A Second Sprint Team to reduce EHR-related burnout! UCHealth – Colorado

https://www.hcinnovationgroup.com/clinical-it/electronic-health-record-electronic-medical-record-ehr-emr/article/21105576/uchealths-wellness-effort-includes-ehr-optimization-sprints

We are so excited to welcome another 11 person team to our Sprint Optimization family!

Our success in re-designing the physician-clinical team-EHR interaction has led to substantial reductions in time spent in the EHR: 16 minutes PER PHYSICIAN PER DAY, and in our sample of one academic medical practice comprising 26 providers (advanced practice providers as well as physicians) this “average physician” is 0.4 FTE. Sixteen minutes is already no laughing matter, but it is possible to imagine that a physician spending 100% of their time in outpatient practice might conceivably save more than 30 minutes per day as a result of a 2-week Sprint.

As you may recall, we assembled an 11 person Sprint team, 1 physician informatics leader, 1 clinical informaticist (RN), 1 project manager, 5 trainers, 3 EHR analysts (who can build and alter items in the EHR). This team arrives on site, in a clinic (of up to 30 physicians and their clinical staff) and spends 2 weeks listening, watching, building tools, and most importantly, coaching EHR use and TEAMWORK and COMMUNICATION strategies to improve care of patients as well as reducing wasted effort.

This has been noticed by our organization (UCHealth) and we are now 22 strong, 2 teams conducting sprints every 2 weeks (with 1 week of recuperation), and 15 sprints per year.

CMIO’s take? It is gratifying when the snowball effect works in your favor. We are striving to shorten the cycle-time between repeated Sprints in clinics. This is a big step in that direction.

“What Matters to You?” instead of “What’s the Matter with You?” -guest post, Heather Coats, PhD, APRN-BC

Is the integration of an individual’s narrative into the Electronic Health Record FEASIBLE to Improve Person-Centered Care? (CT Lin: I’m excited to welcome Guest Blogger: Heather Coats PhD)

Person-Centered Care, a buzz word to refocus our Western (US) healthcare system on the user of the system, the person who has a health need.  We as clinicians, use the word “patient” but they are a human, just like us the clinician. We all have past, present and future stories that make up “who we are” However, this whole self sometimes is seen as parts in our western medicine culture…the cancer patient in room 202, instead of Jon, the person…who is a grandpa, a dad, and businessman whose illness is impacting his ability to be all of these things.

In recent years, the shift in Western Medicine to incorporate the person’s experience has been moving upstream. The IHI (Institute for Health Improvement) “Person- and Family-Centered Care” domain–Putting the patient and the family at the heart of every decision and empowering them to be genuine partners in their care, goal is to develop “partnerships between clinicians and individuals where the values, needs, and preferences of the individual are honored; the best evidence is applied; and the shared goal is optimal functional health and quality of life”  http://www.ihi.org/Topics/PFCC/Pages/default.aspx

Since 2015, the IHI helped share the practice of asking the individual receiving health care:  a simple question…“What matters to you?” in addition to “What’s the matter?” This reframing of the clinician-person interaction orients the care being provided more to the whole person, to give a much different light to a plan of care that opens the door for opportunities to involve the person’s whole self. http://www.ihi.org/about/Documents/IHI_Timeline_2018.pdf.

Now, I do not want to diminish the physiological as an important component in the delivery of care. As clinicians, our expertise (life experiences, training) are grounded in knowledge of the physiological, but I would dare to ask, we are not the experts in the whole person who is sitting across from us. Second, when a person is facing an illness…cure of the illness may not be a reality, but healing of the self is still possible.

A recent NPR Morning Edition aired on their Morning Edition program (June 8, 2019): “Storytelling Helps Hospital Staff Discover the person within the Patient aired on June 8, 2019 on Morning Edition on National Public Radio.

https://www.npr.org/sections/health-shots/2019/06/08/729351842/storytelling-helps-hospital-staff-discover-the-person-within-the-patient

Person-centered narratives are one proposed way to have dedicated tools to shift to more person-centered care.  

An exemplar of this narrative shift, is the MyLife/MyStory program at the William S. Middleton Memorial Veterans Hospital in Madison, WI. https://www.youtube.com/watch?v=_Wy1aMXQCTk. This program has included over 2,000 person centered co-created narratives into the electronic health record since 2013. Their program has trained an additional 50 sites to implement programs similar to theirs. 

