For patients, navigating the medical system is a struggle — even when they are relatively well. It’s worse when they’re sick, such as patients with complex medical problems requiring urgent attention, like work-ups for cancer. Simply trying to coordinate appointments between specialists can be incredibly frustrating and time-consuming. And because specialists often work in individual silos, they don’t communicate with one another, leaving hapless patients and their families to shuffle themselves and their reams of information from one specialist to the next.

A recent survey commissioned by ZocDoc, which is trying to apply an OpenTable-style online scheduling model to health care, found that young adults are especially frustrated with the current health-care infrastructure. More than half of 2,000 18-to-34-year-olds surveyed said they delayed getting medical care because the process is a “pain.” More than 60% of these tech-savvy Gen Yers — who are accustomed to scheduling their lives with the touch of a screen — said they felt they were at the mercy of their doctor’s receptionist just to make an appointment.

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Kyle Gospodarek expected to feel nervous about seeing a dead body up close on his first day of anatomy lab. He steeled himself for the smell — a pungent blend of latex, embalming fluid and something indescribable whose odor would cling to his clothes for days — but he never imagined he would have to get in touch with the cadaver’s family. "I’ll be honest: when I first heard about what we were doing, I was weirded out," he says. "I didn’t know what to say to them."

At Indiana University Northwest, an IU branch campus located in Gary, Ind., anatomy professor Ernest Talarico instructs his medical students to probe beyond the nerves and muscles of the bodies lying on their examination tables and think of the cadavers as their "first patients." "We ask students to use the name of the patient out of respect and to acknowledge that this was a person," he says. His students also typically exchange letters with family members to glean more information about their patients’ medical histories, hobbies and interests. They may even meet the family in person at the conclusion of the course during a memorial service held in the laboratory.

The annals of medical school training are filled with sordid tales of students taking glam shots with corpses or assigning unflattering nicknames to cadavers. When Talarico was in medical school, he remembers his classmates calling one cadaver "Salty" because of the tattoo of the naked woman on his chest. "These people had lives and names," he says, "and to use other names disrespects them."

Talarico believes his approach not only helps students be more respectful of the individuals who have given their bodies to science but also prepares them to act as empathetic clinicians when they’re faced with the cold, hard medical decisions they’ll have to make in their careers. He has no formal data to prove his approach gets better results, but anecdotally, the students say they feel better prepared to address patients as individuals and consider their feelings. As one student, Adam Harker, explains: "I think it translates into better post-op care and compliance."

While Talarico has won praise from many of the individuals involved in the program, he’s also raised concerns among critics who question the ethics of his teaching technique. When donated bodies are passed on to medical schools, the institutions are usually only given the basics — the donor’s name, gender, age and immediate cause of death. The name of the donor is typically not shared with students, and students do not usually interact with the donor’s next of kin.

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Studies have shown in recent years that the quality of data in many electronic medical records is often not very good. According to Peter Witonsky, president and chief sales officer at iSirona, this is largely due to simple inaccuracies that occur more often than we think.

"A lot of these fall into the same category, in my mind, but it's different ways of getting to that category," said said Witonsky. "That latency of data is terrible. We have customers, prior to us, with eight to 10 hours in latency of data, and that's not uncommon. It's not the end of the world, but there are tons and tons of examples of what latency of data will do to decision making on the other side."

Witonsky highlights five reasons why data inaccuracies occur in EMRs.

1.Simple miskeying. Although it may be easy and "quite common," said Witonsky, the main way data inaccuracies tend to occur is because of simple miskeying. "If you look at any nurse of any floor, there's about 1,000 or over 1,000 data elements a shift that person is responsible for," he said. "So if you're an ICU nurse, and you're taking vitals and other critical information every 15 minutes, or if you're a low acuity nurse and you have for patients to be responsible for, it seems to average out just north of 1,000 data elements." And to expect a nurse to key in those elements with 100 percent accuracy isn't a realistic goal, Witonsky said. "The idea any person [can do that] is ludicrous," he said. 

2.Miscommunication from the patient. Bad information or miscommunication from the patient is another all-too-common way these inaccuracies can occur, said Witonsky. And this can include the patient not telling which drugs they're on, not knowing the name of the drug or the dosage or even the patient lying about his or her weight. "So it's sort of a garbage in, garbage out theory," said Witonsky. "If you don't tell me that you're allergic [to a drug] and I give you Penicillin and it's a bad result, again, that's bad data in the EMR." It's for that reason, he pointed out, that most of today's EMRs have allergies highlighted at the top of every patient screen.

3.Wrong entry or lack of entering device data. Looking back to simple miskeying, said Witonsky, 1,000 data elements, over time, is "an awful lot of work," he said. "So you have something called smoothing, [which is] a long practice of smoothing data where a nurse of physician is expecting to see normal [results], and they put in normal regardless of what the device is telling you." These generic readings tend to bring out inconsistencies in data, he continued, which wouldn't occur if the person inputting data took the actual information from the device. "That's not intended to be a knock," he said. "That's intended to say, in performing the hardest job on the planet, if they knew [a patient] was healthy, they leave all the vitals on the machine and may choose to put [the patient] in as a normal patient, as opposed to the exact answers."

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Memorial Hermann-Texas Medical Center in Houston plans to live tweet brain surgery today. Under the Twitter handle @houstonhospital, the hospital will provide a "rapid play-by-play" removal of a brain tumor for about four hours using the hashtag #MHbrain on Wednesday, May 9 from 7:30 a.m. to 11:30 a.m. CT.

The surgery will be led by Dr. Dong Kim, neurosurgeon and Director of the Mischer Neuroscience Institute in Houston. Dr. Kim was the neurosurgeon who oversaw Rep. Gabrielle Giffords' care at the hospital after she was shot in the head in January 2011.

Medical personnel will live tweet all the steps of the tumor removal procedure, including prep, removal of the bone flap, resection of the brain tumor and closing of the surgical site. In addition to tweets, users will see pictures and videos live via Dr. Kim's microscope video feed. The first incision is expected to start at 9:00 a.m. CT (10:00 a.m. ET).

"What will come out of this is a detailed, real-time sequence of what happens in a brain surgery through all the stages from preparation, to shaving the hair, to making the incision, to draping," Dr. Kim told Mashable. "People are very anxious and want to know what goes on in a brain surgery like this."

Dr. Scott Shepard, a brain tumor specialist at the hospital and Director of the Gamma Knife Radiosurgery program will respond to questions online from outside the operating room during the Twittercast.

Natalie Camarata, Memorial Hermann's digital marketing manager, told Mashable the hospital decided to live tweet brain surgery following a successful live tweeting of open-heart surgery several weeks earlier, which was viewed an estimated 125 million times through Twitter and other platforms.

According to Mashable, video clips from the surgery will be posted to YouTube, photos will be shared on Pinterest, and recaps of each hour of the surgery will be available on Storify.

To find out more, visit Memorial Hermann-Texas Medical Center.

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Amy Robbins, RN, BSN, started blogging in 2006 to document her experience as a travel nurse. "I grew up writing in a journal and decided to start keeping at least a portion of my journal in the form of a blog," Robbins said. "I had a ton of pictures from different nursing assignments on my computer and wanted to put them on the internet and give them some context."

Robbins, author of the blog "Travel Nurse Aim" (www.TravelNursingJob.BlogSpot.com), still writes about her adventures as a travel nurse, but makes sure to omit patient and hospital names to abide by HIPAA laws.

Nurses blog for many reasons, including to educate and connect with others and for business reasons, said Nurse.com’s Donna Cardillo, RN, MA, who blogs on her website www.Nurse-Power.com and is an expert blogger on www.DoctorOz.com.

Blogging is an important marketing and credibility tool for nurses who start businesses, offer services or hold political positions. It’s a communication tool to connect with others — whether they are nurses in general or in the same specialty, patients or others.

"For some nurses, it is strictly a pastime — a form of self-expression," Cardillo said.

Getting started
To launch a blog, nurses first have to find or build a template. An easy approach is to use ready-to-go blogging platforms or templates. A few popular sites offering those are Nurse.com (www.Nurse.com/Blogs), Blogger (by Google, at www.Blogger.com) and the blogging option at www.WordPress.com. All are free.

Nurses who want to own their blogging domain names, or Web address, instead of having a space on an established blogger site, can buy their blogging homes. Robbins, who owns www.TravelNurseAim.com, said she pays about $8 a year for her domain.

To set up a domain name, bloggers must visit a domain registry site, such as www.GoDaddy.com. After purchasing a domain, they will have to decide where to host it and download a blogging platform, which is software to manage the blog such as www.WordPress.org.

Once you have a blogging home, the next step is to start writing.

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Under more scrutiny from patients and insurers, some doctors are working to improve their patient-interaction skills.

Dr. Melissa Neisen takes a seat next to her radiology patient, Susan Jesso, and leans close. With expressive hands, Neisen calmly describes the diagnostic procedure she just completed to check Jesso's kidney dialysis capability.

"We'll get you feeling better," Neisen assures the Blaine resident. "Do you have any questions? Is there anything you want to ask me?" The doctor-patient exchange seems textbook in nature. But it's something that Neisen studiously works to perfect. "I want to be close, but not too close, to bond with the patient," she explains later. "I want to build a rapport in short order and use layman's terms. I want to leave room for questions."

Neisen's mentor on her beside manner is Susanne Egli, a professional actress by training and an executive coach by vocation at Talon Performance Group. The two met periodically two years ago to work on patient communication and, in turn, patient satisfaction. They did role-playing. Egli videotaped Neisen as she worked through hypothetical patient experiences. They studied voice tone and modulation, how to communicate bad news as well as good news.

Egli's work in the medical field comes at a time when patient satisfaction is in the spotlight of health care providers and plans. In a medical world where pay-for-performance is an increasing trend, it doesn't hurt to have an edge. Egli worked with about a dozen doctors last year to improve patient skills as well as leadership skills in packages ranging from three months of periodic interaction to a year at a cost of up to $5,900.

"Doctors are in practice to serve," said Egli. "They want to help a patient solve a problem. Trust and credibility is very important to them. I encourage them to touch the patient and pick up on the patient's personality. The patient will leave feeling they've been heard, that they've been taken care of."

Neisen agrees. "I wanted to be able to project my message more effectively," Neisen said. "I was a fast talker, and she told me to take my time and not rush. It was a game-changer for me. I'm proud that I did it."

The daughter of a retired doctor, Egli said that a decade ago doctors had more time to spend with their patients and naturally had a closer rapport with them. In her father's day, she said, it was not uncommon for the doctor to treat an adult whom the doctor had delivered as a baby. "These are not skills that you would necessarily learn in medical school," said Egli.

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