A picture of change (and inspiration for informatics. NYTimes)

From the Metropolitan Museum of Art via NYTimes: a Japanese Print to teach us about the modern world

The artistry in our journalism can be remarkable. Spend a few minutes zooming in and out of this Japanese print with Mr. Farago. It is inspiring and completely engrossing.

From an informatics perspective, can we take an EHR screenshot, and zoom in and out as entertainingly? Could we =gasp= make learning about EHR’s as engaging as an art exhibit?

The Pyramid of Possibility: explaining informatics to others

Use this to explain to your colleagues that some requests are easy and others might just be impossible.

Have you ever been asked by a colleague: “Hey, wouldn’t it be great if Epic could just do ___ ?”

Some recent examples from my life:

  • Show me my last progress note so I don’t have to hunt for it (Yes, it does that, right here in the Story Board, I can show you in 2 minutes).
  • Find all the open appointments to put a patient into a provider’s schedule, quickly at a glance (Yes, Epic top tool bar: Provider Calendar does that)
  • Remind me of the pre-op scrub protocol (Yes, we can build that into an order set but you have to develop consensus, that will take YOU weeks of discussion)
  • Fund a Sprint EHR optimization team to teach everyone efficient work tools (sure, took me 2 years of convincing leadership to invest in a Sprint team)
  • I want to bill insurance for responding to online messages WITHOUT a co-pay (Welllll, you’ll need to change Federal and Medicare rules, so that will be YEARS TO NEVER).

Yes, we know our colleagues have great ideas and they’re well intentioned, but only IT and informatics people have a sense of what it will REALLY TAKE. So, I made this pyramid to show people, examples of how an tiny, itty-bitty, innocent request can turn out to be nearly nothing or an ENORMOUS MONSTER.

https://www.dropbox.com/s/b6a7dn1hix5kf6j/2022%20EHR%20Pyramid%20of%20Possibility%20CTL.pdf?dl=0

CMIO’s take? Hope you like it and maybe find it useful. Did you make a better version? Let me know!

Blowing apart EHR classroom training, TikTok, Microlearning (and a uke song)

What does TikTok have to do with Classroom Training? And what is “so last year” with EHR onboarding? And which uke song is up next?

 

We discuss: uPerform (self-paced EHR online training), Amplifire (adult learning theory and what we call “pot-hole” training for difficult EHR workflows), no-more-classroom, and 1:1 coaching sessions based on “cognitive struggle” and EHR Signal data. And of course, TikTok.

CMIO 3.0, according to Healthcare Innovation (and quotes from me)

Hear from Drs. Pageler, Hanson, DePuy (and me) about how the CMIO role has evolved and where we think this role is headed.

https://www.hcinnovationgroup.com/clinical-it/electronic-health-record-electronic-medical-record-ehr-emr/article/21250442/cmio-30

I’ll remind folks that I have an “About” page that speaks to the role of CMIO, here: https://ctlin.blog/about/.

An excerpt:

…being a CMIO

A good CMIO installs an electronic health record (EHR).
A great CMIO sees the EHR as a building block for excellent clinical care.

A good CMIO teaches physicians to use the EHR.
A great CMIO listens, learns, and removes barriers to inspire creative and collaborative use of the EHR.

A good CMIO hires people for informatics / EHR work.
A great CMIO builds teams that perform better than any individual could.

A good CMIO communicates well.
A great CMIO builds trust so that constant change & improvement is not scary.

We believe that a high-functioning EHR is the central nervous system of a group of dedicated physicians, nurses, staff and patients, who work together to improve the health of individuals and communities.

I think Centaur teams are the only way forward in healthcare. In chess competitions now, hybrid human/computer teams regularly outperform both humans alone, and computers alone. These so-called Centaur teams (in Greek mythology, half human, half horse) are all the rage.

“We improve physician and team wellness and effectiveness by building extraordinary relationships and innovative tools.”

Vision Statement of our Physician Informatics Group (the Large PIGs)

“Epic Man” ukulele audio recording from a recent Becker’s Podcast featuring — me

3 minutes to change your life. Cheer? Boo? Choose your own adventure if you listen in.

Hope you enjoy this. I think this is the “least bad” version of my ukulele parody song “Epic man” (with apologies to Elton John and Rocket Man). Audio only.

https://www.dropbox.com/s/picuhxmbeagdws0/2022-EpicManAudio3min.mov?dl=0

Parkview Epic go live 3/10. A panoply of ukulele parody songs?

