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A Truly Useful EMR

I love computers. Really, I do. Despite my oft-repeated claims about the shortcomings of electronic medical records in their current form, I do believe that information technology has the potential to be of great help to me and other physicians in providing quality care to Americans.

Stop laughing. I really mean it.

I do not believe, however, that IT best serves the medical needs of our patients when used to create non-interactive silos of information sequestered in the offices and clinics of individual doctors. Even hospitals and large integrated health systems information remains stuck within that system, providing limited utility when patients travel, or even go to a doctor not affiliated with the system.

Although some (especially in government) seem to feel that expanding those kinds of integrated systems is the way to go, the problem is that not all patients want to get their care from Mayo Clinic clones across the country. Still, I have an idea for using currently available technology to vastly improve the way medical care is delivered anywhere in this country. Read more »

*This blog post was originally published at Musings of a Dinosaur*

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. 
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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*

Online Medical Records: Not All Patients Want All That

Anytime you come across a healthcare article that implies that every patient wants access to this or that – i.e. their medical record, patient-centered care, etc. – you can safely assume that the claim is wrong. Why? Patients are not a monolithic group –- they don’t all share the same motivations, preferences, beliefs or experiences when it comes to their health.

But let’s face. If you are trying to push an agenda, just saying some people want this or that is not the same as implying that everyone wants it.

Take the issue of patient access to physician notes in their medical record. Robert Wood Johnson (RWJ) recently announced their OpenNotes study. The OpenNotes project will evaluate the impact on both patients and physicians of sharing, through online medical record portals, the comments and observations made by physicians after each patient encounter. Okay…so far, so good.

Things begin to fall apart, however, when RWJ cites “a recent study“ in the Journal of General Internal Medicine, as part of the basis for the OpenNotes research. According to RWJ, the study found that “most consumers want full access to their medical records.” Since when did six focus groups (64 people) constitute a representative sample, e.g. most people? Read more »

*This blog post was originally published at Mind The Gap*

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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