Discover and read the best of Twitter Threads about #ehr

Most recents (14)

1) So you get a copy of your medical records & dive in, reading line by line, trying to make sense of your new lung #cancer diagnosis.

“Wait a second, this doesn’t sound right. This is a mistake. I don’t have a history of a heart condition & I don’t smoke cigarettes.
#PtExp
2) You call your oncologist’s office to report the mistakes you found & ask to have it updated. You are told to write down the correction & fax it to the office. You do exactly that.
#PtExp #addendum #EHR
3) At your next follow up appt a month later, you ask the dr if your record was updated & the correction was made.

The dr looks at you like:

#PtExp #addendum #EHR
Read 16 tweets
1/ Here is an update on the current status of #mCODE (thread format) based on the Cancer Data Summit @MITREcorp mitre.org/cancer-data-su…
2/ APPROVED: #mCODE 0.91 was approved by @HL7 as a Standard for Trial Use (STU) - congrats
3/ DATA GAPS: We still struggle to capture #cancer disease status in the #EHR. Cancer staging and status are not the same - stable disease, progression, etc.
Read 9 tweets
Most deep learning #AI work to date has been supervised. 1. Now we're seeing a trend towards much more unsupervised, aka "self-supervised" (after @ylecun) or weakly supervised.
Figure from @GaryChoy in #DeepMedicine
@ylecun @GaryChoy 2. In the past 2 weeks, 4 important papers published:
—Process 3.3 M abstracts in materials science
—Prevail at 6-player Texas Hold'em poker
—Solve Rubik's cube in 1.2 secs
—Classify whole slide #cancer pathology images
Read 6 tweets
Here is a summary of the @ASCO Minimal Common Oncology Data Elements (#mCODE) project ... in thread format
#ASCO19
1/ Problem:
#clinicaltrials continue to be the primary way to answer question in oncology but few patients enroll. Despite more data being stored in the #EHR, we can't easily combine data across systems as few are interoperable. This is a missed opportunity.
2/ Solution:
#mCODE is a newly proposed data standard that leverages and expands existing data standards to promote answering clinically meaningful oncology questions across medical records allowing us to learn from more patients
Read 8 tweets
Happy to say our @AcadMedJournal article on #wikifying clinical documentation is now in print. Time to recapitulate the Twitter explainer from a few months ago! 1/n @jefferyrlsmith
As an enthusiastic @Wikipedia user, producer of clinical docs at @VUMChealth, and deputy editor of the medical wiki HemOnc.org, I teamed up with @jefferylsmith (VP of Public Policy at @AMIAinformatics) & Adam Wright @BrighamWomens to put out this thought piece 2/11
We came together around the groundswell of concern about the negative effects of #EHRs on the quality of clinical documents. Having delved deep into the history of clinical documentation, we began to realize how far afield from original intent we are. 3/11
Read 13 tweets
Last week we described in @JAMA_current how we collected, de-identified, scrubbed, linked, and analyzed real-world #EHR clinical data LINKED to tumor sequencing data, all obtained in the course of ROUTINE #cancer care #RWD #RWE

jamanetwork.com/journals/jama/… (1/n)
The manuscript represents deeply collaborative work done by large teams @FoundationATCG + @flatironhealth. The process of working with another team/company on everything from patient privacy to data pipelines to research queries could be the subject of an entire blog post (2/n)
Suffice it to say that we have LOVED working w/ @GauravSingalMD, Peter Miller, Gerald Li, @gaurav_bio, @BostonGenomics et al on this work.

