November 14th, 2011 by Bryan Vartabedian, M.D. in Opinion
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I always loved to type. It started in high school with typing class. We were told that typing was critical for college term papers. I liked it so much that I took advanced typing. It was myself and 12 girls with Farrah Fawcett hair. Heaven.
Fast forward to 2011. My interface with the medical record is my fingers. Most of my communication flows through my hands. I complete the core of my documentation in the exam room. Fast documentation of information at the outset of an encounter allows for meaningful, eye-to-eye dialog during the latter part of the visit.
Those who can’t type have a different experience with their EHR. Sure there’s voice recognition but when pressed they wish they could make a sentence instantly flow onto the screen. Two colleagues this week, one from Barbados and another from the UK, Read more »
*This blog post was originally published at 33 Charts*
November 6th, 2011 by Bryan Vartabedian, M.D. in Opinion
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I saw it begin to happen in the ’90′s. Residents came to rounds with their daily notes produced on a word processor. The notes were impressive. Legible, lengthy and meticulously detailed at first glance.
Then I started to notice a pattern. The impressive notes began to look very much alike. The thorough exam varied little from patient to patient. And problems that occurred on previous days seemed to persist in the medical record, even when it had resolved. In some cases the previous day’s note was printed only to have one or two additional elements added by hand. It was never really clear what was worse: the lack of effort or the illegible writing.
Our electronic health records (EHR) offer similar options. We can smart text our way to clinical efficiency. Some doctors have entire impressions and elements of the history pre-generated for common conditions. These are advertised features of the most common EHRs. Technology can make us look Read more »
*This blog post was originally published at 33 Charts*
October 31st, 2011 by Bryan Vartabedian, M.D. in News, Opinion
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If you want a glimpse at a company putting precision medicine into practice look no further than Prometheus Labs. They make diagnostic products for personalized care in digestive disease and oncology. I use their products to diagnose and target therapy in children with inflammatory bowel diseases (crohn’s disease and ulcerative colitis).
IBD offers a nice place to see the evolution of precision diagnostics:
Early biomarker testing. Initially we had ASCA and pANCA antibodies to discern crohn’s and ulcerative colitis.
Advanced biomarker testing. Read more »
*This blog post was originally published at 33 Charts*
October 25th, 2011 by Bryan Vartabedian, M.D. in Opinion
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While most of us fail to see it, doctors are changing. We’re changing as a result of the social and technological innovation. In 2050 what we do and how we do it will be very different from what we did at the turn of the century. We’re evolving from analog to digital. I think it’s important to consider the ‘digital physician’ as a concept worthy of attention. The training and support of this emerging prototype has to meet its different needs and workflows. Perhaps the criteria by which we choose medical students should take into consideration the anticipated skill sets and demands of this next generation. And we need hard information about the digital physician and her habits.
Here are some differences between the digital and analog physician:
The digital physician
- Information consumption is web-based
- Rarely uses a pen. Care and correspondence is conducted through an EMR.
- Socially connected. Comfortable with real time dialog at least on a peer-to-peer level. Recognizes Read more »
*This blog post was originally published at 33 Charts*
October 18th, 2011 by Bryan Vartabedian, M.D. in Opinion
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I suffer with herniated lumbar disks. L4-L5 bulges and ruptures on occasion. If you catch me on the wrong day I have a little curvature to my back representing the spasm that makes me miserable.
I saw an extremely well-referenced orthopedic surgeon in consultation recently. But through the course of my visit he never touched me. We spent an extraordinary amount of time examining my MRI. Together in front of a large monitor we looked at every angle of my spine with me asking questions. I could see first hand what had been keeping me up at night. I could understand why certain positions make me comfortable. What we drew from those images could never be determined with human hands. In my experience as a patient, I consider it Read more »
*This blog post was originally published at 33 Charts*
