Ukulele EHR parody: Yampa Roads

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?

Oh, well.

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!

Day 3 of Go Live! hospitals and clinics. And another uke song: UCHealth Rocky Mountain High

 

Command Center is hopping!
More hospital art
The Women and Infants’ wing has the best art

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.

Go live day 2: solve EHR system issues before Monday (and a uke song: If You’re Going to Yampa Valley)

Red shirts swarming the nurse/physician work areas. 
Cool hospital art. 
Cool hospital art marred by presence of the author. 

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.

Love these clever posters. 

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.

Command center: Another day, another go live (and some uke songs)

I’m here at YVMC: Yampa Valley Medical Center in Steamboat CO for Friday’s Epic EHR go live. Setting up the command center, at least half the room is festive. Prepping for the inevitable phone calls. We are finishing up our Preflight sessions, an innovation we created to get docs ready for the big day. Beyond the classroom and online training, we put docs in front of our Physician Informaticists to discuss actual workflow and also to double check that they can login successfully, and finally to teach them some personalization within the EHR:

  • Create some auto-correct phrases to expand common abbreviations into readable words
  • Learn how to build macros for physical exam and review of systems
  • Learn how to build smartphrases for commonly typed statements that docs say: risks and benefits, usual treatment for common conditions, the ABCDE of melanoma screening, any of a dozen common items.
  • ‘Wrench in’ frequently used quick-reports that docs of that specialty use, to get at problem lists, diabetes reports, flowsheet trends

It is fascinating to meet a new crew of physicians. Fun to see what local culture has m built. We are proud to be joining such a reputable hospital in our front range and have them join the UCHealth family.

Reminds me of a ukulele song (I’ve Been Everywhere Man). And also Hospital of the Rising Sun.

Maybe this time there will be time to record ‘Epic Central.’ We’ll see.

CMIO’s take? It is good to be growing. Better than the alternative. Reminds us of the importance of our work, our vision for the Physician Informatics group: ‘We improve physician and team wellness and effectiveness by building extraordinary relationships and innovative tools.’

Doc Prudence (new ukulele performance)

uke
here we go again

Thanks to videographer @DrDannySands for taping my latest spontaneous ukulele performance of “Doc Prudence” a uke parody song and cautionary tale (not really) about Open Notes at #sgim18 (Society of General Internal Medicine, national meeting in Denver last week).

CMIO’s take? Self-aggrandizement never pays off. OR, taking oneself too seriously never pays off. One of these two. Or maybe both.

EPCS: Morphine (ukulele video)

ctlukeepicmanbig
This guy thinks he can sing. How unfortunate.

Has your organization adopted technology to electronically prescribe controlled substances (EPCS)? If so, good for you! If not, what are you waiting for? UCHealth is kicking off this project on April 9, 2018, a “big bang” for all providers who have a DEA number to be able to e-prescribe and avoid that horrible, bifurcated workflow of “electronically transmit all the regular prescriptions directly to pharmacy, but remember 1) keep your tamper-proof prescription paper stocked in the correct drawer of the printer, 2) to go get that narcotic prescription off the printer, 3) sign it with pen-and-ink, 4) then tell your staff to track down the patient to come pick it up or remember to put it in certified mail to the patient, especially if the patient called to request, or worse, you forgot to get it off the printer before the patient left clinic.

After the DEA ruling to permit EPCS a few years ago, our EHR vendor developed the 2-factor authentication tool to meet the regulation, and now we have finally contracted with a company to provide that service, link our physician identities to their smartphones via an encrypted app, and now a smartphone alert and a password (something you have and something you know) are our two factors that permit EPCS.

Here’s a little something I wrote to commemorate our EPCS go live:

CT on ukulele singing “Morphine” inspired by Eric Clapton’s classic song “Cocaine.” https://youtu.be/EC6yXXYl1vY
(Part of my YouTube channel)

I also created an internal-only training video for Duo Mobile as second factor for EPCS.

I learned the structure of a well-told instruction video from the original “Apple Business” video tips back in the early zips (2000’s). You’ll see a human, then a quick screen video, then close with a human. Perfect format:

https://www.youtube.com/watch?v=oswqRHFJqH4

CMIO’s take? Sometimes a video tip (or video musical tribute) is what gets an audience’s attention.

I’m a Fellow of the American College of Medical Informatimusicology!

That’s FACMIMI to you regular folk.

