737 Max software lessons – a critique for EHR (IEEE news)


Photo: Jemal Countess/Getty Images from original article above

I watch the airline industry as both a beacon towards safety culture, and also as a cautionary tale of “there but for the grace of God, go I.”

This article from a software developer with intimate knowledge of engineering, software and design principles, rips the 737-Max experience apart in a way I have not read in the broader press.

CMIO’s take? As a CMIO with responsibility to improve the implementation and design of an EHR that influences the lives of millions of patients, such lessons are humbling, and instructive. Read the article. Think of how each of us plays a role.

I Can See Clearly That My Sprain is Gone – Ukulele parody (and an XGM talk)

Author along with co-conspirator Peter Sachs MD. Neither can sing.

We (Dr. Peter Sachs, Vice Chair of Radiology at UCHealth, and I) recently had the pleasure of presenting our recent quality improvement work at Epic’s XGM (eXpert’s Group Meeting) in Verona, WI this week. In brief, we created and turned on the ability for patients to view their own radiology IMAGES online in their patient portal. We had already been sharing radiology REPORTS with our patients for over a decade, and this is an additional step towards information transparency. We think we are among the first to do this.

Despite some minor misgivings on the part of our clinical leaders, we were given the green light to turn this on. Short answer, over 22,000 patients viewed their images in the first month, September 2018 and … no complaints from either doctors or patients! So, we get to keep our jobs!

If you have 2 minutes, here’s the song:

And, if you have another 25 minutes, here’s the talk, and some Q/A after:

Patients Viewing Their Radiology Images Online. Peter Sachs, CT Lin, XGM 2019

CMIO’s take? It is terrific to have a close community of like-minded physician informaticists and technologists pulling to improve healthcare and patient experience, and celebrating each other’s successes. I’m ever grateful to innovative and inspiring colleagues.

Getting to Yes (Book review)

OK, nobody has time to read an actual book, so here is William Ury speaking at Creative Mornings about his book. Do you have 30 minutes to be a better person? Ever seen the arm-wrestle exercise? Watch the video.

I’ve read his book several times now. At least put it on your bookshelf. My take-aways for me and my colleagues and my work. We discussed this in our Large PIG book club recently.

  • Separate people from the problem. Personality is NOT at issue. Avoid blame on either side
  • Focus on interests, not positions. Be curious. See (and demonstrate your understanding of) the other party’s position clearly
  • Learn to manage emotions. Allow expression of strong emotions. Else, may block clear thinking
  • Express appreciation. Reflective listening (data, ideas, feelings, values). Seek others’ perspective.
  • Put a positive spin on your message. Avoid blame.
  • Escape the cycle of action and reaction. Instead, explore interests, invent options for mutual gain, leverage differences, brainstorm jointly as “wizards” (lower level persons who are permitted to work on ideas without leadership pressure)
  • Prepare your BATNA (Best Alternative To Negotiated Agreement) What will you do if you don’t agree?
  • Seek a third party who is trusted by both sides
  • Be SOFT on the people (care about the person), HARD on the problem (principled thinking)

I’ve read authors with similar points:
-Steven Covey: Listen first to understand, THEN speak to be understood
-Crucial Conversations: Make it safe to converse, Control your own stories, Contribute to shared pool of meaning, Ask other’s interpretations, Be tentative in your theories, Seek win-win opportunities.

CMIO’s take? This is a foundational book for Informatics and leadership in general. Find time to learn these lessons. Find the win-win.

Are you pro-friction or anti-friction? (NYtimes: Is Tech Too Easy to Use?)

I love articles like this that challenge long-held assumptions. For decades, “everyone knows” that technology is too hard to use, and we have spent countless hours designing “frictionless” interactions. Look at books like “Don’t Make Me Think.” As a result, we’re so enamored of our devices, that we prefer to answer the ‘buzz’ of a notification or spend hours developing neck cramps looking down, instead of interacting with our fellow humans, our friends, our loved ones. The pendulum has swung too far. But does this hold true in healthcare? After all, the article states

“No one wants a doctor who prioritizes speed over safety.”

