Physician, Reengineer Thyself

Dr. James J. Cimino had a problem. To find out if his patient's confusion was a sign of neurological disease, Cimino needed to test the man's spinal fluid. But scheduling a visit to Columbia Presbyterian Hospital's busy neurology unit was difficult. So he made a note in his computer: Order a spinal tap the next time the patient's chronic heart condition brought him to the New York City hospital's emergency room. Two weeks later, the patient was there. And yes, having read Cimino's note--which was stored with the patient's records in the hospital's computer system--doctors did the spinal tap.

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