Innovation partnerships at UCHealth (Healthfinch)

Tracy Sawyer, RN

Our UCHealth Care Innovation Center is dedicated to implementing partnerships with companies that improve and simplify our work. Our most recent example is our partnership with Healthfinch to improve prescription renewals, by assessing the data in the electronic health record, presenting it to nurses and pharmacists on a centralized prescription renewal team and demonstrating efficiencies, like cutting per-prescription refill time in half.

As we move into value-based contracts in healthcare, and continually need to remove inefficiencies and lower costs, to stay competitive, partnerships like this will move us in the right direction. See the video of UCHealth’s Tracy Sawyer RN, speaking at the AMDIS conference in Ojai, California, as she describes our journey and our results: http://info.healthfinch.com/implementing-charlie-at-a-centralized-renewal-center-experiences-at-uc-health

CMIO’s take? There are more smart people who DON’T work for you, than who do. Find a way to work with them when you can.

Showing Rx Co-Pay Cost at time of Prescribing, in the EHR (info transparency!)

Sometimes you work hard, and cool things happen. UCHealth is partnering with RxRevu, makers of SwiftRx, an EHR-embedded tool that shows prescribing doctors the co-pay cost of patient medications AT THE TIME OF PRESCRIBING! We believe we’re one of the first in the country to do this successfully.

Yes, at the time of prescribing. NOT the usual “guess-again” game that we’re all tired of. “Hey, I’m gonna prescribe doxycycline from this chronic condition. It’s an older drug so, I’m GUESSING it will be inexpensive at the pharmacy, but WHO KNOWS?!” And then the inevitable phone call “Doc? That prescription has a $241 copay! Isn’t there something else?”

We are all tired of this game.

After quite a bit of hard work and innovative partnering with RxRevu, we are pleased to have launched, about a month ago, the ability for our docs to prescribe medicines within our EHR, and (like magic!) right within their workflow (don’t have to make a phone call, don’t have to launch a web browser and figure out the patient’s insurance specifics, or look up in some massive formulary book), right in our EHR, we see the co-pay! The Real-time benefits check shows up in about 1-2 seconds, just like above.

With that particular patient, we saved him about $200 by switching from tablets to capsules. Silly, but true.

Here’s the news article on SwiftRx at UCHealth.

Here’s the recent webinar I participated in describing this innovation.

CMIO’s take? There are so many ways information transparency will help us and our patients, in healthcare. Have you found success with information transparency? Let me know!

EHR Sprint Optimization Executive Summary – using Stories, Images AND Data to change minds

Many of you know that in my role as CMIO at UCHealth, I’ve stepped in my share of potholes. My Failure Resume is replete with examples (eg: my 16 year journey to implementing Open Notes). Having studied the Open Notes phenomenon back in 2000 and published in 2003, it was a big disappointment when, after presenting to the medical leaders at University of Colorado, I was soundly voted down for implementing this transparency initiative (sharing doctors progress notes with patients online) repeatedly in 2002, 2003, 2004, until I stopped asking. Then, about a decade later, AFTER the Open Notes organization (thanks, Tom Delbanco and others) formed and pushed the agenda in 2011, we gathered steam and I finally succeeded in May 2016 to implement Open Notes system-wide for several million patients). You can call it a failure or an eventual success.

Nevertheless, when we implemented our Sprint Team for EHR optimization, we were at risk of being disbanded and told to return to our usual jobs (I had “stolen” these resources from IT and informatics to “Sprint” one endocrinology clinic of 29 doctors). In defense of our program I wrote this 1 page Executive Summary. We know that readership of white papers drops by half with every additional page. I included images/graphs (internal marketing, make your document attractive and interesting), STORIES (because, what p-value has ever REALLY changed someone’s mind?) and DATA (because, what self-respecting doctor or leader DOESN’T ask for evidence?).

And no, it wasn’t an overnight success, but it was one of the core documents that drove our executive team to finally approve the budget to continue our Sprint efforts. Download the 2-year-summary version below.

https://www.dropbox.com/s/o3qh33l7wdna3xe/2018-08%202y%20Sprint%20Aggregate%20Exec%20Sum.pdf?dl=0

We have now sprinted over 750 clinicians, hundreds of ancillary staff (MA’s, RN’s, front desk clerks), over 70 clinics, with uniformly RAVE reviews. And, even better news, we were recently funded to DOUBLE our Sprint team to 22 people. We are grateful to our leaders for such foresight.

