The ongoing remote vs return-to-work debate (nytimes)

What is your organization doing? We (as of early June) seeing a “test positivity rate” as high as 28% for COVID in our region (it was as low as 3% a couple months ago just before Omicron variant), but a low hospitalization rate.

The informatics team (my Large PIGs) are still exclusively meeting remotely.

We are actually writing this COVID pandemic textbook paragraph-by-paragraph together, my friends. There is no “playbook” for how to behave now.

City Scooters: an informatics viewpoint

A colleague and I were recently making fun of tourists and others riding the city scooters around Seattle and other large cities. Nearly no one was wearing helmets, they’re zipping in and out of traffic, going up against SUV’s and 16 wheelers. Just asking for it. Now, it is true that Seattle has some the best bike lanes around, with dedicated ‘green lights’ just for bike lanes, to improve safety. It IS a bike friendly town.

As an aside, my son and daughter, when they were 9 and 11, were riding their Razor scooters to the park, when I overheard them:

S: my scooter has a turbo boost to go fast.

D: oh yeah? My scooter has jets.

S: So, my scooter shoots out flames

D: Well, my scooter has apps, and I can download anything and plug it in to make mine better.

Wow, kids of the smartphone age.

I thought of my children, while I hopped on this scooter, downloaded an app to unlock and pay for a day of scooting, used Google maps to find the Art museum, used Yelp to find a good chinese noodle place, and Weather to see if I needed a rain jacket. All from one device. We are living in the future, folks.

So I’m humbled to report, dear reader, that I stooped to try one myself. I have returned from that ‘undiscovered country from whose bourn no traveler returns’. Hmm. Not exactly, but you get my meaning.

Seattle Chinatown gate

Here are some quick personal observations.

$ a city scooter is a nuisance – Some folks ride the scooter on the sidewalk, endangering pedestrians. Then they ride the scooter down wrong way streets against traffic endangering themselves. Often though, they ride in the many bike lanes, merging easily with bike traffic and other electric motor powered personal transport. It even looks harmonious!

$ a city scooter is a danger to the rider. There’s no way I would ride one. Okay maybe once. Okay, I’m pretty tired after my bike ride yesterday and maybe I could try it. At least it will be an interesting blog post. Hey this is scary. Hmm. Good design, my first ride is speed limited so as to protect the newbie. Wow, after a half mile of starts and stops I’m getting the hang of this and can’t wait to unlock a full speed ride. Zoom! Full speed second ride! This is a blast!

$ A city scooter is an app. The founders of this idea realized that their potential customer base is THE ENTIRE CITY of people who have a smartphone and need to get somewhere. With a QR code, snap a pic, set up an account, and in 3 minutes you’re on your first ride. Clever.

Museum of pop culture. Where are the ukuleles?

$ a city scooter is transportation disambiguated. I’m here in Seattle for an organized bike ride later, but don’t want to put my nice bike on the street with a lock. This is a great alternative: scooters on many street corners with an app-map to show you the nearest. Then, when you arrive, park (safely) and leave it.

$ a city scooter is micropayments. Even better with a day pass. $7 per ride or $21 per day, up to 6 rides. Cool. It’s like you own a fleet of scooters all over town.

$ a city scooter is a network which grows in value with more nodes. And Seattle supports several! not only are there Link scooters, but Lime scooters and bikes, and several other brands of mobility. Unlike the first generation of e bikes that required charging and locking stations, these can be left any where for convenience as long as they don’t obstruct.

$ a city scooter is an information highway. Interesting to think about what data is reported in real time, what adjustments leadership and management need to make to redeploy, fix, recharge, see where the scooters are needed and ‘rebalance’ their locations.

Seattle art museum

$ a city scooter is modular. The components of the network are easily swappable. Riders will report issues, the scooter will tell when the battery is low or needs repair. It is self-repairing as a network.

$ a city scooter has to gain popularity while promoting safety. After my second ride I received a mandatory quiz: which scooters are parked legally? What are the relevant city laws that apply to me? And yet there is the need to grow the business, so ‘helmets are required’ but a photo proof of a helmet is not required. ‘Photo proof of parking correctly’ is required. Hmm.

$ a city scooter has soooo many customers: the city government, employees, riders, the driving and waking public, shareholders. it is interesting also to think about how many city regulations had to be addressed and met, how the public perception must be managed, how the pricing and profit models have to continually be tweaked. Is there ‘surge pricing’ like with Uber? How do you balance all these demands and make a profit? What are the guiding principles?