I think our answer must be more nuanced, and less of an epigram.

  • When EHR’s are hard to use, YES, frictionless is an important goal, so that doctors’ intent can easily translate to correct action (order the right prescription, the right test, assemble the important medical data for good decision-making)
  • When computer-generated alerts are important, frictionless MIGHT be a problem: in some parts of our EHR, doctors have learned that pressing “escape button” twice, will bypass the alert, without having to read and respond. In this case, frictionless is NOT good.
  • In those borderline cases, where SOME thought is necessary, but there appears to be a BETTER choice in the vast majority of cases (we use the 80/20 rule, so-called the Pareto Principle), we design the alert so that the EASIEST thing to do is also the right thing (something that Staples made famous with their EASY button)

CMIO’s take: Friction, frictionless, Easy Button. Do you have any stories about designing the future of healthcare IT?

What is a Yottabyte, and How Do You Treat It? (a talk)

I gave a keynote speech late last year at Technology Awareness Day, hosted by the University of Colorado, Anschutz Medical Campus about Big Data, Tech acceleration, and Artificial Intelligence, as applied to healthcare.

I enjoy making my colleagues uncomfortable. How long will doctors have jobs? Will the AI eliminate internal medicine doctors? If Watson can beat humans at Jeopardy, can it beat me at reading medical literature? Can it be dermatologists at diagnosing skin cancer? Can it beat radiologists at interpreting CT scan images?

It is true that the most complex object known to us is the human brain, with its trillions of neurons and extensive interconnections. From this physical matter, something called “general adaptive intelligence” and “consciousness” arises, neither of which we understand or know how to construct or deconstruct. On the other hand, fundamentally though, isn’t a neuron a collection of physical and chemical processes that we DO understand? And then extrapolating upward then, is it not conceivable that we could eventually figure out how to construct a human brain in all its complexity? Hmm.

Reading books like “Life 3.0” and “Superintelligence” gets me thinking about stuff like this. It is both humbling and exciting at the same time.

CMIO’s take? Decide for yourself. I know, it is almost an hour long, and who has an hour anymore, especially if TED speakers can get their point across in 10 minutes? Well, consider my talk a series of 4-5 TED talks. Yeah, that’s it.

Seeing a black hole (NYTimes) is astounding

We are all involved in our little lives, our noses at the grindstone, making a living, trying to make a difference. Sometimes it is worth looking up … wayyyyy up, and see that fellow scientists are hard at work expanding the edges of our knowledge. We have known, based on Einstein’s theories, about black holes, believed in their existence based on indirect evidence from light bent around massively heavy objects. I had never heard of Sagittarius A*, the name applied to the mysterious unseen object at the center of Milky Way, but apparently we’ve been able to track large stars that slingshot around an unseen object with the mass of 4 billion suns(!) and have named that entity Sagittarius A*, and believed it to be a supermassive black hole. Wow, the theories we can craft with the puzzling evidence from our telescopes.

Of course, we still have NO IDEA about such things as Dark Matter, a theoretical construct we need in our understanding of how galaxies stay together (there is not enough matter in the ,mutual gravitational attraction of visible stars to explain why a galaxy spirals and stays together), or Dark Energy, another theoretical construct we need to explain why galaxies are moving moving away from each other at an ACCELERATING rate, when they should be decelerating due to gravitational attraction? Is it like Dark Fiber, those unused cables of internet connectivity? (No) or Dark Mode in the Mac operating system? (No)

And now, this, an actual image of a massive black hole at the center of galaxy M87. We finally see what Einstein saw in his equations half a century ago. Cool beans. Einstein rocks.

CMIO’s take?

If you want to get better, ask yourself these 2 questions (HBR)


Ask yourself these 2 questions (from Harvard Business Review):

  1. Do you want to get better?
  2. Are you willing to feel the discomfort of putting in more effort and trying new things that will feel weird and different and won’t work right away?

CMIO’s take? Read the article. It is inspiring, true, and worth repeating to yourself and anyone you’re mentoring.