CMIO’s take? Sometimes internal marketing can be as or more important that external marketing. Do you have success stories of how you wrote/composed documents for success? Let me know.

Time management regret? (NYTimes) Work-life (im)balance? Start now.


We can all benefit from reminders. And self-forgiveness. And taking a single step, (or creating the “next action”) as David Allen says in his book “Getting things Done (book summarizing video).” Atomic Habits (book summarizing video) is another book with similar suggestions. There are a growing number of books, articles, videos dedicated to this topic; go ahead and explore. After all, the ancient Chinese saying is: “The journey of 1000 miles begins with a single step.”

We are all burdened with too much work and too little time. If we are not careful, our work overwhelms other parts of our lives and we lose balance. I struggle with this myself. It is helpful, then, to have a quiver of tools to deploy in the moments when your self-awareness kicks in: “whoa, I’m out of balance; I missed my kid’s field hockey game, or that school event, or the dinner with my family.” Or maybe all of the above. 😦

In these moments, as the article suggests, break it down to ONE action.

  • Forgive yourself. Move past it and commit to behaving differently NOW.
    Self-disappointment gets in the way of personal progress.
  • Do ONE thing. Leave today, early enough to go exercise, for example.
  • Find a SMALL thing to change. “Managing time” is a huge monster, but getting THIS particular project started involves finding THAT one phone number. There. That’s progress.
  • Read a book about process (This works for me, instead of doing better, read about doing better, maybe implement ONE idea from it, and rejoice. As you read more and pause and reflect more often, you WILL find more opportunities to change or establish a new habit. It is okay if this takes weeks, months, years, decades. We are all works-in-progress.)
  • Set yourself a task for teaching Work-Life balance. Nothing like see one, do one, teach one, like we did in medical school. Or worse yet, don’t even see one or do one, but figure out how to TEACH one, and that forces you to examine yourself and pay attention. (Speaking of which, come to the CMIO Leadership Academy where I’m going to be teaching … Work Life Balance). Hilarious!

CMIO’s take? Having trouble managing time or really getting started changing yourself? Break it down into a small “next” action. Read the article. Watch a YouTube video. I’m surprised at home many authors now offer their best ideas on video or in short articles. Are Books “so last century”? Maybe so.

Why we still love tech… (WIRED)

Detail of a Monet. Captures the wistfulness of this post…

https://www.wired.com/story/why-we-love-tech-defense-difficult-industry

Paul Ford is CEO at PostLight and recently wrote an impassioned “Proudshamed” reflection on his career growing up with tech. I resonated with a lot of it, as CMIO with responsibility to improve the digital lives of our patients and our physicians.

New PIGlet? Or, interested in medical informatics? How to start…

Piglet: ie a New PIG (physician informatics group member)

Are you a PIGlet? Someone interested in the field of medical informatics? One of our newest informaticists coined the term PIGlet (Physician Informatics Group member). Cute. Increasingly I’m meeting with medical students, medical residents and now physicians as well as allied health persons (nurses, physical therapists) interested in the field, and unsure how to get started. Well…

Fallacy: informatics is about designing computer screens and talking with vendors about features and screen design.

Fallacy: informatics is about going into a dark room, creating a fantastic tool and launching it into the public and collecting all the acclaim from co-workers who instantly understand why you are requiring more clicks and typing to complete your amazing new software package.

Fallacy: informatics is about being smarter than everyone else and just KNOWING that your solution you cooked up in your head is going to work for everyone IF ONLY THEY DID THINGS THE RIGHT WAY, like you.

Instead: informatics is about creating a vision of what healthcare COULD BE, empowered with knowledge. This is a team sport. It is about collaboration: collecting everyone’s best ideas, developing consensus, trying a bunch of things in small batches, seeing what works, and then making a big bet, measuring outcomes, and diving back in for the next cycle of improvement. Done well, Informatics is Design Thinking and Teamwork, and the “information technology” is just how it is implemented. This is completely the opposite of what many think informatics is.

They’re … wrong.

Here are some ideas for getting started. A fair number of these are associated with a TED talk or other online video summaries.

