Iinspired by the VA’s big bold step of going OpenNotes, I wrote a blog post titled OpenNotes in geriatrics: 6 awkward concerns.
It was written in the spirit of just about everything I write: to share the nitty-gritty complexities of what I find myself navigating in geriatrics, to bring attention to medical issues that older adults and PCPs struggle with, and to try to bridge …
Should OpenNotes become the standard of care?
The progeny of the iPhone and the iPad will change the shape of your institution — and your balance sheet.
One of the more striking images, to me, out of the online spew in the last few months was from the inauguration. It was a wide view of an inaugural ball. There was the president waltzing with the first lady, and a crowd of several hundred watching them. What was striking …
Medical apps: We are approaching the tipping point
Dear mobile health app developers,
We—patients and caregivers—need your help to reduce the demands of self care. Mobile health (mHealth) apps have enormous potential to lessen our burdens. But our needs are often only loosely related to what clinicians and/or the evidence expect us to do. Most mobile app developers have ignored this fact by designing tools that primarily reflect the imperatives of …
What patients want from mobile apps
IBM’s Dr. Watson of Jeopardy! fame has finally completed its residency and fellowships and, presumably to its creators’ utter delight, is now a practicing oncologist.
The prodigy “cognitive system” completed its training in less than a year at the illustrious Memorial Sloan-Kettering Cancer Center, and although only proficient in lung cancer right now, Dr. Watson’s career as an advisor to oncologists …
IBM’s Watson starts its medical career
A good hockey player plays where the puck is. A great hockey player plays where the puck is going to be.
–Wayne Gretzky
Recently, I attended an end-of-year review with one of our hospital partner’s executive team. We reviewed our performance for the past year, and discussed mutually strategic goals and how to improve upon our excellent service. As part of the conversation turned …
Make small bets during the era of health reform
It happened, of all times, when I was in the car driving the kids to violin practice. My pager buzzed with a message from one of the medical floors. I waited till the car was parked, and dutifully pecked the numbers on my cell phone.
Hello doctor, we have your patient, can you please put admitting orders into EPIC?
I, of course, like most doctors, wasn’t sitting by my phone waiting at a computer terminal. …
Our most scarce health resources are asked to carry the largest load
The big news at HIMSS13 was the unveiling of CommonWell (Cerner, McKesson, Allscripts, athenahealth, Greenway and RelayHealth) to “get the ball rolling” on data exchange across disparate technologies. The shame is that another program with opaque governance by the largest incumbents in health IT is being passed off as progress. The missed opportunity is to answer the call for patient engagement and the frustrations of physicians with EHRs …
Will CommonWell solve one of the biggest problems in health IT?
For the record: I am a geek. I love technology. I adopted EMR when all the cool kids were using paper. Instead of loitering in the “in” doctors lounge making eyes at the nurses, I was writing clinical content and making my care more efficient. I was getting “meaningful use” out of my EMR even when nobody paid me to do it.
But …
Only one company can deliver the perfect EMR: Google
A few months ago I wrote a post about the 159 page digital fax that I received, containing records for a patient’s recent lengthy hospitalization.
I’ve now discovered something even more time-consuming and annoying: a 202 page paper record mailed to me by a major medical system. (I won’t name names right now; suffice to say this system uses Read more…
My workflow for going through old paper charts
Today I’m doing anesthesia for colonoscopies and upper GI scopes. Nowadays we have three board-certified anesthesiologists doing anesthesia for GI procedures every single day at my institution. I’ll probably do 8 cases today. I will sign into a computer or electronically sign something 32 times. I have to type my user name and password into 3 different systems 24 times.
I’m doing essentially …
10 ways to make EMRs more doctor-friendly
Since I started my new practice, it’s been an über hectic and very draining time, but I am happy to report that the end of the week was significantly better than the beginning.
Here are some things I am learning.
1. Starting a business is really, really hard. I did my best to make my business as simple as possible, mainly because I understand my own deficiencies when it comes to business-related activities. …
Lessons from starting a new practice from scratch
Somewhere between the 20th century bank ATM and the 25th century Tricorder, lays the EMR that we should have today. Somewhere between the government-designed meaningful use EMR and the holographic doctor in Star Trek, there should be a long stretch of disposable trial-and-error cycles of technology, changing and morphing from good to better to magical. For this to happen, we must release the EMR from its balls and chains.
We must …
EMRs cannot fix the financial and physical health of the nation
The electronic medical record (EMR)’s promised contribution to health care cost savings got a second look recently, and the results were poor at best. But what I found interesting was the “second look” was from the same organization that did the first look: the corporately-funded, non-profit think-tank called the RAND Corporation.
From their second and more recent report:
A team of RAND Corporation researchers projected in 2005 that rapid …
When EMR interactions trump patient care
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Ok, I’ll admit it: I had no idea. I thought that the whining and griping by other doctors about EMR was just petulance by a group of people who like to be in charge and who resist change. I thought that they were struggling because of their lack of insight into the real benefits of digital records, instead focusing on their insignificant …
Patients don’t matter as much as payment in our system
My cardiologist recommended I get a stress echocardiogram so he could rule out the cause of some new symptoms. After I had scheduled the test, I realized that some of my other doctors should have a record of this test. But whose scope of concern would include these troubling symptoms? Probably at least three of them: my primary care physician, my survivorship …
Compensating for the lack of progress in EHRs
Right now, the technology exists to completely transform healthcare.
A doctor should be able to walk into the room where a patient is waiting for them and get everything they need to make an informed decision about that patient’s care.
Location-based technology should sense the doctor approaching and already know which patient is waiting for them. A computer or a tablet in the room should have access to thousands of data points …
Technology is being held back from transforming healthcare
There are an estimated 15,000 medical apps presently on the market and is expected to grow 25% per year according to one study. There are issues which are common in the development of these apps and other categories of apps. However, some technical and non-technical issues are unique to the sector. As someone who does not design apps, …
5 reasons why mobile health apps fail
I recently read an article on the RAND Corporation’s analysis of electronic health records (EHRs). As a practicing pediatrician currently using EHRs, and given the reality that EHRs are still a relatively new addition to the U.S. medical profession and have created a fundamental shift to the care delivery process, I am compelled to respond to assertions made in this article.
The first RAND study, sponsored by a …
Refuting RAND: Why I am optimistic about EHRs
Office-based medical practice is changing fast. The government is providing incentives to those practices that use electronic prescribing and electronic records systems and will soon penalize those that don’t. Health reform will shortly deliver many newly insured patients to your office. A host of new patient care models aimed at making healthcare more team-based are emerging. Reimbursement tied to outcomes will demand a greater level of patient management and engagement …
Your EHR needs a population health management system
The X-Files fans will remember the poster that Agent Mulder had on his bulletin board with a picture of a flying saucer and the words, “I want to believe.” That’s how I feel reading EMR notes sometimes. I want to believe, but I doubt.
I know how this happens. The EMR vendor, the practice implementation team and the doctor have a meeting to develop the “normal” template for a hospital admission …
The EMR template: I want to believe
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