jcowdy

Nice work! It would be great if after clicking on the text within the podcast that matches my term, I was brought to that section of the transcript rather than to the beginning.

Thanks, I’ll check it out

I’m a big fan of Cal Newport. His overarching theme is to be intentional about how you use your time. If you aren’t specifically planning and blocking your schedule, it will turn into a fragmented mess and not allow you to get in the deep thinking periods that many projects require. This is a good reminder that you may need to advocate for yourself (and work with your partner) to establish these slots in your schedule.

The advantage I find using a Stream Deck is that it can be configured to use the context of your active window to show a subset of buttons. This unlocks a lot of power in terms in application specific shortcuts / macros that can all be triggered from a small device. I have >100 different buttons but only see the most relevant by default based on what I’m doing.

The fine is depressing and invalidates much of the benefit and work that went into passing the rule. Until the fine amount is increased (which I suspect may take quite some time if it ever happens) compliance will continue to be low without some other external pressure on the health systems. Are there any tools / organizations that are aggregating this data for consumers to use for comparison of service pricing? The pressure of consumers may be the best chance we have to drive compliance, but it also seems like a chicken / egg scenario where it will be hard to get enough consumer pressure without more than 25% of health systems releasing their pricing.

If you’re looking more to be able to intelligently communicate rather than program independently, I’d recommend the Harvard CS50 for Business Professionals.

https://www.edx.org/course/cs50s-computer-science-for-busine...

I use Trello and have a specific list for ideas. It works for me because Trello is always “with me” as an app on my phone, on my desktop, or via a browser. I tend to have creative thoughts while out running and use speech to text to add a new card through the iPhone app without stopping.

I was one of the people that gathered and analyzed the data that the cited study used and can't agree with your conclusion more. Sure, the EHR makes "note bloat" easier than paper but the difference in length across different countries (using the same software) shows that note length is more a result of the environment than the tool.

I think there is also a general misunderstanding of "the note" in an EHR context. The progress note is really just one aspect of a provider's documentation of a visit. Things like medications and allergies are generally indicated as "reviewed" elsewhere in the chart and yet all of this information is many times also entered into the progress note unnecessarily adding to note bloat. In the days of the paper chart the progress note ended up being the only summary of the visit and even though it's now just one piece of the visit documentation, it's still written as though it will be the only source of truth.

Yes, definitely an option although eventually the volume of "final approval" items will stack up. Another option could be to allow items that pass protocols for non-controlled substances to be approved by nursing staff. Conversations like this are exactly what need to take place for each item on the provider's plate.

EHR vendors and clinicians need to find a way to come together to both design software that will make clinicians lives easier, but also to change any billing/legal/compliance hurdles that are in the way of putting this technology in clinics. If someone can put all of these pieces together we could see some powerful changes. Perhaps Dr Gawande's new venture with Amazon, Berkshire Hathaway and JPMorgan will give him a chance to control both sizes of this puzzle and create a better environment for clinicians and patients.

The problem with this article is that Dr Gawande is too quick to point the finger at the EHR vendors for increasing the amount of non-clinical work that physicians are responsible for today. The EHR has become the face for arcane and archaic billing, regulatory, and compliance requirements which, when enforced through the software of the EHR, cause additional work to be shifted to the physician. Those questions that you get when you place a radiology order have typically not been added by the EHR vendor. More than likely they were added at the advice of legal / compliance.

Unfortunately the problem isn't as simple as getting more competent EHR designers and developers (although that certainly wouldn't hurt), but rather a deeper look into each aspect of increased work for physicians and analysis of why it is in the workflow (5 whys application would be great). At that point, organizations and physicians will better understand the reason work is on the physicians' plate and have a chance to weigh the pros and cons of either removing that work or shifting it to another person.

The other side of this that most don't see is that EHR vendors are also being held back by these same billing and compliance pressures. Here's a secret - EHR vendors actually want to help physicians be as efficient as possible and would love to automate work off of their plate. Unfortunately the environment created by compliance departments who are afraid of being sued and hospitals who would like to get paid has handcuffed the more innovative development from EHR vendors. If a system reviews incoming medication refill requests from patients, evaluates protocols, and determines that a refill should be approved who does is listed as the authorizing provider for the purpose of the pharmacy and the patient's insurance?