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

Latest Posts

ER Doc Considers Some Of The Issues That Arise With iOS 5 In Emergency Medicine

I’ve been using my iPad in the ED, with my white coat’s sewn-in iPad-sized pocket, for some time now — mostly for patient and resident education, and to look up dosages or rashes. Hitting up my Evernote database or Dropbox documents is also useful. Occasionally I’ll use my iPhone, for its LED light (when the otoscope can’t reach to where I need to see) or rarely, its camera (in compliance with my hospital and department photo policy, naturally).

Our ED’s EHR isn’t quite accessible enough via iPad for me to quickly check results or place orders at the bedside — right now it’s just too cumbersome. But there’s been progress — enough so that I start to wonder about the flip side: instead of reviewing iOS medical apps and pining for an optimized EHR experience on the iPad, what if there are features of the iPad that could limit the utility of medical apps?

Well, there are some product design issues, like impact resistance and bacterial colonization, that have been discussed. But the operating system, iOS 5, has some quirks, too. Some have received a lot of attention. Some are maddening in their capriciousness. Read more »

*This blog post was originally published at Blogborygmi*

Survey Asks Doctors And Patients If Doctor’s Notes Should Be In The EHR

We are fast entering the era of the electronic health record, when it will be possible to call up our medical records on our computers and mobile devices. Medication lists, lab results, appointment schedules—they’ll all be available with clicks of your mouse or taps on the screen of your smartphone or tablet.

But one question that’s far from settled is whether the electronic health record should include the notes that doctors make about them. A doctor’s notes can be straightforward, such as a reminder that an additional test might be needed. But they can also include somewhat speculative observations and hunches about a patient and his or her medical conditions. The Open Notes project is a research program designed to test the consequences of giving patients access to doctors’ notes. Harvard-affiliated Beth Israel Deaconess Medical Center is one of the test sites.

The Open Notes project is far from finished. But results of a survey of the expectations that doctors and patients have for note sharing are being reported in today’s Annals of Internal Medicine.

I don’t think there are any great surprises here.  More than half of the primary care physicians Read more »

*This blog post was originally published at Harvard Health Blog*

The Future Of Health Care Requires Considerable Typing Skills

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*

Sometimes Little Changes Can Add Up: The Extra Work Of The EMR

“I estimate these changes to your charting work flow will take only five minutes.”

Five minutes is fine if it happens for only one patient. But when it is multiplied by as many as forty patients in a day, the multiples get impressive. Five minutes x forty patients = 200 minutes (more than 1.5 hours a day).

Minor five-minute changes to administrative charting requirements aren’t so minor, especially when you add more time for quality assurance reporting or pay-for-performance initiatives. Suddenly huge swaths of time from a doctor’s opportunity to take care of their patients. We need more care time and less data entry time. Doctors must insist that we not become data entry clerks.

Increasingly, I see the data entry burdens of regulatory health care documentation requirements falling on doctors. On first blush, this seems logical because only doctors (or very capable, highly trained surrogates) understand the nuances required to make potentially life-altering adjustments to the electronic medical record. But when new administrative documentation requirements are added to doctors and other care providers, it Read more »

*This blog post was originally published at Dr. Wes*

Does The EHR Carry The Risk Of Making All Patients Look Alike?

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*

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 »