posted by jantzl on April 17, 2019

We just attended the Academic Internal Medicine Week in Philadelphia and came back so inspired by the people that we met and conversations that we had. We learned from Coordinators, Chiefs, and Directors from all over the country. Every conversation was a valued opportunity to learn. We met HealthTech innovators from secure chat that can improve transition of care to interactive diagnostic guidelines that can integrate with EHR to an exciting upcoming pain medication. There were so many brilliant, energetic, caring people who care about helping other people. It is such an honor, privilege, and inspiration to know and serve this group. These interactions fuel our desire to continue to learn and find new ways to support this community of healers and educators.

posted by jantzl on April 13, 2019

If you search for the difference between EHR and EMR, you'll find other sites that answer this question.

Some sites will define EHR as holistic and EMR as a narrower view. Another way this is explained is that EHR is interoperable and portable, while EMR was built to be an institutional record, in a single practice.

I don't know if everyone who reads this difference sees the same thing that I see. It looks to me like a glossing over or an apologetic view of EMR. Engineers knew better than to build a siloed health record. EMR should never have been built. From conceptualization, every vendor should have been building for interoperability. We didn't need the internet to know that the information belongs to the patient. We had standardization techniques in the 18th century. Patient Health Information should never be tied to a particular system. It should have been built to be portable and this should be a core component of every system going forward.

posted by adgrooms on April 12, 2019

“Just log into your patient portal to see your blood test results in a few days” said the front desk lady, answering my question, as she hurried me out the door. I looked back down the hall and said bye to my doc as he hurriedly typed on his little laptop. I wondered what else he could be inputting at such a furious pace...Is he still typing about my appointment? Another patient? Billing? Perscriptions? Perhaps writing a blog.

I logged into my patient portal. I didn’t know what to expect really, but I was surprised at how bad the experience was. I felt like I was on a site from the beginning of the internet. The right-hand side of the text was cut off. The navigation spun me in circles. In general, it was not intuitive at all to use. I could only imagine the frustration the older patients experienced.

This interface didn’t seem to be designed with the patient in mind. It didn’t even include my weight or blood pressure, measured during my visit. I thought this would be a statistic that would be interesting to review over the years. Maybe it is in there somewhere and I just haven’t found it yet.

One positive thing I noticed. The billing page is really easy to read.

posted by jantzl on April 11, 2019

The people working on the frontlines of healthcare have been raising issues about EHRs for frankly too many years now. A great multi-part article (which is an excerpt from a great book) from 2015 illustrates in frustrating detail the compounding of errors, human and system, that can lead to disaster.

This isn't news. As I write this it is 2019. The article/book, written by a doctor who has experienced these things first-hand offers solutions and I can offer no better:

  • improve communications
  • take care of the workforce
  • provide better leadership
  • provide better training
  • provide better tools

Instead, in most institutions, the workforce continues to be squeezed, which does not help communications, and training is reduced, for fear that it will take time away from dollar earning activities.

The problem still exists, 4 years later. Clearly, this approach is not working. It is well past time to try a different approach. Why not listen to the people on the front line?

posted by adgrooms on April 10, 2019

I took a long break from going to the doctor. Not really by choice, but I spent my 20’s and part of my 30’s as an uninsured, usually broke musician. My health care experience 20 years ago was probably a little different than most people as my grandfather was my Primary Care Provider.

If I were sick, it was either a quick trip down the road to his house or stop by the urgent care clinic where he worked. As a young man, I was in good shape, and my vitals never showed anything concerning. I never thought about wanting or needing to access my medical records, but I knew that on a shelf somewhere is a folder with my medical history, probably since birth.

Now I’m back in the groove of getting checked up. As I finish out my 30’s, I figured it’s a good idea to see how everything is working even though I feel just as healthy as I did when I was 20.

I had heard a little about Electronic Health Records, but really didn’t know what to expect. I was surprised to get a stack of papers for my intake at the doctors office. I guess I was expecting a more streamlined electronic process. Maybe an intake form at home online to pre-fill? Oh well... I’m sure the cranky office lady was going to do that for me after I handed her the papers.

The next part was pretty much the same as the old days also. The nurse comes to get me, weighs me, takes my blood pressure...and writes it down on some papers. I’m still not really seeing anything “electronic” about my visit yet. Then after waiting a bit, the doctor comes in. After a few minutes of small talk, he opens up a small laptop and starts asking some lifestyle and diet questions. Typing furiously he eventually pulls out the stethoscope and does a quick inspection of my breathing. He says I’m looking like I’m in great shape and he’d see me next year.

I finish up with a trip down the hall to get my blood drawn. I’m told that they will send this away to the lab and get results on how much cholesterol is in my blood among other things. Once again I don’t see a computer being used by the nice lady with a needle.

In the end, my experience kind of showed me that we are still in the infancy stages of EHRs. It didn’t make anything more efficient, and probably detracted from my meeting with my PCP. It wasn’t terrible. It just felt forced that he had to type a bunch of stuff while interviewing me….or maybe I was just used to my grandfather scribbling instead back in the day.

What is this EHR thing and what is it going to tell me about my health???