It has been 5 years since the passage of the HITECH Act portion of the Affordable Care Act. The purpose of HITECH was "to promote the adoption and meaningful use of health information technology." While the result of this legislation has been the significant increase in the adoption of EHRs, most of the potential benefits of digital technology have yet to be demonstrated. there are multiple reasons for this lack of proof. The ...

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A few years ago, I was doing a summer internship in which I looked at health outcomes for hospitalized patients. I sat in an office and read about patients with issues like high blood pressure and cholesterol. At a certain point, I realized that the reports on their outcomes were interesting, but the real solution to the problems I was studying was happening outside my window. My window overlooked a ...

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Helicopter emergency services: A disparity between aviation and medical proficiency As the helicopter emergency services (HEMS) industry enters its fifth decade, there is an 800-pound gorilla in the room and nobody is talking.  The average EMT, fireman and emergency physician too often make the flawed assumption that when it comes to HEMS, the industry is a uniform, high quality, strictly regulated entity.  They assume that all HEMS programs use state of ...

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ZDoggMD once again entertains and educates with his Ebola parody.  "Too soon?" some say.  Actually, as ZDogg says, not soon enough.  Watch why.

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 42-year-old man is evaluated for a 6-day history of severe burning and stabbing pain in both feet that is worse in the toes. The pain is more severe at night, is aggravated when the bed sheets touch his skin, and is partially relieved when he walks or massages his feet. The ...

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Twitter counts for this doctor. Read why. Whenever I speak about social media, much of it has to do with Twitter. It has become part of my daily routine, much like checking email or going to news media sites. I will often check-in on Twitter and will respond to items of interest -- whether or not tweets were sent directly to me. However, I am cognizant ...

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The idea of starting over with computerized electronic health record (EHR) systems and doing them right as mentioned in a previous post has struck a resonant chord. Unfortunately designing an EHR that works may be a fantasy, due to one huge hurdle that would have to be overcome first. But it is fun to imagine an alternative universe where EHR systems were patient-centric instead of being ...

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Assimilating independent physician practices: Is resistance futile? Fans of Star Trek: The Next Generation will recall that the most disturbing aliens encountered by the Federation were the Borg, a part-cyber, part human collective race that functioned as an integrated and cyber-connected whole that existed only for the good of the collective, rather than as distinct individuals with their own thoughts and personalities -- much like honey bees work together as ...

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Quit smoking: It takes a community to spread the wordYou never know when something special is going to happen, as in one of those times when you just wish you had a camera rolling to capture a moment, a comment, a statement about the way the world is -- and the way the world could be. This past weekend my wife and I were attending a meeting in ...

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Ruth was problematic.  Well into her seventies, her body may have dulled but her tongue was sharper than ever.  And she used it to lash me with complaint after complaint.  If it wasn't her knees, it was her ankles.  If it wasn't her ankles, it was her hips.  I battled the impossible month after month, year after year.  Our interactions left a bitter taste in my mouth.  Nothing makes a ...

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Martin Seligman, PhD, in his book Authentic Happiness, references a colleague, Mike Csikszentmihalyi, when discussing the concept of “flow.”  For Seligman and Csikszentmihalyi, flow is that feeling one gets when fully engaged or “in the zone” with an activity during which the passage of time seems suspended.  Often, the activity is aligned with one’s natural, signature strengths. For me, flow comes when I’m mountain biking: There are moments without thoughts, it’s just ...

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I don't remember all of the details. It was the summer of 1990, sometime in the first 3 months of internship. I spent those months on the 11th floor of the VA Lakeside Medical Center (now the vacant lot just east of the hospital). The VA was familiar territory for me. I spent 3 months there as a third year student, also on the 11th Floor. 11 East, to be ...

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Lesson learned: Not everyone is crazyLesson learned: Not everyone is crazy An excerpt from The Spattered White Coat: Intense experiences which formed a young doctor. I'll never forget one of the first patients I interviewed. When I went to get him, I could see him sitting in the waiting room, looking around and scratching his arms repeatedly. He was a very ...

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Over the past 5 to 10 years, hospitals and physician offices have been in a mad dash to implement electronic health records (EHRs) in order to meet governmental regulatory requirements.  Now that most projects are either complete or well on their way, what are we doing with all of the data that EHRs promised to generate? From my experience as a physician at a large academic medical center with one of ...

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The best way to avoid the flu is spending the months from fall until spring in a solitary bunker, communicating with other people only electronically. The second best way is getting the flu vaccine. The Centers for Disease Control and Prevention (CDC) recommends the flu vaccine for everyone over 6 months who doesn’t have a specific contraindication to it. Because of the increasing number of different flu vaccines that are now ...

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The Sunshine Act escalates the war on physicians The media has feasted on the recent release of data by the Center for Medicare and Medicaid Services (CMS) that details payments made by the pharmaceutical and device companies to hospitals and physicians in 2013. This was part of the the Physician Payments Sunshine Act (PPSA) -- also known as section 6002 of the Affordable Care Act (ACA) of 2010. What the ...

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A case that illustrates the good, the bad and the ugly of American medicine I had a recent conversation with an old friend about her elderly father that encapsulates a lot of what is both great and terribly wrong with health care in America today. Here are the basic facts: the man is in his mid-80s, retired from teaching school, and is active and vigorous, living in the community; he is cognitively intact. He has a ...

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Top stories in health and medicine, October 23, 2014From MedPage Today:

  1. Aortic Dissection Becoming Less Deadly. Aortic dissection survival has improved, particularly for patients getting surgical repair.
  2. Preparing for Ebola: Is New York City Ready? The hall was packed, the speakers were primed, and the message to thousands of healthcare workers gathered here today was simple: Ebola will not sneak ...

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After listening to a lecture, third-year students at the Harvard School of Dental Medicine were surveyed about distractions by electronic devices and given a 12-question quiz. Although 65% of the students admitted to having been distracted by emails, Facebook, and/or texting during the lecture, distracted students had an average score of 9.85 correct compared to 10.444 students who said they weren't distracted. The difference was not significant, p = 0.652. In ...

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If another case of Ebola emanates from the unfortunate Texas Health Presbyterian Hospital, the root cause analysts might mount their horses, the Six Sigma black belts will skydive and the safety champions will tunnel their way clandestinely to rendezvous at the sentinel place. What might be their unique insights? What will be their prescriptions? One never knows what pearls one will encounter from after-the-fact risk managers. I can imagine Caesar consulting a Sybil ...

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