I recently did a tally.  Since starting my locums adventure last year, and going to full-time locums in January, I’ve worked in a grand total of 11 emergency departments.  Let me qualify that for the occasional visitor to my blog.  I decided to do this for purposes of flexibility, finances and a much needed change of scenery.  Not because I’m a problem physician, or unable to do the work in ...

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There is a growing group of articulate and engaged patients committed to getting access to all their medical information in order to be better positioned to work collaboratively with their clinical teams. Published studies like the OpenNotes project have consistently shown significant benefits and a lack of serious problems. Health care systems are slow to change and just beginning to understand both the need and value to this ...

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Health care information technology has of course grown exponentially over the last decade, as electronic medical records (EMRs) and computerized physician order entry (CPOE) systems have become ubiquitous. It’s funny to think that not so long ago, physicians and nurses had to trawl through piles and piles of paper charts to search for the information we needed -- whether it was lab results or patients’ notes. However, the road to this ...

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We believe in data. We are scientists after all. And yet in this new era of big data is it possible we are measuring the wrong things? Most measures of physician performance are process or intermediate outcome measures aimed at a production line model of care. Was an A1c done, did the physician use a computer to send an order to the laboratory, were antibiotics given within two hours of presentation. Yet ...

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A wish list for Apples HealthKit Apple has been making headlines again, which is not unusual for a company that sets trends and moves markets. Recently, they announced that iOS 8 would have a built-in app to collect all of your health info in one place. Then there was the announcement of the partnership with Mayo Clinic and Epic Systems. This generated even more headlines.  I saw all ...

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Without a doubt, the death of American veterans as a result of the VA waitlist debacle is tragic and unacceptable. The Obama administration must move quickly and deliberately to fix the underlying problems and restore faith in the agency. If these issues were common throughout the VA network of hospitals and clinics, it might make sense to consider dramatic, earth-shaking alternatives like moving veterans to private providers and shuttering the ...

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The health care IT space is possibly the most exciting and dynamic industry in the United States right now. Health care is going through a total transformation driven by massive regulatory change, the consumerization of health care and the important shift from a system that manages sickness to a system that manages health. Underlying all of this change is the software that runs large health care organizations: specifically, the big EMR ...

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A pivotal moment in the U.S. health care system is taking shape. Physicians across the U.S. are wondering what their role will be in this new health care landscape that is being shaped by legislation (from the Affordable Care Act and from meaningful use), by social media, and by technology advancements. It’s an existential moment. Physicians are wondering if we are knaves, pawns, or knights in this chess game called the ...

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My 87-year-old father broke his hip this past weekend.  He was in Michigan for a party for his 101-year-old sister, and fell as he tried to put away her wheelchair.  The good news is that he’s otherwise pretty healthy, so he should do fine. Still, getting old sucks. During the whole situation around his injury, surgery, and upcoming recovery, one thing became very clear: Technology can really make things much easier:

There is a recent and interesting piece in the Wall Street Journal by an orthopedic surgeon, Dr. Craviotto, about the maddening aspect of forced mandates and bureaucratic requirements in medicine that seem to have very little to do with actual medical care and more about hoops through which we must jump that seemingly lead to nowhere. While I do find the bureaucracy of medicine in the United States insane versus the Canadian ...

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