Of Zombies, Emperor’s New Clothes, Documentation Inertia: LIngering Untrue Diagnoses That Persist in the Electronic Health Record

Jaan Sidorov

Posted 4/04/12 on The Disease Management Care Blog

Every practicing physician using an electronic health record (EHR) has seen them.  Past diagnosis zombies that stumble endlessly through every encounter record.  “Coronary heart disease” that the patient never really had, “diabetes” that was only one possibility among many and a “fracture” that never appeared on any x-ray.

These undead conditions clutter the technology-enabled health system basically because of two EHR value propositions:

Continue reading “Of Zombies, Emperor’s New Clothes, Documentation Inertia: LIngering Untrue Diagnoses That Persist in the Electronic Health Record”

Young Doctors Swimming Upstream

Brian Klepper

Over the weekend we had a small dinner party, in which one of the guest couples’ daughter, a delightful 2nd year internal medicine resident at a major academic safety net health system, tagged along. Over the course of the evening, she told me many things that reflected the intense frustration that any young physician would have with the current system. The quotes below are paraphrased, but I’ve tried to ensure that sentiments expressed are accurate.

“My hospital uses EPIC, which is a terrible system. It’s unintuitive, and so many simple things that should be easy to find – a particular lab test or a diagnostic image with a certain perspective – are often buried and not easily found, even with the search function. I can spend 10 minutes looking for something that should be easy to navigate to but isn’t, which continually slows down my productivity. All the residents are frustrated with the way it wastes time by simply being at odds with the ways physicians think and work.”

“Learning a new, complicated electronic medical record (EMR) is like learning a new language. It takes time, but when I’m finished here and move to the next hospital, I’ll probably have to learn a different system, which will be an additional waste of time. The lack of standardization may serve the vendors’ interests, but its costly to health care organizations, clinicians and patients.”

“When I’ve called on the EPIC support staff, they’ve responded by asking whether I know things like my log-in and whether I’m computer literate. I’m 27 and, like nearly all my peers, I have used computers my entire life. I’m comfortable not only with Apple and Windows but with Linux. My sense is that the support people and maybe our own administration think that the difficulty is with the clinicians but, at this point, we know the difference between an ergonomic and a lousy application. The residents I work with believe that this is just a bad app, and that we’re stuck with it. Tools built like this slow us down rather than facilitate better care. I have to believe there are better designed EMRs out there.”

“In a 12 hour shift, I can only spend about 4-5 hours actually caring for patients. Most of the time is spent charting or trying to navigate insurance. I never imagined that this is how doctors would spend their time.”

“I’m assigned to the indigent care clinic, where I see many patients with serious problems but no money. We often don’t have specialists or diagnostics to refer to if there’s no insurance, so our options for caring for these patients are very limited. The patients are usually very aware that there are possible next steps, but there’s often nothing the physicians can do without coverage. It’s a shameful situation.”

Why Doctors Don’t Like Electronic Medical Records

Richard Reece, MD

Posted 10/07/11 on Medinnovation Blog. It originally ran in the 9/27/11 issue of Technology Review, an MIT Press publication.

Why are doctors so slow in implementing electronic health records (EHRs)?

The government has been trying to get doctors to use these systems for some time, but many physicians remain skeptical. In 2004, the Bush administration issued an executive order calling for a universal “interoperable health information” infrastructure and electronic health records for all Americans within 10 years.

And yet, in 2011, only a fraction of doctors use electronic patient records.

In an effort to change that, the Obama economic stimulus plan promised $27 billion in subsidies for health IT, including payments to doctors of $44,000 to $64,000 over five years if only they would use EHRs. The health IT industry has gathered at this multibillion-dollar trough, but it hasn’t had much more luck getting physicians to change their ways.

