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.

Can decision support tools actually harm patients?

Christine A. Sinsky, MD

Physician

February 28, 2014

Have you ever encountered an intrusive, insistent popup decision support screen while trying to take care of patients? Found yourself stuck in a dead end electronic hallway without egress? A situation where you had to choose an option that was inappropriate for your patient just to exit the screen?

This is the situation with my local medical institution’s “DVT Advisor,” a mandatory decision support screen for all patients.

DVT Advisor was implemented …

Do patients value their health information privacy?

Jessie Gruman, PhD

Patient

February 20, 2014

Do I value the privacy of my health information? What do you mean?

That if I email my doctor about an embarrassing symptom, only my doctor will read it?

That only my doctor, my nurse and I have access to the information in my electronic medical record, including notes on our confidential conversations, prescriptions and test results?

That my local drug store doesn’t sell information about me to pharmaceutical companies?

That …

Why hospitals should be scared of cyberattacks

Joe Flower

Health Technology

February 18, 2014

If you are a CEO or COO of a health care organization, and your IT people have been trying to get your attention, it’s time to have a serious sit-down with them.

If they haven’t been trying to get your attention, it’s time to have an more serious sit-down with them, complete with charts and graphs and arrows on fip charts.

Here’s why.

Remember in November it was revealed that the Target retail …

Entering the exam room without the weight of the computer

Christine A. Sinsky, MD

Physician

February 16, 2014

It started with a dead laptop. For the first time in more than 3 years I felt like a doctor again. I had forgotten what it was like.

Having neglected to plug in my laptop the night before, it was without power. (Without power!) An opportunity for an uprising, of consciousness if not full revolt.

For the first 1½ hours of clinic I entered each exam room without the weight of the …

Electronic medical records obstruct patient interaction

Kevin Pho, MD

KevinMD

February 15, 2014

A version of column was published in USA Today on January 19, 2014.

Over half of physicians today use electronic medical records, thanks to the federal government spending more than $22 billion dollars incentivizing providers to transition away from paper charts. Supporters of digital records, including President Obama, say they improve patient care and reduce health costs. Having navigated a transition from paper charts to electronic records in my own practice, …

Use emerging digital technology to improve communication with patients

Anita Gupta, DO, PharmD and Reem N. Sheikh, DPM

Health Technology

February 9, 2014

With the growing demand of patient demands, change in healthcare delivery with Affordable Care Act, physicians are asked to adapt to these changes rapidly. In order to be efficient and provide this level of care to patients, the use of digital technology in medicine has grown dramatically. New platforms for integrating medical care and digital technology have been developed to enhance doctor patient communication.

Digital technology encompasses a broad range of …

They’ll soon be talking about my generation, but I’m not there yet

Greg Smith, MD

Physician

February 4, 2014

I had had a long day yesterday, starting with a trip up the interstate to Columbia to meet with other medical chiefs from around the state of South Carolina to discuss the issues that affect the practice of psychiatry in the mental health system today.

We had struggled with the electronic medical record, Medicare paybacks, e-prescribing, CPT coding, content of notes, billing time, and motivating our medical staffs to accept the …

Death of the physician progress note

David Mokotoff, MD

Physician

February 2, 2014

I am not sure of the date or time of death. However, I am reasonably certain of the cause. Death was by electronic data and formatting. The victim was the time-honored physician’s progress note. To be sure, these notes, even the now “ancient” written ones, were far from perfect. And they were often illegible. Shortcuts such as “as above” or AVSS (all vital signs stable) littered the pages of the …

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Death of the physician progress note

Cloning: Great for Dolly the sheep, not so good for EHRs

Betsy Nicoletti, MS

Physician

February 2, 2014

Certain medical stories are irresistible to the popular press: ICD-10 external cause codes that are ridiculous (W61.43XD, pecked by a turkey, subsequent encounter) or medical practices using their electronic health records in a way that increases their revenue.

A recent headline was eye-catching, as headlines are meant to be, “Report finds more flaws in digitizing patient files.” The New York Times reported that the Office of Inspector …

Primary care has to go multimedia

Jorge Stanham, MD

Health Technology

January 31, 2014

I passed the 60 mark more than a year ago and since then have been more aware of my limitations: some joint aches, getting tired easier, more need to rest and longing for a slower pace in my everyday routine. Meanwhile, general medical practice is speeding up and increasingly shedding its limitations.

