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Burnout is Overused and Under Defined

Posted on December 8, 2017 I Written By

When Carl Bergman isn’t rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

Recently, John hosted a #HITsm chat on using technology to fight physician burnout (Read the full transcript from the chat here). The topic’s certainly timely, and it got me to wondering just what is physician burnout. Now, the simple answer is fatigue. However, when I started to look around for studies and insights, I realized that burnout is neither easily defined nor understood.

The Mayo Clinic, among others, defines it this way:

Job burnout is a special type of job stress — a state of physical, emotional or mental exhaustion combined with doubts about your competence and the value of your work. 

So, it is fatigue plus self doubt. Well, that’s for starters. Burnout has its own literature niche and psychologists have taken several different cracks at a more definitive definition without any consensus other than it’s a form of depression, which doesn’t have to be work related.

Unsurprisingly, burnout is not in the DSM-5. It’s this lack of a clinical definition, which makes it easy to use burnout like catsup to cover a host of issues. I think this is exactly why we have so many references to physician or EHR burnout. You can use burnout to cover whatever you want.

It’s easy to find articles citing EHRs and burnout. For example, a year ago April, The Hospitalist headlined, “Research Shows Link Between EHR and Physician Burnout.” The article then flatly says, “The EHR has been identified as a major contributor to physician burnout.” However, it never cites a study to back this up.

If you track back through its references, you’ll wind up at a 2013 AMA study, “Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy.” Developed by the Rand Corporation, it’s an extensive study of physician job satisfaction. Unfortunately, for those who cite it for EHR and burnout, it never links the two. In fact, the article never discusses the two together.

Not surprisingly, burnout has found its way into marketing. For example, DataMatrix says:

Physician burnout can be described as a public health crisis especially with the substantial increase over the last couple of years. The consequences are significant and affect the healthcare system by affecting the quality of care, health care costs and patient safety.

Their solution, of course, is to buy their transcription services.

What’s happened here is that physician work life dissatisfaction has been smushed together with burnout, which does a disservice to both. For example, Medscape recently published a study on burnout, which asked physicians about their experience. Interestingly, the choices it gave, such as low income, too many difficult patients – difficult being undefined — are all over the place.

That’s not to say that all physician burnout studies are useless. A recent study, Electronic Health Record Effects on Work-Life Balance and Burnout Within the I3 Population Collaborative, used a simple, five item scale to ask physicians how they viewed their work life. See Figure 1.

Figure 1 Single-Item Burnout Scale.

Their findings were far more nuanced than many others. EHRs played a role, but so did long hours. They found:

EHR proficiency training has been associated with improved job satisfaction and work-life balance.14 While increasing EHR proficiency may help, there are many potential reasons for physicians to spend after-hours on the EHR, including time management issues, inadequate clinic staffing, patient complexity, lack of scribes, challenges in mastering automatic dictation systems, cosigning resident notes, messaging, and preparing records for the next day. All of these issues and their impact on burnout and work-life balance are potential areas for future research.

There’s a need to back off the burnout rhetoric. Burnout’s overused and under defined. It’s a label for what may be any number of underlying issues. Subsuming these into one general, glitzy term, which lacks clinical definition trivializes serious problems. The next time you see something defined as physician or EHR burnout, you might just ask yourself, what is that again?

Patient Data Sharing and EMR Usability

Posted on December 7, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It’s been a while since we’ve done a Twitter roundup, so it was time to do one again. This time we highlight 3 recent tweets that will make you go hmmmmm. Lots of great insights from amazing people.


More and more people are open to sharing their records. However, there’s still a lot of education needed for people that are afraid that sharing their records could harm them. While there is that risk, it’s important to remember that not sharing your records could harm you too.


Is this the right balance or resonsibility? Should vendors, leaders, and clinicians all be responsible? Is the reason EMRs aren’t usable is that it takes all 3 of these groups working together to make it usable?


I’ll just leave this one here without comment. Lots to chew on in this image!

EHR-Based Order Prioritization Could Streamline MRI Use

Posted on December 5, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

New research suggests that the overuse of STAT requests for MRIs could be trimmed down considerably if criteria for using such requests were integrated into healthcare organizations’ EHRs. The study also suggests, indirectly at least, that adding timing requests for various procedures into EHRs could help with overall workflow in many facilities.

