Category: Mindfulness / Wellness

“That’s a waxing gibbous. That means it’s going to get bigger” (NYTimes)

‘Luddite’ Teens Don’t Want Your Likes. When the only thing better than a flip phone is no phone at all.

From Scott Rossi for the NYTimes

Luddite Teens Don’t Want Your Likes

This is a fascinating throwback to the Luddite Movement where workers rebelled against the new machinery.

This is teens taking back their lives from the pressures of social media.

I think we could all learn something from these teens. Yes, I realize I’m a CMIO.

How to Think Outside Your Brain (NYTimes.com)

https://www.nytimes.com/2021/06/11/opinion/brain-mind-cognition.html
 

This is awesome in several ways (read the article, link above).

  1. Having a “creative desk” full of glue, scissors, sticky notes, colored pens is always better when designing something. Once done, you can move to your computer and finish it at your “publishing desk”. This research tells you why (you can think outside your brain using your body and your physical space)
  2. The EHR (electronic health record) is a way to help your brain think, if we do it right. Do we do it right? This is “using tools” to augment our thinking.
  3. Then we have “other people’s minds” with the hint that teams who know how to draw on complementary skills from others in a team, perform better than individuals or uncoordinated teams. What does that teach us about our informatics work?

I will have to sit with this article for awhile. What are you taking away from it?

My Gratitude Letter (to Dr. Fred Platt), and why you should write one too

Learning to write a gratitude letter is worthy exercise, for both the writer and the recipient. There are surprises here …

In our wellness work, we learn surprising things about ourselves.

First, that expressing gratitude benefits both the giver and the recipient, in terms of mood and overall health.

Best of all, giving gratitude, unlike carefully wrapped, commercially-obtained holiday gifts, is FREE.

One particular activity worth noting, is the GRATITUDE LETTER.
Here’s how to do it.
Write a letter to someone for whom you are grateful, and tell them why.
Make an appointment to see them in person.
Read the letter out loud to them.

The research tells us that both the giver and recipient receive a months-long boost in mood from that event.

WHY DO WE NOT DO THIS ALL THE TIME?!

…

Reader, I did this last week. I’m here to tell you how it went. One of my mentors is Dr. Fred Platt, author of many peer-reviewed articles and books on Physician-Patient Communication: Field Guide to the Difficult Patient Interview, and the Annals of Internal Medicine’s Words that Matter series, including “Let me see if I have this right …“. In later years, he wrote poetry.

He helped me get started in academic medicine, in teaching medical students, in learning how to be an excellent communicator, in being a better doctor, a better colleague, a better human being.

Now, decades later, his health declining, I wrote him a letter, made an appointment, and drove to see him. He only had the energy for a 30-minute visit, but loved the letter enough to have his wife and I read it to him twice.

Not a dry eye in the house.

I will miss you, Dr. Platt. Thank you.

November, 2022

Dear Fred

Thank you for the chance to tell you how you’ve changed my life.

I met you at the Bayer Institute CPC Workshop: Clinician-Patient Communication to Improve Health Outcomes. You facilitated a group of 16 junior faculty in Internal Medicine in 1997, and taught me, among other things, Reflective Listening: “So, it sounds like you’re having some belly pain, and it is going down to the right side, and you think it is … gout? Do I have that right?”

I learned about Ideas, Feelings and Values, and it changed my life. I became a Bayer-certified Communications Facilitator to follow your footsteps.

You took me under your wing, you re-ignited my passion for patient care, and gently taught me tools for difficult conversations: “On the one hand you think … On the other hand I worry …”

You co-founded Foundations of Doctoring at University of Colorado. Our initial trials at teaching communication in lecture halls met with abject failure. 160 students at the first lecture, and only 5 come to the second one.

We repeatedly redesigned the course until it really sang: 1 standardized patient, 4 student learners coaching each other, and a facilitator guiding ILS: Invite, Listen, Summarize. I use and teach these tools today to incoming students.

You generously asked me to co-author numerous communications papers, published in several journals, including the series WORDS THAT MATTER in the Annals of Internal Medicine. We discussed a number of delightful cases, including the case of the patient who ate too many pies at work, and wanted to claim workman’s compensation, prompting an outburst from my resident.

For this computer-geek doctor, you taught me compassion and connection and relationship-building. These are my guiding principles to this day. In my national travels and talks that I give in the Informatics world, there are few who have had a mentor like you.

I am proud to teach your ideas that words matter, communication matters, relationships matter.

I’ve learned over the years, that I have an internal Judge voice, who sounds suspiciously like my father, and an internal Sage voice, who I call Fred.

I am so grateful for your teaching, your counsel, your collegiality, and your friendship.

Thank you, Fred.

With Love
CT Lin
Chief Medical Information Officer, UCHealth
Professor of Medicine, University of Colorado

 

CMIO teahouse menu

How can tea improve clinical decision support? How does it help change organizations? Are you kidding?

Links to some of these teas:

CMIO’s take? Those of you who have worked with me know that one of my favorite things is to have 1:1 meetings in my office and serve tea. Taking inspiration from my spouse who enjoys throwing cocktail parties and creating a fanciful drink menu, I recently put together a CMIO’s teahouse menu. I hope you enjoy it.

“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!

Controlled breathing. Take a minute (nytimes)

I know many patients, colleagues, (and also I, myself) can benefit from this reminder.

Take a minute and do this now.

And maybe STOP DOOMSCROLLING and go outside (I’m going to shovel some snow), or read a physical book, or at least move away from a screen for awhile.

Epic EHR webinar with UCHealth: Inbasket Re-invention: did we really delete 12 million messages?

Yes. Yes, we did.

https://userweb.epic.com/Webinar/View/7968/Taming-the-In-Basket-with-UCHealth-Teaching-an-Old-Dog-New-T/

Are you and your organization struggling with:

  • How to tackle the hyperobject that is the EHR inbasket?
  • Does your legal/compliance team worry that deleting messages is bad idea?
  • Do you have users with tens of thousands of unread inbasket messages?
  • Are you having trouble getting starting on this ambiguous, massive effort?
  • Would you like to know some of the specific settings and decisions we made?
  • Are you concerned that it is difficult to measure improvement with inbasket?
  • Are you eager to see CT Lin and team fail at yet another ambitious but ill-fated project?

If so, you =might= find some answers in our recorded discussion above.

We touch on: leadership, governance, organizational change, legal concerns, specific Epic EHR inbasket settings and decisions, clinician burnout, high-performing teamwork, and human connection. Really.

Note: Hosted by Epic. Login to Epic Userweb required. Go watch it, then come back and tell me what you REALLY think.

Here’s your moment of zen – cactus images from Arizona

Here is the “burr in my sock” or “pebble in my shoe” that bad EHR design can become. In another context, this is can be beautiful.

Found this in my sock in the middle of my hike.

The only way to hike in Tucson in the fall is starting at 630am and being done before 9am.

CMIO’s take? Be present, get outside, take a breath.

Is the EHR Inbasket a Hyperobject? And what are you going to do about it?

Inbasket Hyperobject: hard to grasp, even harder to cut down in size.

https://www.wired.com/story/timothy-morton-hyperobjects-all-the-way-down/

This is a mind-blowing read. What is a hyper-object? It is a somewhat disturbing concept of something bigger than an object, something that transcends our understanding as a human. The concept’s inventor, Morton, defines it as: “phenomena too vast or fundamentally weird for humans to wrap their minds around.”

Okay. What?

Consider examples like “all the plastic in the world” or “climate change” or “a black hole” or “massive oil spills.”

Science fiction author Jeff VanderMeer has said “hyperobject” neatly describes the bizarre alien phenomenon he wrote about in Annihilation, his surreal novel turned 2018 movie.

Annihilation: Southern Reach Trilogy, Book 1 | Books, Novels, Audio books
from Jeff Vandermeer

OK, now that’s disturbing, as I read the book and felt chills during a summer evening. That guy can write. This is as close to a jump-scare that I’ve ever had, reading a book. Even had to put it down for awhile to calm down.  =shiver=

Now, I’m thinking: the Epic electronic health record’s INBASKET is a hyperobject.

EHR Inbasket as Hyperobject?

Now, we’re talking. Something that is weird, difficult for humans to grasp, and alas, vast. To the uninitiated, the Epic EHR inbasket is a message center where much of our internal communication takes place: incoming phone calls from patients can be sent to inbasket for nurses, docs, assistants to help manage the request; incoming patient portal messages come here; prescription renewals from pharmacies, from patients; consultation reports from specialists, hospital discharge summaries; notifications that “you did not finish writing this note for this patient visit”; test results from blood tests, radiology studies, biopsy reports; nurse-doctor communications; provider-provider communications. Lots of things.

And, for our busy clinicians, some inbaskets have dozens, hundreds, and sometimes THOUSANDS of unread messages that can be weeks, months, YEARS old. Yikes.

Hyperobject.

Solving the Rubik’s (hyper)cube?

First, improve teamwork, huddles

Ok, but that is a future post. Aside from the idea that we need to improve our internal teamwork and fundamentally redesign how we use our internal tools, there are some simple changes we can start with.

Time to cut our hyperobject down to size. We know that incoming inbasket messages from patients has tripled (see previous post). We know that our healthcare professionals are suffering from burnout (see previous post). We (I) have been guilty of delivering automated messages to our docs that we originally thought were helpful. Maybe it is time for a re-think.

Our plan to re-size our Hyperobject:

  • Pick a date (in December 2021), a one time PURGE of all messages 6 months or older in our Inbaskets. This is 7 million messages. Seriously. Rationale: If the provider hasn’t handled this by now, either the patient has called or messaged again (a more recent message), already come for a visit, or perhaps even left the practice to go elsewhere; there is NO VALUE in keeping these.
  • In December, begin a 90-day expiration clock on all new incoming messages. If you haven’t addressed a concern or responded or read a message by 3 months, it will disappear. Yes, there are theoretical risks of deleting reminders to complete a task or respond to a patient. But, here we are in mid November; is it still relevant that a patient called for advice in August, before school started? Also it is theoretically possible that a provider will stop someday and spend a weekend reading and replying to thousands of messages, but this is not likely at all. We are aware of some inbaskets with messages that number in the thousands. Yes, we are not proud of it. Our current setting where we NEVER delete old messages, I consider a personal failure of bad EHR design and configuration on my part. Behold: the man who ruined healthcare. :(. But, we’ll fix it now.
  • We are discontinuing the delivery of automatic CC (carbon-copy) messages from consulting specialists back to the referring provider and PCP (primary care provider). In 2011, CT Lin and his merry band thought we were doing everyone a favor by CRUSHING the BLACK HOLE (a DIFFERENT HYPEROBJECT!) of the University docs who never remembered to send a consultation letter back to the referring doc. “Hey, we sent you a patient for this clinical question, and WE NEVER HEARD BACK FROM YOU.” We created a technical solution to AUTOMATICALLY send a specialist’s clinic note back to the referring doc AND the primary care doc (if different). In the beginning, this was a great idea! However, this rule now sends several HUNDRED THOUSAND messages a year to our 6000 internal and innumerable community providers. I am personally burying my colleagues. Asking one of my full time internal medicine colleagues, he tells me “I receive about 100 to 150 auto-CC notes per week. Every couple of weeks I take a Saturday and read through 200-300 messages of which about 5 are useful to me. But I can’t NOT read them, what if I miss something?” What an excellent, OCD (obsessive compulsive) physician. But also the way to burn out on patient care. You work 40-60 hours a week and then spend evenings and weekends “catching up” on the blizzard of messages and tasks in the EHR. We need to do Today’s work Today. By the way, specialists can always manually send an important note back to the referring doc or PCP “hey, calling your attention to this” with a single click. And, our specialists ALREADY do this, so I often receive the automated note AND a manually sent note for specific concerns.

Thus, I feel pretty good about stopping the automation. How often do you read that sentence from a CMIO?

Clearly insane CMIO

To be clear, we have “internal” providers who use our Epic EHR and can look up the consultant specialist’s notes the next time they see the patient. These are the folks who will benefit. ON THE OTHER HAND, we have “external” providers in our communities who do NOT have access to our Epic EHR, they use a different EHR or perhaps are still using paper: We plan to continue to eFax or otherwise deliver these notes UNCHANGED. Thus, still addressing the community need for information and stopping the internal clogging of our own pipes.

Whew! That was a lot more long-winded than I intended, but this is a big deal, a big movement, that has already generated a lot of heat, a lot of concern about “why are you moving my cheese?” So far, in our internal provider discussions, we are hearing 90% support and 10% anxiety from our colleagues. We plan on moving forward and creating innovative solutions for those who do not see this as an improvement.

CMIO’s take? Hang on everybody. This Inbasket Hyperobject is getting resized. We have lots more plans for reducing the burden of inbasket messaging, this is just phase 1 of 4 major phases to come. Stay tuned!