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.

The burden of frequent technology transitions

Health Technology
May 29, 2013

I made a big decision recently: I decided to give up my Blackberry smartphone.

Why? Like a good geriatrician, I considered the benefits and the burdens of sticking with the Blackberry. And since the burdens seem to outweigh the benefits, bye-bye Blackberry.

This was a difficult decision for me, however. To begin with, becoming comfortable with a new device for one’s daily work takes time. During the transition phase, one is slower …

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The burden of frequent technology transitions

English is the second language of medical documentation

Health Technology
May 24, 2013

acp-logoA guest column by the American College of Physicians, exclusive to KevinMD.com.

English is the international language of medicine, according to many. Regardless of whether that is true, what is becoming increasingly clear is that English is the second language of medical documentation.  For those of you who blame EHRs for this, the replacement of English by something else started …

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English is the second language of medical documentation

The impact of outdated communications technologies in healthcare

Health Technology
May 23, 2013

As a physician, I experience first-hand the impact that internal communication at a hospital—both good and bad—has on patient care.

If I am able to quickly access clinical systems, analyze patient information and collaborate with colleagues, I can diagnose and interact with the patient much more efficiently and effectively. Conversely, breakdowns and inefficiencies in the communications process can inhibit the delivery of quality patient care by bogging down workflows, creating delays …

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The impact of outdated communications technologies in healthcare

Bringing OpenNotes to Geisinger

Physician
May 20, 2013

Recently, over 520 of our doctors began sharing their office visit notes with patients.

All primary care doctors and general pediatricians, and selected physicians within pediatric subspecialties, dermatology, endocrinology, pulmonology, nephrology, rheumatology, cardiology, cardiothoracic surgery, vascular surgery, neurosurgery, and women’s health—including obstetrics and gynecology and gynecologic oncology—are participating in OpenNotes.

That means tens of thousands of our patients will have access to the notes doctors write about them. After each …

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Bringing OpenNotes to Geisinger

10 mistakes practices make in implementing information technology

Health Technology
May 18, 2013

What is the measure of successful technology adoption? Is it never having to hunt for a missing chart? Is it a reduction in specific operating cost line items? Is it about access to clinical information when you need it and where you need it?

Technology implementation has a significant effect on profitability. The Medical Group Management Association Cost Survey Report beginning with 2010 data shows that total medical revenue after operating …

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10 mistakes practices make in implementing information technology

Why it’s risky to pay for a proprietary health IT system

Health Technology
May 10, 2013

“No aspect of health IT entails as much uncertainty as the magnitude of its potential benefits.”

A few years into the Meaningful Use program, it seems this quote from a 2008 Congressional Budget Office report entitled “Evidence on the Costs and Benefits of Health Information Technology” may have been written with the assistance of a crystal ball.

Fast forward to 2013.

“Just from reading a week’s worth of news, …

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Why it’s risky to pay for a proprietary health IT system

The advantages of having a connected EHR

Health Technology
May 10, 2013

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Most clinical providers are aware of the more common capacities of EHRs.  However, there are many capacities that are being underused that can be of great assistance in providing safe care that avoids waste and identifies best practices.  Electronic communication with providers outside of one’s clinical setting, clinical decision support and improving the body of knowledge of best practices are three of …

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The advantages of having a connected EHR

5 critical elements of patient-centric care

Health Technology
May 7, 2013

I would like now to delve into what I consider critical elements of patient-centric care. They all involve technology to various extents.

1. There must be buy-in from providers. I am including payers, healthcare systems as well as clinical providers in this category.  While I realize that much of healthcare is devoted to satisfying legal and regulatory mandates, there is great opportunity to improve the care experience (and dare I say …

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5 critical elements of patient-centric care

Dzhokhar Tsarnaev and his right to privacy

Physician
May 4, 2013

I am affiliated with the institution where Dzhokhar Tsarnaev is currently hospitalized. I am friends with people who have treated him. I’m trying to stay away from those people; I would be unable to help asking them about him. They might be unable to help talking about him.

There has been a flurry of emails and red-letter warnings cautioning people here not to talk about Mr. Tsarnaev or look him up …

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Dzhokhar Tsarnaev and his right to privacy

The skills that tomorrow’s doctors will need

Physician
April 29, 2013

What does the 21st century physician look like?

