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!
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.
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!
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.
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?
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 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.
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
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.
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!
One death is a tragedy. 500,000 deaths is a statistic. Don’t let the statistics numb us to the tragedy of singular deaths. Please listen to these stories. We MUST bring this pandemic to an end. We still lose over 1000 people a day.