I am NOT Throwin’ Away My Shot – Covid Vaccine (ukulele)

I wondered what Lin-Manuel meant when he wrote this song. Turns out, it was for THIS moment.

While my colleagues are working hard delivering vaccine doses to healthcare workers as fast as we can (15,000 doses given in the last 5 days! Woo!), I’m hard at work at the Ukulele Parody Studios.

Here it is: the world premiere of a song that seems titled for this moment in time: I am not throwin’ away MY SHOT.

Thanks to Lin-Manuel Miranda for the original, and the overall miracle of the Hamilton musical. No thanks to him, on how hard this song is to sing.

Happy holidays, y’all.

This is the best Covid-19 graph I’ve ever seen

Perhaps the image of the year. Control group vs Vaccine group in the Pfizer trial: see the red line COMPLETELY FLATTEN at 10 days.

The Pfizer vaccine flat-out works. Read the New England Journal of Medicine article yourself; open access:

https://www.nejm.org/doi/10.1056/NEJMoa2034577

But, what’s the TL;DR?

  1. 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.
  2. 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.”

Wow. Hang in there everybody.

I am NOT throwing away my Shot (I got mine today!)

Covid-19 Vaccine! I got mine! And University of Colorado Hospital is set up to give over 1000 doses per day just at our hospital.

As you know, Covid-19 vaccine is out in the wild. Colorado received the first shipment earlier this week, and we at UCHealth received the first 17,000 doses. We set up an infrastructure to schedule vaccinations through My Health Connection, our patient portal. We sent out over 10,000 invitations this week, and already 5000 health care workers have already booked their appointment. IN 48 HOURS! Never have I ever heard of something moving this fast. 97% of physicians/providers state their willingness and intent to be vaccinated.

Among my colleagues, many of us were hitting “refresh” waiting for our invite to schedule the vaccine. Last night, I was super excited receive my invite. Woo! So organized the portal ensures you book both appointments at the same time. Super simple!

Then, super easy on arrival; we use our patient portal to e-check in, verify my demographics, read the consent form for the vaccine, so that my check in can be super simple and super quick. Yes!

And here we are! 8 check-in stations humming smoothly. Everyone masked up, smiling, everyone so excited to be part of DOING SOMETHING to fight back against the pandemic. Bam!

Here we are in our auditorium. Sixteen vaccination stations, with appointments every 10 minutes, and vaccine service hours from 5am through 9pm. I calculate our capacity to vaccinate about 1000 people a day. This just at UCH; we have 9 other vaccine locations throughout UCHealth’s hospitals in Steamboat, Fort Collins, Colorado Springs, Pikes Peak, also actively vaccinating. Our goal: to administer our entire received batch before Christmas day. Zowie!

I got mine! 15 minutes socially distanced in the auditorium to observe for immediate reaction, and then done! In and out in about 30 minutes! Woo!

As you know, the FDA and CDC guidance is: Healthcare workers and long term care residents and staff first (winter), then high risk general public (spring) and then general public (summer). We are getting started, and have infrastructure now to deliver shots just a quickly as possible. We anticipate vaccinating up to 20% of all people of the State of Colorado. Hope to see you here soon!

CMIO’s take? I am NOT throwin’ away MY SHOT! (could it be there is a new ukulele song/rap? … stay tuned!)

Covid Vaccine education: THIS is how you do it (Denver Health Grand Rounds)

Want to know how to teach science that makes sense to scientists as well as the general public? And, it is about Covid vaccine effectiveness and safety. Watch and learn. So proud of our Denver Health Colleagues.

I am unhappy that many physicians and scientists are so bad at educating colleagues and the general public on important topics. We get too much into the weeds, we lose sight of the forest when describing the trees too-up-close.

Dr. Anuj Mehta, a physician at Denver Health held a grand rounds that blows these low expectations out of the water. In 40 minutes, he tells us:

  • How vaccines work in general
  • Why and how the new Covid mRNA vaccines work
  • The actual safety data from the Pfizer, Moderna and AstraZeneca trials
  • How vaccine approval works in the US, and what the FDA and CDC are saying
  • He then summarizes “COVID-19 Vaccine: Reasons Why NOT To Be Scared”

Finally, in our recent surveys of physicians and staff at my organization, over 97% of physicians state they plan to get the vaccine, while only about 65% of medical assistants state this. This speaks to both physician confidence in the science, and also to the concerning gap that we are not teaching our non-physician colleagues adequately about the science and how important this is.

CMIO’s take? 1. This is a tour-de-force, folks. Watch it. Learn. There are brighter days ahead. 2. Please spread the word. Vaccinations will save lives. AND, continue to wear masks and social distance. It all works together.

EHR v Covid-19. Trends in testing, telehealth, hospitalizations

Welcome back to Where does the data lead?!

Here we are eight plus months into the pandemic and our testing volume and our positivity rates have been up and down. Testing volumes have varied because of limitations on receiving re-agents for our labs to process the specimens. It does appear that our test positivity rate, on the red line above, is increasing this month. This is also concordant with our Colorado state level data.

During this time, UCHealth has continued to grow as a system. We have opened a few new facilities in the past year, so the clinic volume, the patient population we serve, as well as the test volume has increased. So, lots going on here, and probably no one factor explains the pattern.

Visit Volumes at UCHealth

Our in-person visit volume for 2020 showed that precipitous drop in mid March (light red) and then nadir at mid April, with gradual recovery to 90% volume by July. At the same time (light green), our telehealth volume exploded at the same time, from a baseline of 20 visits a day, reaching a peak of about 4000 visits a day by mid April. As we figured out how to see patients safely in clinic, our in-person visits gradually returned and our telehealth volume declined, and we are now steady-state at about 1000 telehealth video-visits per day. Magenta is the scheduled telephone visits, a new visit type that Medicare began reimbursing. Blue is the regular telephone volume, essentially unchanged. The dark red is a gradual but consistent increase in patient portal messages, both gratifying that our patients have found a way to connect with their provider, and also worrisome in that this near-doubling of volume does impact the unreimbursed workload of providers in our system.

Cliffhanger

We are now back to our “cliffhanger” TV series. What will happen tomorrow? UCHealth has restarted our Incident Command Center given the increase in hospitalizations. Like many hospitals around the country, we are seeing a bump in inpatients with COVID-19. We had a peak of about 120 in April, then gradually fallen to a nadir of 17 inpatients in late summer, and are back up to mid 50’s this week, and rising.

CMIO’s take? Hang on to your hats.

Telehealth World: CT finds ukulele song partners!

Telehealth Ukulele Song!

Thanks to George Reynolds, CMIO and CIO extraordinaire, who put together a dream team of CMIO leaders to facilitate a course for up-and-coming leaders in the area of informatics. This year, CHIME (the College of Healthcare Information Management Executives) opened up the future-CMIO candidates for this course, to nurse, pharmacist, and other clinical informatics candidates. Our 30 participants this year made this 6-week, 2-hours-live-with-weekly-homework a blast to teach and discuss. That course concluded this week. Here’s how to sign up for future courses through CHIME:

https://ignitedigital.org/clinical-informatics-leadership-boot-camp-digital

We tackled: governance, high performance teams, creating value, leading change, and other topics.

And of course, what would an informatics session be, without some ukulele. Thank you to Amy Sitapati from UCSD, Brian Patty, former CMIO at Rush, and George Reynolds, former CMIO and CIO, and now with CHIME, singing with me.

CMIO’s take? Make music! Make art! You can clearly see, we are not gonna win any awards with our skills, but we sure had a great time putting this together. I am grateful for colleagues willing to stick their necks out to sing with me.

EHR v Covid-19. Telehealth after 6 months at UCHealth

Six months into pandemic, what is happening to telehealth visits at UCHealth? Inquiring minds want to know!

Here we are, data dilettantes, on our long journey into the unknown.

At the prompting of online colleague John Lynn, we look back at telehealth usage at UCHealth in the past few months. The above graph depicts January 1 to present, the curve of in-person visits at UCHealth (purple) and telehealth visits (cyan). You see that telehealth visits temporarily outpaced in-person visits.

First of all, I feel very sophisticated for writing “cyan” instead of my first (caveman-male) instinct “blue-ish”.

Second of all, notice the curve above compared to our evolving curve from March, 5 months ago (remember, those purple divots are from Thanksgiving and Xmas holidays):

Be careful how you extrapolate, right? Based on this original, one would have thought “Holy Smokes! Telehealth is going to rule the world in a few more weeks!”

And one would have been wrong.

So, now it comes upon us Armchair Data Scientists to hypothesize: why? Why did the curve do what it did? Well, our first external data point is: Colorado Governor’s Safer-At-Home order expired on April 26. On the top graph, this corresponds to the day our 2 lines cross in April, with in-person visits rising again. This also corresponds to our surgery clinics opening up again to see patients.

