As a physician who openly despises many aspects of current EMRs (see “How An EMR Gave My Patient Syphilis” or “The Medical Chart: Ground Zero For The Deterioration Of Patient Care” ) I recognize that they are here to stay. And so, since we’re all stuck with these digital middlemen, I have some suggestions (based on popular social media platform functionality) for making them better.
1. Likes. Healthcare providers should be able to “vote up” an excellent note in the medical record. Let’s face it, not all doctors are equally good at documentation. Untold hours of our time are spent trying to cull through pages of auto-populated, drop-down-box checks to figure out what’s actually going on with a patient on a particular day. Once in a while you stumble upon some comprehensive free text that a physician took the time to type after a previous encounter, and suddenly everything becomes clear. If there were a way to flag or “like” such documents, it would help other readers orient themselves more quickly to a patient’s history. A “liking” system is desperately needed in EMRs and would be a valuable time saver, as well as encouragement to physicians who document notes well. Hospitals could reward their best note makers with public recognition or small monetary bonuses.
2. #Hashtags. Tagging systems are sorely lacking in medical records systems, which makes them very difficult to search. Patients make multiple visits for various complaints, often with numerous providers involved. If physicians had the ability to review notes/records unique to the complaint that they are addressing, it would save a lot of time. Notes could be tagged with keywords selected by the author and permanently recorded in the EMR. This would substantially improve future search efforts. Even if the EMR generated 10 search terms (based on the note) and then asked the physician to choose the 3 most relevant to the current encounter, that would be a step in the right direction.
3. Selfies. Medical records would benefit from patient-identifier photographs. In a busy day where 20-30 patients are treated and EMR notes are updated after the patients have gone home, a small patient photograph that appears on each documentation page will serve the physician well in keeping details straight. Patients should be able to upload their favorite portrait to the EMR if the standard one (perhaps taken during the intake process) is not acceptable to them. In my experience, nothing brings back physical exam and history details better than a photograph of the patient.
4. Contextual links. All EMRs should provide links to the latest medical literature (on subjects specifically related to the patient’s current diseases and conditions) in a module on the progress note page. UpToDate.com and other reference guides could easily supply the right content (perhaps based on diagnosis codes). This will help physicians practice evidence-based medicine and keep current with changes in recommended treatment practices.
5. Microblogging. Sometimes there are important “notes to self” that a physician would like to make but don’t need to be part of the official medical record. EMRs should provide a free-text module (like a digital sticky note) for such purposes. These sticky notes should not be admissible in court as part of the medical record, and should not be uploaded to the cloud. Content included in these notes could include social information (patient’s daughter just had a healthy baby girl), hunches (patient looks slightly pale today – will check H&H next time if no change), and preliminary information (remember to review radiology result before calling patient next Tues).
It is my hope that EMRs will slowly adopt some best practices from top social media platforms. After all, if millions of users are effectively using voting, tagging, linking, searching and imaging in their daily online lives, it only makes sense to capitalize on these behaviors within the constraints of the medical environment. Maintaining strict confidentiality and appropriate professional boundaries (often missing in the social media world at large) is certainly possible with EMRs. Let’s build a better information capture and retrieval process for the sake of our patients, and our sanity.
At least one EMR is already providing #3 and #5 as part of its software: see MDHQ.com Are you aware of any others already implementing these ideas?
In case you hadn’t seen this announcement in my Twitter stream – there are a number of writing fellowships available for US medical students and residents. (Bloggers and those heavily engaged in social media are preferred.) Join The American Resident Project Writing Fellows in brainstorming about how to make the healthcare system better for future generations. Fellowships are awarded on a rolling basis. Opportunities for travel are included. From their website:
The American Resident Project is a platform for future physician leaders – medical students, residents and physicians newly in practice – to connect, explore ideas for transforming American health care delivery, and exchange these views with other health care providers and opinion leaders across the country.
Sponsored by ThinkWellPoint, The American Resident Project focuses on key issues affecting today’s frontline physician workforce, including:
New care coordination models
Strategies for patient engagement
Innovations in health technology
Join our growing community, lend your voice and share your ideas on these and other important topics shaping the future of health care delivery in America.
I will be playing a mentorship role in the program going forward, and look forward to meeting some of my young Writing Fellows in the near future!
Apply for the fellowship here.
I am consistently bemused by those who recommend more rigorous or more pervasive standardized testing as the primary means for insuring physician quality. The vast majority of physicians have already passed through a complex gauntlet of multiple choice exams, extended credentialing and certification processes, and lengthy tests of knowledge and skill. And yet, some physicians (to put it bluntly, sorry friends) are very bad at what they do.
Intellectual intelligence is necessary, but not sufficient, for doctoring. It is emotional intelligence (EI) that is sorely lacking – because it has neither been cultivated, nor selected for, by many training programs. Some educators openly acknowledge the problem, pointing to “extra-curricular activities” as their primary means of distinguishing equally qualified applicants. The disappointing reality is that non-academic performance may be a tie-breaker for students with similar standardized test scores, but raw scores almost always trump any other factor. In the end, we have a physician work force that is highly adept at assimilating and regurgitating facts, but is only accidentally good at human interactions.
Is there hope for change in this arena? I believe that the prognosis is guarded. As our culture becomes more and more digital data-driven, a tsunami of “meaningless use” threatens to drown us all in false quality measures, electronic medical record documentation “quality assurance” requirements, and analysis of trends without comprehension of context or influencing variables outside the scope of the measuring instruments. Lies, damn lies, and statistics. We can’t get enough! And guess who are the biggest proponents of these methods? Why, people who only excel at standardized testing – mostly because their true flaws also lie outside the measuring instruments. Bad doctors (sometimes turned-administrators) themselves are often fueling the onslaught of fruitless quality improvement initiatives.
