Author's posts
Electronic medical record interoperability is a total mess
Just the other day, while I was in the middle of seeing a morning schedule full of patients, I opened one patient’s chart and was thrilled to see a whole bunch of new icons in Chart Review in the electronic health record that I had never seen bef…
What do we want our health care system to look like?
I think the time has come for us all to do a little more than put our 2 cents in. Our health care system is a mess, and while many of us fighting in the trenches and taking care of patients are working to make things better (despite the best efforts of…
What do we do when guidelines come crashing into the real world?
Every day, as we care for our patients, we are placed in a unique position, where we are armed with the world of literature, randomized controlled trials, society recommendations, national screening and practice guidelines, and more, working to prompt …
What if EMRs can never capture the clinical experience?
Apocryphal story from residency: On morning rounds in the critical care unit, the post-call resident starts to present a complicated patient admitted overnight with chest pain, and after the first bits of the history have been presented, the wise old c…
Why increasing patient volume won’t work
Once again, we find ourselves stuck between a rock and a hard place. Increasingly, providers are being pressured to improve access for our patients, which we certainly think is a good thing. We want our patients to come in, whether it’s for their…
How one insurer’s mistake wrecked a practice’s quality score
To do the math right, you have to get your numerator and denominator correct, or else things just don’t work. Recently, in the midst of a large patient safety and quality improvement project trying to bridge gaps in breast cancer screening among …
The problem with abbreviations in the medical record
Several patients seen in our practice recently were significantly and dramatically transformed by the electronic health record (EHR). And not in a good way. Take, for instance, the patient whose outside chart was reviewed when she showed up in our offi…
Patient care suffers when you squeeze patients into a tight schedule
86 minutes. That’s what I found when I added up how late patients were through a single practice session earlier in the week. Some patients arrived on time, and some a few minutes early, but the average was about 8 minutes late, ranging up to one…
To do population health right, think about individuals
How do we change the way we think about taking care of patients, particularly when it comes to not the individual patient sitting in front of us, but a whole population of patients just like them (or somewhat like them)? In our practice, we have been s…
Electronic health records: separating the signal from the noise
5,177. That’s the current number of “cc’ed charts” as of this morning in my electronic health record in-basket. While it might sound like a lot, this is not at all an unusual accumulation, partly due to the fact that I receive a…
