Ghost Kitchens and their meaning

image from the NYTimes article

https://www.newyorker.com/news/letter-from-silicon-valley/our-ghost-kitchen-future

This is a great thinking piece from the New York Times. A ghost kitchen is a trailer set up in a parking lot, with chefs cooking dishes from restaurants, sometimes from 3-4 different restaurants. This can result in serving meals in the parking lot, or setting up for local delivery AS IF delivered from the main restaurant. This solves the problem of underemployed chefs at restaurants with inadequate social distancing seating, or restaurants that have had to remain closed for some reason.

Observations:

  • Placing ghost kitchens in parking lots leverages old spaces
  • Ghost kitchens emphasize hyperlocal location
  • Ghost kitchens are thriving during the pandemic
  • Ghost kitchens leverage internet tools: apps, A/B testing, analytics, and allows nimble innovation, recombination, creativity, disruption

Read the article, and come back here to think with me. What could healthcare learn from Ghost Kitchens? We are already seeing the beginning of disruption in healthcare: the use of telehealth visits with patients has increased the flexibility of patients and providers by removing geography as a constraint (in some cases). What could A/B testing, or analytics do to further serve our patients in a high-quality, personalized, lower cost way?

CMIO’s take? Sometimes, you have to look outside your usual work-sphere to get the best ideas. Sometimes you have to be willing to disrupt yourself before someone else gets there first.

Doomscrolling. Are you guilty of it? (nytimes)

image from the NYtimes article

https://www.wired.com/story/stop-doomscrolling

Here is a new term for you: Doomscrolling. I am guilty of this, until I become aware of it and have to wrench myself away. It is a like car-crash in slow motion and you want to know how this horror story ends.

CMIO’s take? STOP. Turn it off, go live your life, and talk about
THREE good things.

EHR v Covid-19. Pandemic mask history

https://www.ctvnews.ca/health/coronavirus/a-history-of-pandemic-masks-why-doctors-wore-beaks-during-the-plague-1.4890564

I did NOT know that these beaked masks were full of theriac, a mixture of 55 herbs, intended to cleanse the air before the plague doctor breathed in.

AND that plague doctors carried long rods to maintain distance from others. I wonder where I can order MY “social distancing rod.” Can’t find one on Amazon, although this might do.

The article is fascinating. I’ll take a break from EHR pontification today.

UCHealth v Covid-19. The second surge (not what you think)

Mind the Brain Logo

https://medschool.cuanschutz.edu/psychiatry/about/in-the-news/psychiatry-news/mind-the-brain-mental-health-in-the-time-of-covid-19

I’m so proud to be part of a multi-disciplinary, talented group of clinicians. Our Department of Psychiatry is gearing up for what may become the second surge of our pandemic, as we relax the stay-at-home orders in Colorado:

Mental Illness. Depression. PTSD. Panic. Suicide.

These terms must no longer carry the stigma they do. There is no shame in reaching out for help. Appropriate and timely treatment can aid a person’s innate resilience and return him or her to health.

We have not experienced a pandemic of this scope for more than a century … We are psychologically inexperienced.

C. Neill Epperson MD

Read more of Dr. Epperson’s ideas and initiatives in this fight for mental health and the major investments UCHealth will be committing to improve the well-being of all residents of the State of Colorado. Welcome to the fight!

UCHealth v COVID-19. Patient success stories

https://www.uchealth.org/today/jbs-worker-with-covid-19-goes-home-after-son-prayed-outside-hospital-for-days

Thanks to the hard work of our outstanding nurses, staff, and physicians, many patients with Covid-19 are pulling through. Here’s a particularly poignant story from UCHealth’s own reporter, Katie McCrimmon. Have your tissues ready.

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.

Viral Misinformation vs Actual Virus (Medium.com)

https://medium.com/swlh/misinformation-goes-viral-1aad951e4492

This article “Misinformation Goes Viral” from the Medium is written by a PhD in Cellular and Molecular Medicine from Johns Hopkins School of Medicine, working now in Neurobiology at the University of Utah. Worth reading, and forwarding.

I agree with his well-written article and his sound reasoning, as a Professor of Medicine at the University of Colorado School of Medicine, the Chief Medical Information Officer at UCHealth, and a General Internal Medicine doctor seeing patients (now primarily via Telehealth!) in clinic.

His article has a number of main points with detailed explanations:

  • Americans did not have Covid 19 prior to Jan 2020
  • The virus is not man-made
  • Models are not deliberately misleading people
  • Covid is NOT the flu
  • Bill Gates is not a Bond villain
  • 5G cell towers do not spread Covid
  • Healthcare workers are not paid off by big pharma
  • Herd immunity must be achieved through vaccination, not unchecked infection

CMIO’s take? Let science and rational thought triumph in these difficult times.

