Patient Safety

The Nursing Home Get Out of Jail Card (“We Don’t Want Our Patient Back”). It’s Now Adios.

The Centers for Medicare & Medicaid Services (CMS) has not updated its rules ("conditions for participation") for nursing homes in twenty-five years. Late last year they finally did. Many of the changes will have an impact on the daily lives of NH residents but are far removed from hospital medicine.  Think a resident's ability to pick their own roommate and have all hours visitors.  However, there are a few changes that intersect with HM, and a notable one will affect how you respond to a frequently encountered roadblock long-term care facilities sometimes throw our way. First, though, some of the changes CMS finalized.  With SHM members now moving into the post-acute and LTC realm, several have real relevance (I only cite a sliver of them): (more…)

The Inmates Are Running the Asylum

OK; that might be a bit of an exaggeration. But if you left your clinical shift asking why you feel so depleted and frustrated and why you had that negative interaction with that patient, you should do yourself a favor and read the recent review in the Journal of Hospital Medicine entitled "When Personality Is the Problem: Managing Patients with Difficult Personalities on the Acute Care Unit". In this article, it notes that about 4-15% of the population is affected by at least one personality disorder and that this prevalence is thought to be much higher in those seeking healthcare services – perhaps as high as 25% of the population. This is thought to be due to in part to lifestyle factors, such as drinking and drug use, as well as the fact that individuals who possess these dysfunctional personality structures may have difficulty accessing and utilizing care adequately. These…

Is NLP-Enabled Data Mining the Digital Breakthrough We’ve Been Waiting For?

Natural language processing might seem a bit arcane and technical – the type of thing that software engineers talk about deep into the night, but of limited usefulness for practicing docs and their patients. Yet software that can “read” physicians’ and nurses’ notes may prove to be one of the seminal breakthroughs in digital medicine. Exhibit A, from the world of medical research: a recent study linked the use of proton pump inhibitors to subsequent heart attacks. It did this by plowing through 16 million notes in electronic health records. While legitimate epidemiologic questions can be raised about the association (more on this later), the technique may well be a game-changer. Let’s start with a little background. One of the great tensions in health information technology centers on how to record data about patients. This used to be simple. At the time of Hippocrates, the doctor chronicled the patient’s symptoms…

My Op-Ed in Today’s New York Times… and My New Book

This week feels like the coming out for my new book, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age. The NY Times ran my op-ed on health IT today (they chose the slightly sensationalist title, FYI). I’ve also started something of a book tour, with several talks and media interviews scheduled this week, including a sit down with Sanjay Gupta. (Note to my wonderful children: sorry, no Jon Stewart; at least, not yet). Since the Times piece does not allow for comments, let me invite any comments here. The op-ed is really a Cliff’s Notes version of the book, whose formal publication date is April 7th but which began shipping from Amazon last week. If anyone would like to comment on the book, I’d love to hear that, too. (Of course, reviews of the book on Amazon are much appreciated, particularly if you liked…

My Interview With Capt. Sully Sullenberger: On Aviation, Medicine, and Technology

The story of Chesley “Sully” Sullenberger – the “Miracle on the Hudson” pilot – is a modern American legend. I’ve gotten to know Captain Sullenberger over the past several years, and he is a warm, caring, and thoughtful person who saw, in the aftermath of his feat, an opportunity to promote safety in many industries, including healthcare. In my continuing series of interviews I conducted for my upcoming book, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age, here are excerpts of my interview with Sully, conducted at his house in San Francisco’s East Bay, on May 12, 2014. Bob Wachter: How did people think about automation in the early days of aviation? Sully Sullenberger:  When automation became possible in aviation, people thought, “We can eliminate human error by automating everything.” We’ve learned that automation does not eliminate errors. Rather, it changes the nature of…
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