Category: Informatics/EHR

Electronic Health Records and Clinical Informatics

Advances in PGx (Pharmacogenomic or Drug-gene interaction) at UCHealth (guest bloggers Dr. Christine Aquilante and Dr. David Kao)

Pharmacogenomics is advancing quickly: we can warn prescribers in the EHR when patients have genomic variants that reduce medication effectiveness. We are going from screening populations (18,000 so far), to anticipatory screening for high risk patients (cancer center patients about to choose a chemotherapy). Cool.

Previously, at the Colorado Center for Personalized Medicine…  

In December 2021, our heroes (CCPM in partnership with UCHealth) began releasing clinical pharmacogenetic test results for CYP2C19 and SLCO1B1 to the Epic electronic health records for CCPM biobank participants.

Eighteen months later, our program has flown to new heights.  We have returned results to over 18,000 biobank participants, which have impacted the care of over 2,600 patients.  We have expanded our program to include an additional 5 PGx genes (DPYD, TPMT, NUDT15, CYP2C9, ABCG2), 4 of which went into production the last week of April.  Altogether, these genes impact the effects of 30 different medications ranging from antidepressants to anti-inflammatories to chemotherapies!   

  

Meanwhile, back at CCPM headquarters…  

Our heroes continue to return high impact genetic variants with potentially life-changing and life-saving impacts for biobank participants and just as importantly, their families.  Our biobank lab and genetic counselor team have returned results for around 30 of these genes to over 250 patients.  As a result of this effort, many patients have been referred to specialists for evaluation and monitoring to identify and treat any concerning conditions as early as possible. In many cases, participants’ siblings and even children are also being tested, often when they otherwise wouldn’t have, giving them the power to battle the villains of genetic disease.     

 Join us next time…  

When we begin performing clinical-first tests for chemotherapies used to treat certain kinds of cancer and medications to reduce the side effects of chemo.  This will be our biggest challenge yet, adding an additional 2 genes, including CYP2D6, which has the potential to affect over 20 medications that treat a host of different conditions. We will start returning non-PGx results to the EHR electronically as well and use invisible data science superpowers within the EHR to identify UCHealth patients most likely to benefit from pre-emptive pharmacogenetic testing. 

CCPM and UCHealth were leading the charge toward use of genetics for clinical care 18 months ago, and our program has grown exponentially since then.  Thank you for joining us for the next phase of our adventure!  

(Photo by Patrick Campbell/University of Colorado)

Christina Aquilante, PharmD
Professor, Department of Pharmaceutical Sciences
University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences
Director of Pharmacogenomics, Colorado Center for Personalized Medicine

David Kao, MDAssociate Professor of MedicineDivisions of Cardiology and Biomedical Informatics/Personalized MedicineUniversity of Colorado School of MedicineMedical Director, Colorado Center for Personalized MedicineMedical Director, CARE Innovations Center, UCHealth

Designing for Health podcast (Salmi, Steitz, Lin) on Patients Receiving Test Results ImmediatelyC

Caution: humor and high quality research facts ahead! What percent of patients worry? What percent of patients prefer immediate release even if result is abnormal? There are research findings?

 

https://www.nordicglobal.com/blog/designing-for-health-interview-with-ct-lin-md-liz-salmi-and-bryan-steitz-phd-podcast

Listen in! This was a great conversation, with Drs. Steitz of Vanderbilt University and Liz Salmi, citizen scientist, patient researcher, punk rock star. I’m there too. Interviewed by Jerome Pagani and Craig Joseph MD. Will there be ukulele?

Here’s the paper:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10028486/

Podcast: Designing for Health: Do patients want to see their test results immediately? (hint: 96% say yes)

Come join us! Dr. Bryan Steiz, first author, Liz Salmi, Chief Patient Informaticist, and I discuss our recent publication on the subject of patients accessing their test results online BEFORE their doctor can inform them. This poses a host of gnarly questions that had no data, no answers … UNTIL NOW. 

 

https://t.co/Tlk1a9hj0c

 

HERE IT IS! EMOJI’s Have Arrived in Epic Secure Chat

It is hard to express the excitement I have for this tiny little (yet disproportionately huge) development in our Unified Communications strategy

To those NOT on the Epic EHR journey, or those who have NOT been implementing “secure chat” tools in their organization, this may not seem like a big deal.

It is.

The challenge? Secure chat is terrific when you’re the sender, you can reach a LOT of colleagues by texting on your smartphone. HOWEVER, there is such a thing as “TOO MUCH OF A GOOD THING.” Some of our residents are receiving upwards of 400 secure chat interruptions PER DAY.

How can one even think, much less be effective as a physician / APP / resident caring for patients?

One of the unwanted interruptions is the expression of “Thank you!” when grateful for a rapid and effective response from a colleague. And YES, we do want to increase our mutual expression of gratitude to build trust and a sense of teamwork and human connection.

HOWEVER! This “Thank you” can come when the physician is scrubbed in to a surgical case, and we can’t tell when something is an new message or a “Thank you.”

One tool we have been begging our Epic Wisconsin developers for, is a NON-interruptive EMOJI that allows the reply with a THUMBS UP or SMILE or SURPRISE or CRY or HEART, that is NOT interruptive but shows up the next time that person checks their phone.

As a result? WIN-WIN! We give gratitude, feel a sense of connection AND the recipient does NOT receive another interruption, but can digest that reply at their leisure.

WELL, your wait is over, UCHealth colleagues, we have installed this Epic version update and now: HOVER OVER (on computer) or TAP AND HOLD (on phone) the message and you too, can send non-interruptive THANK YOU emoji’s.

Now, I’m going to go send our Epic Wisconsin colleagues an nice THUMBS UP.

AI and reinventing learning in health systems (Beckers podcast, with ME!)

