Grok-board: the 2025 update (instantly empathize and understand the EHR)

As tech accelerates, I wonder what has AI done for me lately? Sure it writes my notes, but does it really help me “grok” this patient? Here is my updated Grok-board design take for EHR’s.

I am worried. Just because our whiz-bang technologies can do lots of stuff, I ask: should it? I previously wrote about my Grok-board idea in 2024. In one short year, we have seen ambient notes, chart summarizers and agents take off.

Here, I still aspire to use an EHR that helps me “grok” the patient. Grok comes originally from Robert Heinlein’s “Stranger in a Strange Land” sci-fi novel from 1961, wow more than 60 years ago. He coined the term “Grok” meaning to “instantly empathize and understand.”

In my 2025 version, the left column of the EHR remains intact, with links to many useful parts of an existing EHR patient chart.

What does it mean?

  • Blue Column 1: The Patient story board. Links to patient details: demographics, allergies, primary care doc, care gaps, selected chart items.
  • Green Column 2: This Human: the patient telling us what is important to them, what are their joys and pressures.
  • Orange Column 3: Homunculus visual problem list and an AI summary of the current status of diseases with any available metrics.
  • Pink Column 4: Insights. Active and suggested AI agents, artificial intelligence entities that can obtain data, and then act on predetermined criteria to achieve a general goal, assess the patient’s top risks and suggested next steps.
  • Blue Column 5: Today: pre-visit questionnaires, solicited patient questions, the last progress note you wrote, and an AI Greek Chorus of somewhat adversarial advisors with suggestions for me.

An ideal Grok-board

should be humane and emphasize the patient’s identity and goals, so a physician can connect human-to-human and communicate more effectively. It should also increase the signal-to-noise of the information presented. It should make it quick to grok and then act. It should prioritize the most important next actions, then make doing the right thing easy

Thanks to Gregory Makoul for his groundbreaking work on connecting patient values to physician thinking. Let’s continue to debate the psychology of which displays gives the quickest, most useful view of the patient. Let’s arm-wrestle, not over sorting of the problem list, but over which display leads to better care of the patient with less cognitive burden and more joy for physicians, the clinical team, and the patient.

Taking it further

Let’s design a video gamer’s chair that helps you use all your senses. What if your left forearm vibrates to warn you of a medication allergy when you’re writing a prescription? What if your right calf feels warm if there is kidney impairment or left calf feels warm if there is liver impairment affecting your next decision. What if your lower back vibrates if you’re about to close a chart with unaddressed care gaps. What if we had smell-o-vision to detect the fruity breath of a patient in keto-acidosis?

CMIO’s take?  We are underusing our senses and our pattern-matching skills. Let’s build a way for our physicians and teams to grok the patient and then make it easy to do the right thing. We must intentionally build our humanity into this future.

Talk and Ukulele: Redesigning Daily Workflow with Digital Tools to Improve Clinician Wellbeing by CT Lin

How’s your summer going? Here’s a talk I gave recently to the Indiana Hospital Association on our current work with generative AI. Yes, it is tough to keep up with the tech acceleration. Optimists and pessimists, there is room for both.

How are you redesigning workflow to improve clinician well-being?

Well, here’s a song about it: EHR Wonderland.

Oh, did you want to hear the actual talk too?

Here’s a talk I gave to the Indiana Hospital Association, describing our Desktop Medicine initiative, our work with Ambient Notes, Inbasket ART, and my worries about Automation Complacency.

Epic UGM 2025 FOMO generator, #final. PIGlet Book Club aftermath! And new ukulele song: The Times They Are a’Changin’

Thanks to the hundreds of attendees, we now have a Wisdom of Crowds idea about skills and books to recommend to newbie informaticists. Take a look! Also, a world premiere ukulele song!

This is what the 400 attendees told us at UGM255: A Book Club for PIGlets – newbie informaticists.

Did you miss our UGM 255 session? See the slides for our talk here.

I asked the question

What are the most important skills of a clinical informaticist bridging clinical medicine and information technology?

Some observations about our crowd-sourcing exercise (watch the 30 seconds here)

  1. It was cool to watch the cloud evolve in real-time on Poll Everywhere
  2. As expected, COMMUNICATION was the top skill, followed by other big ones: listening, translation, patience, relationships
  3. People are cute, they added: “p-value, sneaky, ukulele, thick skin”
  4. There are a great variety of words that make me proud of how thoughtful our group is, even in the couple minutes I gave us to work on this together.

Then I asked

What books do you recommend for newbie informaticist PIGlets (physician informatics group members)?

This is verbatim. There might be a few titles that might not exist. I love that in a couple minutes we could build such a robust library. Personally, my existing top 10 books include:

I am intrigued, from our crowd-sourced list, to pick up books new to me:

  • Atomic Habits
  • Animal Farm (time to re-read!)
  • Never Split the Difference
  • Green Eggs and Ham (hah! the DUUUBIOUS look is everything)
  • The Mythical Man Month
  • Literary Theory of Robots (looks interesting)
  • Beginners (Tom Vanderbilt)
  • Be Know Do
  • Turn This Ship Around

What a wonderful collaboration of big brains sharing big ideas. I am grateful for standing on the shoulders of colleagues to see further into our future.

Finally, did you want to hear the song? The world premiere of

For the Times They Are a’Changin’ (apologies to Bob Dylan) ukulele parody

Upcoming UGM 2025 talk: Grow your own PIGlets – and a new ukulele song parody

Grow your own PIGlets! A book club and 1-year curriculum to train newbie informaticists. Come for talk, stay for the ukulele. We will also be polling the audience for their best recommended books, so come back for the crowd-sourced compilation!

This is a preview of an upcoming talk I’ll be giving at Epic’s User Group Meeting on August 20 at 230pm. UGM 254. Thanks to Dr. Jennifer Simpson for co-presenting with me and bringing the data and her own stories. Mark your calendars! Because I’ll be including a QR code to download and review our slides and book club and article recommendations, I’m posting here ahead of time. Enjoy!


In brief, see below for our book club recommendations and articles. I tell some stories from my past failures and learnings. Perhaps my life serves as a warning to others…

And, introducing the Psycho 80, and old, and a new concept.

I look forward to seeing many of you, new friends and old, at Epic UGM!


 

 

How to give a talk (advanced) CT Lin’s version 2025. Closing. Part 4 of 4

OK, you’ve told a story, you’ve fixed your visuals, you can stand and hold the stage, how do you tie up and finish? Finally, let’s be both great scientists and innovators AND ALSO great communicators.

If you set a hook at the beginning, answer the question before the end, but not too early. Keep them thinking.

Lots of folks take photos with their smartphone. Do you make it easy for them to take a lesson back home?

Plan your talk to be 5 minutes too short. You will not regret ending early. Ending late when everyone is getting up to walk out while you rush to finish completely ruins what might otherwise have been a great talk. Don’t be that guy.

Make a 1-page handout summarizing your best points. Make it so that it can stand alone, even if they did not hear you speak. Even better, store your document online and make a QR code so they can take it home in their fancy little mobile device.

When you wrap up, create a clear call to action. Keep It Simple, Stupid. Audiences will typically have lots on their mind. They might remember ONE THING. What one thing should they remember?

You decide.

The best talks have moments of mirth.

Thank your audience at the end. I can’t tell you how many talks get to the end and the presenter ruins a great closing by, “… and so that its it. Any questions?” And the audience cannot tell if they should clap or be quiet for the first hand-raise. Just take all the doubt away and ask for applause by saying, “THANK YOU.” Then after the applause, say “We are open for questions!” or “Please come up front, we’re happy to chat with you.”

A small point, but so much clearer. The opening and ending moments are what an audience will remember the most.

I like to have a summary slide with my biggest points, and then my contact info on the same page, that I can leave up during the question and answer period.

And, if the audience has been nice to me, I may take out my ukulele and strum some relevant EHR song parody.

CMIO’s take

Did you make it this far? Do you agree? Are you interested in the entire deck? See the link below to the PDF of the slides. Do you have a favorite book on how to make slides or give a talk? Have you seen Steve Jobs and his infamous Reality Distortion Field? Have you watched TED talks and seen how different they are from most dry academic lectures?

Let’s be both: great scientists and innovators, and also great communicators.

LINK to PDF of How to Give a Talk, Advanced: CT LIN

https://www.dropbox.com/scl/fi/2fstbq44vgk35vkn6th1h/2025-05.How.to.give.a.talk-advanced.CTLin.pdf?rlkey=78jgcibakerv0210rkdxl4z26&dl=0

How to give a talk – advanced. By CT Lin. Presenting. Part 3 of 4

OK your slides are done, how do you actually stand up there and do the thing in front of a dozen, a hundred, maybe a thousand people? OMG.

