I had a nice conversation with a dermatologist at a party recently.  He started complaining about the notes he receives from other physicians.  He used terms like piles and piles of junk. Talk to any experienced physician and they will tell you that once upon a time our teachers taught us to write notes appropriate to the situation, not appropriate to the billing system. Several years ago I ranted about the necessity ...

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"It looks like you've done very well, Mr. Smith." "Thank you, doctor." He left the patient's room and ambled back to the nurses station, legs tired and ankles somewhat swollen.  It had been a long case and now he just had to type his note, send an email message, and review his schedule for the following day.  He sat down at the computer and logged in.  That's when he looked up briefly ...

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The recent revelation of the NSA’s top-secret mass surveillance program by Edward Snowden has spotlighted the benefits and burdens of our increasingly digitally connected world.  According to President Obama, monitoring our phone calls, emails, and web activity has helped thwart dozens of terrorist attacks.  But the idea of the government keeping track of what had hitherto seemed private raises the specter of an Orwellian world in which everyone is under ...

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Just a little over four years ago, President Obama, in his inaugural address, challenged us a nation to “wield technology’s wonders to raise health care’s quality and lower its costs.”  This was an awe-inspiring, “we will go to the moon” moment for the healthcare delivery system.  But the next thought that ran through the minds of so many of us who work on health IT issues was this: how were ...

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5 ways Google Glass can be used in a hospital I recently had the opportunity to test Google Glass. It’s basically an Android smartphone (without the cellular transmitter) capable of running Android apps, built into a pair of glasses.  The small prism “screen” displays video at half HD resolution.  The sound features use bone conduction, so only the wearer can hear audio output.   It has a motion sensitive accelerometer for gestural commands.   ...

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George W. Bushs angioplasty: Did he receive the best care? Former president George W. Bush underwent an angioplasty recently, and the details sparked a public debate about the controversies of heart disease treatments. His spokesman stated that he underwent a routine physical exam and had no symptoms of heart disease. A stress test showed EKG changes and a CT angiogram found a blocked artery. He was transferred to another hospital and underwent an ...

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Eligible physicians are dropping out of the HITECH incentive program. Why? Often, it's because a practice implements an EHR and then tries to mimic all their old paper processes and workflows. That can get them through the vendor's initial implementation, but it is not sustainable for the long term. Workflows and operational processes must be modified to optimize the new tool. Technology changes what is feasible, and to adapt, we need to ...

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The first resident who really reamed me out on the wards was having trouble reading my handwriting. My handwriting became doctor-unreadable well before medical school, but how quaint. It was the beginning of my second month of clinical training, and hers of internship. She couldn’t follow our shared patient’s daily progress note. I didn’t tell the story in the right order. The format was wrong. Instead of noting only pertinent ...

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I recently tweeted about Danielle Ofri’s important piece, The Doctor Will See Your Electronic Medical Record Now.  I like the piece, and especially like some of the quotes, but still I believe the problem needs an expanded take. Context represents the major advantage of 38 years experience as a physician.  Over time, one sees trends come and go.  Hopefully one can see the strengths of the “good old days” and ...

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There is so much entropy in health care right now.  So much finagling, so much shifting, so much arguing, so much uncertainty, so much shock.  Shock at prices, shock at waiting times, shock that doctors don't know how to increase referrals, shock that doctors aren't doing more to help.  What gives? In triage, you don't spend time with the expectant. Doctors are keeping their heads down.  They are still seeing patients.  They ...

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