Review: We Are Legion (We Are Bob)

We Are Legion (We Are Bob)
We Are Legion (We Are Bob) by Dennis E. Taylor

My rating: 5 of 5 stars

Not all Sci-fi books are BIG idea, massive-world-building enterprises, clearly researched and diagrammed to the infinite detail, to sustain disbelief over multiple volumes (I’m talking to you: Foundation, and The Expanse, and Three Body Problem, and Quicksilver, and anything by Alastair Reynolds). This one doesn’t take itself seriously, AND YET is a rollicking read, full of laugh-out-loud moments, and then chin-scratching “hmm” moments. Reminiscent of Ender’s Game and Hitchhiker’s Guide in tone and action.

CMIO’s take? If you get the chance to “freeze” your head after a massive accident, AND someone offers you the chance to be the brains behind a Von Neumann probe that can self-replicate and explore the universe? Do it.

Seriously, it is not necessarily good to have a team of “yes-men” to rubber-stamp your actions; instead, a team of those with common strategic goals, with varied expertise and opinions (see: Wisdom of Crowds by Surowiecki) that is most likely to succeed.

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Pager inversus? Beeper Obliterans?

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(images: http://throwbackvb.blogspot.com/2009/04/pager-code.html and  http://www.zeppy.io/discover/us/used-pager-system)

There was a time when the last major industries using a pager were: drug runners and physicians. But then, drug runners switched to disposable, cash-purchased “burner” phones. Apparently, Breaking Bad and The Wire taught us about this. Having seen neither show (yet: saving up to “power-disk” them some day), I’m still faithfully carrying my pager around.

Why are physicians the last ones? I’d have to agree with other articles that reliability (signal penetrates buildings where cell signal might not), flexibility (don’t have to give out personal cell number, and don’t ‘have to’ respond to a page), low maintenance (change the AA battery once a month, so what if hospital power goes out), and low cost ($10 per month or less) are the main drivers. That, and massive inertia.

I’ve been in healthcare since 1985, and in that time, I remember wearing audio pagers (bee-doo-bee-doo! *static* Doctor, please call *static* 347 *static* Come QUICK! *static*). Sigh. What was the full phone number? Who? Where?

I’ve seen some services try to transition to texting (Please come tell Mr. Jones in 307 that he is HIV positive). Sigh. What was that thing about privacy? Did you really just tell AT&T about Mr. Jones?

I’ve seen other physicians miss critical messages because texting did not work in certain internal locations in hospitals. Gives a new meaning to “dead zones.”

With a growing number of hospitals installing internal cell-signal repeaters, it is possible that pagers are finally on their way out. I will miss them, when they’re gone. They did inspire an entire range of emotions over my career.
PRIDE: Hey! You mean medical students get to wear one?!
FEAR: Oh, man, this thing never stops. Can I just eat/pee/poop without being disturbed?
JOY: Finally, I have graduated residency and I am TURNING THIS DAMN THING OFF!
RESIGNATION: Oh, I have to wear one as an attending physician?
HOPE: Maybe, just maybe we can get rid of it and use our anticipated secure texting system

Finally, I recall my favorite research article, published in JAMA in 1992: BEEPER OBLITERANS. It references the older style “audio” pagers with a small “test” button on the top surface that was easy to accidentally “set off.” I won’t ruin it; you have to read it:
http://www.neonatology.org/pearls/beeper.html

 

Epic Sprint! Or, how we learned to love the EHR (part 1)

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Ok, so maybe that’s a little overstated, but it got your attention. And maybe Dr. Strangelove seems too apt a reference for our times.

In the past few months, our fantastic Epic informatics physicians partnered with our EHR analysts and developed a new way to improve the circumstances of our physicians using the Epic EHR. We all know about the national plight of physicians and the epidemic of ‘burnout.’ Much of this burnout is attributed to the documentation burden of interacting with an EHR.

Of course, having lived through the past 22 years of the birth and growth of informatics, this situation is a stake through my heart. I know, for a FACT, that the future of healthcare REQUIRES a high functioning Electronic Health Record, and a team of forward thinking informaticists looking to tie together this often-mindless, multi-headed beast of a health care system with a nimble, responsive, intelligent, adaptive, predictive nervous system. At its best, an EHR can remind, prod, nudge, assist and sometimes advise and improve, the care of individual patients, and even entire populations and communities.

So, it is heartbreaking to hear stories of doctors retiring, “burning out,” losing the joy of practice, and looking forward to retirement, citing the EHR as a reason.

