Arguing For Patient Data Access Amidst Provider Pushback (news article)


Arguing For Patient Data Access Amidst Provider Pushback

Sara Heath

January 23, 2017 – When OpenNotes came onto the healthcare scene in 2011, it introduced the fairly innovative concept of allowing patients to have full access to their clinicians’ notes. Physicians questioned whether this was the right or responsible approach to interacting with patients, and in some cases, cultural barriers within individual organizations kept providers from widely adopting this strategy…

Thanks, Sara and Patient Engagement HIT for an excellent write up.

STEMpathy, via Thomas Friedman, and Sean the teacher

Automation is coming for the American worker.

I have been bothered by our recent election, with all its swirling issues. However, one aspect swirling out of this maelstrom, is the dissatisfaction of Americans put out of work with globalization, and the technological acceleration based on Moore’s law. Much has been made of the President’s claim that he brought Carrier jobs back from overseas.

Much has ALSO been written that the massive forces of “off-shoring” of jobs is NOT just a redistribution to countries with lower-cost labor, BUT ALSO a continuing acceleration of technology and automation. Bringing jobs back is but a brief speed-bump along the way to losing the jobs again to robots and computers.

As a parent, how are we to advise our younglings as they prepare to head out into the world? If globalization and Moore’s law are contributing to the destabilization of our visions of the future, how can we see clearly enough to help them choose wisely?

Tom Friedman’s latest book, “Thank you for being late” is a thoughtful, broadly researched, multi-cultural, geopolitical, economist’s answer to this question. And one of his answers to this question is:


Although, to be fair, a google search on the term first shows a WordPress blog by an insightful 5th grade science teacher: 

that appears to predate Mr. Friedman’s best-selling tome. Thank you Sean.

Nevertheless, I love this term. STEMpathy encompasses two ideas. The first is, that having a solid understanding of Science, Technology, Engineering and Math is a requisite foundation for the coming age of scientifically- and computationally-based Age of Acceleration. AND YET, STEM skills are insufficient to survive into this future, for as computation power doubles every 18 months and costs continue to fall, the capabilities of robotics and automation, powered by machine learning, are sure to outstrip almost all human occupations, from manual labor to highly technical and cognitive fields, including (gasp) MEDICINE.

What is a high-school or college student to do? Friedman notes, and I agree, that obtaining a solid college (and for some, post-college) education would set one up for a lifelong career in some respectable field. No more. Now, one would be lucky to complete a college degree, that might lead to one’s FIRST job for a few years, but that as the speed of change increases, one must learn to find employment as jobs change and entire categories of jobs collapse, or are born.

So, what skill(s) might future-proof a youngling over the coming decades?

This is the second part of the STEMpathy idea: the combination of a solid grounding in rigorous STEM scientific thinking WITH exceptional skills in EMPATHY, communication, human connection. In my experience, this combination of skills rarely occurs “in the wild” and must be explicitly learned. This is the double-whammy of left-brained logical, numerical thinking, combined with right-brained words, story, art, connection, that is so hard to find in one individual.

And perhaps the most hopeful note, is that empathy, communication, and human connection, unlike the mythology that “you’re either born with it or not” is NOT TRUE. In our organization, we have incorporated several Communications and Empathy courses into the curriculum for medical students, residents, and more recently, our academic faculty. For example, our recent Communications Workshop that I teach (more on this in a future post) is from the Institute for Healthcare Excellence. One set of skills taught includes the acronym PEARLS (partnership, empathy, acknowledgement, respect, legalization, support). These are discrete skills that can be practiced, learned, and mastered.

My bet, is that STEMpathy is useful now, and is one way to future-proof yourself, and the next generation. Be safe out there!

Open Notes: we have the broadest deployment in the country (news)


We (UCHealth) show patients their physician progress notes ACROSS our entire enterprise, including:

7 hospitals (discharge summaries)

21 emergency departments (physician progress notes)

350+ outpatient clinics

(soon: 2 out of 8 psychiatry clinics as of mid February 2017).

Onward and upward!

Review: Patients Come Second: Leading Change by Changing the Way You Lead

Patients Come Second: Leading Change by Changing the Way You Lead
Patients Come Second: Leading Change by Changing the Way You Lead by Paul Spiegelman

My rating: 3 of 5 stars

I wanted to like this book more. The provocative title says a lot. However, the point could have been made with fewer words. Moreover, I looked forward to real-life examples to illustrate this idea, and was disappointed.

In brief, the authors claim that over-focusing on the customer (or in healthcare, the patient), although wonderful on the surface, can be twisted into ununtentional results. Shall we, as physicians, chase after the increasingly important “patient satisfaction” metric at the cost of, say, antibiotic overprescribing? “Oh, so you’ve had a cough for a day, and you’d like some antibiotics?” It is indeed easy, and quick, to say “Sure, here you go” and get back on track with an over-scheduled clinic day, and be assured of a higher patient satisfaction rating. Who would rather spend the 5-10 minutes to discuss the patient’s root concerns, explain the risks of overprescribing, and grit the teeth anticipating the inevitable “I drove all the way over, paid my co-pay, and THE NERVE of that doctor to withhold my necessary antibiotics” and resulting low patient satisfaction score.


Yes, this is not news to any practicing physicians. Yes, we know we’re being pinched from all sides. Yes, there is too much ‘fat’ in the US healthcare system and something has to be done. Yes, Obamacare did some great things and also did not do enough. Yes, we need to listen to our patients and ensure we do the best for every one of them. Yes, we need to treat our physicians better, so that they can step back from the brink of burnout, of retirement, of leaving medicine in disgust, of suicide. Yes, this book is a call-to-arms.

No, its not as helpful as it could have been. There’s less substance than the pages would indicate.