Well, you recognize this one

$ a city scooter shrinks a city. This is perhaps my most profound observation. After the first nervous scoot, I had a face-splitting grin the entire time I was riding. Kick start, push the thumb lever and ZOOM I could see the city literally shrink in size as I rode. Blocks whizzed by, hills flattened, and I was master of the domain, blending into bike lane traffic with all my best friends. From Pike Place Market to the Space Needle and Museum of Pop Culture to the Seattle Art Museum to Biang Biang Noodles and back to the hotel. So easy.

CMIO’s take? Multi-dimensional thinking like this is common in healthcare informatics. I enjoy thinking, feeling, and working through hard problems like this. Do you? If so, come join our ranks! We and the larger healthcare industry need your brains and emotional intelligence.

Ethics Grand Rounds: The Ethical Issues with Open Notes and Open Results (CT Lin @ uchealth)

Hear about: Anticipatory Guidance, Cancer Diagnoses revealed online, Risk of marginalization, the Ethics of Ethics notes, and more…

Here’s a link to our University of Colorado, Anschutz Medical Campus, Ethics Grand Rounds with our topic: Ethical Issues with Open Notes and Open Results.

Thanks to all who participated; a robust conversation about the value of information transparency, leavened with concerns about worsening disparity for the digital divide, language and cultural barriers, the unintended disclosure of bad medical news, other unintended consequences of immediate transparency to progress notes and results.

For example: A medicine service is treating a patient. There are suspicions that there may be domestic violence at home. Team calls “Ethics consult: shall we call Adult Protective Services before the patient returns home from hospital?” Should this note be shown to the patient / family? Could a family member gain access to this note which then CREATES a problem when none existed before?

This and more!

Dr. Glaucomflecken’s graduation speech to University of Colorado School of Medicine 2022

Of course the entire 90 minutes is worth watching, AND Dr. Glaucomflecken starts at minute 24. His speech is only about 13 minutes long. You won’t regret hearing what he has to say. He has survived 2 cancers, and a cardiac arrest (really? wow)

I’m so grateful to amazing folks like Dr. Will Flannery (Glaucomflecken’s real name), his humility, his insight, his humor, his TikTok channel. He’s a shining example of what a humanist physician aspires to be.

A.I. Is Mastering Language. Should We Trust What It Says? (nytimes)

GPT-3 can write text that astounds, based on its Large Language Model. Things are happening, people. Are we paying attention? #hcldr #hitsm #whyinformatics

I’m always on the looking for developments in computing outside of healthcare. This is a longer read, but so thought provoking:

  • What is a Large Language Model and why is it only recently important?
  • What is GPT-3 and what are all these magical things it supposedly does?
  • Can GPT-3 digest 1000 progress notes of a patient chart, say, and write a cogent 1-page summary for a clinician to digest rapidly? I’d pay for THAT.

‘‘The underlying idea of GPT-3 is a way of linking an intuitive notion of understanding to something that can be measured and understood mechanistically,’’ he finally said, ‘‘and that is the task of predicting the next word in text.’’ 

Prompt the algorithm with a sentence like ‘‘The writer has omitted the very last word of the first . . . ’’ and the guesses will be a kind of stream of nonsense: ‘‘satellite,’’ ‘‘puppy,’’ ‘‘Seattle,’’ ‘‘therefore.’’ But somewhere down the list — perhaps thousands of words down the list — the correct missing word appears: ‘‘paragraph.’’ The software then strengthens whatever random neural connections generated that particular suggestion and weakens all the connections that generated incorrect guesses. And then it moves on to the next prompt. Over time, with enough iterations, the software learns.

Ilya Sutskever

There is all this discussion of “is this a sophisticated parrot” or “truly an artificial intelligence capable of generating new ideas.” Well, in our Electronic Health Record world, just the first item would be transformative, if we can get an AI to digest a hyperobject large set of data into an executive brief. Just that.

CMIO’s take? This is an important article by Steven Johnson in the New York Times Magazine. Watch this space; the development of GPT-3 heralds a qualitative improvement in AI language models; so much so that we feel compelled to teach it values and culture lest it start spewing hatred it learns on the internet. This is a worthwhile long read.