A Good Covid Vaccination Is Like Calligraphy

Join CT on the front line of vaccine clinic at UCHealth!

Hi y’all! I volunteered for a vaccine shift. Me and a couple dozen of my best friends. Here’s the scene: this clinic day was dedicated to second-vaccine doses for nearly 1000 healthcare colleagues, 12 vaccinator stations, and a constant stream of patients down the hallway. Our location can handle 2-3x this number, if we had vaccine supply to do so (and on last Friday, our location and 9 other UCHealth vaccine locations dispensed over 5000 vaccine doses across UCHealth).

Having been a grateful recipient of both my shots, I’m ready to wade in and do my part as well.

Ever wonder what it is like to be a vaccinator at a high-volume vaccine clinic?

On the Vaccine Front Line

First, you receive an email to take your training on EHR documentation requirements ahead of time, and a super quick anatomy refresher on deltoid muscle and intramuscular injections. Easily done, about 10 minutes. Then you report for duty at one of the twice daily 7-hour shifts. You get a quick in-person briefing, some quick hand-holding (ok sounds weird in pandemic times), and off we go!

Here’s my station. Because, as my daughter says, I’m totally into ‘hume-optimizing’ (determining the optimal way for humans to do things – sometimes to the great annoyance of family members or colleagues: sorry y’all) I thought hard and asked lots of questions of my more experienced medical assistants and nurses sitting nearby. Here’s what I learned:

  • Card colors: Green card: hold in air when ready for another patient; Yellow card: running out of any supplies; Red card: medical question (just embarrassing to hold this one up if you’re a physician)
  • Computer: login, find the immunization clinic, filter out discharged patients, sort by time of arrival, click to remove word-wrap to show more patients per screen.
  • The data entry fields pull forward 80% of relevant data to each new patient, as well as the vaccine name, lot#, and details, and I’m down to just confirming patient identity, confirming injection site (6- R deltoid, 7-L deltoid: even the physical mapping makes it easy: when patient facing you, the 6 key is on the same side as the patient’s R arm!), asking the 3 screening Q.
  • Then the shot itself! Vaccine syringe (obvious) but don’t stick yourself or the patient unintentionally. (HOT TIP) And when you insert the needle, do it with a quick pop so that breaking the skin and finishing the motion are in the same moment and the patient’s sensory nerves don’t get a chance to register more than one ‘oh’ of surprise. Specifically, don’t be slow.
  • (HOT TIP from a PA colleague in Interventional Radiology) hold the syringe between your thumb and 3rd and 4th digits, with your index positioned over the plunger. Really? That’s the way? (Sooooo much faster than my jab, then switch hands, try not to be awkward, plunge, untangle my hands and pull back) and the jab+plunge was now less than a second. Level up! (Gamer talk). After my “technique improvement” lots of patients were surprised: “Hey! Didn’t feel that at all!”
https://www.jacksonsart.com/blog/2017/03/28/maggie-cross-chinese-painting/
  • (Irrelevant aside) I notice that this new syringe grasp is reminiscent of the way you are to hold a Chinese Calligraphy brush, like you are cupping an egg and then grasping the brush. Ah, such elegance.
  • (HOT TIP From a brilliant nurse colleague) After the alcohol swab of the deltoid, pre-attach half of the bandaid and let it hang down. That way, you know where to put the shot and you don’t lose track (if no spot of blood) of where it went as you look away to dispose of the syringe. Then flip the bandaid fully on, VOILA! Totally changed my life.
  • Click the needle protector closed with one finger, toss in Sharps container.
  • Mumble sweet nothings to your anxious client while doing the next steps. Answer any questions.
  • Type ‘n’ in the time field to get the time Now. Click Accept to complete the vaccine charting. Their patient portal account is automatically updated, and the State Vaccine Registry is updated (I believe either real-time or at midnight every night)! Add 15 minutes to write onto a sticky note to attach to their vaccine card for them to know when they can leave if feeling okay.
  • Reach for a tiny sticker to put on the vaccine card with vaccine name, lot#, date, location.
  • Smile with your eyes, gesture to the seating area.
  • (HOT TIP from another RN colleague): Wipe down: with gloves on, pull an antiseptic wipe for the desk, chair, relevant surfaces. Whip off gloves, rip and prep an alcohol swab and bandaid —easier with gloves off. New pair of gloves, position a new syringe on desk, check if running low on supplies, raise the green card.
  • NEXT! Cycle time when all was humming, as little as 3 minutes. Less time than it took to read this.

Of course, GEEZ some patients had the temerity to ask questions. Or we would briefly run low on vaccine as the pharmacy team whipped up another batch in the next room, or someone had to run for sticky notes or wipes or gloves etc. Or maybe I NEEDED A POTTY BREAK, OK? Other times, we would have lulls in the action. Then it was up to our green-card-waving skills as to which of a half dozen vaccinators the lone patient would walk to.

Here’s a counterintuitive tip for non-medical workers.

You might think that having your vaccine done by a person in green scrubs or a white coat (in my case, both) would be ideal: they’re the doctors or providers. In our organization, nurses wear dark blue scrubs, medical assistants wear dark purple (violet?). Almost uniformly, the docs volunteering haven’t given vaccinations since … medical school. In my case, 30+ years ago. My recommendation: go with blue or violet scrubs for technical proficiency and years of practice. Of course, if you want a long medical conversation, by all means stop by my booth!

Here’s my tally. Actually 55 by end of day. I figured out that I could keep my needle caps on the desk until I had a break to make my hash marks and throw out the caps. The system worked. I know many of my RN and MA partners were quicker than me or had better patient-attracting green-card-waving skills or took shorter breaks. Not bad for my first half-day shift.

This was unlike my daily work.

As a physician in an internal medicine clinic I would worry about how to reduce the blood sugar of an overweight, depressed and anxious diabetes patient with high blood pressure, severe arthritis, needing wheelchair repairs, a dozen prescription refills and several prior-authorization meds, and now with several new worrisome symptoms and family pressures. As CMIO I would worry about how to balance the anger of providers spending long hours writing notes and orders versus allowing a sloppy, error-prone verbal-order paper-like system. And how to allocate time and effort between reducing physician burnout and improving predictive algorithms when those projects were sometimes in conflict.

Working in a vaccine clinic by contrast was like playing a fun, fast-paced, team-based video game (not that I would know): clear goals, mutual reinforcement, visible progress, strong team camaraderie, repetitive (and improving) physical skills, opportunities for rapid learning, immediate positive feedback and customer appreciation, excitement over doing a public good. We were IN THE ZONE.

Honestly, on good days, both regular clinic and informatics work is like this too.

What’s not to like?

Oh, here’s one of our physician leaders, Dr. Andy Meacham, even with everything he knows about how docs are the worst vaccinators, willing to be my victim. Thank you for your service, Dr. Meacham.

Gratitude

Honestly, it humbles me to part of such an amazing organization that assembled the people, the process, the tools so that I could drop in as part of a well-oiled machine, only a couple weeks into this brand new process. I’ve noted quite a few physician leader colleagues also taking part. So cool. 

“Covid-19, Yes, Your Days are Numbered! We’ll take back our streets and those jobs you’ve plundered!” — CT Lin & his terrible (My Shot – Covid) ukulele song

If all this talk gets you interested in the vaccine, See my recent blog post on how to get in line for a vaccine at UCHealth

CMIO’s take? Serving as a Covid Vaccine vaccinator was one of the most gratifying things I’ve done. I’m signing up for more shifts. See you soon!

Sign up for COVID Vaccine at UCHealth. (The EHR is our superpower).

UCHealth, like all health systems across the state of Colorado, are following the guidance of the Colorado Department of Public Health and Environment (CDPHE). As the guidelines change (sometimes daily!) we follow the guidelines. Our supply of COVID-19 Vaccine is closely tracked, and each next shipment depends on our adherence to guidelines.

The change

We are now opening up vaccination signups to segments of the general public beyond health care workers. See the CDPHE guidelines here: https://covid19.colorado.gov/for-coloradans/vaccine/vaccine-for-coloradans. Based on the state’s plan, UCHealth is focusing efforts on vaccinations for people 70 years old and older. You do not need to be a UCHealth patient in order to get vaccinated.  

Here is how it works

Keep in mind that most health systems in Colorado are working on vaccine distribution. Please first check with your primary care provider or primary health system. For those over 70 with interest in getting their vaccine from UCHealth,

  1. We will use My Health Connection, the patient portal for UCHealth’s electronic health record, to communicate with people. If you have an active My Health Connection account, you will automatically receive updates regarding the vaccine. If you do not have an active My Health Connection account, please create one to receive these updates. To learn more and create an account, go to www.uchealth.org/covidvaccine.
  1. Over 80% of patients at UCHealth have a MHC account, and we’ll be using our Electronic Health Record (EHR) to determine our patients who meet the criteria for vaccine (currently, using date-of-birth to calculate age 70+).
  2. You DON’T have to be an existing UCHealth patient or be seeing a UCHealth provider to create an MHC account and to indicate your interest in the COVID-19 Vaccine.
  3. You WILL need to have an email address and be able to access the patient portal yourself. You may have a proxy (trusted designee) sign up for you; keep in mind that this proxy would also potentially have access to your UCHealth electronic health records as well.
  4. At this time, we do not have enough vaccine doses to offer it to everyone. As UCHealth receives shipments of the vaccine, we are providing it as quickly as possible, according to the state’s plan. As we receive additional quantities of vaccine, we will send vaccination invitations through our randomized selection process to give everyone the same chance of receiving a vaccine.
  5. When vaccine becomes available to your phase of distribution, you will receive an invitation from My Health Connection with instructions about how to schedule your vaccine appointments. Please be patient until you see the message titled “Urgent: Schedule your COVID-19 vaccine”. When you receive this message, you will be able to schedule both vaccine doses. You will have 48 hours to get your appointments scheduled. If you miss the 48-hour time frame, you will receive a new opportunity to schedule in a future distribution phase. 
  6. An appointment is required to receive the COVID-19 vaccine; walk-ins cannot be accommodated.
  7. For the most current information regarding COVID-19 vaccines, go to the COVID-19 vaccine page on the UCHealth website.

The EHR is our superpower

This process has worked well for our first 37,000 COVID-19 vaccinations, and we plan on scaling up further, as vaccine availability improves.

Some may criticize us for using an electronic patient portal and perhaps leaving out those without access to the internet. (I have even heard the term “digitalism.” However, looking that up, it seems to mean “being poisoned by digitalis from the foxglove plant.” Hmm. But we digress.)

At the same time, we’re putting plans in place to ensure that those without access to a computer or smartphone also have access to the vaccine. Through phone hotlines, clinics that target low-income areas of the state, and outreach to underserved communities, we aim to provide the vaccine fairly to everyone. Some of these efforts have already begun.

Our main point from using our patient portal was that, using our existing infrastructure where we already have nearly 1 million patients, we could move quickly, filter our patients by age, and create and send invitations thousands at a time. This contrasts with those who might have to postal-mail invitations or make phone calls and set up (and staff-up!) a phone bank, that could take days and weeks. 

We launched the invitation and scheduling process over one weekend (thank you and sorry to our IT and project leaders who built this) and offered vaccines the next weekday after receipt of our first batch. I’m so grateful to work with such amazing colleagues and their amazing teams, and grateful that we have an existing information technology infrastructure that allows this. The EHR is our superpower.

News items

Fox31 news (patients 70+): https://kdvr.com/news/coronavirus/covid-19-vaccine/uchealth-patients-over-70-start-getting-vaccinated/

The Coloradoan: https://www.coloradoan.com/story/news/2021/01/05/covid-19-colorado-next-up-vaccine-heres-what-know/4127958001/

9news (mass vaccination): https://www.9news.com/article/news/health/coronavirus/vaccine/colorado-hospital-systems-get-ready-for-mass-vaccinations/73-3f1a2fbb-df90-4007-8f1d-35c372c71414

KOAA news (mobile clinic):
https://www.koaa.com/news/covering-colorado/uc-health-goes-mobile-with-covid-19-vaccine-in-colorado-springs

UCHealth mobile vaccine clinic: https://www.uchealth.org/today/older-adults-receive-covid-19-vaccine-at-home-through-mobile-clinic/

UCHealth older adult vaccine news: https://www.uchealth.org/today/older-adults-rejoice-as-they-begin-getting-coronavirus-vaccines/

CMIO’s take? We are excited to be part of the solution for our community throughout Colorado and the Rocky Mountain region!

What clinical informatics is NOT. Also Nerd Glasses and Propeller Hats.

My offspring. An out-take from Go-Go, their K-pop dance routine. See hyperlink below.

I’m reading a book called Mindfulness in Plain English: another book my daughter left laying around the house with her annotations in it. I love the underlining and ‘YES!’ marks and also the ‘is it though? You shouldn’t wait to be perfect…’ comments. Just a few short years ago, she was in the playpen, and now I love to see her mind at work.

Anyhow, mindfulness meditation is something that I aspire to: I have had months where I meditate daily, and there are times when I forget and lose the habit. I have found it calming and centering and have found clarity through the practice.

You can refer to my blog series ‘CT Meditates, a comedy’ from 2017.

What I love about this current book is the chapter on what Meditation is Not. I love it. It helps define the thing by talking about what it is NOT. For example an annotated list:

WHAT MEDITATION IS NOT

  • Misconception 1: meditation is just relaxation
  • Misconception 2: meditation means going into a trance
  • Misconception 3: meditation is mysterious and cannot be understood
  • Misconception 4: meditation is for saints. Not regular people.
  • Misconception 5: meditation is running away from reality

I love this idea. Writing about the negative space helps clarify what something IS. So, here goes.

There are lots of misconceptions about what Clinical Informatics is.

It can be defined as the science and practice of managing information by capturing, storing, analyzing, retrieving, and using data to improve the care of patients and populations.

Sure, whatever. Perhaps it is more meaningful to talk about misconceptions.

WHAT CLINICAL INFORMATICS IS NOT

  • Misconception: informatics people are the secret Star Chamber of the Electronic Health Record. They wear propeller hats or nerd glasses. <– Yes, these are my nerd kids wearing propeller hats and nerd glasses. And yes, I am proud of them.
  • Misconception: informatics helps you set up your computer. (That’s Information Technology)
  • Misconception: informatics has to do with servers, network cables, wifi problems. (still, IT)
  • Misconception: informatics is a way to force people to do things they don’t want to do. (no, no, no)
  • Misconception: informatics is only about designing things, we leave training to others. (ok, partly right, but we all fail if we don’t train adequately)
  • Misconception: informatics is for people who prefer computers and don’t like talking with humans. (no. please do not send us “the doctor who is our resident computer nerd.”)
  • Misconception: informatics is quick and easy, just put a hard stop there, and DONE! (no. we do not “force those other doctors to do this thing because it makes it more convenient for me and my project” UNLESS it is also good for patient care and clinical leaders all agree)
  • Misconception: informatics has no need of customer/user (patient or clinician) feedback. (just no)
  • Misconception: informatics is a special and arcane field that only computer geeks will understand. (sigh. we fail if this happens)
  • Misconception: informatics is a field of medicine where most people tell you, NO we can’t do that.
  • Misconception: informatics always takes months to achieve the goal or complete a project. (when we do Sprints, we can amaze our docs)
  • Misconception: informatics is unnecessary: an EHR project only needs a subject matter expert and a computer analyst (sorry, without an informaticist to translate, such a project is likely to fail)

Informatics is NOT “Hard stop, and Done!” Instead it is building relationships, understanding the pressures and desires of patients, providers, staff, and understanding the ultimate goal of health care.

Indeed, it is perhaps, one of the major advances of modern healthcare. I would argue, the field of “clinical informatics” should eventually become standard curriculum for ALL physicians.

