Category: My Talks

Talks I’ve given locally and nationally. May include ukulele songs…

Predictive Algorithms Save Lives Sepsis @uchealth: A 5-slide talk

This data dilettante (see previous posts: dilettante #1, dilettante #2) has enjoyed armchair theorizing with all of you, my best (online) friends. Today we explore how our super-smart team scrambled our way to improving sepsis care with a predictive algorithm we built.

The old saying goes: the success of any major project in a large organization follows the 80:20 rule. 20% of the work is getting the technology right, and 80% is the socio-political skill of the people doing the work.

We all underappreciate this fact.

It turns out that we spent months building a sepsis alert predictive tool, based on various deterioration metrics, and a deep analysis of years of our EHR data across multiple hospitals. We designed it to alert providers and nurses up to 12 hours BEFORE clinicians would spot deterioration.

We patted ourselves on the back, deployed the predictive score in a flowsheet row, and in the patient lists and monitoring boards, with color coding and filters, and stepped back to revel in our glory.

Right?

Nope.

Turns out that our doctors and nurses were ALREADY FULLY BUSY (even before the pandemic) taking are of critically ill patients. Adding YET ANOTHER alert, even with fancy colors, did NOT result in a major behavior shift to ordering IV fluids, blood cultures, or life-saving antibiotics any quicker.

Hmph.

See the fancy patient-wearable tech on the left (Visi from Sotera, in this case), and one of our hardworking nurses, with ALL of our current technology hanging off her jacket and stethoscope. She should be the visual encyclopedia entry for “alert fatigue.” 🙁

(right: one of our overburdened hardworking nurses, image used with authorization)

Back to the drawing board

As result of our failure, we huddled to think about transforming the way we provided care. It was time to disrupt ourselves. We decided to implement a Virtual Health Center, mimicking what we had seen in a couple places around the country: we deployed 2 critical care physicians and about a half-dozen critical care nurses on rotation, off-site at an innovative, award-winning Virtual Health Center.

This second time around, we created a cockpit of EHR data and predictive alerts to the VHC clinicians, who were dedicated to watching for deterioration across ALL our hospitals, and responding quickly. This does several things:

  • Takes the load off busy front line clinicians
  • Creates a calm environment for focused, rapid response
  • Dramatically improves the signal-to-noise ratio coming from predictive alerts

This way, the VHC nurses view all the alerts, investigate the chart, and contact the bedside nurse when the suspicion is high for sepsis, and start the sepsis bundle immediately.

Soon, by tweaking the ways our teams worked together, we were able to reduce the burden on bedside nurses and physicians and simplify handoffs.

See chart above: Before the VHC, bedside nurses were responsible for detecting sepsis (infrequent, subtle signals during a busy shift with lots of loud alarms for other things), with many ‘grey box’ tasks, as well as ‘magenta box’ delays.

After implementing the VHC, the VHC nurses took over the majority of ‘green box’ tasks, reducing the bedside ‘grey box’ work and completely eliminating ‘magenta box’ delays.

As a result, we have dropped our “time to fluids” by over an hour, and “time to antibiotics” by 20 minutes, which we estimate has saved 77 more lives from sepsis each year.

CMIO’s take? Predictive analytics, data science, machine learning, call it what you like. This is a paradigm shift in thinking that requires disrupting “business as usual” and is hard, but rewarding work. I can’t wait to see what we all can achieve with these new tools.

My Failure Resumé (a talk)

What lessons can we learn from CT Lin’s failures?

https://youtu.be/woozgn3viHI

 

Thanks to the Colorado Chapter of HIMSS (Health Information Management Systems Society) and to Bonnie Roberts and Rich Morris for co-hosting my presentation.

Based on my recent Failure Resumé 1 pager. Here are some personal stories, life lessons, and 3 exercises to help you build a failure-tolerant future.

With, of course, a bonus ukulele song at the end.

CMIO’s take: Have you written a failure resumé? Are you building a failure tolerant future? Let me know in the comments.

I can see clearly now, my Sprain is gone (ukulele)

Thanks to my collaborators on the Patient Radiology Image Viewing team at UCHealth: Evan Norris MD, Ciarra Halaska, Justin Honce MD, Peter Sachs MD, and Kate Sanfilippo. Come see our talk at Epic XGM 2021 (eXpert Group Meeting) next month! Session Rad 1.4

What’s the TL;DR? Allowing patients to view their radiology images in their patient portal, alongside their radiology reports, is technically feasible, and does NOT cause increased anxiety for patients or increased workload for providers (in fact, ZERO phone calls, and yet our patients view 39,000 images per month!). Eighty percent of patients liked it. Many showed their images to their providers, some saved copies, some posted on social media! Some had technical difficulties, some had trouble understanding the images.

It is a good start, but there is more work to be done!

Wanna know more? Here is our pre-print publication.

CMIO’s take? It is wonderful to work on teams with great colleagues in the service of better, more transparent patient care.

