HEALTHY ONLINE

EMRs are not designed for patient care. Is there anyone working in health IT who can honestly say that he or she never heard this statement being made hundreds or thousands of times? Is there any clinician actually working with patients and EMRs who can state that such thought never crossed his or her mind? This includes health IT evangelists and physicians spearheading IT initiatives at the most excellent of centers of excellence. People complained that EMRs are not designed for patient care seven years ago, when the first EMR certification body was created. They said the same thing four years ago when billions of dollars were made available for the purchase of EMRs. They kept insisting even as use of EMRs was becoming widespread two years ago, and the chorus remains unchanged today: EMRs are not designed for patient care. Seven years is an eternity in the world of computer technology. Seven years ago Motorola and Blackberry ruled the world and the iPhone was getting ready to be born...

The first President to take a shot at fixing health care was a Bull Moose trying to become President one more time. Unfortunately Teddy Roosevelt failed to win those elections and instead of providing “ protection of home life against the hazards of sickness, irregular employment and old age through the adoption of a system of social insurance ”, America took the low road leading to the Great Depression. Fixing health care was on the minds of all subsequent occupants of the White House, from FDR to Barack Obama , to varying degrees, but as America’s circumstances and character evolved over many decades, so did the understanding of why and how health care should be fixed. For Franklin D. Roosevelt “ [t]he right to adequate medical care and the opportunity to achieve and enjoy good health ” were part of a second Bill of Rights to provide security at home for all Americans. It was a lofty attempt to “ assure us equality in the pursuit of happiness ".  FDR failed to implement his pr...

Say you are a pediatrician in an average middle class lily white suburb and most of your little patients are either sitting stiffly in the pews next to you or are elevating your spirits with angelic voices clad in white robes on a blessed Sunday morning. Say little Johnny trips on his way down the altar and ends up taking a ride to the ER to have his forehead stitched. Does the ER doc need to know that the 13 year old altar boy is not a smoker? Does he need to know that Grandpa Joe died from prostate cancer, but other than that the family history is unremarkable? Does the nurse washing Johnny’s forehead need to be informed that the boy has a history of ear infections and had tubes put in when he was 3 years old? Not a fair example, right? Let’s cross the 8 Mile road and look at another Johnny who shows up at the other ER at 2 am with two gunshot wounds to the chest. Does anybody on his care team gives a damn about Mom suffering from depression and diabetes, or the fact that Johnny is a...

It’s that time of year again when Meaningful Use conversations heat up because all sorts of deadlines are approaching, and as expected, nobody is ready. Meaningful Use was originally intended to have 3 stages, each lasting two years. At the end of 2011, Meaningful Use Stage 2, which should have started in 2013, was postponed by one year and reduced to 90 days to allow vendors and providers enough time to build, deploy and implement new functionality required for Stage 2. As 2013 is drawing to a close and Stage 2 is practically upon us, a flurry of organizations is petitioning the Secretary of Health and Human Services (HHS) to delay Stage 2 just a little bit longer. The College of Healthcare Information Management Executives (CHIME) fired the first shot back in May, asking for one more 12 months extension. Later in July, the American Medical Association (AMA) and the American Hospital Association (AHA) , combined forces and jointly requested additional flexibility to be built into Sta...

(Source: forgotten-ny.com ) When a doctor, a lawyer, an accountant or any other professional graduated from University, or moved to a new town, he or she would most often locate a nice little office, prepare it for the big day and hang out a shingle to let the world know that new services are available. The world back then consisted of the immediate neighborhood in the big city or an entire small town out in the country.  While waiting for the new shingle to do its thing, the new doctor would most likely join the country club, attend the pee-wee league games of his/her children, patronize local eating establishments and slowly the word of mouth would help build a new practice that would become a fixture in the community for years to come. Fast forward to 2013 when nobody strolls leisurely where shingles are not hanging any more, and doctors rarely live and raise families within walking distance of their medical practice. Word of mouth has been largely replaced by text of iPhone and...

This is a warning shot across the bow of the mighty health care ship which seems to be changing course in search of calmer waters to carry the riches stowed deep in its rusty hull. I have no arsenal to fire anything more than sporadic warning shots through the descending darkness, but this ship is now on a collision course with the American people, the 47% that Gov. Romney scoffed at and an equal number that is yet to be awakened by the ringing disaster bells. The navigation chart used by the captains of this ship, mapping an America full of dumb and gullible people, too fat and too lazy to make any sudden movements as the corroding ship sails through their bodies, is woefully incorrect. Americans may be slower than most, more forgiving than others, but sooner or later, the health care ship will have to battle the people, and it will be sank, or emerge victorious at the conclusion of the American experiment. A couple of weeks ago I wrote about Dr. Ezekiel Emanuel’s thinly veiled fury ...

At some point it was decided that the exchange of clinical information between facilities of care is lacking in both quantity and quality, and it was further decided that a drastic increase in frequency of such exchange will improve the health of people and the quality of care they received, while reducing costs of health care. The idea, which is almost as old as medicine itself, has been perfected by physicians over centuries of evolving documentation standards and sharing of knowledge in general. As medicine became a service provided by a bewildering array of entities in parallel and/or in sequence over one lifetime, the need for clinical information exchange increased exponentially, making this particular activity a perfect candidate for computerization in the Internet age. Since all computerized functions are better and cheaper than their manual predecessors, it was decided that the Nation must engage in sophisticated exchange of health information to the point where one’s medical ...