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.

Watson and Siri: The David and Goliath in health care delivery

Robert Pearl, MD

Health Technology

November 21, 2013

apple-iphone-siri-ibm-watson-illo

In every strength lies a weakness and in every weakness a strength. This maxim has held true throughout history — from biblical days to the battles of modern times.

And it holds just as true in the information technology (IT) “arms race” that’s playing out in American health care today.

In Malcolm Gladwell’s newest work David and Goliath, he suggests that when we fail to …

Keep your government hands off my EHR

Robert Hitchcock, MD

Health Technology

November 17, 2013

Consider this scenario. Your clunker is on its last legs, and it’s time to get a new car. Most likely, you’ll search product reviews to help you decide which make and model is best — best according to people who’ve driven them and kicked the tires a bit, not based on company accolades. You’ll want to know what drivers think. Amazon.com does the same thing for books (and every other …

Read more…

Keep your government hands off my EHR

Can technology be a change agent for health care?

Jay Parkinson, MD

Health Technology

November 15, 2013

I was invited to attend a private breakfast with book author, surgeon, and New Yorker contributor Dr. Atul Gawande shortly before Dr. Gawande’s talk at The New Yorker Festival. Over breakfast, Dr. Gawande spoke with IBM executive Dr. Paul Grundy on the future of health care. The event was sponsored by IBM so there was plenty of talk about how technology can and will influence the practice of medicine — …

The benefits of a free, web based EHR

David Wyatt, MD

Health Technology

November 10, 2013

A recent article by Elizabeth Hipp decried the so-called hidden costs of free EMR systems.

As a physician who uses a free EHR, I chuckle at stories trying to drum up fear and uncertainty about these systems. Though free EHRs have become mainstream, there still seems to be a clever news angle in highlighting their supposed pitfalls. We live in a time when Google offers all of its services …

Read more…

The benefits of a free, web based EHR

Use technology to build trust with your patients

Howard Luks, MD

Health Technology

October 26, 2013

Trust: A firm belief in the reliability, truth, ability, or strength of someone or something.

Technology, technology, technology.

It is all we hear.

Ugh.

Let’s change the focus from “technology” to the useful and meaningful processes that technology enables:

knowledge
sharing
communication
trust

Technology is only an enabler, much like the social graph. They are tools, they are platforms, and if properly utilized, they may enable “disruption” or transformation. It is the few individuals, and I do mean a few, …

Why electronic medical records are dangerous to older adults

Michael Wasserman, MD

Health Technology

October 20, 2013

A recent experience with my father-in-law reminded me of something that has concerned me for some time. While EMRs have some benefits for older adults, on balance I believe that they portend more dangers. There are multiple reasons, but the biggest is that health care providers tend to believe everything they read in an EMR. Even if what they read is wrong!

A wise computer programmer once told me that “computer’s …

Patient care appears to be catching up with mobile technology

Joseph Kvedar, MD

Health Technology

October 18, 2013

The hype over mobile health is deafening on most days and downright annoying on some. So it is with some reluctance that I admit that mobile has the potential to be a gamechanger in health. I’ve professed enthusiasm before, but that was largely around the use of wireless sensors to measure physiologic signals and SMS text as a way to deliver messages to patients and consumers. For several years, the …

Advice to the next national coordinator for health IT

John Halamka, MD

Health Technology

October 18, 2013

Over the next few months, Jacob Reider will serve as the interim National Coordinator for Health Information Technology (ONC) while the search continues for Farzad Mostashari’s permanent replacement.

What advice would I give to the next national coordinator?

David Blumenthal led the ONC during a period of remarkable regulatory change and expanding budgets. He was the right person for the “regulatory era.”

Farzad Mostashari led ONC during a period of implementation when resources peaked, grants were …

Health IT will dictate how health is provided in the future

Margalit Gur-Arie

Health Technology

October 16, 2013

Health IT is booming, or so they say. The hotly debated and highly politicized health care reform, a.k.a. Obamacare, has been shining bright lights on a segment of our economy that is quickly approaching $3 trillion per year, and is in dire need of improvement, or so they say. Depending on who you ask, some say that health care resources must be redistributed in a more equitable manner, while others …

Technology should not define medical education

Terence P. Ma, PhD

Medical Education

October 8, 2013

In July, I began an exciting role at Einstein: assistant dean for educational informatics. One of my main objectives is to optimize the use of technology to advance and deepen learning. But as much as I welcome it, technology alone will not achieve our educational goals.

