Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

Patient Participation In EMRs Can Improve Efficiency

Our office has been on Electronic Medical Records (EMR) for nearly thirteen years.  We see a high volume of patients, keep our overhead down, and are able to be quite successful financially.  All of the “EMR is impossible” and “EMR makes things worse” stuff you read around the web are disproved quickly with a step into our office.  We implemented EMR successfully in a private practice setting without help from an economic stimulus, a hospital system, or a magic wand.

Not that it was easy; we went through many years of struggle to get to where we are today.  We struggled mainly because we were exploring unknown territory.  We had very few other successful EMR implementations to learn from.  We used slow computers and programming developed in the pre-Internet era.  We made huge mistakes and struggled at times to make our monthly budget.

But we did it, and practices implementing now can learn from my and others’ success.  Probably the main lesson we learned is to put office function ahead of implementation.  Since we are a business, we must stay profitable while implementing.  Since we are practicing medicine, we must never compromise quality in the process.  This meant that we implemented over time, focusing on parts that would either improve our process or at least not bring us down.

Now we are at the position I thought might never come: survival is no longer in question, so we can dream.  We don’t have to act defensively, we can push the envelope.  We can afford to ask the question: “How can we build the best medical experience for our patients?”  We can imagine a destination and actually attempt to get there.

The ideal destination is one in which our patients’ care is improved by maximizing efficiency on our end.  Obviously I don’t want to make things harder for our practice, I want to make things easier.  But the goal of care is ultimately centered on the patient, not us.  So is there a way to accomplish both goals?  I think there is, and I think that our EMR is the tool that makes it possible.

Here are our goals in the process:

  • Simplify how things are done
  • Always have the right information available
  • Make communication clear and easy
  • Achieve the highest quality possible

I’m sure some think this is just idealism and can’t happen in reality.  I agree and disagree.  No system can be perfect, but the current healthcare system is so inefficient and ineffective that huge gains can be made.  The best way to show that is to get down to specifics.  Here is where our practice is heading:


The thing that takes the most time away from actual patient care is documentation.  Doctors are paid by the volume of documentation, not its quality.  Still, the main purpose of a record is to accurately know what is going on with the person facing you in the exam room.  Unfortunately, the patient is continually changing, so some information is only accurate for a short time.  Has the patient seen a specialist or been in the hospital?  Have the medications been changed, or just not taken?  Have they changed jobs, quit smoking, or gotten married?  Did their sister just get diagnosed with cancer?  The task of keeping this information up to date is extremely difficult.

Patients are the ones who know these things best, but they are only passive participants in the process.  To keep the record accurate, I must ask them all the right questions on a regular basis.  This cuts into time that should be devoted to care.  So why can’t the patients be allowed to maintain this part of the record?  Why shouldn’t they have access to parts of their record and the ability to correct errors?  Here is how we see this happening:

  • Certain parts of the record should be available for patients to review online.  Basic demographics, medications and allergies, family history, and lifestyle information is a good start.  If something new has happened, the patient can either update this information directly (like marital or smoking status) or notify the office of changes (like medication lists).
  • If the patient doesn’t update it online, then they can do so when they come into the office (while sitting in the waiting room).  Some people will undoubtedly not want to do this, but a significant percent will, decreasing the workload on the office while maximizing the quality of information.
  • Patients should be able to communicate important information to the office online.  If they go to the ER or see a specialist, if their blood pressure or sugars are high, they should be able to send that information directly to the physician.

Another area of potential gain is the gathering of information for a visit.  When a person comes to the office, they have to answer a series of questions related to the visit:

  • what are the symptoms the are having?
  • Are there any other symptoms?
  • How have they been since the last visit?

Gathering this information is essential, but it is one of the main causes of delays.  Here is how we want to employ technology to improve this process:

  • Put kiosks in our waiting room where patients can provide information, such as:
    • History of their present illness.  If they are sick, then what are the symptoms and how long have they gone on?
    • Review of systems.  What other things are going on in their health?
    • Medication and demographic review (if not done already online).
  • If patients fill out information online before coming to the office, the staff will bring them to see the doctor immediately (or at least as soon as possible).

