My code: “You cannot overestimate the unimportance of practically everything.” (NYTimes)

Wait, what?

www.nytimes.com/2021/04/17/opinion/letters/personal-philosophy.html

Happy weekend! I just saw this on the NYTimes.

Read this sentence a couple of times. Then read the 100-word “life philosophy” letters to the editor. This one, from David Pastore, Mountainside, N.J.  …  Wow. 

CMIO’s take: Do you have a life philosophy to share? Please comment below.

I can see clearly now, my Sprain is gone (ukulele)

Thanks to my collaborators on the Patient Radiology Image Viewing team at UCHealth: Evan Norris MD, Ciarra Halaska, Justin Honce MD, Peter Sachs MD, and Kate Sanfilippo. Come see our talk at Epic XGM 2021 (eXpert Group Meeting) next month! Session Rad 1.4

What’s the TL;DR? Allowing patients to view their radiology images in their patient portal, alongside their radiology reports, is technically feasible, and does NOT cause increased anxiety for patients or increased workload for providers (in fact, ZERO phone calls, and yet our patients view 39,000 images per month!). Eighty percent of patients liked it. Many showed their images to their providers, some saved copies, some posted on social media! Some had technical difficulties, some had trouble understanding the images.

It is a good start, but there is more work to be done!

Wanna know more? Here is our pre-print publication.

CMIO’s take? It is wonderful to work on teams with great colleagues in the service of better, more transparent patient care.

Your Colleagues Don’t Read Anything You Write (NYT)

TL;DR: Improve your email writing skills so that colleagues will read your stuff!

OK, this is distressing. Just like the statistic that 1/3 of prescriptions are never even filled by patients (what?!), turns out colleagues really don’t read your emails. Pause here, and just feel that surprise and disappointment seep in.

Take a breath. Ok?

Having read Bit Literacy a few years ago, a digital riff on Getting Things Done, I have always known there are better ways of handling the email deluge. For example: the Eisenhower box: Do it, Decide to Schedule it, Delegate it, Delete it.

from jamesclear.com

Also the idea that there are URGENT things, and NON URGENT things, and IMPORTANT things and NON IMPORTANT things. Email tends to be the URGENT and NON IMPORTANT and we all have long term strategies that are NON URGENT and IMPORTANT, and how do we move our daily work from one to the other. This is the story of my life.

However, in the service of improving email communication, Mr. Orendorff, of the New York Times updates the best-practices of WRITING emails to improve your chances of being read and being effective. My favorites:

  • Make the Subject Line useful: REPLY REQUESTED: thenyoursubjecthere or FYI ONLY: thenyoursubjecthere. Even better, if I can possibly ask my question or make my statement really short, I write it entirely in the subject line and end with my initials, signalling there is NOTHING in the email body.
  • Write a TL;DR. Cool internet slang for Too Long; Didn’t Read. As an internal medicine physician, I’m always guilty of being over-explanatory. Write the extra short summary at the end of your email AND THEN if you did well with that last part, you can DELETE your original email and ONLY SEND the TL;DR. Good job!

CMIO’s take? Read the article and change your life (and your colleagues lives) Today!

INFORMATICS: Put the road signs on the road, not in the garage

Why make folks go to training or read a tip sheet if you could guide them just-in-time as they do their work?

Here’s a lovely example of our Physician Informatics Group (Large PIG) evolving as we improve the “intelligence” that our Electronic Health Record (EHR) supplies to our hardworking providers (physicians and advanced practice providers).

In the past

clinicians might have pulled up an app on their smartphone dedicated to the ASCVD: atherosclerotic cardiovascular disease RISK CALCULATOR, punch in some numbers and get a result to type back into the EHR.

Later on, some well known national websites would do the calculation for you. Still requires finding the website and typing in numbers.

Even later, we would put hyperlinks within the EHR to link you automatically, but the typing was still required to get an answer.

NOW

we have built a smartphrase (while using the EHR, in any text field, type “.ASCVDRISK”, hit the RETURN key, and Voila, the answer above:

Risk calculated based on what the EHR knows about your patient: age, sex, diabetes, smoking, blood pressure, cholesterol. AND THE ANSWER: 9.1%. FURTHERMORE, disappearing help text guides you to use this information appropriately, and only saves the relevant info to keep in your progress note.

My colleague’s wonderful metaphor for Clinical Decision Support like this?

Put the road signs on the road, not in the garage.

It is already hard enough to use an EHR with patients. Don’t make me go looking for that training document from weeks or months ago, don’t make me think. Make it easy to do the right thing. It is a small celebration every time we can do this right.

CMIO’s take? Thanks to Rich Altman MD for a beautiful new tool in our system. What road signs can YOU take out of the garage and put on the road?

SpinLaunch will get to space with 1/10 the cost: the edge of what is possible

The inside of the SpinLaunch centrifuge. Image from Wired dot com

https://www.wired.com/story/inside-spinlaunch-the-space-industrys-best-kept-secret

I love these stories about entrepreneurs coloring outside the lines. “That can’t be done” or “There is a big gulf between theory and reality”. These are statements everyone faces when trying to change the status quo, including in healthcare.