Funny how after the hard work, the long planning hours, the anxiety about building a robust system for colleagues to use to care for patients, it boils down to this. At least in my world.

Recounting our go lives, in our 12-hospital pluse 4-affiliate-hospital system on our Epic EHR instance, this is my 8th hospital go live event (sometimes several hospitals at once) over last 11 years (this does not enumerate the countless clinic go lives we have engineered over the past decade).

The funny thing is, my debut as a ukulele EHR parody performer coincides with our initial Epic go live at the University of Colorado Hospital in September of 2011. I played ‘Epic Man’ for our 50 member command center, a sea of red shirts fielding 7000 complaint calls in the first 5 days from angry doctors and nurses who couldn’t believe we had moved all of their cheeses.

What you may not know is that I’m strongly introverted, and that day almost didn’t happen. My introverted daughter, a tweenager at the time, and super-embarrassed about everything her parents did, saw me planning to take my uke to work and told me: ‘Dad, you’re NOT going to take that to work, are you?! You KNOW you can’t sing, right?!?

Sigh. Fortunately, I overcame that hesitation and brought it anyway. A few years later, I played the same song on the Epic Wisconsin campus:

I thought I would lay out some of the uke parody songs I’ve written over the last 11 years since that fateful day. Last count: 24 songs on my YouTube channel, 12 not yet recorded. Yes, more than you wanted to know!

Hospital of the Rising Sun – pandemic version

Click on me (Epic Command Center)

COVID sea shanty

I’ve been everywhere man (UCHealth geography)

I am not throwin’ away My Shot (COVID)

Morphine (apologies to Eric Clapton’s Cocaine – e-prescribe controlled subst)

UCHealth Rocky Mountain High

Ortho virtual care (Louis Armstrong’s Wonderful World)

Telehealth world (multiple CT Lins – you can never unsee this)

Yampa roads (epic central)

We are physician builders, my friends …

Slicer dicer (coincidentally has the same # of syllables as “Helter Skelter”)

Doc Prudence (Open Notes)

RTBC: Empty wallet. https://youtu.be/EFEapU0EjlI

Everyone knows it’s Becky (practice transformation)

I can see clearly now, my sprain is gone (patients viewing radiology images)

Dear burned out colleague (thank you, Hamilton)

If you’re going to Yampa Valley (If you’re going to San Francisco…)

Yampa Roads (Country Roads)

Another brick in the wall (with apologies to Pink Floyd)

Pina colada EHR analytics

Wonderful world (Epic)

Hospital of the rising sun (original)

If the stars align, we may have future recordings of …

  • Inbasket Dynamite (BTS!)
  • You got a friend in me (Academy Award winner, actually needs NO parody words to be a perfect informatics song).
  • Workstations on wheels (proud mary)
  • Urology optimization (59th street bridge)
  • Clinical decision support (here comes the sun)
  • Billie Jean for PGx (pharmacogenomics)
  • Disruption – tradition (fiddler on the roof)
  • Super grouch (super freak)
  • Wild horses (Rolling Stones)
  • Scanners lament (500 miles)
  • Betty and the RAC (Elton John)
  • Home (Phillip Phillips)

Parkview Epic go live 3/9: Monkey Brains, a Haiku, and Physician Technology Adoption

Day 4

End of day 4 of and EHR go live. Are we getting punchy? No, this is a real sushi roll from a real restaurant here in Pueblo.

How can we not order Monkey Brains from the menu?

A pretty good day overall. Our physician informatics team is doing the rounds on 6 floors of the hospital, about 8 physical buildings and about 30 clinics. Here we are ‘debriefing’ over beers.

The vast majority of the clinics are doing really well, physicians and providers learning the note writer tools, order sets, pre-op process, secure chat communications, inbasket messaging, 2 factor authentication for controlled substance prescribing, and dragon speech recognition. And, seeing patients (and in one case, treating a mass casualty from a freeway pileup!).

Parkview Rocks

We are so impressed with the dedication of the clinicians and the hospital and clinic staff.

Makes me think of that song from Fiddler on the Roof:
‘Tra-DI-tion, tra-DI-tion!’

Instead we would sing it ‘Dis-RUP-tion, Dis-RUP-tion!’

Oh, that’s a uke song candidate you say? Hmm.

Musings about tech adoption

During a major go live like this, we see all sorts of interesting things. For example, we actually experience and can see the bell curve of technology adoption exhibited among clinicians.

Early adopters

Some clinicians are flexible, see the EHR as a new set of tools, and appreciate our help as we suggest best practices using the new tools. Within 2-3 days they are discovering innovations and pushing themselves to see ‘what this new thing can do.’

