The policeman was two cars in front of me. I meandered down the road cautiously adjusting my speed a few ticks above the limit. I lamented the forced, measured pace as the road lazily formed a long straight path. The clock refused to slow for my new found law abiding citizenry.
A sports car motored around a curve and flew past us unaware. The cop switched on his lights and tried …
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When patient care becomes secondary to filling out the medical record
The first thing I noticed when I walked into the physician’s office were the tall cabinets filled with manila folders, tabbed with names and organized alphabetically. There were three of these cabinets, taking up the entire length of the back wall, filled with hundreds upon hundreds of patients’ records.
“I see you still have paper records. Do you plan on implementing an EHR anytime soon?” I inquired.
The doctor paused for a …
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The user interface for EHRs should be uniform
This example of a disaster waiting to happen, in the form of an error-promoting CPOE, is a poster example of why the net of litigation needs to be cast far wider than just clinicians when EHR-related errors result in injury or death.
This order entry screen, from a production system shows the following. In all fairness, I do note it’s unclear if the vendor or the customer’s configuration “experts” were responsible …
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EMR liability needs to go further than just the physician
Healthcare IT News recently asked, “Do doctors have to be typists to get MU incentives?”
That question reminded me that given the many hours of unreimbursed labor performing EMR data entry at end of day, a significant chunk of a clinician’s workday is spent performing medical secretary services. Let me set the record straight, I am a good typist. But EMR data entry interfaces are often unnecessarily cumbersome, so clinicians put …
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EMRs require better user-centered design
One morning recently, I found another physician standing morosely at one of the mobile computer terminals we refer to as “cows”—computers on wheels—that are everywhere now in our hospital. I asked what was the matter. “Oh nothing, really,” she said. “It’s just that I don’t feel I know the patients as well as I used to.”
I knew exactly what she meant. Things are different now that we have the EMR—the …
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Electronic records don’t tell us stories that make cognitive sense
Technology to lower costs rather than accelerate them. Smart phones to increase physician and other providers’ productivity. Fewer primary care physicians but more involvement by nurse practioneers and others. And increasing appreciation of the value of integrative medicine. These are but a few of the disruptive changes in care delivery that are coming.
I have posted concepts on how the health care delivery system will change in coming years – quite …
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Look to technology to reduce health costs
I have the great privilege of being a medical educator. Everyday, I have an incredible time working with internal medicine residents at their continuity clinic, teaching the art of ambulatory medicine. Our working environment here is academically rich and fulfilling. The name of the legendary Dr. Martin Leibowitz (an iconic figure in ambulatory medicine here) stands outside our conference room as a constant reminder of how medicine is practiced and …
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How an EMR makes connecting with the patient more difficult
In our rush to establish a national electronic medical record (EMR) system as part of the American Recovery and Reinvestment Act of 2009, powerful silos of independent EMR systems have sprung up nationwide. While most systems are being developed responsibly, like the Wild, Wild West, many have been developed without an objective eye toward quality and the potential harm they may be causing our patients.
As most readers of this blog are aware, …
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Should electronic medical records be considered medical devices?
Earlier this year, my team presented a list of risks to the Compliance, Audit and Risk Committee at BIDMC. Here’s my list of top risks for 2012:
1. Old Internet browsers. Many vended clinical applications require specific versions of older browsers such as Internet Explorer 6, which are known to have security flaws. We’ve worked diligently to eliminate, upgrade or replace applications with browser specificity. At this point we …
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What keeps a hospital CIO up at night
Everyone has heard of a recall of a consumer product such as a component of an automobile, child’s toy, or an over the counter medication. A recall of those types of products often implies taking them off the market as well as replacement or repair (in the case of device or car components).
During my 20 years as a practicing cardiac electrophysiologist, I witnessed firsthand the evolution of how implanted medical …
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Why mobile health devices need FDA oversight
It’s been said that losing weight is much harder than kicking cigarettes or alcohol. After all, because one doesn’t need to smoke or drink, the offending substances can simply be kept out of sight (if not out of mind). Dieting, on the other hands, involves changing the way a person does something we all must do everyday.
It’s no surprise, then, that reports of problematic doctor interactions with social media are …
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How can doctors curb digital distractions?
There was no mistake, but a bad thing has happened. Despite the best efforts of the doctors, Bob’s wife is very sick. Due to a rare side effect of treatment, her liver is failing. Bob believes this could have been prevented. He is very mad.
“When we go to see the doctor, he stares at the computer,” says Bob. “He does not look at us. Most of the time, the doctor …
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The computer had stopped the doctor from communicating
An old colleague once told me: “When you assume it makes an ass out of u and me.”
Many of us would consider being an ass a bad thing. If so, why are we making so many assumptions about digital health? Belief in the power of digital technologies to solve a host of pressing problems in health has us poised to devote billions of dollars to their adoption and development. But …
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We need to systematically evaluate digital health technologies
The world of health care today is much different than the one I became involved in as a physician over 35 years ago. But why should that surprise me? The world in general is so dramatically changed from that which I knew then, it would seem reasonable and totally understandable that we’ve had to make dramatic changes in how we work with the population in maintaining health. Or have we? …
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Embrace the explosion of the new technologies
If you cannot measure it, you cannot improve it.
-Lord Kelvin
Asking science to explain life and vital matters is equivalent to asking a grammarian to explain poetry.
-Nassim Nicholas Taleb
Of course the quantified self movement with its self-tracking, body hacking, and data-driven life started in San Francisco when Gary Wolf started the Quantified Self blog in 2007. By 2012, there were regular meetings in 50 cities and a European and American conference. …
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Is the quantified self movement the future of American health?
The Internet beta 0.5 version was nothing like it is today. Back in the ’80s and the early ’90s the most common way to access the outside world was to use a phone modem to dial the number of a remote computer. These primitive servers usually ran DOS based software called a Bulletin Board System (BBS) which allowed users to post messages to each other. For the most part, these …
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Why Facebook should be a template for electronic medical records
My primary care physician, the last time I was in for a checkup, had not adopted ePrescribing or started using an electronic health record (EHR). My understanding is that the medical group to which he belongs had not rolled out these capabilities to him yet but was planning to do so. Hopefully, this summer when I see him again he will be plugged into the electronic health record that the …
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How doctors should adopt new technology
A recent Health Affairs article casts doubt on the cost-saving prospects of health information technology despite the significant investments made by hospitals, physicians, and the federal government to promote electronic records.
Reduced ordering of imaging and other diagnostic studies by physicians is often cited as a likely mechanism for estimated cost savings due to health information technology. Possible mechanisms include reduction in redundant (duplicated) tests secondary to better access to …
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Doubting the cost savings of health information technology
