Interview with Becker’s Hospital Review (CT Lin on the CMIO role)

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Thanks to Becker’s for interviewing me and posting our conversation:

https://www.beckershospitalreview.com/healthcare-information-technology/crucial-skills-for-aspiring-cmios-q-a-with-uchealth-s-cmio-dr-c-t-lin.html

Some back story for my role as CMIO: I began as the “chief complainer” back in 1998 or so… It has been a long journey over the past 20 years. I used to think “informatics” was about designing computer screens and the colors and placement of buttons, and the selection of features. Now, I realize “informatics” is about effective human connections, developing skilled multidisciplinary teams, and nudging colleagues to do their best work in the common interest of the organization. Much more vague, but SO rewarding when it works.

CMIO’s take? This is the core of our job: “We improve physician and team wellness and effectiveness by building extraordinary relationships and innovative tools.”

Dept of Medicine Innovation talk (video) on EHR Sprints

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I play a doctor in this blog, and sometimes in real life. 

http://www.ucdenver.edu/academics/colleges/medicalschool/departments/medicine/Pages/RIC-09-20-2018-Lin.aspx

Recently I gave a talk for the Department of Medicine Innovation and Research seminars at the Anschutz Medical Campus for University of Colorado’s School of Medicine. I spoke about one of my favorite topics, some of which I have discussed in these blog pages: Reducing the EHR burden and improving physician burnout with EHR Sprints.

CMIO’s take: what is YOUR organization doing to address physician burnout? Something similar? Let me know!

Book review: Born a Crime, Trevor Noah

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https://www.amazon.com/Born-Crime-Stories-African-Childhood/

Trevor is someone I only know from his hosting the Daily Show on Comedy Central. He is hilarious, insightful and holds up an incisive mirror to America by being from another culture, by being from South Africa. Now he brings us along through his hilarious and also terrible childhood and growth into adulthood.

One memory of his childhood stands out: a childhood friend named Hitler (long story) ends up in a DJ and dance contest. It is important to note that the education of blacks in South Africa about the Holocaust has been limited, at best. Also, blacks are required to have an English name in addition to a name in their native tongue (of which there are apparently dozens). As they’re taught history, “Hitler” and “Mussolini” are names of folks, who, apparently are “strong” and “fearsome” but whose names do not carry any further cultural significance. SO, why NOT name your kid “Hitler?” Trevor and his friend end up as a hip hop DJ and dance act with local color at a celebration in a Jewish community center. The chapter titled: “Go Hitler!” is even more hilarious and mortifying than you can imagine. Can that boy tell a story!

I am grateful for the journey and his inviting us along into his home, his fears, his joys, his schemes, his failures; his successes. It is a roller coaster. It is as if de Tocqueville, who commented on American life as a British outsider in the 1800’s was funnier and lived in the modern era. Finally, the voices that Trevor uses to evoke his grandmother, his mother, his best friends, and all the many languages he spoke in Soith Africa… they are indescribable. Don’t read this book. Listen to Trevor tell it like he’s telling a Daily show story, except it is Real Life and he survived it.

CMIO’s take? Audible names this among the top 100 audio books of all time. I agree.

White paper: the Future of EHRs (National Symposium at Stanford)

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I had the privilege recently of being invited to a national symposium hosted by Stanford Medicine and Dean Lloyd Minor, sporting numerous EHR clinical experts, informaticists, vendors and other thought leaders. See the resulting white paper (caution, in addition to expert opinions, there are quotes from me):

http://med.stanford.edu/content/dam/sm/ehr/documents/SM-EHR-White-Papers_v12.pdf

CMIO’s take? I found it an invigorating, forward thinking symposium with lots of great ideas for where we are and where we are going. Most importantly, we tackled WHY solving the EHR conundrum (so important, but so far from where we need to be) is crucial to the future of healthcare.

Book review: Blade Runner (Do Androids Dream of Electric Sheep?)

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Five stars.

I have wanted to read this book for decades. Now, with my emphasis on reading consistently (both via Audible.com and in print, but alas only rarely on my Kindle app or Kindle device that my son discarded), I’m finally making progress on that enormous mountain of backlogged titles.

I love coming home, seeing the stack of tantalizing covers on the coffee table (apologies to my spouse, who is forever trying to keep the house tidy), and picking one up to spend hours lost in the worlds within.

Yes, I loved the recent Blade Runner 2049, yes, I watched the online shorts that led up to it. Yes, I re-watched the original, including the directors cut (and the hilarious back-story to the poorly-performed Harrison Ford voice over in the actual released movie: look it up yourself). And yet.

