201–206 of 206 posts
I do NLP with medical notes. What I have observed is that the redundancy between the note and information available elsewhere in the EHR in structured formats is pretty high, as is the amount of boilerplate (e.g. section headers and list templates that may not be filled in). This makes machine learning using the notes difficult since the content is so muddied up. It's far from impossible to do useful things with them…
Interesting insight! Where do you work?
Earlier quoted context omitted.
every time I've done it the response is always defensive, ie "why do you need them" I was asked this once after requesting mine. I flatly said "I don't", and waited. The person on the other end of the line was clearly thrown off by this, probably expecting something they could dish out a canned response to, hoping I'd give up. It was obvious from their voice they were scrambling for what to say to that. A bit of rigm…
Why would they be so hesitant? Surely it’s not that extra work for an office admin to pull something up and hit “print”.
Individual documents/entries, yes. Everything, no.
Earlier quoted context omitted.
Forget "view". I want to own my records. It's my personal data that I've enlisted a professional to gather on my behalf.
can you elaborate on the distinction you are making between viewing and owning?
Earlier quoted context omitted.
I was working for a large multi-state HMO during their transition to a major EHR (I'll let you guess, since I do not speak for either). I have a background in IT and was a systems consultant for a number of years. On paper, I could get a relatively uncomplicated chest pain case from the ER to the hospital unit with all the orders for workup ready in 45 minutes. With the EHR, we had abominations like double medication…
What is a “double” medrec? And what initial electronic order sets were implemented? Did the organization not just implement (as best as possible) the previously on-paper order sets? It’s not a perfect approach (you can do things with an online form that you can’t do on paper and vice-versa), but it seems like a good approach to avoid (more) mass confusion on Day1.
I think that's when you need a second doctor to approve orders for another.
Earlier quoted context omitted.
I found omissions to be particularly interesting too. For example, I once declined to take a shot after the doctor explicitly told me that it would most likely not yield any benefit, given the response I had from other treatments. The medical record simply shows that I declined the shot, but not that this was upon strong recommendation from the doctor. This became an issue later when the provider went back to the rec…
Half the goal of note taking is not writing down anything that will implicate you in a future legal battle.
The article has an example of the opposite, but equally important oddness of liability. If you don't mark down "XYZ thing is normal" then someone will come back to complain that you didn't find a problem with XYZ when examining them 27 years ago.
Earlier quoted context omitted.
You were downvoted for this, and I agree that it’s a controversial stance, but there is a genuine point to be made here. It’s not uncommon for teenagers to be misdiagnosed with mental illness or ADHD and either of those are disqualifiers for FAA medical certification, military pilot careers, and likely many other military, law enforcement, and intelligence careers. IIRC, a prolonged history of ADHD treatment is enoug…
The relative risk of driving while having ADD/ADHD (accidents/km with / accidents/km without) is around 1.54 [1]. This isn't horrible , of course, but it's still bad . Non-disqualifying visual impairments have a relative risk down around 1.2, implying a surprisingly low cutoff for a visual impairment being disqualifying. "Severe behavioral problems due to ageing (dementia)" have a RR 1.45. A category covering epileps…
"That all said... while we can certainly complain about rampant misdiagnosis - I wish I had a dollar for every time someone told me that I'm just addicted to stimulants - my opinion is that this particular rationale for disqualification is absolutely justified."
So, I'm also an ADHD patient, medicated. I've gone back and forth between believing in the diagnosis and thinking maybe I'm just dependent on the medication that I've taken for so many years. It's hard to say now, and of course quitting stimulants requires a LOT of time off work and learning to execute tasks without pharmaceutical aid. So, if you were to take a patient who has been on amphetamine for 10 years and abruptly cut him/her off, the patient would likely go through a period of fatigue, low-interest in activities or work, and struggling getting anything done. I've heard this can take as long as 6 months or a year for certain people. I don't believe you can diagnose ADD/ADHD or any comorbid mental illness in the presence of drug withdrawal. Think of it as a "brain re-training" period. As you can imagine, not many people have the willpower or resources ($) to take time off work and truly "reset" their brains, so they stay on the meds and hope that it works out..