Well, you thought AI-generated static images were both cool and concerning. Now, META (formerly Facebook) introduces AI-generated VIDEO based on simple user inputs. If distinguishing fake from real was hard before, where is this going?
Is it like “Waiting for Godot?” Is it Triste? It’s great, but what is it?
In a past life, I have vague memories of learning French. And I learned there is a word in French that does not translate to English. Triste: the idea of sadness with an indefinable quality (I think).
I feel this, having finished this book. How I found this book, is now lost in my past history, some other book referenced this, and I thought at one point: “I must read.” now, having spend time on/off for 10 years (I first shelved this TO READ in 2012), I have come to the end of the book.
How do I feel? After a decade of pursuing the completion of reading?
Having binged my share of Netflix, HBO, Prime TV shows and movies, I can say that It is not an action flick. It is not a military triumph. So what is it?
I don’t really know.
It feels a little like “Waiting for Godot”: we are sitting, waiting for something, just around the corner, it peeks, and then disappears. Tantalizing.
I’m reading/listening to a different book: Mythos right now by Stephen Fry (hilarious), and Tantalus, one of the old gods, was punished by having tremendous thirst, and water, right THERE, just out of reach. Yes, it feels like that.
It feels a little like Ambivalence, with a capital A, for someone, indecisive, torn between two ideas, two worlds, two things one MUST do, and yet. Just hold, just one more day. Perhaps tomorrow. Like a person staring at their cigarettes, despising them, desiring them, not quite ready to quit smoking.
It feels a little like wanting, desiring, deserving.
How does he do it? Evoking these emotions, without speaking them. The words, the images, beautiful.
The action: a man joins the military. He is sent to the Fort, a desert frontier, facing the North, from where no one expects an attack to come. One hopes for glory, for action. Day after day, year after year, unexpected drama, tragedies, but the expected / not expected attack? Nothing. And when Something Looms, through the telescope, one believes: “it is too much to hope for.”
And the end? Realization, surprise, mostly at oneself.
Writing about it really doesn’t do it justice. Will this review be oblique enough to evoke the mood, the triste, the indirection of the narrative? You must decide.
You’re kidding right? No one wants to start with a BLANK EHR screen when seeing patients. There HAS to be a way to automatically move data from ___ EHR (fill in name) to ___ EHR (fill in name), RIGHT? RIGHT?
It is a tale as old as time (or at least since the early 2000’s when clinics started installing Electronic Health Records). HEY, my EHR sucks! That other one over there MUST be better. Let’s rip out the current one and put in a new one. SURELY that will fix everything.
First of all, that is a fallacy. 20% of the success of an EHR project is due to the technology. 80% is due to the socio-political skills and workflow designs of those doing the installation.
Secondly, maybe we’re too late, and the NEW system is nearly fully installed. We’re just waiting on the data-load. How much data do you pull out of the current system and push into the new? Easy, right? ALL OF IT! Surely all that typing, mousing, clicking that our physicians and APPs and nurses and staff did entering data CAN’T BE WASTED.
In fact, I’ll make it easy:
Here’s a list of data to pull over
Problems (clinical diagnoses, billing diagnoses, problem list)
Medications (historical meds, active prescriptions)
Past Medical History / Surgical History / Social History / Family History
Progress Notes, Hospital Notes, Emergency Department Notes
Done! W00t! Our new system is pre-loaded with lots of useful stuff!
Happy, nāive CMIO moving data around.
Not so fast, Sherlock.
Here are a sample of problems we encountered trying to make this happen in our organization:
We tried loading ICD10 codes from one EHR to another. Maybe 1/2 of the codes come across okay. Others start with “Adrenal Adenoma” and end up with “Adrenal Mass, Not Otherwise Specified”. In many charts, our physicians complained that “It would have been easier to enter NEW diagnoses rather than fix the details of the ones that imported incorrectly.”
Another issue: sometimes you end up merging EHR’s between two organizations. Then, you’ll get “Diabetes, type 2” and then a semi-duplicate “Diabetes, poorly controlled, type 2” and “Elevated Glucose” and “Diabetes, type 2, well controlled”. And then your physicians end up cleaning duplicates OR worse, just leaving the mess as is.
We transitioned EHR’s, years ago, from Allscripts Touchworks) to Epic. We pulled 2 million medications out of one EHR and ported it into the other. Unfortunately, data stored in Allscripts was, for example:
Lisinopril / 10mg / total dose: 20mg / once daily / quantity 180 / refills 3
As a result, the third field caused an error, and now the result of the import:
Lisinopril / 10mg / __ (defaulted to 1) / once daily / quantity 180 / refills 3
And the physician using the new system might prescribe the wrong dose. Thus, we hired a team of pharmacy technicians to go through each patient and FIX THE ERRORS. It turns out to be MUCH FASTER to enter an entirely brand new prescription than to correct an imported one. Booooo.
A Human Team for importing data
We ended up hiring a team of abstractors. How did we do this cost-effectively? As UCHealth grew as a system, we would add new clinics and hospitals, often with patients in common (eg, electronic data in 2 EHR’s, in health systems that were coming together). Automation and importing tools are still not up to the task of seamlessly merging data sets (eg: here is a lisinopril prescription from 9/2019, here is another one from 3/2020. Are they the same?). As a result, we thought about the most efficient way to fund a team to do this work. We ended up with:
Pharmacy Technicians, supervised by a Pharmacist.
Import Team work
We would send a team into a clinic, to look at the clinic schedule and import Problems, Meds, Allergies, Immunizations. We decided AGAINST importing Past Medical History, Past Surgical History, Social History, Family History. These last 4 were generally of poor quality. Garbage In, Garbage Out (and costly in person-hours).
Pharmacy Techs do well at meds, allergies and immunizations, and diagnosis selections were easily trained.
Sometimes clinics would pay overtime to MA’s, RN’s and some clinicians in advance of the EHR cut-over (bonus: increased time spent on the newer EHR grew their skills).
The team would abstract charts up to 3 to 6 months while using the new system, thinking that the most complex patients in a clinic would be seen more frequently, and then the bulk of the complex patients would be loaded.
We chose NOT to bring scanned images wholesale into the new EHR. We did a trial for a busy primary care clinic, and scanned 1 month of about 30,000 images. Usage / viewing of those images by clinicians and staff after a year was … ONE PERCENT. About 300 images were ever viewed, and most of the views were insurance cards!!! This is a very low utilization rate for a high cost, slow process for scanning, importing and indexing. Perhaps newer OCR (optical character recognition) and AI – self categorization tools might help in the future…
Instead, we asked clinicians to do EITHER: A) Incorporate data from old notes/EHR into the new one in their progress notes or problem list. We kept the old EHR live for one year, so that clinicians could cross reference without importing.
And/Or, B) Allow clinicians to “tag” individual scans from the OLD EHR to be individually moved to the NEW EHR. This resulted in a small, manageable list of scans to bring over that were most useful (discharge summaries, consultant notes, critical radiology reports).
Data transitions between EHRs? Hire a team. Maybe give them Red Shirts.
I am a collection of contradictions. I alternate between hedonistic Netflix binges and an occasional classic book (Ptolemy, Copernicus, Kepler). What contradictions do you embody, and what has it taught you?
Son brought this book home from his sophomore year at St. John’s College in Santa Fe. You know the school has its bona fide’s when their faculty have written, edited and published the definitive modern editions of these classic books.
This was a fun read. I started with Ptolemy, and the geocentric worldview he championed about 40 CE, and followed some of the geometry proofs (having studied Euclid too many years ago). I watched him build his ‘epicycles’ (circles upon circles) to explain the progression and retrograde motions of the 5 visible planets.
Retrograde: here’s a bonus term for those of us no longer into astrology: it is the apparent reversal of the motion of planets gradually migrating across the sky. From the newspaper, I recall reading statements like ‘Mars is retrograde in Capricorn’ and thinking ‘what hocus pocus is this?!’ Now I know that it means Mars is migrating in reverse direction and it is positioned inside the constellation of Capricorn in the sky. It makes a little more sense descriptively, but I still don’t buy that astrology foretells my future as a result.
Clearly, says Ptolemy, the only rational view of the heavens are that they are concentric spheres. The proof is that with his excellent math, he can predict the positions of the stars into the future.
1400 years later, Copernicus thinks deeply and has an insight (how, though, did he have that insight?). I love books, like Lavoisier’s on Chemistry, where the author lays out his stepwise experiments and failures, and gradual reasoning toward the invention of the concepts of oxygen and hydrogen…
Nevertheless, Copernicus lays out the groundbreaking and heretical thought that the Earth is not the center, and that the sun is the ‘center of the world.’ Heliocentrism. He has to tread gently, as he is shattering what has been accepted by scholars (and the Church) for over one thousand years. (What do WE accept that has been true for 1000 years?)
In his introduction Copernicus gingerly states that both he and Ptolemy have explanatory systems that predict planetary motion successfully. But, the heliocentric model is SO MUCH SIMPLER.
So, how to explain why Mercury and Venus have a much smaller range as they move across the sky night after night, and Mars, Jupiter and Saturn seem instead to span the entire sky? Ptolemy has to jump thru hoops and invent weird epicycles to make sense of this, and yet Copernicus sweeps away all that complexity by saying Earth is itself a planet with an orbit BETWEEN Venus and Mars. Thus the ‘inner planets’ behave differently from the ‘outer planets’ based on Earths own orbit and ‘overtaking’ the orbits of those outer planets. And all the epicycles fall away. It is one of the most ‘ohhh’ beautiful moments in the history of science.
Devastatingly, he draws out what Ptolemy’s epicycles requires planets to do (spirographic pirouettes through space, ridiculous when you look at it that way).
Cool read, even if this aging person is too lazy to revisit Euclid and plow through the math. The thinking, the paradigm shifting, the worldview challenging. That’s fun. Next up, Kepler and Galileo.
This is a nice quick (3 minute read) of the ways Science can be done quickly and effectively, and points out some of the common friction points that we can eliminate in our journey. Thanks to the NYTimes for giving us perspective on what we’ve just lived through.
This is awesome in several ways (read the article, link above).
Having a “creative desk” full of glue, scissors, sticky notes, colored pens is always better when designing something. Once done, you can move to your computer and finish it at your “publishing desk”. This research tells you why (you can think outside your brain using your body and your physical space)
The EHR (electronic health record) is a way to help your brain think, if we do it right. Do we do it right? This is “using tools” to augment our thinking.
Then we have “other people’s minds” with the hint that teams who know how to draw on complementary skills from others in a team, perform better than individuals or uncoordinated teams. What does that teach us about our informatics work?
I will have to sit with this article for awhile. What are you taking away from it?
Having succeeded at getting folks to social distance and mask for a couple years, the viruses are staging a comeback: lots of kids and adults with LESS immunity to flu and RSV (respiratory syncitial virus) and thus a sharp spike in infections this fall.