I’ll admit that the question on the face of it struck me as a bit absurd, especially when juxtaposed with the term “tomorrow’s doctor.”

Tomorrow’s doctor needs to be doing a much better job of dealing with today’s medical challenges, because they will all be still here tomorrow. (Duh!) And the day after tomorrow.

(As for the 21st century in general, given the speed at …

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The skills that tomorrow’s doctors will need

A plea for a universal, unified EMR

Health Technology
April 29, 2013

At some point, this gets to be ridiculous. Online, I can buy any item from anywhere at any price, pay any bill, watch any movie, listen to any song, order dinner, schedule car repair or read about any subject on Wikipedia.  I can determine the weather in Rio, sport scores of Barcelona, Parisian traffic or by GPS the location of my kids, just down the block.

However, I absolutely cannot learn …

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A plea for a universal, unified EMR

Copy and paste medicine is not new

Physician
April 28, 2013

As a second year medical student in 1971, I still remember an article in the prestigious New England Journal of Medicine, describing a new phenomenon, The Emperor’s New Clothes Syndrome. It was based upon the famous Danish author, Hans Christian Anderson’s fairly tale from the 1800’s.

A vain emperor, who cares for nothing except wearing and displaying clothes hires two swindlers who promise him the finest, best suit of clothes from …

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Copy and paste medicine is not new

Building a true collaborative health record: Ask your patients

Physician
April 25, 2013

I’ve been going about this all wrong.

It’s not my dumping of the payment system so I can focus on care over codes, my use of technology to connect better with patients, or my vision of the “collaborative record” that is wrong.  It’s the fact that I am doing this without my most important resource: my patients.

I realized this while driving in to work this past week.  My first patient was …

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Building a true collaborative health record: Ask your patients

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How natural language processing can help EHRs

Health Technology
April 21, 2013

An excerpt from Too Big to Ignore: The Business Case for Big Data (Wiley and SAS Business Series).

Unstructured and semi-structured data is, by its nature, largely text based. Even numbers are often surrounded by words, like an article on a company’s stock. This section describes some of the tools that trans­late what is often a bunch of gobbledygook into meaningful informa­tion, the result of …

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How natural language processing can help EHRs

Are we ready to creatively destroy medicine?

Health Policy
April 21, 2013

We recently marked the third anniversary of the passage of the Affordable Care Act by reflecting on the positive changes it has brought about and by mulling over the multifaceted challenges that stymie our efforts to build more accessibility, equity, quality, safety, and cost-effectiveness into one of the most complex healthcare systems in the world.

Reining in healthcare costs, a central element in the reforms we seek, is inextricably linked to …

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Are we ready to creatively destroy medicine?

Let’s mourn the death an EMR evangelist

Health Technology
April 19, 2013

It feels like part of me is dying.  I am losing something that has been a part of me for nearly 20 years.

I bought in to the idea of electronic records in the early 90′s and was enthusiastic enough to implement in my practice in 1996.  My initial motivation was selfish: I am not an organized person by nature (distractible, in case you forgot), and computers do much of the …

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Let’s mourn the death an EMR evangelist

EMR tips for locum tenens doctors

Health Technology
April 19, 2013

If I’m learning anything from working locum tenens jobs, it’s that there is a wide, mind-numbing variety of electronic medical records (EMR) systems in place around the country.  At my primary work site, we use Med-Host.  Like every EMR, it has some bugs. But having seen other systems in other places, it’s clearly a Cadillac product in a great, big car lot of Yugos.

I’m not going to disparage other systems …

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EMR tips for locum tenens doctors

If you build a patient portal, why won’t they come?

Health Technology
April 13, 2013

I hate saying I told you so.  But “patient engagement is a physician-patient communications challenge and not an HIT (health information technology) challenge.”

Just take a look at the Mayo Clinic’s patient portal experience which was discussed at a HIMSS 2013.

The headline: “Mayo Clinic struggles to meet stage 2 meaningful use thresholds for engaging patients.”

Always innovating, the Mayo Clinic some three years ago introduced a web-based portal to share information with …

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If you build a patient portal, why won’t they come?

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