Help! Secure Chat in Epic, a ukulele EHR parody

The latest ukulele song. Yet another illustration of how Culture Eats Technology for Lunch.

We’re working on a Unified Communications strategy at UCHealth. We have a history of implementing multiple communications channels over the years:

Bell-boys

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Bell-boys (the precursors to pagers), with verbal alerts. You call a phone number, you record your 8 second message, and a minute later, someone, somewhere in the hospital hears this coming from the bell-boy at at their hip. Usually, you say: “This is East-8. Please come to bed 8217. Patient vomited blood.”

Worst case, you have excited nurses who don’t give you complete information. My favorite bell-boy utterance: “Doctor! Come Quick!”

Hmm. Which floor wing of the hospital? Which of the 12 floors?

Pagers

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Then, there have been actual pagers, those infernal beeping machines that were the bane of residents and attendings worldwide (but the badge of honor for medical students offered one for the first time).

Of course, there’s Pager Inversus, but that is a blog for another day.

Doc Halo, Vocera, Tiger Text

And then came the flowering of 100 new ideas. “Hey, I think my department could really use X. We don’t really like Y because, X is better. Everyone know that. And because our organization in years past did not have a well-centralized decisionmaking body, every department went and did as they liked. As a result …

Pandemonium

Why can’t the nurses and operators page me in time? They are SOOOO SLLOOOWWWW. We need to hire more.

Well, imagine this. The number of places a nurse has to look in the paper or electronic chart to find the contact information for any one physician or APP was in non-overlapping, non-cross-indexed dictionaries:

  • Handwritten pager number in the progress notes
  • Call my service and my staff will then reach me on my private cell. I don’t give that out
  • Look me up in Doc Halo’s website
  • Look me up in Tiger Text index
  • Look me up in Vocera

Fortunately, we finally have a tool in Secure Chat in Epic EHR that will replace all these technologies.

Network Effects

(image from wikipedia.com)

Over years, the building of telephone networks made owning a telephone increasingly valuable. The larger the network and more people you can reach, the more useful the tool.

The opposite is also true: the more different and non-connected communications tools you use in an organization, the worse it gets, and the harder it is to reach anyone.

I think we’ve finally learned this lesson: Secure Chat it is.

Culture Eats Technology for Lunch

Of course, the IDEA of unified communications and getting rid of older networks, like pagers, other secure chat tools in favor of one, seems simple. Don’t under-appreciate the need for LOTS of meetings and discussions.

In fact, it might be time to re-read Leading Change.Have to think about finding the Burning Platform, building Buy-In, building a Guiding Coalition, and so on. Informaticists would say, it is the classic 80:20 rule. Technology, as hard as it is to create, is only 20% of your success. The other 80% is the socio-political skill of those deploying the tech.

CMIO’s take? We are, after years of effort, growing our success. And to celebrate, this song (youtube link above).

 

90 x 4, don’t bother me no more (ukulele)

Thanks to Chris Sinsky’s saying “90×4, don’t bother me no more”. Here’s a ukulele ditty go along with that. We’re making these changes to our inbasket for noncontrolled, maintenance meds.

We’ve been noodling on various ways to reduce the Electronic Health Record burden for our docs. One thing we’re going to change, across our system, is the way we set defaults for new prescriptions and for prescription renewals, for non-controlled, long term maintenance medications, like for diabetes (eg insulin, metformin), hypertension (lisinopril, hydrochlorothiazide), heart disease (metoprolol, spironolactone), and so on.

What does it mean? In the past, we have prescribers writing for 30 days, 60 days or 90 days supply of medication, and then some random number of refills, up to 1 year. As our practices get busier (and with the pandemic, as we have fewer clinical staff in our offices), the volume of prescription renewal requests are growing quickly. Why not, with these low-risk, unchanging medications, to reduce the burden for both prescriber and patient by writing for a 90 day (maximum allowed) supply and specifying 4 refills?

Our previous default, 3 (three) refills gets you to 360 days, for the patient who renews on time, so adding a 4th refill allows you to fill within 365 days (maximum allowed by federal law).

The countervailing federal law, for Medicare patients, is that annual visits will not be paid by insurance within 365 days, it must be AT LEAST 365 days since last annual visit. So… you can see how patients could routinely run out of their meds a week before their earliest annual appointment.

Hence, the song above: “King of the Code.”

CMIO’s take? The Solution: “90 by 4, don’t bother me no more.” Thanks to Christine Sinsky for the pithy rhyming couplet. This will take a chunk of unnecessary work out of our inbaskets and get us back to more important patient care.

My newest ukulele EHR parody song: Inbasket Dynamite

Has anyone ever written a K-pop anthem into an EHR parody? Is it possible to set an hyperobject to music? Regrettably, someone has tried.

CT’s at it again: doesn’t he ever learn?

It is great to be back together among our tribe of informaticists at Epic’s XGM (eXpert Group Meeting) in Verona, Wisconsin, where the best and the brightest share our work, our leadership and change management lessons, and celebrate our successes.

Inbasket Dynamite refers to the Hyperobject that is the EHR inbasket, the nerve center of communications that, like the post office, can grow to unmanageable size and could contribute to physician and provider burnout. Time to “light it up” and redesign it.

I’m on stage at the Epic Physician Advisory Council (PAC) reception, grateful to receive the 2021 PACademy Award (physician of the year) from the voting of our international physician informatics community, along with Heidi Twedt (2020 awardee) and Joel Buchanan (2022 awardee). Due to the pandemic, we have missed the last 2 years of the PAC meeting in person, so this is our catch-up. I’m honored to be in such company.

If you’re not a BTS fanatic, like we are at our house, here are a couple of videos to whet your appetite:

My son Avery covering BTS’s dance moves in Dynamite, for the pure joy of it:

And, one of the official BTS music videos on Dynamite. Many of their videos have been viewed over a billion times (ahem, a Billion):

Blowing apart EHR classroom training, TikTok, Microlearning (and a uke song)

What does TikTok have to do with Classroom Training? And what is “so last year” with EHR onboarding? And which uke song is up next?

 

We discuss: uPerform (self-paced EHR online training), Amplifire (adult learning theory and what we call “pot-hole” training for difficult EHR workflows), no-more-classroom, and 1:1 coaching sessions based on “cognitive struggle” and EHR Signal data. And of course, TikTok.

“Epic Man” ukulele audio recording from a recent Becker’s Podcast featuring — me

3 minutes to change your life. Cheer? Boo? Choose your own adventure if you listen in.

Hope you enjoy this. I think this is the “least bad” version of my ukulele parody song “Epic man” (with apologies to Elton John and Rocket Man). Audio only.

https://www.dropbox.com/s/picuhxmbeagdws0/2022-EpicManAudio3min.mov?dl=0

Sepsis, Machine Learning and the Centaur (my SMILE conference talk)

Find out: What is a centaur and what does it have to do with healthcare? What are the criteria for a good machine learning project? What is the role of a virtual health center with predictive models? And most importantly: What ukulele song goes with machine learning?

Here are the slides for my talk given at SMILE (Symposium for Machine learning, ImpLementation and Evaluation). The slides are mostly self-explanatory. You can also watch my talk at YouTube. Here is a PDF of the entire deck.

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.

Covid-19 Sea Shanty

It was social media blowing up with Sea Shanties that got me into this. What is a Sea Shanty, anyway? My wife thought it was a tiny house on the edge of an ocean. Hmm.

Turns out, Nathan Evans from TikTok sings a New Zealand Whaling song “The Wellerman” with a beautiful Scottish lilt. It is the perfect antidote for Work From Home Loneliness. 10.4 million views later, lots of folks agree. The New York Times covers the story.

My favorite quote from the story: “It’s not the beauty … it’s the energy”, “You’re not supposed to sing pretty.” I think they’re talking about me!

I am so tired of working from home, of not seeing anyone, that I fantasize about working together, singing in cadence on a crew of a ship.

CMIO’s take? Fighting Covid is a little like a high-seas adventure. Hope you like my version.

I am NOT Throwin’ Away My Shot – Covid Vaccine (ukulele)

I wondered what Lin-Manuel meant when he wrote this song. Turns out, it was for THIS moment.

While my colleagues are working hard delivering vaccine doses to healthcare workers as fast as we can (15,000 doses given in the last 5 days! Woo!), I’m hard at work at the Ukulele Parody Studios.

Here it is: the world premiere of a song that seems titled for this moment in time: I am not throwin’ away MY SHOT.

Thanks to Lin-Manuel Miranda for the original, and the overall miracle of the Hamilton musical. No thanks to him, on how hard this song is to sing.

Happy holidays, y’all.

Telehealth World: CT finds ukulele song partners!

Telehealth Ukulele Song!

Thanks to George Reynolds, CMIO and CIO extraordinaire, who put together a dream team of CMIO leaders to facilitate a course for up-and-coming leaders in the area of informatics. This year, CHIME (the College of Healthcare Information Management Executives) opened up the future-CMIO candidates for this course, to nurse, pharmacist, and other clinical informatics candidates. Our 30 participants this year made this 6-week, 2-hours-live-with-weekly-homework a blast to teach and discuss. That course concluded this week. Here’s how to sign up for future courses through CHIME:

https://ignitedigital.org/clinical-informatics-leadership-boot-camp-digital

We tackled: governance, high performance teams, creating value, leading change, and other topics.

And of course, what would an informatics session be, without some ukulele. Thank you to Amy Sitapati from UCSD, Brian Patty, former CMIO at Rush, and George Reynolds, former CMIO and CIO, and now with CHIME, singing with me.

CMIO’s take? Make music! Make art! You can clearly see, we are not gonna win any awards with our skills, but we sure had a great time putting this together. I am grateful for colleagues willing to stick their necks out to sing with me.