City Scooters: an informatics viewpoint

A colleague and I were recently making fun of tourists and others riding the city scooters around Seattle and other large cities. Nearly no one was wearing helmets, they’re zipping in and out of traffic, going up against SUV’s and 16 wheelers. Just asking for it. Now, it is true that Seattle has some the best bike lanes around, with dedicated ‘green lights’ just for bike lanes, to improve safety. It IS a bike friendly town.

As an aside, my son and daughter, when they were 9 and 11, were riding their Razor scooters to the park, when I overheard them:

S: my scooter has a turbo boost to go fast.

D: oh yeah? My scooter has jets.

S: So, my scooter shoots out flames

D: Well, my scooter has apps, and I can download anything and plug it in to make mine better.

Wow, kids of the smartphone age.

I thought of my children, while I hopped on this scooter, downloaded an app to unlock and pay for a day of scooting, used Google maps to find the Art museum, used Yelp to find a good chinese noodle place, and Weather to see if I needed a rain jacket. All from one device. We are living in the future, folks.

So I’m humbled to report, dear reader, that I stooped to try one myself. I have returned from that ‘undiscovered country from whose bourn no traveler returns’. Hmm. Not exactly, but you get my meaning.

Seattle Chinatown gate

Here are some quick personal observations.

$ a city scooter is a nuisance – Some folks ride the scooter on the sidewalk, endangering pedestrians. Then they ride the scooter down wrong way streets against traffic endangering themselves. Often though, they ride in the many bike lanes, merging easily with bike traffic and other electric motor powered personal transport. It even looks harmonious!

$ a city scooter is a danger to the rider. There’s no way I would ride one. Okay maybe once. Okay, I’m pretty tired after my bike ride yesterday and maybe I could try it. At least it will be an interesting blog post. Hey this is scary. Hmm. Good design, my first ride is speed limited so as to protect the newbie. Wow, after a half mile of starts and stops I’m getting the hang of this and can’t wait to unlock a full speed ride. Zoom! Full speed second ride! This is a blast!

$ A city scooter is an app. The founders of this idea realized that their potential customer base is THE ENTIRE CITY of people who have a smartphone and need to get somewhere. With a QR code, snap a pic, set up an account, and in 3 minutes you’re on your first ride. Clever.

Museum of pop culture. Where are the ukuleles?

$ a city scooter is transportation disambiguated. I’m here in Seattle for an organized bike ride later, but don’t want to put my nice bike on the street with a lock. This is a great alternative: scooters on many street corners with an app-map to show you the nearest. Then, when you arrive, park (safely) and leave it.

$ a city scooter is micropayments. Even better with a day pass. $7 per ride or $21 per day, up to 6 rides. Cool. It’s like you own a fleet of scooters all over town.

$ a city scooter is a network which grows in value with more nodes. And Seattle supports several! not only are there Link scooters, but Lime scooters and bikes, and several other brands of mobility. Unlike the first generation of e bikes that required charging and locking stations, these can be left any where for convenience as long as they don’t obstruct.

$ a city scooter is an information highway. Interesting to think about what data is reported in real time, what adjustments leadership and management need to make to redeploy, fix, recharge, see where the scooters are needed and ‘rebalance’ their locations.

Seattle art museum

$ a city scooter is modular. The components of the network are easily swappable. Riders will report issues, the scooter will tell when the battery is low or needs repair. It is self-repairing as a network.

$ a city scooter has to gain popularity while promoting safety. After my second ride I received a mandatory quiz: which scooters are parked legally? What are the relevant city laws that apply to me? And yet there is the need to grow the business, so ‘helmets are required’ but a photo proof of a helmet is not required. ‘Photo proof of parking correctly’ is required. Hmm.

$ a city scooter has soooo many customers: the city government, employees, riders, the driving and waking public, shareholders. it is interesting also to think about how many city regulations had to be addressed and met, how the public perception must be managed, how the pricing and profit models have to continually be tweaked. Is there ‘surge pricing’ like with Uber? How do you balance all these demands and make a profit? What are the guiding principles?

Well, you recognize this one

$ a city scooter shrinks a city. This is perhaps my most profound observation. After the first nervous scoot, I had a face-splitting grin the entire time I was riding. Kick start, push the thumb lever and ZOOM I could see the city literally shrink in size as I rode. Blocks whizzed by, hills flattened, and I was master of the domain, blending into bike lane traffic with all my best friends. From Pike Place Market to the Space Needle and Museum of Pop Culture to the Seattle Art Museum to Biang Biang Noodles and back to the hotel. So easy.

CMIO’s take? Multi-dimensional thinking like this is common in healthcare informatics. I enjoy thinking, feeling, and working through hard problems like this. Do you? If so, come join our ranks! We and the larger healthcare industry need your brains and emotional intelligence.