EHR v Covid-19. From the front lines: Virtual Visits take off at UCHealth. The Covid-19 burning platform

In-person clinic visits by week (red) and virtual visits (blue) at UCHealth, part of 2019-2020: UNVALIDATED DATA (red blips are likely Thanksgiving and December Holidays)

As recently as 2 months ago, we, the virtual visit leadership team, sat in a conference room bemoaning our fates: HOW will we get our 4000 providers (doctors and advanced practice providers) to start conducting Telehealth or Virtual Visits with patients? In all of 2019, our organization conducted about 2700 visits between providers and patients. This was a disappointing number, having spent a year integrating a 2-way video system (Vidyo) inside our Electronic Health Record (Epic). This was also disappointing because the state of Colorado passed the Parity law requiring insurers to reimburse healthcare providers the same rate for video visits as with in-person visits. What else could one want? Video visits for everybody!

Not so fast.

Turns out, doctors are humans too: you figure out a way to do something well (in-person visits with all your equipment for vital signs, sensors, gee-gaws, tests, fine-tuned teamwork honed over decades of practice), you don’t wanna change.

“If it ain’t broke, don’t fix it.”

CT’s inscrutable high school coach, to an uncomprehending student

We came up with all sorts of leadership plans to increase video visits: more education to front-line physicians (not helpful); sending experts to clinic to tout the benefits (nope); introducing video visits to clinicians already on bundled payments, such as surgeons whose post-op visits were no-fee (slight adoption). Video visit adoption was a local phenomenon: a few docs found it useful and did several hundred visits that way over the course of a year, and most others did not try it. Finally, we did get some traction by dedicating some urgent care docs to Virtual Urgent Care, for either a flat $49 fee or co-pay with participating insurers. For the most part though, bupkis.

In the graph above, the blue line indicates fewer than 100 video visits a week leading up to … March 2020.

And then, we know what happens next: PANDEMIC. Social Distancing. Stay-at-Home order from the governor. Suddenly clinic in-person visits plummet. And all across our 600 clinics: “Hey, wasn’t there someone here last year talking about some kind of video-thingy that we could use to see patients? Anybody have their phone number?”

We are luckier (or perhaps more prepared) than most other healthcare organizations:

  • We already integrated video into our EHR
  • We have a high-functioning IT infrastructure on a single EHR
  • We have a strong informatics group (physicians, APP’s, nurses)
  • Our clinical and administrative leaders collaborate well, and nimbly

And, okay the Feds helped:

  • CMS relaxed the rule prohibiting Medicare from paying for video visits
  • HHS relaxed the rule for HIPAA-regulation on providers of video (allowing for Skype, Zoom, even FaceTime), not that our organization needed this.

As a result, within a week of that first pandemic-related request from our providers, we scaled from 2700 visits in ALL of 2019, about a dozen per day, to 3000+ visits PER DAY. Lets say that again:

Video visits went from a dozen per day to 3000+ per day within a week

That’s just crazy talk. And also proof that John Kotter is STILL right, from his book Leading Change: Your first step is a creating a sense of urgency: a Burning Platform. And boy do we have one now, thanks to a microscopic life form .

And now? Now, I sit here in my home office, with my laptop and my smartphone connected, waiting for my next patient, who is visiting me from their home, arranged by my medical assistant, sitting at her home. Our bricks-and-mortar medical office is 2/3 empty, with a reduced crew seeing in-person visits for those without video visit tools, or needing physical exam or other services.

When we connect, every interaction feels like a victory. Every “return visit” feels like re-connecting with an old friend. In fact, I reflexively raise both arms like our team scored a goal:

“You made it!”

“Yes, I did!”

“It is GREAT to see you!”

“Yes! And how are YOU, doctor? Are you doing okay?”

The empathy of patients toward ME and my colleagues, is touching, and genuine, and so much appreciated. Unbiased opinion: longitudinal primary care internal medicine has the BEST patients in the world. Truth.

CMIO’s take? We are creating a new healthcare world, by necessity. Will we ever go back?

Take a breath! and try JOMO during our pandemic

from esteemed colleague George Reynolds, former CIO and CMIO

I was chatting with an informatics colleague last week, mentioning that our family had spent some time in Utah recently.

He sent me this photo he had taken in Utah recently. Beautiful, no?

Are you taking care of yourself? It looks like we are in this for the long haul. Colorado is now under a stay-at-home order, and it looks like our infection curve is more like Italy than it is like Taiwan or South Korea: it is still accelerating, and will be awhile before the worst is past.

So, take a break. I tried hard this weekend to step away, watch a movie, hang out with the family, go for a walk, a run, a bike outing, bask in the sun, get some sleep, in between online-work. Maybe JOMO is a good word to think of at times like this.

We wrote on our family white board some daily tasks:

  • Cap your news/social media at 30 minutes a day
  • Exercise: ping pong / walk / run / bike / dance
  • Play or listen to music!
  • 3 Good Things

CMIO’s take? Do you give yourself moments of beauty? of music? of laughter? play a game?

Please do.

Consider asking your family members to do the 3 Good Things exercise (see above) , thinking of things you’re grateful for.

Hand wash. Stay healthy, best you can.

Thanks for the photo, George.