A Colorado original: 10th Mountain Division Hut system

If you said to me a few months ago: “You are going to enjoy spending 5 hours at the brink of your anaerobic threshold, gasping for air at 11,000 feet, carrying a 50 pound backpack to a remote hut in the Colorado back country?” I would have called you crazy.

Having just returned from a long weekend involving a 12 mile round trip to Uncle Bud’s Hut, part of the 10th Mountain Division Hut Association, I can say that it was an amazing, once in a lifetime experience.

Once in a lifetime, because, maybe I don’t need to ever do that again.

For example, a few decades ago (1994!) I trained for and completed the Davis Double Century ride; or 200 miles in one day on a bike. I did enjoy the mind-expanding (and thigh-muscle-expanding) experience. The months leading up to the event were both exciting and grueling (riding 20 to 60 miles on days leading up, just to prepare). The actual event was transformative, and an achievement that I’ll always be proud of. Starting out with thousands of other cyclists, decorating the road with the splashy rainbow of cycling jerseys, chatting as we, amoeba-like, engulfed miles of asphalt with human-powered wheels, devouring hundreds of pounds of cyclist snacks every 20 miles, climbing and descending gentle slopes in the company of adventurous souls.

HOWEVER, the last few hours, the last 50 miles, riding in darkness, our newly-purchased bike lights fading, our legs giving out, the bananas and snack bars and chicken soup no longer filling our always-hungry bellies, the road ahead stretching (literally) into invisible infinity, our saddle sores more urgently uncomfortable, our on-the-road cycling companions dropping away and disappearing. And then pulling in to the start/finish line at 200 miles, and, no longer having strength to unclip from my pedals, falling over in both exultation and exhaustion.

After that ride, I did not get back on the bike for a month, and to this day, still have NO interest in joining another 200 mile ride.

In that spirit, I can report that my Uncle Bud’s experience was also transformative. Here’s how it went down. Come along!