Beautiful Visuals: Gulf Stream, AMOC and “Global Weirding” (nytimes)

https://www.nytimes.com/interactive/2021/03/02/climate/atlantic-ocean-climate-change.html

I wish our informatics work had beautiful animations like this to bring the lessons home. You must read this, both for the visuals and the powerful impact of the lesson.

My Interview on INFO BLOCKING With 33 Charts

https://touchpoint.health/podcast/vrx-how-virtual-therapeutics-will-revolutionize-medicine-a-conversation-with-dr-brennan-spiegel/

Thanks to Dr. Bryan Vartabedian for a fun wide-ranging conversation about INFO BLOCKING and our information transparency efforts at UCHealth over the past 2 decades. A trip down memory lane, and the potholes I’ve stepped in, and the battle scars from pushing the edge of what providers are ready for…

In case you are willing to come reminisce with me for 50 minutes…

https://touchpoint.health/podcast/vrx-how-virtual-therapeutics-will-revolutionize-medicine-a-conversation-with-dr-brennan-spiegel/

My Failure Resumé: A TALK

You know you’ve wanted to see it, hear it, and revel in the schadenfreude: CT Lin’s famous FAILURE RESUMÉ: a talk.

http://colorado.himsschapter.org/event/virtual-professional-development

CT has failed at so many things, it isn’t funny. Or maybe it is.

Date: Thursday, November 12, 2020. Noon, Mountain Time.

Thank you to the Colorado Chapter of HIMSS (Health Information Management Systems Society) for sponsoring and presenting My Failure Resume. Sign up (free) here.

Those of you who follow The Undiscovered Country know that this is by far my most popular blog post, in 3 years of weekly posts on health care, informatics, leadership, change management, and the general chaos of our lives.

I hope you can make it! Here are some random pictures to whet your appetite.

 

 

But what does it all mean? Come find out! Hope to see you there.

Information Blocking and the End of Secrecy in Healthcare? (a rant, a talk and a uke song)

What is CT looking at? Could it be … his own radiology image in his patient portal? What does this mean about secrecy in healthcare?

What is CT looking at? Could it be … his own radiology image in his patient portal? What does this mean about secrecy in healthcare?

In this blog:

  • A rant about Information Blocking, Open Notes, and unintended consequence
  • The slides from my talk at CHIME “Is this the End of Secrecy in Healthcare?”
  • A ukulele song “I Can See Clearly Now, My Sprain is Gone”

THE RANT

Followers of this blog, the Undiscovered Country, know that I’ve written about our Open Notes journey, our innovation to release radiology images to patients via the patient portal, our sharing of patient co-pay for prescriptions, and we are participating in the Our Notes project to have patients co-author their own clinic progress notes.

And now, CMS’s latest regulation on Information Blocking, part of the 21st Century CURES act, has detailed stipulations on what must be released to patients, including Open Notes in clinic, in the emergency department, and for inpatient notes. It turns physician paternalism on its head: we should RELEASE all information to patients UNLESS there is a compelling reason not to.

If your organization is NOT scrambling to get this in front of your providers to discuss: immediate release of progress notes, consult notes, history/physicals, operative reports, discharge summaries, laboratory report narratives, radiology report narratives, pathology report narratives, THEN YOU ARE BEHIND THE EIGHT BALL.

Full disclosure, I was part of a Robert Wood Johnson sponsored event to explain Open Notes to congressional leaders in Washington DC 2 years ago. Little did I know we’d end up here, with the regulations not only catching up to the literature (benefits of Open Notes in ambulatory settings), but surpassing it and requiring Open Notes (patients ability to access their providers notes written about them and their are) for Inpatient Settings. We published our experience with Inpatient Open Notes in 2013. The results: lukewarm. Our providers and nurses were very concerned before the project, somewhat less concerned after. Our patients were underwhelmed with the offer of viewing their notes. Others have written about inpatient Open Notes, that potential challenges with communication, anxiety and increased workload may negate the benefits. Specifically patients and providers were concerned: will providers STOP writing important discussions and debates in progress notes because of fear that the patient or their family will immediately see them (eg: “there are several possible cancer diagnoses we are considering that might cause this”, OR, “be careful when you go in that room, the father can be very aggressive”). Certainly, with more care and thoughtfulness, we can write better notes, but should we require that? Are hospital providers not already working too-long shifts and already burned out from excessive administrative work? I’m uncertain.

I am concerned that MANDATING release of inpatient daily progress notes immediately to the patient may result in significant unintended consequences, with benefits that may not overcome the risks.

But, here we are. The full details and FAQ of Information Blocking (how soon must notes/results be released? how extensively? Retroactive to ALL notes written electronically (for us, back to 2003)? are still pending, and yet the regulation goes into effect in November. 2020. Soon.

We have had rules for built-in time delays to the release of test results to patients that have been in place since 2003. These applied to both outpatients and inpatients. We have been pleased that our release of blood tests to patients has been “immediately” since 2003. However, we do delay complex radiology imaging (CT, MRI, PET) for 7 days and pathology results for 14 days so that potential cancer diagnoses are communicated from the provider rather than “discovered” online.

