Which is an entirely unreasonably long list; there are some great selections there. I’ll leave you to browse.
During pandemic, I’ve been learning clawhammer style, from this guy:
Makes my uke sound more like a banjo. Weird, and cool.
Meantime: Our clinics are getting back to business; our patients are returning to in-person care, our visit volumes are back up, past the 80% mark. I hope you are all staying safe; we’re not out of this yet, but it is starting to feel less like a sprint and more like a marathon. Take care of yourself, get some exercise, bring back a hobby or two.
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!
Ross Martin is a physician informatician extraordinaire. Among his many talents, he is a singer-songwriter with his own musical show, and he publishes a blog at at ACMIMIMI: the American College of Medical InformatiMusicology. Turns out there is a small community of physician informaticians who cross the line between work-a-day informatics and the arcane arts of … music?
For example, a fellow Fellow of ACMIMIMI is Dr. Francis Collins, founding member of the Human Genome Project, and Director of the National Institutes of Health. August company.
CMIO’s take? I’m sure all you health IT geeks out there have hidden talents. Let me know what they are!
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:
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.
Okay, so you’re probably here for the Informatics knowledge, but too bad, we’ll lead with ukulele. Thanks to Dave Beuther for writing us a world-premiere song parody of Grace Vanderwaal’s “I don’t know my name” ultimately winning America’s Got Talent a couple years ago (meaning Grace, not Dave).
I’m really grateful to our Denver Region sister-health-systems. We have quite a few health systems in our region with Clinical Informatics expertise, and we spent the better part of a day getting to know each other, conduct round tables, and discuss our common challenges in designing next-generation, innovative Electronic Health Records to improve the care of patients in Colorado. Thanks to attendees and leaders from: Boulder Community, Steamboat (Yampa Valley), Centura Health, Children’s Hospital Colorado, Denver Health, Kaiser, National Jewish Health, SCL Health, UCHealth and the Denver VA Medical Center.
We had about 30 attendees from various health systems touring our Virtual Health Center (VHC), seeing our capabilities for Virtual ICU, Virtual Remote Monitoring, Virtual Urgent Care, Safety View, Telemetry and more.
About 50 attendees participated in our afternoon Clinical Informatics Seminars, a series of Round Table discussions ranging across such topics as Clinical Documentation, Order Sets, EHR burden and optimization, Physician Builders, Virtual Health, Innovation, Clinical Decision Support, Analytics and Data Science. Whew!
CMIO’s take? Although we could probably benefit from more frequent information sharing and collaboration, for my taste (as coordinator), once a year is pretty good! It is cool what our sister health systems are doing to improve the care of patients; we are better together!
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:
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.
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!
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.
YVMC’s head nurse Maria took me aside yesterday: “I have BIG favor to ask of you.” With trepidation, I stepped aside for a brief chat. “I need you to write a song about Mark and Heather; they’ve been amazing and led the teams to our EHR go-live success. And, can you put it together by tomorrow’s 9am Safety Huddle?”
What!?! Seriously? Does she know how hard it is for me to write these, learn to play the song (badly), practice enough to be willing to play in public?
Turns out, looking through my song parody library on my Notes app on my phone, I had a parody song, I called “Anschutz Roads” written in 2011 for our initial Epic go live at University of Colorado Hospital. With growing relief, I found that I could adapt it for our purposes here. I also recruited Juliette Callander, Manager of the UCHealth Rev Cycle team, and equally important, a wonderful singer, whose harmonies added a lot to the song.
She took me up on the challenge of learning the melody and the words, as I struggled to get my chord progressions and my strum pattern down. A few minutes of rehearsal in the nearby board room the next morning, and we were on stage at the end of Safety Huddle.
CMIO’s take? You can’t always get what you want, but if you try sometimes, you get what you need. I enjoyed how embarrassed Mark and Heather were during the song. Thanks, you guys are great. Also, I’m winding down my daily coverage of YVMC EHR go live, and returning to our regularly scheduled weekly posts starting tomorrow. See you then!
Finally, the Command Center begins to fill out with analysts supporting the full spectrum of IT areas: ambulatory, scheduling, inpatient, informatics, nursing, staff, health info management, security, networking, desktop support, interfaces, speech recognition, implementation specialists (jack-of-all-trades support).
Overall we are doing well. No big fires, just a steady stream of the usual. Printers not mapped to the right spot, meaning that printouts (after visit summary, printed orders for external labs, etc). Security challenges. Some clinics switched from ‘community connect’ to employed clinics, so all the clinicians have new security for logins an their previous personalized settings were ‘lost.’ Some test results are not flowing exactly as expected. So each of these requires investigation and fixing. It is rewarding to see issues come in and watch them be fixed within minutes to hours, since we are focused.
Fun fact: we’re using Microsoft Teams to communicate internally. All of my physicians in the Large PIG (physician informatics group) are on Teams. We have set up a communication channel called YVMC go live (Yampa Valley Medical Center), and conversation threads regarding clinic support as well as hospital support. As issues come and go, we post our conversation there, Facebook-like (except stored securely and not polluted by silly cat videos or rogue-bots), so that my entire team is not spammed by me, and anyone interested can dip into the conversation as needed, as each of them will rotate through Steamboat for 1-2 days, and can see all the issues posed and resolved previously. Teams is not perfect, but it is good-enough. We can link to shared calendars, to common file storage, to best practice tip sheets, for addresses of all the clinics. We can set it to “ping” us on our phones and our desktops, and can treat it as both email-like, file storage-like, as well as instant-message like. And our email congestion is slightly less.
Finally, another uke song:
CMIO’s take? Whew. Going back to the hotel to put my feet up. Back at it tomorrow.
I love hospital art. Why not improve the lives of employees by showing something beautiful?
Day 2 is going well. It is fascinating to see each department with very different concerns come together to solve problems.
We have a doc who can order tests and prescriptions but can’t place billing charges without ‘changing context.’ Call the command center. We can fix it.
We have a doc whose USB Dragon mic doesn’t work. Solution: call in a ticket to command center with details, move to a different computer until it is fixed.
Some breast milk scanning process is not well known. Send a red shirt with expertise. Teach the new workflow, get staff up to speed. Done, this morning.
Someone in respiratory therapy is trying to place a lactate order, as they always used to. Can’t do it in the new system. Ok, something we didn’t find out during our ‘discovery’ interviews. It is always something. We’re on it.
Of course when you can sneak in a song…
If You’re Going to Yampa Valley. Based on the Scott Mackenzie song ‘If you’re going to San Francisco.’
CMIO’s take? Good news: everything we solve today is one less crisis tomorrow when we are back to full speed patient care.