  • Go get your stuff. We headed out to Bent Gate, apparently one of the few stores in Denver Metro (Golden actually) that will rent AT ski’s and backcountry gear (All-terrain, for us newbies). $800 for 2 of us for 3 days: avalanche beacon, avalanche 20 foot collapsible probe, shovel, boots, ultra-light skis that somehow behave BOTH like alpine downhill skis with good edges for sliding down and have lockable heels for a stable foot platform, AND are lightweight and can be made into cross-country, pivoting-toe attachment skis. Don’t ask me more. They’re both like telemark skis and also not. ?!?
  • Read the map (OMG 6 miles to Uncle Bud’s, along a fire road and then UP for the last 3 miles). Stress.
  • Plan on making dinner for 17 people on the trip on Sunday night (what to make? will it cook at 11,500 feet? Where is the online cooking guide and adjustment for time/temp for much lower boiling temperature at 11,500? what will taste good at altitude? Are there vegetarians? vegans? allergies? who’s gonna carry all the materials?). Stress.
  • Watch the weather dump an additional foot of snow the week before going. Stress.
  • Carbo-load the night before. Stress.
  • Borrow my daughter’s hike/camp backpack and stuff it with 50 pounds, including sleeping bag and clothing and lunch and dinner supplies and 4 liters of water. Why would I need 4 liters of water for ONE measly hike? 50 pounds is not bad, but that is without skis on the feet. Son and daughter have plenty of advice for “old dad.”
  • Get up at 4:45am, STILL GET CAUGHT in I-70 skier traffic on the way out of town, and instead of taking 2.5 hours to get to Leadville, take 3.5 hours and arrive around 9am. AND, leave behind a winter shell and have to buy a replacement in Leadville. Stress.
  • Get to trailhead as everyone is ready to head up. Buckle up quickly, half-remembering what they guy in the store said about all the boot settings. Wonder how to use the avalanche probe and beacon, trust that 15 of 17 people in your group are Colorado natives and have done this several times a winter for a decade. Start sliding toward the trail.
  • Hey, this is … fun? It is snowing lightly, the sun peaks through occasionally. Even though it is 7 degrees, I’m wearing plenty of layers and a 50 pound backpack. My last-minute winter shell is bright GREEN which goes great with my bright RED ski pants. I’m focusing on pushing with one leg, bending the other knee and pausing to slide for a second before taking a second step. On flat terrain or a slight downhill, this works well for forward motion (I can slide about 1-2 feet for NO ADDITIONAL EFFORT), but side to side balance is a different thing. I nearly topple several times. Just moving toward the trailhead in the parking lot. Stress.
  • Trailhead! OK, this is just a fire-road; the dirt road that trucks in the summer and snowmobiles (and trucks) in the winter go up to service some parts of the forest. The snow is fluffy, nice, not scratchy or icy. There are ruts in the road from recent passage of snowmobiles, but no problem. My feet start to notice that the rental boots are not a perfect fit. Surely this won’t be a problem later…
  • Sloping uphill: Hey! This is hard work! Most of the team has “jogged” out of sight up the hill, whooping it up on the way; they’re in their native element. On the other hand, the bi-coastal transplant to the Mile Hi City is huffing and puffing. Why hasn’t living in Denver for 2 decades translated to growing a second set of lungs? Nice think about the gasping for air as I slide up the trail is it takes my attention of my increasingly painful feet. I also ask my trail-buddy (who has been left behind to guard me against falling to the pack of wolves that pick off slow, enfeebled members at the back of the convoy): “hey is the rest of the trail ahead also this steep?” Reply: “Oh, don’t worry, it gets much steeper ahead.”
  • Lunch! At 3 miles (hey! almost halfway!) we pull over, take off our backpacks, snarf down some snack bars (and my lifesaving colleague pulls out a Banh Mi Vietnamese sandwich and generously donates 1/2 to me) and I have never had such delicious food in all my life. Ambrosia.
  • Then, off the fire road and the REAL trail starts. I become aware of the value of Skins, the unidirectional fibers sticking out of the carpet-like attachment to the bottom of my skis that allow me to slide forward, “catch” the fibers and essentially walk straight up the slope without sliding back, unlike in alpine or even regular cross country skis where a major “herringbone” diagonal walk up the hill is necessary. This is like a stairclimber exercise, but at 11,000 feet with 50 pounds on your back and 30 pounds strapped to your legs. I can feel my heartbeat in my throat going about 170 and my lungs scrabbling for every single O2 molecule. “Hey, isn’t this beautiful, CT?”
    =pant pant= “Huh?
    =pant pant= “Wha?”
    =pant pant= “Where?”
    =pant pant= “Lemme”
    =pant pant= “Catch”
    =pant pant= “My”
    =pant pant= “Breath”
    =pant pant= “Yeh. Nice.”
  • In another 2 miles, my guardian and I catch the 9-year old daughter of friends who is finally starting to get tired. Wow, what an amazing backcountry expert she’ll be growing up! Then some of the teenagers, having reached the hut, dropped their gear, started the fireplace, have come down to help some adults with carrying backpacks the rest of the way. I resolve to carry MY OWN BURDEN the rest of the way.
  • Arriving at the hut is perhaps the sweetest sensation of the past few years. I go in, shuck off everything, swap out clothes, and sleep for a solid 2 hours.
  • We end up making dinners (although cooking is a challenge with water boiling at a lower temp and having to melt all your own snow for drinking water, the food is extra delicious for being so hungry), singing campfire songs accompanied by the ukulele, teaching some kids some ukulele strumming chords, skiing through untracked powder in the coming days and generally having a blast. Moleskin becomes a second skin on my feet.
  • Our slide down is heavenly. There are sections of trail up to a 1/4 mile that qualify as a Maslow’s Peak Experience for me; gliding effortlessly downhill through a glade of trees, the sunlight filtering down, a fine drifting mist of fresh powder, the temperature perfect, my pack and everything balanced just so, knowing that I CLIMBED THIS MYSELF (about 30 minutes of climbing for every minute of gliding down), glimpses of the San Juan mountains encrusted with snow…Wow.
  • Then, back to the car, returning the gear, merging back into I-70 traffic, back to reality. It is something I will never regret having done.

CMIO’s take? I think all Coloradoans should do this. The cameraderie, the triumph of effort over gravity, the cleverness of technology to overcome natural obstacles, the pure transcendent beauty, the sense of achievement and teamwork, and of course, the singing. Have you done a hut trip? Let me know.

Denver Regional Clinical Informatics Summit (and ukulele) – second annual, hosted at UCHealth

Okay, so you’re probably here for the Informatics knowledge, but too bad, we’ll lead with ukulele. Thanks to Dave Beuther for writing us a world-premiere song parody of Grace Vanderwaal’s “I don’t know my name” ultimately winning America’s Got Talent a couple years ago (meaning Grace, not Dave).

I’m really grateful to our Denver Region sister-health-systems. We have quite a few health systems in our region with Clinical Informatics expertise, and we spent the better part of a day getting to know each other, conduct round tables, and discuss our common challenges in designing next-generation, innovative Electronic Health Records to improve the care of patients in Colorado. Thanks to attendees and leaders from: Boulder Community, Steamboat (Yampa Valley), Centura Health, Children’s Hospital Colorado, Denver Health, Kaiser, National Jewish Health, SCL Health, UCHealth and the Denver VA Medical Center.

Amy Hassell explains how components of the Virtual Health Center work to Summit attendees from across Metro Denver

We had about 30 attendees from various health systems touring our Virtual Health Center (VHC), seeing our capabilities for Virtual ICU, Virtual Remote Monitoring, Virtual Urgent Care, Safety View, Telemetry and more.

About 50 attendees participated in our afternoon Clinical Informatics Seminars, a series of Round Table discussions ranging across such topics as Clinical Documentation, Order Sets, EHR burden and optimization, Physician Builders, Virtual Health, Innovation, Clinical Decision Support, Analytics and Data Science. Whew!

What’s a good conference without a Selfie?!

We wrapped up the day with an evening CHIMSS (Colorado chapter Health Information Systems Society) event with a keynote by Dr. Rich Zane on Innovation in Healthcare.

This was followed by a panel discussion on innovation with Brandi Koepp, Pharmacy Coordinator, UCHealth, Paul Schadler, SCL Health, David Beuther, National Jewish Health.

Here are the reviews of the event! https://www.surveymonkey.com/stories/SM-P7KFLZDL/

The evening CHIMSS event in the Bruce Schroeffel Conference Center main auditorium @UCHealth

CMIO’s take? Although we could probably benefit from more frequent information sharing and collaboration, for my taste (as coordinator), once a year is pretty good! It is cool what our sister health systems are doing to improve the care of patients; we are better together!

Large PIG Annual Summary FY-2017-18: our successes, challenges, and plans for the coming year

Our Large PIG (actually JIG: Joint Informatics Group)

How do you give thanks and acknowledge your teams each year? I know WE don’t do it nearly enough. Here’s a partial list of our PIG achievements from 2017-18, now that we’re into 2019 (I know, I know, I can’t blog fast enough to keep up with smart amazing colleagues, a great problem to have).

Physician Informatics Group Annual Executive Summary
Submitted by CT Lin MD, August 20, 2018

Vision statement: We improve physician/APP and team wellness and effectiveness by building extraordinary relationships and innovative tools.

FY2017-18 Achievements

  • Go Lives: MANY Clinics, 2 Hospitals
  • Sprint: 17 Sprints in 2 years, 496 providers, 315 staff
  • PI’s conduct specialty-specific and general projects to improve provider and staff efficiency and effectiveness in patient care
  • PI’s create and educate via newsletters, tip sheets, videos, meetings
  • PI’s help review, test, educate and implement Epic upgrades
  • PI’s develop and lead service line governance for UCHealth
  • PI’s chair or co-chair or participate in at least 2 dozen UCHealth governance committees to guide both Epic EHR development as well as UCHealth provider leadership overall.

Examples of successful projects:

  • Conversion of OIC (infusion) orders from “referrals” to “Therapy Plans” for safety, efficiency
  • Creation of 5 new UCHealth-wide service lines to facilitate Epic EHR build, reduce unnecessary variation
  • Creation of an APP Epic Concierge meeting to improve effectiveness and training
  • Dragon Speech expansion and elimination of Partial Dictation
  • Creation of a PI onboarding document, training, getting-up-to-speed
  • Creation of an Opioid management steer and Epic customizations to support initiative
  • Implementation and expansion of innovation partner tools within Epic: AgileMD, RxREVU, APPRISS
  • Implementation of Radiology Indications software, phase I
  • Implementation of patient access to images via My Health Connection
  • Use of EHR, scheduling and billing data to improve clinic operation efficiency, effectiveness
  • Creation of an Universal APSO note to improve both standardization AND customization
  • Creation of an MA-smartform to dramatically improve consistency of data capture in Practice Transform
  • Connection of Epic data to ORIEN (oncology research network) with dramatic efficiencies
  • Implementation of iECG, physician informatics/organizational change support to change EKG capture platforms across all hospitals/clinics
  • EPCS: E-prescribe Controlled Substances deployment of 2-factor authentication
  • Support of Palliative Care and Spine Surgery smartforms, note templates, registry reporting tools
  • Standardization of UCHealth Order Sets, physician leadership, phase I
  • Support of AMC Neurology Practice Transformation, note templates, flowsheets
  • Book Club: Read books this year on Organizational Change, Communication, Connection: Design of Everyday Things, Good to Great, Great by Choice, Crucial Conversations, Leading Change, Nudge
  • Creation of Small PIG program to mentor newer PI’s

Opportunities for Improvement

  • Counseling and coaching of PI(s) to further improve internal and external communication and leadership skills in a rapidly growing organization
  • More emphasis on analytics, use of information in our PI role, beyond “go live” and “optimization”

Plans for Coming Year

  • Implementation of approved Sprint Team 2, improvements on process for Team 1
  • Implementation of expanded rollout of Practice Transformation (changing the MA:MD ratio to 2:1), and supporting EHR tools
  • Support of ongoing hospital go lives
  • Ongoing redesign of PI support of clinic go-lives and onboarding individual providers
  • Incorporate analytics into Sprint
  • Dragon speech QI/research project: Dragon in the exam room
  • Radiology imaging shown to patients QI/research project
  • Expansion of Innovation projects
  • Expansion of MHC questionnaires, possibly PROMIS questionnaires
  • Acceleration of the Order Set Synchronization project
  • Further reducing the EHR burden, improving patient care and human connection, in everything we do

CMIO’s take? What’s YOUR take? What do you plan for the coming year?

Happy holidays from the Large PIGs, JIG, and CMIO

Dave Corry arriving late to our group photo, to the CMIO’s amusement and dismay

I hope that you are making plans to celebrate the season, to connect with friends, colleagues, family, and take time for yourself.

I consider myself so fortunate to work with such a great group of informaticists or informaticians (inforMAGICIANs?!), or informatics people, whatever we call ourselves. The work we do, sometimes seems like a grind, but keep in mind, fellow informagicians, that we strive to improve the lives of patients, colleagues and staff by improving the information systems we use for the greater good. 

We try to keep it light in our naming of projects and committees. For example, our Joint Informatics Group (including clinical informatics nurses as well as physician informatics) is JIG. Our physician informatics group are the PIGs. This leads to the New PIG book club, the Small PIG leadership group, and the meeting, which encompasses all physician informaticists: Large PIG. 

And, be sure to throw up your hands and have a good laugh once in awhile. By the way, here’s an updated picture with Dave raising a glass. 

CMIO’s take? Here’s to you and the good work we all do. Cheers!