These are early adopters and digital natives. They need no ‘push’ from the informatics team, instead sometimes we judiciously apply the brakes on their wild flights of ideas. ‘Why don’t we survive this go live first before investing in your proposed next set of tools.’

Silent majority

Some clinicians are circumspect. Although they come in all age groups, most are older, less comfortable with computers and smartphones, think of EHRs as glorified paper charts, but valiantly spend time to learn, adapt, and willingly accept help and advice as they find their way in a new land. They are willing to consider that this might be better than the old paper process.

These are digital immigrants with open minds, and the largest group in the middle of the bell curve. Establishing trust and nudging are the best informatics tools. ‘Hey, good to see you again. How is it going? How can I help? Can I suggest trying another new thing today?’ Or, expressed as a haiku:

Come, see what I learned!
No, not that trick, but this trick.
It’s tricky but cool.

Late adopters

Some clinicians are doubting Thomases. They’ve heard that Epic is coming and have looked for jobs elsewhere, surprised to learn there are no new positions open that don’t also require EHR use. They are often senior clinicians with deep expertise, have established practices, large patient panels, finely tuned paper-based workflows honed over years. They are used to generating high volume and providing high quality care, and now everything has changed.

For these clinicians, their clinical expertise and years of experience are drowned under the heavy mantle of technology inexperience. They may perceive a loss of respect, a loss of autonomy, a loss of mastery. These are digital immigrants who were forced to relocate to this unfamiliar and hostile land, and wish to return to a home that no longer exists.

It behooves us in informatics to be humble and remember their value, their deep history and their expertise.

Extremes

Some clinicians are super early adopters: ‘Hey, I want a bluetooth speech recognition mic to go with my mobile tablet.’ ‘Show me your predictive algorithms for sepsis and how we are going to do surveillance.’ ‘I hear there is a way that the EHR can write your whole note for you.’

In the other direction, conversations can boil over into emotion and outbursts at staff, at colleagues, and at our informatics and IT teams. I’m told that a clinician did throw a trash bin in frustration this week.

However, we are proud to say that our primary metric is ‘Days since last chair-throwing’ and that is an unbroken streak of 2500 days, back to 2014, since a trash bin is clearly not a chair.

Kidding.

Hence my cryptic quote from yesterday, as we philosophically debriefed our team over beers:

The bell curve is made up of the entire bell curve.

Every medical staff has members in all these groups, including the extremes.

(from wikimedia.org)

Choose your own adventure!

Want to try out the CMIO / physician informatics role during a go live? Here are some challenging questions. How would YOU respond? Answer honestly before reading our approach.

Q: SO. What’s allowed as a Verbal Order? (meaning, I intend to use YOUR computer system as little as possible)

A: Actually, UCHealth policy is “verbal orders only in clinically urgent situations, or when the clinician is scrubbed in, or in transit and unable to enter their own orders.” However, the EHR only reflects your hospital’s medical staff policy. Let’s work with your leadership to clarify this.

Q: That “F2” key doesn’t work right in the note. It doesn’t even go where it is supposed to.

A: Let’s sit down and you can show me what you mean

Q: Why do I have to cosign all these orders and notes that my resident/fellow wrote? I trust them. Can’t I just “shift-click” and get rid of all of them?

A: Sounds great that you trust your team and that you’ve developed a great team workflow. At this time, the system does insist you glance at the work as your signing them one at a time. If there are standard protocols or policies that allow clinical colleagues to do their work, let’s develop them, document them, and we might be able to eliminate these co-sign tasks.

Q: I haven’t seen a thing that is quicker in this new system compared to our existing system. It is an expensive waste of time.

A: I’m sorry to hear this. However, you are only in the first week of a major go live and disruption in your work. Nothing is the same. The tools are flexible, and I’m convinced that our team and your team can work together to build new workflows to match or exceed your previous methods. It usually takes 1-2 months to fine tune your team’s new process.

Empathy. Trust. Respect.

Regardless of my artificially applied categories, there is a universal approach to clinician adoption of technology. We treat everyone with empathy and respect, honesty and transparency. We tell them why. We tell them where we are going, that the technology-empowered medical team performs better than the unassisted medical team. We open a dialogue, build trust, set behavior boundaries (when it comes up), and get through the transition together.

When we do this right, every clinician we work with will look back and say, ‘I can’t believe we used to do this any other way.’

CMIO’s take? Our ideal: no physician left behind.