Compose a talk (a blog, a paper) with sticky notes


This is my favorite way of constructing new talks now. Stickies that you can move around, just like manipulatives from grade school.

I came across an interesting idea in my recent reading, that your office should have 2 desks: one that has NO COMPUTER and only lots of paper, pens, stickies, glue, and other manipulatives. This is your CREATIVITY desk, where ideas come together, and the joy of using your hands, your mind, your physical space helps build connections, thoughtfulness, foster good ideas. Thanks to Austin Kleon and Steal Like an Artist.

Then, across the room, you set up a second desk. This is your PUBLISHING desk, and has a computer, a printer, and all the tools you need to electronify a finished set of ideas into a Presentation, a Blog post, a Manuscript.

And, never the ‘twain should meet! For computers, although great at publishing and formatting, can be DEATH to idea creation. Yes, I type faster and more legibly than I can write. Yes, pictures drawn in Powerpoint can be sharper and with straighter lines. But, can any tablet, laptop, desktop equal the ease with which we can sketch, scratch out, tape over, scribble, dog-ear, lay out a dozen books, cut out pictures from magazines, mash-up ideas quickly, reshuffle?

And, isn’t an idea “under the glass” (see book review: The Glass Cage) an anesthetizing soporific?

Don’t we want to “feel” something in our fingers? Run our fingers through the dirt? the sand? the snow? OK, I don’t miss paper cuts, sure. But, scribbling, taping, retaping, scribbling, drawing connecting lines, scribbling, erasing and blowing away the eraser-crud, isn’t that the stuff of imagination?

CMIO’s Take? When I say all this, I’m not sure if I’m a digital immigrant losing ground to digital natives (Mark Prensky, thanks), or if I’m rediscovering a general principle that the younger Boomers, the Millenials, Gen Y, Gen Z have all lost. What do you think?

How to write an Open Note for patients



Having been asked a number of times: what is the best way to participate in open notes and sharing physician progress notes with patients? Attached is our one-page PDF guide. Feel free to use and share. Please do include attribution when you share.

In short:

  1. Don’t Panic! Despite physician fears, patients are not looking for a completely rewritten layperson-friendly note. Many patients find it useful just to have access and be able to show that note to their next healthcare provider. You DON’T have to change a thing.
  2. The handful of “gotcha” topics in physician progress notes are few, and not difficult to write in a way that is respectful and still accurate. For example, use “shortness of breath” instead of “SOB”; “BMI>30” or “overweight per medical criteria” instead of “morbidly obese”; and “patient is non-adherent” instead of “patient refuses”.
  3. It gets easier with practice.
  4. I love the quote from Cassandra Cook. To paraphrase: If we write things that might offend patients, consider if such writing affects our own attitudes and behavior.

Furthermore, the website has a great toolkit for organizations looking to make the leap:

CMIO’s take? Lets push open notes until it is the default standard for Electronic Health Records and Personal Health Records everywhere. Is your organization on board with open notes? Let me know.

Releasing test results to ICU patients and their families? Surely a bad idea?!?


I’m always thankful for great colleagues who do good work. One of our former residents, Jonathan Sprague co-authored a report called “Divergent Care Team Opinions about Online Release of Test Results to an ICU patient.”

At it’s root, was the issue that we routinely signed up outpatients for our patient portal called My Health Connection. We also release ALL laboratory test results immediately to the portal, with no time-delay. This means that physicians and nurses often saw the result AFTER a patient received it online. Despite the anxieties of such an approach, we had decided back in 2008 that all our lab results would be delivered this way; we have released over 2 million results with negligible problems and highly satisfied patients.

In fact, our urology practice, initially hesitant to adopt these “open results” policies, found that 1) likelihood of missing a prostate cancer recurrence was less, since patients were assiduous at checking their own results online and then checking in with their clinic team and 2) one third of their telephone volume DISAPPEARED because patients would routinely call and ask “what was my PSA result this time?” Now, they’re one of our biggest proponents of information transparency.

In this case, a patient in transplant clinic signed up for the portal, got used to viewing results online, and then shared his account with his wife. When he was admitted to ICU after transplant, she continued to check results and found that in-hospital and even in-ICU results showed up on her tablet even before the ICU nurse was aware.

You can imagine the surprise the nurse felt when she responded to the call button: “What are you going to do with this high potassium result? What about that low oxygen result on the blood gas?”

See write up for what we did with this. In the end we resolved this peacefully, and our organization took another step forward, formalizing that inpatient test results would follow our outpatient results release rules:

  1. All lab results are immediately released with no time delay, EXCEPT that qualitative HIV and broad genetics panels ordered by genetics clinic are never shown online.
  2. All radiology and ultrasound are released immediately EXCEPT CT, MRI, PET are delayed 7 days to allow for possible cancer diagnosis to be communicated by physician to patient
  3. All pathology is delayed 14 days to allow multidisciplinary tumor boards to develop a complex treatment plan before releasing the result


CMIO’s take?
1. Nothing ventured, nothing gained.
2. Open Results policies work well for patient satisfaction, patient engagement, and DO NOT adversely impact physicians and staff IF well-communicated and expectations and guidance put in place. We’ve done this for 10 years and have reaped the benefits.
3. Even inpatients can handle test results, it turns out.

Coursera MOOC: Learning how to learn


Just started a new course on learning how to learn. Want to join me? Of course, there’s no time. It is like saying “I was too sick to go to the doctor” or as some physician colleagues tell me in regards to the always-despised EHR: “I don’t have time to learn how to be more efficient.”

My high-school son and I have taken MOOC (massive open online courses) classes; he is taking his second class on astro-biology (cool!). I have taken one on Machine Learning through and this will be my first on Coursera. These online learning platforms are revolutionizing education, and we need to pay attention. There are free versions (what we’re doing) and paid versions, for little cost, to receive a certificate, that require additional documented work for deeper learning.

I came across the “Learning about learning” on my social media feed. Knowing that what builds resilience for me, is feeding my voracious appetite for new ideas, new things to mull over and recombine. So, when reading dead-tree-based books at home (mostly sci-fi, admittedly, and sometimes non-fiction psychology) and listening to on my commute becomes insufficient, taking an online class seems to fit the bill. It is a multi-week course, with maybe an hour or so of video-based learning with associated transcript, and LOTS OF GREAT IDEAS.

Want to join me? It is a four week course, started last week. Or take the next cycle. The important thing is: keep learning something new. Juxtaposing unfamiliar ideas against your usual work often results in new recombinations, I find.

For example, some neat ideas from the course:  Salvador Dali used to hold a brush while falling asleep and when the brush hit the floor, he would awaken and write down any associations and ideas that came to him just as he was falling asleep. This is an example of unfocused (but likely more creative) thinking. The twilight of our consciousness taps into this free association mindset. Often that unfocused time allows ideas to recombine. This does NOT occur when focused on a particular task, as we so often do.

CMIO’s take?
1. Keep learning something new
2. Consider trying or for something you’ve always wanted to learn.