Practice. I presume you will have read other books on presentations. When you think about being anxious, I love the idea of taking that tachcardia, those palpitations and heart-flopping sensations and re-interpreting them NOT as anxiety, but as excitement.

You are the expert. You have done more reading and more research that just about everyone on the planet. With extremely rare exception, everyone is here to support you and learn from you.

Speak to the person in the very back of the room. When you do that, you will find yourself projecting your voice more, and waving your arms more to make a bigger point. This works for your entire audience. Don’t look at the front row where you hope your friends are sitting.

Worst case, if you have frowny faces in the audience, look for anyone who is nodding or smiling, and use them as your islands in the sea and rotate your attention between them.

Avoid MONOTONE. Vary your speed, volume. Practice speaking clearly. Consider recording yourself and listening for verbal tic’s, or for swallowing the ends of your sentences (I do that, get quiet at the end of a sentence), or have someone listen and give you feedback. DON’T let anyone tell you your natural speaking voice is too fast or too slow. If you are excited about your topic, go for it, just make sure you don’t slur your sentences together.

Too many words. And, sitting behind a desk or standing behind a podium hides most of your body. Unless you are doing a technical demo, get out from behind and the them see your whole body and your non-verbal communication.

Dr. Corey Lyon is a dynamic speaker and does exactly that.

Try this! To engage your audience, hide a piece of paper. Have it be a printout of one of the slides with the answer to your question. Now you have at least one member of the audience who will respond to your question!

Pose the question (top right).

Your designated audience member finds the paper. Ask them to stand up, speak loudly and tell us the ANSWER! It is a surprise move that most audience have not seen, and it works well to wake people up and break the routine from your monologue.

CMIO’s take?

Do any of these presenter’s tricks resonate with you? Do you have other tricks? Let me know!

How to give a talk (advanced) CT Lin’s version 2025. Visuals. Part 2 of 4

More lessons on how to talk good #2. Polluting the channels.

See part 1 of 4, prior post.

Don’t skimp on the size of your images, even if Powerpoint suggests framing them in cute little frames. No.

Full-bleed, a term from the days of the printing press, where you would size your photo/image to the edges of the press, so that the color ‘bleeds’ off the edges of the print, give an impression that there is no border between the image and real life. Make your images big as possible for more impact.

Tiny images are a waste of effort. And please don’t pack the page full of words. Please.

More like this. Full-bleed image. Then, talk about your points.

Yes, this is a full bleed image of some dummy. But please do prepare. Your preparation will show in how well you convey your ideas.

Too many words. How often have you heard people say “I know you can’t read this, but …” or “I’m sorry …” You control the slide. You decide what images to use, how to crop it, how to emphasize your point. Don’t passively paste something and the heave a big shrug “not my problem.”

YOU make it work or not work.

Here is an alternative. Keep your big ideas over a large icon or image, and then tell some stories to make your points. Talks are never about being comprehensive. They are about setting fire to someone’s imagination.

Please put some effort into making your ideas clear and easy to grasp.

Don’t make the audience work to figure out what you are trying to say.

Just because you have all these formatting tools does NOT mean you have to use them. The formatting should stay out of the way so that your ideas shine through. You want your audience to go “Wow, what a great idea” instead of “Can you read that? What do those words mean anyway?”

For example, when I see word widows (one word wrapping over onto the next line), I completely stop learning and get mad at the way the words show on the screen. What an aggravation and a waste for both of us.

Go read Richard Mayer’s work from 1988. Or Andy Goodman who writes about good communication for public interest companies http://thegoodmancenter.com. Specifically, this post:

https://www.thegoodmancenter.com/blog/icymi-say-the-words-show-the-pictures/

The point is: your learner has 2 channels: an audio channel, and a visual channel. If the information you are sending complements each other, more gets through. For example, show a picture with no words. Then, the Visual channel is uncluttered. Then, speak the words, telling about water vapor condensing into clouds. The Audio channel is uncluttered, and learning occurs.

HOWEVER! If you put words on the screen with the visual, the words and image clutter the visual channel. Even if speaker is silent, having both words and image on screen is WORSE for learning than a wordless image and a spoken lesson. There is a lot to absorb visually.

EVEN WORSE. If the screen contains an image, and also explanation words as above, AND THEN the speaker says the words or similar explanation, the learning is EVEN WORSE. The audio channel interferes with the visual channel and the learner automatically starts comparing comparing your spoken words with the written words, and now no one is paying attention to the idea, they’re all stuck on comparing words.

THIS IS TERRIBLE and WE ARE ALL GUILTY OF PUTTING WORDS ON SCREEN AND THEN VERBALLY EXPLAINING WITH SLIGHTLY DIFFERENT WORDS.

I call this Polluting the Channels. I do it, you do it.

I both love this and hate it. I have now encapsulated my entire idea on one slide. And it is exactly, according to Dr. Mayer’s theories, the worst way to do it.

CMIO’s take?

Giving a talk, it turns out, is really hard. Knowing what we know now, how will you change? How will I change? Good luck to all of us.

How to give a talk (advanced) CT Lin’s version 2025. The Arc. Part 1 of 4

Everyone thinks they know how to give a powerpoint talk. Everyone is wrong. Only I do. =and if you believe that…!=. Part 1 of 4

I hate this, don’t you?

OK, lets see if these make sense to you.

Thanks to Dall-E for showing an asian doctor afraid of the scary In Basket Hyperobject part of the EHR.

I often forget that I’m talking to an audience whose needs might be different from what I want to talk about.

Make sure to start with a hook that will keep your audience from leaving. In this case, talk about Story and about the ABT technique, but don’t explain yet.

Sound smart by quoting smart people.

Here’s one of many books I’ve read on storytelling. Randy Olsen is a tenured professor of marine biology who went on to become a Hollywood script writer, one of the working-class storytellers of our age. We can trust his experience.

Olsen tells us that too many scientific presentations and articles are written in AAA style. This is the DEATH of communication: a litany of achievements with no story. Instead go after the strong bones of a good story: ABT: and … but … therefore.

Here’s an example.

CMIO’s take?

Practice your ABT this week. Come back next week for more lessons on presenting. The terrible state of scientific and indeed EHR communication means that it won’t take much to elevate your talk above the average. Let’s go!

Sepsis, AI and the Centaur. Also a discussion of Automation Complacency at iPractise (CTL talk)

I-PrACTISE – Improving Primary Care Through Industrial and Systems Engineering

Thanks to Dr. Beasley at the University of Wisconsin-Madison’s lecture series iPractise:Improving Primary Care Through Industrial and Systems Engineering (I-PrACTISE)

I enjoyed speaking with the thoughtful group of clinicians, engineers. See the website above, my talk was on 3/14/25 and use the password on that same website to launch the video recording of my talk.

In brief:

  1. Predictive analytics, AI with challenging signal to noise requires us to reconfigure human teams to achieve our goals.
  2. Furthermore, automation effectiveness will always lead to human complacency.

Of course, we discuss a lot more than that. Lets keep the conversation going!

Digital Health Most Wired 10 awardees (UCHealth-Colorado, our 5th year!)

CHIME (College of Healthcare Information Management Executives) Fall Forum was this past week. They award the DHMW: Digital Health Most Wired awards. Also, CT gave one of his talks … what ukulele song did he play? #CHIMEfallforum #InformaticsFTW #MostWired10 #CHIME24 #CIOs-and-CMIOs-can-be-friends

In this post: 

  1. Gratitude to CHIME for what they do
  2. Gratitude to Most Wired organizations for what they do
  3. Gratitude that people will come to my talk
  4. An observation about our industry

Gratitude to CHIME.

For 5 years, CHIME has offered the MOST WIRED survey, so that organizations can review the industry best practices for being an EHR (electronic health record) powered health system, using EHR and related electronic tools to improve patient care, patient safety and quality of care. Here we are at Breakfast for Most Wired awardees, 2024. 

 

Humble-brag; we’re the only organization to earn Most Wired 10 for all 5 years. This of course, only matters to parents and grandparents. 

Gratitude to colleagues

I am grateful to the other 2 dozen Most Wired level 10 organizations, an the hundreds on their journey to Most Wired 8 and 9 and climbing the ladder of performance. We are all striving, not just to survive a go-live, but to thrive. As more organizations learn how to best use our new electronic tools, and then share our best ideas, this rising tide raises all boats. 

 

Thanks, Mark Clark, VP of IT at UCHealth. He makes a lot of our stuff go smoothly. 

 

Lining up backstage, after rehearsals. “Stand here. Don’t touch the table. Photo first, then shake hands. Exit stage right. Quickly!”

 

Over 1000 CIO’s are members of CHIME, most attend Fall Forum and share their best ideas. I love this community and what it stands for. 

 

Gratitude to friends.

Here’s me giving my talk to my 50 best friends: Embracing Failure on the way to success. A litany of all the many ways I have failed my colleagues.