RESCUE October: Colorado’s regional Epic UGM: success!

What did you miss at the Colorado Regional EHR Seminars? Read on! #epic #RESCUEoctober @uchealth #informaticsiscool

Hello Friends! 

Thanks to my wonderful Colorado colleagues at: Colorado HIMSS for co-running our Regional Epic UGM, that we called RESCUE: Regional EHR Seminars: Colorado UGM Epic, 2024. 

We hosted 160 attendees, from Colorado HIMSS (health information management systems society) Thanks to Sarah Sample-Reif, president Colorado chapter, and many others from CHIMSS. Also, colleagues from Aspen, Boulder, CommonSpirit, Children’s Hospital Colorado, AdventHealth, Intermountain, Denver Health, National Jewish, Sidney Regional Medical Center, Nebraska, and our own UCHealth colleagues.

We had great talks on AI in draft responses to patients, an ambient notes panel, a secure chat and unified communications panel, breakout sessions for clinical nursing informatics, and developers and analysts in IT, and physician/APP informatics. 

Dr. English led us through our recently published paper: Utility of Artificial Intelligence Generative Draft Replies to Patient Messages. In which we found that nurses like the draft replies MUCH MORE than medical assistants or physicians/APP’s. How about that. More in the article!

We ended the day with Janet Campbell from Epic giving us a “drinking-from-the-firehose” talk on Cool Stuff ahead from Epic. 100+ AI-powered workflow tools coming soon!

Janet Campbell (Epic), Jennifer Simpson MD (Conference organizer), CT Lin, random local blogger. 

We also enjoyed a keynote by Dr. Chris Longhurst, Chief Clinical and Innovation Officer at UC San Diego Health on the Learning Health System and the future of informatics. 

Dr. Longhurst arriving and lending us his cool California vibe. 

Dr. Longhurst argues that patient safety efforts over the decades, despite much effort, have not yielded much improvement or reduction in mortality. Disappointing.
 

 

He calls out that AI use in healthcare does require thoughtful deployment. Already federal and state bodies are thinking about what oversight looks like. 

He also calls out that implemented AI algorithms are rarely researched, and researched algorithms are rarely implemented, a substantial paradox, and this has led to his establishing a center at UCSD to tackle exactly this problem. We’re with you, Dr. Longhurst. 

He ended by blowing our minds with an AI-generated PODCAST with simulated hosts analyzing a set of papers, that happen to be on generative AI and future risks and benefits. Have a listen at the QR code. He notes that the “GPS in a cornfield” reference that the simulated podcast hosts talk about is a metaphor he did not think of, and is completely appropriate.

Mind blowing.

I leave you with a ukulele performance of ChatGPT sung (with audience accompaniment) to Sweet Caroline. 

RESCUE 2024 is in the books! See you next year!

NerdMD efficiency unlocked (podcast) — interviews CT Lin

Thanks for Adam Carewe and Dale Gold for a fun conversation about informatics, complainers, AI and a hodgepodge of hodge of other topics.

https://rewskidotcom.substack.com/p/ep-30-ai-songwriting-and-storytelling?trk=feed-detail_main-feed-card_reshare_ingested-content-summary-external-video-content

“ChatGPT” ukulele parody song @InterSystems Global Summit

ChatGPT sung to Neil Diamond’s “Sweet Caroline”. What’s not to like?

Thanks for InterSystems asking me to give a Keynote presentation at the Global Summit in National Harbor, MD this week. I enjoyed the conference, with various speakers from UCSF, the ONC and others discussing the effect of predictive as well as generative AI on the practice of medicine, the health of patients and the burnout of doctors, APP’s, nurses, and all clinical staff in healthcare.

The more we talk about it, the more we can shape our tools into effective interventions. I strongly believe that changing a healthcare organization is only 20% about new technologies or tools, and 80% about relationships, effective communication, and redesigned teamwork.

Blank Space – AI (apologies to Taylor Swift) EHR ukulele parody – CT Lin

A new EHR parody song! This time, come see how the sausage is made and how much was written by GPT and how much by the human collaborators.

Performed at the University of Colorado Advanced Practice Providers Symposium, following the talk “I’m Sorry Dave, I’m Afraid I Can’t Do That: Big Data and Generative AI in Healthcare” by CT Lin

I realize Taylor Swift is all the rage for her ERAS tour and her boyfriend Travis Kelce, and yes I am a recent converted Swiftie.

Thanks to Casey Greene for collaborating with ChatGPT to develop and then iteratively improve the lyrics. I added a few human flourishes of my own.

How the sausage was made

Want find out how this particular set of lyrics came about? I’m sure you’re out there experimenting with ChatGPT and similar Generative AI tools.

Here’s a sampling of how we built these lyrics. First an actual chat between Dr. Greene and the Gen-AI, and then my layered edits.

Casey Greene (to ChatGPT): 
Summarize what this verse from Taylor Swift's song Blank Space is saying: 

Nice to meet you, where you been?