Even 50% participation by patients in this process will have a huge impact on our office workflow.  The end result is a win-win: the patient is seen sooner, the information is more accurate, and the workload of the staff is reduced.  Will there be problems?  There always are; but the advent of ATM machines, airport kiosks, and online shopping are a few examples of process automation that have greatly improved the customer experience.  Why should medicine be different?

I am going to stop here, as I don’t want to lose you (if you haven’t already whacked the keyboard with your forehead).  Hopefully you can see that the use of technology applied smartly can help patients and medical offices at the same time.

And this is just the start.

**This post was published originally at Musings of a Distractible Mind blog.**

Medblogger Conference In Las Vegas

The Medbloggers are now a part of BlogWorld/New Media Expo 09!

Thanks to sponsorship from Johnson & Johnson and MedPage Today, the “Medlblogger Meet-Up” is now a reality.

But it is so much more than “just” a meet-up.


A full day of topics, voted on by the medical bloggers themselves, will be presented, with plenty of time to mix and mingle with our blogging colleagues.

Blog World/New Media Expo 09 will take place at the Las Vegas Convention Center the weekend of October 15-17.

New blogger, established blogger, podcaster or internet broadcaster, there is a place for you in Las Vegas!

Interested in just the Medblogger topics?

You’ll want to join us on October 15th, when the Medbloggers will take their place in the premier blogging conference by holding a full day of sessions and meetings devoted specifically to medblogging.

Want to get deep into the heart of blogging as a lifestyle? Ready to take your blog to the next level?

Then you’ll want to attend the entire BlogWorld/New Media Expo conference where you will learn from the very best of the blogosphere. If you’ve heard of them, they will be at the BlogWorld/New Media Expo 09.

There is a price range for every budget.

The option is yours.

The pleasure is ours.

Please join us!

Check out the BlogWorld/New Media Expo site for details (link above).  Registration begins soon!

**This blog post was first published at Kim McAllister’s Emergiblog.**

US Radiologists: Jobs Outsourced To India

More hospitals are resorting to so-called “dayhawk” radiology services to read their x-rays.

It’s modeled after the “nighthawk” model, where radiologists (via Shadowfax), in some cases as far away as India, remotely read films in the middle of the night.

Now, the phenomenon is happening during business hours as well, which according to radiologist Giles W. L. Boland, means that “some radiologists can no longer assume long-term job security because their core value proposition can now be outsourced.”

This trend was entirely foreseeable. Cash-strapped hospitals are finding it cheaper to outsource x-ray readings, and furthermore, it seems that both nighthawks and dayhawks provide better service and more timely interpretations. This adds up to a declining need for an in-house radiology staff.

That’s bad news for some. Radiology departments at smaller hospitals may close, and eventually general radiologist salaries will come under pressure.

The answer? Like everything else in medicine, radiology sub-specialists will increasingly be in demand. Expect procedure-based, interventional radiology to grow, since what they do cannot be outsourced. Health care costs will correspondingly rise.

So, like primary care, don’t be surprised if the days of general radiology are numbered.

**This post was originally published at Dr. Kevin Pho’s blog, KevinMD.**

Scammers Alive And Well In The Health Blogosphere

On January 28th I exposed the tactics of a certain unscrupulous company called Wellsphere. In a nutshell, they lured unsuspecting bloggers to join their network with a series of flattering emails from their Chief Medical Officer, Geoff Rutledge, M.D., Ph.D. The emails suggest that by being featured at Wellsphere, the bloggers would receive higher visibility and more traffic to their blogs. In reality, when the bloggers signed up to join, they unwittingly gave Wellsphere the right to take all of their blogs’ content, aggregate it on Wellsphere and then SELL it to Health Central (without compensating the bloggers a penny). The bloggers whom I spoke with did not notice any increase in their traffic – in fact, since their entire RSS feed was featured at Wellsphere, readers had no incentive to click back to their blogs.

Beyond the shady blog-scraping practices, Wellsphere encouraged bloggers to answer medical questions (regardless of their qualifications to do so) on their site. Health Central’s tagline, by the way, is “trusted, reliable, and up to date health information.” In return, they were offered a “Maven” badge which suggested that they had special authority to do so. One blogger pointed out how unsafe this was:

I’m supposed to be a “Health Maven” in the “General Medicine” group … and I got my qualifications from …. a Cracker Jacks box? Wellsphere made it appear as if I was someone knowledgeable in General Medicine, and no one was checking in to make sure I wasn’t killing someone with bad advice! Dude! In fact, most of the questions which were sent in weren’t being answered at all, or they were being answered by numbos like me. Answers from real medical professionals were meager. Imagine if the readers took Wellsphere seriously, and actually trusted our replies!!!

When I first posted the story, about 60 commenters relayed horror stories of how misled they were by Wellsphere, and how their content was not removed from the site in a timely manner when they asked to cease participation. Twitter lit up with more disgruntlement. I figured that Health Central would have issued an apology to the bloggers who felt betrayed, but instead Chris Schroeder, CEO
of Health Central, had this to say,

“Most bloggers are happy about Wellsphere.”

In an early announcement to the media about the acquisition of Wellsphere, Mr. Schroeder revealed that the blogger content would allow Health Central “to more effectively monetize their advertising” because bloggers tend to come back regularly to the site, thus increasing advertising page views.

The Plot Thickens

So after doing my part to make bloggers aware of what was happening – and let them decide if they’d like to remain members of Wellsphere – I decided to move on. However, yesterday a member of Better Health was sent a flattering email from Dr. Geoff Rutledge inviting her to join Wellsphere. This same blogger had received similar emails over a year ago, had joined Wellsphere, figured out that there was NO value proposition for her or her blog, and requested that her content be removed.  Now many months later she receives this email:


I’m writing to give you an update on Wellsphere’s HealthBlogger Network, and tell you about the new and greatly increased benefits of participation in the network. My name is Dr. Geoff Rutledge I’m a board certified physician who practiced and taught at Stanford and Harvard medical schools before joining Wellsphere. Wellsphere is the fastest-growing online health platform and is now one of the Top 5 consumer health websites, helping nearly 5 million people each month find health and healthy-living information and support.

Several months ago, I discovered your blog while searching for the best health bloggers online. After reviewing your writing, I thought your blog would be a great addition to the network, and sent you an invitation to join in the Nursing community.  Since then, the benefits of participation have grown dramatically as the network has grown to nearly 2,000 bloggers, we’ve introduced a variety of blogger widgets and status badges, and the number of visitors has skyrocketed to 5 million per month and we are still growing fast!

Once you agree to participate, we republish the articles you have already written for your blog (with links back to your blog), so there is no extra work for you to do. Your articles will appear in the Nursing community, and on all the search results and WellPages (topic pages) where your articles match a relevant topic or search query. 

I would like to emphasize that YOU will RETAIN FULL COPYRIGHT TO YOUR WRITING <image001.png> the only right you give us is to republish your content on Wellsphere for AS LONG AS YOU CHOOSE. These terms are spelled out clearly on the Health Blogger Network Participation Agreement at

When you participate in the HealthBlogger Network, you’ll be eligible for a variety of badges that will recognize you for your achievements and leadership in your fields, including the Top Health Blogger and Health Maven badges (we’ll send you information about how to become a Health Maven, if you choose to do so). Here are some of the options for these badges that are available to you.

