Another sign of the times: older books getting a resurgence in sales from fans posting emotional reactions on TikTok.
Hmm. It seems that one can quickly change minds (and behavior!) on a population scale with super-short emotional appeal.
The good: Shows that Daniel Kahneman’s “Thinking, Fast and Slow” is an important pillar of modern online technology: emotions and story change more minds than just data. (link is to a blog post on The Undoing Project about Kahneman’s life and work).
The bad: Shows that Nicholas Carr’s book “The Shallows: what the internet is doing to our brains” is also right — we don’t have patience to read long-form fiction, except maybe when TikTok tells us to. (link to my mindfulness blog series, and a review of Carr’s book).
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.
The TL;DR? 15 seconds should be the length of your educational videos. Wanna know why? and how? read on.
I was a Late adopter of Facebook
I’ve been thinking about the evolution of social media. In early days, I was a late adopter of Facebook, not getting why it was any better than email. Now, I get it: saying something once allows your network to see it, from close friends, to casual acquaintances. Medical residents explained to me that photos and memories were easier to share more broadly. AND, an existing large network made participation more valuable (hey! look at all the people I already know on here!).
Just like in the old days, getting a telephone was INCREASINGLY useful if there were MORE people and stores you could call. The network effect.
That led me over the years to LinkedIn (mostly for work contacts and posting my CV and work products publicly) and Twitter (still figuring it out, but a good way to keep up with news if you curate your network carefully, and also a way to post blog content). Also, Twitter allows you to curate for yourself an international community with similar interests, like #medtwitter.
And, my brilliant younger sister taught me that Twitter could also be good for lecture commentary and discussion (she will give a talk on 2 screens: one with her slides and another with a live pre-filtered Twitter feed: how brave! and give out a custom hashtag, like #postitpearls_lecture, and ask the audience to submit questions this way: wow).
And, some of you know that I’ve dabbled in amateur song-parodies with EHR songs on my youtube channel.
Finally, I’ve figured out how to blog regularly and then use IFTTT to cross-post my content auto-magically to my other platforms (Facebook page, Twitter, LinkedIn) so that I can seem more connected and omni-present than I really am (Thanks for another great tip, Sis).
BUT! TikTok is another thing altogether. My colleague and her daughter suggested that I take my latest Hamilton parody song (that I had gamely posted to YouTube and here I am shamelessly showing it to you again)
#notthrowinawaymyshot and now post it on TikTok, a post-millenial social media platform restricted to 60 second videos. Leaving aside the recent kerfuffle about Chinese ownership and control, this is qualitatively a different animal: getting your thoughts across in 15 seconds (preferred duration, and the time restriction being a result of the music industry’s maximum replay length of a copyrighted song). It has since been extended to 60 second maximum if you have an original soundtrack on your video.
So, I dove in. Unlike my “dozens” of views on my YouTube channel (with which I was satisfied; my broadcast domain is, admittedly to a relatively small physician informatics audience), my TikToks quickly blossomed to nearly 1000 views in 2 days.
Wow! I thought. I am AMAZING on TikTok.
What I did not appreciate is the 15 to 60 second format is much more attuned to the rapid “swipe” of post-millenials, and EVERYONE racks up lots of views. And, ultra-short videos are so easy to consume one after the other. AND, TikTok doesn’t need you to establish your network before your video gets out there; it shows your video to a random selection of viewers, and then those who LIKE it or SUBSCRIBE to you trigger the algorithm to show it to more viewers. So, an easy way to game the system is to use trending (but highly inaccurate) hashtags, like #superbowl, etc. Sadly, this user does not seem to have understood, or be willing to follow, some of these informal rules.
Furthermore, if you read online chatter about TikTok views “500 views total, is pretty sad; what you want is 500 views per hour.” For example, Nathan Evans, of Sea Shanty fame? He went viral at about 250,000 views, and now he’s at 12.9 million. Oh, well. Here’s my paltry Covid Sea Shanty, currently at 62 views (not 62,000) and SIX LIKES.
In contrast, our Informatics team at UCHealth just retired/deleted a 17-minute video I made a 10 years ago for a full “walkthrough” of how to use the Electronic Health Record for our ambulatory clinic physicians. Whew, how out of touch was THIS guy? Here’s a one minute snippet of the kind of video I posted back then, when we were on Allscripts Touchworks. So young, so naive.
Our more recent training videos are more like 1-2 minutes and focused on ONE technique or tool. Now, I’m thinking, maybe we need to shoot for 15-30 seconds. The cool thing about TikToks is that you can trim seconds, speed things up, because those viewers who “get it” can be done watching in 15 seconds, but the video can be paused and also it automatically replays so the viewer can catch subtle details. Hmm, is this a paradigm shift? Should we embed TikTok length education videos into our EHR?
