Electronic health records and clinician burnout: A story of three eras.

OBJECTIVE: The study sought to provide physicians, informaticians, and institutional policymakers with an introductory tutorial about the history of medical documentation, sources of clinician burnout, and opportunities to improve electronic health records (EHRs). We now have unprecedented opportunities in health care, with the promise of new cures, improved equity, greater sensitivity to social and behavioral determinants of health, and data-driven precision medicine all on the horizon. EHRs have succeeded in making many aspects of care safer and more reliable. Unfortunately, current limitations in EHR usability and problems with clinician burnout distract from these successes. A complex interplay of technology, policy, and healthcare delivery has contributed to our current frustrations with EHRs. Fortunately, there are opportunities to improve the EHR and health system. A stronger emphasis on improving the clinician's experience through close collaboration by informaticians, clinicians, and vendors can combine with specific policy changes to address the causes of burnout. TARGET AUDIENCE: This tutorial is intended for clinicians, informaticians, policymakers, and regulators, who are essential participants in discussions focused on improving clinician burnout. Learners in biomedicine, regardless of clinical discipline, also may benefit from this primer and review. SCOPE: We include (1) an overview of medical documentation from a historical perspective; (2) a summary of the forces converging over the past 20 years to develop and disseminate the modern EHR; and (3) future opportunities to improve EHR structure, function, user base, and time required to collect and extract information.

[Fifty years of services of biomedical information in health documentation centers in Puebla, Mexico]. / Cincuenta años de los servicios de información biomédica en centros de documentación en salud de Puebla.

Librarian and information services focused on supporting research, teaching, and health care are vital for the generation of new knowledge and its application in health care, both by staff and students, helps to improve the quality of medical care. Therefore, in this article we expose an historical and social tour of 50 years of the Instituto Mexicano del Seguro Social's library services in Puebla. From 1964 to 2014 occurred many events in the development of these services in our area, from the creation of a small space in the basement, to the implementation of spaces created deliberately to provide dignified service to all users, which is why this historical sketch is here as an acknowledgement to the first librarians who contributed to the training of specialists in Mexico.

Los servicios bibliotecarios y de información enfocados a apoyar la investigación, la docencia y la atención médica son de vital importancia para la generación de nuevos conocimientos y su aplicación en la atención médica por el personal del área de la salud, y los alumnos en proceso de formación, contribuye a mejorar la calidad de la atención médica. Por ello, en el presente artículo exponemos un recorrido histórico y social de 50 años de los servicios bibliotecarios del Instituto Mexicano del Seguro Social en Puebla. De 1964 a 2014 ocurrieron muchos sucesos en el desarrollo de estos servicios en nuestro medio, desde la creación de un espacio pequeño ubicado en el sótano, hasta un espacio establecido ex profeso para otorgar servicio digno a todos los usuarios, por lo que se muestra este bosquejo histórico como reconocimiento a aquellos primeros bibliotecarios que contribuyeron a la formación de especialistas en México.

Interpreting seventeenth-century probate documents: John Carter, master carpenter in St Albans.

This is a study of a successful seventeenth-century carpenter in St Albans, John Carter, using probate and other documents, assisted by a large-scale computer database of St Albans residents of the period. Sections of the article cover his family, his work and his house and its contents, which have been reconstructed from his probate inventory and from knowledge of the structure of other local houses of the period. Carter's social standing is discussed, both in its local context and in relation to previous probate inventory analyses. This micro-study sheds unusual light upon aspects of the life of a 'middling sort' of person, living in a thriving market town in close proximity to London, at the beginning of the consumer age.

The form, the permit and the photograph: an archive of mobility between South Africa and India.

Inspired by recent scholarship that calls for a more critical engagement with archives and knowledge production, this article plots the biography of an archive in Cape Town. Unravelling the layers of paperwork, it locates the origins of the archive in a repressive state project of excluding Indian immigrants and controlling those within the borders of the Cape Colony. The paper trail reveals documents of identity and the state's attempts to verify identity. In seeking to answer the question as to how the historian should approach such an archive of control and surveillance, it concludes that a social history and gendered approach to migration is possible and the real treasures are those documents that enter the archive beyond the limits of state intentions.

[Obligatory documentation for narcotic drugs over the course of time : the morphine and cocaine book for physicians according to the 1930 parliamentary law gazette]. / Dokumentationspflicht für Betäubungsmittel im Wandel der Zeit : Das Morphin- und Kokainbuch für Arzte nach dem Reichsgesetzblatt 1930.

According to the opium law and prescription statute of 1930, physicians were duty-bound to maintain a stock ledger to allow a traceable record of the location of narcotic drugs. If a simplification of the prescription of opiates was welcomed 10 years ago then 2 years after amendment of the addictive drugs statute thought should be give to safe use, as can be concluded from a morphine logbook from the time of the introduction of the Federal opium law. "Receipt and issue... deliverer and recipient" must be able to be extracted from the documentation, which means the delivery and the dispensing but not the individual application.

One minute after the detonation of the atomic bomb: the erased effects of residual radiation.

The U.S. Government's official narrative denies the effects of residual radiation which appeared one minute after the atomic bomb detonations in Hiroshima and Nagasaki. This paper explores declassified documents from the U.S. Atomic Energy Commission, the Atomic Bomb Casualties Commission, and others and shows that these documents actually suggested the existence of serious effects from residual radiation.

The St. Lawrence Island famine and epidemic, 1878­80: a Yupik narrative in cultural and historical context.

A collaborative study of the Smithsonian Institution's ethnology collections has inspired the narration of Alaska Native oral traditions, including Yupik Elder Estelle Oozevaseuk's re-telling (in 2001) of the story of Kukulek village and the St. Lawrence Island famine and epidemic of 1878­80. The loss of at least 1,000 lives and all but two of the island's villages was a devastating event that is well documented in historical sources and archaeology, as well as multiple Yupik accounts. Yupiget have transmitted memories of extreme weather, bad hunting conditions, and a wave of fatal contagion that swept the island. The Kukulek narrative, with origins traceable to the late nineteenth century, provides a spiritual perspective on the disaster's underlying cause, found in the Kukulek people's disrespect toward the animal beings that sustained them. This paper explores the cultural and historical contexts of this narrative, and contrasts it with Western perspectives.

Impact of DRGs on the medical profession.

OBJECTIVE: To present an overview of the history of diagnosis-related group (DRG) reimbursement and its impact on physicians and hospitals. DATA SOURCES: Recent research articles on reimbursement and medical ethics. STUDY SELECTION: Not applicable. DATA EXTRACTION: Performed by the author. DATA SYNTHESIS: The DRG system is part of a system developed at Yale University to provide hospitals with incentives to control costs. Hospital Medicare inpatients are classified into groups that are clinically coherent and homogenous with respect to resource use. The classification is also dependent on principal and secondary diagnoses and procedures, age, gender, and discharge status of the patient. Reimbursement is determined by the classification. Hospitals can create excess revenues by treating the patient more efficiently and economically, or they can absorb monetary losses by doing otherwise. It is argued that hospitals will become more frugal and that physicians will adjust their methods of practice as well. Hospitals that fail to adapt will close, reducing overall Medicare expenditures and deterring inefficiency by example. CONCLUSION: DRGs provided a way to prevent the collapse of the Medicare program but have also required stricter criteria for hospital admissions. DRGs remain in evolution and under evaluation for expansion into other health care settings.