The Premonition – Michael Lewis: not the pandemic story you think it is.

from Amazon.com

When my book club decided to read “The Premonition” and I found out it was about the pandemic, I discovered that I was TIRED OF READING ABOUT THE PANDEMIC.

But, I underestimated Michael Lewis’s skill as a storyteller. I guarantee that you have not heard these stories. Not about Dr. Charity Dean, Santa Barbara County’s Public Health Officer. Not about the Wolverines, a shadow organization comprised of current and former federal government employees connecting resources and brainstorming ideas. Not about the fundamental structural problems and failures with the CDC since 1976.

I was entranced and raced through this book. It was complementary to the things I thought knew about the pandemic, having just lived through it.

The CDC does not come out smelling like roses. Neither do most federal agencies with political appointments. And Lewis dives into it incisively, following these personal tales where they lead.

He ends with a hopeful note, that Dr. Dean has left public service to found a private sector company called “The Public Health Company.” Maybe if the feds, our public health infrastructure, and the CDC cannot act effectively, those who DID act effectively in 2020 can become a consulting firm to private industry (there is immediate demand among large international companies for such services, advice and protection) and eventually support the federal government if we do not fix our pandemic responsiveness, when the next pandemic (and yes, it is coming) arrives.

CMIO’s take? I have new respect for public health officers. I have new respect for the CDC prior to 1976 and hope that this book points us to lessons on how to re-invigorate our federal institutions, and make them effective again. This is very readable, and worth your read.

The most effective way to approach the vaccine-hesitant

From Haymarket marketing communications website MM+M

https://www.mmm-online.com/home/podcasts/the-mmm-podcast-6-24-21-zss-jacob-braude

This is a 28 minute podcast. The crucial moment (for me) is about 12:30.

Of the all the psychologies and tactics to address various subpopulations of the vaccine hesitate (for pediatrics, for adults, for COVID in particular), ONE tactic was most effective across all these subpopulations, use of “confirmation bias” as a tactic.

If you’re in a conversation about the vaccine, leave aside all the data and arguments.

Often we see people trying to persuade by saying ‘OK, here are the facts. Here’s why you should get vaccinated,’ ” Braude said. “But this research says actually what you should ask is ‘OK, why would someone want to get vaccinated?’ and have them go through the process in their own words. That works much better than the persuasion techniques we see people trying to use.

It turns out that 20-44% of people who answered this question, who were asked to TAKE THE EMPATHIC STEP of putting themselves in the shoes of someone wanting to be vaccinated, and then having to describe the reasons why, ended up changing their mind and agreeing to get vaccinated.

Huh. I think I have never done that. Time to learn and use something new.

CMIO’s take? There are so many interesting facets of the human mind. Even amongst physicians and healthcare workers, we have a lot to learn about how humans think, and how we make decisions. We need to harness this for the public good. Who is with me?

Intersection of Robotics and K-pop

from hyundai.com via wired.com

https://www.wired.com/story/boston-dynamics-bts-spots-on-it/

I love when robotic engineering cross-fertilizes with art and dance, as in this mash-up.

I’ve mentioned before that my son has his own youtube channel, as, during the pandemic he and his sister got into K-pop, learned some dances from BTS and others, and now Mom and Dad are also nascent K-pop (and K-drama!) fans. Heck, even PBS has gotten into explaining the nuances of K-pop (9 min Youtube).

On the other hand, I’m always interested in taking science and engineering ideas and making them more accessible, more beautiful, more elegant.

Here’s Boston Dynamics’ Robot(s) SPOT dancing to IONIQ from BTS. Enjoy.

Cognitive load with the EHR and burnout:

why aren’t we measuring this more?

Dr. Elizabeth Harry, image from twitter

https://www.sciencedirect.com/science/article/abs/pii/S1553725020302464

Thank goodness for smart colleagues. Dr. Elizabeth Harry is first author on an important work that ties physician/provider task load to burnout. See link above. 

Using the NASA task load index, and the Maslach burnout inventory, she was able to demonstrate a substantial correlation with an increased task load (mental, physical, and temporal demands, and perception of effort) and burnout.

Far from pointing the finger at EHR’s alone, task load generalizes across many industries, with electronic tools such as the EHR being a major negative or positive influence.

I can see a fruitful future line of investigation and collaboration with this measurement tool.

CMIO’s take? How are YOU measuring and tackling provider burnout?

To Sleep, Perchance to Dream? Aye, there’s the rub…

Image linked from Quanta Magazine

https://www.quantamagazine.org/sleep-evolved-before-brains-hydras-are-living-proof-20210518/

QUICK, which Shakespeare character gives this famous speech (that I dutifully memorized in high school)?

“…To die: to sleep;
No more; and by a sleep to say we end
The heart-ache and the thousand natural shocks
That flesh is heir to, ’tis a consummation
Devoutly to be wish’d. To die, to sleep;
To sleep: perchance to dream: ay, there’s the rub;
For in that sleep of death what dreams may come
When we have shuffled off this mortal coil,
Must give us pause…”

Yes, thank you, Hamlet.

Back to the Science:

I have always understood from my neuroscience colleagues, that humans (and animals) need sleep because our powerful multi-processing brains need downtime to repair, rebuild, consolidate memories, and even allow a pseudo-lymphatic system to remove waste.

Now, it seems, that brainless hydras and jellyfish exhibit sleep behavior. So, if we needed sleep before we needed brains, WHAT IS GOING ON?

Another fact: as life evolved, we had guts before we had brains, so is that a hint?

