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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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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With the advent of information technology in health care, patients and providers alike have begun to feel a cultural angst about what this means for the future of medicine.
As a recently minted MD with a keen interest in health IT that began with working on Google Health six years ago, I’m decidedly on the forward-looking end of the spectrum in the physician community. I think decision-support algorithms have the potential ...

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Lessons learned during an unplanned EMR downtimeA guest column by the American College of Physicians, exclusive to KevinMD.com. On a Thursday in April, my practice upgraded its electronic health record to the next version, the “latest and greatest” with more features, as well as compliance with meaningful uses 2 through infinity. That was the good news. The bad news was that it meant that our EHR ...

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Fifteen minutes. Give or take. That’s about how long a patient typically spends with a primary care doctor during an office visit. If you’re lucky enough to be healthy, maybe that visit comes once every year or two.  Or if you’re less healthy, maybe every few months. In either case, it’s not a lot of time. Not a lot of time to share all the relevant developments. Not a lot ...

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It’s rare for doctors to turn out en masse for a public protest. But that’s what happened at “Doccupy” in Contra Costa County, California in 2012. A group of safety net physicians testified before county supervisors -- in what they only half-jokingly called “Doccupy” -- that the cumbersome move to electronic health records (EHRs) had taken an enormous toll on patient care. The doctors saw half their usual number of patients. ...

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I’m back at it again, talking about my continued love/hate relationship with EMRs. From my conversations with doctors at different hospitals in our region, it seems that most docs appear to be falling into the “hate” column. Meanwhile, I’m still chugging along with the EHR that’s been installed in my office. And while it works just fine for the needs of a 3 physician single-specialty outpatient practice, it’s hardly the ...

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I’ve been thinking about EMRs, electronic medical records, lately. It’s a subject, despite some professional experience, I don’t feel particularly close to. In fact, if anything, they are a source of consternation. As an industry insider, I see them as an expensive albatross around our collective neck. As a human centered design adviser, I see them as an encumbrance for both providers and patients. And, as a patient I see ...

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