Month: May 2019

New PIGlet? Or, interested in medical informatics? How to start…

Piglet: ie a New PIG (physician informatics group member)

Are you a PIGlet? Someone interested in the field of medical informatics? One of our newest informaticists coined the term PIGlet (Physician Informatics Group member). Cute. Increasingly I’m meeting with medical students, medical residents and now physicians as well as allied health persons (nurses, physical therapists) interested in the field, and unsure how to get started. Well…

Fallacy: informatics is about designing computer screens and talking with vendors about features and screen design.

Fallacy: informatics is about going into a dark room, creating a fantastic tool and launching it into the public and collecting all the acclaim from co-workers who instantly understand why you are requiring more clicks and typing to complete your amazing new software package.

Fallacy: informatics is about being smarter than everyone else and just KNOWING that your solution you cooked up in your head is going to work for everyone IF ONLY THEY DID THINGS THE RIGHT WAY, like you.

Instead: informatics is about creating a vision of what healthcare COULD BE, empowered with knowledge. This is a team sport. It is about collaboration: collecting everyone’s best ideas, developing consensus, trying a bunch of things in small batches, seeing what works, and then making a big bet, measuring outcomes, and diving back in for the next cycle of improvement. Done well, Informatics is Design Thinking and Teamwork, and the “information technology” is just how it is implemented. This is completely the opposite of what many think informatics is.

They’re … wrong.

Here are some ideas for getting started. A fair number of these are associated with a TED talk or other online video summaries.

  1. Read about informatics (but ONLY after reading about leadership and organizational change)
    1. Lorenzi, Riley, Managing Technological Change
    2. Journal of the American Medical Informatics Association
    3. The Design of Everyday Things (Norman), others
    4. Nudge (Thaler)
    5. The Glass Cage (Carr)
  2. Books to read (leadership, culture change, a book club if you’re lucky)
    1. Leading Change (Kotter)
    2. Good to Great (Collins), and others
    3. Death by Meeting (Lencioni)
    4. Delivering Happiness (Hsieh)
    5. Tribal Leadership (Logan)
  3. Books on self improvement
    1. Getting Things Done (Allen)
    2. Deep Work (Newport)
    3. The ONE Thing (Keller)
    4. Atomic Habits (Clear)
    5. The Practicing Mind (Sterner)

There are blogs:

Above all, be curious, be useful, pace yourself, take care of yourself so that when opportunities arise, you can occasionally sprint into action. Create learning habits to stay abreast of changes that affect your clinical practice and that of your colleagues. Read broadly about other industries unrelated to your own, and how problems are solved elsewhere.

CMIO’s take? Informatics has become a crucial part of medical training. The most commonly used (and often hated) tool for physicians today is the EHR; more common than the Yankauer, the retractor, the scalpel, the stethoscope, even. Why not develop exceptional skills with this tool? Until it matures into a self-aware entity (! a later post), it is on US to shape it into a useful tool.

School of Medicine Commencement: a tradition from the middle ages

 

Graduation season, and another 186 medical school students became doctors this month. The CU Anschutz campus is a fantastic home to 5 major health-related schools: the College of Nursing, the School of Medicine, the School of Pharmacy, the Dental School, and the School of Public Health. Thousands gathered, for all 5 schools, at the Boettcher Commons on campus and had a wonderful, sunny ceremony at the end of this rainy, snowy week in Colorado. How lucky we are.

Congratulations to Dr. Mark Earnest, recipient of the Sabin award for his selfless devotion to championing public health and care of the under-served. He’s also my boss, as Chair of the Division of General Internal Medicine (walking, with glasses and the green collar/hood in the photo above).

My colleague Larry Feinberg was right (as always): Commencement is something we, as faculty physicians, should attend. The work we do to educate, inspire, and support our students, and now newest colleagues in the profession of medicine, is an important tradition, and one that reaches back to the Middle Ages. When else do you get to wear a Tam (short for, apparently, “tam-o-Shanter” a traditional Scottish cap. Who doesn’t want to look, at least sometimes, like Leonardo da Vinci, in heroic pose?

Furthermore, the green Hood signifies Medicine, and the colors within the hood symbolize the specific school where we each trained (for those who bother to obtain the specific hood). For CU, that is gold and black.

I was proud to see the student I mentored, Thea Tran, graduate and be accepted to a Physical Medicine and Rehabilitation residency in Nashville, TN. Congratulations to her! She was well-loved by my patients and is sure to make her mark wherever she goes.

In an age when we’ve lost or look down on many of our traditions, having something that stretches back a millennium, is amazing and stirring, renews our sense of purpose.

In Colorado, we have adapted the Oath of Hippocrates over the years, and I found it inspiring:

I devote myself to the health of humanity, with full respect for the dignity and worth of each person. Above all, I will strive to do no harm.

I recognize that my knowledge and skills are imperfect, and that I must always seek further training and growth. I will not perform treatments for which I am not qualified, and I will call upon others for help. In turn, I will gladly render aid when asked.

I commit myself to the profession of medicine, to the advancement of scientific knowledge, and to the education and mentorship of those who follow me.

I will respect the rights of my patients and colleagues and shall safeguard those confidences placed in me.

I will speak out when silence is wrong. I will respect the law, but I will not fail to seek changes that would reduce suffering or contribute to good health.

I recognize the trust that has been placed in me by society and by my colleagues. I will at all times comport myself with dignity, honesty ,humility, and integrity.

