (ONC) to embark on a fishing expedition …

Health care fails to adopt technology. Here are 5 reasons why.

Robert Pearl, MD

Health Technology

September 25, 2014

Why do so many seemingly great technologies fail to penetrate the health care system?

I hope the following five answers shed some light on the realities of technology adoption in health care.

1. Many new technologies don’t address the real problem

Tech entrepreneurs often take a backward approach to invention. They start by discovering a nifty technology. Later, they figure out how people can use it.

This technique often teaches entrepreneurs a tough lesson: Technology …

5 examples of what health care IT should look like

Suneel Dhand, MD

Health Technology

September 25, 2014

Over the last year I’ve written a lot about the problems with health care IT and how we need to get better. Unfortunately, unlike other aspects of our life where information technology has actually made life easier, in health care the user experience been nowhere near as smooth. IT solutions, including electronic medical records, are for the most part slow, inefficient and cumbersome. They cause a great deal of frustration …

5 things EMRs should learn from social media

Val Jones, MD

Health Technology

September 16, 2014

As a physician who openly despises many aspects of current EMRs (see “How An EMR Gave My Patient Syphilis” or “The Medical Chart: Ground Zero For The Deterioration Of Patient Care” ) I recognize that they are here to stay. And so, since we’re all stuck with these digital middlemen, I have some suggestions (based on popular social media platform functionality) …

In the age of EHRs, don’t turn your backs to patients

David Mann, MD

Physician

September 13, 2014

One of the most important tricks of the trade that I learned in medical school was what some might have considered a little throwaway bit of advice.

During my psychiatry clinical rotation the preceptor advised that, when applying the stethoscope to the patient’s back, one should rest the other hand gently on his or her shoulder. Human touch was important. It would relax the patient and convey subconsciously a sense of …

Disappointing outcomes despite a massive investment in EHRs

Mark Nunlist, MD and Betsy Nicoletti, MS

Health Technology

August 30, 2014

The Health Information Technology for Economic and Clinical Health Act of 2009 committed to the expanded adoption of health information technology, expecting electronic health records (EHRs) to transform medical care while promising dramatic improvements in quality, efficiency and safety. Five years and $25 billion later, the results have fallen short of expectations, and there are multiple reasons for our disappointment.

First, EHRs were designed to document the provision of health care …

Health care big data will fail unless we remove the silos

Jason Giffi, DO

Health Technology

August 29, 2014

A few days ago a colleague of mine was inching south through the mother of all traffic jams: 60 straight miles of construction work on I-95 just south Washington, DC. The three-lane highway was jammed. Route 1, which runs parallel to I-95 was also jammed. Cars were stalled in the middle of the highway having run out of gas from waiting so long.

He looked at the map on his phone …

The medical chart is coming to an end. Here’s why.

Mike Sevilla, MD

Physician

August 29, 2014

“Dr. Sevilla, I have a question for you,” a patient asked me this week. “I’m going to tell you something, but I DO NOT want it put in the chart.” Hmm, I asked myself, can I really do that? It’s the patient’s wish, right?

The patient went on to tell me that she heard about this week’s story about a hospital network being hacked and 4.5 million records being stolen. …

Why can’t an EHR fit into a mobile device?

David Mann, MD

Health Technology

August 27, 2014

It’s been a while since my last rant about electronic health records (EHRs), so let’s remedy that right now. EHRs in their current iteration are — how to put this delicately? — an unmitigated disaster. Nevertheless, much of the criticism of EHRs, including mine, has been in the destructive category. What about some constructive criticism? How could EHR software be made better?

I am not …

Are patient portals a gateway or barrier to patient-centered care and communication?

Yul Ejnes, MD

Health Technology

August 13, 2014

A guest column by the American College of Physicians, exclusive to KevinMD.com.

Patient portals. They have great potential, but is it being met? And are we losing something in return? I ask myself these questions now that my practice offers a patient portal linked to our electronic health record (EHR). I did not expect to feel that way, …

Why bad EMRs are forced on physicians

Edwin Leap, MD

Health Technology

August 7, 2014

I recently did a tally. Since starting my locums adventure last year, and going to full-time locums in January, I’ve worked in a grand total of 11 emergency departments. Let me qualify that for the occasional visitor to my blog. I decided to do this for purposes of flexibility, finances and a much needed change of scenery. Not because I’m a problem physician, or unable to do the work in …

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Why bad EMRs are forced on physicians

A physician responds to OpenNotes critics

Peter Elias, MD

Physician

July 31, 2014

There is a growing group of articulate and engaged patients committed to getting access to all their medical information in order to be better positioned to work collaboratively with their clinical teams. Published studies like the OpenNotes project have consistently shown significant benefits and a lack of serious problems. Health care systems are slow to change and just beginning to understand both the need and value to this …

5 ways health care IT must improve

Suneel Dhand, MD

Health Technology

July 29, 2014

Health care information technology has of course grown exponentially over the last decade, as electronic medical records (EMRs) and computerized physician order entry (CPOE) systems have become ubiquitous. It’s funny to think that not so long ago, physicians and nurses had to trawl through piles and piles of paper charts to search for the information we needed — whether it was lab results or patients’ notes.

However, the road to this …

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5 ways health care IT must improve

Big data in health care: Are we measuring the wrong things?

Christine A. Sinsky, MD

Health Policy

July 23, 2014

We believe in data. We are scientists after all. And yet in this new era of big data is it possible we are measuring the wrong things?

Most measures of physician performance are process or intermediate outcome measures aimed at a production line model of care. Was an A1c done, did the physician use a computer to send an order to the laboratory, were antibiotics given within two hours of presentation.

Yet …

A wish list for Apple’s HealthKit

Joseph Kvedar, MD

Health Technology

July 7, 2014

Apple has been making headlines again, which is not unusual for a company that sets trends and moves markets. Recently, they announced that iOS 8 would have a built-in app to collect all of your health info in one place. Then there was the announcement of the partnership with Mayo Clinic and Epic Systems. This generated even more headlines. I saw all …

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A wish list for Apple’s HealthKit