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EMRs and Primary Care: The Good, The Bad and The Challenges

Josh Freeman

First published 6/11/11 on Medicine and Social Justice

My PhotoOne of the centerpieces of health reform as promulgated by almost everyone, and very much the Affordable Care Act (ACA) is the use of electronic medical records (EMR, also called, in a more inclusive formulation, electronic health records, or EHR). The Health Information Technology for Economic and Clinical Health Act (HITECH) specifically addresses specifications for EMRs. Demonstration of effective use of EMRs, including “e-prescribing” (in which prescriptions are routed electronically directly from the physician’s office to the patient’s pharmacy of choice), maintenance of patient registries (who in your practice has diabetes?) and compliance with a set of quality measures (What percent of the people in your practice with diabetes have had their sugar measured? What percent are in control?) account for a great deal of the added payment for chronic disease management, as well as payment for patient-centered medical homes (PCMH).

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EHRs for a Small Planet

David C. Kibbe and Brian Klepper

First published 1/09/10 on The Health Care Blog 

Right now, American health care information technology is undergoing two enormous leaps. First, it is moving onto Web-based and mobile platforms – which are less expensive and facilitate information exchange – and away from client-server enterprise-centric technologies, which are more expensive and have limited interoperability. In addition, more EHR development activity is headed into the cloud, driven by large consumer-based firms with the technological depth to take it there. Both these trends will facilitate greater openness, lower user cost, improved ease of use, and faster adoption of EHRs.

But they could also impact the shape of EHR technologies in another profoundly important way. What is often lost in our discussions about electronic health record technology in the US is the relationship these tools have to our health and health care problems…globally. We could be designing our health IT in ways that are good for the health of people both here and around the world, not simply to enhance care in the US.

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Half of US Health Consumers Want Online Access To Doctors – Including Electronic Medical Records

Jane Sarasohn-Kahn

First published 3/28/11 on Health Populi

Most U.S. health consumers would be keen to take advantage of alternative communications for their health care encounters. Of these 6 in 10 people, 72% would like nurse helplines, 60% email, and 1 in 3 would use a private online forum for their health. However, only 1 in 10 would use some form of social media for interacting with their providers, such as Facebook or Twitter, were it available to them in February 2011.

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Adapt or Die: How Desktop Virtualization Will Reshape the Value-Added Reseller

Simon Bramfitt

First published 2/17/11 at Simon Bramfitt Blog.

Brian’s Note: A pal passed this along. It struck me as a little geeky, though a good read, until I realized the author was talking about a revolution in how IT in small and mid-sized physician practices is underway. If you’re a doc or a practice manager, then I’d urge you to take a few minutes, bear with the author, and read this through.

Back in 1987 I spent a while working for a PC dealership, what we now call a Value Added Reseller.  I don’t actually recall that the term VAR had been coined at that point, and besides the people I worked for tended to be referred to as “that bunch of bloody cowboys” more often than not.

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Clinical Groupware: Platforms, Not Software


Originally published 4/24/2010 on The Health Care Blog


Clinical Groupware is rapidly gaining acceptance as a term describing a new class of affordable, ergonomic, and Web-based care management tools. Since David first articulated Clinical Groupware’s conceptual framework on this blog early last year — see here and here — we’ve been discussing Clinical Groupware with a growing number of people and organizations who want to know what it is, where it’s going, and what problems it may solve, particularly for small and medium size medical practices, their patients and their institutional/corporate sponsors and networks.

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How To Get Your Doctor To FINALLY Use A Computer


Originally published 11/19/10 on The Doctor Weighs In.

I had the chance to attend the first ever user’s conference of Practice Fusion – a company that provides Electronic Medical Records to doctors over the web for free (free!).  It was a most amazing experience to hear users of the product clap and cheer with every announcement of an improvement or an update.  Love this idea.  Love that it is free.  Love that they are cranking out code as fast as they can to respond to the requests of their customers.

I asked the PF folks if they could help our dear readers at TDWI understand why this is so important.  Here is the response from the founder and CEO of this amazing company:

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