This will now have to change, and urgently. I am convinced we can get to IMMEDIATE release of all results and notes, but it will take some hard thinking, some hard cultural conversations, some letting-go of old traditions, some problem-solving of potential new problems, lots of anticipatory planning (how to educate patients on what they might be the first to see online), and also (as per the Leading Change principles) to grieve the loss of the “old ways.”

IS THIS THE END OF SECRECY IN HEALTHCARE?

So, this is the slide deck content for the talk I gave at CHIME (College of Healthcare Information Management Executives) last fall, and at a couple of other national venues, detailing the information transparency efforts we are undertaking at UCHealth:

https://www.dropbox.com/s/mzhujn6vqiwsevt/2020-02%20CT%20Lin%20End%20of%20Secrecy%20in%20Healthcare.pdf?dl=0

AND A SONG

Far be it from me to lose an opportunity to sing you a song…

https://youtu.be/Uii-hGIboUo

Dr. CT Lin’s Covid-19 advice for patients. KOSI 101 and Mile Hi Magazine

In the link below, it is the interview from April 12, 2020.

https://kosi101.com/mile-high-magazine-public-affairs/

I had the pleasure of being interviewed by Mile Hi Magazine last week in regards to questions about how patients can cope with Covid-19 at home.

I responded to such questions as:

  • So many people contract but recover, is this what our body is designed to do?
  • Can people determine whether they have the virus without a test on symptoms alone?
  • When contracted, quarantine is the first step. What’s next in terms for two weeks – nutrition, special foods to eat to help the immune system fight?
  • Any special foods we should be eating now to be in top immune condition should we contract?
  • Any over-the-counter medicine to take for the fever or diarrhea?
  • Should people change out bed linen during the two-three weeks period?
  • Once fever breaks, is this a key sign that its over?
  • Should people exercise while body is fighting the infection?
  • Once over, should person we wait a couple days to ensure no symptoms return?
  • If Covid-19 is a flu strain, will it mutate into another strain as flu does each season for next winter?
  • Anything else you feel is pertinent to help people feel they can get over it if infected.

I made one particular point at the end of the interview. I shared our family’s strategy for coping with the anxiety and stress during this pandemic:

  1. Exercise every day
  2. Play or make music every day
  3. Limit yourself to 30 minutes of news or social media daily
  4. Three Good Things. At dinner each of us discusses THREE THINGS we are grateful for, today. INSTEAD of our natural tendency to focus on the negative, this exercise helps us reframe our day in a positive light.

CMIO’s take? I challenge all of us to do THREE GOOD THINGS with our loved ones at dinner every night.

UCHealth: ‘Most Wired’ level 10!

Uncomfortable-looking author

We are incredibly honored and humbled to be awarded Most Wired level 10 by CHIME: the College of Healthcare Information Management Executives.

We were one of the three organizations, out of thousands applying, to be awarded level 10, indicating the highest achievement in superior performance and process for information technology used to improve clinical care. This is the first year that CHIME separated out the awardees into levels 7, 8, 9, and 10.

See my last blog post for some of the details of our presentation at CHIME and some of the projects contributing to our success.

It was humbling to stand by the CIOs from Cedar Sinai and Avera Health to receive the honor. Link to article from CHIME below.

CHIME Posts 2019 Most Wired’s Awards and Recognition List

What I said in my acceptance comments, and I stand by them:

At UCHealth, Clinical and IT excellence arises from Partnerships:
1. Partnership between the CIO and CMIO and our teams. We make each other better than we could be alone.
2. Partnerships between UCHealth and our vendor partners: we know that there are more smart people who DON’T work for us, than who do.
3. Partnerships between UCHealth and the CHIME community. Healthcare CIO’s are a brilliant lot. We know we stand on the shoulders of giants.
Lastly, we want to pay it forward. More than 3 health systems deserve to be level 10. ALL patients deserve to be treated by a health system performing at its best and we want to see MANY MORE health systems on stage next year.

The End of Secrecy? (a preview of a talk at CHIME19)

I’m at CHIME19 this week: the College of Health Information Management Executives, Fall Forum. Eight hundred Healthcare CIO’s and a growing number of CMIO’s are members. My CIO, Steve Hess and I are giving a talk called “Is this the End of Secrecy in Healthcare?” where we outline our (sometimes) rocky journey toward ever-increasing transparency for our patients.

We know that an informed patient is much more likely to be an engaged patient, and engaged patients have better health outcomes. So, how do we increase the information available to patients? We have to overcome inertia, fear, and sometimes, epithets.

We were interviewed by Kate Gamble of Health System CIO to preview the contents of our talk, see below.

https://healthsystemcio.com/2019/11/01/how-uchealth-is-leveraging-transparency-to-create-a-better-user-experience/

Sometimes we have to look outside of healthcare for our inspiration:

  • OpenTable
  • Travelocity
  • Wikipedia
  • Instagram
  • Yelp
  • 23andMe

Confused? Excited? Freaked out? So were we.

CMIO’s take? Is this the End of Secrecy? Yes. Yes it is.