I find myself spending close to an hour on the computer each morning at the hospital. I spend this time dutifully looking up vital signs, labs, recent radiology or pathology results as well as many other valuable pieces of information about each of my patients. I watch as my colleagues frantically record values, while making sure to point out important trends and gross abnormalities.
When we round, there is always a …
To listen to all those desperate to reform health care, you get the impression that physicians are pretty horrible people. We are all sexist, greedy, money grubbing tyrants who will perform unnecessary tests and procedures just to make money. We don’t care about quality or cost. We are killing off 250,000 patients every year with our ignored “errors.” We purposely keep our patients in pain, or we addict them to …
The business value of medication adherence tools is coming into focus. For years, I remarked that, while we could create a case for why adherence was the right thing to do, we had great difficulty creating the right financial incentives to move these programs from curiosity to scale. That is changing now with the collision in the marketplace of new payment models and exorbitantly priced pharmaceutical products.
The poster child for …
Ah, EMTALA! The revered Emergency Medical Treatment and Active Labor Act! It’s one of those things which is like a nursery rhyme to emergency medicine folks like me. We’ve heard about it from the infancy of our training. “And then the bad doctor sent the poor lady to another hospital because she couldn’t pay! And the King came and crucified him for doing it!” The end.
EMTALA, for the uninitiated, is …
Think keeping your life organized is hard? Try keeping your doctors organized.
In this era of fragmented health care, patients find themselves in the impossible position of having to coordinate their care themselves — a task that many can’t meet. Having multiple chronic medical conditions often means being subjected to a dizzying assortment of specialists, medical terminology, and tests that can quickly overwhelm patients.
How many times have you found yourself in …
In early 2014 I decided to use the six state licenses I had obtained as a locum tenens physician to start practicing telemedicine. Since then I have worked with several telemedicine platforms. I use telemedicine to keep up my outpatient skills. I have found that telemedicine companies differ dramatically in their overall ease of use for the provider.
Here are my top 7 tips for deciding which telemedicine company to work …
The U.S. health care system is the world’s top in health care spending per capita, but in terms of performance, we’re dead last among developed countries. As a young physician embarking on a career in this landscape, it’s glaringly obvious that we need disruptive innovation to create better health at a lower cost. Physicians are uniquely positioned to make critical contributions to medical innovation, but even among …
During our dermatology section in medical school, a classmate recounted having had Henoch-Schonlein purpura as a child. Over a holiday break, he visited his primary care physician and asked if he could review his records out of curiosity. His family physician pulled out the index card that served as this man’s medical record. Yes, you read that correctly. It was not a chart or computer printout; rather a 4 x …
I order pregnancy tests on men. In fact, I do it pretty frequently.
Now before you go and question my professional competency, let me assure you that I went to a good medical school. I also completed a four-year residency in emergency medicine at a top-notch residency program. I was board-certified less than one year after finishing and have maintained that status ever since.
Despite this, I still order pregnancy tests on men.
Perhaps …
It’s been a long day in the psychiatry clinic.
Seeing patients is never dull, and each interaction is meaningful in its own way. From the moment they walk into my office to the moment they leave, I try my best to be fully present with the patients sitting in front of me. That means listening to every word, watching every nuance of body language, hearing every concern — both spoken and …
Last week I was playing golf with some friends. The Boston area has been having a bit of an Indian summer, and we are lucky to still be getting out there (long may it last). The conversation during one of the holes turned to health care information technology, when my friend, who is also a physician, told me about his experiences with a (certain famous) new electronic medical record that’s just been installed in their …
I have a love-hate relationship with the electronic health record (EHR).
To be precise, it’s 90 percent hate, 6 percent love. The missing 4 percent? That would be the percentage of time spent on the phone with tech support trying to figure out which order set I have to use to input percentages.
I’ve been in practice long enough to straddle the transition from paper … to even more paper (thanks EHR, you’re the …
I peeked. Several months ago, I met a 60-year-old woman with shortness of breath. Her hospital stay was a whirlwind. She had lost weight, and a test detected her stool had blood in it. This was an ominous sign. Within a few hours, she underwent a colonoscopy that revealed she had colon cancer. The colorectal surgery team whisked her away from my general medicine team. I soon left that hospital for …
I recently read an article in Politico entitled “Doctors barred from discussing safety glitches in U.S.-funded software.” The article states that, despite massive public funding of electronic health records (EHR), the EHR corporations (including Epic Systems, Cerner, Siemens, Allscripts, eClinicalWorks and Meditech) routinely attach gag clauses to contracts with the hospitals and medical groups who purchase their systems. We are talking about gag clauses that prevent criticism by …
The health information technology (HIT) world has been hit by a watershed event like no other. The Department of Defense (DoD), widely respected for its indiscriminate generosity to contractors, has awarded the most coveted prize in recent HIT memory: the Defense Healthcare Management Systems Modernization (DHMSM) contract. And the winner is … Leidos, the contractor formerly known as SAIC. A couple of years ago, when the race for …
So, there I was yesterday, working frantically to keep myself above the water level of the rapidly rising swamp of patients. Navigating, haltingly, the onerous and demonic EMR. So I thought I ordered three nebulizers, but it was only one. The respiratory tech approached me and informed me that she would put them in, but only this time. That I’d have to …
The U.S. health care system is headed toward a profoundly digital future. Provider organizations around the country are adopting and updating their health information technology (HIT) infrastructures. Many have begun requiring that clinicians gain proficiency in electronic health records (EHRs) in order to provide clinical care. A proliferation of start-ups and HIT companies in health care is poised to disrupt (innovatively or …
I have a unique perspective as a physician. Having traveled to many hospitals in the past two years, working as a locums emergency physician, I can comment on a variety of issues with a reasonable amount of experience.
One of those issues is EMR, or electronic medical records. I have spent plenty of time writing about this in the past, and I …
Citing slow load times, confusing menu structure, and overall frustration with the user interface, St. Barnaby’s Hospital has announced that the old electronic health record (EHR) will be replaced with a new state of the art binder-based system, in which a so-called “paper chart” is kept for each patient.
The new …
While the electronic medical record (EMR) has advantages, it also has introduced liability risks. EMRs can lead to lawsuits or result in a weak defense by casting the physician in an unfavorable light.
For example, examine these exchanges in a recent malpractice trial:
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