As information expands exponentially, doctors need not only to keep up with the information that reaches them directly, but …

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Primary care has to go multimedia

Patient portals for hospitalized patients: Do they make sense?

Suneel Dhand, MD

Health Technology

January 20, 2014

Patient portals are very much the future of health care. Having easy access to ones’ medical history, diagnoses, and test results, seems like such a natural thing that it’s hard to imagine that only a couple of decades ago medical information was regarded as private for the physician’s eyes only.

Of course, the Internet and technology revolution has taken this concept to a whole new level. Health care organizations across the …

Finding the right EMR vendor can help navigate mandates

Sally Ginsburg, MD

Physician

January 18, 2014

As a physician, not a day goes by without a new acronym I need to look up, a new policy I need to follow, another box I need to click or another criteria I need to meet — and this is just to keep up. While the health care picture and its various unknowns loom ever larger in the news, and health information emails overstuff my inbox, it is worth …

Make the EHR a safe harbor from criminal prosecution

Adrian Gropper, MD

Health Technology

January 16, 2014

The governor of Vermont, Peter Shumlin, devoted all of his annual speech to the problem of drug addiction. On the national news, Shumlin points out the link between prescription painkillers and death, and he calls for treating opiate addiction as a medical problem no different than cancer. The White House praised the governor’s position.

Meanwhile in another part of Washington, I’m involved in the federal effort to link the law enforcement Prescription Drug …

Why I will never take EMRs for granted again

James C. Salwitz, MD

Health Technology

January 10, 2014

One of the spinoffs of being an oncologist is that you do not to take the world for granted. Each morning, I walk around the yard and smell the morning breeze. I am thankful for my children, my wife and my own health. I am thrilled, if occasionally skeptical, to have the opportunity to pay taxes in a country that I love. So, who would believe I would take our …

How EHR design can affect patient safety

Michael Chen, MD

Health Technology

January 7, 2014

Besides the importance of physician happiness when using an EHR, using design principles that maximize user intuition and presentation of relevant information, there is one aspect of health care information systems that should never be overlooked: patient safety.

Scot Silverstein, MD, blogging at Health Care Renewal as InformaticsMD, frequently brings to light issues surrounding health care IT implementations that compromise patient safety. Reading his posts should be sobering and concerning to both …

Fixing EHRs requires changing the way we pay for care

Ira Nash, MD

Health Technology

December 30, 2013

I was talking to a colleague recently about his practice, and remarked that he was still keeping a paper medical record. Without hesitation, he made it clear that he not only liked the paper record, but he positively dreaded switching to an electronic record. He said sadly that he thought it was inevitable that he would be forced to switch, but hoped that the day would be far into the …

Change will happen when millennial doctors step into leadership roles

Davis Liu, MD

Physician

December 6, 2013

I recently stumbled across a blog post by Dr. Jay Parkinson, an entrepreneur and founder of Sherpaa, who reflected on a recent private breakfast with New Yorker and best selling author Dr. Atul Gawande.

The question posed by Gawande: Can technology be a change agent for health care?

The inevitable answer is yes, with one important caveat. It’s not the technology that will change the practice of medicine, it’s the doctors who …

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Change will happen when millennial doctors step into leadership roles

Car dealerships have something to teach hospitals

Suneel Dhand, MD

Health Technology

December 4, 2013

A couple of weeks ago I took my car in for its regular servicing. I’ve always had excellent service at this dealership and have gotten used to some pretty high standards. But on this particular visit, I was about to receive a dose of new technology as well. After I pulled my car into the garage, I was immediately greeted by a welcoming and friendly customer service agent. She had …

The human side of medicine that no computer can ever touch

Suneel Dhand, MD

Health Technology

November 27, 2013

As I look back all those years ago to when I chose medicine as a career, I suspect that my motives were similar to most people who enter this wonderful profession. I wanted to become a doctor because I had a genuine and sincere desire to help people. I also liked the idea of a busy and energetic job, one where I was comfortably as far away as possible from …

I spend more time checking boxes than talking to patients

Regina Harrell, MD

Physician

November 26, 2013

I am a primary care doctor who makes house calls in and around Tuscaloosa, Alabama. Most of my visits are in neighborhoods, but today my rounds start at a house located down a dirt road a few miles outside of town.

Gingerly, I cross the front walk; Mrs. Edgars told me that she killed a rattlesnake in her flowerbed last year.

She is at the door, expecting my visit. Mr. Edgars sits …