The proposal in brief, use a massive centrifuge to speed a rocket up to 5000 mph and launch it like a slingshot so that it can coast up to the stratosphere and then a tiny rocket pushes it into orbit: it avoids the Tyranny of the Rocket Equation – that most of the mass of a rocket is dedicated to massive engine and the fuel it must burn to put a relatively tiny payload into space.

More power to folks like these. Yes, they might flame out as they get closer to a real trial, but imagine if they succeed:

  • Launch costs of $400k, instead of 10x as much
  • Being able to launch 5x month instead of 5x a year
  • Commoditizing access to space without massive rockets

CMIO’s take? Color outside the lines! I give it a 50:50 chance this is viable as a commercial enterprise after vaulting all the potential hurdles.

Clergy Preach Faith in the Covid Vaccine to Doubters (NYTimes)

Clergy embody the trust to heal our communities. They may be the boost the Covid Vaccine needs.

This article is an elegant discussion

of the importance of clergy in addressing vaccine hesitancy among those with doubts; they are the trusted community leaders we need right now. Click the image above to go to the article.

Bonus:

the article discusses UCHealth’s partnership with Shorter AME (African Methodist Episcopal) Church in Denver, with a photo of Yours Truly.

Even more amazing,

Shorter’s Fellowship Hall, where we gave vaccines, is named for Omar D. Blair, a Tuskegee Airman who went on to be a civil rights advocate. This is particularly poignant, as ALL clinical researchers at University of Colorado, and across the United States, must learn about the Tuskegee Syphilis Experiment, an unfortunate chapter in the early history of medical research in the US, and a source of great distrust on the part of the black community towards American medicine.

We are therefore so grateful to develop and grow a trusting partnership between UCHealth and black churches and community centers, to fight the pandemic with our best medical tools.

A Church-based Vaccine clinic

  • Some interesting ways vaccination at a Black Church is different from a vaccination on-site at a UCHealth facility.
  • Most people know each other; these are strong communities; folks getting shots spend more time waving and chatting than getting nervous about a vaccine.
  • Lots of church leaders guiding, comforting, coordinating a smooth vaccine clinic, alongside our UCHealth clinicians and leaders.
  • As a UCHealth worker, feeling like we are invited into the inner sanctum of a close-knit extended family

When I suggest to a vaccination recipient: “You can go be observed in the chapel for 15 minutes by our nurses and doctors. However, that observation time is optional and you can leave now if you like.” The response is: “Oh, I’m going in there! I haven’t seen these folks for a YEAR! I’m gonna talk to EVERYBODY.”

Some Churches UCHealth has been to in recent weeks

NYTimes and Shorter AME Church, Denver CO
New Hope Baptist, Denver, CO
Colorado Community Church, Aurora, CO

PBS and Black Churches

If you missed it, PBS recently ran a special on Black Churches in American History, that is a fascinating look at how the DNA of America runs deeply through these communities (from slavery, the Underground Railroad, Civil Rights, Women’s Suffrage, Martin Luther King, and the rise of black clergy in political life). Amazing and well-told.

CMIO’s take? It is a privilege (and also the right thing to do) to partner with strong community organizations to get minorities and medically under-served communities vaccinated. It is a privilege to be part of this effort.

Info Blocking Rule is coming 4/5/2021. Here is some last-minute help for health systems

Break down those barriers!

Well, it is finally here.

The 21st Century Cures Act has an Information Blocking Rule that goes into effect as of April 5, 2021. It was originally supposed to launch in November of 2020, but the federal government told us “JUST KIDDING” 3 days before and delayed until 4/5.

Because we laid all the groundwork and also felt it to be the RIGHT THING FOR PATIENTS, we went ahead and launched our changes in November, and SURPRISE: I still have a job, wasn’t fired. Thanks to our MMOLC sharing community.

A brief reminder

The rule stipulates that patients should be able to receive a copy of

  • Test Results (laboratory, pathology, radiology) and
  • Their Provider’s (physicians and advanced practice providers) Progress Notes

upon request. The interpretation was that if a patient had a Patient Portal account in the EHR (electronic health record) of the clinic or health system, this meant immediate release of this information. This is a major change for many health systems who had not yet adopted Open Notes (release of progress notes) or delayed the release of test results by several days.

Since our adoption of Immediate Release

of Progress Notes and Test Results since November of 2020, I have had exactly 2 complaints reach my desk, both from oncologists representing unhappy patients who read their CT imaging study on Friday evening and had difficulty reaching their doc until Monday. This is in the setting of about 1 million clinic visits, 800,000 radiology studies, 30,000 hospital stays, millions of lab and pathology results in these last 4 months.

So, not perfect, but not nearly the “sky is falling” result, as anticipated by many colleagues.

In case you’re still working through this, here are some documents (some updated) that we used. Some are actually named Information SHARING instead of BLOCKING, just a more hopeful attitude. I hope these might help you. Images here, links to full PDFs further down.

Even better, our colleagues at OpenNotes.org are doing some terrific office hours with experts online where you can hear the real-life experience of leaders ALREADY doing this work in various fields, successfully.

CMIO’s take? Are you ready? Do you have documents YOU can share? Lets do this!