More such collaborations will be required to break down data silos in healthcare! (3/n)
Read 12 tweets
A look at the U.S. attempt to switch medical charts into electronic records. “The system is an unholy mess.” via @FredSchulte and @erikafry KHN/⁦@FortuneMagazinekhn.org/OTI3ODU5
Electronic health records have created a host of risks to patient safety. Alarming reports of deaths, serious injuries and near misses — thousands of them — tied to software glitches, or other system flaws have piled up for years in government and private repositories. #EHR #EMR
It started with the "HITECH" Act and a goal of improving patient safety and creating a system of easily accessible patient health info. The software code was so buggy, that when one glitch got fixed, another would develop, the government found. #EMR #EHR
Read 8 tweets
Excited for our ⁦@YaleMed@JMIRpub on the design of a user-friendly health IT solution to facilitate rapid adoption of ED-initiated buprenorphine in routine emergency care /1 humanfactors.jmir.org/2019/1/e13121/
Buprenorphine decreases mortality, withdrawal symptoms, craving, and opioid use. But ED-initiation is not currently routine emergency care for people suffering from opioid use disorder. /2
In our pragmatic user-centered design process we learned (confirmed) that clinicians don’t want another annoying pop up. Instead, we provide only the info you want/need with a flexible and streamlined workflow whether waivered or not, new or experienced with ED bupe processes
Read 6 tweets
every year I give my #neurology residents a very personal talk on how I sought to overcome #burnout during #residency. I call it “finding the good.” I gave that talk to my residents today, and it contains my core beliefs as a clinician educator. #meded 🧠
(these are some realizations that helped me, and your mileage with them will vary. not all will resonate with all, of course. I welcome your comments, anecdotes, and additions. but, for what it’s worth, here are my educational mantras)
“finding the good” is a creative, proactive endeavor composed of generosity of spirit, cognizance of the gravity of others’ situations, deep listening, and creative thinking. there are no protocols or algorithms for finding the good, though a few pointers follow...
Read 9 tweets
@RichDuszak 1- MT @Aiims1742 “This @katekelly article reads like a paid infomercial for EPIC (in fact, I actually looked for the “This is an advertisement” disclaimer). Would have been nice to have interviewed one or two end users of the chocolate factory product.”
nytimes.com/2018/12/20/bus…
@RichDuszak @Aiims1742 @katekelly 2- Nice digs, clever marketing spin, BUT Epic highly disliked by users. #EHR has significantly disrupted relationships w #patients, #ptexp, led to clinician & pt dissatisfaction, & is seen as one cause of #burnout. @JackMurtha hcanews.com/news/ehrs-are-… @BarbaraMcAneny @meggerber
Read 28 tweets
@Aiims1742 @katekelly Nice digs, clever marketing spin, but EPIC is highly disliked by end users. #EHR has significantly disrupted relationships with #patients, led to clinician & pt dissatisfaction, & is seen as one cause of #burnout. @choo_ek @darakass @tgoetz @tmprowell @cardiobrief @DrMJoyner
@Aiims1742 @katekelly @choo_ek @darakass @tgoetz @tmprowell @cardiobrief @DrMJoyner @GregT_156 @rgergelymd @matthewherper @charlesornstein @ddiamond @JeffYoung @sarahkliff @adamfeuerstein @dariustahir @ReasObBob @EJSMD “I began to see the insidious ways the software changed how people work together. They’d become more disconnected; less likely 2 see & help one another, & often less able to”–@Atul_Gawande newyorker.com/magazine/2018/… @GavinPrestonMD @agropper @joyclee @LaurentLantieri #EHR @BobLeeMD
Read 11 tweets
Read 22 tweets
THREAD Friday mini #tweetorial! Despite having a learner w me in #periopmedicine clinic the last two days, I neglected to tweet any #postitpearls (though lots of great learning + pt care!). BUT had 2 back-to-back cases raising questions of weight we place on self-reported pt info
2/ will be intentionally vague to protect PHI without diluting learning value...for all the talk re #EHR clutter, EHRs helping propagate accurate info but also "chart lore" false info, #backtobedside, #patientsbeforepaperwork...when can you "take a pt's word for it" in preop?
3/ pt A-early 50s, elective ortho surgery (though pain affecting QOL & activity levels), VERY vague "MI" and "CAD" history in chart from decade ago, no immediately available records, some risk factors for premature CAD (tobacco) but no interval events...
Read 18 tweets
Dear #hospitals:

Your discharge planning sets #patients up for failure. How? Let me explain (again, & again, & again). #PtExp #PtSafety #PtEng #EHR #interoperability #PatientAdvocacy #medtwitter #GMDD #hcldr

Photo Credit: Rob Potter (Unsplash)
1)Follow up appts, essential to a patient’s health & recovery, are listed as part of the discharge summary. These appts are recommended to be scheduled within 7-10 days. To be best prepared, patients need their records. #healthcare #PtExp #PtSafety #PtEng #EHR #GMDD #medtwitter
2)All records from a patient's hospital admission should be AUTOMATICALLY sent to every listed follow-up physician. Hospitals, you know which drs patients need to see; it’s listed in the discharge plans. This step needs to be embedded in the workflow #PtExp #EHR #interoperability
Read 14 tweets

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