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.

Intelligent information synthesis is the basis of error prevention

Val Jones, MD

Physician

September 20, 2013

As I travel around the country, working in the trenches of various hospitals, I’ve been struck by the number of errors made by physicians and nurses whose administrative burden distracts them from patient care. The clinicians who make the errors are intelligent and competent — and they feel badly when an error is made.

However, the volume of tasks required of them in a day (many of which are designed to fulfill …

Does electronic communication actually improve care?

Natalie Azar, MD

Health Technology

September 18, 2013

The subject heading of a recent email correspondence read “beware, graphic picture ahead!” Obviously this piqued my curiosity, so, with one eye closed, I scrolled down on my iPhone to a picture of my patient’s tongue, which, truth be told, had a certain “you haven’t seen anything yet quality.”

The tongue in question? Maybe some white spots, certainly nothing gruesome, and most assuredly nothing I hadn’t seen before in my 12+ …

Better patient care doesn’t require more mouse clicks

Fred N. Pelzman, MD

Health Technology

September 15, 2013

Here are just a few of the mouse clicks, key strokes, and computer screens I need to make or navigate to get through my day: Control-Alt-Delete. User Name. Password. Double click on the icon to load the electronic health record (EHR). User Name again. Password again. Schedule. In-basket. Results. Patient Calls. Rx Requests.

And that is just to get started. Before I finish my first cup of coffee.

Every patient interaction that needs …

E-health initiatives that focus on patients can improve outcomes

Donald Tex Bryant

Health Technology

September 14, 2013

Health care providers want their patients to have the best outcomes possible. They know that for this to happen that the patient must be engaged in managing his or her condition, whether it is an acute or chronic condition. Patients need to follow the provider’s directions and orders. If they do not, then the outcomes will be sub-par.

For instance, if you the provider give a patient a prescription then they …

We need tools to meaningfully interpret health data

Peter Alperin, MD

Health Technology

September 11, 2013

We generate it every minute of every day of every week of every month of every year. Data, in countless forms. Of recent and growing interest to a great many people is how this data can be use to improve health (not just sell people more stuff).

Wear a FitBit or Jawbone? Amazing source of activity information. Check in on Foursquare? Insight into dietary habits. Post on Twitter? Sentiment analysis around …

What keeps this hospital CIO up at night

John Halamka, MD

Physician

September 11, 2013

Now that Labor Day has come and gone, I’ve thought about the months ahead and the major challenges I’ll face.

1. Mergers and acquisitions. Health care in the US is not a system of care, it’s a disconnected collection of hospitals, clinics, pharmacies, labs, and imaging centers. As the Affordable Care Act rolls out, many accountable care organizations are realizing that the only way to survive is to create “systemness” through mergers, …

A doctor creates his own EMR out of pure survival

Rob Lamberts, MD

Health Technology

September 9, 2013

The question has been raised: Why re-invent the EMR wheel? What is so different about what I am doing that makes it necessary to go through such a painful venture? I ask myself this same question, actually.

Here’s my answer to that question.

What medical records offer:
High focus on capturing billing codes so physicians can be paid maximum for the minimum amount of work.

What I need:
No focus on billing codes, instead a …

Your EMR is watching you

Skeptical Scalpel, MD

Health Technology

September 2, 2013

A recent article on American Medical News titled “Medical charting errors can drive patient liability suits” led with a case involving a bad outcome after coronary artery bypass surgery. The plaintiff’s attorney alleged that the doctors did not review the patient’s lab results or x-rays because they did not specific say so in the medical record.

The article quoted a defense attorney who said, “By the time [the doctors] are deposed, …

Read more…

Your EMR is watching you

The sad state of EMRs: How they are doing more harm than good

Val Jones, MD

Health Technology

August 30, 2013

I used to be a big believer in the transformative power of digital data in medicine. In fact, I devoted the past decade of my life to assisting the “movement” towards better record keeping and shared data. It seemed intuitive that breaking down the information silos in healthcare would be the first logical step in establishing price transparency, promoting evidence-based practices, and empowering patients to become more engaged in their …

We must demand a return to meaningful notes

Robert Centor, MD

Physician

August 30, 2013

I had a nice conversation with a dermatologist at a party recently. He started complaining about the notes he receives from other physicians. He used terms like piles and piles of junk.

Talk to any experienced physician and they will tell you that once upon a time our teachers taught us to write notes appropriate to the situation, not appropriate to the billing system.

Several years ago I ranted about the necessity …

The young doctor’s organized orientation to electronic dehumanization

Wes Fisher, MD

Physician

August 29, 2013

“It looks like you’ve done very well, Mr. Smith.”

