You’re gonna release WHAT? WHEN? Info Blocking vs Info Sharing

Info Blocking means inpatient and outpatient progress notes released immediately to patients, along with lab results, CT/ MRI/ PET scan results, pathology results. Immediately. Ready?

My 1-page White Paper on WHY and 4 following pages on HOW/WHAT

LINK TO UCHealth’s INFO BLOCKING WHITE PAPER

What is Changing

The 21st Century Cures Act has an Information Blocking regulation that addresses the concern that some health systems or facilities delay or block patient information from other treating health systems, or from the patient. Of immediate concern to this CMIO is the impact this rule has on our health system, to wit:

We are already an Open Notes organization, since 2016, releasing outpatient provider progress notes to patients immediately upon signature. This applies to emergency department and urgent care notes, also to hospital discharge summaries. We’re happy with this, and proud to lead the charge in Colorado for information transparency. Same with immediate release of the vast majority of lab test results.

HOWEVER, we still delay some results 4 days, 7 days or 14 days depending on category (see above). The new INFO BLOCKING regulation stipulates that systematic delays like this will Violate the Info Blocking rule, and that the potential penalty for such delay is $1 million.

Wow.

This is great news for patients and patient advocates; they have long stated the maxim: “Nothing about me without me.” I love this idealism. Practically? We have struggled with how to make this happen. Now the feds have conveniently stepped in with a mandate. This makes the conversation easier.

Our big struggles ahead

  • Teach our inpatient providers to write notes that are ready for patients to read each day they’re in the hospital.
  • Teach ALL our providers how to anticipate patient concerns and the range of possible results coming from pathology (biopsies and PAP smears and other results that may show cancer or severe disease). Same with complex imaging like CT scans, MRI’s, PET scans, mammograms. Same with lab results that may show genetic variants, like Down’s syndrome.

How I made this

Beyond the specifics of the INFO BLOCKING rule, this also illustrates the value of Form Factor and Communication Strategy. My mentor always taught me: if you write a white paper executive summary, every additional page beyond one side of one page cuts your readership in half.

So, for my white paper, I have written a ONE PAGE summary of WHY this is important and what action is needed. For those who just need “at a glance” the color grid in the center tells the story of exactly what is changing. And because data alone does not change minds, the call-out box at the bottom includes a few quotes from selected leaders, telling a brief story.

Finally, if you get to the end of the page and are interested in doing something, I have 4 more pages of HOW and WHAT to take you to the next level.

This, COMBINED WITH a road show, where I am going to every major physician leadership meeting, is how I’m getting the word out. There is, of course, much more work to do at the individual provider and manager and service and clinic level, but I’m trying to give everyone a running start. There’s not much time left.

CMIO’s take? We all have hard work ahead. This is a federal mandate, so 4000 hospitals, countless health systems and clinics will be facing this as well. The link to my white paper here (and above) is my contribution. I hope this helps you get to the right place with this regulation AND with doing the right thing for our patients.

Telehealth World: CT finds ukulele song partners!

Telehealth Ukulele Song!

Thanks to George Reynolds, CMIO and CIO extraordinaire, who put together a dream team of CMIO leaders to facilitate a course for up-and-coming leaders in the area of informatics. This year, CHIME (the College of Healthcare Information Management Executives) opened up the future-CMIO candidates for this course, to nurse, pharmacist, and other clinical informatics candidates. Our 30 participants this year made this 6-week, 2-hours-live-with-weekly-homework a blast to teach and discuss. That course concluded this week. Here’s how to sign up for future courses through CHIME:

https://ignitedigital.org/clinical-informatics-leadership-boot-camp-digital

We tackled: governance, high performance teams, creating value, leading change, and other topics.

And of course, what would an informatics session be, without some ukulele. Thank you to Amy Sitapati from UCSD, Brian Patty, former CMIO at Rush, and George Reynolds, former CMIO and CIO, and now with CHIME, singing with me.