CMIO’s take: Health care is about using our best science, our best work-flow, our best teamwork. We use this information to heal individual patients and improve the health of our communities. We need great, up-to-date information to do that. Only by capturing, storing, analyzing data, creating new knowledge, and delivering that seamlessly to the provider at the bedside (or directly to the patient) can we grow, improve and evolve as a learning health system.

UCHealth launches OurNotes: how patients co-author clinic progress notes

As of November 2, 70 primary care practices went live with Our Notes. Read more about OurNotes here. Dr. Tom Delbanco and Jan Walker, researchers at Beth Israel Deaconess initiated and ran the study.

In brief, it is a way for patients, just ahead of an upcoming appointment to tell their provider what has happened to them since their last visit: changes in medication, new or changing symptoms, life changes. And then to ask up to 3 questions they’d like to discuss with their provider at the visit.

These notes were then automatically inserted into the providers’ progress notes. They could then be cited in their entirety, with no action needed by the provider while composing the rest of their progress note. Or, the provider could edit for clarity before signing the note. In this way, both patient and provider contribute the data from that visit, improving communication and collaboration.

We were so successful from our pilot test, conducted in coordination with Beth Israel Deaconess Medical Center (BIDMC), in our one primary care clinic, we have now launched it for ALL primary care clinics throughout UCHealth.

Our early findings showed that over 90% of providers (physicians and APP’s: advance practice providers) responding to surveys viewed OurNotes positively and wanted to continue, as did over 90% of patients who participated.

Not all patients who have a patient-portal account respond to the OurNotes questionnaire ahead of their visit. Those who do not, have a regular visit, just like before. About 15-20% of patients who have an appointment respond send an OurNote, and providers are using the notes regularly.

Others are catching the OurNotes trend as well, including Sanford health, UCLA, and the original OurNotes health system research partners: BIDMC, University of Washington and Dartmouth-Hitchock. Thank you to all the trailblazers out there for transforming patient-centered care.

CMIO’s take? More like this please! IT is a win-win-win: better engagement for patients, shared documentation for providers, more readable, narrative notes in our EHR’s.

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.

When Can I See Results in My Patient Portal?

We are all scrambling to put together simple documents to explain to patients and providers about INFO BLOCKING / SHARING coming in a week. Here’s our latest document. Link to full PDF here. Feel free to adapt this for your organization. We are also hoping our very smart Epic colleagues in Wisconsin can add a patient-preference setting into MyChart to accommodate the variety of patients out there, regarding seeing their own test results.

Remember, the rest of our INFO SHARING education documents are on my last blog post HERE.

CMIO’s take? Are you developing education tools that are simple 1-page explanations of complex topics? Let me know.

UPDATED FOR INFO BLOCKING rule: UCHealth’s 16 year OpenNotes Journey (and a ukulele song)

Since the passage of the 21st Century Cures act and the INFORMATION BLOCKING rule, I’ve gotten a ton of questions about our experience with Open Notes and Open Results. AND A UKULELE SONG

patient20and20doc_2

Image courtesy of Healthcare Informatics

OCTOBER 2020 UPDATE. 

In this update:

  1. A ukulele song on Open Notes! What?! Read to the end…
  2. Our current interpretation of INFO BLOCKING rules and our current plans
  3. Links to important tip sheets that you can use/share

Since the passage of the 21st Century Cures act and the INFORMATION BLOCKING rule, I’ve gotten a ton of questions about our experience with Open Notes. Followers of this blog the Undiscovered Country will have heard this before. However, if you’re new here, welcome! I’m updating my original post from 2017. This now will include:

Important Links

  1. Link to my post on INFORMATION BLOCKING and the 1-page WHY plus 4-page HOW/WHAT that we are circulating at our Health System, affecting 6000 docs.
  2. Link to my post on HOW TO WRITE AN OPEN NOTE, with language suggestions.

UCHealth’s INFO BLOCKING settings

FYI, in regards to INFO BLOCKING, there are tons of nuanced decisions healthcare organizations are making, since the 1200 page rule still leaves some specifics quite vague, and the often-rumored FAQ that will clear up some of the vagueness is not here yet (less than 30 days until rule takes effect!). Here are our (interim) decisions at UCHealth:

  • All outpatient, emergency dept, urgent care provider progress notes will release immediately upon signature to the patient (already doing this)
  • All clinical notes associated with those visits (MA, RN, technologist) notes will also release immediately
  • All hospital progress notes will release to patients upon signature. This will include: H/P, daily progress notes, consult notes, operative reports, discharge summaries.
  • All medical student notes that are cosigned by physicians and used for billing will be immediately released. We are in discussions about the remainder of medical student notes that are NOT part of the legal medical record.
  • All resident and fellow notes will release immediate upon attending signature
  • All nursing and clinical notes that can be considered progress notes will release upon signature
  • NO psychotherapy notes will release to patient (they are not stored in our EHR)
  • NO notes that may be involved in legal, criminal or similar proceedings
  • NO notes that may ruin research randomization if revealed to patients
  • SOME of our psychiatry provider progress notes already release to our patients. Three of our 8 psychiatry clinics committed to Open Notes in 2017 and have had no issues. We are still working through this, in discussions to release more behavioral health progress notes (psychiatry, psychology, social work, case manager, others) to patients. There are some concerns about the possibility of risk to staff for patients reading some of these notes in real-time. Stay tuned!
  • All progress notes, inpatient and outpatient have a “DO NOT SHARE” button where providers can individually opt a note out of sharing with patient if it is deemed a risk. Our share rate is typically in the 90% range.
  • We already release all lab results immediately to patients, including sexually transmitted diseases, hepatitis B and C, etc.
  • HIV is on a 7 day delay and will move to immediate
  • We already release all plain film radiology and ultrasounds immediatelly.
  • Complex radiology: CT/MRI/PET are moving to immediate
  • Pathology, Cytology is moving to immediate.
  • We plan to manually release a handful of genetic tests, including Huntington’s disease only AFTER discussion with the patient. The remainder are moving to immediate release.
  • We have over 850,000 patients on our patient portal, so these settings will affect a great many patients.

Our 16 year journey to Open Notes

Thanks to @RajivLeventhal of Healthcare Informatics for a nice write up of our Open Notes work at UCHealth. The journey to “overnight success” can sometimes take a decade or so. To paraphrase Machiavelli: “Nothing is so difficult as Change in a large organization, as your proponents are, at best, lukewarm, and your detractors have ALL THE PASSION IN THE WORLD.” I discuss some of my hard-won lessons in Change Management on the journey to OpenNotes.

Link to story (March 16, 2017):
UCHealth’s OpenNotes Journey: From a Few Docs to Enterprise-Wide Acceptance

Original Research in 2001

The original research on SPPARO (System Providing Patients Access to Records Online, conducted in 2001, 10 years before the official, and better-named Open Notes initiative) is still available:

Ross, Lin, et al. Providing a Web-based Online Medical Record with Electronic Communication Capabilities to Patients With Congestive Heart Failure: Randomized Trial. J Med Internet Res. 2004 Apr-Jun; 6(2): e12.

Earnest, Lin, et al. Use of a patient-accessible electronic medical record in a practice for congestive heart failure: patient and physician experiences. J Am Med Inform Assoc. 2004 Sep-Oct;11(5):410-7. Epub 2004 Jun 7.

And … a song!

A ukulele song on Open Notes: Doc Prudence.

CMIO’s take? It has been a long time coming. Information Transparency for patients is the RIGHT THING to do. For myself, it was a 16 year journey from our first research studies, completed in 2001, until system-wide adoption of Open Notes for clinics, emergency depts and hospital discharge summaries in 2016. For others it is hitting them all at once here in 2020. It is a better place we are going to. In the meantime there is a lot of work and culture adjustment until we get there. Good luck to all of us.

You’re gonna release WHAT? WHEN? Info Blocking vs Info Sharing

Info Blocking means inpatient and outpatient progress notes released immediately to patients, along with lab results, CT/ MRI/ PET scan results, pathology results. Immediately. Ready?

My 1-page White Paper on WHY and 4 following pages on HOW/WHAT

LINK TO UCHealth’s INFO BLOCKING WHITE PAPER

What is Changing

The 21st Century Cures Act has an Information Blocking regulation that addresses the concern that some health systems or facilities delay or block patient information from other treating health systems, or from the patient. Of immediate concern to this CMIO is the impact this rule has on our health system, to wit:

We are already an Open Notes organization, since 2016, releasing outpatient provider progress notes to patients immediately upon signature. This applies to emergency department and urgent care notes, also to hospital discharge summaries. We’re happy with this, and proud to lead the charge in Colorado for information transparency. Same with immediate release of the vast majority of lab test results.

HOWEVER, we still delay some results 4 days, 7 days or 14 days depending on category (see above). The new INFO BLOCKING regulation stipulates that systematic delays like this will Violate the Info Blocking rule, and that the potential penalty for such delay is $1 million.

Wow.

This is great news for patients and patient advocates; they have long stated the maxim: “Nothing about me without me.” I love this idealism. Practically? We have struggled with how to make this happen. Now the feds have conveniently stepped in with a mandate. This makes the conversation easier.

Our big struggles ahead

  • Teach our inpatient providers to write notes that are ready for patients to read each day they’re in the hospital.
  • Teach ALL our providers how to anticipate patient concerns and the range of possible results coming from pathology (biopsies and PAP smears and other results that may show cancer or severe disease). Same with complex imaging like CT scans, MRI’s, PET scans, mammograms. Same with lab results that may show genetic variants, like Down’s syndrome.

How I made this

Beyond the specifics of the INFO BLOCKING rule, this also illustrates the value of Form Factor and Communication Strategy. My mentor always taught me: if you write a white paper executive summary, every additional page beyond one side of one page cuts your readership in half.

So, for my white paper, I have written a ONE PAGE summary of WHY this is important and what action is needed. For those who just need “at a glance” the color grid in the center tells the story of exactly what is changing. And because data alone does not change minds, the call-out box at the bottom includes a few quotes from selected leaders, telling a brief story.

Finally, if you get to the end of the page and are interested in doing something, I have 4 more pages of HOW and WHAT to take you to the next level.

This, COMBINED WITH a road show, where I am going to every major physician leadership meeting, is how I’m getting the word out. There is, of course, much more work to do at the individual provider and manager and service and clinic level, but I’m trying to give everyone a running start. There’s not much time left.

CMIO’s take? We all have hard work ahead. This is a federal mandate, so 4000 hospitals, countless health systems and clinics will be facing this as well. The link to my white paper here (and above) is my contribution. I hope this helps you get to the right place with this regulation AND with doing the right thing for our patients.

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.

Czernik: Counter-intuitive way to connect with the patient (Annals Internal Med)

My awesome colleague Zuzanna Czernick and collaborators have written a brilliant piece about the EHR. She used a CT scan image with a large pulmonary abscess to get the attention of an otherwise hostile, disengaged hospital patient.

Link to article Annals of Internal Medicine : https://annals.org/aim/fullarticle/2738161

My awesome colleague Zuzanna Czernick and collaborators have written a brilliant piece about the EHR. She used a CT scan image with a large pulmonary abscess to get the attention of an otherwise hostile, disengaged hospital patient.

The EHR, although widely disparaged, is also a wonderful tool to bring medical data alive for the patient. She offers a few guidelines on how to most effectively create the trusted “triangle” of provider-patient-computer:

  • Prepare
  • Setup
  • Educate
  • Chart together
  • Review

There are so many opportunities to connect with our patients; why not bring up a screen to show an image, a result, a graph, a note written by a consultant that illustrates and answers a question.

CMIO’s take? Yes, we need counter-intuitive (and soon perhaps simply intuitive) stories about the benefits of a modern information system in caring for patients. Thanks, Dr. Czernik!