<image002.jpg> <image003.jpg> <image004.png>
You will also be able to choose among a set of custom tailored widgets that you can post free of charge on your blog and provide your readers a richer experience on your site:
· Health Knowledge Finder - comprehensive health search results for your blog. See
· Wellevation - motivational and inspirational quotes. See
· WellTips - simple, bite-sized pearls of wisdom on topics ranging from weight loss to running to yoga, and more
· Wellternatives - healthy menu options at your favorite restaurant! Gives your readers the nutrition information for restaurant menu items, and a Wellternative – a healthier dish that is similar, but better for you. See

Here are some examples of what your blogging colleagues have said about their experience after joining the Health Blogger Network:
Since joining Wellsphere I’ve had numerous opportunities to accomplish my goals for Mommy Motivation, not to mention that I’ve increased my traffic by at least 40%. … Thanks, Wellsphere. - Cathy Tibbles

Joining the HealthBlogger Network was a great move. I look forward to getting the great comments and feedback each time I post and knowing that there’s a growing community there all interested in the same areas. The traffic to the site has increased, too! It’s well worth getting on board if you can. Jeff A.

“My involvement in HBN has been great in that I’ve seen more traffic to my own site.” – Brett Blumenthal

“There are many benefits to becoming a health blogger. Wellsphere offers great promotion and a friendly atmosphere. It allows you to show your talents and share your insight with others. It has been a pleasure being a part of the Wellsphere community. - Lisa Robertson

Here is what some of the members have told us about the benefits of the badges and widgets:
“The badges give my blog credibility. My traffic has steadily increased since I added the awards badges from the People’s HealthBlogger Awards. I’ve also started a new related business that I’m advertising on my blog.  The increased traffic may help me make a living while I help care for my mother.” – Jacqueline Jones

“Honestly, I have to say that the widgets I have (Top Health Blogger and Health Maven) help immensely in terms of credibility.  ….  I have allowed very few widgets on my blog – only the two Wellsphere ones, because it helps me, but even more important, it helps my readers find what I believe to be the BEST health site on the net.  Thanks for all that you do!” -  Lynette Sheppard

We invite you to join the HealthBlogger Network and experience these benefits for yourself. All you have to do is go to the Health Blogger Network Registration Page at , confirm your email and blog URL, and select a password! We’ll do the work to connect your blog and begin republishing your articles for Wellsphere’s millions of visitors to read. Of course, you are also welcome to participate as a user on Wellsphere, interact with other HealthBloggers and Wellsphere members, and take advantage of the many features and functions of the site. 

If you have any questions about how this works, or would like to chat about it, please feel free to give me a call at (650) 345-2100, or send me email to


Geoffrey W. Rutledge MD, PhD
Chief Medical Information Officer

I am astonished that these emails are still being sent, and the bold faced lie at the beginning (“Several months ago I discovered your blog…”) is truly disturbing.

I personally feel that these emails are now bordering on harassment, and that something needs to be done to protect bloggers from continued contact with Wellsphere.

As a point of interest, I NEVER joined Wellsphere, yet here is a screen shot from their website, featuring blog posts about me, my headshot, and my YouTube videos of recent TV interviews where I was a guest.


What do you think should be done next?

In Case Of Emergency: How To Prepare For The Unexpected

Would you know what to do if you needed an ambulance or if you had to go to an emergency room?  During 2005, an estimated 115 million visits were made to emergency rooms in the United States – up 31 percent from 1995. About 14 percent of patients arrive via ambulance. Emergency rooms across America are overloaded – partly because many of the almost 50 million uninsured use the emergency room as their primary physician (and partly because we tend to focus on treatment of illness rather than prevention – but that’s another blog post).

During the next two segments, I will take you way behind the scenes and give you tips on how to be prepared in case the unexpected happens and you end up on your way to an emergency room.  This week I play the part of a patient with chest pain and take you inside a New York City ambulance with paramedics Ray Cordi and Hanan Cohen.  Next week my colleague, Richard Schlesinger, and I continue your tour inside the emergency room at New York Presbyterian Hospital/Columbia University Medical Center, the first time this institution (where I am on staff) has ever allowed such inside access to the media.

Watch CBS Videos Online

**This blog post was first published at CBSDOC.COM**

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »