Epic man, singing about immediate release of results, covers Anticipatory Guidance.

Immediate release of test results, discussed with a radiologist audience: a pro and con debate. What could go wrong? And, of course, the ukulele.

Thanks to Dr. Jennifer Kemp who designed and invited me to present a panel called: “Information Blocking Pro and Con: A  Debate.”

I am at RSNA today. My first. Did you know the Radiological Society of North America is the largest medical conference in the world? I did not know this until yesterday. 40,000 attendees, over 4000 speakers. That works out to about 80 speakers PER HOUR. Geez.

I was one.

Disappointingly, not all 40,000 attendees came to see our panel presentation. 🙁

Nevertheless, of the 80 attendees, we had an excellent discussion in the context of releasing complex radiology images to patients, including MRI CT PET etc. and the resulting problems if/when patients find out about cancer or other devastating result by viewing their results online.

There are exceptions to the federal rule:

  • If the patient prefers not to see the results
  • If releasing the results may result in Physical Harm to the patient or other person (note that anxiety or psychological harm does NOT qualify)
  • Systematic embargo or delay of release of result is forbidden based on this federal rule.
  • The proposed penalty for violating this rule is $1 million. However, we are aware of only about 400 registered complaints of information blocking, 3/4 of which are organization to organization blocking, and only about 100 of patients registering because of not receiving notes or results. And we are not aware of any successful complaints resulting in actual penalties, as yet.

Question from the UK

We had a question from a colleague from the United Kingdom, as they are just now about to formulate a similar law. ‘Would it be reasonable given US experience to establish a national standard for embargo: let’s say all providers uniformly delay a high risk result for 3 days?’

Our reply: probably not. Airline passengers are now aware of every moment of their luggage transport, and every moment of their arriving Uber driver. Why would radiology reports be any different? The consumerism movement is unidirectionally toward more transparency. Maybe 5 years ago, if the UK was considering a standard, that would have been standard of care in the US, but no longer. 

Furthermore, research that we (reference) did

indicate that among 8000 patients who had already received test results from a patient portal, 96% indicated they wished to continue to receive results immediately. Even among those receiving abnormal results, 95% still wished to receive results immediately.

It is also true, however, that 8% of patients receiving immediately released results did worry more. However, we believe this worry is based on getting “bad news” more than it is about getting “bad news immediately.” These are the patients we need to focus on, and more details we need to study. 

Our suggested plan: that ordering physicians use anticipatory guidance: ordering physicians will eventually need to explain the result to the patient. Why not spend one more minute at the time of ordering to dramatically reduce the anxiety of the patient when they view the result later at home?

3 easy steps:

1. We are ordering a test. You may see the result before me. Best case, this is normal and I will contact you this way…

2. Worst case it could be … there is X% chance of this. If that is the case this is how I would reach you…

3. You have a choice: look immediately or wait to hear from me. What Q do you have?

In our experience this works very well and doesn’t take much time at all.

And for radiologists, publishing a contact number for patients to call if they have questions is very reassuring to patients and, guess what: they rarely use that number: in a busy multi-radiologist practice over the course of years reading hundreds of thousands of studies, their office has received 1-3 phone calls A YEAR from patients. And most of the time it is about factual errors in the report, and rarely is it to ask about the medical impact of the findings. It is quite minimal work.

CMIO’s take? The time for immediate release is here. There are great solutions to the anticipated problems. It also happens to be the law in the US.

If you’re still not convinced, or even if you are, here is a song for you, fresh from Chicago’s RSNA 2023:

Epic Man 2023: Information Blocking. (YouTube)

Podcast with me, CT Lin and John Lynn: CIO Podcast

Now, without further ado, we’re excited to share with you the next episode of the CIO Podcast by Healthcare IT Today.

Interview w John Lynn

For the 63rd episode of the CIO podcast hosted by Healthcare IT Today, we are joined by CT Lin, MD, CMIO at UCHealth-Colorado to talk about patient messaging. To kick off the episode we dive into his work in sharing patient results and the efforts to keep it private. Next, we talk about how the sudden increase in patient messaging has led to some practices charging for the service to get Lin’s experience and thoughts on the topic. Then we take a look into Lin’s past projects to get his insights on what project he felt was the most successful and what made it successful. Looking forward, we also discuss what projects Lin wants to work on but hasn’t had the time. We then talk about AI and where we think it’s heading. Finally, Lin shares the best career advice he’s been given and how playing the ukulele has impacted his career.  Plus, he finishes off the episode with a health IT ukulele song.

Here’s a look at the questions and topics we discuss in this episode:

  • You were ahead of the curve with sharing results with patients. Where are you at today with Information Blocking and sharing data with patients?
  • Patient messages are overwhelming doctor’s Epic inboxes. Many are starting to charge for these messages. What’s been your experience with this and how is UCHealth approaching it?
  • What’s the project you’ve worked on that’s brought you the most personal satisfaction and feeling of success and what made it successful?
  • What’s a project you want to work on, but just haven’t had time to yet?
  • Where is all this AI headed?
  • What’s the best piece of career advice you’ve been given?
  • Where did you learn to play the Ukulele and how’s that impacted your professional career?

I’m speaking at CHIME Fall Forum: the pre-course on informatics AND the main forum

Come for the Informatics discussion, stay for the ukulele. Or don’t. Topics: Big Data / AI in practical use; Blowing up the Classroom for EHR Training; Inbasket Hyperobject: what is that, exactly? And can we deconstruct it?

Here is the registration link:

https://www.chimeinnovation.org/nov23-clinical-informatics-innovation-summit

Hope to see you there! Looking forward to our discussions.

 

Incremental Healthcare (Dr Nick Van Terheyden) Audio Podcast with CT Lin

An audio podcast of EHR trends including AI chatbots, shiny new objects, and boring old governance.

Thanks to Dr. Nick for hosting me on his podcast the Incrementalist.

We covered a bunch of topics in our time together:

  • AI, big data
  • CMIO work
  • Digital Health
  • Disruptive tech
  • EHR trends

Healing Harmonies – Dr Nick (incrementalhealthcare.com)

And maybe, a ukulele song. Transcript available for those who aren’t patient enough to listen (but then, song lyrics and melodies don’t translate well with an auto-transcriber).

CT

I’m sorry Dave, I’m afraid I can’t do that (updated big data and AI talk for 2023) given at CSO HIMSS Ohio

Lovely conference facilities in Dublin Ohio

https://www.facebook.com/Csohimss/videos/1790352804768745/?mibextid=rS40aB7S9Ucbxw6v

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

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?

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!

Wide-Ranging Interview w This Week Health (CT Lin and Bill Russell)

Bill and I chat about Info Blocking, Anticipatory Guidance, Inbasket Redesign, a 350% increase in portal messages, a one-page pediatric medical record, and more!

I’ve made it to the big time! I enjoyed chatting with Bill about Burnout, documentation, inbasket, messaging online, and information blocking in a 15 minute chat in the hallways at CHIME 22 fall forum in San Antonio. See link above.

Tips on Mentorship (a conversation)

The PAC mentor program

I recently had the chance to sit down with David Bar-Shain MD, of MetroHealth, who single-handedly started the a mentorship program in the PAC (Physician Advisory Council), hosted at Epic in Verona Wisconsin.

The program has been running for 4 years now and has matched over 70 mentor-mentee pairs, over 170 people involved, supporting young physician and APP informaticists by matching them with mid- and late-career informaticists (and some who serve as both mentee and mentor!).

We recently had a chance at the Epic 2022 User Group Meeting to sit and chat about the fundamentals of mentorship, and what I find interesting and fun about being a mentor.

What did we talk about?

  • The importance of having more than one mentor
  • Mutual curiosity: telling our own journeys
  • Who sets the agenda for our meeting?
  • War stories and are they appropriate?
  • 1-pagers
  • Storytelling
  • 80:20 rule of informatics: socio-political vs technical skill
  • Book club and leadership
  • Learning from outside of healthcare
  • Mentorship is about asking open ended questions
  • 3 psychological principles that apply to therapy as well as mentorship
  • Rowing downstream, not upstream
  • Advocacy, offering connections from your network
  • Peer mentorship
  • Blind spotting
  • Validation and encouragement
  • Lateral thinking
  • The Failure Resume

Here’s the audio-only interview (33 minutes).

CMIO’s take? Let us know what you think! From YOUR experience as a mentor or mentee, what have YOU learned?

Creativity DOES NOT come from our laptops

For all the great mind mapping tools out there, for all the shiny new apps that covet my attention, when it comes to creative thinking, designing things, or brainstorming a new talk, paper is it. #whyinformatics #hitsm #hcldr

Here are some examples:

Designing my Failure Resumé talk

Designing my AI talk

Designing my Sprint talk

Attending the Stanford Design Thinking for Social Systems

Of course, you should know that it is never this clean, never this simple. You don’t see the crumpled sheets, the trash can overflowing, the angry scribbles, the hair torn out and the yelling into the void. No, you don’t see it.

I’ll give John Cleese the last, inspiring words on this.

We don’t know where we get our ideas from. What we DO know is that we do not get them from our laptops.

John Cleese
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