Category: My Talks

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

Making slides for a talk? How to make them more memorable (advanced tips)

Powerpoint deck on how to give a good powerpoint talk linked here: https://www.dropbox.com/s/pmzloklxmmr5132/2019-0513%20How%20to%20give%20an%20effective%20presentation%20-%20advanced%20-%20CTLin.pptx?dl=0

I’ve been thinking about giving talks backed by powerpoints. Leaving aside the many talks on “Death by Powerpoint”, the lifeblood of the industry is on slides-man-ship in presenting new ideas to our own organization’s leadership, and at national meetings.

And then you see these lovely presentations by TED speakers who are inspiring, tell great stories, but DO NOT have to provide detailed scientific rigor underneath their high-flying narratives.

We, in informatics, have to contend with both parts of this conundrum: how to tell a compelling story well enough to capture imaginations, and more importantly, purse-strings, and yet back it with enough data and science to be compelling to our very picky bean-counters and scientists.

Further complicating this fact is that often, our powerpoints get distributed by email and have to STAND ALONE to convince others, sometimes. Therefore, the whole TED TALK, with IMAGES ONLY and NO DATA become useless in this context; now we have to figure out EITHER how to write an entire white paper (1-4 page brief that can be read quickly) to supplement any slides we give, or to modify these slides so that they CAN stand alone. Ideally, we can write a powerpoint slide deck that includes enough detail to satisfy data-hounds, and yet engaging enough, with a minimum of words, to create a compelling narrative.

CMIO’s take? Only you can judge if I’ve achieved my goals (see link). This is a summarization of more than a decade of my ‘doing it wrong’ and set of guiding principles that I’ve used to continually improve my own talks. I already presume that you know how to build a Powerpoint deck, and that you’ve read other articles on How-To in powerpoint, maybe Garr Reynolds’ Presentation Zen, or Dan Roam’s Show and Tell. There’s lots out there. But this is my take.

 

Improving Wellness via EHR Optimization Sprints and High Performing Teams. WellDOM speaker series with Amber Sieja and Katie Morrison

It is always a pleasure to stand up and discuss our Informatics work in public forum. We always strive to reduce physician burnout and the EHR burden by improving teamwork and practice efficiency. As a side effect, we discovered the principles behind Agile teamwork, reducing waste, and the ideas underlying High Performance Teams (both running one, and teaching clinics how to become one).

The talk is 50 minutes and the podium is shared with my colleague Katie Morrison MD, Director of the WellDOM program (Wellness in the Department of Medicine at University of Colorado) and my colleague Amber Sieja MD, Senior Medical Director of Informatics at UCHealth. I’m grateful for their brilliance and collaboration.

The TL;DR is:

  • Sometimes you have to borrow and steal a team to get started
  • Get the right people on the bus: a physician informaticist, nurse informaticist, project manager all are crucial
  • EHR efficiency is NOT only about physicians: it is about teamwork
  • 2-week Sprints are a good timeline: short enough to be urgent, long enough to make some real change in the clinic
  • Eventually you’ll discover Agile, Lean, High Performance Team principles. Live them, and teach them to sustain yourselves

CMIO’s Take? TL;DR. Just do it.

“Empty Wallet” or Real Time Benefits Check interfaced into the EHR (woo!) Ukulele

Yet another misadventure with our protagonist

Thanks to all our EHR colleagues; I’m returning from Epic’s UGM (User Group Meeting: check out the twitter-verse at #UGM19) and learned a ton from other customer presentations and from Epic’s future vision as a company. Here is our contribution: a successful integration of RTBC (real time benefits check) of prescription co-pay, prior authorization data, and “payer suggested alternative” meds, right in the prescriber’s workflow, right inside the EHR. Simple, works fast (pharmacy- and patient’s insurance-specific real-time check within about 1 second) for every prescription written. Now, you can tell the patient “This prescription has a $4 co-pay at Target pharmacy”. What a difference.