(side note: Amazon Originals now has a one season series: Electric Dreams, that is a fantastic collection of video interpretations of Dick’s short stories. Don’t miss ‘Autofac.’)

The book blows all the movies away. Philip K. Dick was not only decades ahead of his time, even now, his writing and thinking are too complex, too interweaved, too subtle for the movie screen. Electric sheep, artificial owls, animals figure prominently in the book, and are only briefly referenced in the movie. And the title finally makes sense. I really enjoyed this.

CMIO’s take?  Nope, not gonna give it away. Read.

More craziness about food and health (Eating in a 6 hour window?!) NYTimes

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I’ve been fascinated recently (as you may know, reader) with meals, modified fasting, weight management, meditation. I guess I’m turning into one of those hippie, birkenstock-wearing, health-food-pushing, “hey, just use lemon juice for that” doctors from from a too-cool-for-school non-metropolitan back-to-earth backwaters.

Not really.

I’m always interested in non-traditional ideas that maybe mainstream medicine has not yet embraced. Chrono-biology for instance (perhaps a future blog post). In short, I find that the ways of our healthcare system are perhaps too ego-centric and too shortsighted to encompass the breadth of human experience, and that maybe, just maybe, folks in other cultures have figured out smart, healthful things as well.

In this case, Michael Pollan, who re-popularized the old adage, appears to be right. Not only his original: “Eat food, not too much, mostly plants” but also “Eat breakfast like a king, lunch like a prince, dinner like a pauper.”

This NYTimes article refers to a book called The Circadian Code by Satchin Panda, a professor at the Salk Institute. One of the main ideas is to consider eating all your meals within a 6 hour window each day, guaranteeing your body an 18 hour fast, which apparently is a healthy and a cycle that your tissues and organs and body expect. It results in less weight gain, easier weight loss, and lots of other downstream benefits.

CMIO’s take? Look outside your usual sources of inspiration for ideas on living healthier.

Reducing Physician Burnout using an Agile team (EHR 2.0 Sprints), Guest Post by Brian Redig

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A little over a year ago, CT Lin, CMIO at UCHealth asked “How might we reduce physician burnout associated with the use of the electronic health record?” as part of an initiative he coined EHR2.0.  Through collaboration with Physician Informatics, Epic Certified Analysts, and Trainers, the optimization sprint pilot was quickly out of the starting blocks. Would the experience be the 100 meter sprint or the 110 meter hurdles?

The team accelerated quickly generating ideas.  They sent out surveys, evaluated provider efficiency profiles, created checklists, investigated prior optimization requests, and observed providers interacting with the system.  The team included Ambulatory Analysts, Trainers, a Scrum Master, a Nurse Informaticist, and a Physician Informaticist.  They had two weeks to accomplish as much as possible through interaction in the provider’s clinic establishing a medium for collaboration in real time.

The hurdles could be anticipated; “everything is critical!”, governance, change control, communication, capacity constraints, time, trust, and differing opinions.  Next, too much work in progress could create a residue effect as the analysts bounce between ideas instead of focusing on immediate next steps towards completion.  Finally, how do we identify and address assumptions, inferences, and facts?

The team leveraged agile methodologies in running the sprint to help address some of these obstacles. They used a Kanban board (Backlog, To Do, Doing, Done) as a way to visualize their work and agree to the work in progress, a Burn Up chart to show their accomplishments, and a Daily Scrum (Huddle) to discuss challenges, priorities, next steps, and context for the upcoming work.

The key to the sprint became the stakeholder participation in prioritizing what was important to them and assisting with trade-offs.  Instead of ideas having a static prioritization of critical, they float relative to other ideas.  There was also simultaneous exploration of the problem and solution domains as the immersion provided immediate feedback loops.  The focus quickly shifted from linear/more is better to high value deliverables.

The team was thinking through doing expressed best by the Chinese proverb,

“What I hear, I forget;
What I see, I remember;
What I do, I understand.”
–Confucius

Early results across the finish line demonstrate high impact to Epic flow sheets, SmartLinks, note templates, In Basket efficiency, Synopsis, and Med Rec along with positive net promotor scores.

The experience was neither a 100 meter sprint nor a 110 meter hurdle, it was a Tough Mudder!

The fastest way to the finish line was to lower hurdles through collaboration and provide performance enhancing features that minimized mundane clerical activities, streamlined charting time, and stimulated the cognitive clinical art of practicing medicine.

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Brian Redig, MBA, SCPM
Lean Six Sigma Black Belt
Board Certified Nuclear Pharmacist