Where Bobby Zarr and I discuss the future of learning in health systems, with AI embedded in tools like the ones in our Learning Assistant, what we internally brand our education from uPerform. 

https://www.beckershospitalreview.com/podcasts/podcasts-beckers-hospital-review/ai-and-the-future-of-ehr-training—with-uperform-118045831.html

 

Blowing up the training classroom; also putting Roadsigns on the Highway in the EHR

Aren’t you frustrated with EHR usability? Don’t you wish you could see just-in-time guidance in the EHR? If the US Highway system can put signs on the highway, why can’t we?

From Dall-E image creation via Bing.AI browser

AMIA Panel: Signs on the roadway with Dr. CT Lin and Dr. Ryan Walsh

I enjoyed our panel discussion, encompassing two related topics:

  1. Replacing the old model of onboard classroom training for new physicians/APP’s/nurses/MA’s/staff for 8 to 24 hours, with self-paced learning modules that follow simulation training and adult learning principles
  2. Hacking the EHR to insert tips and tricks just-in-time, right where we anticipate our EHR users (physicians, APP’s etc) to get stuck with more challenging tasks. Or as we call it, Putting Signs on the Roadway.

From Dall-E via Bing.AI

CMIO’s take? We have found success with our technology innovation partners, uPerform and Amplifire. Click the link to learn!

The Fatal Uber Self Driving Car Saga is Over (NYTimes) and Automation Complacency

The classic case of the Uber self driving car, in-person monitor, and the fatal pedestrian accident, is now legally concluded. A sober reminder of ALL OUR complacencies. Or paraphrasing Shakespeare: “But, soft ye now, the fair Ophelia, nymph in thy orisons, be all my complacencies remembered.”

https://www.wired.com/story/ubers-fatal-self-driving-car-crash-saga-over-operator-avoids-prison/

This made news a few years ago: a self driving Uber, under testing with a monitoring person in the driver seat, hit and killed a pedestrian (who was not as a crosswalk).

The monitoring driver plead guilty to reckless endangerment and will avoid prison time.

This reminds us of the constant and growing influence of AI and automation on our daily lives. We are all less vigilant when an assistant gets really good. Maybe 99% effective, maybe 99.9, 99.999, like with self-driving vehicles. What happens to the 0.001%?

Recently I was criticized by a medical colleague because “I wrote a prescription for a muscle relaxer, and it caused a drug interaction with the patient’s birth control medication. Epic did NOT stop me, and it should have.” The implication was, that it was Epic’s fault, and thus, those who configure Epic (CT Lin and his henchmen).

CMIO’s take? Classic automation complacency. We give the automation power over our daily lives and we stop watching carefully. Have you seen this in your work? Let me know.

Information Blocking / Sharing NEW UPDATE summer 2023

Any health systems still struggling with decisions about sharing Open Notes and Open Test Results, and how to build a win-win-win relationship between physicians/APP’s, patients and hospital leadership? Here you go, the result of years of building together at UCHealth

https://www.dropbox.com/s/y2449iiq8xles9m/2023-06%20Info%20Blocking%20Immediate%20Results%20Release%20White%20Paper%20SBAR.pdf?dl=0

The general idea of information sharing between a clinic / hospital / physician/APP and their patients seems like “Mom and Apple Pie”. However, the devil is in the details. How do we approach this at UCHealth?

We do have over 2 decades of discussion on these topics, and these are now distilled for you. I’ve published earlier versions of this document (search info blocking on my blog and you’ll get them).

I was prompted by hospital leadership, as we rebuilt our “physician/APP onboarding” education plan, on how to explain Open Notes and Open Results to our newest providers. I thought of including our latest document from 2020 (wow, that is 6 internet generations ago!), but there were lots of outdated statements.

CMIO’s take? Here you go! My up-to-date version of Information Blocking / Sharing / Open Notes, Open Results introductory document for our newest colleagues at UCHealth; feel free to share amongst yourselves. If you make improvements, please let me know! We’re always looking to improve.

Grok the Bones of a Good Story (a talk proposal for CHIME fall forum 2023)

Here’s a sneak peak at my newest talk. Did someone’s story defeat your data-driven brilliant proposal? Do you understand why? Like me, did you go crawl under a rock and wonder “wtf”? With luck, I’ll share this talk in November.

 

This is my proposal for CHIME fall forum. Storytelling for Leaders.

And recently given as a talk for UCSF’s Rehab Informatics Group.

If all the stars align, maybe I’ll see you in November?!

Give us feedback on EHR optimization at your health system (from UCHealth and UVermont)

Do you struggle with EHR workflow and optimization? Do you have an optimization team where you work? Can you tell us about it? We’re gathering a national feedback sample. Come help make things better!

Dear informatics colleagues, 
 
As leaders in healthcare and clinical informatics, we appreciate the opportunity to learn about and share information about best practices at our organizations. This brief, 7-10 minute survey is our attempt to gain and consolidate feedback on the current state of clinical informatics and EHR optimization. Our goal is to distribute that information either through peer-reviewed publication or survey result distribution by the end of the calendar year. 

Survey link:  https://redcap.link/Keeping_up_with_the_EHR_survey

Thank you for your time and attention.

Rachel and Amber

Rachel K. McEntee, MD | she, her, hers
Assistant Professor, Hospital Medicine
Associate Chief Medical Information OfficerThe University of Vermont Health Network
https://www.linkedin.com/in/rachel-mcentee-md-9328729/

Amber Sieja, MD | she, her, hers
Professor of Medicine | University of Colorado School of Medicine
Director, UCHealth Sprint EHR Optimization and Training Program
Senior Medical Director of Informatics, UCHealth and Ambulatory Services
https://www.linkedin.com/in/amber-sieja-4058b777/

%d bloggers like this: