“Empty Wallet” or Real Time Benefits Check interfaced into the EHR (woo!) Ukulele

Yet another misadventure with our protagonist

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!

CMIO’s take? Enjoy the song.

InformatiMusicology is a thing (thanks, Ross!)

https://www.acmimimi.org/2018/10/InformatimukulelogicalOfferingsfromCTLin.html 

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!

I Can See Clearly That My Sprain is Gone – Ukulele parody (and an XGM talk)

Author along with co-conspirator Peter Sachs MD. Neither can sing.

We (Dr. Peter Sachs, Vice Chair of Radiology at UCHealth, and I) recently had the pleasure of presenting our recent quality improvement work at Epic’s XGM (eXpert’s Group Meeting) in Verona, WI this week. In brief, we created and turned on the ability for patients to view their own radiology IMAGES online in their patient portal. We had already been sharing radiology REPORTS with our patients for over a decade, and this is an additional step towards information transparency. We think we are among the first to do this.

Despite some minor misgivings on the part of our clinical leaders, we were given the green light to turn this on. Short answer, over 22,000 patients viewed their images in the first month, September 2018 and … no complaints from either doctors or patients! So, we get to keep our jobs!

If you have 2 minutes, here’s the song:

And, if you have another 25 minutes, here’s the talk, and some Q/A after:

Patients Viewing Their Radiology Images Online. Peter Sachs, CT Lin, XGM 2019

CMIO’s take? It is terrific to have a close community of like-minded physician informaticists and technologists pulling to improve healthcare and patient experience, and celebrating each other’s successes. I’m ever grateful to innovative and inspiring colleagues.

Music lessons? Don’t have to drive to Mrs. Bulecza’s house anymore #lifehack

Don’t underestimate the power of the dark side. No, I mean the power of music, in generating happiness and creativity in our lives. I could have the worst day at work, and after a few minutes of ukulele when getting home, it no longer matters. This recent NYTimes article shows the profusion of online services (many free!) to pick up the instrument of your dreams and plunk away.

In my deep, dark past, I rode my bike several blocks away every Tuesday afternoon to Mrs. Bulecza’s house to have my piano lesson. At times, it was a drudgery, to be forced to practice for an hour a day (uhhh! Mom! Whhhhyyyyyy?!?) when it was nice out and your friends were calling for you. (Just kidding, I didn’t actually have any friends growing up). Now, in hindsight, I just regret that my Mom let me STOP taking piano lessons in high school because I had so many more important things to do, and when I want to sit down and sight-read Hiyao Miyazaki’s amazing and beautiful music (Sixth Station from Spirited away), that I can barely do it
(uhhh! Mom! Whhhhyyyyyy did you let me quit lessons?!?) .

My personal favorite, to which I still subscribe, is Ukulele Underground, a fun place to learn ukulele, taught by a former kindergarten teacher (who better than a kindergarten teacher to gently guide you into your ukulele future?) and traveling performer, and full of one minute tips, and more detailed lessons to learn just about anything ukulele. AND, he routinely comes to Denver’s annual Ukefest to perform and teach master classes!

CMIO’s take? What instrument do you play? Or do you PLAN to play? Don’t miss this: it is a COMPETITIVE ADVANTAGE for work! Or tell yourself whatever you need to, to pick up an instrument and make your own life better. And (bonus) sometimes you can torture others with bad music that you made.

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!

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

ctlukeepicmanbig.jpg

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.

We are Physician Builders (ukulele EHR parody)

Here we are at #ugm2018 Epic’s annual User Group Meeting. We’re at our first Directors’ Advisory Council session with over 600 attendees, and we discussed our governance approach to Physician Builders and how we overcame internal resistance to the idea that Physicians could do a good job creating new designs, templates, smart tools, and other content (and some actual programming) in the Electronic Health Record (they can!). In fact, our 19 Physicians who are now certified builders have made substantial improvements to our EHR environment on behalf of numerous medical and surgical specialties, as well as our physician users in general.

The point being, that although IT analysts are terrific for creating most of the content of the EHR, having physician builders with deep knowledge of the EHR technology leads to some interesting capabilities:

  1. Physician informaticists, with clinical knowledge, strong communication skills, and now technical know-how, can help other physicians reduce the EHR burden by matching tools to the clinical scenario, and reduce cognitive burden. For example, it is difficult to order the right cardiac arrhythmia monitoring tool (Holter? Event Monitor? Zio? Some other device?). Instead of building what a cardiologist physician was requesting, our physician builder thought about it, and suggested some the creation of a cascading order panel that gently guides the ordering physician to the right order WITHOUT building an exhaustive long checklist with difficult-to-follow paragraphs of instructions. Having a foot in both worlds is beneficial in this case.
  2. It is delicate and important do develop EXCELLENT relationships, CLEAR communication and strong guidelines so that the IT analyst team and the physician builders know what to expect from each other. When done poorly, turf battles erupt: “don’t touch those tools that I built!” But, done well, we become a synergistic team: “wow, thanks for taking on those Express Lanes; we would not have achieved our Honor Roll status (and helped all those urgent care centers) without your help.”

Really proud of our high functioning team.

And to ensure our audience got the point, we sang them our song. Lyrics below, YouTube link above.

We’re Physician Builders (Champions, Queen)

I’m a frustrated doc. Am Em
Passed my builder test
I wanna build
But she says: ‘You jest!’

And bad mistakes. C F
I’ve made a few
I’ve had my share of bad code kicked in my face C G Am
But I’ve come through! D7 G A

We’re physician builders, my friend D F#m Bm G A
And we’ll keep on buildin’ ’til the end D F#m G A
We’re physician builders, we are the builders Em A7 Gm A7
Those are happy users, cause we are the builders D C F G7
Of an Epic world. G7 D

I’ve set up smartlists. Am Em
And CER rules
You sent us Foundation and everything that GOES w it
I love those smart tools.

And maybe with time C F
Create a team goal,
We’ll share build in Text and Hyperspace
And make Honor Roll! C G Am D7 G A

We’re physician builders, my friend. D F#m Bm G A
And we’ll keep on buildin’ ’til the end. D F#m G A
We’re physician builders, we are the builders Em A7 Gm A7
Those are happy users, cause we are the builders
Of an Epic world.  D C Bb G7 D

CMIO’s take? What are YOU doing to ensure that you don’t take yourself too seriously? Are you here at Epic #ugm2018? Let me know!