Researchers from Emory University School of Medicine in Atlanta, who presented their findings at the RSNA 2017 show last month, found that the volume of STAT brain MRIs had increased to the point where 60% of all MRI orders were ordered as STAT between 2012 and 2015.

The increasing use of the STAT designation has ended up creating a bottleneck, researchers concluded. They found that the volume of STAT requests for brain MRIs was so high that it actually led to delays in turnarounds for those studies. In fact, they found that the mean turnaround time for STAT brain MRIs was roughly 50% longer than routine brain MRIs (23.43 hours versus 15.46 hours).

Among the sources of this problem, it seems, is that few clinicians were aware of the hospital’s policy for STAT MRIs. In an online survey of 97 providers, only 4% were aware that a STAT imaging study should be initiated within 30 minutes of the order. Instead, many expected that a stat MRI would be completed within the same day for inpatients within 2 to 3 days for outpatients, according to a story appearing in Radiology Business.

To address this problem, the researchers are proposing that hospitals add order prioritization criteria to their EHR.  These criteria will include definitions and clinical examples to help clinicians sort out which category to use when ordering a brain MRI.

This approach would also help clinicians better understand how the institution defines normal versus STAT priority for imaging orders. The researchers are recommending that hospitals include EMR documentation defining both STAT and routine categories, as well as a statement of when they can expect imaging to be completed under each category.

Adding categories and definitions of when imaging orders should be categorized as STAT would actually appeal to clinicians, the study suggests. Researchers found that more than 70% of clinicians said they would find clinical examples of an order prioritization scheme useful. What’s more, 84% of clinicians responding to the study said they would order routine MRIs if they were assured the studies would be completed within 24 hours.

The authors admitted that integrating order prioritization schemes for imaging could be time-consuming for IT departments, which suggests that finding other ways to set these priorities over the short term is probably a good idea. But given how supportive clinicians seem to be the idea of improving order turnaround, it seems likely that the EHR integration work should get done before too long.

Are Improved EMR UI Designs On The Way? I Doubt It

Posted on December 4, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

More or less since EMRs were first deployed, providers have been complaining about the poor quality of the interface they’ve had to use.  Quite reasonably, clinicians complained that these interfaces weren’t intuitive, required countless extra keystrokes and forced their work processes into new and uncomfortable patterns.

Despite many years of back and forth, EMR vendors don’t seem to be doing much better. But if a new story appearing in Modern Healthcare is to be believed, vendors are at least trying harder. (Better late than never, I suppose.)

For example, the story notes, designers at Allscripts create a storyboard to test new user interface designs on providers before they actually develop the coded UI. They use the storyboard to figure out where features should sit on a given screen.

According to the magazine, designers at several other EMR vendors have begun going through similar processes. “They are consulting with and observing users inside and outside of their natural work environments to build EHRs for efficient – and pleasant – workflows, layouts and functionality,” the magazine reports.

Reporter Rachel Arndt says that major EHR vendors now rely on a mix of approaches such as formal user testing and collection of informal feedback from end-users to meet their products more usable for clinicians. In some cases, this has evolved into official UI design partnerships between EHR vendors and customers, the story says.

Okay. I get it. We’re supposed to believe that vendors have finally gotten their heads together and are working to make end-users of their products happier and more productive. But given the negative feedback I still get from clinicians, I find myself feeling rather skeptical that the EHR vendors have suddenly gotten religion where UI design is concerned.

For what it’s worth, I have no doubt that Ms. Arndt reported accurately what the vendors were telling her. If any of us would ask vendors they are partnering with customers – especially end-users – to make their products more intuitive to work with, they will swear on a stack of user manuals that they’re improving usability every day.

Until I hear otherwise, though, I’m not going to assume that conditions have changed much out there where EHR usability is concerned. Today, all the feedback I get suggests that EHRs are still being designed to meet the needs of senior management within provider organizations, not the doctors and nurses that have to use them every day.

Of course, I hope I’m wrong, and that the story is accurate in ways that offer some hope to clinicians. But for now, color me very doubtful that EMR vendors are making any earth-shattering UI improvements at present.

Will 2018 Be The Year Of The Health IT/Non-Health-IT Merger?

Posted on December 1, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Within the last several days, the news broke that Amazon Web Services would probably be doing some sort of far-reaching cloud deal with Cerner. Given that AWS is a nearly $20 billion cloud organization, and Cerner one of the largest health IT players in the game, a lot could happen here.

My guess, not that it’s any leap of imaginative genius, is that if the currently-rumored deal between the two partners works, Amazon will make a serious bid to buy out Cerner as a whole. Given the massive profits potentially at stake in health IT, the idea of such an acquisition seems credible to me, at least if Cerner’s stockholders approve. After all, isn’t Amazon the company that just did a multibillion-dollar buyout of Whole Foods to fuel its growing (but still relatively small-scale) efforts in food retailing?

Not only is this particular deal interesting, I think it may portend some major structural changes in the health IT business as a whole. Specifically, I think we’re reaching a point where there will be a lot of pressure on companies with adequate cash and compatible goals to target HIT organizations, particularly if they need to scale up quickly and don’t have much internal knowledge on the subject.

And there’s no question that as healthcare settles into being a digital business, a range of digital businesses outside of healthcare will see that as an opportunity to step into such an important market. After all, how could they not want to be part of any organization that’s competing effectively in an industry that consumes a double-digit portion of the US GDP?

Over this period, many small internal workgroups outside healthcare will be transformed into scouting units seeking the next big digital healthcare deal. At the same time, these divisions will start forming quiet alliances strategic to their business, not only with giants like Cerner and Epic but also well-positioned startups in hot areas such as, say, blockchain security or supply chain management. (How could an ERP vendor not wonder how a healthcare supply chain management company running over blockchain could enhance their business?)

Then, of course, there are the more obvious moves which will bring a new critical mass of health IT customers, knowledge and talent to companies with a giant market presence already, such as Apple and Samsung.

Such M&A efforts won’t be optional. As Microsoft’s experience has proven in the past, and Amazon has apparently found more recently, you can’t just storm into the enterprise healthcare world and demand your cut, no matter how big a player you are. Getting there will take a well-finessed, mutually-fruitful agreement, if not an acquisition, even for a mega-company like Google/Alphabet.

Now, can I tell you which companies will be executing on such deals next year? I have a few theories, but no specific intelligence to share that you couldn’t pick up on your own by skimming industry headlines. But I do stand by my prediction that by the end of 2018, we’ll have seen a few spectacular deals between HIT vendors and digital companies outside the industry that will have a major influence for years to come.

Google, Stanford Pilot “Digital Scribe” As Human Alternative

Posted on November 29, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Without a doubt, doctors benefit from the face-to-face contact with patients restored to them by scribe use; also, patients seem to like that they can talk freely without waiting for doctors to catch up with their typing. Unfortunately, though, putting scribes in place to gather EMR information can be pricey.

But what if human scribes could be replaced by digital versions, ones which interpreted the content of office visits using speech recognition and machine learning tools which automatically entered that data into an EHR system? Could this be done effectively, safely and affordably? (Side Note: John proposed something similar happening with what he called the Video EHR back in 2006.)

We don’t know the answer yet, but we may find out soon. Working with Google, a Stanford University doctor is piloting the use of digital scribes at the family medicine clinic where he works. Dr. Steven Lin is conducting a 9-month long study of the concept at the clinic, which will include all nine doctors currently working there.

Patients can choose whether to participate or not. If they do opt in, researchers plan to protect their privacy by removing their protected health information from any data used in the study.

To capture the visit information, doctors will wear a microphone and record the session. Once the session is recorded, team members plan to use machine learning algorithms to detect patterns in the recordings that can be used to complete progress notes automatically.

As one might imagine, the purpose of the pilot is to see what challenges doctors face in using digital scribes. Not surprisingly, Dr. Lin (and doubtless, Google as well), hope to develop a digital scribe tool that can be used widely if the test goes well.

While the information Stanford is sharing on the pilot is intriguing in and of itself, there are a few questions I’d hope to see project leaders answer in the future:

  • Will the use of digital scribes save money over the cost of human scribes? How much?
  • How much human technical involvement will be necessary to make this work? If the answer is “a lot” can this approach scale up to widespread use?
  • How will providers do quality control? After all, even the best voice recognition software isn’t perfect. Unless there’s some form of human content oversight, mis-translated words could end up in patient records indefinitely – and that could lead to major problems.

Don’t get me wrong: I think this is a super idea, and if this approach works it could conceivably change EHR information gathering for the better. I just think it’s important that we consider some of the tradeoffs that we’ll inevitably face if it takes off after the pilot has come and gone.

In The Hot Seat Again: eClinicalWorks Faces Billion-Dollar Suit Over Alleged Software Problems

Posted on November 27, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Earlier this year, eClinicalWorks agreed to pay $155 million to the U.S. Department of Justice to resolve allegations that it had faked its conformance with Meaningful Use criteria. The DoJ suit alleged that by withholding information needed for certification, eCW violated the False Claims Act.

Now, the vendor is facing what could be an even more serious legal threat, according to a news report appearing in Becker’s Hospital Review. BHR is reporting administrator of the estate of a deceased cancer patient is suing the vendor over data display errors that may have affected the patient’s care.

What makes the stakes so high in this case is that the complaint is asking the court to certify the case as class action, with members to include “all persons residing in the United States whose physicians used eCW to record and store their medical records at all dates relevant.” The suit is asking the court to award plaintiffs $999 million in damages, Becker’s Hospital Review reports.

According to the complaint, which was filed by Kristina Tot, administrator of the estate of the deceased Stjepan Tot, errors with eCW software began to appear before the cancer patient’s death. For example, “he was unable to display his medical history or progress notes,” the complaint reportedly states.

The cancer patient’s problems were far from unique, however, the suit asserts. According to the complaint, important eCW software functions didn’t work or violated regulatory guidelines. The filing claims the vendor didn’t provide accurate and reliable health information, displayed incorrect panels and didn’t record EHR user actions in audit logs.

The bottom line, the suit claims, is that millions of patient records were compromised, leaving patients and physicians unable to rely on the eCW platform.

I am not qualified to speak on whether there’s any merit to the latest suit against eCW, though I think it’s reasonable to assume that the company may not have its act together. (You might also want to check out the angry eCW critiques on this site — whose publisher, like our fearless leader John Lynn, I know to have an impeccable reputation for honesty.)

Ultimately, it’s hard to say whether this latest suit is largely blowback from the previous certification problem or yet another (extremely) costly headache. Either way, if I were part of its leadership team I’d be more than a little shaken by recent events even if the recent complaint gets dismissed.

EMR Twitter Roundup

Posted on November 21, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Always fun to do some searches on Twitter and find some interesting content. In this roundup, we cover a lot of ground starting with a lawsuit that could be the first crack in breaking the damn wide open.


This picture is hilarious for this story. That part aside, I’ll be personally surprised if this case is successful. However, you can be sure that every EHR vendor out there is watching this case careful. It would be a big deal if eCW does lose.


This is a huge problem. However, it’s not a problem with the EHR. In fact, the EHR could be the solution to the problem as it creates a usable clinical display while still satisfying the billing requirements. Even better would be for us to streamline our billing requirements so that EHR vendors didn’t have to produce these thousands of pages of documentation in order to bill and get paid by insurance companies.


We all know about this challenge. In fact, I’ve heard this used as the rationale for why some people used the term EMR instead of EHR. However, more disturbing is that Matthew doesn’t know that you can remove EHR from the autocorrect table in Word and not have that problem. Kind of reminds me of a lot of EHR complaints. EHR users complain about things that have solutions if they just knew how to use the EHR properly.

Patients Showing Positive Interest In NY-Based HIE

Posted on November 16, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A few months ago, I shared the story of HEALTHeLINK, an HIE serving Western New York. At the time, HEALTHeLINK was announcing that it had managed to obtain 1 million patient consents to share PHI. The HIE network includes 4,600 physicians, in addition to hospitals, health plans and other providers.

This month, HEALTHeLINK has followed up with another announcement suggesting that it’s making significant progress in getting patients and physicians connected and perhaps more importantly, interested in what it can do for them. In particular, the study suggested that consumers were far more aware of the HIE’s existence, function and benefits than one might’ve assumed.

The study found that 90% of respondents said they knew their doctors use EHRs, a percentage which differed but remained high across all demographic groups study. Respondents also knew that their doctor could send and receive medical information back and forth with other healthcare providers involved in their care using EHRs.

Not only that, 51% of respondents felt that the use of EHRs by doctors and hospitals made healthcare “more safe,” though 24% said EHRs made no impact on their care and 18% said EHRs made care “less safe.” Fifty-eight percent of respondents said that electronic access is good for healthcare, and 24% answered “strongly yes” when asked whether electronic access was beneficial.

When asked whether electronic access is good for healthcare, 24% of respondents said “strongly yes” and 58% said “yes.” Things looked even more positive for the future of the HIE when patients were specifically aware of HEALTHeLINK, with 57% of this group of patients rating care as “more safe.”

Those who rated care as “more safe” using HEALTHeLINK also included respondents with a two-year degree, those who visited Dr. more than 15 times a year and those who fell into 35 to 44-year-old age bracket.(However, it is worth noting that 41% to respondents said they weren’t aware of the name HEALTHeLINK.)

The only significant downside mentioned by HEALTHeLINK users was a lack of face time, with 37% reporting that their doctor or healthcare professional was spending too much time on a laptop or computer, and another 11% saying that this was a significant problem. (Another 60% had no issue with this aspect of the electronic medical records use process.)

Despite those reservations, when asked if they were willing to cut their doctor to use the HIE to give the other providers instant access to medical records, 57 percent said “yes” and 24% said their answer was “strongly yes.”

Lest this begin to sound like a press release for HEALTHeLINK, let me stop you right there. I am in no way suggesting that these folks are doing a better overall job of running its business than those in other parts of the country. However, I do think it’s worth noting that HEALTHeLINK’s management is building awareness of its benefits more effectively than many others.

As obvious as the benefits of health information sharing may seem to folks like us, it never hurts to remind end users that they’re getting something good out of it — and if they’re not, to find out quickly and address the problem.

Twitter Highlights from AMIA17

Posted on November 15, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Last week I had the privilege of attending the 2017 American Medical Informatics Association (AMIA17) annual conference in Washington DC. I thoroughly enjoyed the experience and came away with new appreciation for the work informaticists do. Check out this blog for key AMIA17 takeaways.

One of the most enjoyable aspects of AMIA17 was the quantity and quality of the live-tweeting. My twitter feed hadn’t been that active at a healthcare conference since HIMSS17. There were no less than 20 attendees actively tweeting throughout the conference.

Below is a selection of memorable AMIA17 tweets.

I wasn’t familiar with Carol Friedman’s work, but her lovely tribute video was riveting – almost Hidden Figures-esque. Friedman not only had to overcome being a female data scientist, she was one of the few in her field to believe Natural Language Processing could be applied to healthcare. Her acceptance speech was filled with humor and funny stories.

One of the major announcements at AMIA17 was the creation of a new open access journal – called JAMIA Open. This new publication will be AMIA’s attempt to break down one of the biggest barriers to innovation – a lack of access to research papers. It will be interesting to track the progress of JAMIA Open in the months and years to come.

A very interesting concept discussed at AMIA17 was the use of EHR audit logs as way to identify areas for improvement. This included finding opportunities where retraining might be needed and where bottlenecks exist in clinical workflows. Suddenly it’s not so bad that EHRs record every action…or maybe it is if you are a bottleneck.

Genomics is very exciting. Carolyn Petersen, an Editor at Mayo Clinic, tweeted one out an interesting use case during AMIA17 – using genomic info to prevent adverse drug reactions. Amazing.

This was an extremely interesting question posed by Dr. Danny Sands. In the OpenNotes session he attended the presenters found that physicians were more honest in their documentation notes than they were with the patients they were seeing face-to-face. This makes for an intriguing scenario when patients gain access to those notes after a visit.

One of the more prolific live-tweeters at AMIA17 was Dr Wayne Liang. I enjoyed reading his tweets from sessions that I was unable to attend. This tweet stood out for me. He expertly summarized the 5 ways HealthIT systems could be improved to allow for better data analytics.

Another active live-tweeter was Pritika Dasgupta, PhD student at University of Pittsburgh Department of Biomedical Informatics. This tweet nicely summed up how sensitive the issue of decision support tools has become. Patients and clinicians both want the latest and greatest tools that will lead to the best outcomes. From that perspective, evidenced-based decision support tools can be very effective. However, medicine is more than simply a set of if/and/or statements. It is truly a craft and there is a concern that we lose something when we try to reduce patients to a set of input parameters.

It is always a special treat to listen to a Ross D Martin live performance. At AMIA17 he performed his latest creation – a theme song for #digituRN, an initiative to transform nursing through digital innovation. You can listen to the song on YouTube.

Shout out to Pritika Dasgupta, Dr Wayne Liang, Carolyn Petersen, Rebecca Goodwin, Dr Paul Fu Jr, Dr Arlene Chung, Jenn Novesky, Scott McGrath, Dr Danny Sands, Ross Martin, Alex Fair and Michael Rothman. It was fun to live-tweet with you at AMIA17.