Health IT is booming, or so they say. The hotly debated and highly politicized health care reform, a.k.a. Obamacare, has been shining bright lights on a segment of our economy that is quickly approaching $3 trillion per year, and is in dire need of improvement, or so they say. Depending on who you ask, some say that health care resources must be redistributed in a more equitable manner, while others ...

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What the unbundling of Craigslist has to do with todays EMRs Recently there’s been a lot of talk about the law of bundling and subsequent unbundling of web services. Many have used Andrew Parker’s brilliant image below to make the point. Craigslist came along and bundled everything into one place and, as a result, completely dominated. They destroyed multiple businesses in the process (including the rental and roommate web service I worked with ...

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I recently supervised a new intern as she conducted a patient interview. Following procedure, the intern reviewed the patient’s electronic medical record (EMR) and checked his lab results. She noticed that his cholesterol was high, and he told her that he had stopped taking his atorvastatin due to a recent trip to the Dominican Republic. “It’s no problem,” my intern replied. “We’ll get you back on the medication.” She began to ...

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EMRs are not designed for patient care. Is there anyone working in health IT who can honestly say that he or she never heard this statement being made hundreds or thousands of times? Is there any clinician actually working with patients and EMRs who can state that such thought never crossed his or her mind? This includes health IT evangelists and physicians spearheading IT initiatives at the most excellent of ...

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The promise and the peril of big data in health careThere was a memorable scene in the movie "The Graduate" from 1967. You may know it or have heard of it, when the older man turns to the college graduate and says the future is all about one word: "plastics." Well, plastics may have been then, but this is now. And the core themes I keep hearing these days there are two central ...

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The medical board of the state of Oklahoma recently sanctioned a physician for using Skype to conduct patient visits.  A number of other factors add color to the board’s action, including that the physician was prescribing controlled substances as a result of these visits and that one of his patients died.  This situation brings up several challenges of telehealth -- that is, using technology to care for patients ...

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I have a vague recollection, a memory shrouded in mist, where I pondered what seemed like a radical question: What would a health record look like if my only concern was patient care?  This was a radical question because in my previous life I was an electronic health record aficionado.  I was good at EMR, which meant that I was really good at finding work-arounds:

  • How can I work around the requirements for ...

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My institution recently switched from its home-grown electronic medical record (EMR) to EPIC, a system for which many great things have been promised. Indeed, it is a considerable improvement over the past one. A number of hopes have been pinned on the latest-generation EMRs, not the least of which is the idea that finally, with this newest generation of tools, a nexus can be created and sustained among comparative effectiveness ...

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Electronic health records (EHR) systems are expensive. Really expensive. In fact, there have been reports of these systems causing significant revenue decreases or business interruptions -- such as Henry Ford Health System in Michigan reporting that implementing EPIC was a direct cause of their 15 percent net income decline in 2012. Using a free EHR system is a tempting alternative for many independent doctors or small practices. But are there ...

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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+ ...

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