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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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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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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Burnout in health care is an epidemic across the nation, contributing to a lack of empathy for patients, poor care, providers electing to leave the workforce, substance abuse, depression, and even provider suicide. In a recently published case study in the American Physicians Group Case Studies in Excellence, Iora Health made a move to shift the conversation around burnout from an individual phenomenon to a ...

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Back in 2016, my hospital, also my employer, changed the EMR. I was fully integrated into another EMR, so changing was not on my to-do list in the later part of my career as a diabetologist. As you would expect, the transition was a nightmare and took me to a new low in my life. Crying in my wine became my new norm. I became distraught, felt imprisoned, and felt that ...

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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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Just imagine the following: your assistant invites in Ms. Nichols, who has a migraine, a bad cough, and feels nauseated. You sit down, start talking about the symptoms, see her throat, measure her temperature, pulse rate, inquire more about the headache. In the end, you set up a diagnosis, you write a prescription for some meds, send the patient for some further exams due to the migraine, but ensure her ...

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“It should be in my chart.” I’m sure we have all heard this statement uttered with a subtle (or not so subtle) edge of frustration from our patients after asking a question such as “what medications do you take?”  I find clinicians despise this comment because it is interpreted as (a) the patient is not making an attempt to recall his or her medical history, or (b) that the patient doesn’t ...

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In the history of medical care, medical records served one purpose and two masters: to record diagnosis and treatment for physicians to refer to and for patients to use to transfer care when they desired. The medical record was a simple 3 x 5 or ledger card in the 1950s. The patient paid directly for care at the time of service. Usually, the physician had a nurse and a spouse ...

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How can we possibly get to standardization in medicine? And is that a good thing? Standardized checklists save lives; rigid procedures for sterilization of equipment saves lives; universal compliance with recommended beneficial treatments saves lives. And while it's sometimes a wonderful thing to let a surgeon solve a problem creatively or to allow a patient visit to go overtime in order ...

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A featured article titled "Death by A Thousand Clicks" addressed some of the serious problems and challenges we still face in the "digitization" of health care. As an early adopter of EHR since 2003 and a self-avowed "techie," I can vouch for the fact that many of the government initiatives in HIT, like "meaningful use," actually made many EHRs worse. Why? Because many of the regulations were being written by ...

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Anyone who has spent any time on the internet knows better than to spend much time on the comments from an opinion piece. The comments section, even one on a site as reputable and respected as the New York Times, is often a minefield of trolls, contrarians, and conspiracy theorists. But after reading “The American Medical System Is One Giant Workaround” by Theresa Brown, I couldn’t resist. Among ...

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During one long ago very hot Washington, DC summer, at the suggestion of my parents, I enrolled in a typing course that was given at our elementary school. This was the summer between sixth and seventh grades, and there were lots of things I would've preferred to have been doing, but my dad, who started out in advertising, felt that touch-typing ...

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Having been an improvement advisor with many quality improvement initiatives and collaboratives, I have observed that stories about successful initiatives too often leave out major relational barriers that got in the way as well as the critical interventions necessary to overcome them. That important details about relational challenges so often remain hidden is not a small problem. Evidence points to relational issues as a major cause of lack of expected success ...

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I was in a discussion with a group of patients about how difficult it is for patients to get access to their own medical records. It was initiated after one of my patients was refused copies of her recent hospitalization. There is much confusion out there about who actually owns the record and how it is allowed to be accessed. Most people are aware of HIPAA, the regulation set into ...

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