Navigating Open Notes and the Information Blocking Rule: an AMA innovation panel discussion

AMA Physician Innovation Network Avatar
from the AMA-Assn.org website

https://innovationmatch.ama-assn.org/groups/ama-physician-innovation-network-public-area/discussions/navigating-open-notes-and-the-information-blocking-rule

There are a whole bunch of Open Notes experts (and also me!) on a panel this week (ends tomorrow!) discussing Open Notes experience in regards to the Information Blocking federal rule. Come join us! Ask challenging questions! See what others have done! Lots of discussion on the pros and cons, the pitfalls and the successes.

“The unattainable best is the enemy of all the available betters” @Bill Burnett

You have more than one life in you. Lets ideate THREE 5-year visions. Do this exercise to generate creative possibilities. — Bill Burnett

In my clinical practice this week, I met a patient with whom I discussed this idea: he was a senior administrator in an academic institution, highly accomplished, well respected, and yet quite miserable at work and at home, feeling trapped.

It made me think back to Design Thinking principles, and creative approaches to hard problems.

Having been to the Design Thinking for Social Systems short course at Stanford, I’ve been working to apply this thinking at work and at home. I posted last year on my enthusiasm for design thinking as a process and approach to creativity and innovation. I came across Bill Burnett’s online video which prompted me to dive back into the material again.

A couple of books to recommend.

Designing your life by Bill Burnett and Dave Evans. More about applying design thinking principles to your life.

Bill also gives an overview in his great Stanford TEDx talk.

Creative Confidence by David and Tom Kelly. A history and principles of design thinking by some of the originators

Designing for Growth by Jeanne Liedtka and Tim Ogilvie. A practical book for application of design thinking. See also the Field Guide.

It made me think of myself, my work, my home, and how “designing your life” might be an exercise we could all apply with immense benefit. Join me?

CMIO’s take: What are you waiting for?

Predictive Analytics or Predictive Shrub?

What can informatics learn from a plant?

https://www.wired.com/story/the-humble-shrub-thats-predicting-a-terrible-fire-season/

The chamise plant in California is a harbinger of a high risk fire season this summer. Fascinating analysis of ecology-based prediction.

CMIO’s take: What can informatics learn from a plant? Sometimes simple methods can be effective.

Fight Disinformation. Journalists, Scientists Unite!

From wired.com

https://www.wired.com/story/opinion-disinformation-researchers-must-work-with-journalists/

I find it does not serve the needs of the community or the world to be merely a scientist. One must also be a communicator. In this age of disinformation, we are drowning in the social media morass. The voice of science, of reasoned, thoughtful scientifically based research is too quiet. Our Filter Bubbles allow us to read online articles that only confirm our biases instead of finding objective, reports that speak to actual evidence. This article is a clear explanation of why journalists and scientists should work hand in hand to raise our voices and be heard.

“Please do your best today”. Not a dry eye in the house.

We need to focus on bringing humanism back into healthcare, to combat the temptation of the e-patient (EHR computer chart and electronic or telehealth communication) numbing us to the suffering of real patients out there. This is a terrific read.

Misleading Patient Portal Data Due To Covid-19?!

What is the Covid Bump in our Patient Portal data, and what does it mean?

Patient Portals and Covid

Okay, everybody knows we are all pushing patients to go online (in our case to UCHealth’s My Health Connection -MHC – patient portal) in order to be a candidate for our “vaccine scheduling” randomization. Because we are so constrained in our vaccine supply, we can NOT offer vaccine to everyone who wants it, and as a result, we can only send out several thousand invitations or so per day for patients to schedule themselves online.

The reason we had to randomize the invitation for vaccine: Can you image if we did it the other way, opened up Vaccine scheduling to EVERYONE over age 70 in Colorado (we think there are 400,000 in the state) and then RAN OUT with people still in line? We do NOT want to replicate other state’s experiences of patients standing in line overnight hoping for a vaccine. Yikes.

Disparity concerns

Keep in mind, we have now set up “popup” clinics for patients in disadvantaged neighborhoods, churches, etc, as well as a phone number: UCHealth COVID-19 Vaccine Hotline: 720.462.2255; and website for additional folks to sign up: http://www.uchealth.org/covidvaccine .

Growth

Having said this, we have seen a TREMENDOUS growth in our patient portal numbers, from 800,000 several months ago, to 1,200,000 now, about a 30% growth in that amount of time. Yes, we realize some of these are patients who never felt the need to sign up for a portal account, and some are community members who are NOT UCHealth patients, signing up JUST FOR access to vaccine.

Anomalous age peak > 65?

Having said all this, look at the chart above. Unlike our previous age distribution of Active MHC accounts that peaked around age 30, we now have this anomalous peak above age 65! Twenty-four percent of our active population.

In hindsight, I am sad that our Slicer tool only sees “Activated patient portal accounts” as of right now, and that I no longer have access to snapshots in time from last year, to show you. To do that would require skills beyond this Data Dilettante, sorry.

65? 75?

So, what if you subdivide >65 into 65-75 and then >75? Lets see!

From my vague recollection, both >65 and >75 age groups with Portal accounts have nearly doubled in percentage.

Can we see the Vaccine Clinics in our Visit data?

Let’s see. Here is a graph (again with CURRENTLY ACTIVE patient portal accounts), by week, from September through end of January, of patients WITH MHC accounts, who are age > 70 (the previous criteria for phase 1b vaccination, and yes I know Colorado has lowered Covid vaccine candidacy to age 65+ this week).

Aha! Since we started vaccinating in December, we focused, as per state and federal guidelines, on healthcare workers and first responders. Thus, we should NOT see any bump in the patient visits for those with a portal account AND age over 70.

However, I can convince myself I see a bump at the end of December where we were telling patients to sign up for MHC to enter the lottery for next phase of vaccination, and then BOOM, a significant growth in visits with patients with MHC and over age 70 in January, scaling up and up. I think this is our in-hospital vaccine clinics, vaccinating about 5000 per day and our 2 weekend Coors Field Mass Vaccine events, the most recent vaccinating 10,000 over the weekend. Do you see me waving from those last 2 data points? Hi!

CMIO’s take? This is more than just an aging boomer population; this is Covid at work in interesting ways. I will be fascinated to see where Colorado, our online populations, and our healthcare will go in the coming months and years. What are you guys learning out there?