We talk a lot in critical care medicine about liberating patients from ventilators. Vents are getting a lot of deserved attention for saving lives in the COVID-19 era. But the machine has downsides that get worse the longer the patient needs it. Because we’re obsessed with taking great care of our patients, we in ICU medicine obsess about ventilator liberation. There are thousands of publications on the topic. Vent weaning protocols ...

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As most of America approaches the one-month mark since shelter-in-place orders began, there is increasing talk of “plateauing” and debate of strategies for resuming “normal” life. Unfortunately, we continue to find ourselves without a clear path out of this unprecedented pandemic.  Now more than ever, in the setting of an infectious disease crisis, health care providers must be at the forefront to advocate for those most at risk of a ...

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The year 2020 might bear witness to a significant shift in control of health care from the providers, insurers, and the government to actual health care consumers. First, it was the politicians, then the tech conferences and promises of 5G, and now global pandemic scares are all signaling the demand for remote health care. The delivery of health care has been in the hands of hospitals and physicians for nearly a century. ...

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I work for a hospital network with the world's slowest computers.  I timed it: Last shift, it took me fifteen minutes to log on. The first computer obtained didn't function at all.  It had been worked on the day before by information technology services (IT). Efficiency and time management appear to be amongst top priorities in medicine. "Did they get their aspirin 24 hours after getting their clot-busting drug after cleared ...

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A major goal of MIPS is to increase the sharing of information between providers and eliminate so-called data silos. Central to this goal is the implementation of fast health care interoperability resources (FHIR). FHIR allows one EHR to directly query and pull information from another EHR, and is based on the belief that medical charts can be reliably abstracted into resources. All ...

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What if I told you just a few years ago that Amazon — a budding e-commerce startup — would come to disrupt the multi-billion dollar retail industry. I seriously doubt that anyone could have given it a serious thought. At least not in the magnitude that will force a slew of big-box retailers to shut their doors for good. I am sure the same response would have been elicited about Uber and ...

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“Let’s take a look together,” was the start of a virtual clinical assessment that led to a primary care provider and a neurologist diagnosing a patient with Parkinson’s Disease. As the neurologist in that conversation, I had the opportunity to play a meaningful role in delivering my expertise and, most importantly, making sure the patient received the highest level of appropriate care. With telemedicine’s support, both providers - and the ...

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A recent study published in Science, one of the world’s leading academic journals, found that a predictive health care algorithm discriminated against black patients. The tool, created by Optum, was designed to identify high-risk patients with untreated chronic diseases, thereby helping administrators re-distribute medical resources to those who’d benefit the most. But there was a glitch in the algorithm, according to researchers. Rather than ranking the needs ...

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The year is 2050. You enter the room, ready to speak with your next patient, a 60-year-old white male with recent episodes of chest pain when he climbs the stairs to his office. Before sitting down to speak with him, a monitor in the room pulls up his recent lab work and current medications. Your patient note is being filled in, but nobody is typing; the computer is avidly listening ...

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I recently spoke with a colleague who transitioned out of the military in the last year. He was previously excited about his new job opportunity, but now a year later, he tells me, "I hate civilian medicine." I was surprised because he had been excited about the opportunity to teach in a residency program again. He said, “I love teaching, and I love the residents. ...

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