EHR Sprint team: work hard, persevere, sometimes you get to build a dream team

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Our outstanding EHR Sprint team recently got written up by our local news for the great work they do supporting UCHealth clinics using the EPIC EHR. The team is led by project manager Christine Gonzalez (sixth from left), and physician informaticists Katie Markley (third from right) and Amber Sieja (on right). Also pictured from left to right: Todd Andrews – lead analyst, Diane Pruitt, RN – clinical informaticist, Megan Cortez – analyst, Barbara Noble – trainer,  Scott Carpenter – lead trainer, Christine Gonzalez – project manager, Dan Golightly – analyst, Dan Kroening – trainer, Rob Lewis – analyst, Katie Markley MD – Senior Medical Director Informatics, Steve Rotholz MD – physician informaticist, Amber Sieja MD – Senior Medical Director Informatics.

https://www.cuanschutztoday.org/epic-sprint-aid-clinics/

They spend two weeks immersed in a specialty clinic. They’re a team of 12, including analysts, trainers, and informaticists, addressing Physician Burnout and clinical inefficiencies by re-inventing teamwork, teaching efficiency through observation, re-training, fixing software and creating new tools.

It is heartwarming to see an idea come to fruition over months and years.

Our initial ideas on Sprint came out of the Apple Genius Bar years ago, and we had created a Touchworks Genius Bar, (see previous post) that ran for about a year, based on a similar concept, run by a team of 3-4 analysts and trainers. We’ve tried other solutions over the years, and after significant lobbying with physician leaders, health system leaders, budgetary impasses, and perhaps most importantly, increasing signs of physician burnout, got the green light to build the team and proceed. I will write more about this in upcoming posts.

Sometimes you get the quick, easy win in technology, that affects a few users, and the benefit of which is self-evident: “Here’s a wide screen monitor for everyone in this one clinic, now you can use the three-pane view to see more relevant information” or “Let me get you a mobile smartphone app to serve as the microphone for your speech recognition software.” Such wins are quick, don’t take much time or effort or training, and the benefit is immediate, for some (small) group of physicians and clinic staff.

On the other hand, we Informaticists (Informaticians? Informagicians?) more often work on harder initiatives that are intended shift the culture, to affect ALL physicians and providers throughout our organization, now grown to over 4000 physicians and associated clinic and hospital staff. We initiated APSO notes (inverting the traditional SOAP note: hmm, I think that may have to be the topic of a future blog post – remind me to tell you about the time I was called a radical extremist) and made them the standard for the health system, we adopted Open Notes (the school of hard knocks taught me some lessons on that journey), and now we are pushing forward with Epic EHR Sprints.

I thank President Kennedy for saying it best:

We want to go to the moon. We want to go to the moon, not because it is easy, but because it is hard.

And, when something on which you’ve worked hard, for months and years, comes to fruition, it is a good feeling of accomplishment.

One of my colleagues told me long ago of the “camel theory of medicine.” I suppose it may apply to other fields as well: On a day-to-day basis seeing patients in clinic, many will come in to see you for routine followups, some will come in and blame anyone but themselves for not achieving their goals, some will not adhere to advice given, or take their meds as prescribed, or exercise as previously agreed. It can feel like walking alone, parched, through a desert. Then, every once in awhile, a patient will come in and say: “You really helped me” or “you saved my life.”

Then, arriving at this surprise oasis, you pause, take a big drink of water from this life-affirming source, refill your hump (and yes, I know recent research indicates that the hump is not water but indeed fat), then you can be ready to head out again into the desert toward your distant, altruistic goals.

CMIO’s take?
1. Grit pays off
2. Pause, take a big drink when you find an oasis. Then push on. All of us in healthcare came for altruism; we often work too hard, too long and forget to recharge. Take time off. Go home and disconnect from work. Do what it takes to come back with a full hump to do more good work.
3. Build a Sprint team if given the chance; they’ll knock your socks off.

Keep your eyes on your goal, not your obstacle

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Some years ago, I was a post-call intern at UC Davis Medical Center. I had been up for about 30 hours in a row, but was hoping to get out for a quick bike ride on the American River bike trail in downtown Sacramento, near where I lived. I called up a fellow intern, and headed out for a quick training ride on a lovely bike trail by the river.

I was proud of myself for getting out, getting some exercise, connecting with a friend, even though I was post-call. In those heady days, I often followed the bike racing events like the Tour de France. My friend and I were learning to “paceline” or draft off each other as we rode through the early afternoon glades.

On our way back, there was a large lawn in between two bike paths, one that goes up to the bridge toward home, and one that continues underneath the bridge, heading towards downtown Sacramento. Due to a miscommunication, I nearly tangled with my riding partner, and swerving slightly to miss him, ended up splitting the difference of both paths and riding into the smooth green lawn.

No, problem, you say?

I immediately spotted a trash can about 30 yards away, sitting by itself, no obstructions around it on this nice green lawn. I was headed straight for it, at about 20 miles per hour, a good clip.

My post-call brain went into emergency mode. My eyes locked on the obstruction as it grew rapidly larger, my hands locked onto the brakes, and I began to skid across the grass.

It became clear that I was slowing down, but not enough to miss the trash can. Now, keep in mind that the trash can was about 3 feet wide, in a large grassy lawn that is about 1/2 acre in size, and no other hazards nearby. I was making a beeline for the can.

The next thing I notice is that the trash can is starting to elevate into the air. Up … up … up; I puzzled over this for some moments until I realized that I was GOING OVER THE HANDLEBARS. This resulted in a flipping movement, my bike tumbling gently to one side, unscratched, and I … did a complete flip, landed on my back, knocked the wind out of myself, and my cycling-shoe’d feet CLANGED violently against the empty green monster.

I lay there, chagrined. Maybe post-call and hence cognitively-impaired, high speed pacelining wasn’t the best idea.

Furthermore, my friend comes over, holds me on the ground to stabilize my neck (he had just learned about cervical spine precautions in his ER rotation that month) and says: “Don’t move! I’ll call 911!” In a fit of inconsiderate and impaired judgement, I swiveled my neck, looked up at him and said, “Nah, I feel fine.” He yells: “I can’t believe you just cleared your own C-spine!” After some recriminations and an apology on my part, we rode home.

This is just a long winded way of saying that our brains work in mysterious ways. You will very likely  hit what you’re looking at. SO DON’T LOOK AT YOUR OBSTACLES. LOOK AT THE CLEAR PATH AHEAD. On subsequent bike rides, some across very technical terrain strewn with boulders and sand traps, this really worked.

In my years of practice, this is one of my favorite personal stories I use as a cautionary tale to my patients. Don’t think about how bad smoking is, think of how you’re going to feel great when you haven’t smoked for a week. Don’ t think about your weight, think about how good exercise feels when you get home. Don’t think about the difficult conversation you just had; think about the ideas to craft a win-win outcome from your next discussion. My patients always get a chuckle out of my personal failures.

CMIO’s take? A lesson from cycling: I can still see that trash can. Sure, acknowledge your obstacles, but don’t stare at them. There’s a path. Stare at that. Your body and mind will help you steer you through.

Book review: Option B by Sheryl Sandberg and Adam Grant

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Rating: 4 of 5 stars
This is a hard book to read, in my opinion. Sure, maybe it is for people who have suffered a recent loss: a parent, a sibling, a son or daughter, a spouse. In that case, there are tons of insights that someone who needs a spirit guide, a confidante, could use.
Ms. Sandberg’s husband of eleven years, Dave Goldberg, CEO of SurveyMonkey, dropped dead suddenly, during a vacation, leaving her with 2 young children and pieces of a shattered life. Option B is her way of coping, and describes the 2 years following that event. Her friend’s quote: “I know you want Dave back, but Option A is not available. Let’s just kick the shit out of Option B.”

Ms. Sandberg, who is well known for her book Lean In, is Chief Operating Officer at Facebook, is good friends with Mark Zuckerberg, with Mark Cuban, with Elon Musk, and with many others. At times her casual references to conversations with these folks, as well as contacts with those who responded to her posts on Facebook of her tragedy and her response to it in the following years, seems a bit entitled. How does one empathize with a widow and single mom who has access to all these resources?

And yet, she navigates these waters with grace. Her vulnerability, honesty, raw emotion, are channeled, over time, into productivity, into insight, into lessons learned for others following her path. She also learns from others and revels in their stories as well, as sources of healing.

Her chapter on resilience is particularly apt.

After spending decades studying how people deal with setbacks, psychologist Martin Seligman found that three P’s can stunt recovery: 1. Personalization-belief that we are at fault; 2. Pervasiveness-belief that an event will affect all areas of our life; and 3. Permanence- a belief that the aftershocks of the event will last forever.

She speaks of ideas about self-compassion and self-confidence. Think of 3 things you’re grateful for, and write them down, EVERY night. This has been shown to be as effective as anti-depressant medication for improving depression symptoms over time. For confidence, write down what you have done well: contributions. This can improve self-confidence over time, especially after major setbacks.

Bouncing forward: ideas about pre-traumatic growth (that is, not waiting until trauma, to grow your own mindset): on your friends’ birthdays, write notes to friends thanking them for their contributions to your life. Gratitude to others often benefits the giver as much as the receiver.

Taking back joy: ‘playing music at the edge of our capabilities is what the psychologists call a “just manageable difficulty.” This level requires all of our attention, giving us no room to think about anything else. Many of us remember being happiest in flow-the state of total absorption in a task.’

Raising resident kids depends on 4 core beliefs:
1. They have some control over their lives.
2. They can learn from failure
3. They matter as human beings
4. They have real strengths to rely on and share

She cites Carol Dweck, the famous educator, on the concept of a Growth Mindset: ‘I am not yet as good as I am going to be.’ Learner’s mindsets can easily be influenced, based on the type of feedback they get from teachers and parents: move away from statements like: ‘you’re smart’ and toward: ‘you worked really hard on this.’ Value persistence and grit (a growth quality) over intelligence (perceived as a static quality: something you have or don’t have).

