Best practices

Grand Rounds needs you.

Val Jones and I have recognized that GR works better when we invest in a higher profile  --

  • e-mail blasts about the next host's deadline and address. 
  • daily tweets through the @grandrounds account, highlighting links from that week's edition
  • identifying and guiding new bloggers through the hosting process
  • coordinating with other online health networks

Trouble is, neither Val or I are in a position right now to do this ourselves.

If you've got the time and inclination to tackle at least a couple of these items, contact us.

Through their vocations

According to this reputable source, (and backed up a little by this source) the concept of the modern grocery store was once laughable. Customers used to walk up to clerks with their shopping lists, and the clerks would fetch the items for them.

No one thought people would want to do the work of picking their own fruits and vegetables.

I think the same is true for CPOE -- computerized physician order entry.

I try to remember this when I encounter opposition to CPOE and electronic medical records (EMR). Sure, I learned for the oral board exam how to rattle off a long list of lab tests to order, medications to give, based on a clinical scenario. But I trained, and practice, with order sets on EMRs. It's just more natural for me to pick among preselected agents and doses, and prompts me to consider alternatives I might not have. I like perusing the items listed in front of me, or a few clicks away, just as I like to feel a few avocados before picking one to purchase.

CPOE is a hot topic, right now. I spent months with my colleagues creating and refining order sets for our new ED information system. I'm watching ACEP's informatics section settle on a policy statement on scribes, who many ED physicians rely on to interface with computerized systems. Here's my own recent piece for EPMonthly about drug-drug interaction warnings and coming era (hopefully) of smarter, more context-aware clinical decision support.

I suppose the analogy to decision support would be expiration dates, or nutrition labels, to help consumers shop. I'd also allow the comparison that modern EMRs are like a confusingly organized grocery store that requires hours of training, and federal incentive plans, before people shopped there.

Maybe the news that NIST is convening an EMR usability workshop should be interpreted in this light -- we've acknowledged that we're heading away from clerks and toward picking out our own items, but the store aisles are going to have to be laid out more intuitively.