  1. Read about informatics (but ONLY after reading about leadership and organizational change)
    1. Lorenzi, Riley, Managing Technological Change
    2. Journal of the American Medical Informatics Association
    3. The Design of Everyday Things (Norman), others
    4. Nudge (Thaler)
    5. The Glass Cage (Carr)
  2. Books to read (leadership, culture change, a book club if you’re lucky)
    1. Leading Change (Kotter)
    2. Good to Great (Collins), and others
    3. Death by Meeting (Lencioni)
    4. Delivering Happiness (Hsieh)
    5. Tribal Leadership (Logan)
  3. Books on self improvement
    1. Getting Things Done (Allen)
    2. Deep Work (Newport)
    3. The ONE Thing (Keller)
    4. Atomic Habits (Clear)
    5. The Practicing Mind (Sterner)

There are blogs:

Above all, be curious, be useful, pace yourself, take care of yourself so that when opportunities arise, you can occasionally sprint into action. Create learning habits to stay abreast of changes that affect your clinical practice and that of your colleagues. Read broadly about other industries unrelated to your own, and how problems are solved elsewhere.

CMIO’s take? Informatics has become a crucial part of medical training. The most commonly used (and often hated) tool for physicians today is the EHR; more common than the Yankauer, the retractor, the scalpel, the stethoscope, even. Why not develop exceptional skills with this tool? Until it matures into a self-aware entity (! a later post), it is on US to shape it into a useful tool.

School of Medicine Commencement: a tradition from the middle ages

 

Graduation season, and another 186 medical school students became doctors this month. The CU Anschutz campus is a fantastic home to 5 major health-related schools: the College of Nursing, the School of Medicine, the School of Pharmacy, the Dental School, and the School of Public Health. Thousands gathered, for all 5 schools, at the Boettcher Commons on campus and had a wonderful, sunny ceremony at the end of this rainy, snowy week in Colorado. How lucky we are.

Congratulations to Dr. Mark Earnest, recipient of the Sabin award for his selfless devotion to championing public health and care of the under-served. He’s also my boss, as Chair of the Division of General Internal Medicine (walking, with glasses and the green collar/hood in the photo above).

My colleague Larry Feinberg was right (as always): Commencement is something we, as faculty physicians, should attend. The work we do to educate, inspire, and support our students, and now newest colleagues in the profession of medicine, is an important tradition, and one that reaches back to the Middle Ages. When else do you get to wear a Tam (short for, apparently, “tam-o-Shanter” a traditional Scottish cap. Who doesn’t want to look, at least sometimes, like Leonardo da Vinci, in heroic pose?

Furthermore, the green Hood signifies Medicine, and the colors within the hood symbolize the specific school where we each trained (for those who bother to obtain the specific hood). For CU, that is gold and black.

I was proud to see the student I mentored, Thea Tran, graduate and be accepted to a Physical Medicine and Rehabilitation residency in Nashville, TN. Congratulations to her! She was well-loved by my patients and is sure to make her mark wherever she goes.

In an age when we’ve lost or look down on many of our traditions, having something that stretches back a millennium, is amazing and stirring, renews our sense of purpose.

In Colorado, we have adapted the Oath of Hippocrates over the years, and I found it inspiring:

I devote myself to the health of humanity, with full respect for the dignity and worth of each person. Above all, I will strive to do no harm.

I recognize that my knowledge and skills are imperfect, and that I must always seek further training and growth. I will not perform treatments for which I am not qualified, and I will call upon others for help. In turn, I will gladly render aid when asked.

I commit myself to the profession of medicine, to the advancement of scientific knowledge, and to the education and mentorship of those who follow me.

I will respect the rights of my patients and colleagues and shall safeguard those confidences placed in me.

I will speak out when silence is wrong. I will respect the law, but I will not fail to seek changes that would reduce suffering or contribute to good health.

I recognize the trust that has been placed in me by society and by my colleagues. I will at all times comport myself with dignity, honesty ,humility, and integrity.

These things I do swear solemnly, freely, and upon my personal and professional honor.

The Colorado Physician’s Oath

CMIO’s take? What traditions do you uphold, and which sustain you? Being part of something larger than ourselves is, paradoxically, both selfless and selfish. And that is a good thing.