It occurred to me over the past week that if you were to get inside my Evernote, you would instantly learn so much about me.

In some ways, the structures of our individual “clouds” say a lot more about us than any diary could. E.g., “this is how I curate”, “this is what matters to me”, “this is my weakness – the stuff I need a cloud to help me remember”.

But this is also what makes Evernote so great. They never really tell you how to use it. It’s up to you. In this way, your Notebooks become insanely personal. And if you come up with something neat, maybe you’ll feature on the Evernote Tumblr.

Well, here’s a glimpse of mine (click to enlarge):

• Blog Ideas: Did I think of something cool on the subway? I note it on my iTouch Evernote app and sync as soon as I get a network connection.
• Clinical Notes: No patient information here. Just interesting clinical insights (right now, mostly useful tips for talking to patients).
• Ethics: I love Virtual Mentor, the AMA’s SUPERB medical ethics journal. I work through the cases in my spare time and save them as notes. Tagging is invaluable here. For example, if I need notes on “abortion”, there you go. Also great for keeping notes on Medical Law.
• Fiction: Bits and pieces of stories.
• Press: The Evernote extension for Chrome and Firefox makes clipping my blog press easy-peasy. Never forget any URLs again!
• Random: A little bit of everything – mostly my favourites from Ask Metafilter and images from websites.
• Research: It started out as a repository for terms I didn’t understand in journal articles like “Principal Components Analysis”. Now I’m beginning to really like Evernote’s PDF capabilities – especially being able to embed and flip through whole articles inside a note – so I will be taking it out for a test drive as a Systematic Revew tool.
• US Health Reform 2009: Possibly my most useful notebook EVER! I started collecting articles on the Health Reform debate in September 2009 by bookmarks, but it just didn’t cut it. Then I got Evernote and spent a few days going back through all the links I shared on Twitter re: HR and this baby was born! So, now, say I want to get all my saved articles on Medicare – I just click the “Medicare” tag. Of course, this notebook is quite interesting in earlier versions of Evernote as the Time Band shows when I added each note – it’s like seeing HR happen right before your eyes – unfortunately, the latest release seems to have scrapped that feature.

A question for you: Evernote and personal health info

One thing I noticed from my own notebooks was the conspicuous lack of personal health information. I have, of course, read all about the dangers of doctors storing any patient information in Evernote (HIPAA nightmare…), but I wonder whether patients themselves go ahead and keep records in Evernote?

Let me know if you’ve seen this!

And now I want to ask you: what’s in your Evernote and why? And, secondly, if you’re a patient, do you/would you store personal health information on it?

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For further reading on Evernote in medicine and health, check out DrV’s post at 33charts: 8 Ways Physicians Can Use Evernote

Just wanted to post about VitalHub, the latest in iPhone + EMR — being developed and implemented in-house at Mount Sinai Hospital in Toronto!

Watch the beautiful video of it in action, courtesy of the Apple website.

The essentials:

• VitalHub allows health care professionals to access records from 66 applications being used at Mount Sinai Hospital, including those storing clinical data, reference materials, and patient information.

“We now have access to exactly what we have in our computers here in the hospital. We can get access to our patients’ data whenever and wherever we want it. Knowing what’s happening with their drugs, radiology, laboratory values, microbiology results — it really enables me to make decisions on the go.”

• Access from anywhere.

“Whether using Wi-Fi or 3G on iPhone, doctors can access VitalHub no matter where they are,” explains Dwivedi. “They can review a patient chart before they come into the hospital, whether they are at home, in a restaurant, or at an airport.”

 

• Security is provided by password and VPN certificates.

FYI, Sinai is one of several large hospitals located just down the street from U of T/MaRS/Center for Global eHealth Innovations (and also where I did my honors thesis!) so I think this is very exciting for the downtown Toronto eHealth conversation!

Yesterday, I was reading on Hans Oh’s blog that eHealth seems to be becoming “mainstream” — in that it’s cool to be devoting time, effort, and research monies towards it, there are articles on NEJM about it – and it seems that VitalHub, which is very openly promoted by the hospital, is an example of that happening in Canada. I am glad to see that people are really noticing what Dr. David Kibbe said: that actually many physicians have been happy to adopt the iPhone, but such a small percentage have adoped EMRs. It might just be that we have been waiting for innovations like this, piggybacking on technologies that are already accepted by health care workers.

We’ll keep an eye on the official website, Apple’s site, and the Baron Group blog for further information in the coming months.

Torontonians (and others), what do you think?

I thought it was about time to write a post about the woes of doctor-patient email.

Last week, a friend was having some issues with his phone, so his family doctor’s office couldn’t get in touch to inform him of the date of his specialist’s appointment. He didn’t know about the trouble until he popped in for a visit, which was when his doctor asked him – if he didn’t hear by a certain date – to call the specialist himself.

A good solution to the problem, but I couldn’t help wondering why email wasn’t an option. I mean, practices routinely collect our emails now, but I still don’t see them used very often. What if my friend kept having phone issues? What if he forgot to call?

Later, after the appointment had been worked out, he told me that the specialist ended up sending him an email with instructions on how to prepare for the procedure. This was appreciated, and got us both thinking about what exactly are the barriers to doctor-patient email.

What counts as private info? How do other providers deal with this around the world?

Let’s look at what’s out there.

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“Geography is destiny in medicine.” –Jack Lord, MD

In my undergrad English lit courses, I heard a lot about “character is destiny”. Which is a fancy way of blowing things out of proportion – e.g., Romeo and Juliet didn’t die via the quality of being “star-crossed”, but because they were super emo.

Well, this week, I watched a TED talk by Bill Davenhall (below) that claimed “geography is destiny”.

This idea is not so exaggerated. Just watch it (9 min.):

What it says: Where you’ve lived may determine how healthy you are.

There’s the classic equation:

health = genetics + lifestyle + environment

and of the three aspects, Davenhall argues that “environment” has been ignored for far too long by physicians.

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The same CBC article (on Canadian doctors’ love-hate relationship with EMRs) that featured Dr. Greiver’s EMR also published this comment that didn’t sit very well with me:

"Let’s be honest," says researcher Dave Ludwick. "Doctors have gone to school to become doctors, to understand how the body works and remedy that body’s failings, not to do IT. And yet with electronic records, IT suddenly becomes their job, too."

I am aware that this doesn’t exactly say that IT isn’t the physician’s job, but it’s certainly implied.

So what gives? Why the downer attitude?

If all jobs matched their job descriptions, the world would be a very foreign place.

Then I thought about the “description”…

In Canada, we have a famous diagram of the CANMEDS competencies (“a guide to the essential abilities physicians need for optimal patient outcomes”):

Indeed, our medical schools are crazy about this flower. Pre-medical and medical students do their utmost to present themselves as embodying these traits. You don’t get a more widely-accepted job description here than this…

And I think that every single petal is relevant to the EMR debate.

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