Category: Innovation

Go Slow to Go Fast, or Human Autonomy vs Bot Autonomy

University of Colorado’s General Internal Medicine leaders have decided to block one appointment per half day clinic for all physicians and APP’s. Find out what happened!

Illustration via Microsoft Bing – Copilot

Thanks to Drs. Robert Doolan and Mark Earnest for developing and studying this idea.

THE CRISIS: Physicians and APP’s in general internal medicine primary care clinics are overburdened and leaving medical practice. How might we make a creative leap to reduce burnout with minimal impact to finances?

THE IDEA: Give the clinicians back some autonomy. Protect one appointment slot per half-day (or 2 slots in a full day) of clinic. That time slot is 100% controlled by the clinician. It could be used for:

  • Working on inbasket messages (incoming patient advice requests from the patient portal; replying to telephone messages recorded by triage nurses; reviewing and/or delivering test results to patients; handling prescription requests; responding to messages from other colleagues)
  • Scheduling patients at their own discretion, for example urgent requests from patients; patients being discharged from hospital
  • Catching up on work (prescriptions, orders, notes) from earlier in the day
  • Doing a team huddle to distribute patient care duties for each half-day

What would happen? Would the clinic lose clinical income by reducing appointment slots? Would patients be unhappy?

Our clinic leaders gave it a shot.

How did it go? Reviewing the appointment data for completed visits and for RVU’s (relative value units: a measure of clinic productivity of seeing patients) and for clinician satisfaction:

The results: pretty incredible.

An 81% reduction in burnout symptoms, and a 53% reduction in “intent to leave or cut back clinical time.” At the same time, minimal change in clinical productivity and minimal incremental cost per clinician AND totally worth reducing the $750,000 cost to replace one primary care provider.

Some clinicians used this time to tackle the large volume of inbox messages.  Others used the time to complete forms for patients. I often used it to squeeze patients in after a hospital discharge, since in my full practice it may take several weeks to see me otherwise. The feeling of being able to flex my own time was surprisingly empowering.

Human autonomy, it turns out, is a big deal in our burnout equation. Instead of pushing for more AI Bots to take over human actions (yes, this is coming), increasing human autonomy can be surprisingly beneficial.

References by Drs. Doolan and Earnest:

Doolan R, Drake L, Fraumeni B, Schilling L, Earnest M. Right Sizing the Primary Care Template to Meet Modern Demands. Oral presentation at the Society for General Internal Medicine Annual Meeting; May 15-18, 2024; Boston, MA.

Fraumeni B, Drake L, Doolan R, Earnest M, Weir G, Schilling L. Humanity in primary care: provider perspectives on dedicated asynchronous work time. Poster presented at the Society for General Internal Medicine Annual Meeting; May 15-18, 2024; Boston, MA.

Making Comprehensive Primary Care Sustainable for the Digital Age
Poster – American Conference on Physician Health. 2023

CMIO’s take: Who else is doing this? As a participant in this study, and a beneficiary of the scheduling and cultural shift in our clinics, I totally love it. Thanks to Drs. Doolan and Earnest for this visionary adaptation.

Most Wired Level 10: Thought Leader Round Table at CHIME Fall Forum

A Thought Leader Round Table at CHIME by Most Wired Level 10 leaders, on AI and many other topics in informatics and healthcare IT.

Picture credit: CHIME CENTRAL

Thank you to my smart colleagues at CHIME and at other Most Wired Level 10 healthcare organizations for peering into the crystal ball to see where the next year’s breakthroughs are going. Our Round Table had some luminaries discussing their priorities and peering into the future. See the link for the transcript.

https://chimecentral.org/content/tlrt-digging-deeper-reaching-farther-with-healthcare-technology#gsc.tab=0

 

The Genius Behind @OKWildlifeDept’s Most Viral Tweets Is Signing Off (wired.com)

There are ways of making science and government cool. “Southerland announced that she’d made her final post. It was about not feeding doughnuts to wildlife. ‘For the past four years, it’s been my job—nay, my PLEASURE—to be the tweeter behind the @OKWildlifeDept account,’ she wrote. ‘It’s been my absolute honor to roast and ratio some of you into the ground in the name of science.'” I had to look up “ratio” on urbandictionary. 🙁

I love this person. Brilliant.

https://www.wired.com/story/oklahoma-department-wildlife-conservation-social-media-legacy

During the pandemic, a new voice on twitter and later on tiktok took up the standard Oklahoma Wildlife twitter account and made it cool. Here’s the backstory on the person behind the account.

We could use such a person in medical informatics. Just sayin’.

Predicting Sepsis and Virtual Health Center at UCHealth: News. Colorado Sun

Saving lives at UCHealth: a combination of predictive analytics (AI) and a dedicated team: the Virtual Health Center nurses. Come see how the sausage is made (kinda cool)

 

Can AI improve health care? Doctors at UCHealth are trying to find out.

Thanks to John Ingold and the Colorado Sun for highlighting our ongoing work to defeat sepsis at UCHealth using predictive algorithms and the Virtual Health Center (VHC). I appreciate my colleague Amy Hassell for the outstanding team she leads in this work.

Together we have reduced mortality, by the equivalent of 800+ lives saved per year from sepsis and other in-hospital deteriorations.

We have moved our internal process. We began in 2018 by showing everything to the bedside team. No change in outcomes.

Then we put the Virtual Health Team as a back-up service to the primary team. Slight improvement (200 more lives saved per year over baseline).

Now, we have the Virtual Health Team as primary service, both detecting deterioration and taking direct action, with the patient’s primary bedside team in the background. This dramatically improves speed and consistency of response to a complicated disease requiring a coordinated approach: now 800+ more lives saved per year from in-hospital deterioration.

We are happy with our internal improvements and are always hungry for more opportunities. Thanks to Amy and the amazing VHC.

TikTok Education Strikes Again: Be a Haiku Hero!

I have always wanted to wear a cowboy hat, pink with flashing lights. And now, my dream has come true. Here is our latest 60-second education video on how to configure your Epic Haiku iPhone secure chat settings for success.

I am getting into ultra-short form education. One minute to jam-pack a bunch of ideas into a quick (and hopefully entertaining) video. Here’s how I built this:

  1. Set yourself an unrealistic expectation to teach sophisticated Secure Chat settings to physicians / APP’s in 60 seconds.
  2. Broach the TikTok video idea to disbelieving and pessimistic informatics colleagues
  3. Turn off the computer, clear your desk, take out a yellow paper pad and sketch out a storyboard for how this will go, six frames to a page. Sit with head-in-hands, thinking “Make it shorter! Make it funnier! But How?!”

 

  1. From that, write up 5-second video scripts and clothing and prop requirements for each video
  2. Text your disbelieving colleagues at the last minute, the morning of your next Large PIG (physician/APP informatics group) in-person meeting to ask for a patient gown, scrubs, white coat, other stuff like a cowboy hat, jack-in-the-box, whatever they can steal from their kids that morning.
  3. Run the (exhausting for an introvert) 2-hour Large PIG meeting in the boardroom and then recruit a handful of colleagues to stay late and shoot 5-second videos until the shot-list is done.
  4. Block out the calendar for an entire day of struggle, fire up Final Cut Pro on the laptop, open YouTube to learn how to use Final Cut, and stumble your way to an amateur production of BE A HAIKU HERO.
  5. Show your colleagues the result. Ignore the fake vomiting noises and keep going anyway.
  6. Ask Epic Wisconsin nicely for permission to use a screenshot and post it to on Youtube and the blogosphere.
  7. Apologize to your marketing department for the completely amateurish nature of the resulting video.

See? Totally simple.

Here you go.

Will Your Next Doctor Be … A Bot? (SunFest) with bonus uke song

What happens when you put a news reporter, and AI researcher, a Bioethicist and a CMIO together to discuss AI, Chatbots, Bias and emerging trends? You get this highly interactive and entertaining panel. And maybe a song.

Thanks to the Colorado Sun, and XCEL Energy for sponsoring our panel on AI in Healthcare at SunFest, held in Denver on the Auraria Campus of the University of Colorado.

I very much enjoyed this conversation with my colleagues at the University of Colorado, including Dr. Casey Greene, Director of the Center for Health AI, Dr. Matthew DeCamp, Bioethicist at the Center for Bioethics, and practicing general internist.

Among other topics, we covered:

  • AI, Large Language Models and Chatbots, defined
  • Predictive analytics and how they’re different from Chatbot AI
  • The potential dark side of AI in healthcare
  • Using ChatGPT-like tools in summarizing electronic health records, in helping doctors write progress notes, and in helping physicians, physician assistants, nurse practitioners and nurses, reply to patients via online messages.
  • Risks of automation, including Automation Complacency
  • The risk of hidden bias in AI, and how that compares with existing bias in healthcare today
  • Future plans for AI in healthcare

Listen to the end for an updated version of “Hospital of the Rising Sun – Pandemic Edition” with me and my trusty ukulele.

SunFest 2023: Watch every session with Colorado politicians, expert panels and more

Advances in PGx (Pharmacogenomic or Drug-gene interaction) at UCHealth (guest bloggers Dr. Christina 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

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

 

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? Also: ukulele song at the end of the link!

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!