As we’ve listened to providers describe their reactions to this pandemic, telehealth continues to be a pervasive theme at the foundation of their response. They refer to this as a “watershed” event that will permanently change healthcare delivery. In that context, many expressed concern that the current relaxation of regulations, and as importantly, the parity payments for telehealth services will be retracted as the crisis eases. While most agree that ...

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The administrative burden of medicine significantly contributes to physician and clinician burnout, electronic health systems, or EHR system design and workflow as a lead culprit. As such, recent EHR technology innovation tactics have focused on automating components of data entry and documentation. These technology innovations could significantly reduce the amount of time we spend crafting our SOAP notes ...

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An excerpt from Man’s 4th Best Hospital, Now available in paperback from Penguin/Berkley. And in the Fat Man Clinic, what about billing? We would do it ourselves on our screens. Using HEAL, the EHR or Electronic ‘Health’ Record system that BUDDIES had installed in Man’s 4th Best and its ...

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"An increasing number of institutions are relying on telemedicine to continue delivering care to patients in lieu of typical outpatient visits in response to the COVID-19 pandemic. Telemedicine has been lauded as a potential equalizer in health care access. Indeed, it allows for safe and easy access to medical professionals. It especially benefits patients with transportation issues or those seeking specialty ...

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The stuffing of things into organs for a desired effect, in this case, fattening a goose, is first recorded in Ancient Egypt and has since been used in multiple culinary traditions. It is now best known for French cuisine. What gastronomes desire animal welfare people abhor. The preferred method is to put more things (food) into an organ (stomach) to cause a secondary change (liver). I am sure the geese ...

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As a physician transitioning from hand-written patient charts to electronic medical records, I have observed the blooming of pop-up alerts prior to my completing each patient visit. These alerts remind me what I should do for my patients: age and gender appropriate screening tests and procedures, vaccinations, pain management suggestions, and prescription renewal reminders, to name a few. These reminders are a great support to caring physicians who find themselves ...

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"Will the unfavorable regulatory environment permit telehealth to flourish? Perforce we’re beginning to see a relaxation of restrictions that have hitherto obstructed progress.  Recently, federal officials approved interstate licensing, thereby prompting greater telehealth conversion, utilization, and expansion. Medicare’s 1135 Waiver is also encouraging, and, in as much as it serves the same ends, the Drug Enforcement Administration’s leave to prescribe via ...

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The Nuance Dragon Ambient eXperience (DAX)This article is sponsored by The Nuance Dragon Ambient eXperience (DAX). The COVID-19 pandemic has triggered seismic shifts in health care delivery. Never before has the health care system mobilized to handle a massive surge in one type of illness while bringing so many other services to an abrupt standstill. Elective ...

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Chronic conditions are justifiably an area of broad concern because of their adverse impacts on patients and effects on health care costs. Recently, the COVID-19 pandemic has drawn attention to the role of telemedicine as a powerful tool for revolutionizing chronic condition management. Going forward, the policy question is whether clinicians should have complete flexibility as to when and how often to substitute telemedicine services for ...

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"Almost overnight, the COVID-19 pandemic has completely disrupted how we deliver primary care to patients. Before the pandemic, telehealth seemed to be a way to deliver urgent care for acute issues to a select group of tech-savvy patients. Now, at least in my practice, the majority of primary care (acute care, chronic disease management, and preventive care) is being delivered through ...

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I did a peer review once of an office note about an elderly man with a low-grade fever. The past medical history was all there, several prior laboratory and imaging tests were imported, and there was a long narrative section that blended active medical problems and ongoing specialist relationships. There was also a lengthy review of systems under its own heading. In an over ten-page long printout, the final diagnosis was ...

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I have written, or more accurately ranted, about electronic medical records (EMR) systems throughout this blog. While the systems have clearly improved since their mandatory introduction into the medical universe, they have still not delivered on many of their promises. Of course, EMR has brought tremendous advantages to the medical profession, and we are all grateful for the technology. But this progress has exacted a cost. Many of them are clumsy ...

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The COVID-19 pandemic has resulted in at least 25 million cases worldwide with a continued spread in the United States, causing global disruption in every sector of society and forcing adaptation to a new normal relying increasingly on technology. Even in the medical field, where there is a pervasive and persistent traditionalist approach to technology adoption, many of the barriers have been overcome. When we reflect back on this life-changing ...

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"Building great tech for doctors is no different from ventilator technology. In some scenarios, you will want to talk to the EMR like you talk to Siri, rather than poring over a screen littered with boxes and lists. In other cases, you will want elegant graphs intuitively laid out to show how your ICU patient is progressing. Other solutions will go ...

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With a combined market cap of more than $2 trillion, technology giants Google and Apple are placing big bets on disrupting the $3.6 trillion health care industry.

Earlier in the year, Apple CEO Tim Cook repeated a claim that “there will be a day we look back and say Apple’s greatest contribution to mankind has been in health care.” Meanwhile, Google Cloud CEO 
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An excerpt from When We Do Harm: A Doctor Confronts Medical Error. One of the selling points for the electronic medical record (EMR) was that it would be a boon for patient safety. Just having all the medical records in one place is a monumental improvement over ...

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If you are a physician unhappy with your current EHR system (surveys suggest 2 out of 3 are), and you do have the ability to switch, this article is for you. Our COVID-19 pandemic may place you in a bad financial time for this, but it's also placed you in an excellent time to plan for it. In 2010, with my then-current EHR software vendor declaring bankruptcy, my private practice, like ...

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In a perfect world, an electronic medical record would aggregate a patient’s medical information from all health care providers into a single, comprehensive record that could be easily accessed by any provider with the patient’s permission. This information could reduce the risk of medical errors, duplicate testing, and inappropriate treatment and the associated cost of these mistakes. It could also be lifesaving in the event of a medical emergency that ...

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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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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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