Book review: Blade Runner (Do Androids Dream of Electric Sheep?)

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Five stars.

I have wanted to read this book for decades. Now, with my emphasis on reading consistently (both via Audible.com and in print, but alas only rarely on my Kindle app or Kindle device that my son discarded), I’m finally making progress on that enormous mountain of backlogged titles.

I love coming home, seeing the stack of tantalizing covers on the coffee table (apologies to my spouse, who is forever trying to keep the house tidy), and picking one up to spend hours lost in the worlds within.

Yes, I loved the recent Blade Runner 2049, yes, I watched the online shorts that led up to it. Yes, I re-watched the original, including the directors cut (and the hilarious back-story to the poorly-performed Harrison Ford voice over in the actual released movie: look it up yourself). And yet.

(side note: Amazon Originals now has a one season series: Electric Dreams, that is a fantastic collection of video interpretations of Dick’s short stories. Don’t miss ‘Autofac.’)

The book blows all the movies away. Philip K. Dick was not only decades ahead of his time, even now, his writing and thinking are too complex, too interweaved, too subtle for the movie screen. Electric sheep, artificial owls, animals figure prominently in the book, and are only briefly referenced in the movie. And the title finally makes sense. I really enjoyed this.

CMIO’s take?  Nope, not gonna give it away. Read.

More craziness about food and health (Eating in a 6 hour window?!) NYTimes

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I’ve been fascinated recently (as you may know, reader) with meals, modified fasting, weight management, meditation. I guess I’m turning into one of those hippie, birkenstock-wearing, health-food-pushing, “hey, just use lemon juice for that” doctors from from a too-cool-for-school non-metropolitan back-to-earth backwaters.

Not really.

I’m always interested in non-traditional ideas that maybe mainstream medicine has not yet embraced. Chrono-biology for instance (perhaps a future blog post). In short, I find that the ways of our healthcare system are perhaps too ego-centric and too shortsighted to encompass the breadth of human experience, and that maybe, just maybe, folks in other cultures have figured out smart, healthful things as well.

In this case, Michael Pollan, who re-popularized the old adage, appears to be right. Not only his original: “Eat food, not too much, mostly plants” but also “Eat breakfast like a king, lunch like a prince, dinner like a pauper.”

This NYTimes article refers to a book called The Circadian Code by Satchin Panda, a professor at the Salk Institute. One of the main ideas is to consider eating all your meals within a 6 hour window each day, guaranteeing your body an 18 hour fast, which apparently is a healthy and a cycle that your tissues and organs and body expect. It results in less weight gain, easier weight loss, and lots of other downstream benefits.

CMIO’s take? Look outside your usual sources of inspiration for ideas on living healthier.

Reducing Physician Burnout using an Agile team (EHR 2.0 Sprints), Guest Post by Brian Redig

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A little over a year ago, CT Lin, CMIO at UCHealth asked “How might we reduce physician burnout associated with the use of the electronic health record?” as part of an initiative he coined EHR2.0.  Through collaboration with Physician Informatics, Epic Certified Analysts, and Trainers, the optimization sprint pilot was quickly out of the starting blocks. Would the experience be the 100 meter sprint or the 110 meter hurdles?

The team accelerated quickly generating ideas.  They sent out surveys, evaluated provider efficiency profiles, created checklists, investigated prior optimization requests, and observed providers interacting with the system.  The team included Ambulatory Analysts, Trainers, a Scrum Master, a Nurse Informaticist, and a Physician Informaticist.  They had two weeks to accomplish as much as possible through interaction in the provider’s clinic establishing a medium for collaboration in real time.

The hurdles could be anticipated; “everything is critical!”, governance, change control, communication, capacity constraints, time, trust, and differing opinions.  Next, too much work in progress could create a residue effect as the analysts bounce between ideas instead of focusing on immediate next steps towards completion.  Finally, how do we identify and address assumptions, inferences, and facts?

The team leveraged agile methodologies in running the sprint to help address some of these obstacles. They used a Kanban board (Backlog, To Do, Doing, Done) as a way to visualize their work and agree to the work in progress, a Burn Up chart to show their accomplishments, and a Daily Scrum (Huddle) to discuss challenges, priorities, next steps, and context for the upcoming work.

The key to the sprint became the stakeholder participation in prioritizing what was important to them and assisting with trade-offs.  Instead of ideas having a static prioritization of critical, they float relative to other ideas.  There was also simultaneous exploration of the problem and solution domains as the immersion provided immediate feedback loops.  The focus quickly shifted from linear/more is better to high value deliverables.

The team was thinking through doing expressed best by the Chinese proverb,

“What I hear, I forget;
What I see, I remember;
What I do, I understand.”
–Confucius

Early results across the finish line demonstrate high impact to Epic flow sheets, SmartLinks, note templates, In Basket efficiency, Synopsis, and Med Rec along with positive net promotor scores.

The experience was neither a 100 meter sprint nor a 110 meter hurdle, it was a Tough Mudder!

The fastest way to the finish line was to lower hurdles through collaboration and provide performance enhancing features that minimized mundane clerical activities, streamlined charting time, and stimulated the cognitive clinical art of practicing medicine.

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Brian Redig, MBA, SCPM
Lean Six Sigma Black Belt
Board Certified Nuclear Pharmacist