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My Favorite Health 2.0 Experience from the Exam Room

HIT From the Trenches

By Hayward Zwerling; MD

Doctors and ComputersI was in the exam room talking to a patient, who I am treating for hyperthyroidism. The patient complained of profound fatigue, of several months duration. It was unclear if the problem was being addressed by the PCP. While talking to the patient, I reviewed all his labs which were in ComChart EMR. There was nothing obviously wrong.

A True Story – July 07, 2006 

From within the exam room, and while still talking to the patient, I connected to my hospital’s computer and download all his labs which were less than 1 year old. I then had ComChart file the labs into his ComChart chart. I then had ComChart EMR create a chart of all his CBCs by clicking the “Chart … CBC” button in the labs. It was obvious that his hematocrit had dropped precipitously sometime between January and March.

The PC computer I was using had Skype installed (a free program which allows you to make free telephone calls from your computer.) I also have a headset attached to this computer, which I use with Dragon NaturalSpeech Medical. While still in the exam room, and from within ComChart EMR, I clicked the “PCP” button in the patient’s Progress Note and a dialog box popped up and asked “Do you want to go to the Dr. XXX’s Addresses file?” I selected “yes.” I then clicked on the label “private,” which is in front of the physician’s “private” phone number. ComChart opened Skype and connected the call. I spoke with the PCP and I arranged for the patient to see the PCP the following day.

I then click the “orders” button and selected my “anemia work-up” panel. This created a lab order slip which included all the necessary blood tests. I choose the option “Send copy of results to … PCP” and then clicked the button “Fax order slip” to lab.

Contemporaneous Progress Notes

Finally, in front of the patient, I dictated a Progress Note, using Dragon NaturalSpeech 8 Medical. The resultant Progress Note included the chart of the patient’s CBCs. I then selected the PCP as the recipient, and clicked the button “Create queued fax.” In my office, I have one computer which continually sends out the “queued faxes” as soon as they are created. Thus, the PCP had received a copy of the Progress Note and the lab had received the lab order slip even before the patient left my exam room. The entire process occurred within a few minutes.


Needless to say, that patient was impressed that my office was able to use technology in order to efficiently advance their healthcare. And, the fact that it all happened in front of the patient, seem to reassure the patient and de-mistify the healthcare delivery process.


And so, your thoughts and comments on this Medical Executive-Post are appreciated. Send us your own favorite Health 2.0 story. And, if you want a picture with your comment, send in a .jpeg or go get a gravatar! Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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2 Responses

  1. Hayward

    Great post, even if it is a bit dated.

    Now, did you know that Aneesh Chopra will use his new position in the White House, as the country’s chief technology officer [CTO] and assist the president in supporting Dr. David Blumenthal, the national health IT coordinator. His goal is to concentrate on innovation, digital security and “pushing the levers of government.”

    Before accepting the federal position, Chopra was secretary of technology for Virginia. The Senate approved his nomination in May.


    Now, please send in another Health 2.0 story “from the exam room.”



  2. MU for License?

    Commonwealth of Massachusetts law that was enacted almost a year ago requires physicians to purchase and use EHRs in order to be licensed by the state after 2014.

    “The [Massachusetts] board (of Registration in Medicine) shall require, as a standard of eligibility for (medical) licensure, that applicants demonstrate proficiency in the use of computerized physician order entry, e- prescribing, electronic health records and other forms of health information technology, as determined by the board. As used in this section, proficiency, at a minimum shall mean that applicants demonstrate the skills to comply with the “meaningful use” requirements.”

    – from “The EMR Use Rule: An Open Letter to Massachusetts Physicians”
    By Hayward K. Zwerling, MD


    Dr. Zwerling: “As we all know, the practice of medicine has become increasingly difficult as a result of external mandates. These mandates specify which medicines we may prescribe, which radiology tests we can order, how many days our patients are allowed to remain in the hospital, which CME classes we must take, etc. And now, the politicians intend to tell physicians which software they must use in their office and which EMR options must be utilized during the office visit.”

    I’m proud to say that several years ago, it became clear to me that HIPAA was designed and amended by and for healthcare stakeholders rather than patients. Dr. Zwerling concludes with a plea to providers not unlike my many pleas to dentists and dental patients:

    “It is past time that physicians reclaim control of their offices, if not the practice of medicine. I strongly encourage all Massachusetts physicians you to contact Governor Deval Patrick, Secretary of Health and Human Services John Polanowicz, your Massachusetts state Senator and Representative and ask them to rescind Section 108 of Chapter 224 of the Acts of 2012. Also tell the politicians to desist from interfering in the physician-patient relationship, which is a prerequisite for high quality healthcare. Please feel free to forward this letter to your colleagues. I also encouraged you to plagiarize this letter, as needed, for your communication to your state representative.”

    I wasn’t nuts after all. I was just early.

    D. Kellus Pruitt DDS


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