Have you ever encountered an intrusive, insistent popup decision support screen while trying to take care of patients? Found yourself stuck in a dead end electronic hallway without egress? A situation where you had to choose an option that was inappropriate for your patient just to exit the screen? This is the situation with my local medical institution's "DVT Advisor," a mandatory decision support screen for all patients. DVT Advisor was implemented ...

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It seems lately that questions of medical ethics are coming up more and more in the news, things like the rights of patients to make decisions, definitions of futile care, and end of life care. The way to look at these things is not in a vacuum. All of us may have our own opinions about right and wrong, but the field of medical ethics is actually one that has ...

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8:00am Sunday: You glance over and notice an email from your boss while you’re eating breakfast and reading the paper. Ok, you think, I’ll respond later, maybe after my run. 8:10am: Ping! A text arrives. "I have a question about the project." Ok, you think, it’s Sunday, but sure, I’ll get back to him after breakfast. 8:20am: The phone rings. It’s him. "I’ll need that slide for tomorrow’s presentation. How soon can you get it to ...

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A new paper says "metastasis of email at an academic medical center" may cost millions of dollars. A pediatrician from the Penn State College of Medicine kept track of all of his emails for an academic year and found that 2035 mass distribution emails were received. They originated from the medical center in 1501, the department in 450, and the university in 84. The emails were about information technology, academic and professional ...

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Uncle Walt died this morning. Finally. I say "finally" because I believed this day would come four months ago, when he had emergency bypass surgery. At the time, I didn't believe Walt would live; he was an ailing, seventy-seven-year-old man with severe pulmonary disease. When his heart started to hurt one Friday, his doctors told him, "With bypass surgery, you might live. Without it, you'll be dead before the weekend is over." Walt's ...

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Patient satisfaction and improving the hospital experience is being discussed in hospital boardrooms across the country. Now that financial reimbursements are directly tied to HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey scores, there is a significant incentive to do so. A multitude of ideas are being put forward into how this can be achieved, and hospitals are investing heavily to get tangible results. Many involve complicated and ...

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If you are a CEO or COO of a health care organization, and your IT people have been trying to get your attention, it’s time to have a serious sit-down with them. If they haven’t been trying to get your attention, it’s time to have an more serious sit-down with them, complete with charts and graphs and arrows on fip charts. Here’s why. Remember in November it was revealed that the Target retail ...

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I have been doing admitting shifts at a large hospital, as hospitalist. It is flu season, so volumes are large. Even people without the flu are sick. It often happens that way. And they are so very sick! The thing about the very sick patients I see is that they are generally what might be called medical "train wrecks." They are very sick because they have had interventions over the years ...

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There is little doubt that over the next few years we will see a wave of increasingly sophisticated point-of-care tools to help clinicians determine the costs and relative value of their medical recommendations. I welcome that day, but I do not intend to idly sit by waiting for it. Not all solutions need to be based on high-level algorithms or slick, user-friendly apps made for iPhones. Last month I came across a ...

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In describing why Cooper Union, a unique college that offers absolutely free education to students, would effectively die if it starts charging tuition, Kevin Slavin wrote:

For many of us, Cooper wasn't even the cheapest way to go to school...So the question is: why did we go? We went not because of the financial value of free--that is, zero tuition--but rather, because of the academic value of free. At Cooper Union ...

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