I could show you incredible things

Magic, madness, heaven, sin

Saw you there and I thought

"Oh, my God, look at that face

You look like my next mistake

Love's a game, wanna play?" Ay



GPT: 
In this verse from Taylor Swift's song "Blank Space," the narrator expresses a mix of fascination and caution upon meeting someone new. The lyrics "Nice to meet you, where you been? I could show you incredible things" suggest an interest ... (etc)



CG: 
That's a great interpretation! Now I'd like to create a version of this about AI in medicine. It'd keep the same cadence and structure as the original, but the fascination would be a doctor thinking about deploying AI & instead of non-serious as a close, perhaps it'd be nervous about getting things quite right.



GPT: 
Certainly! Here's a version of the verse inspired by "Blank Space" by Taylor Swift, adapted to reflect the theme of a doctor considering the use of AI in medicine:



Nice to meet you, what's your code?

I could show you data, endless rows.

Logic, learning, cure, and glitch,

Saw your specs and I thought,

"Oh, my tech, look at that interface,

You look like my next big leap,

Health's a maze, ready to guide?" Eh.



CG: 
This is pretty great! Two lines from that aren't quite working from me: "Saw your specs and I thought, Oh, my tech, look at that interface," -> Could we rework these?



GPT: 
Of course! Let's rework those lines to better fit the context. Here's a revised version:



Nice to meet you, what's your code?

I could show you data, endless rows.

Logic, learning, cure, and glitch,

Peered into your lines and I mused,

"Ah, this code, such a promising trace,

Seems like a venture into uncharted space,

Health's a maze, ready to guide?" Eh.



CT Lin: 
Additional revisions to include informatics experience into the first stanza. Swift's original in green, CG/GPT words in blue, CTL changes in red. 



Nice to meet you, what's your code?Data streaming in shiny rows.Logic, learning, sepsis risk.
Saw your specs and I thought,You might catch just one more caseOR, you could be my next mistakePrediction’s hard: what’s your take?

It is a delicate balance to

  • keep the rhyme scheme across the stanza
  • keep the syllable count per line
  • maintain the rhythm and “sing-ability” of each line
  • the story within the song: challenge and resolution
  • insert coherent electronic health record content
  • retain occasional call-backs to the original lyrics

Here’s the entire parody lyric, color coded:
Swift original;   Greene/GPT;    Lin

Nice to meet you, what's your code?Data streaming in shiny rows.Logic, learning, sepsis risk.
Saw your specs and I thought,You might catch just one more caseOR, you could be my next mistakePrediction’s hard: what’s your take?



AlgoRITHmic BIAS in the AISignal to Noise is tough to spyHidden dangers with DEIWorkflow hiccups for you and ISo-o hey, lets collaborateI’m eager to see what we’ll createGrab your blueprints, take my handWe can make the old ways better in a weekend



So I test your sensitivityAnd I feel like it’s gonna work outNow I check your specificityAnd I worry and I’m full of doubtHere’s a long list of false positivesYou shrug and give a smirk'Cause you’re a black box, babyAnd I’ll check your work.So it's gonna be forever
Or it's gonna fail and fade,
You can tell me when it's over,
If the leap was worth the upgrade
Got a long list of successes,
These are the lives we’ve saved,
So I’ve got a Blank Space, baby
And I'll write your name.

CMIO’s take?
Its a new world baby, ready or not!

“ChatGPT” a new ukulele parody about Generative AI and EHRs by CT Lin

What happens when CT Lin allows ChatGPT to help write EHR parody lyrics about ChatGPT? Does the Universe invert itself?

Recorded at the Vanderbilt Annual Otolaryngology Seminar at Vail, Colorado. An invited talk by CT Lin on AI in Healthcare, but wait, does he end with a NEW song?

Yes. Here it is: “ChatGPT” sung to the melody of “Sweet Caroline.”

THANK YOU to Dr. Eben Rosenthal at Vanderbilt University, Sarah Rosenthal at UCSF, and the entire VUMC Otolaryngology Group.

Epic man, singing about immediate release of results, covers Anticipatory Guidance.

Immediate release of test results, discussed with a radiologist audience: a pro and con debate. What could go wrong? And, of course, the ukulele.

Thanks to Dr. Jennifer Kemp who designed and invited me to present a panel called: “Information Blocking Pro and Con: A  Debate.”

I am at RSNA today. My first. Did you know the Radiological Society of North America is the largest medical conference in the world? I did not know this until yesterday. 40,000 attendees, over 4000 speakers. That works out to about 80 speakers PER HOUR. Geez.

I was one.

Disappointingly, not all 40,000 attendees came to see our panel presentation. 🙁

Nevertheless, of the 80 attendees, we had an excellent discussion in the context of releasing complex radiology images to patients, including MRI CT PET etc. and the resulting problems if/when patients find out about cancer or other devastating result by viewing their results online.

There are exceptions to the federal rule:

  • If the patient prefers not to see the results
  • If releasing the results may result in Physical Harm to the patient or other person (note that anxiety or psychological harm does NOT qualify)
  • Systematic embargo or delay of release of result is forbidden based on this federal rule.
  • The proposed penalty for violating this rule is $1 million. However, we are aware of only about 400 registered complaints of information blocking, 3/4 of which are organization to organization blocking, and only about 100 of patients registering because of not receiving notes or results. And we are not aware of any successful complaints resulting in actual penalties, as yet.

