Welcome home from Epic UGM 2023. Another action packed few days of hob-nobbing with 15,000 of our best Epic customer friends, and learning about each other’s successes, failures, innovations.
Thanks to my colleagues Heidi Twedt MD and Deepti Pandita for our session on Growing an Informatics Program.
Here are the lyrics:
HELP! Secure Chat (apologies to the Beatles)
[Am]Help! I need a consult
[F]Sage! I cannot tell if you got my
[D]Page! You know I need someone, [G]Help!
When I was younger, I used to carry 5 bell-boysG Bm
I had to wear an extra belt to handle all my toys.Em C F G
Pagers phones and VOIP devices pulling down my pants G Bm
Wishing for a way to connect without hospital intercom blasts. Em C F G
Help me if you can, I’m feeling down Am
And I do appreciate seeing u on rounds F
Help me get my pockets off the ground D
Won’t you please please help me?G
And now my life has changed, in oh so many ways. G Bm
The weight around my neck has seemed to vanish in the haze. Em C F G
And now those days are gone, I’m much more where it’s at. G Bm
Now I find I’ve changed my mind, I’m loving Secure Chat. Em C F G
The latest ukulele parody. Does it mention note bloat? GPT?
The Clinical Informatics Conference has come to a close in Chicago. I am always gratified by the community of clinical informaticists who come together to share ideas, to make each other better.
I had a chance to participate in 2 panels: Blowing up the Classroom by deconstructing training / Putting the Roadsigns on the Highway. Also: Redesigning the Inbasket, along with colleagues from UCSF, Epic and MedStar.
Here’s my contribution to the fun; an updated version of Epic Man.
What does mindfulness mean to a CMIO? Also, patient engagement, information transparency, and FAILURE? And finally, gratitude. Listen all the way through for a special treat. #Podcast #healthcare #healthIT #hitsm #whyinformatics #hcldr #somedocs
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
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
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).
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.
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).
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.
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):
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.
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.
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.
