Tag: Innovation

Letting patients file their Advance Care Planning (Advance Directives) online via Patient Portal (Hillary Lum et al)

Dr. Hillary Lum

https://www.sciencedirect.com/science/article/pii/S0885392418310479

Thanks to Dr. Lum for her persistence and clarity of purpose. She led a team of physician leaders and IT staffers through a complex process, resulting in a first-of-its-kind online tool:

The ability for patients to complete their Advance Care Planning and upload the results using an EHR (electronic health record) patient portal. 

Why is this so important 

  • Very few patients, much less US adults, have an Advance Care Planning document (including Advance Directive, Living Will, 5 Wishes, No CPR, or any other document that records the wishes of the patient in regards end-of-life care)
  • It is difficult for patients to find the form, to understand the form, complete the form, return the form, AND THEN to have clinical staff file or record the form and its wishes in a way that is easily accessible by both healthcare providers as well as patients themselves.
  • Patients without any advance care planning documents risk the possibility of receiving unwanted care at the end of their lives; since patients are so often non-communicative as their health deteriorates, unless the doctors and nurses have a clear statement from the patient, we must assume that the patient wants CPR and other aggressive measures, even if it borders on inappropriate. This tragedy can easily be avoided with easily available documents expressing the patient’s wishes.

And now, at UCHealth, patients can avoid this risk! From the privacy of home, patients can now log in, launch the Advance Care Planning module, complete the questions, and even upload any signed documents in regards to their wishes, into their online Patient Portal, in a permanent storage location easily accessible by the patient (or their permitted proxy) or any of their healthcare providers at UCHealth.

This is pretty cool, and a big leap forward. In fact, even without any publicity to patients (the module just appeared in the portal), over 1000 patients recorded a NEW advance care plan in the first month after this module went live. And, patients continue to sign up at a constant rate.

We hope this continues at UCHealth, and more importantly, that other organizations start doing this as well. Only 36% of US adults (studied in 2017) have an advance directive; meaning that about 2/3 do NOT!

CMIO’s take? We have a lot of work to do, people. Let’s get the rate of advance care planning much closer to 100% of US adults; we never know when we’re going to need one, and by then it is often too late.

Arborealization and the Ping Pong Robot (from Omron)!

OMRON’s ping pong robot is a demonstration

Interesting. OMRON, maker of the blood pressure measuring device that I recommend to patients, is moving into human-augmenting AI. Purely as a demonstration project to showcase technologies, they built a Ping Pong robot that will play with you to:

  1. Rally with you
  2. Assess your ping pong skill
  3. Assess your emotion from facial recognition
  4. Use the “net” as a screen to tell you what it is thinking and doing
  5. Coach you to be a better player, using what it knows about you

From the video, it is not infallible, but it will rally with you, it will serve the ball, it will give you a ranking, it will speed up or slow down based on how you are doing and feeling, it will note that ‘we are having fun!”

Part of the idea of “arborealization” of technology (a made-up word), this is a term I heard about a decade ago. In short, with technology acceleration powered by Moore’s law and the constant doubling of computing power, tech acceleration is NOT in just a single direction (eg: self-driving cars, faster personal computers), but in ALL directions (eg: ping pong robots, poetry-composing AI, symphony-composing AI, deep-sea diving AI, Google Duplex being able to book an appointment by telephone for you, etc).

Still, weak AI and strong AI are different things. Pointing software at a difficult single problem (Weak AI solution) is very different from building an AI that can tackle ALL problems (Strong AI). I’m reading Life 3.0, a easy-to-read NYT bestseller that is the latest foray into describing the exploding fields of AI and general intelligence.

CMIO’s take? I need one of these robots in my basement ping-pong room. Humans are so disappointing; no one will take me up on my nightly ping-pong challenge.

Holy Geez! Storm surge animation takes imaging to the next level

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https://www.wired.com/story/weather-channel-hurricane-florence-storm-surge-graphic/

We are living in a wondrous time. Read this WIRED article about how the Weather channel very quietly deployed a brand new imaging technology to very viscerally depict Storm Surge data in a way that WILL GET FOLKS OUT OF THE FLOOD ZONE. Some do not leave because there is a lack of understanding of “how bad will it be, really?” After watching the video above, I don’t think there will be ANY question.

It is a fascinating illustration of how far we are coming with virtual reality, and combining this with real images to create augmented reality.

CMIO’s take: We need this in EHRs and healthcare IT to bring home the visceral impact of our care and our decisionmaking. Who’s in?

Open notes in a Resident clinic: research study results

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Research study paper is here:    http://ow.ly/6eY530jYZJy

We’re published! Thanks to co-authors Bradley Crotty MD, Corey Lyons MD, and Matthew Moles MD, we helped a multi-health system collaborative to study the idea of Open Notes in primary care residencies (family medicine and internal medicine at University of Colorado Health system), with research findings above.