This was the difference between my patient NOT paying $291 for doxycycline tablets vs $90 for doxycyline capsules. Really?

See my blog post on RxRevu previously. This is working well, and we’ve scaled up to all 3000 prescribers at UCHealth with excellent results.

TO celebrate, we’ve come to discuss our success at UGM … and (of course) to sing a song. Thanks to Terri Couts, VP of Epic Applications at Guthrie Clinic, co-presenting the topic, and for agreeing to sing with me!

CMIO’s take? Enjoy the song.

I Can See Clearly That My Sprain is Gone – Ukulele parody (and an XGM talk)

Author along with co-conspirator Peter Sachs MD. Neither can sing.

We (Dr. Peter Sachs, Vice Chair of Radiology at UCHealth, and I) recently had the pleasure of presenting our recent quality improvement work at Epic’s XGM (eXpert’s Group Meeting) in Verona, WI this week. In brief, we created and turned on the ability for patients to view their own radiology IMAGES online in their patient portal. We had already been sharing radiology REPORTS with our patients for over a decade, and this is an additional step towards information transparency. We think we are among the first to do this.

Despite some minor misgivings on the part of our clinical leaders, we were given the green light to turn this on. Short answer, over 22,000 patients viewed their images in the first month, September 2018 and … no complaints from either doctors or patients! So, we get to keep our jobs!

If you have 2 minutes, here’s the song:

And, if you have another 25 minutes, here’s the talk, and some Q/A after:

Patients Viewing Their Radiology Images Online. Peter Sachs, CT Lin, XGM 2019

CMIO’s take? It is terrific to have a close community of like-minded physician informaticists and technologists pulling to improve healthcare and patient experience, and celebrating each other’s successes. I’m ever grateful to innovative and inspiring colleagues.

What is a Yottabyte, and How Do You Treat It? (a talk)

https://youtu.be/OReBJIbYAfU

I gave a keynote speech late last year at Technology Awareness Day, hosted by the University of Colorado, Anschutz Medical Campus about Big Data, Tech acceleration, and Artificial Intelligence, as applied to healthcare.

I enjoy making my colleagues uncomfortable. How long will doctors have jobs? Will the AI eliminate internal medicine doctors? If Watson can beat humans at Jeopardy, can it beat me at reading medical literature? Can it be dermatologists at diagnosing skin cancer? Can it beat radiologists at interpreting CT scan images?

It is true that the most complex object known to us is the human brain, with its trillions of neurons and extensive interconnections. From this physical matter, something called “general adaptive intelligence” and “consciousness” arises, neither of which we understand or know how to construct or deconstruct. On the other hand, fundamentally though, isn’t a neuron a collection of physical and chemical processes that we DO understand? And then extrapolating upward then, is it not conceivable that we could eventually figure out how to construct a human brain in all its complexity? Hmm.

Reading books like “Life 3.0” and “Superintelligence” gets me thinking about stuff like this. It is both humbling and exciting at the same time.

CMIO’s take? Decide for yourself. I know, it is almost an hour long, and who has an hour anymore, especially if TED speakers can get their point across in 10 minutes? Well, consider my talk a series of 4-5 TED talks. Yeah, that’s it.

Dept of Medicine Innovation talk (video) on EHR Sprints

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I play a doctor in this blog, and sometimes in real life. 

http://www.ucdenver.edu/academics/colleges/medicalschool/departments/medicine/Pages/RIC-09-20-2018-Lin.aspx

Recently I gave a talk for the Department of Medicine Innovation and Research seminars at the Anschutz Medical Campus for University of Colorado’s School of Medicine. I spoke about one of my favorite topics, some of which I have discussed in these blog pages: Reducing the EHR burden and improving physician burnout with EHR Sprints.

CMIO’s take: what is YOUR organization doing to address physician burnout? Something similar? Let me know!

We are Physician Builders (ukulele EHR parody)

Here we are at #ugm2018 Epic’s annual User Group Meeting. We’re at our first Directors’ Advisory Council session with over 600 attendees, and we discussed our governance approach to Physician Builders and how we overcame internal resistance to the idea that Physicians could do a good job creating new designs, templates, smart tools, and other content (and some actual programming) in the Electronic Health Record (they can!). In fact, our 19 Physicians who are now certified builders have made substantial improvements to our EHR environment on behalf of numerous medical and surgical specialties, as well as our physician users in general.

The point being, that although IT analysts are terrific for creating most of the content of the EHR, having physician builders with deep knowledge of the EHR technology leads to some interesting capabilities:

  1. Physician informaticists, with clinical knowledge, strong communication skills, and now technical know-how, can help other physicians reduce the EHR burden by matching tools to the clinical scenario, and reduce cognitive burden. For example, it is difficult to order the right cardiac arrhythmia monitoring tool (Holter? Event Monitor? Zio? Some other device?). Instead of building what a cardiologist physician was requesting, our physician builder thought about it, and suggested some the creation of a cascading order panel that gently guides the ordering physician to the right order WITHOUT building an exhaustive long checklist with difficult-to-follow paragraphs of instructions. Having a foot in both worlds is beneficial in this case.
  2. It is delicate and important do develop EXCELLENT relationships, CLEAR communication and strong guidelines so that the IT analyst team and the physician builders know what to expect from each other. When done poorly, turf battles erupt: “don’t touch those tools that I built!” But, done well, we become a synergistic team: “wow, thanks for taking on those Express Lanes; we would not have achieved our Honor Roll status (and helped all those urgent care centers) without your help.”

Really proud of our high functioning team.

And to ensure our audience got the point, we sang them our song. Lyrics below, YouTube link above.

We’re Physician Builders (Champions, Queen)

I’m a frustrated doc. Am Em
Passed my builder test
I wanna build
But she says: ‘You jest!’

And bad mistakes. C F
I’ve made a few
I’ve had my share of bad code kicked in my face C G Am
But I’ve come through! D7 G A

We’re physician builders, my friend D F#m Bm G A
And we’ll keep on buildin’ ’til the end D F#m G A
We’re physician builders, we are the builders Em A7 Gm A7
Those are happy users, cause we are the builders D C F G7
Of an Epic world. G7 D

I’ve set up smartlists. Am Em
And CER rules
You sent us Foundation and everything that GOES w it
I love those smart tools.

And maybe with time C F
Create a team goal,
We’ll share build in Text and Hyperspace
And make Honor Roll! C G Am D7 G A

We’re physician builders, my friend. D F#m Bm G A
And we’ll keep on buildin’ ’til the end. D F#m G A
We’re physician builders, we are the builders Em A7 Gm A7
Those are happy users, cause we are the builders
Of an Epic world.  D C Bb G7 D

CMIO’s take? What are YOU doing to ensure that you don’t take yourself too seriously? Are you here at Epic #ugm2018? Let me know!

How can the Triple Aim help patients? Here’s how.

2018-0529AneurysmRepairPatientCenteredQuadAim
Three amigos, with very different approaches to Aneurysm repair

My father (hi Dad!) recently was diagnosed with an incidentaloma. In medical speak, that is an “incidental” (or, unintended) finding on an imaging study conducted for an entirely different reason. His physician found an ascending aortic aneurysm of a certain size, on CT scan of the chest.

Dad was interested in finding a vascular surgeon in the Los Angeles area who was experienced in evaluating and if necessary, performing surgery for this condition. “So,” he asks me, “who’s good at vascular surgery in Los Angeles?”

I was completely stumped.

I went online, as all good internet-enabled adult children do, and found several dozen websites that purport to show and rate surgeons in the Los Angeles area. NONE of them were useful. Angie’s list, HealthGrades, lots of commercial and informal sites trying to meet an important need. Either there were no surgeons listed, or maybe there is a fragment of a listing and no data, or maybe there is a marketing blurb associated with that surgeon, or maybe someone ranting about a surgeon with whom they were unhappy. Nothing in terms of quality of care, operation case volumes, patient outcomes, very little of patient satisfaction…

And yet, we now are collecting such data in our massive EHR’s. WHAT IF we took the Triple Aim of improving healthcare:
-Improving health of populations
-Enhancing the experience of care
-Reducing costs

And gave a such tool to our patients? What if we could apply Amazon.com principles to searching for physicians and showed the screen above: how many operations of this type per year, the re-hospitalization rates; the complication rates, the patient satisfaction, the cost of that care, wrapped up with an overall star rating?

Yes, I can hear the outcry now. There are SO MANY REASONS that we can’t do this. As a former hospital CEO (Dennis Brimhall) said to me decades ago:

NO PATIENT SHALL WAIT. This is our vision. I know there are 300 reasons why patients HAVE to wait in our hospital. And yet, we ALL know that waiting is one thing patients hate about our care. So, NO PATIENT SHALL WAIT. And it will be ALL OF US working to solve the 300 things so that this can come true.

So it is, with this vision. It is hard, and nearly impossible with the sociopolitical structures we have now. The technology is just about able to do this, but the much harder work is convincing all the stakeholders in the healthcare industry (and in my own organization!) that this is valuable, this is important, and we must do it.

It is also possible, that by the time we achieve this, the 2 “surgeons” pictured above will have grown up and helped solve this problem. And that clearly irrelevant, untrustworthy guy on the right will have retired.

And, Dad’s fine, by the way. Thanks for asking.

CMIO’s take? If you don’t like change, you’ll like irrelevance even less.

Ukulele parody: Everyone Knows its Becky

Thanks to the medical informatics division at UC San Diego Health for hosting me at their informatics seminar series. I gave a talk about our efforts on improving physician well-being and reducing burnout (see previous blog posts on Sprints and Practice Transformation).

Sometimes, I travel with my ukulele. Sometimes, I sing at the end of my presentations. Sometimes, I climb out of my meditative, introvert bubble and see what happens.

Thanks to the one guy in the seminar who clapped for me. Kidding. UCSD has a great crew of informaticists doing great work. Christopher Longhurst (CIO) and his team are implementing a team with the purpose of getting physicians “Home for dinner” among the many other good things they’re doing.

Anyway, my apologies to The Association, whose song “Everyone Knows It’s Windy” I ripped off and re-purposed.

And yes, since I’m binge-watching “Breaking Bad” right now, I know the song features prominently in one of the episodes (NSFW). Where do you think I got my inspiration?

CMIO’s take? Always keep ’em guessing.

CT meditates: a comedy (14) Stanford wellness, military mindfulness, and Death Sticks

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I like Stanford’s relatively new Physician Wellness site; something we can all aspire to. It includes links to self-assessments (see “Test yourself” link on the far left of that page.

http://wellmd.stanford.edu/

What highly-competitive health care provider doesn’t want to test themselves against others? Maybe I can score the highest! Wait, maybe not the highest on a burnout scale…

It is a good conversation to have, with yourself about your own elements of burnout, and internal resources of resilience. How do you stack up? Is it time to “go home and rethink my life?”  (link: youtube video on the guy who tries to sell Star Wars’ Obiwan “Death Sticks”).

Remember, if you’re coming on the 3-minute daily journey with me:  eyes closed, with just the simple goal of spending 3 minutes in a comfortable pose, and focusing on breath. Then to watch the inevitable stream of thoughts floating by, observing each one as a puffy cloud, letting it just drift by without diving into it, and returning to breath.

Teaching our Communication workshop recently, I was reminded that the US military now has soldiers undergoing Mindfulness training with quantitative improvements in focus and performance. Hmm! Maybe this IS more than just mumbo-jumbo.

CMIO’s take? Mumbo-jumbo sometimes is good.