Question from the UK

We had a question from a colleague from the United Kingdom, as they are just now about to formulate a similar law. ‘Would it be reasonable given US experience to establish a national standard for embargo: let’s say all providers uniformly delay a high risk result for 3 days?’

Our reply: probably not. Airline passengers are now aware of every moment of their luggage transport, and every moment of their arriving Uber driver. Why would radiology reports be any different? The consumerism movement is unidirectionally toward more transparency. Maybe 5 years ago, if the UK was considering a standard, that would have been standard of care in the US, but no longer. 

Furthermore, research that we (reference) did

indicate that among 8000 patients who had already received test results from a patient portal, 96% indicated they wished to continue to receive results immediately. Even among those receiving abnormal results, 95% still wished to receive results immediately.

It is also true, however, that 8% of patients receiving immediately released results did worry more. However, we believe this worry is based on getting “bad news” more than it is about getting “bad news immediately.” These are the patients we need to focus on, and more details we need to study. 

Our suggested plan: that ordering physicians use anticipatory guidance: ordering physicians will eventually need to explain the result to the patient. Why not spend one more minute at the time of ordering to dramatically reduce the anxiety of the patient when they view the result later at home?

3 easy steps:

1. We are ordering a test. You may see the result before me. Best case, this is normal and I will contact you this way…

2. Worst case it could be … there is X% chance of this. If that is the case this is how I would reach you…

3. You have a choice: look immediately or wait to hear from me. What Q do you have?

In our experience this works very well and doesn’t take much time at all.

And for radiologists, publishing a contact number for patients to call if they have questions is very reassuring to patients and, guess what: they rarely use that number: in a busy multi-radiologist practice over the course of years reading hundreds of thousands of studies, their office has received 1-3 phone calls A YEAR from patients. And most of the time it is about factual errors in the report, and rarely is it to ask about the medical impact of the findings. It is quite minimal work.

CMIO’s take? The time for immediate release is here. There are great solutions to the anticipated problems. It also happens to be the law in the US.

If you’re still not convinced, or even if you are, here is a song for you, fresh from Chicago’s RSNA 2023:

Epic Man 2023: Information Blocking. (YouTube)

Secure Chat: Ukulele EHR parody to Beatle’s HELP!

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-boys  G 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

I can help you if you’re feeling down. Am

We can quickly answer questions during rounds. F

We’ll send EMOJI’s with the joy we’ve found. D

Won’t you please, please chat me. G

Epic Man: Immediate Release of Test Results and Anticipatory Guidance

New performance! Epic Man, the version for Immediate Release of Test results and Anticipatory Guidance.

In the era of the 21st Century Cures Act and Information Blocking Statute, how else are we going to each folks what to do?

Just put on an Epic UGM 2023 hat, get the 4-strings out, and plug away. Here are the lyrics:

& Epic man. Open Results 2023

She checked my templates last night preflight.

Zero hour, eight AM,

I’ll be deep in my Inbasket by then,

I miss paper charts so much, I miss my life,

It’s lonely in HyperSpace,

On such a timeless flight.

And I think it’s gonna be a long long time

Before I delay a test result again

I’m not the man they think I am at all,

Oh, no no no.

I’m an Epic-man, Epic-man sharing test results instantly

7 days ain’t the kinda way to delay your results

In fact, info blocking is now banned

And there’s no one here will defend you, if you did

And some results, patients won’t understand

Anticipatory guidance is our plan

Epic-man, Epic-man.

And I think it’s gonna be a long long time

Before I delay a test result again

I’m not the man they think I am at all,

Oh, no no no.

I’m an Epic-man, Epic-man sharing test results instantly

And it ain’t gonna be a long long time

And it ain’t gonna be a long long time

Blowing up the training classroom; also putting Roadsigns on the Highway in the EHR

Aren’t you frustrated with EHR usability? Don’t you wish you could see just-in-time guidance in the EHR? If the US Highway system can put signs on the highway, why can’t we? Also: ukulele song at the end of the link!

From Dall-E image creation via Bing.AI browser

AMIA Panel: Signs on the roadway with Dr. CT Lin and Dr. Ryan Walsh

I enjoyed our panel discussion, encompassing two related topics:

  1. Replacing the old model of onboard classroom training for new physicians/APP’s/nurses/MA’s/staff for 8 to 24 hours, with self-paced learning modules that follow simulation training and adult learning principles
  2. Hacking the EHR to insert tips and tricks just-in-time, right where we anticipate our EHR users (physicians, APP’s etc) to get stuck with more challenging tasks. Or as we call it, Putting Signs on the Roadway.

From Dall-E via Bing.AI

CMIO’s take? We have found success with our technology innovation partners, uPerform and Amplifire. Click the link to learn!

Epic Man – 2023: world premiere at AMIA CIC

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.

The author still believes he can sing.