On a 12-hour shift in the hospital, I recently spent a mere hour with patients, with the rest glued to a computer screen, to the "iPatient." When a patient comes to the hospital, speaking to them has become an afterthought to reading extensive medical records, physical exam findings from the emergency room, and synthesizing laboratory data. I, as a millennial doctor, have been on the cusp of this shift. My ...

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It is a heart pounding, head spinning, edge of your seat page-turner; the sort of rare saga that takes your breath away as it changes you, forever.  It hints at a radically different future, a completely new world a few years away, which will disrupt the lives of every man, woman, and child.  Available now, from the National Coordinator for Health Information Technology (ONC), Office of the Secretary, United States ...

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Doctors and hospitals often exist in a universe parallel to the consumers, patients, and caregivers they serve, a prominent chief medical information officer told me last week. In one world, clinicians and health care providers continue to implement the electronic health records systems they’ve adopted over the past several years, respond to financial incentives for meaningful use, and re-engineer workflows to manage the business of health care under constrained reimbursement. In ...

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A lot has been written about how awful electronic health record (EHR) systems are. They are overwrought, overengineered, dreadfully dull baroque systems with awkward user interfaces that look like they were designed in the early 1990s. They make it too easy to cut and paste data to meet billing level requirements, documenting patient care that never happened and creating multipage mega-notes, full of words signifying exactly nothing. They have multitudes of ...

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shutterstock_97947788 As I watch the business world's fascination with the electronic medical record (EMR) and all of the big data that it accumulates, I see more and more processes codified and treatment pathways carefully honed. Only one small thing remains until the computer can tell doctors how to behave based on the developed algorithms: To turn free text in the patient chart ...

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I once wrote about the communication difficulties caused by electronic medical records systems. The response on Twitter ranged from sentiments including everything from “right on, sister” to “greedy doctors are only complaining about EMRs because of their price tag.” The disconnect between policy wonk’s (and EMR vendor’s) belief in the transformative power of EMRs and exasperated clinician users of these products is jaw-dropping. Physicians are often labeled as ...

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shutterstock_196442450 A common complaint regarding the use of electronic medical records (EMRs) is that physicians spend the majority of their time with a patient “tinkering” on a computer rather than interacting with the patient. Use of EMRs is now mandatory in the U.S., creating many advantages: Patient information can be more easily shared in a secure environment, there are no lost files or ...

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shutterstock_164594111 An article from the JAMA has been gnawing at my consciousness for the last couple of weeks. Dr. Prashant Kaul and colleagues out of the University of North Carolina reviewed records from hospitals in the state of California from 2008 through 2011, looking for patients who had been hospitalized with heart attacks. Specifically, they were looking for patients with ST elevation ...

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shutterstock_169875926 The job of a nurse has changed dramatically over the last couple of decades. I’ve witnessed these changes at close quarters and heard feedback from nurses in several different hospitals. The biggest change undoubtedly is the interaction with information technology and the move away from paper charting. The theory behind this push, which is part of the federal government’s meaningful use policy, ...

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shutterstock_130682090 By the time the next decade rolls in there will be no paper charts. There will probably still be paper floating around in various capacities, but there will be no one charting on paper. The term “charting” itself may become obsolete, like yonder or popinjay. The term EHR, which is what replaces the paper chart, won’t last either because it doesn’t ...

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