“I, EHR” A thoughtful first person reply by our friend, the EHR

from thenounproject.com

A couple of our University of Colorado medical students and their mentor wrote this wonderful, thoughtful piece about the intersection of medicine and technology and how it has impacted our colleagues. This is a unique first-person EHR response to the various critiques.

I don’t have feelings and I can’t read, but I do know what you and your colleagues have been writing about me.

I, EHR. J. Hospital Medicine

Read the 1 page article here: https://www.journalofhospitalmedicine.com/jhospmed/article/200581/hospital-medicine/i-ehr

Consider how I can help you be present for your patients. Let me empower you to hear their stories as you deliver compassionate, humanistic, and evidence-based patient care. Paraphrasing Albert Einstein, the technology of medicine and the art of medicine are branches from the same tree.

I, EHR

Why I read and blog about Sci-Fi. Life 3.0, Superintelligence, and the Sirens of Titan

This is a fun read. My father never understood my passion for fantasy (The Hobbit, the Lord of the Rings) in middle school or sci-fi in high school (Ender’s Game, entire libraries of Asimov, Heinlein, PK Dick, and countless others). I’d try to explain, (not nearly as cogently as this journalist) that science fiction was imagining about our future, and that so many predictions from sci-fi authors have come true.

I’m currently reading Life 3.0 and SuperIntelligence for an upcoming book club, and also stumbled across The Sirens of Titan by Kurt Vonnegut, from 1959! Vonnegut is prescient; he predicts future concerns of machine intelligence, indeed artificial general intelligence, the concept (and worry) that, once created, a superintelligent being will be difficult or impossible to control and may find its human creators tiresome and unnecessary.

Hmm. The same theory is proposed, 60 years later by the authors of Life 3.0 and Superintelligence, but with more evidence and detail.

CMIO’s take? Where is the sci-fi about the future of Electronic Health Records? Ready to write one?

InformatiMusicology is a thing (thanks, Ross!)

https://www.acmimimi.org/2018/10/InformatimukulelogicalOfferingsfromCTLin.html 

Ross Martin is a physician informatician extraordinaire. Among his many talents, he is a singer-songwriter with his own musical show, and he publishes a blog at at ACMIMIMI: the American College of Medical InformatiMusicology. Turns out there is a small community of physician informaticians who cross the line between work-a-day informatics and the arcane arts of … music?

For example, a fellow Fellow of ACMIMIMI is Dr. Francis Collins, founding member of the Human Genome Project, and Director of the National Institutes of Health. August company.

CMIO’s take? I’m sure all you health IT geeks out there have hidden talents. Let me know what they are!

My Failure Resume

This is my Failure Resume. I got the idea from several sources, and thought: this will be fun and humbling for me, and perhaps encouraging to my junior colleagues facing a tough uphill climb through academia or in their organizations. In hindsight, it is easy to cherry-pick my best successes (ignoring my many failures) and construct a narrative that makes it sound like I have always been successful.

This is FAR from the truth.

Reality is much messier, and often, much more interesting. Sharing this with my colleagues has been fun and eye-opening for everyone. Here are links to my one page Failure RESUME and by comparison, my one page Regular RESUME.

CMIO’s take? I think it would be a wonderful world if more of our senior Professors and respected clinical leaders (in informatics or not) posted their Failure Resume’s. It makes us more human and gives hope to our next generation of rising leaders.

CHA2DS2-VASc and HAS-BLED integrated into EHR. Wow. Humility thy name is…

Yes! I am an internist. Yes! I have practiced for many years. Yes! I know about CHA2DS2-VASc and HAS-BLED*. Yes! I vaguely recalled that we installed built-in calculators right into our EHR to reduce the barriers for our docs to use these calculators while seeing patients.

No, until today, I had not actually used them in the service of a patient. I had been able to skate by with awesome colleagues doing these calculations at hospital discharge, or seeing them prior to me, and I would follow the recommendations generated by these discussions.

UNTIL TODAY! So, I typed in dot phrases to invoke CHADS and here come both calculators, fill in some quick data and see above; really awesome automatically generated displays that can be placed in patient charts (and shared with patients!), and now I can have a thoughtful discussion.

