Jenni Prokopy (aka Chronicbabe) put us to the challenge for this week’s Grand Rounds by asking for our 2011 clinical resolutions. I have to admit that I’m not one for resolutions because I can never take them seriously. But admittedly there are things that I need to tighten up. So here goes:
1. Clear my chart rack every afternoon. This is key because my creative mind operates better when my charts are done. Of course this means no more tweeting “47 charts” or “33 charts” when I’m behind. Had I made this resolution for 2009, this blog wouldn’t have a name.
2. Cultivate innovative communication channels with my referring docs. While I need to be consistent and compulsive with my referral letters, I want to improve mobile, real-time communications between me and my referring docs. For example I’d like to get my local community on Doximity so that I can launch a quick, HIPAA compliant, encrypted SMS messages on my iPhone the second I see a patient. Read more »
*This blog post was originally published at 33 Charts*
There are three Internets. Here’s some Venn goodness (note that “The” was spelled “Teh” on purpose):
When it comes to “sEMR” (Social EMR), we are somewhere in the middle of the Web of “People” and the Web of “Things,” in case you’ve been wondering. Read the rest of the story over on Health Is Social.
*This blog post was originally published at Phil Baumann*
One of the supposed strengths of electronic medical records is better tracking of test data. In theory, when using more sophisticated digital systems, doctors can better follow the mountains of test results that they encounter daily.
But a recent study, as written in the WSJ Health Blog, says otherwise. Apparently, a study performed in 2007 found:
VA doctors failed to acknowledge receipt of 368 electronically transmitted alerts about abnormal imaging tests, or one third of the total, during the study period. In 4% of the cases, imaging-test results hadn’t been followed up on four weeks after the test was done. Another study, published in March in the American Journal of Medicine, showed only 10.2% of abnormal lab test results were unacknowledged, but timely follow-up was lacking in 6.8% of cases.
Consider that the VA has what is considered the pinnacle of electronic systems — their unified, VistA program that permeates all their hospitals and clinics. Apparently the problem is one of alert overload:
Hardeep Singh, chief of the health policy and quality program at the Houston VA’s health and policy research center, led both studies. He tells the Health Blog that doctors now receive so many electronic alerts and reminders — as many as 50 each day — that the important ones can get lost in the shuffle.
This is not unlike the alarm fatigue issue that I recently wrote about. Too much data — whether it is written or on the screen — can overwhelm physicians and potentially place patients at harm. Curating test results by prioritizing abnormals will really be the true power of electronic test reporting.
*This blog post was originally published at KevinMD.com*
Next in our series on my experience with OpenNotes, a project sponsored by the Robert Wood Johnson Foundation’s Pioneer Portfolio.
This item has nothing to do with OpenNotes itself –- it’s what I’m seeing now that I’ve started accessing my doctor’s notes. In short, I see the clinical impact of not viewing my record as a shared working document.
Here’s the story.
In OpenNotes, patient participants can see the visit notes their primary physicians entered. Note “primary,” not specialists. I imagine they needed to keep the study design simple.
So here I am in the study, going through life. Five weeks ago I wrote my first realization: After the visit I’d forgotten something, so I logged in. Read more »
*This blog post was originally published at e-Patients.net*
Why do we physicians chart the way we do? Hopefully, we do it perfectly well and have no concerns at all. But where I practice emergency medicine, we are approaching maximum inefficiency in charting.
It all became much clearer when we started using our new EMR system. Let me make it clear, I’m not against EMR. In fact, typing and templates work better for me than dictating. My dictations were usually a mine field of blanks and misunderstood words.
Furthermore, if I wanted to use it, we have a new voice recognition dictation system in addition to our templated chart. Though admittedly, the voice recognition program clearly hates some of my partners, as evidenced by the way they grasp the screen and yell at it (‘Chest Pain, not west rain!’) and by its inexplicable use of profanity in the occasional chart.
But I digress. The problem as I see it is the evolution of the medical record. Why does the medical record exist? Read more »
*This blog post was originally published at edwinleap.com*