CMIO’s take? This book is more valuable for the shocking title and its use in conversation and leadership meetings, than it is for its actual content.

View all my reviews

Open Notes, a how-to Webinar with Homer Chin MD and CT Lin MD via HealthsystemCIO

Well folks, here’s more information about Open Notes from a physician who led a city-wide initiative to get ALL the hospital systems to adopt Open Notes, nearly a decade ago, with resulting excellent patient engagement and satisfaction and improved outcomes. And then I’m also on the webinar, too! Seriously, Homer Chin MD, formerly of Kaiser Northwest, where they pioneered many aspects of Open Notes, was able to collaborate with competitor healthcare systems throughout Portland and take the entire city to Open Notes; one of the few community wide collaborations of the sort.
If you’ve not been paying attention to the growing Open Notes tsunami, well, in a nutshell, its the idea of patients viewing their doctor’s progress notes about them, online.
Listen to the youtube channel recording of our 30 minute webinar:
We’ve been live on Open Notes in one form or another since our original research back in 2000, but we finally went system-wide in May 2016. None of the anticipated fears of the docs materialized in a significant way (fears of: too many phone calls, lawsuits from offended patients, volumes of complaints about pejorative terms). We found lots of benefits: patients more engaged in their care, patients more adherent to therapy, patients asking better questions (instead of “what’s my test result”, more like “I read about my results, and does it mean this or that?”).
However, not everything is straightforward; from a technology standpoint, remember to set Open Notes as “default on” with docs having to “opt out”. This will get your open notes release rate into the 95-99% range. If you allow docs to “opt in”, requiring a doc to press a button to allow a patient to view their notes, your release rates will be in the single digits. Just like Staples’ infamous EASY button, in informatics, we want to MAKE THE RIGHT THING EASY.
If any of you have not read Leading Change (maybe a blog post on this in the future), it is one of my all-time favorite and most useful books for CMIO’s. Creating a burning platform was one thing I never did well in the early days of our Patient Portal and transparency efforts. Turns out, our research and scientific data, without corroborating human stories, did not change minds and hearts. Who knew? The medical leadership at our health system did not agree to go along with this project, back in the early 2000’s.
This time (2016), I packaged Open Notes as part of our EHR system upgrade (hey, guys, turns out Epic version upgrade that’s coming on May 16, 2016 ONLY COMES WITH OPEN NOTES! Let me help you get ready for that!), obtained the leadership buy-in from our CMO’s, developed a thorough marketing plan, met in-person with key physician leaders (specifically, loud and opinionated physician ctlukeepicmanbigleaders), enlisted patients from our Patient and Family Centered Care council, conducted a small Open Notes pilot project in 7 primary care clinics for 6 months, gathered good left-brain-appealing statistics and right-brain-appealing stories, and generally jumped in with both feet.
If you stay till the end, you might hear (an improved) rendition of Doc Prudence, my anthem to Open Notes on the ukulele.
From Twitter @CIOCHIME


Review: Stargirl

Stargirl by Jerry Spinelli

My rating: 4 of 5 stars

My teenaged daughter handed this book to me with a smile, stating that I might enjoy it. She’s almost always right. For some reason I do enjoy YA fiction. Is it the yearning? The optimism? The world view that “anything is possible, but its just so HARD for me right now?”

Nevertheless, this was a fun, quick read. Not perhaps in the same category as “The Fault in our Stars” but a solid rollercoaster of a read. Stargirl is a fanciful embodiment of Richard Feynman’s “What do you care what other people think?” Playing ukulele, dressing up, oblivious to the stares of others, Stargirl is both attractive and repulsive to the high-school mindset. Interesting to read it as an adult, with perspective. I’m looking forward to reading the sequel.

My favorite quote of the book:
“Like so many of Archie’s words, they seemed not to enter through my ears but to settle on my skin, there to burrow like tiny eggs awaiting the rain of my maturity, when they would hatch and I at last would understand.”

CMIO’s take? The pressure of conformity, of habit, is comforting, lulling, deadening. Sometimes it takes an extrovert or an unexpected event to shake us out of our doldrums and open our eyes again.

View all my reviews

Review: The One Thing: The Surprisingly Simple Truth Behind Extraordinary Results

The One Thing: The Surprisingly Simple Truth Behind Extraordinary Results
The One Thing: The Surprisingly Simple Truth Behind Extraordinary Results by Gary Keller

My rating: 5 of 5 stars

So, is it realistic to clear 4 hours of your work day EVERY DAY to work on your ONE THING? Yes, I agree, not going to happen, even if Gary Keller tells you to. However, it is inspiring to read about new ways of working, new ways of structuring the day, the week, the month, to think about focus. Given the 17 priorities I’m working on now, and my many colleagues with highly variant concerns and demands, I completely understand where this book comes from and its audacious goal.

I also know, from my recent work on APSO notes (inverting the SOAP progress note written by doctors, to place the Assessment and Plan at the top of the note, for easier reading and understanding by all), and making this change (highly resisted, because IT’S DIFFERENT AND UNFAMILIAR) throughout the 3000 doctors at our hospital system, that this was my primary focus for years, until it was achieved as a universal standard. Focus does have its benefits. When I look back on my career, it is NOT the hundreds of smaller projects, or the hundreds of thousands of emails I crafted or responded to, it is not the ‘crucial conversations’ I had with individual docs and patients that maybe moved their beliefs and attitudes very slightly. Instead, I look back at BIG projects that were HARD, and where we accomplished something as a team, as an organization.

CMIO’s take: In hindsight, it was the unintentional “One Thing” attitude that put these projects over the top. Perhaps I could learn from my past, of the projects never reaching fruition, and the few that did, and allow the “One Thing” more of an influence in what I do. Highly recommended as a book.

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