The article linked above is a fascinating dive into neuroscience and makes you question what you know. The best kind of writing.

TikTok Crowdsources a Parkinsons-friendly Pill Bottle

The better angels of our nature also exist on social media.

https://www.theverge.com/2021/1/23/22244673/parkinsons-tiktok-crowdsourced-pill-bottle

I love stories like this. Jimmy Choi has a TikTok page where he documents his athleticism. He also has Parkinson’s Disease, with an uncontrollable shaking in his arms. At one point, he complained about how difficult it is for people with Parkinsons to take their medications; the shaking often completely spills the pills from the bottle.

As a result, a community of TikTokkers began brainstorming and then modeling and then 3-D printing an innovative pill bottle design that ensures only ONE pill is dispensed at a time.

Read on!

CMIO’s take? Having access to the brain power and creative energy of the world, via communication technologies like TikTok and other Social media tools, is, I think, a wonderful antidote to our recent experiences, and the best expression of humanism. How can we design to augment this, the better angels of our nature?

Covid Vax Status, and Our Mental Health Status

We have a monthly Epic Provider Newsletter where we share system updates, and I send CMIO Update paragraph to my colleagues. Here is my update for this month:

With our next Epic system upgrade this week, Covid Vaccine status is now in the patient Storyboard! This is HUGE. It is now instantly visible when opening the chart, if/when the patient was vaccinated. This should help with rapid patient assessments and counseling, since the Covid-19 Pandemic Crisis now morphs into Covid-19 Ongoing Management. Possible Vaccine Statuses include:

  • Unknown (instead of ‘unvaccinated’ we know lots of vaccinations are not in our system; this prompts us to ask)
  • Dose 1 complete (if a 2 dose vaccine)
  • Dose 2 overdue (if late for second)
  • Vaccinated (XX date) if within last 2 weeks
  • Vaccinated

This is a nice improvement in our EHR.

IN PARALLEL, in discussions with colleagues this week, there is a sense that we are emerging from the pandemic. However, the prevalent emotion is not necessarily “relief”. Some say that they feel a sense of PTSD, or symptoms of exhaustion. In my mind, I feel like we have just finished running a sprint and are ready to stop and lie down.

BUT NO, there is no time take a break, it is time to resume the marathon of our regular healthcare jobs. 

We spent the last 15 months putting aside our burnout, putting aside our lives, and putting EVERYTHING into fighting this crisis, hoping to extinguish it.

Now, we put down our crisis tools, and look up and see … no end in sight. There is no way we are all collectively taking a year-long vacation, and our psyche’s are just realizing, now it is back to our regular, difficult jobs.

So, what is YOUR Covid Recovery Status on the grid below?

from: Responder Stress Continuum, via CU Anschutz Psychiatry presentation

We are starting to use this Stress Continuum Model to assess ourselves, and each other. More than ever, we need to take care of ourselves, and each other.

CMIO’s take? I hope all of you DO find a way to ‘take a break’. Although it is not a celebration, we SHOULD recognize that we stood on the front lines of an astounding moment in history. I am proud to have stood with all of you.

Navigating Open Notes and the Information Blocking Rule: an AMA innovation panel discussion

AMA Physician Innovation Network Avatar
from the AMA-Assn.org website

https://innovationmatch.ama-assn.org/groups/ama-physician-innovation-network-public-area/discussions/navigating-open-notes-and-the-information-blocking-rule

There are a whole bunch of Open Notes experts (and also me!) on a panel this week (ends tomorrow!) discussing Open Notes experience in regards to the Information Blocking federal rule. Come join us! Ask challenging questions! See what others have done! Lots of discussion on the pros and cons, the pitfalls and the successes.

“The unattainable best is the enemy of all the available betters” @Bill Burnett

You have more than one life in you. Lets ideate THREE 5-year visions. Do this exercise to generate creative possibilities. — Bill Burnett

In my clinical practice this week, I met a patient with whom I discussed this idea: he was a senior administrator in an academic institution, highly accomplished, well respected, and yet quite miserable at work and at home, feeling trapped.

It made me think back to Design Thinking principles, and creative approaches to hard problems.

Having been to the Design Thinking for Social Systems short course at Stanford, I’ve been working to apply this thinking at work and at home. I posted last year on my enthusiasm for design thinking as a process and approach to creativity and innovation. I came across Bill Burnett’s online video which prompted me to dive back into the material again.

A couple of books to recommend.

Designing your life by Bill Burnett and Dave Evans. More about applying design thinking principles to your life.

Bill also gives an overview in his great Stanford TEDx talk.

Creative Confidence by David and Tom Kelly. A history and principles of design thinking by some of the originators

Designing for Growth by Jeanne Liedtka and Tim Ogilvie. A practical book for application of design thinking. See also the Field Guide.

It made me think of myself, my work, my home, and how “designing your life” might be an exercise we could all apply with immense benefit. Join me?

CMIO’s take: What are you waiting for?

Big data graphics: NYTimes – Every Building in America (and Ed Tufte)

In informatics, we often are faced with big data sets and how to make this data comprehensible. Here is an example from cartography. Beautiful graphics, highly usable. We can aspire this “data density” in our own graphics.

My favorite book crafting great information graphics from data, is of course Edward Tufte’s Visual Display of Quantitative Information. He talks about data density, sparklines, lots of cool stuff. AND he has an online course. I have been his disciple for years, and have ALL his books.

The only thing better than gathering and making sense of big data, is being able to explain it clearly to change minds and behavior.