This is where my “story” comes in,  I had the pleasure to attend MyLife/MyStory  training back in 2015, which allowed me to think about this type of program could be implemented outside the VA, and have a program of research that tested person centered narratives interventions to improve communication between clinician and persons receiving healthcare. My NIH/NINR funded research focuses on the implementation of a person centered narrative intervention that co-creates a first person narrative that is approved by the person, then uploaded into the person’s electronic health record for their healthcare team to learn more about “What matters to them?”  The first phase of the program did prove to be feasible and acceptable by the individual- the person hospitalized for serious illness, their family, and their clinicians. Through this work, perhaps, there is just one more way to help shift Western healthcare to “truly” be person and family centered.

Heather Coats, PhD, APRN-BC
Assistant Professor of Research
Office of Research and Scholarship
University of Colorado, College of Nursing
Nurse Practitioner, University of Colorado Hospital Palliative Care Consult Service (PCCS), Department of Medicine, Division of General Internal Medicine, University of Colorado, School of Medicine

Giving Advice? How to do it right (NYTimes)

I love this: giving advice is often not giving advice.

This Zen statement is not about Zen.

Our physician informatics credo emphasizes relationships .

“We improve physician and team wellness and effectiveness by building extraordinary relationships and innovative tools.”

Extraordinary Relationships come from excellent communication.

Excellent communication comes from listening well.

Listening well comes from a position of empathic understanding.

Empathy is what we all crave. We should all learn the skills to exhibit empathy to others; this is the only way we might receive some in return. This article is a start.

UCHealth: ‘Most Wired’ level 10!

Uncomfortable-looking author

We are incredibly honored and humbled to be awarded Most Wired level 10 by CHIME: the College of Healthcare Information Management Executives.

We were one of the three organizations, out of thousands applying, to be awarded level 10, indicating the highest achievement in superior performance and process for information technology used to improve clinical care. This is the first year that CHIME separated out the awardees into levels 7, 8, 9, and 10.

See my last blog post for some of the details of our presentation at CHIME and some of the projects contributing to our success.

It was humbling to stand by the CIOs from Cedar Sinai and Avera Health to receive the honor. Link to article from CHIME below.

CHIME Posts 2019 Most Wired’s Awards and Recognition List

What I said in my acceptance comments, and I stand by them:

At UCHealth, Clinical and IT excellence arises from Partnerships:
1. Partnership between the CIO and CMIO and our teams. We make each other better than we could be alone.
2. Partnerships between UCHealth and our vendor partners: we know that there are more smart people who DON’T work for us, than who do.
3. Partnerships between UCHealth and the CHIME community. Healthcare CIO’s are a brilliant lot. We know we stand on the shoulders of giants.
Lastly, we want to pay it forward. More than 3 health systems deserve to be level 10. ALL patients deserve to be treated by a health system performing at its best and we want to see MANY MORE health systems on stage next year.

The End of Secrecy? (a preview of a talk at CHIME19)

I’m at CHIME19 this week: the College of Health Information Management Executives, Fall Forum. Eight hundred Healthcare CIO’s and a growing number of CMIO’s are members. My CIO, Steve Hess and I are giving a talk called “Is this the End of Secrecy in Healthcare?” where we outline our (sometimes) rocky journey toward ever-increasing transparency for our patients.

We know that an informed patient is much more likely to be an engaged patient, and engaged patients have better health outcomes. So, how do we increase the information available to patients? We have to overcome inertia, fear, and sometimes, epithets.

We were interviewed by Kate Gamble of Health System CIO to preview the contents of our talk, see below.

https://healthsystemcio.com/2019/11/01/how-uchealth-is-leveraging-transparency-to-create-a-better-user-experience/

Sometimes we have to look outside of healthcare for our inspiration:

  • OpenTable
  • Travelocity
  • Wikipedia
  • Instagram
  • Yelp
  • 23andMe

Confused? Excited? Freaked out? So were we.

CMIO’s take? Is this the End of Secrecy? Yes. Yes it is.

NYTimes Magazine travelogue photos (Shinrin-yoku, and take a breath)

from NYTimes

Is this goofing off, or is this about personal resilience? Like the idea of “forest bathing” (youtube) or shinrin-yoku, I seek out opportunities during the day to pause and reflect, and walk where there are trees. Sometimes this ends up being an online article with lots of nature photos 😦 .

Hey, you do what you can.

The photos from this travelogue are pretty amazing.

And, did any of you watch the movie “Crazy Rich Asians”? The skyscraper-top boat-like structure in Singapore is apparently an Infinity Pool and is REAL (see the background in the photo at the top). Gotta put this on my bucket list.

CMIO’s take? Harken back to the tripartite model of physician burnout and resilience: a) develop a culture of wellness, b) work on improving practice efficiency and c) work on personal resilience. And ‘forest bathing’ belongs firmly on this list. Take a moment.