In the past years since launching Epic in 2011, we have tried many ways to improve the lot of our docs. We tried:

**A lecture series in the early AM, at noon, in the evening (mostly flops).
**We tried anonymous email tips (‘The Surgeon’s Friend’). Ok, it was funny and maybe some folks read it, but no.
**We tried emailing a ‘tip of the week.’ And various forms of EHR newsletters. We still send out monthly newsletters with 4-6 tips in social-media-like teasers with hyperlinks (getting about a 25-30% readership rate, not bad, but…)
**We tried adding a topical “Haiku” poem (the Epic Haiku, get it?), and hoping that at least my colleagues might read 17 syllables about Health IT. As a result, I received email critiques on my syllable count and not adhering to the “true spirit” of Haiku.
**We tried restricting our IT ‘optimization’ and tech improvements efforts to those items that would benefit most of our 3000 physicians (thus, being very generic improvements, not specialty-specific and, like milque-toast, accepted blandly). For example, making general improvements to the sorting of the Problem List (partnering with a company called IMO on their Intelligent Problem List), adjusting Chart Review to be easier to navigate, for all doctors, etc.

**We tried an ‘EHR Genius Bar’ stolen whole-cloth from Apple, where we waltzed into clinic with a steel rolling table “borrowed” from the OR, and parked ourselves in a conspicuous corner of the clinic. (Thanks to Trish Milton-Hoffman for sneaky execution of this project “under the radar.”) We brought a couple of IT analysts, a trainer and a physician informaticist, to administer the Genius Quiz (top 10 ways to be more efficient in the EHR). Those answering more than 7 of 10 right got an I’M A GENIUS sticker, with (pick one) a picture of Einstein or Homer Simpson with a tiny brain. And, if you were NOT YET A GENIUS, we would teach you tips until you WERE a GENIUS. At least the stickers went over well.

Actually, this effort over VERY well, with physicians feeling “heard and appreciated” for their struggles. The team spent a week in clinic, observing use of the EHR (amazing what one can spot in about 30 minutes of silent observation). Then, there would be 1:1 training sessions specific to the individual physician’s “pain points” and specific struggles, and the analysts would occasionally “fix” some templates or smart-phrases, or set up some preference lists and short cuts. Eventually, the physicians who wore their GENIUS stickers on their hospital badges piqued the interest of other docs who were ignoring us, leading to a snowball effect of interested docs dropping by the GENIUS BAR.

Unfortunately, dedicating even a small team of analysts, trainers and docs to this effort was costly (the opportunity cost of other projects they were taken away from), and requesting the formal budget to fund such a team, or teams on a more permanent basis, was very, very difficult, as it never had a “return on investment” that would show up in dollars. And, such a team could “only” help one clinic at a time for a week. With our health system encompassing 50 clinics back in 2011, and 350+ now, our work would never be done. After living on for several months, and helping out about a dozen clinics, even this effort closed its doors.

Stay tuned for future Episodes of … The Epic Sprint.

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The opposite of a recursive meme: Here’s a social media post telling you to stop reading and posting on social media.

Why? I love my increased reading this past few years. It results in more creativity, more interesting things to say at work and at home, and a more fulfilled thought process. 

How? Audible.com during my commute, a book club or 3, books piled on the coffee table, ignoring and trimming magazine subscriptions, choosing a book that fills a knowledge gap at work, stopping my podcasts. And trimming my social media and TV consumption (the hardest). 

Great suggestions in the Harvard Business Review article. Good (book) hunting to all of you. 
https://hbr.org/2017/02/8-ways-to-read-a-lot-more-books-this-year

Review: Houston, We Have a Narrative: Why Science Needs Story

Houston, We Have a Narrative: Why Science Needs Story
Houston, We Have a Narrative: Why Science Needs Story by Randy Olson

My rating: 5 of 5 stars

So many scientists and doctors I know are terrific at science, and SO impressively smart. Kudos to their years of training, discipline, self-sacrifice. And yet … many (perhaps most) have no idea how to tell a story. In fact, “telling stories” is often construed as lying, or at the very least, being unscientific, and not “evidence-based.”

It is a terrible tragedy, therefore, as the Internet echo chamber relentlessly promotes those who can write a tagline, a teaser, a STORY (autism and vaccines, anyone?), and those scientists and researchers with deep knowledge and expertise, have no effective training to fight back, and are drowned out in the hue and cry.

