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.

Clinical Informatics Accelerates Adaptation to Covid-19: Examples from Colorado. JAMIA-accepted manuscript!

https://academic.oup.com/jamia/article/doi/10.1093/jamia/ocaa171/5873873

Thanks to a great team of collaborative physician and nurse informaticists and our broader community of brilliant clinicians. We are happy to share our many uses of informatics in response to the Covid-19 crisis and hope that some of these findings are of use to other clinicians and health systems.

The article is open access, linked above. DON’T MISS the 11 supplementary online-only files with lots of details of “How we built this.”

CMIO’s take: these are the moments that make us proudest; being able to share the work of colleagues on the international stage in the service of improving patient’s lives, improving clinician lives, and in the advocacy for practical, clinical informatics.

Pharmacogenomics (PGx) at UCHealth, getting serious about Personalized Medicine (published article)

Thanks to Pharmacogenomics Journal at Future Medicine

https://www.futuremedicine.com/doi/10.2217/pgs-2020-0007

Thanks to Christine Aquilante, lead author and main force of nature behind our early experience with Pharmacogenomics. Pharmacogenomics is the specifc branch of Genomics and Personalized Medicine that deals purely with “drug-gene pairs” or how a patients genetic variants might affect their ability to process and metabolize medication. The upshot is: some patients don’t respond well to some medications. There are now several dozen drug-gene pairs well described in the literature, where patients won’t respond well to certain medications because of their genomic variant. However up until now, it has been difficult to get any knowledge of such variants in front of the patient and prescriber at the most important time: when deciding on a new prescription.

UCHealth has a Biobank where we have obtained research lab samples from over 100,000 patients (drawing an extra lab tube in the course of routine clinical care) and have been testing samples for pharmacogenomic markers. In a few cases, we have found clinically relevant genetic variants that we are beginning to deliver back into the Electronic Health Record in the form of test results for clinician, in the form of test results and notification to the patient in the patient portal, and finally and most importantly, to the prescriber of the affected drug AT THE TIME OF PRESCRIBING for any affected patient.

This is groundbreaking, and hard work on so many levels:

  • Have to educate providers about pharmacogenomics: something that most did not learn in school
  • Have to educate patients on complexities of homozygous, heterozygous, population risks and multiple gene variants, balancing transparency with unintended alarm
  • Have to figure out when/how to alert prescribers at just the right time, for exactly the right population so that we don’t overstep what the science tells us is true in the research. In other words, don’t alert ALL patients with the genetic risk and a particular prescription if 99% of them will NOT ultimately have a problem with that prescription.
  • Lots of other things to think through (we just spent an hour just starting the conversation on our next drug-gene pairing)

CMIO’s take? We are happy to be among the few organizations setting up, and scaling up our efforts on Biobanking: conducting research AND benefiting patients in clinical care with PGx. Here we are expanding the boundaries of medical knowledge, and turning around to translate this into better decision making for our providers and patients.

Medical Scribes: mixed methods study by Heather Holmstrom and team

https://medinform.jmir.org/2019/3/e14797/

A mixed methods study. Important work on how to reduce documentation burden and also impact physician and patient satisfaction in ambulatory encounters.

Dr. Holmstrom and colleagues at the University of Michigan did some nice work investigating the Medical Scribe model, and it’s acceptability by patients and impact on physicians.

I look forward to our technology-enabled future, where various tools assist physicians in building therapeutic relationships with their patients. Medical scribes, whether in-person, or virtual, or perhaps augmented by artificial intelligence, are an interesting experiment.

CMIO’s take: Is YOUR organization pursuing innovation in reducing the EHR burden? Let me know! And, Happy Holidays!

“I, EHR” A thoughtful first person reply by our friend, the EHR

from thenounproject.com

A couple of our University of Colorado medical students and their mentor wrote this wonderful, thoughtful piece about the intersection of medicine and technology and how it has impacted our colleagues. This is a unique first-person EHR response to the various critiques.

I don’t have feelings and I can’t read, but I do know what you and your colleagues have been writing about me.

I, EHR. J. Hospital Medicine

Read the 1 page article here: https://www.journalofhospitalmedicine.com/jhospmed/article/200581/hospital-medicine/i-ehr

Consider how I can help you be present for your patients. Let me empower you to hear their stories as you deliver compassionate, humanistic, and evidence-based patient care. Paraphrasing Albert Einstein, the technology of medicine and the art of medicine are branches from the same tree.

I, EHR

Optimization Sprints: Improving Clinician Satisfaction and Teamwork by Rapidly Reducing Electronic Health Record Burden (published in Mayo Clinic Proceedings Feb 2019)

Sprint team action shot!

Congratulations to Amber Sieja, Katie Markley, Jon Pell, Christine Gonzalez, Brian Redig, Patrick Kneeland, co-authors on our published article in Mayo Clinic Proceedings this week. I’ve spoken of some of the details on this blog, so I’ll let the paper speak for itself. Nice to be recognized! Coming soon: a video by Dr. Sieja explaining some of the highlights of the paper.

https://ac.els-cdn.com/S0025619618307882/1-s2.0-S0025619618307882-main.pdf?_tid=c94d2fe7-8f2b-4e66-9852-277fb952f3eb&acdnat=1551313804_a8d687bb190fdb632cd1ed9f45c8ef41

CMIO’s take? When team members do great work, we all get better.

White paper: the Future of EHRs (National Symposium at Stanford)

image_img_1200_high

I had the privilege recently of being invited to a national symposium hosted by Stanford Medicine and Dean Lloyd Minor, sporting numerous EHR clinical experts, informaticists, vendors and other thought leaders. See the resulting white paper (caution, in addition to expert opinions, there are quotes from me):

http://med.stanford.edu/content/dam/sm/ehr/documents/SM-EHR-White-Papers_v12.pdf

CMIO’s take? I found it an invigorating, forward thinking symposium with lots of great ideas for where we are and where we are going. Most importantly, we tackled WHY solving the EHR conundrum (so important, but so far from where we need to be) is crucial to the future of healthcare.

Successful Implementation of APSO Notes Across a Major Health System (AJMC publication)

ambersieja
Amber Sieja MD

Congratulations to colleague Amber Sieja MD on her first-author publication of our work on improving EHR (electronic health record) usability by reconfiguring traditional SOAP notes into APSO notes, and then deploying it across an entire health system, AND THEN measuring the outcomes.

As always, a pleasure to work with smart people who can turn their daily work (physician informatics and deploying and improving the EHR) into new knowledge (publications, talks, quality improvement). Congrats to Amber!

“In this study, the authors demonstrate widespread adoption and satisfaction with the novel APSO (Assessment, Plan, Subjective, Objective) format for progress notes at a large, integrated health delivery network.”

http://www.ajmc.com/journals/ajac/2017/2017-vol5-n1/successful-implementation-of-apso-notes-across-a-major-health-system