Ultimately there is some anxiety from both faculty and residents about patients reading their written progress notes online, after the physicians have signed off on those visit notes. We are happy to claim that our program, of all the training programs was least optimistic that this would turn out well for our physicians and patients.

Overall, though, since we gathered this survey data, we have gone on to turn on Open Notes throughout our health system (UCHealth) and now uniformly offer Open Notes to all patients in our 700 clinics, 11 hospitals, and 21 emergency departments. The fear that the “world would come to an end” has not yet come to pass, and we are hearing positive things from our patients about their ability to read notes and benefit from them, including:

  • I often forget much of what we discussed in the visit, now I can go back and refresh my memory
  • Sometimes my wife asks me “what did the doctor say?” and now we can go review it together
  • Sometimes my other doctors don’t receive the consultation letter from my specialist, and now I can show him/her that letter/note from my patient portal. I can be in charge of my own information
  • I can use my doctors note to look up words I don’t understand and get more background information so that I can ask more intelligent questions at my next visit; I feel like a part of my own healthcare team

CMIO’s take: it is good to study what we do. As Robert Anderson MD, one of my mentors told me: “We should use the laboratory of our direct patient care to study and learn. Everything we do with patients should be evaluated and can be improved.” Thanks, Bob!

Where does creativity come from?*

“Where does creativity come from? We don’t know but we are certain that it doesn’t come from our laptops” –John Cleese

Thank you, Sir Cleese. I have enjoyed your movies, your quips, your oeuvre, and even the way you say “oeuvre.” And now, you give talks on creativity.

In my readings, I must agree, working on computers, on laptops is simple, is portable, allows us to store our thoughts in the CLOUD to avoid getting our papers lost in some stack. And yet, the non-verbal result of our tapping away at our computers, our laptops, our tablets, our phones, is an implied communication that we are in our own bubble.

Furthermore, using keyboards seems to reduce the ability for our brains to engage in encoding incoming information, with research showing that students learn better when they take notes ON PAPER as opposed to using an electronic device, maybe because SLOW handwriting forces a brain to choose the important words rather than take down words verbatim, and maybe because having an open laptop (often open to SOME other interesting website) distracts us AND OTHERS SITTING BEHIND US to losing focus and not really listening.

Finally, numerous books on creativity talk about how computers may be terrific at creating beautiful documents and flyers, but are generally terrible at restricting the free flow of ideas that is only possible with pencil, colored markers, sticky notes, lots of paper and scissors. Some advocate for having TWO desks in your office: one for creative work that has NO electronics, only paper manipulatives, and one for the computer, when the creative work is done, to put the completed work into a pretty format for printing or electronic storage and transmission.

I’ve taken to this model and try to do creative work away from my computer now. I also take notes in a small black book, not on my phone, and I’ve found this (although not searchable) a great way to better encode and remember discussions.

CMIO’s take? Keep in mind where creativity comes from
and where it doesn’t come from.

Augmented Reality: the Homecourt app on iPhone XS: wow!

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https://www.si.com/tech-media/2018/09/12/steve-nash-homecourt-app-apple-event-iphone-xs-camera-watch-shot-tracker

More whiz-bang tech. The latest iPhone now supports more augmented reality, by allowing the app access to a video stream of someone practicing shooting hoops and giving feedback in REAL TIME as to the spots from which shots are attempted and made. In other words, AI now auto-processes video that used to take hours of video TAPE pored over by coaches and players, and simplifies this into a device we already carry. (OK, those of us with >$1000 disposable income and a desire for the latest and greatest geek toy).

But, think, if we applied this to healthcare, would we use this to:

  • Monitor patient meals by automatically calculating what is being consumed?
  • Watch how patients are flowing through clinic to learn how to optimize efficiency?
  • See how ER patients are doing in the waiting area and triage and in the treatment areas?
  • Watch for improved efficiency in procedural areas like endoscopies, bronchoscopies, cath labs?
  • Watch how minor procedures are performed and suggest tweaks to clinician performance without the shame of having a human supervisor around?

CMIO’s take? Interesting to see how and where Augmented Reality might show up in healthcare, based on bleeding edge ideas in other fields like sports.

CT Lin MD, CMIO and his views on world domination (news, Becker)

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Kidding. Not kidding.

https://www.beckershospitalreview.com/healthcare-information-technology/crucial-skills-for-aspiring-cmios-q-a-with-uchealth-s-cmio-dr-c-t-lin.html

Further thoughts about Becker’s Hospital review for interviewing me and talking about my role as CMIO.  I have enjoyed their series on CMIO’s, and our collective vision:

  • Clinicians, in the care of patients in an increasingly complex world
  • Technologists, who whisper to the Ghost in the Machine
  • Leaders, who learn (some via the school of Hard Knocks) how to establish a vision, drum up consensus, listen to the cacophany of feedback, hold true to important principles, compromise when needed, and slowly, slowly drag your organization toward a more perfect future. For me, this includes:
    • Creating a “Sprint optimization team” to health system leadership and getting it funded long term
    • Creating “APSO notes“, convincing a dubious physician audience and implementing it as the default progress note in our EHR
    • Creating Open Results (sharing test results with patients) over 15 years ago, convincing a dubious physician audience, and implementing it as the system-standard across the entire enterprise
    • Open Notes (sharing clinician progress notes with patients), same…
    • Open Images (sharing radiology images with patients, live as of August 2018, FUTURE BLOG POST!), same…

And, sometimes a ukulele makes it better.

CMIO’s take? For all the difficult conversations and troublesome daily fire-putting-out crises, this is an amazing job, and I get to do this with an amazing team. Thanks to ALL my colleagues.

Dept of Medicine Innovation talk (video) on EHR Sprints

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I play a doctor in this blog, and sometimes in real life. 

http://www.ucdenver.edu/academics/colleges/medicalschool/departments/medicine/Pages/RIC-09-20-2018-Lin.aspx

Recently I gave a talk for the Department of Medicine Innovation and Research seminars at the Anschutz Medical Campus for University of Colorado’s School of Medicine. I spoke about one of my favorite topics, some of which I have discussed in these blog pages: Reducing the EHR burden and improving physician burnout with EHR Sprints.

CMIO’s take: what is YOUR organization doing to address physician burnout? Something similar? Let me know!

White paper: the Future of EHRs (National Symposium at Stanford)

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I had the privilege recently of being invited to a national symposium hosted by Stanford Medicine and Dean Lloyd Minor, sporting numerous EHR clinical experts, informaticists, vendors and other thought leaders. See the resulting white paper (caution, in addition to expert opinions, there are quotes from me):

http://med.stanford.edu/content/dam/sm/ehr/documents/SM-EHR-White-Papers_v12.pdf

CMIO’s take? I found it an invigorating, forward thinking symposium with lots of great ideas for where we are and where we are going. Most importantly, we tackled WHY solving the EHR conundrum (so important, but so far from where we need to be) is crucial to the future of healthcare.

Reducing Physician Burnout using an Agile team (EHR 2.0 Sprints), Guest Post by Brian Redig

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A little over a year ago, CT Lin, CMIO at UCHealth asked “How might we reduce physician burnout associated with the use of the electronic health record?” as part of an initiative he coined EHR2.0.  Through collaboration with Physician Informatics, Epic Certified Analysts, and Trainers, the optimization sprint pilot was quickly out of the starting blocks. Would the experience be the 100 meter sprint or the 110 meter hurdles?

The team accelerated quickly generating ideas.  They sent out surveys, evaluated provider efficiency profiles, created checklists, investigated prior optimization requests, and observed providers interacting with the system.  The team included Ambulatory Analysts, Trainers, a Scrum Master, a Nurse Informaticist, and a Physician Informaticist.  They had two weeks to accomplish as much as possible through interaction in the provider’s clinic establishing a medium for collaboration in real time.

The hurdles could be anticipated; “everything is critical!”, governance, change control, communication, capacity constraints, time, trust, and differing opinions.  Next, too much work in progress could create a residue effect as the analysts bounce between ideas instead of focusing on immediate next steps towards completion.  Finally, how do we identify and address assumptions, inferences, and facts?

The team leveraged agile methodologies in running the sprint to help address some of these obstacles. They used a Kanban board (Backlog, To Do, Doing, Done) as a way to visualize their work and agree to the work in progress, a Burn Up chart to show their accomplishments, and a Daily Scrum (Huddle) to discuss challenges, priorities, next steps, and context for the upcoming work.

The key to the sprint became the stakeholder participation in prioritizing what was important to them and assisting with trade-offs.  Instead of ideas having a static prioritization of critical, they float relative to other ideas.  There was also simultaneous exploration of the problem and solution domains as the immersion provided immediate feedback loops.  The focus quickly shifted from linear/more is better to high value deliverables.

The team was thinking through doing expressed best by the Chinese proverb,

“What I hear, I forget;
What I see, I remember;
What I do, I understand.”
–Confucius

Early results across the finish line demonstrate high impact to Epic flow sheets, SmartLinks, note templates, In Basket efficiency, Synopsis, and Med Rec along with positive net promotor scores.

The experience was neither a 100 meter sprint nor a 110 meter hurdle, it was a Tough Mudder!

The fastest way to the finish line was to lower hurdles through collaboration and provide performance enhancing features that minimized mundane clerical activities, streamlined charting time, and stimulated the cognitive clinical art of practicing medicine.

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Brian Redig, MBA, SCPM
Lean Six Sigma Black Belt
Board Certified Nuclear Pharmacist

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