Dr. Howard Luks, orthopedic surgeon and social media activist, wrote a provocative blog post on the subject of why physicians don’t engage more in social media. He suggests that many avoid it because they lack people-skills in the first place and don’t genuinely enjoy engaging with patients. If you’re a “jerk” in real life, he argues, then what advantage is there to making that more obvious on blogs, Facebook, Twitter, etc.? Better to stay socially quiet.
The interesting thing is that social media might be the most reliable way to discover whether or not your doctor is kind, thoughtful, observant, and detail-oriented. Reading a physician’s thoughts online can help you get to know their true personality and work ethic. In the future it would be nice if medical schools and residency training programs took the time to read applicants’ blogs (for example) instead of crunching their test scores for admission via the path of least resistance. An extra hour of reading up front could save our medical system from a new wave of low EI providers.
As Seth Godin put it, “Uncaring hands are worth avoiding.”
We all recognize the importance of this statement intuitively, but have a hard time quantifying “caring” with standardized tests. That’s why admissions officers and patients alike must use their judgment when selecting doctors. We pay verbal homage to the importance of “clinical judgment” in medicine but in reality are culturally afraid of straying from numbers to support our decision-making.
How will you know a good doctor? You’ll know him [or her obviously] when you see him. And sometimes you can see him best on social media platforms.
A few caveats of course:
1. Social Media is a sensitive but not specific test. Meaning, you can probably accurately identify caring doctors from their blogs, etc. but if they don’t have one, it doesn’t mean they aren’t good/caring.
2. It may not matter if you find a great doctor online if they’re not in your limited ACA network.
3. Direct primary care is a potentially excellent way to get connected to exceptional doctors. I am a fan of this movement and have been actively involved in a practice in VA. The practices can reduce costs and enhance quality care, though recent caps on Health Savings Accounts (initiated by the Obama administration) have reduced consumer freedom to spend pre-tax income on direct primary care.
I started medical blogging in 2006, and posted something new every day for over two years straight. I met some terrific fellow bloggers in those “early years”, and soon wondered if we might reach a larger audience if we pooled some of our blog content. This blog site (Better Health) was born in October 2008, and soon grew to have over 130 contributors! We developed a large following on Facebook and Twitter and partnered with such prestigious organizations as the CDC, Harvard Health Publications, and the American College of Physicians. We actually grew so large so fast that I had to hire a small staff to help me run the blog… Which became logistically challenging and pretty expensive, rather quickly!
Because Better Health has always been a labor of love, and not a well- oiled, monetization machine, I eventually had to close the doors. It broke my heart. It was such a shame that a collection of the best medical blog writing just couldn’t be supported financially – at least I couldn’t find a way to do so! In January 2012 I posted a farewell note and decided to continue my social media life on Twitter and Facebook instead.
A few days ago I noticed a large uptick in Twitter followers and was surprised to see that I had been recommended (by Healthcare IT News) as one of the top 10 physicians to follow on Twitter. In the article it commended my work as a Better Health blogger… the blog that I had recently shuttered.
I had been toying with the idea of starting a personal blog again because I found it rather challenging to say all I wanted in only 140 characters, and this new influx of followers gave me food for thought. What if I just keep it simple this time? What if I write blog posts at Better Health when the spirit moves (instead of feeling pressured to post something every day or to include 100′s of others in my blog posts?)
So that’s what I’m going to do. This is just me again – the way it all began. But without any regard for traffic, numbers, or popularity. Maybe only a handful of people will read my posts here. And that’s ok with me! So welcome back to the OLD new me. The cycle is complete?
P.S. I will continue to blog at Healthline to educate patients about their eyes, and I also hope you’ll listen in to my Healthy Vision radio show. Or follow @drval on Twitter?
Dear Better Health Friends & Contributors,
2012 will mark Better Health’s 4th year anniversary of group medical blogging. I began Better Health with the hope of organizing “voices of reason” in the health blogosphere so that our ideas would enjoy greater circulation and be more influential. We were the early adopters of social media – some of the first physicians, nurses, patient advocates, and scientists to join together to provide trustworthy content to our readers via blogs. We grew to represent over 130 bloggers and, over the years, were joined by such prestigious organizations as the American College of Physicians, Harvard Health Publications, Diario Médico, and the Centers For Disease Control And Prevention. I am proud of our excellent writing, and I know that we touched many lives through our blogging.
Many of our contributors have enjoyed such success in blogging that they are regular features of several publishing platforms. Others have gone on to careers in social media education and are now sought-after speakers across the U.S. and beyond. Today’s blog audiences often receive their health information via personalized “filters” on Facebook and Twitter, rather than specific websites. And so for these reasons, Better Health has achieved its purpose to promote medical bloggers. I will discontinue future publication of blog posts at the getbetterhealth.com website as of today. Better Health, LLC will continue on as my personal consulting company.
I want to thank you all for contributing content to Better Health – I have personally enjoyed reading your work and I wish you success in your future writing endeavors. As I look forward to the next chapter of my life I hope to remain in touch with you all via email, Facebook (/drvaljones) or Twitter (@drval).
Please note that Grand Rounds will continue as usual, and that the getbetterhealth.com website will remain in archive format indefinitely.
With all my best for 2012,
P.S. I will continue to promote medical blogging via Grand Rounds, and I will be hosting it at USA Today in the near future (date TBD). Please stay tuned for submission information. The Grand Rounds calendar will remain updated at the top of the Better Health home page indefinitely.