EHR creates more documentation of less value by allowing doctors to copy/paste notes from previous visits. On the surface, copy/paste seems to cover their liability for seeing a patient. But the additional text with no new valuable information means that incoming doctors have to re-read the same thing multiple times to grok a chart before seeing the patient. Or skip the pages of text because it is presented in a small window on a low-resolution screen. EHRs haven't caught up with the notion of quoting text, or having AI summarize notes/scan notes for new changes when a lazy doctor copies/pastes the previous write-up.
EHRs are a step toward every treatment plan being codified as a flow chart, which is a step toward better AI doctor assistants.
I am glad that doctors will be able to read computer font instead of hand-written illegible notes. But now the problem is too many redundant copy/paste notes.
The EHR presents new privacy problems - instead of having to physically go look up a file, in some systems anybody with access can snoop on anybody else's charts or insurance history. This prevents health care professionals from seeking treatment because they know their co-workers will be able to find out. This is especially true for mental health treatment of medical professionals. I know of doctors who have resorted to waiting at a free psychiatric emergency clinic next to heroin addicts to seek mental health treatment to stay out of their hospital's EMR system.
The article highlights another problem - more bureaucracy in hospitals. More administrators who haven't ever treated patients but are needed to ensure the business runs until they have too much power and make bad decisions that drives doctors/patients elsewhere and the hospital into bankruptcy.
Hospitals are dirty places, and the keyboards/mice are often not cleaned well. My doctor friend brings a laptop to be able to type without fingers sticking to keys.
The IT staff support size for hospitals is another issue; EHRs contribute to the problem. The article complains about immediate effects, but what does the long-term cost recovery look like? Where are the gains in efficiency? Some gains, like computers catching bad dosages, rely on knowledge-based codifications that aren't there yet.
There are many problems associated with EHRs/EMRs after the productivity/workflow kinks are worked out. The idea of them is a step in the right direction.
Resistance to change is a problem everywhere when business processes are computerized. The health industry is just playing government-mandated catch-up. It's also tough for doctors who have to rotate at different sites and systems (e.g. medical residents in training).
A little history from a consumer's perspective on Jawbone's fitness tracker foray-- Jawbone purchased and shut down BodyMedia; BodyMedia made arm-band fitness trackers that were worn on the tricep and were the only FDA-approved fitness tracker for use in a clinical setting -- the television show The Biggest Loser used BodyMedia armbands for many seasons (i.e. since before the iPhone existed.) BodyMedia had years of clinical data relating to accelerometer/heart rate/temperature/galvanic sensor readings, diet/nutrition intake, and user biometric data/weight. After the acquisition, Jawbone killed the next-gen BodyBugg/GoWearFit wireless/Bluetooth/waterproof Core armband that BodyMedia had announced at CES, and then Jawbone tried to shrink the BodyMedia galvanic skin response (sweat-sensing) technology down to fit into the UP3 wrist band. But Jawbone owed Chinese contract manufacturers money and the manufacturers held them hostage with ransom for a bigger share of the profits to produce the UP3 (after a delay because the initial production units were defective). Jawbone's woes were previously covered on Slashdot. Meanwhile, during Jawbone's CM debt turmoil, Apple announced the Apple Watch which caused many of the UP3 preorder customers to request refunds on their undelivered UP3s -- refunds that Jawbone was legally required to provide by the merchant terms of major credit cards that require product delivery within 90(ish?) days of accepting payment. (Yep, Jawbone charged money up front for the UP3 preorders.) I hated Jawbone for killing BodyMedia and for their poor previous products-- In 2008 I bought an Aleph One headset that didn't noise cancel (when the promotional video showed it being used in a helicopter.) After acquisition, Jawbone took the BodyMedia brand and shuttered BodyMedia's superior technology, abandoned paying happy monthly BodyMedia subscribers, and managed to botch the UP3 manufacturing and overall product. And yes, I feel that their CEO sounded like a tool/prick in his brief fireside interview with Embedded.fm. What a waste. The last BodyMedia armband was more accurate and discrete than my Apple Watch when I wore them both at the same time as a test. But Jawbone shuttered the BodyMedia subscription service and told subscribers to buy feature-poor and inaccurate UP3s. So now we are stuck with sub-par watch-based fitness trackers due to Jawbone's arrogance and held patents.
I updated to fix security vulnerabilities, but now I, too, encounter more bugs with old and new features. My favorite new bug: Last week, an incoming iPhone call caused my MacBook to play a ringtone to indicate that the call was available for Handoff transfer. The call went to voicemail but my MacBook kept playing the ringtone, for one hour, before I realized what was going on and canceled the notification. My phone had been sitting 1 foot away from the MacBook the entire time, yet some sloppiness in the Handoff protocol, combined with lack of fault correction like software timeout on the MacBook, caused my computer to play a ringtone for an hour while waiting for user input. My favorite old bug: Yesterday I experienced a repeatable application crash while creating new appointments in the OS X Calendar program. Two years ago I received a personal follow-up for my detailed bug report in iPhoto. Now, the Apple bug report forms are outdated such that it is sometimes impossible to submit a bug for the latest version of released software. Simplicity is the essence of design. Simplicity in design implies a tractable set of unit tests. Apple's quality control is lacking.
Don't use a mail-order service. The tapes could be exposed to magnetic fields from a variety of sources. The tech will most likely record in a lossy format and then export to your lossless format. Do record multiple passes, preferably from different playback devices. Save the multiple passes so in the future they can be sent through reconstruction software to correct for tape rot, etc. Enhancement software normally uses consecutive frames, but it might help having two interpretations of corrupted magnetic tape.
The 5 successful medical students that I know did M1 and M2 this way: Contact the medical school. They most likely professionally record and stream the lectures and have the slides posted online. Don't go to class unless travel time is less than 10 minutes. Watch the lectures in comfort at home at 1.5x, and pause to annotate the printed slides as-needed. Come up with a system for colored highlighting and cross-referencing the lectures, slides, and book material. Take books to office max and have them de-bound and 3-hole-punched. Organize binders by subject. The expense here is in the binders, binding services, a good laser printer, and a comfortable yet upright chair that can withstand 18-hours per day of sitting.
There are a number of artificial intelligence notebooks that cross-reference notes automatically. I use DevonThink for CSE grad school notes.
An all-digital workflow is hindered by the need to digitize textbooks. Instead of 3-hole punching the de-bound textbooks, you could pay a friend to run them through a scanner with an auto-sheet feeder and batch OCR them to PDF. File sharing services most likely will only contain out-dated editions. Hence, you are most likely stuck with annotating lecture slides as the central index to the lectures and text book references.
I hope this happens at my uni - encouragement will encourage people to start swapping on ad-hoc wireless networks - much faster than using p2p with our current packet shapers! I've had my eyes on the guy down the hall's collection of 17,000+ songs, but haven't had a real good excuse to make him *share*. BTW, he ripped the 17,000 songs all from borrowed library CDs - I wonder if that would be enough to trigger him as a terrorist under the Patriot Act...
My engineering professor mentioned the Icarus system being developed at U.Miami, FL. - That might be considered open source because it's being developed by a university.
Slashdot Mirror
EHR creates more documentation of less value by allowing doctors to copy/paste notes from previous visits. On the surface, copy/paste seems to cover their liability for seeing a patient. But the additional text with no new valuable information means that incoming doctors have to re-read the same thing multiple times to grok a chart before seeing the patient. Or skip the pages of text because it is presented in a small window on a low-resolution screen. EHRs haven't caught up with the notion of quoting text, or having AI summarize notes/scan notes for new changes when a lazy doctor copies/pastes the previous write-up.
EHRs are a step toward every treatment plan being codified as a flow chart, which is a step toward better AI doctor assistants.
I am glad that doctors will be able to read computer font instead of hand-written illegible notes. But now the problem is too many redundant copy/paste notes.
The EHR presents new privacy problems - instead of having to physically go look up a file, in some systems anybody with access can snoop on anybody else's charts or insurance history. This prevents health care professionals from seeking treatment because they know their co-workers will be able to find out. This is especially true for mental health treatment of medical professionals. I know of doctors who have resorted to waiting at a free psychiatric emergency clinic next to heroin addicts to seek mental health treatment to stay out of their hospital's EMR system.
The article highlights another problem - more bureaucracy in hospitals. More administrators who haven't ever treated patients but are needed to ensure the business runs until they have too much power and make bad decisions that drives doctors/patients elsewhere and the hospital into bankruptcy.
Hospitals are dirty places, and the keyboards/mice are often not cleaned well. My doctor friend brings a laptop to be able to type without fingers sticking to keys.
The IT staff support size for hospitals is another issue; EHRs contribute to the problem. The article complains about immediate effects, but what does the long-term cost recovery look like? Where are the gains in efficiency? Some gains, like computers catching bad dosages, rely on knowledge-based codifications that aren't there yet.
There are many problems associated with EHRs/EMRs after the productivity/workflow kinks are worked out. The idea of them is a step in the right direction.
Resistance to change is a problem everywhere when business processes are computerized. The health industry is just playing government-mandated catch-up. It's also tough for doctors who have to rotate at different sites and systems (e.g. medical residents in training).
A little history from a consumer's perspective on Jawbone's fitness tracker foray-- Jawbone purchased and shut down BodyMedia; BodyMedia made arm-band fitness trackers that were worn on the tricep and were the only FDA-approved fitness tracker for use in a clinical setting -- the television show The Biggest Loser used BodyMedia armbands for many seasons (i.e. since before the iPhone existed.) BodyMedia had years of clinical data relating to accelerometer/heart rate/temperature/galvanic sensor readings, diet/nutrition intake, and user biometric data/weight. After the acquisition, Jawbone killed the next-gen BodyBugg/GoWearFit wireless/Bluetooth/waterproof Core armband that BodyMedia had announced at CES, and then Jawbone tried to shrink the BodyMedia galvanic skin response (sweat-sensing) technology down to fit into the UP3 wrist band. But Jawbone owed Chinese contract manufacturers money and the manufacturers held them hostage with ransom for a bigger share of the profits to produce the UP3 (after a delay because the initial production units were defective). Jawbone's woes were previously covered on Slashdot. Meanwhile, during Jawbone's CM debt turmoil, Apple announced the Apple Watch which caused many of the UP3 preorder customers to request refunds on their undelivered UP3s -- refunds that Jawbone was legally required to provide by the merchant terms of major credit cards that require product delivery within 90(ish?) days of accepting payment. (Yep, Jawbone charged money up front for the UP3 preorders.) I hated Jawbone for killing BodyMedia and for their poor previous products-- In 2008 I bought an Aleph One headset that didn't noise cancel (when the promotional video showed it being used in a helicopter.) After acquisition, Jawbone took the BodyMedia brand and shuttered BodyMedia's superior technology, abandoned paying happy monthly BodyMedia subscribers, and managed to botch the UP3 manufacturing and overall product. And yes, I feel that their CEO sounded like a tool/prick in his brief fireside interview with Embedded.fm. What a waste. The last BodyMedia armband was more accurate and discrete than my Apple Watch when I wore them both at the same time as a test. But Jawbone shuttered the BodyMedia subscription service and told subscribers to buy feature-poor and inaccurate UP3s. So now we are stuck with sub-par watch-based fitness trackers due to Jawbone's arrogance and held patents.
I updated to fix security vulnerabilities, but now I, too, encounter more bugs with old and new features.
My favorite new bug: Last week, an incoming iPhone call caused my MacBook to play a ringtone to indicate that the call was available for Handoff transfer. The call went to voicemail but my MacBook kept playing the ringtone, for one hour, before I realized what was going on and canceled the notification. My phone had been sitting 1 foot away from the MacBook the entire time, yet some sloppiness in the Handoff protocol, combined with lack of fault correction like software timeout on the MacBook, caused my computer to play a ringtone for an hour while waiting for user input.
My favorite old bug: Yesterday I experienced a repeatable application crash while creating new appointments in the OS X Calendar program.
Two years ago I received a personal follow-up for my detailed bug report in iPhoto. Now, the Apple bug report forms are outdated such that it is sometimes impossible to submit a bug for the latest version of released software.
Simplicity is the essence of design. Simplicity in design implies a tractable set of unit tests. Apple's quality control is lacking.
Don't use a mail-order service. The tapes could be exposed to magnetic fields from a variety of sources. The tech will most likely record in a lossy format and then export to your lossless format.
Do record multiple passes, preferably from different playback devices.
Save the multiple passes so in the future they can be sent through reconstruction software to correct for tape rot, etc. Enhancement software normally uses consecutive frames, but it might help having two interpretations of corrupted magnetic tape.
The 5 successful medical students that I know did M1 and M2 this way: Contact the medical school. They most likely professionally record and stream the lectures and have the slides posted online. Don't go to class unless travel time is less than 10 minutes. Watch the lectures in comfort at home at 1.5x, and pause to annotate the printed slides as-needed. Come up with a system for colored highlighting and cross-referencing the lectures, slides, and book material. Take books to office max and have them de-bound and 3-hole-punched. Organize binders by subject. The expense here is in the binders, binding services, a good laser printer, and a comfortable yet upright chair that can withstand 18-hours per day of sitting. There are a number of artificial intelligence notebooks that cross-reference notes automatically. I use DevonThink for CSE grad school notes. An all-digital workflow is hindered by the need to digitize textbooks. Instead of 3-hole punching the de-bound textbooks, you could pay a friend to run them through a scanner with an auto-sheet feeder and batch OCR them to PDF. File sharing services most likely will only contain out-dated editions. Hence, you are most likely stuck with annotating lecture slides as the central index to the lectures and text book references.
Hayest01@odjfs.state.oh.us is Tom Hayes e-mail address. God Bless Google. site: http://wdr.doleta.gov/contacts/dirs_list_new.cfm?s earchstate=OH&searchcategory=WIA+State+Contact
I hope this happens at my uni - encouragement will encourage people to start swapping on ad-hoc wireless networks - much faster than using p2p with our current packet shapers! I've had my eyes on the guy down the hall's collection of 17,000+ songs, but haven't had a real good excuse to make him *share*. BTW, he ripped the 17,000 songs all from borrowed library CDs - I wonder if that would be enough to trigger him as a terrorist under the Patriot Act...
My engineering professor mentioned the Icarus system being developed at U.Miami, FL. - That might be considered open source because it's being developed by a university.