Averaging the last few weeks of data, we are seeing about 8000 telehealth visits vs 60,000 in-person. Or about 13-15% of appointments being conducted by telehealth. REMEMBER, this is unvalidated data, so, take with some salt.

What have we learned? From anecdotal evidence, I have heard from quite a few patients (most of mine are over 65) that they prefer in-person visits when possible, although telehealth has been “acceptable” when fears of contagion are high. Also, much of internal medicine requires blood testing, vital signs monitoring, examination. Also, I’m finding that non-verbal communication, although “acceptable” via telehealth (tone of voice, body language), it is much richer in-person.

Even when we were conducting 2/3 of clinic sessions exclusively by telehealth, our in-person clinic slots were full, and our telehealth clinics routinely had open time slots. Now that we are scheduling 75% in-person, all our in-person slots are full, and our telehealth slots still sometimes are open.

It will take some intrepid ethnographic researcher to pull interesting trends out of this, as I’m hearing from other parts of the country that telehealth visits are preferred to in-person. Is this: geography and distance needed to travel? Is it the rarity of the specialist’s expertise? Is it access to surgeons? Is it the (gasp) lack of skill of the telehealth provider (please, no)?

We are also still struggling with CMS (Medicare) regulations that, for example, for home vital signs to be “acceptable” for quality reporting, either the MA or the provider MUST view the actual blood pressure from the display of the machine over the video link, or view a printout from the machine, otherwise it “doesn’t count.” Hmm. I get why administrators want good data provenance (proof of authenticity), but isn’t telehealth hard enough? Why make it even harder for patients and docs? Who is going to be so motivated to PAY their co-pay for a telehealth visit, have that visit, and then LIE about their actual blood pressure reading at home, so that they “look good” for the doc, or the doc can “look good” for the regulators, payors? Ridiculous.

Nevertheless, our pandemic / telehealth story evolves. With the fall approaching, schools reopening, flu season coming, watch this space for what happens next.

Things are briefly, perhaps, not as dire as in March and April, in Colorado.

CMIO’s take? Telehealth was gangbusters in March, April, and is now settling down to 13-20% of total volume of clinic visits. We are back to 95% of original clinic volumes (in person plus telehealth together), so there are still some patients who haven’t returned to see us. And, although we have learned a lot, I think we still haven’t optimized “best practice” on when to use telehealth with patients. I think there are still some adjustments and opportunities out there. Let me know in the comments what you’re seeing!

EHR v Covid-19: MDPOA (power of attorney) & Advance Care Plans and the Covid BUMP

Full open-access paper here. https://preprints.jmir.org/preprint/21385/accepted

What I love about working in an academic health center is the luxury of being surrounded by people smarter, and more hardworking than I am. Here are Drs. Portz and Lum analyzing our data on the capture of patient’s Advance Care Plans – ACPs (including the Medical Durable Power of Attorney MDPOA) and other documents online via our patient portal.

We believe we are among the first in the country to offer the ability for patients to complete this online and designate a medical decision-maker in the event of their incapacity. Furthermore, we now accept photos of documents (easy and convenient via our patient portal app integrated with a smartphone camera — hooray modern tools for modern medicine) into the patient chart, and can see signatures, names, contact information, and details of MDPOAs, Living Wills and other ACPs.

And, during the anxieties of the pandemic, we had a significant uptick in patients completing the MDPOA and uploading images.

CMIO’s take? Another publication for our smart colleagues — good. Better patient care — great.

EHR v Covid-19. Taiwan, EHR and effective pandemic response leads to economic growth

image from Statnews

https://www.statnews.com/2020/06/30/taiwan-lessons-fighting-covid-19-using-electronic-health-records/

It is fascinating, inspiring (and disappointing) to see effective responses to the Covid pandemic from other countries. Great partnerships and effective connection of governmental leadership, industrial production, and healthcare information can combine to combat the pandemic.

Taiwan has had only 446 cases and 7 deaths, for 24 million residents, since the start of the pandemic, despite their proximity to, and the frequent travel and many flights to and from China.

EHR v Covid-19. rt.live; a fascinating way to look at state-by-state data

https://rt.live/

One my good colleagues Dr. Patrick Guffey turned me on to this website, that takes publicly available Public Health data and turns it into a graph projecting the current R(0) or infectivity rate, per state. I have found it to be compelling, and it reflects what we are hearing in reports from various states.

Consider adding this to your usual litany of sites monitoring the pandemic. I come and refresh my website view each day.