These things I do swear solemnly, freely, and upon my personal and professional honor.

The Colorado Physician’s Oath

CMIO’s take? What traditions do you uphold, and which sustain you? Being part of something larger than ourselves is, paradoxically, both selfless and selfish. And that is a good thing.

737 Max software lessons – a critique for EHR (IEEE news)

https://spectrum.ieee.org/aerospace/aviation/how-the-boeing-737-max-disaster-looks-to-a-software-developer

Photo: Jemal Countess/Getty Images from original article above

I watch the airline industry as both a beacon towards safety culture, and also as a cautionary tale of “there but for the grace of God, go I.”

This article from a software developer with intimate knowledge of engineering, software and design principles, rips the 737-Max experience apart in a way I have not read in the broader press.

CMIO’s take? As a CMIO with responsibility to improve the implementation and design of an EHR that influences the lives of millions of patients, such lessons are humbling, and instructive. Read the article. Think of how each of us plays a role.

I Can See Clearly That My Sprain is Gone – Ukulele parody (and an XGM talk)

Author along with co-conspirator Peter Sachs MD. Neither can sing.

We (Dr. Peter Sachs, Vice Chair of Radiology at UCHealth, and I) recently had the pleasure of presenting our recent quality improvement work at Epic’s XGM (eXpert’s Group Meeting) in Verona, WI this week. In brief, we created and turned on the ability for patients to view their own radiology IMAGES online in their patient portal. We had already been sharing radiology REPORTS with our patients for over a decade, and this is an additional step towards information transparency. We think we are among the first to do this.

Despite some minor misgivings on the part of our clinical leaders, we were given the green light to turn this on. Short answer, over 22,000 patients viewed their images in the first month, September 2018 and … no complaints from either doctors or patients! So, we get to keep our jobs!

If you have 2 minutes, here’s the song:

And, if you have another 25 minutes, here’s the talk, and some Q/A after:

Patients Viewing Their Radiology Images Online. Peter Sachs, CT Lin, XGM 2019

CMIO’s take? It is terrific to have a close community of like-minded physician informaticists and technologists pulling to improve healthcare and patient experience, and celebrating each other’s successes. I’m ever grateful to innovative and inspiring colleagues.

Getting to Yes (Book review)

https://www.youtube.com/watch?v=-c-SUdBoD6M

OK, nobody has time to read an actual book, so here is William Ury speaking at Creative Mornings about his book. Do you have 30 minutes to be a better person? Ever seen the arm-wrestle exercise? Watch the video.

I’ve read his book several times now. At least put it on your bookshelf. My take-aways for me and my colleagues and my work. We discussed this in our Large PIG book club recently.

  • Separate people from the problem. Personality is NOT at issue. Avoid blame on either side
  • Focus on interests, not positions. Be curious. See (and demonstrate your understanding of) the other party’s position clearly
  • Learn to manage emotions. Allow expression of strong emotions. Else, may block clear thinking
  • Express appreciation. Reflective listening (data, ideas, feelings, values). Seek others’ perspective.
  • Put a positive spin on your message. Avoid blame.
  • Escape the cycle of action and reaction. Instead, explore interests, invent options for mutual gain, leverage differences, brainstorm jointly as “wizards” (lower level persons who are permitted to work on ideas without leadership pressure)
  • Prepare your BATNA (Best Alternative To Negotiated Agreement) What will you do if you don’t agree?
  • Seek a third party who is trusted by both sides
  • Be SOFT on the people (care about the person), HARD on the problem (principled thinking)

I’ve read authors with similar points:
-Steven Covey: Listen first to understand, THEN speak to be understood
-Crucial Conversations: Make it safe to converse, Control your own stories, Contribute to shared pool of meaning, Ask other’s interpretations, Be tentative in your theories, Seek win-win opportunities.

CMIO’s take? This is a foundational book for Informatics and leadership in general. Find time to learn these lessons. Find the win-win.

Are you pro-friction or anti-friction? (NYtimes: Is Tech Too Easy to Use?)

I love articles like this that challenge long-held assumptions. For decades, “everyone knows” that technology is too hard to use, and we have spent countless hours designing “frictionless” interactions. Look at books like “Don’t Make Me Think.” As a result, we’re so enamored of our devices, that we prefer to answer the ‘buzz’ of a notification or spend hours developing neck cramps looking down, instead of interacting with our fellow humans, our friends, our loved ones. The pendulum has swung too far. But does this hold true in healthcare? After all, the article states

“No one wants a doctor who prioritizes speed over safety.”

I think our answer must be more nuanced, and less of an epigram.

  • When EHR’s are hard to use, YES, frictionless is an important goal, so that doctors’ intent can easily translate to correct action (order the right prescription, the right test, assemble the important medical data for good decision-making)
  • When computer-generated alerts are important, frictionless MIGHT be a problem: in some parts of our EHR, doctors have learned that pressing “escape button” twice, will bypass the alert, without having to read and respond. In this case, frictionless is NOT good.
  • In those borderline cases, where SOME thought is necessary, but there appears to be a BETTER choice in the vast majority of cases (we use the 80/20 rule, so-called the Pareto Principle), we design the alert so that the EASIEST thing to do is also the right thing (something that Staples made famous with their EASY button)

CMIO’s take: Friction, frictionless, Easy Button. Do you have any stories about designing the future of healthcare IT?

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