Thanks to the medical informatics division at UC San Diego Health for hosting me at their informatics seminar series. I gave a talk about our efforts on improving physician well-being and reducing burnout (see previous blog posts on Sprints and Practice Transformation).
Sometimes, I travel with my ukulele. Sometimes, I sing at the end of my presentations. Sometimes, I climb out of my meditative, introvert bubble and see what happens.
Thanks to the one guy in the seminar who clapped for me. Kidding. UCSD has a great crew of informaticists doing great work. Christopher Longhurst (CIO) and his team are implementing a team with the purpose of getting physicians “Home for dinner” among the many other good things they’re doing.
YVMC’s head nurse Maria took me aside yesterday: “I have BIG favor to ask of you.” With trepidation, I stepped aside for a brief chat. “I need you to write a song about Mark and Heather; they’ve been amazing and led the teams to our EHR go-live success. And, can you put it together by tomorrow’s 9am Safety Huddle?”
What!?! Seriously? Does she know how hard it is for me to write these, learn to play the song (badly), practice enough to be willing to play in public?
Turns out, looking through my song parody library on my Notes app on my phone, I had a parody song, I called “Anschutz Roads” written in 2011 for our initial Epic go live at University of Colorado Hospital. With growing relief, I found that I could adapt it for our purposes here. I also recruited Juliette Callander, Manager of the UCHealth Rev Cycle team, and equally important, a wonderful singer, whose harmonies added a lot to the song.
She took me up on the challenge of learning the melody and the words, as I struggled to get my chord progressions and my strum pattern down. A few minutes of rehearsal in the nearby board room the next morning, and we were on stage at the end of Safety Huddle.
CMIO’s take? You can’t always get what you want, but if you try sometimes, you get what you need. I enjoyed how embarrassed Mark and Heather were during the song. Thanks, you guys are great. Also, I’m winding down my daily coverage of YVMC EHR go live, and returning to our regularly scheduled weekly posts starting tomorrow. See you then!
Finally, the Command Center begins to fill out with analysts supporting the full spectrum of IT areas: ambulatory, scheduling, inpatient, informatics, nursing, staff, health info management, security, networking, desktop support, interfaces, speech recognition, implementation specialists (jack-of-all-trades support).
Overall we are doing well. No big fires, just a steady stream of the usual. Printers not mapped to the right spot, meaning that printouts (after visit summary, printed orders for external labs, etc). Security challenges. Some clinics switched from ‘community connect’ to employed clinics, so all the clinicians have new security for logins an their previous personalized settings were ‘lost.’ Some test results are not flowing exactly as expected. So each of these requires investigation and fixing. It is rewarding to see issues come in and watch them be fixed within minutes to hours, since we are focused.
Fun fact: we’re using Microsoft Teams to communicate internally. All of my physicians in the Large PIG (physician informatics group) are on Teams. We have set up a communication channel called YVMC go live (Yampa Valley Medical Center), and conversation threads regarding clinic support as well as hospital support. As issues come and go, we post our conversation there, Facebook-like (except stored securely and not polluted by silly cat videos or rogue-bots), so that my entire team is not spammed by me, and anyone interested can dip into the conversation as needed, as each of them will rotate through Steamboat for 1-2 days, and can see all the issues posed and resolved previously. Teams is not perfect, but it is good-enough. We can link to shared calendars, to common file storage, to best practice tip sheets, for addresses of all the clinics. We can set it to “ping” us on our phones and our desktops, and can treat it as both email-like, file storage-like, as well as instant-message like. And our email congestion is slightly less.
Finally, another uke song:
CMIO’s take? Whew. Going back to the hotel to put my feet up. Back at it tomorrow.
I love hospital art. Why not improve the lives of employees by showing something beautiful?
Day 2 is going well. It is fascinating to see each department with very different concerns come together to solve problems.
We have a doc who can order tests and prescriptions but can’t place billing charges without ‘changing context.’ Call the command center. We can fix it.
We have a doc whose USB Dragon mic doesn’t work. Solution: call in a ticket to command center with details, move to a different computer until it is fixed.
Some breast milk scanning process is not well known. Send a red shirt with expertise. Teach the new workflow, get staff up to speed. Done, this morning.
Someone in respiratory therapy is trying to place a lactate order, as they always used to. Can’t do it in the new system. Ok, something we didn’t find out during our ‘discovery’ interviews. It is always something. We’re on it.
Of course when you can sneak in a song…
If You’re Going to Yampa Valley. Based on the Scott Mackenzie song ‘If you’re going to San Francisco.’
CMIO’s take? Good news: everything we solve today is one less crisis tomorrow when we are back to full speed patient care.
Thanks to videographer @DrDannySands for taping my latest spontaneous ukulele performance of “Doc Prudence” a uke parody song and cautionary tale (not really) about Open Notes at #sgim18 (Society of General Internal Medicine, national meeting in Denver last week).
CMIO’s take? Self-aggrandizement never pays off. OR, taking oneself too seriously never pays off. One of these two. Or maybe both.
Has your organization adopted technology to electronically prescribe controlled substances (EPCS)? If so, good for you! If not, what are you waiting for? UCHealth is kicking off this project on April 9, 2018, a “big bang” for all providers who have a DEA number to be able to e-prescribe and avoid that horrible, bifurcated workflow of “electronically transmit all the regular prescriptions directly to pharmacy, but remember 1) keep your tamper-proof prescription paper stocked in the correct drawer of the printer, 2) to go get that narcotic prescription off the printer, 3) sign it with pen-and-ink, 4) then tell your staff to track down the patient to come pick it up or remember to put it in certified mail to the patient, especially if the patient called to request, or worse, you forgot to get it off the printer before the patient left clinic.
After the DEA ruling to permit EPCS a few years ago, our EHR vendor developed the 2-factor authentication tool to meet the regulation, and now we have finally contracted with a company to provide that service, link our physician identities to their smartphones via an encrypted app, and now a smartphone alert and a password (something you have and something you know) are our two factors that permit EPCS.
Here’s a little something I wrote to commemorate our EPCS go live:
CT on ukulele singing “Morphine” inspired by Eric Clapton’s classic song “Cocaine.” https://youtu.be/EC6yXXYl1vY
(Part of my YouTube channel)
I also created an internal-only training video for Duo Mobile as second factor for EPCS.
I learned the structure of a well-told instruction video from the original “Apple Business” video tips back in the early zips (2000’s). You’ll see a human, then a quick screen video, then close with a human. Perfect format: