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Latest Posts

5 Clinical Resolutions For 2011

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*

Social EMR And “Teh” Three Internets

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*

Too Much Data: Can It Overwhelm Doctors And Harm Patients?

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*

A Story Of Online Care Without OpenNotes

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*

Why Improved Patient Care Isn’t “In The Chart”

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*

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…

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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…

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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…

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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…

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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…

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