Asking for help is the heart of building resilience. Sometimes just being there is supportive and appreciated.

CMIO’s take? Resilience takes many forms. In human matters, it is an effective response to trauma. In recent years, to a CMIO, resilience is not just a personal reflection on the difficulty of the job. It is also a stepladder offered to colleagues suffering unprecedented levels of professional burnout related to electronic systems with as-yet inadequate coping systems, inadequate practice efficiencies and inadequate cultural wellness safety nets. A worthwhile read.

Instagram is a diagnostic portal for depression (NYTimes)

From the colors and faces in their photos to the enhancements they make before posting them, Instagram users with a history of depression seem to present the world differently from their peers, according to the study, published this week in the journal EPJ Data Science.

I love work like this; the growing links between disparate databases that lead to innovative ideas, weird conjunctions (Conjunction Junction, anyone?). I could imagine asking our patients to grant us access to their twitter handles, their instagram posts for purposes of diagnosis, follow-up. These are fascinating, uncharted waters.

I look forward to more cool mash-ups like this in the future.

Patient Engagement HIT article on patient access to Medical Records

File sharing and transfer vector concept
From Patient Engagement HIT

Thanks for a great write up from Patient Engagement HIT, on the important topic of the Pros and Cons of Digital Patient Health IT access. It is hard work, an uphill climb, a Sisyphean task for those who promote cultural change in physicians, clinics and hospitals, but worth it in the end.

“Do you want patients to call us with terminology questions? Will they be offended when we call them obese? Or if we say they’re smoking or they smelled like smoke? This is going to be terrible,’” Lin recalled his colleagues saying.

https://patientengagementhit.com/news/4-pros-and-cons-of-digital-patient-health-data-access

Clear. Clean. Rested.


I’m spending the week away. No email, no meetings, virtual or otherwise, phone in airplane mode, escaping the trappings of life on the grid.

We are out camping, scrounging for firewood, burning our food on camp stoves or in the fire ring, canoeing up meandering rivers, and hiking Colorado’s spectacular wilderness.

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This is so fun, who cares about catching actual fish?

I’m perfectly happy to have others in the family gear up to fly fish. What I have under-appreciated is that fly fishing is also a spectator sport. To me, catching the fish is incidental: we catch and release anyway. The draw, for me, is watching the sublime curve of the line and the meditative ‘ssshhh’ as it undulates back and forth and then settles silently into the lake.

We are just car camping, but it is just out of my comfort zone, so this is enough of a stretch for me. Found a perfect hike near Vail: 6 miles up to and back from the cascading falls near Lower Piney Lake.

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My favorite thing: picking a sunny boulder at the edge of a mountain stream at the turnaround of our hike, slipping the hiking boots and socks off, anticipating the bracingly-cold water. Then, easing the aching feet into the stream: the first Yelp of surprise (every time!) the almost-painful cool, the feeling of ice-cold veins rising up, developing an internal minty feeling. Clear. Clean. Rested.

Nothing like it.

Gets me recharged for the hike back.

CMIO’s take? Seek rest and moments of peace. Resilience stems from recovery in the face of change. There has been so much changed in recent months and years, and too often I see physicians not taking the hiking boots off, no time for the mountain stream refresh.

Let me know how YOU recharge.

Review: Hamilton: The Revolution

Hamilton: The Revolution
Hamilton: The Revolution by Lin-Manuel Miranda

My rating: 5 of 5 stars

It is no secret among my acquaintances that I am a Hamilton (and by extension Lin-Manuel Miranda) fanatic. I never thought myself a scholar of the Founding Fathers, but it turns out, I am! At least the way that Ron Chernow, and now Lin-Manuel have digested this history for me.

I bought the iTunes music album on a lark last summer when getting ready to go on a camping trip. Turns out, our family listened to the soundtrack all the way through in one sitting during our drive out of town and into the Colorado outback. We were mesmerized. My teen son memorized several songs during that trip, sitting in the minivan (willingly!) as the only source of reliable power in the campground, and replaying songs over and over.

It is the quintessential American story, coming in as an “immigrant coming up from the bottom” to work hard and make his way in the land of opportunity. And it is a story of unbridled ambition, meteoric rise, and downfall.

And, of course the duel. I’m actually glad to have THIS be my main knowledge of Hamilton, and not just the famous Milk Industry advertisement, with peanut butter and radio-show call in (watch it again, it’s as good as ever).

What this particular book does for this fanatic, is to explain the back-story of all these songs, the additional Easter-eggs that Lin-Manuel hid in the lyrics, the struggles and triumphs of an ambitious son-of-an-immigrant as he assembles in private, and then in public (Poetry Slam at the White House), this improbable rap-based story about our Founding Fathers.

CMIO’s take? This is fun on so many levels. The Hamilton’s story itself is compelling. Hamilton learns leadership and politics on-the-fly. These lessons still serve us well today, and are applicable to leadership within healthcare organizations “Winning is easy, son … Governing is harder.”

Reading great writing by authors like Chernow is brain-expanding. Watching great art arise from hungry, aspiring artists is inspiring. Reading the backstory lets you feel like an insider.

View all my reviews