Here’s the ACMImi blog, with a recent contribution by yours truly for the EPCS “Morphine E-prescribe” song.

https://www.acmimimi.org/

Here’s to colleagues in healthcare getting the word out, and having fun while we’re at it! Also, here’s an update with more songs!

https://www.acmimimi.org/2018/10/InformatimukulelogicalOfferingsfromCTLin.html 

CMIO’s take? What are YOU doing to inject fun into your daily work? Let me know!

Ukulele: Dear Burned Out Colleague

Ukulele at CHIME17

https://www.dropbox.com/s/6z8470q2ccjbfpg/2017%20UGM%20CEO%20Council%20CT%20Uke%20Performance.mp4?dl=0

Ukulele at Epic UGM17 CEO Council

Thanks to the organizers at CHIME17 for a great conference. Just returned from giving my presentation on “EHR 2.0 Sprints: Can Providers and EHR’s Just Get Along?” with my collaborator and colleague Steve Hess, CIO at UCHealth.

We are all about improving the well-being of our provider colleagues using the EHR by developing our 2-week in-clinic technology sprints to improve provider efficiency. We created an 11-person team, led by a physician informatics, managed by a project manager, with a clinical nurse informaticist, 4 Epic analyst-builders and 4 Epic trainers. Their main directive: “Go in there and make things better, but whatever you do, you must be done in 2 weeks.” They spent 1/3 of their time on building new, specialty-specific custom tools and 2/3 of their time on training efficiency strategies on the existing EHR tools. Most importantly, they created a people/process/tools conversation and redesigned quite a few workflows.

We measured Net Promoter Score (NPS: range of -100: terrible, to +100: perfect). We are gratified to be able to move our providers from an NPS of -15 to a +13 by end of a 2-week Sprint. And, the NPS for Sprint itself (how likely would you recommend Sprint to friends or colleagues?) was +54, which is up the range for Apple, Inc. We are in good company!

We also measured provider burnout on the Maslach Burnout Inventory scale. At baseline we found a 39% burnout rate, which decreased to 35% when measured within a month after completion of the 2-week sprint, a small but significant decrease. Importantly, providers told us “finally, someone cares!” “You made me a better mother! – I’m getting home to see my family.” and “I’m no longer going to retire because of EHR issues.” The rapid cycle improvements made a huge difference provider satisfaction.

From the great attendance at our session (standing-room only?!?), it seems there’s lots of interest also from many in the healthcare CIO community; and for that we are grateful for their feedback and conversation.

And, as with other talks I give, I ended with a song… enjoy!

CMIO’s take? Dance like no one can see you; Sing like no one’s listening.

Doc Prudence (a ukulele parody) about Open Notes

I’m here at CHIME16, the College of Healthcare Information Management Executives, at the fall CIO forum, speaking about Open Notes. I’m honored to be invited to speak, and even more honored to be selected as an Encore by the audience, who choose their favorite presentations for an ‘encore’ presentation on the last day of the conference. And at the end of my talk, a ‘bonus’ presentation on ukulele of “Dear Prudence” by the Beatles, repurposed to illustrate the benefits of Open Notes and the principle of information transparency in healthcare.

It has been great to be here in Phoenix learning from and sharing ideas with healthcare’s pre-eminent CIO’s.

Slicer Dicer, ukulele parody of Helter Skelter

 

So, I just got back from Wisconsin, hob-nobbing with over 15,000 people at Epic’s UGM 2016 (national user group meeting). We sent a half-dozen folks to present talks on such topics as our Physician Builder governance program where our physician informaticians are trained and given the keys to build sophisticated charting, ordering and reporting tools directly into Epic; our Smart-pump integration to deliver safer IV medications to patients; and this, my participation on the Slicer-Dicer discussion panel.

Slicer is an Epic tool for the average Epic physician user to “surf” the de-identified patient data in a simple self-explanatory way in order to see patterns in the data (in our case, applying to over 5 million unique patients). The tool can make it easier to look for quality improvement opportunities (what percent of my coronary artery disease patients are taking the recommended aspirin dose?), for teaching opportunities (does an increasing BMI correspond to an increasing rate of being diagnosed with diabetes?), for process improvement (which clinics have the highest patient-adoption of our online patient-portal for communication?), and even pre-research, hypothesis generating questions (which blood pressure medications are associated with the highest rate of patients with blood pressures below 140 systolic?). The tool shows bar graphs of de-identified data that can point out surprising trends and lead to more sophisticated projects downstream.

Of course, in case the audience of 250+ wasn’t adequately entertained with our expert panel’s recommendations (Stanford Childrens, Novant, and ourselves at UCHealth), I volunteered to play my uke to illustrate the finer points of our academic arguments…

Forgive the off-key singing and enjoy!

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