“Thank you, doctor.”

He left the patient’s room and ambled back to the nurses station, legs tired and ankles somewhat swollen. It had been a long case and now he just had to type his note, send an email message, and review his schedule for the following day. He sat down at the computer and logged in. That’s when he looked up briefly …

The mixed blessing of health information technology

James Marroquin, MD

Health Technology

August 25, 2013

The recent revelation of the NSA’s top-secret mass surveillance program by Edward Snowden has spotlighted the benefits and burdens of our increasingly digitally connected world. According to President Obama, monitoring our phone calls, emails, and web activity has helped thwart dozens of terrorist attacks. But the idea of the government keeping track of what had hitherto seemed private raises the specter of an Orwellian world in which everyone is under …

The challenge of using health IT more effectively

Ashish Jha, MD, MPH

Health Technology

August 21, 2013

Just a little over four years ago, President Obama, in his inaugural address, challenged us a nation to “wield technology’s wonders to raise health care’s quality and lower its costs.” This was an awe-inspiring, “we will go to the moon” moment for the healthcare delivery system. But the next thought that ran through the minds of so many of us who work on health IT issues was this: how were we …

5 ways Google Glass can be used in a hospital

John Halamka, MD

Health Technology

August 20, 2013

breakthrough-prize-sergey-brin-google-glass

I recently had the opportunity to test Google Glass.

It’s basically an Android smartphone (without the cellular transmitter) capable of running Android apps, built into a pair of glasses. The small prism “screen” displays video at half HD resolution. The sound features use bone conduction, so only the wearer can hear audio output. It has a motion sensitive accelerometer for gestural commands. …

George W. Bush’s angioplasty: Did he receive the best care?

Albert Fuchs, MD

Conditions and Diseases

August 19, 2013

Former president George W. Bush underwent an angioplasty recently, and the details sparked a public debate about the controversies of heart disease treatments.

His spokesman stated that he underwent a routine physical exam and had no symptoms of heart disease. A stress test showed EKG changes and a CT angiogram found a blocked artery. He was transferred to another hospital and underwent an …

7 golden rules to optimize EHR implementation

Rosemarie Nelson

Health Technology

August 18, 2013

Eligible physicians are dropping out of the HITECH incentive program. Why? Often, it’s because a practice implements an EHR and then tries to mimic all their old paper processes and workflows.

That can get them through the vendor’s initial implementation, but it is not sustainable for the long term.

Workflows and operational processes must be modified to optimize the new tool. Technology changes what is feasible, and to adapt, we need to …

Why EMRs will not placate technology-hungry medical students

Maureen Miller, MD, MPH

Health Technology

August 17, 2013

The first resident who really reamed me out on the wards was having trouble reading my handwriting. My handwriting became doctor-unreadable well before medical school, but how quaint. It was the beginning of my second month of clinical training, and hers of internship. She couldn’t follow our shared patient’s daily progress note. I didn’t tell the story in the right order. The format was wrong. Instead of noting only pertinent …

We need to reassess the patient note

Robert Centor, MD

Physician

August 16, 2013

I recently tweeted about Danielle Ofri’s important piece, The Doctor Will See Your Electronic Medical Record Now. I like the piece, and especially like some of the quotes, but still I believe the problem needs an expanded take.

Context represents the major advantage of 38 years experience as a physician. Over time, one sees trends come and go. Hopefully one can see the strengths of the “good old days” and …

Read more…

We need to reassess the patient note

Thousands of dollars are put at risk with a single click of a button

Wes Fisher, MD

Health Policy

August 12, 2013

There is so much entropy in health care right now. So much finagling, so much shifting, so much arguing, so much uncertainty, so much shock. Shock at prices, shock at waiting times, shock that doctors don’t know how to increase referrals, shock that doctors aren’t doing more to help. What gives?

In triage, you don’t spend time with the expectant.

Doctors are keeping their heads down. They are still seeing patients. They …

Boston hospitals go Epic: Hear from a holdout

John Halamka, MD

Health Technology

August 11, 2013

In the Boston marketplace, Partners Healthcare is is replacing 30 years of self developed software with Epic. Boston Medical Center is replacing Eclipsys (Allscripts) with Epic. Lahey Clinic is replacing Meditech/Allscripts with Epic. Cambridge Health Alliance and Atrius already run Epic. Rumors abound that others are in Eastern Massachusetts are considering Epic. Why has Epic gained such momentum over the past few years?

Watching the implementations around me, …