Thanks to all our EHR colleagues; I’m returning from Epic’s UGM (User Group Meeting: check out the twitter-verse at #UGM19) and learned a ton from other customer presentations and from Epic’s future vision as a company. Here is our contribution: a successful integration of RTBC (real time benefits check) of prescription co-pay, prior authorization data, and “payer suggested alternative” meds, right in the prescriber’s workflow, right inside the EHR. Simple, works fast (pharmacy- and patient’s insurance-specific real-time check within about 1 second) for every prescription written. Now, you can tell the patient “This prescription has a $4 co-pay at Target pharmacy”. What a difference.
This was the difference between my patient NOT paying $291 for doxycycline tablets vs $90 for doxycyline capsules. Really?
See my blog post on RxRevu previously. This is working well, and we’ve scaled up to all 3000 prescribers at UCHealth with excellent results.
TO celebrate, we’ve come to discuss our success at UGM … and (of course) to sing a song. Thanks to Terri Couts, VP of Epic Applications at Guthrie Clinic, co-presenting the topic, and for agreeing to sing with me!
Ross Martin is a physician informatician extraordinaire. Among his many talents, he is a singer-songwriter with his own musical show, and he publishes a blog at at ACMIMIMI: the American College of Medical InformatiMusicology. Turns out there is a small community of physician informaticians who cross the line between work-a-day informatics and the arcane arts of … music?
For example, a fellow Fellow of ACMIMIMI is Dr. Francis Collins, founding member of the Human Genome Project, and Director of the National Institutes of Health. August company.
CMIO’s take? I’m sure all you health IT geeks out there have hidden talents. Let me know what they are!
This is my Failure Resume. I got the idea from several sources, and thought: this will be fun and humbling for me, and perhaps encouraging to my junior colleagues facing a tough uphill climb through academia or in their organizations. In hindsight, it is easy to cherry-pick my best successes (ignoring my many failures) and construct a narrative that makes it sound like I have always been successful.
This is FAR from the truth.
Reality is much messier, and often, much more interesting. Sharing this with my colleagues has been fun and eye-opening for everyone. Here are links to my one page Failure RESUME and by comparison, my one page Regular RESUME.
CMIO’s take? I think it would be a wonderful world if more of our senior Professors and respected clinical leaders (in informatics or not) posted their Failure Resume’s. It makes us more human and gives hope to our next generation of rising leaders.
Yes! I am an internist. Yes! I have practiced for many years. Yes! I know about CHA2DS2-VASc and HAS-BLED*. Yes! I vaguely recalled that we installed built-in calculators right into our EHR to reduce the barriers for our docs to use these calculators while seeing patients.
No, until today, I had not actually used them in the service of a patient. I had been able to skate by with awesome colleagues doing these calculations at hospital discharge, or seeing them prior to me, and I would follow the recommendations generated by these discussions.
UNTIL TODAY! So, I typed in dot phrases to invoke CHADS and here come both calculators, fill in some quick data and see above; really awesome automatically generated displays that can be placed in patient charts (and shared with patients!), and now I can have a thoughtful discussion.
I am amazed, and humbled. In a high-functioning physician informatics organization, the CMIO should NEVER be the bottleneck. We should be innovating, improving our EHR, and balancing “good governence” (hey! don’t put all those interruptive alerts in here UNLESS those being alerted agree that this is a valuable use of their time!) with “rapid cycle innovation” (well, if the nurse leaders on that unit REALLY want to have a pop-up alert every 30 minutes, every time a heparin blood test returns, as long as the nurse leadership wants to try it…)
The innovation here is, lowering the barrier for docs to use it IN THEIR WORKFLOW within the EHR. Furthermore, to have it DISCOVERABLE! So many innovations are “hidden” (Oh, you didn’t read our monthly newsletter with 20 items? It was number 12. Oh, our newsletter went to your spam folder? Sorry about that). So, being able to type a search for CHADS or HASBLED into our search field actually teaches the doc how to use the tool. Amazing, being a customer of my own informatics team’s development. Sometimes, stuff just works.
*CHA2DS2-VASc and HAS-BLED are fantastic medical calculators that, based on scads of high quality evidence, that we can now effectively calculate the future stroke risk score of atrial fibrillation patients, AND ALSO that we can calculate the future bleeding risk of anticoagulants (having patients take blood-thinners to prevent stroke in high risk situations). And then we can have a thoughtful data-driven conversation with patients instead of licking our fingers and putting them up to the wind to see which way the wind is blowing that day. You can try it yourself; there are online calculators for CHA2DS2-VASc and HAS-BLED.
CMIO’s take? A big dose of humble pie for the CMIO is part of a good diet. What cool things have YOU discovered in your EHR?
Sometimes our patients push us into our discomfort zone. Thanks to one of my long-time patients, who, as a former smoker, wanted to discuss the risks and benefits of low-dose CT scan Lung Cancer Screening. She had heard of this opportunity at her employer, and wanted to see if I could get her set up for one.
Knowing that we had an entire Lung Cancer Screening clinic set up to discuss this with candidate patients, and to discuss how to think about and address the inevitable “what do I do with THIS tiny nodule in my lung, which is likely benign, but who knows” and “how high IS my risk of cancer exactly, and what is the chance that this will make a difference in my life?”
So, I heavily weighted our discussion: “You could either work with ME and I can figure out some stuff, OR you could go see the EXPERTS who do this all day long and have a thoughtful discussion.”
My patient tells me: “Nah, I want to work with you, and I don’t want another co-pay.”
So there it is. Knowing that we have documentation templates and guides, I dove right in, on the exam-room computer. It does take some humility (see previous post) to discover things in front of your patient (after all, are we NOT supposed to KNOW EVERYTHING?!). But, soon, we discovered there was a nicely structured template, searching “LUNG CANCER SCREEN” in our EHR, that asked the right questions, and then sent me to the above website, which then created a spectacular graph display (for Shared Decision-Making with Patient).
CMIO’s take? Having ‘discoverable’ EHR tools that link to sites of external knowledge, really cool. This is a glimpse into our future, where researchers and knowledge discovery, fully vetted, can be created ANYWHERE and used by ANYONE to improve the care of patients universally. There are more smart people who DON’T work for you, than who DO.
Thanks to George Reynolds and those organizing CHIME’s recent Leadership Academy for existing and upcoming CMIO’s. I enjoyed teaching this year with other co-faculty like Brian Patty, Natalie Pageler, Cindy Kuelbs, George, Howard Landa, Keith Fraidenburg and David Butler.
The topics we covered in our Academy over 2 days included such CMIO best hits such as:
The Role of HIT in Today’s Provider Environment
Setting Vision and Strategy
Making Change Happen
Demonstrating Business Value
Budgets and Business Plans
Creating Effective Teams
Instilling Customer Service as a Value
Building Networks and Community
Achieving Life/Work Balance
Thanks to my awesome and inspiring faculty colleagues; I learned a ton as a N00bie faculty member, and got lots of new books to read, for example Brian Patty’s “What Customers Crave.”
CMIO’s take: See one, do one, teach one is the norm during internship and residency training. Sometimes Teach One ends up being the best learning of all. And, join us next year at CMIO Leadership Academy.
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.