Ethics Grand Rounds: The Ethical Issues with Open Notes and Open Results (CT Lin @ uchealth)

Hear about: Anticipatory Guidance, Cancer Diagnoses revealed online, Risk of marginalization, the Ethics of Ethics notes, and more…

Here’s a link to our University of Colorado, Anschutz Medical Campus, Ethics Grand Rounds with our topic: Ethical Issues with Open Notes and Open Results.

Thanks to all who participated; a robust conversation about the value of information transparency, leavened with concerns about worsening disparity for the digital divide, language and cultural barriers, the unintended disclosure of bad medical news, other unintended consequences of immediate transparency to progress notes and results.

For example: A medicine service is treating a patient. There are suspicions that there may be domestic violence at home. Team calls “Ethics consult: shall we call Adult Protective Services before the patient returns home from hospital?” Should this note be shown to the patient / family? Could a family member gain access to this note which then CREATES a problem when none existed before?

This and more!

My newest ukulele EHR parody song: Inbasket Dynamite

Has anyone ever written a K-pop anthem into an EHR parody? Is it possible to set an hyperobject to music? Regrettably, someone has tried.

CT’s at it again: doesn’t he ever learn?

It is great to be back together among our tribe of informaticists at Epic’s XGM (eXpert Group Meeting) in Verona, Wisconsin, where the best and the brightest share our work, our leadership and change management lessons, and celebrate our successes.

Inbasket Dynamite refers to the Hyperobject that is the EHR inbasket, the nerve center of communications that, like the post office, can grow to unmanageable size and could contribute to physician and provider burnout. Time to “light it up” and redesign it.

I’m on stage at the Epic Physician Advisory Council (PAC) reception, grateful to receive the 2021 PACademy Award (physician of the year) from the voting of our international physician informatics community, along with Heidi Twedt (2020 awardee) and Joel Buchanan (2022 awardee). Due to the pandemic, we have missed the last 2 years of the PAC meeting in person, so this is our catch-up. I’m honored to be in such company.

If you’re not a BTS fanatic, like we are at our house, here are a couple of videos to whet your appetite:

My son Avery covering BTS’s dance moves in Dynamite, for the pure joy of it:

And, one of the official BTS music videos on Dynamite. Many of their videos have been viewed over a billion times (ahem, a Billion):

Patients View their Own Radiology Images Online: first published experience (UCHealth)

What uses did they find for these images? Does UCHealth recommend this practice? Did CT Lin get fired as a result of these actions? #hcldr #whyinformatics #hitsm #hotoffthepress

From freepixel via JMIR

https://formative.jmir.org/2022/4/e29496

We surveyed patients who had access to view NOT ONLY their radiology reports BUT ALSO their radiology images (including plain film, CT, MRI, PET, etc) online via the EHR patient portal.

What did they think? Were they worried? Did they post the images online? Who did they share with? (hint, 4% shared on social media)

These questions, and more, are answered in the article. Click the link above, dear Reader, and press on.

HIMSStv: video interview about innovation and RxRevu, real-time benefits at UCHealth

We talk about EHR optimization, clinician burnout, real-time prescription cost data

https://himsstv.brightcovegallery.com/category/videos/cio-spotlight?trk=organization-update-content_share-embed-video_share-article#/overlay/6303639594001

“The useful part of a pot is where there is no pot” -Audrey Tang, Digital Minister of Taiwan

Hollowed out
clay makes a pot.
Where the pot’s not
Is where its useful.

Poem 11

Thirty spokes
meet in a hub.
Where the wheel isn’t
Is where it is useful.

Hollowed out
clay makes a pot.
Where the pot’s not
Is where its useful.

Cut doors and windows
to make a room.
Where the room isn’t,
there room for you.

So the profit in what is
is in the use of what isn’t.

Taken from Ursula LeGuin’s version of the Tao Te Ching

https://www.wired.com/video/watch/wired25-2020-audrey-tang-taiwan-covid-19-pandemic

Watch this video/ read the transcript. I love this for several reasons:

  • The Taiwanese are my people
  • “Digital Minister” is the best title of all time
  • Taiwan’s national response to COVID is a model for the world (Taiwan: fewer than 1 death per 100,000 vs USA: 66 deaths per 100,000)
  • The transparency of information and the building of trust: the government published its COVID and mask data with open API’s so private industry and nonprofits could build 100’s of apps to improve healthcare and the commonwealth
  • The POETRY of Taoism!

CMIO’s take? It is worth a watch. Informatics applied effectively at the national level. And, bonus: mindful Taoist philosophy applied to transparency of information. Zowie!

Clinical Informatics Leadership Bootcamp, CHIME, Salt Lake, May 2022 (I’m teaching!)

What will CT Lin be teaching at the next Informatics Leadership Bootcamp? And, will there be ukulele?

Our discussion and workshop agenda includes:

Clinical Informatics Success Factors

1. Shaping Transformational Strategy: Role of Innovation

2. Leading Change in Dynamic Times: Monitor and Influence the Dynamics of Adaptive Change

3. Driving Consumerism & Patient Engagement: Ensure Continuous Customer Satisfaction

4. Achieving Organizational Value: Demonstrate Clinical Informatics Business Value

5. Developing High Performance Teams: Orchestrate a High Performing Organization

6. Building Networks and Community: Cultivate Collaboration for Mutual Benefit 

Come join us, or forward to a colleague!

A picture of change (and inspiration for informatics. NYTimes)

From the Metropolitan Museum of Art via NYTimes: a Japanese Print to teach us about the modern world

The artistry in our journalism can be remarkable. Spend a few minutes zooming in and out of this Japanese print with Mr. Farago. It is inspiring and completely engrossing.

From an informatics perspective, can we take an EHR screenshot, and zoom in and out as entertainingly? Could we =gasp= make learning about EHR’s as engaging as an art exhibit?

The Pyramid of Possibility: explaining informatics to others

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.

https://www.dropbox.com/s/b6a7dn1hix5kf6j/2022%20EHR%20Pyramid%20of%20Possibility%20CTL.pdf?dl=0

CMIO’s take? Hope you like it and maybe find it useful. Did you make a better version? Let me know!

Parkview Epic go live 3/10. A panoply of ukulele parody songs?

Funny how after the hard work, the long planning hours, the anxiety about building a robust system for colleagues to use to care for patients, it boils down to this. At least in my world.

Recounting our go lives, in our 12-hospital pluse 4-affiliate-hospital system on our Epic EHR instance, this is my 8th hospital go live event (sometimes several hospitals at once) over last 11 years (this does not enumerate the countless clinic go lives we have engineered over the past decade).

The funny thing is, my debut as a ukulele EHR parody performer coincides with our initial Epic go live at the University of Colorado Hospital in September of 2011. I played ‘Epic Man’ for our 50 member command center, a sea of red shirts fielding 7000 complaint calls in the first 5 days from angry doctors and nurses who couldn’t believe we had moved all of their cheeses.

What you may not know is that I’m strongly introverted, and that day almost didn’t happen. My introverted daughter, a tweenager at the time, and super-embarrassed about everything her parents did, saw me planning to take my uke to work and told me: ‘Dad, you’re NOT going to take that to work, are you?! You KNOW you can’t sing, right?!?

Sigh. Fortunately, I overcame that hesitation and brought it anyway. A few years later, I played the same song on the Epic Wisconsin campus:

I thought I would lay out some of the uke parody songs I’ve written over the last 11 years since that fateful day. Last count: 24 songs on my YouTube channel, 12 not yet recorded. Yes, more than you wanted to know!

Hospital of the Rising Sun – pandemic version

Click on me (Epic Command Center)

COVID sea shanty

I’ve been everywhere man (UCHealth geography)

I am not throwin’ away My Shot (COVID)

Morphine (apologies to Eric Clapton’s Cocaine – e-prescribe controlled subst)

UCHealth Rocky Mountain High

Ortho virtual care (Louis Armstrong’s Wonderful World)

Telehealth world (multiple CT Lins – you can never unsee this)

Yampa roads (epic central)

We are physician builders, my friends …

Slicer dicer (coincidentally has the same # of syllables as “Helter Skelter”)

Doc Prudence (Open Notes)

RTBC: Empty wallet. https://youtu.be/EFEapU0EjlI

Everyone knows it’s Becky (practice transformation)

I can see clearly now, my sprain is gone (patients viewing radiology images)

Dear burned out colleague (thank you, Hamilton)

If you’re going to Yampa Valley (If you’re going to San Francisco…)

Yampa Roads (Country Roads)

Another brick in the wall (with apologies to Pink Floyd)

Pina colada EHR analytics

Wonderful world (Epic)

Hospital of the rising sun (original)

If the stars align, we may have future recordings of …

  • Inbasket Dynamite (BTS!)
  • You got a friend in me (Academy Award winner, actually needs NO parody words to be a perfect informatics song).
  • Workstations on wheels (proud mary)
  • Urology optimization (59th street bridge)
  • Clinical decision support (here comes the sun)
  • Billie Jean for PGx (pharmacogenomics)
  • Disruption – tradition (fiddler on the roof)
  • Super grouch (super freak)
  • Wild horses (Rolling Stones)
  • Scanners lament (500 miles)
  • Betty and the RAC (Elton John)
  • Home (Phillip Phillips)
Chimerealism

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