I am amazed, and humbled. In a high-functioning physician informatics organization, the CMIO should NEVER be the bottleneck. We should be innovating, improving our EHR, and balancing “good governence” (hey! don’t put all those interruptive alerts in here UNLESS those being alerted agree that this is a valuable use of their time!) with “rapid cycle innovation” (well, if the nurse leaders on that unit REALLY want to have a pop-up alert every 30 minutes, every time a heparin blood test returns, as long as the nurse leadership wants to try it…)

The innovation here is, lowering the barrier for docs to use it IN THEIR WORKFLOW within the EHR. Furthermore, to have it DISCOVERABLE! So many innovations are “hidden” (Oh, you didn’t read our monthly newsletter with 20 items? It was number 12. Oh, our newsletter went to your spam folder? Sorry about that). So, being able to type a search for CHADS or HASBLED into our search field actually teaches the doc how to use the tool. Amazing, being a customer of my own informatics team’s development. Sometimes, stuff just works.

*CHA2DS2-VASc and HAS-BLED are fantastic medical calculators that, based on scads of high quality evidence, that we can now effectively calculate the future stroke risk score of atrial fibrillation patients, AND ALSO that we can calculate the future bleeding risk of anticoagulants (having patients take blood-thinners to prevent stroke in high risk situations). And then we can have a thoughtful data-driven conversation with patients instead of licking our fingers and putting them up to the wind to see which way the wind is blowing that day. You can try it yourself; there are online calculators for CHA2DS2-VASc and HAS-BLED.

CMIO’s take? A big dose of humble pie for the CMIO is part of a good diet. What cool things have YOU discovered in your EHR?

Shouldiscreen.com is a great example of “there are more smart people who don’t work for you than who do.”

https://shouldiscreen.com/

Sometimes our patients push us into our discomfort zone. Thanks to one of my long-time patients, who, as a former smoker, wanted to discuss the risks and benefits of low-dose CT scan Lung Cancer Screening. She had heard of this opportunity at her employer, and wanted to see if I could get her set up for one.

Knowing that we had an entire Lung Cancer Screening clinic set up to discuss this with candidate patients, and to discuss how to think about and address the inevitable “what do I do with THIS tiny nodule in my lung, which is likely benign, but who knows” and “how high IS my risk of cancer exactly, and what is the chance that this will make a difference in my life?”

So, I heavily weighted our discussion: “You could either work with ME and I can figure out some stuff, OR you could go see the EXPERTS who do this all day long and have a thoughtful discussion.”

My patient tells me: “Nah, I want to work with you, and I don’t want another co-pay.”

So there it is. Knowing that we have documentation templates and guides, I dove right in, on the exam-room computer. It does take some humility (see previous post) to discover things in front of your patient (after all, are we NOT supposed to KNOW EVERYTHING?!). But, soon, we discovered there was a nicely structured template, searching “LUNG CANCER SCREEN” in our EHR, that asked the right questions, and then sent me to the above website, which then created a spectacular graph display (for Shared Decision-Making with Patient).

Go see for yourself; the full display is cool

CMIO’s take? Having ‘discoverable’ EHR tools that link to sites of external knowledge, really cool. This is a glimpse into our future, where researchers and knowledge discovery, fully vetted, can be created ANYWHERE and used by ANYONE to improve the care of patients universally. There are more smart people who DON’T work for you, than who DO.

CHIME’s CMIO Leadership Academy in Ojai. Listen and learn.

http://chimecentral.org/mediaposts/cmio-leadership-academy-2019-images

Thanks to George Reynolds and those organizing CHIME’s recent Leadership Academy for existing and upcoming CMIO’s. I enjoyed teaching this year with other co-faculty like Brian Patty, Natalie Pageler, Cindy Kuelbs, George, Howard Landa, Keith Fraidenburg and David Butler.

The topics we covered in our Academy over 2 days included such CMIO best hits such as:

  • The Role of HIT in Today’s Provider Environment
  • Setting Vision and Strategy
  • Making Change Happen
  • Creating Buy-In
  • Demonstrating Business Value
  • Budgets and Business Plans
  • Creating Effective Teams
  • Instilling Customer Service as a Value
  • Organizational Culture
  • Building Networks and Community
  • Achieving Life/Work Balance

Thanks to my awesome and inspiring faculty colleagues; I learned a ton as a N00bie faculty member, and got lots of new books to read, for example Brian Patty’s “What Customers Crave.”

CMIO’s take: See one, do one, teach one is the norm during internship and residency training. Sometimes Teach One ends up being the best learning of all. And, join us next year at CMIO Leadership Academy.