Michaelangelo said: “I saw the angel in the marble, and I carved until I set him free.”

Reminiscent of the great artist, this book laid out 3 techniques to help me see the narrative inside our lengthy, cluttered, many-faceted, detail-oriented scientific pursuits. This book was written by a dissatisfied, tenured Marine Biologist, who quit his job to go be a screenwriter in Hollywood. Screenwriters, he says, are the “working class storytellers of our age.”

CMIO’s take: I thoroughly enjoyed and devoured this book, and now, like the ageless Hero described by Joseph Campbell, and with the aid of such books as this, I will face my personal limitations, and transform myself in order to face and overcome my challenges.

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Arguing For Patient Data Access Amidst Provider Pushback (news article)

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Arguing For Patient Data Access Amidst Provider Pushback

Sara Heath

January 23, 2017 – When OpenNotes came onto the healthcare scene in 2011, it introduced the fairly innovative concept of allowing patients to have full access to their clinicians’ notes. Physicians questioned whether this was the right or responsible approach to interacting with patients, and in some cases, cultural barriers within individual organizations kept providers from widely adopting this strategy…

PatientEngagementHIT.com

Thanks, Sara and Patient Engagement HIT for an excellent write up.

STEMpathy, via Thomas Friedman, and Sean the teacher

Automation is coming for the American worker.

I have been bothered by our recent election, with all its swirling issues. However, one aspect swirling out of this maelstrom, is the dissatisfaction of Americans put out of work with globalization, and the technological acceleration based on Moore’s law. Much has been made of the President’s claim that he brought Carrier jobs back from overseas.

Much has ALSO been written that the massive forces of “off-shoring” of jobs is NOT just a redistribution to countries with lower-cost labor, BUT ALSO a continuing acceleration of technology and automation. Bringing jobs back is but a brief speed-bump along the way to losing the jobs again to robots and computers.

As a parent, how are we to advise our younglings as they prepare to head out into the world? If globalization and Moore’s law are contributing to the destabilization of our visions of the future, how can we see clearly enough to help them choose wisely?

Tom Friedman’s latest book, “Thank you for being late” is a thoughtful, broadly researched, multi-cultural, geopolitical, economist’s answer to this question. And one of his answers to this question is:

STEMpathy.

Although, to be fair, a google search on the term first shows a WordPress blog by an insightful 5th grade science teacher:

http://stempathy.wordpress.com 

that appears to predate Mr. Friedman’s best-selling tome. Thank you Sean.

Nevertheless, I love this term. STEMpathy encompasses two ideas. The first is, that having a solid understanding of Science, Technology, Engineering and Math is a requisite foundation for the coming age of scientifically- and computationally-based Age of Acceleration. AND YET, STEM skills are insufficient to survive into this future, for as computation power doubles every 18 months and costs continue to fall, the capabilities of robotics and automation, powered by machine learning, are sure to outstrip almost all human occupations, from manual labor to highly technical and cognitive fields, including (gasp) MEDICINE.

What is a high-school or college student to do? Friedman notes, and I agree, that obtaining a solid college (and for some, post-college) education would set one up for a lifelong career in some respectable field. No more. Now, one would be lucky to complete a college degree, that might lead to one’s FIRST job for a few years, but that as the speed of change increases, one must learn to find employment as jobs change and entire categories of jobs collapse, or are born.

So, what skill(s) might future-proof a youngling over the coming decades?

This is the second part of the STEMpathy idea: the combination of a solid grounding in rigorous STEM scientific thinking WITH exceptional skills in EMPATHY, communication, human connection. In my experience, this combination of skills rarely occurs “in the wild” and must be explicitly learned. This is the double-whammy of left-brained logical, numerical thinking, combined with right-brained words, story, art, connection, that is so hard to find in one individual.

And perhaps the most hopeful note, is that empathy, communication, and human connection, unlike the mythology that “you’re either born with it or not” is NOT TRUE. In our organization, we have incorporated several Communications and Empathy courses into the curriculum for medical students, residents, and more recently, our academic faculty. For example, our recent Communications Workshop that I teach (more on this in a future post) is from the Institute for Healthcare Excellence. One set of skills taught includes the acronym PEARLS (partnership, empathy, acknowledgement, respect, legalization, support). These are discrete skills that can be practiced, learned, and mastered.

My bet, is that STEMpathy is useful now, and is one way to future-proof yourself, and the next generation. Be safe out there!