CMIO’s take? Make music! Make art! You can clearly see, we are not gonna win any awards with our skills, but we sure had a great time putting this together. I am grateful for colleagues willing to stick their necks out to sing with me.

The Centaur in Healthcare: AI and humans (WIRED)

from WIRED magazine article

https://www.wired.com/story/algorithm-doesnt-replace-doctors-makes-them-better/

In the battle between the future of super-intelligent Artificial Intelligence and the paltry skills of increasingly left-behind human brains, some rays of hope. There are a growing number of projects dedicated to combining the skills of AI and humans to perform better than either alone.

The WIRED article above discusses Dermatology AI and how it improves the performance of physicians in detecting skin cancer. However, it mainly improves resident and primary care physician performance, and not expert dermatologists.

Is this good? Bad?

And, what is a Centaur? A horse-human hybrid from greek mythology.

I think this illustrates Arther C Clarke’s (paraphrased) saying:

Any teacher physician who can be replaced by a machine should be.

This is not necessarily a bad thing. Consider: if we can allow AI to be trained to augment physicians or advance practice providers in every case where the providers’ experience is not expert-level, we could raise the standard of healthcare throughout the country, or the world.

AI’s still can’t hold a hand, counsel patients on complex and competing issues, be compassionate, and create human connection.

We already have our computers helping remind us of the mundane yet critical tasks of doing the right thing for out patients: remembering tetanus and pneumonia vaccines, remembering to screen patients for colon and cervical cancer, remembering to repeat diabetes exams at frequent intervals. Why not allow them to give a second opinion on whether a skin mole is likely to be malignant?

CMIO’s take? More like this please. The co-evolution of AI and human is accelerating. We are finding a way forward.

Access to Telemedicine and disparities (WIRED)

from WIRED magazine article

https://www.wired.com/story/access-telemedicine-is-hardest-those-who-need-it-most/

As we work on telehealth options for patients, it is important to keep in mind the population of patients we serve. This article demonstrates the differences in access our most vulnerable patients have in accessing technology.

We cannot rest. We have miles to go, before we sleep.

Explaining Science using a Horse Metaphor

This is a poster I saw last fall at an AI conference sponsored by University of Colorado School of Medicine. The science is interesting and very well conducted.

HOWEVER! Pay close attention to the middle column. The authors have, in my opinion, created a clear metaphor to explain a very complex concept. Do YOU know how to do this? As scientists, we are increasingly subspecialized. How do we translate our important findings so that others can understand? This is getting harder and harder to do, as even OTHER SCIENTISTS (I count myself among them) have a hard time understanding what SCIENTISTS IN OTHER FIELDS are doing.

CMIO’s take? Take a moment to digest this, and decide for yourself: can you tell a story and explain as well as these scientists did? Why not?

Czernik: Counter-intuitive way to connect with the patient (Annals Internal Med)

My awesome colleague Zuzanna Czernick and collaborators have written a brilliant piece about the EHR. She used a CT scan image with a large pulmonary abscess to get the attention of an otherwise hostile, disengaged hospital patient.

Link to article Annals of Internal Medicine : https://annals.org/aim/fullarticle/2738161

My awesome colleague Zuzanna Czernick and collaborators have written a brilliant piece about the EHR. She used a CT scan image with a large pulmonary abscess to get the attention of an otherwise hostile, disengaged hospital patient.

The EHR, although widely disparaged, is also a wonderful tool to bring medical data alive for the patient. She offers a few guidelines on how to most effectively create the trusted “triangle” of provider-patient-computer:

  • Prepare
  • Setup
  • Educate
  • Chart together
  • Review

There are so many opportunities to connect with our patients; why not bring up a screen to show an image, a result, a graph, a note written by a consultant that illustrates and answers a question.

CMIO’s take? Yes, we need counter-intuitive (and soon perhaps simply intuitive) stories about the benefits of a modern information system in caring for patients. Thanks, Dr. Czernik!