Put Road Signs On the Roadway
As we say internally, shouldn’t we put the Road Signs and Driving Directions (our tips and tricks) on the Roadway (where our users are actually using the EHR) and not in the Garage (our online reference library and training webinars)? Aren’t our users more likely to click on tips WHEN they’re doing work, rather than when “oh, I have some time, let me see what I can go learn.” (which is never)
Austin Chang is my hero
There clearly is an entire evolution of thinking needed to succeed in this TikTok medium. And I don’t have the savvy (yet), the luck, or the persistence to grind out the many tries needed to break through. However, there are medical professionals who have. For example, Austin Chang.
Austin is … well, just go watch him. In 15 seconds, with hilarious music over-dubs, he uses captions and terrible dancing while in scrubs (ok not so terrible), to get his medical facts out there.
I both bemoan the general public’s deterioration of attention span (15 seconds now? Really?) and his ability to fit his tiny education bites (bytes?) into this format. It works. Some of his TikToks are over 2 million views. On MEDICAL TOPICS. Nice. Here’s the NYTimes writing about him.
This reminds me of reading The Shallows, a book about what the Internet is doing to our brains. Are we losing the ability to read a book? I don’t know. I, for one, did not finish reading the book. Ironic.
CMIO’s take: Beat ’em or Join ’em? What are YOU doing about TikTok in your field?
This is a 28 minute podcast. The crucial moment (for me) is about 12:30.
Of the all the psychologies and tactics to address various subpopulations of the vaccine hesitate (for pediatrics, for adults, for COVID in particular), ONE tactic was most effective across all these subpopulations, use of “confirmation bias” as a tactic.
If you’re in a conversation about the vaccine, leave aside all the data and arguments.
Often we see people trying to persuade by saying ‘OK, here are the facts. Here’s why you should get vaccinated,’ ” Braude said. “But this research says actually what you should ask is ‘OK, why would someone want to get vaccinated?’ and have them go through the process in their own words. That works much better than the persuasion techniques we see people trying to use.
It turns out that 20-44% of people who answered this question, who were asked to TAKE THE EMPATHIC STEP of putting themselves in the shoes of someone wanting to be vaccinated, and then having to describe the reasons why, ended up changing their mind and agreeing to get vaccinated.
Huh. I think I have never done that. Time to learn and use something new.
CMIO’s take? There are so many interesting facets of the human mind. Even amongst physicians and healthcare workers, we have a lot to learn about how humans think, and how we make decisions. We need to harness this for the public good. Who is with me?
In informatics, we often are faced with big data sets and how to make this data comprehensible. Here is an example from cartography. Beautiful graphics, highly usable. We can aspire this “data density” in our own graphics.
My favorite book crafting great information graphics from data, is of course Edward Tufte’s Visual Display of Quantitative Information. He talks about data density, sparklines, lots of cool stuff. AND he has an online course. I have been his disciple for years, and have ALL his books.
The only thing better than gathering and making sense of big data, is being able to explain it clearly to change minds and behavior.
Because we laid all the groundwork and also felt it to be the RIGHT THING FOR PATIENTS, we went ahead and launched our changes in November, and SURPRISE: I still have a job, wasn’t fired. Thanks to our MMOLC sharing community.
A brief reminder
The rule stipulates that patients should be able to receive a copy of
Test Results (laboratory, pathology, radiology) and
Their Provider’s (physicians and advanced practice providers) Progress Notes
upon request. The interpretation was that if a patient had a Patient Portal account in the EHR (electronic health record) of the clinic or health system, this meant immediate release of this information. This is a major change for many health systems who had not yet adopted Open Notes (release of progress notes) or delayed the release of test results by several days.
Since our adoption of Immediate Release
of Progress Notes and Test Results since November of 2020, I have had exactly 2 complaints reach my desk, both from oncologists representing unhappy patients who read their CT imaging study on Friday evening and had difficulty reaching their doc until Monday. This is in the setting of about 1 million clinic visits, 800,000 radiology studies, 30,000 hospital stays, millions of lab and pathology results in these last 4 months.
So, not perfect, but not nearly the “sky is falling” result, as anticipated by many colleagues.
In case you’re still working through this, here are some documents (some updated) that we used. Some are actually named Information SHARING instead of BLOCKING, just a more hopeful attitude. I hope these might help you. Images here, links to full PDFs further down.
Even better, our colleagues at OpenNotes.org are doing some terrific office hours with experts online where you can hear the real-life experience of leaders ALREADY doing this work in various fields, successfully.
CMIO’s take? Are you ready? Do you have documents YOU can share? Lets do this!
The control group (blue line measuring cumulative, or total number of infections of Covid-19 in the control group) grows at a constant rate, as expected.
The vaccine group (red line) rises in parallel for the first 9 days, and then by day 10, BAM the red line is almost completely flat, indicating almost NO infections in the vaccine group. This makes sense, as it takes the body awhile to detect the vaccine antigen (spike protein), then manufacture antibodies in great volume
SO COOL. As Michelle Barron MD, our infection prevention specialist states: “I would have been happy with a vaccine that is 50% effective, like the flu shot some years. This one is 95% effective.”