Recently, David J. Hefland, the president and vice chancellor of Canada’s Quest University, characterized the model of contemporary education as “students as empty vessels that must be …

What the unbundling of Craigslist has to do with today’s EMRs

Brian Manning

Health Technology

October 6, 2013

criagslist-image

Recently there’s been a lot of talk about the law of bundling and subsequent unbundling of web services. Many have used Andrew Parker’s brilliant image below to make the point.

Craigslist came along and bundled everything into one place and, as a result, completely dominated. They destroyed multiple businesses in the process (including the rental and roommate web service I worked with …

EMRs make it easier to just order the test

Corbin Rayfield

Medical Education

October 5, 2013

The discourse on the problems of the modern healthcare system contains much vitriol and blame. There is a distinct flavor of adversarial combat in the discussion; pitting physicians, those in the trenches, with those politicians and lawmakers on the other side. With estimates of healthcare costs exceeding 15% of the gross domestic product of the United States, it is easy to understand the passion that the topic evokes. The complexity …

Fighting the patient-computer attention war

Sharon Parish, MD

Health Technology

October 2, 2013

I recently supervised a new intern as she conducted a patient interview. Following procedure, the intern reviewed the patient’s electronic medical record (EMR) and checked his lab results. She noticed that his cholesterol was high, and he told her that he had stopped taking his atorvastatin due to a recent trip to the Dominican Republic.

“It’s no problem,” my intern replied. “We’ll get you back on the medication.” She began to …

Why physicians will never learn to like EMRs

Margalit Gur-Arie

Health Technology

October 1, 2013

EMRs are not designed for patient care. Is there anyone working in health IT who can honestly say that he or she never heard this statement being made hundreds or thousands of times? Is there any clinician actually working with patients and EMRs who can state that such thought never crossed his or her mind? This includes health IT evangelists and physicians spearheading IT initiatives at the most excellent of …

The promise and the peril of big data in health care

J. Leonard Lichtenfeld, MD

Health Technology

October 1, 2013

There was a memorable scene in the movie “The Graduate” from 1967. You may know it or have heard of it, when the older man turns to the college graduate and says the future is all about one word: “plastics.”

Well, plastics may have been then, but this is now. And the core themes I keep hearing these days there are two central …

Using Skype for patient visits: A doctor is sanctioned

Joseph Kvedar, MD

Health Technology

September 29, 2013

The medical board of the state of Oklahoma recently sanctioned a physician for using Skype to conduct patient visits. A number of other factors add color to the board’s action, including that the physician was prescribing controlled substances as a result of these visits and that one of his patients died. This situation brings up several challenges of telehealth — that is, using technology to care for patients when doctor …

Creating a truly meaningful and useful patient medical record

Rob Lamberts, MD

Health Technology

September 26, 2013

I have a vague recollection, a memory shrouded in mist, where I pondered what seemed like a radical question: What would a health record look like if my only concern was patient care? This was a radical question because in my previous life I was an electronic health record aficionado. I was good at EMR, which meant that I was really good at finding work-arounds:

How can I work around the requirements for …
Read more…

Creating a truly meaningful and useful patient medical record

Addressing the disparities in those using patient portals

Zackary Berger, MD, PhD

Health Technology

September 24, 2013

My institution recently switched from its home-grown electronic medical record (EMR) to EPIC, a system for which many great things have been promised. Indeed, it is a considerable improvement over the past one. A number of hopes have been pinned on the latest-generation EMRs, not the least of which is the idea that finally, with this newest generation of tools, a nexus can be created and sustained among comparative effectiveness …

Who will pressure physicians to join the 21st century?

Robert Pearl, MD

Physician

September 22, 2013

A Bank of America ATM can figure out who you are and how much money is in your account in seconds. It can spit out cash in virtually any currency from nearly any spot in the world — even if you’re a Chase customer. It’s a technological convenience we’ve all come to expect.

Hospitals and doctors’ offices are starting to replace hard copy patient records with computerized heath systems. Some U.S. …

The hidden cost of free EMR systems

Elizabeth Hipp

Health Technology

September 21, 2013

Electronic health records (EHR) systems are expensive. Really expensive. In fact, there have been reports of these systems causing significant revenue decreases or business interruptions — such as Henry Ford Health System in Michigan reporting that implementing EPIC was a direct cause of their 15 percent net income decline in 2012. Using a free EHR system is a tempting alternative for many independent doctors or small practices. But are there …

Read more…

The hidden cost of free EMR systems