Robert was the picture of health. He had run eight marathons and finished countless 5K and 10K races. He tracked everything from sleep to food intake, logging his exercise parameters religiously. A seven-minute mile was a routine workout for Robert. But over the course of a few days, he noticed that he felt more winded during his run. One morning, when he awoke and checked his heart rate variability (HRV), it ...

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“It’s going to be ugly today” was my colleague’s assessment at 6:30 a.m. Wednesday morning, when the electronic medical record failed to launch, the Internet could not be accessed, pagers and phones could not connect, and a recording on the helpdesk line noted, “Systems are down, and there is currently no estimated time of resolution.” So we waded into fourteen hours of practicing medicine without computers. This was not good. Patients’ ...

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As more hospitals move to electronic health records (EHRs), many physicians have started writing about their growing discontent with the new systems. Authors have declared that EHRs are poorly designed, inefficient, lead to over-billing, and are downright dangerous. When my supervising physicians gripe about this, I mainly nod along to avoid conflict. But I have a confession to make: Most physicians currently in training love electronic ...

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The use of information technology in health care holds so much promise, and potential yet to be realized. Ask any front line physician and they will list electronic medical records (EMRs) as one of their biggest daily frustrations. A brilliant video by Zubin Damania, also known as ZDoggMD, recently parodied the current situation and the pain felt by doctors on a daily basis. But it really isn’t all about ...

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Recently, I was dining with elite radiologists. In that uncomfortable silence between dessert and the check, I said, “radiology must shift the traditional paradigm by creating value streams using disruptive innovation to leverage population health to build strong ecosystems and a robust ectoplasm.” I was experimenting if excreted verbiage hastens the check. Instead, it sparked a vigorous conversation about disruptive innovation, compelling me to drink more cognac. In health care, no two ...

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Dr. Lisa Rosenbaum has an excellent piece in the NEJM entitled "Transitional Chaos or Enduring Harm? The EHR and the Disruption of Medicine."  In essence a review of Dr. Robert Wachter’s book, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age, it deals with the ever increasing intrusion of the digital-industrial medical complex on the practice of medicine.  Bottom line: Electronic health records ...

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I have recently discussed imperatives of patient-centric health care, creating patient engagement, and potential value of various digital health technologies. Apart from these considerations are those involving roles of stakeholders and barriers they face in adopting technologies and optimal models of adoption. Not lost in the technical, regulatory, and clinical issues required to be addressed are ...

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I have a love-hate relationship with the electronic health record (EHR). To be precise, it's 90 percent hate, 6 percent love. The missing 4 percent? That would be the percentage of time spent on the phone with tech support trying to figure out which order set I have to use to input percentages. I've been in practice long enough to straddle the transition from paper ... to even more paper (thanks EHR, you're the ...

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I peeked. Several months ago, I met a 60-year-old woman with shortness of breath. Her hospital stay was a whirlwind. She had lost weight, and a test detected her stool had blood in it. This was an ominous sign. Within a few hours, she underwent a colonoscopy that revealed she had colon cancer. The colorectal surgery team whisked her away from my general medicine team. I soon left that hospital for ...

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I recently read an article in Politico entitled “Doctors barred from discussing safety glitches in U.S.-funded software.”  The article states that, despite massive public funding of electronic health records (EHR), the EHR corporations (including Epic Systems, Cerner, Siemens, Allscripts, eClinicalWorks and Meditech) routinely attach gag clauses to contracts with the hospitals and medical groups who purchase their systems. We are talking about gag clauses that prevent criticism by ...

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