Over the next few months, Jacob Reider will serve as the interim National Coordinator for Health Information Technology (ONC)  while the search continues for Farzad Mostashari’s permanent replacement. What advice would I give to the next national coordinator? David Blumenthal led the ONC during a period of remarkable regulatory change and expanding budgets. He was the right person for the “regulatory era.” Farzad Mostashari led ONC during a period of implementation when resources peaked, grants were ...

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Health IT is booming, or so they say. The hotly debated and highly politicized health care reform, a.k.a. Obamacare, has been shining bright lights on a segment of our economy that is quickly approaching $3 trillion per year, and is in dire need of improvement, or so they say. Depending on who you ask, some say that health care resources must be redistributed in a more equitable manner, while others ...

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In July, I began an exciting role at Einstein: assistant dean for educational informatics. One of my main objectives is to optimize the use of technology to advance and deepen learning. But as much as I welcome it, technology alone will not achieve our educational goals. Recently, David J. Hefland, the president and vice chancellor of Canada’s Quest University, characterized the model of ...

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What the unbundling of Craigslist has to do with todays EMRs Recently there’s been a lot of talk about the law of bundling and subsequent unbundling of web services. Many have used Andrew Parker’s brilliant image below to make the point. Craigslist came along and bundled everything into one place and, as a result, completely dominated. They destroyed multiple businesses in the process (including the rental and roommate web service I worked with ...

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The discourse on the problems of the modern healthcare system contains much vitriol and blame. There is a distinct flavor of adversarial combat in the discussion; pitting physicians, those in the trenches, with those politicians and lawmakers on the other side. With estimates of healthcare costs exceeding 15% of the gross domestic product of the United States, it is easy to understand the passion that the topic evokes. The complexity ...

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From MedPage Today:

  1. 'Meaningful Use' Still on Target During Shutdown. The government shutdown may be slowing or halting a number of health-related activities, but federal incentives for electronic health records aren't one of them.
  2. Inappropriate Antibiotic Use Still High. Despite years of persuasion and publicity, antibiotics are still drastically overprescribed for two common complaints -- sore throat and bronchitis.
  3. Fecal Transplant, Now ...

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I recently supervised a new intern as she conducted a patient interview. Following procedure, the intern reviewed the patient’s electronic medical record (EMR) and checked his lab results. She noticed that his cholesterol was high, and he told her that he had stopped taking his atorvastatin due to a recent trip to the Dominican Republic. “It’s no problem,” my intern replied. “We’ll get you back on the medication.” She began to ...

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EMRs are not designed for patient care. Is there anyone working in health IT who can honestly say that he or she never heard this statement being made hundreds or thousands of times? Is there any clinician actually working with patients and EMRs who can state that such thought never crossed his or her mind? This includes health IT evangelists and physicians spearheading IT initiatives at the most excellent of ...

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The promise and the peril of big data in health careThere was a memorable scene in the movie "The Graduate" from 1967. You may know it or have heard of it, when the older man turns to the college graduate and says the future is all about one word: "plastics." Well, plastics may have been then, but this is now. And the core themes I keep hearing these days there are two central ...

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The medical board of the state of Oklahoma recently sanctioned a physician for using Skype to conduct patient visits.  A number of other factors add color to the board’s action, including that the physician was prescribing controlled substances as a result of these visits and that one of his patients died.  This situation brings up several challenges of telehealth -- that is, using technology to care for patients ...

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