Computerized physician order entry (CPOE) is being rolled out across our nations’ hospitals. The old days of written, and often illegible, orders from doctors are fast becoming a thing of the past. The potential for this measure to improve patient safety and transform medical practice is unquestionable. As a physician who has worked in several different hospitals since finishing my residency, my time in practice has coincided with the new age ...

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Health technology must improve patient safetyThis was the dream: We would use technology to create a seamless health care system, one where people, computers and machines would work together to improve patient care in many different ways. Health care would be more efficient, it would be safer, it would be less expensive, we would be able to transfer health-related information quickly and accurately. After ...

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Imagine you go to work one day and your boss says all employees will be evaluated based on the performance of a new set of job skills that require additional training and, perhaps, new computer hardware and software. The boss also announces that some employees will be reimbursed for the cost of acquiring these skills and tools. You aren’t among this privileged group. In government, this is called an unfunded ...

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The digital age of medicine is upon us.  Recently at the opening plenary session at the annual Heart Rhythm Society meetings, we heard Dr. Eric Topol and others tell us that we must embrace social networking in order to engage patients and improve care.  The Affordable Care Act has now changed the landscape of medical practice in the US: We must do more to focus on preventative care and work harder to curtail costs. ...

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The road to improving health care over the past several years has most certainly had a focus on implementing upgrade technologies such as EMRs and tablets, but also creating new technologies like 3-D printers and Watson-like doctors. However, in my opinion as both a practicing doctor and technology entrepreneur, the focus is all wrong. EMRs, 3-D printers, and Watson-like brains are not fixing the real problems that plague the broken health ...

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After I read this blog on OpenNotes, I struck up a discussion with a radiologist friend. We commiserate over laws and loopholes in laws that cause system abuse. I am so happy that Obama recommended to close the loophole in the Stark Law in his 2015 budget. That loophole has created some rampant abuse. I worry about and applaud the possible effects of patients being able to read their notes online. ...

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Why doesnt everyone have a pocket ultrasound machine? For about 2 years now a tiny ultrasound machine has been part of my standard physical exam tools as I take care of patients in the hospital and in the outpatient clinic. In November 2011, I first picked up an ultrasound transducer in a continuing medical education course on bedside ultrasound for emergency physicians. I am an internist, not an emergency physician, ...

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Shakespeare said that brevity is the soul of wit. I say brevity is the soul of a good note. As a resident back in the early 90s I would look at office notes written by older, near-retiring physicians. I’d read these one or two lines written on 3 1/2-inch note cards, turn to my fellow residents and ask, “How can someone possibly document this way?” Years later, I realize the genius, ...

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During my 2+ decade tenure as a physician I have always believed that a physician’s promise of confidentiality was a pre-requisite to obtaining accurate information from a patient. With the enactment of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) the rules which stipulate when a physician must disclose confidential medical information (protected health information, PHI) without the prior consent of the patient were codified into law. In today’s ...

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CMS has paid out over $21 billion dollars in incentive payments to providers and hospitals who have successfully attested under the EHR Incentive Program (i.e. meaningful use). With that much money out the door, you can bet that Congress is watching closely to ensure that those dollars are only going to people who really have met the requirements. One way that CMS is monitoring meaningful use is by conducting audits ...

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