January 29, 2021

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January 29, 2021: Do you have an efficient workflow mindset? Do you get excited by the words ontology, hierarchy, indexing and usability? Dirk Stanley, MD CMIO shares his top 15 signs that you may work in clinical informatics. What makes a good clinical informaticist? Have we fine tuned the usability of technology? What kind of impact do the information blocking rules and API rules have on interoperability? How do you ensure that projects are meeting the financial return goals for your organization? What does it mean to prevent medication errors? What does it mean to make patients happier with the way they get their results? Why is order set design so hard? And at bedtime, are your kids protesting that they’re tired of discussing project intake and change management and they just want to go to sleep?

Key Points:

  • Your IT friends think you are ‘too clinical’, and your clinical friends think you are ‘too IT’. [00:04:45]
  • You’ve successfully used the words “ontology”, “hierarchy”, “indexing”, or “usability” in a Scrabble game. [00:07:40]
  • In your spare time, you write poetry about Interoperability and Meaningful Use. [00:08:05]
  • You keep looking for ways to optimize the workflow for walking your dog. [00:10:05]
  • You get panic attacks every time you hear the phrase, “new Federal regulations”. [00:15:50]
  • When bringing your car for routine maintenance, you ask the mechanic about the “ROI” and “TCO” of your “future state”. [00:20:50]
  • Your friends stage an intervention after you start inviting them to ‘flowcharting parties’. [00:23:30]
  • At bedtime, your kids protest : “We’re tired of discussing project intake and change management, can we just go to sleep?” [00:24:20]
  • Your best friend falls asleep on the phone, while you rant about the importance of maintaining a written home glossary for ‘good terminology management and data standards’.
  • Instead of asking your kids to do their chores, you ‘look for opportunities to better engage family stakeholders in household incentive-based productivity efforts.’
  • You actually enjoy debating whether your title should be “Clinical Informaticist” or “Clinical Informatician”
  • You’ve wondered how to increase global awareness about the complexity of order set design. [00:30:15]
  • Your retirement planner asks you, “Are you SURE you want to do this?” [00:34:35]
  • You nod and smile graciously every time someone asks you, “You work in IT, right? Isn’t that fun, just working with computers all day?” [00:39:25]
  • You’ve spent countless holiday gatherings trying to explain ‘Clinical Informatics’ to your in-laws. [00:39:55]
  • Dirk Stanley Twitter
  • Dirk Stanley website
  • Healthcare IT: Top 15 Signs You May Work in Clinical Informatics

Clinical Informatics Explained

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Clinical Informatics Explained with Dirk Stanley, MD CMIO

Episode 358: Transcript – January 29, 2021

This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

[00:00:00] Bill Russell: [00:00:00] Thanks for joining us on This Week in Health IT Influence. My name is Bill Russell, former healthcare CIO for 16 hospital system and creator of This Week in Health IT, a channel dedicated to keeping health IT staff current and engaged. 

[00:00:17]Today Dr. Dirk Stanley joins us. He’s the CMIO for UConn Health and he is a phenomenal writer, but he’s really excellent on Twitter as well. He has a great blog [00:00:30] around clinical informatics. And today we talked about his top 15 signs you may work in clinical informatics. There was a post he did out on LinkedIn and on Twitter. And we utilize it as a framework for our conversation today.

[00:00:42]Special thanks to our influence show sponsors Sirius Healthcare and Health Lyrics for choosing to invest in our mission to develop the next generation of health IT leaders. If you want to be a part of our mission, you can become a show sponsor. The first step is to send an email to [email protected] [00:01:00]

[00:01:00]I want to take a quick minute to remind everyone of our social media presence. We have a lot of stuff going on on social media. You can follow me personally, bill J Russell on LinkedIn. I engage almost every day in a conversation with the community around some health it topic. You can also follow the show at this week in health it on LinkedIn.

[00:01:20] You can follow us on Twitter Bill Russell H I T you can follow the show This week in Health and HIT on Twitter as well. So [00:01:30] we’ve got a lot of different things going on in each one of those. Those channels has different content. That’s coming out through it. We don’t do the same thing across all of our channels.

[00:01:38] We don’t blanket posts. We don’t just, you know schedule a whole bunch of stuff and it goes out there. We’re actually pretty active in trying to really take a conversation. You know in a direction that’s appropriate for those specific channels. So we spend a lot of time on this. We really want to engage with you guys through this.

[00:01:54] We are trying to build a more broad community. So invite your friends in [00:02:00] to follow us as well. We want to to make this a dynamic conversation between us so that we can move and advance healthcare forward.

[00:02:08]All right. Today we have Dr.  Stanley the CMIO for UConn Health in with us to talk about clinical informatics. Good morning, Dirk. Welcome to the show. 

[00:02:17] Dirk Stanley: [00:02:17] Good morning. Thank you for having me. 

[00:02:19] Bill Russell: [00:02:19] I don’t know why. I always say, I say good morning. I’ll assume that people only listen to podcasts in the morning and the afternoon. They don’t listen to it. I don’t know why I do that. This is our first time meeting. I’m looking forward to this [00:02:30] conversation. 

[00:02:31] Dirk Stanley: [00:02:31] And me too. I’m honored to be a guest on your podcast. 

[00:02:35] Bill Russell: [00:02:35] Yeah,  it’s going to be fun. You we were talking earlier how we feel like we know each other, cause I’ve read so much of your stuff.

[00:02:41] I read your stuff on health system, CIO, and I see your stuff on Twitter and whatnot. You post some interesting things on Twitter. I remember the one post you had you were describing a terminology and you had like a graphic with oranges and those kind of things. Actually, I should have had it pulled up. Talk about do you remember that post? 

[00:03:01] [00:03:00] Dirk Stanley: [00:03:01] I was just trying to explain how like, my terminology matters so much forusability and trying to explain, because sometimes understanding the difference between apples and oranges and fruit, like they’re all related, but they’re sort of different. And when you look at those terminology things it’s helpful to make software more usable and less clicks.

[00:03:21] So these are like, sometimes people don’t appreciate how the terminology results in extra workflow [00:03:30] challenges, but yeah. But once you harmonize that terminology and really like, get it, like appropriate for the clinical purposes, it often helps reduce clicks. So that’s what that post is about.

[00:03:41] Bill Russell: [00:03:41] Well we’re gonna, we’re going to have a little fun. We’re going to demystify clinical informatics a little bit. We’re going to. Do that by using your top 15 signs that you may work in clinical informatics as a framework for our discussion. So you posted this on Twitter and did you intend it to be funny? I mean, cause [00:04:00] I’ve talked to people it’s kind of funny. 

[00:04:02] Dirk Stanley: [00:04:02] Yeah, actually I did. I was sort of, I was thinking like I had one of those moments where I’m like boy, I wish people understood like what my life is like. And then I drew some inspiration from David Letterman’s top 10 list.

[00:04:15] And initially it started as a top 10, but then like I kept going, I’m like, Ooh, I have a top 15 here. And I knew I struck a nerve because so many people shared it and commented on it. So I guess I hit a nerve. 

[00:04:28] Bill Russell: [00:04:28] Here’s what we’re going. We’re going to, we’re going [00:04:30] to share the top 15. And so whom I’m just gonna throw questions in afterwards.

[00:04:34] Because I think it’s a great framework to talk about what you do and how you do it and how you go about doing it. So the 15th, I guess the last one is, “your IT friends think you are too clinical and your clinical friends think you are too IT.” I’ve heard that a fair amount.

[00:04:55] Let me ask you this. What makes a good clinical informaticist? What type of [00:05:00] person should go into the field? 

[00:05:03] Dirk Stanley: [00:05:03] Other than, I mean, there’s lots of punchlines I have here, like seeking abuse or punishment or but but like it’s being a translator, right?

[00:05:14] It’s like being an interpreter, somebody who. My, my dad was a was a military interpreter for awhile when he was in his military career and he was a an interpreter and he always taught me something that kind of [00:05:30] stuck with me, like good interpreters spend half their time in one culture and half of their time in another culture.

[00:05:38] And they have to learn both cultures to be an effective interpreter. And I think clinical informatics and it’s the same sort of principle. Like you need to be able to spend some of your time in it and some of your time in clinical and once you understand their customs and their traditions and your words and their culture, then you [00:06:00] become an effective interpreter between the two and I guess that would be my answer. 

[00:06:05] Bill Russell: [00:06:05] Well, I’ll tell you, I’ve sat in those meetings where we’re trying to take a single word that I’ve talked about this on the show a couple of times or a single event in the hospital. We’re going to, okay, well, let’s define this and it’s not the you look at it and the terminology at this is easy.

[00:06:20] I mean, this should be a five minute meeting. Three hours later, you’re sitting there going all right. We have six definitions for this very- what appears to be very simple thing. And the [00:06:30] problem is it shows up on 150 reports that go out. So don’t we have to get to a single thing. I mean, is that the, is that one of the bigger challenges that you have is the, is defining the terminology and getting the terminology, right?

[00:06:45] Dirk Stanley: [00:06:45] Yeah. Yeah. I mean, I think we’re it’s funny because when people hear what I do, they’re like, well, you must be kind of a doctor or maybe you’re like an IT person. Maybe you do technology. And, but really it’s a lot of [00:07:00] it is exactly what you said. It’s about understanding both cultures and terminology is so important.

[00:07:05] It’s so critical for effective communication between the two. And I often sit there in meetings, like, it sounds like you have too where you’re watching both sides talking at each other, but they’re not quite communicating. And once you like, kind of really like narrow in on, like, what is it going to take for the communication to be established?

[00:07:27] Suddenly it just, it changes the whole dynamic [00:07:30] and you can almost see the lights go on as both sides are like, “ah, I see what you’re looking for.” And then, and it’s awesome. Watching solutions then fall into place. It’s really great. 

[00:07:40] Bill Russell: [00:07:40] Yeah, so let’s, so one of your next ones is you have successfully used the words, ontology hierarchy, indexing, and usability in a Scrabble game.

[00:07:50]Those are fun words. I would ask you to define all of them, but the these are also extremely important- ontology. Again, we get back into [00:08:00] the definition and categorizing things, indexing usability is huge, which gets to your next one, which is in your spare time, you write poetry about interoperability and meaningful use. That really has driven- so meaningful use really has driven a lot of the work of clinical informaticist. For the better part of a decade. Is that still the case? Are we starting to move into maybe a new era beyond meaningful use? [00:08:30] 

[00:08:30]Dirk Stanley: [00:08:30] I think and about ontology and hierarchies, like clinical informatics has its own language, right?

[00:08:35] Like its own sort of vernacular and traditions and customs, I think just like watching the interpreters at the United nations. Right. They have their own internal, ways of handling things and certain protocols. I often think, for example, by the way about. Like, do you ever wonder who the interpreters were, who were trying to interpret wing during the Cuban missile crisis?

[00:08:56] Right. And you have like two world leaders, one speaks Russian and one [00:09:00] speaks English and you’re like, Ooh, I better make sure that we’re interpreting this right.  And so those same sort of standards, that’s what the, 

[00:09:06] Bill Russell: [00:09:06] So, so interpreters can start wars or escalate wars is essentially what you’re saying.

[00:09:11] Dirk Stanley: [00:09:11] You’re probably right like yeah. Like if you’re not careful about how you interpret, like yeah, you could potentially the whole negotiation can fall apart through a bad interpretation. So, so that’s what when I’m referring to ontologies and hierarchies, it’s about like, What is the language of clinical informatics and getting [00:09:30] back to the writing poetry about meaningful use?

[00:09:33] I mean, I think I think most people would agree that meaningful use really set the ball in motion and the ship started to sail with meaningful use, but now we’re like entering all new waters and. There is a new, like we’re, I think we’re breaking new ground in terms of interoperability and usability and and I look forward to seeing what the next 10 years brings us.

[00:09:56] But but yeah, these are the type of things. When I was [00:10:00] like if you had to write like haiku about meaningful use, what would it look like? Right. 

[00:10:05] Bill Russell: [00:10:05] Yeah, well, and it’s your next one is you keep looking for ways to optimize the workflow for walking your dog.

[00:10:13] There is sort of a mindset once you get locked into efficient workflow and those kinds of things that’s half joking, but all of us have been there. Like you do it at work all the time, and then you come home and you’re like this house could be a lot more efficient. We could do this, or you could [00:10:30] do you drive your family crazy with some of that stuff?

[00:10:32] Dirk Stanley: [00:10:32] I keep asking my dog, like, could you walk yourself? Do you think, would you be able to, you know, but he hasn’t answered me yet, but but yeah, like it, it starts to permeate. You start looking for like if. Like I, I remember the moment I started to wonder, like, if we put the, in the, in our kitchen, if we put the knives on the right side and the spoons on the left side, would there be like a time saving somehow like, or if you’ve ever [00:11:00] organized your closet, like, okay, is there any benefit?

[00:11:02] Why do I have my socks in the top drawer? Maybe? Like, is there a benefit, like maybe I should move the socks to the bottom drawer. It does start to impact your life. 

[00:11:10] Bill Russell: [00:11:10] Yeah. So have we turned the corner on EHR usability, do you think? Are we getting to the point where we are fine tuning things? Or do we still have big big movement to go here from a usability of the technology, from a improvement of the workflow from [00:11:30] integrating all the different disparate systems and data sources that we have out there? 

[00:11:35]Dirk Stanley: [00:11:35] It’s hard, like usability and interoperability are very difficult, complex, complicated things, and there’s so much that goes into making systems usable. And I mean, I think it’s getting better or at least people are recognizing the issue more, but there’s still a long way to go.

[00:11:56] I remember I think it was at HIMSS a couple of years ago. I [00:12:00] saw somebody once lecture. I apologize. I don’t remember who brought this up, but they said that like, good clinical decision support feels, right. Like, it feels like you’re walking down the street and just at the moment when you’re thirsty, somebody hands you a glass of water and when you’re hungry, somebody hands you a food, like it should, like, it should feel natural and it should feel right. And we’re not quite there yet. 

[00:12:25] Like, I think there’s a long way to go in terms of like, how do we know. When [00:12:30] doctors and nurses feel thirsty. Like we want the EMR to give them what they need at that moment, not before and not after. So there’s so to really like help improve usability, we need to understand workflows better, and we need to understand what information they need at the moment when they make the decisions that they do for patient care.

[00:12:53] Like Another example that I often use when I’m talking about it is [00:13:00] if you were in the physical world and somebody built a set of stairs and you walked up the stairs and like, there was nothing at the end of the stairs, like no door, no window, no light switch or anything.

[00:13:11] You’d probably be like, Why did somebody build the stairs here, and then eventually you might kind of walk down the stairs and go about your business. That’s the type of thing. There’s still pieces of that, like the virtual equivalent of that still happens sometimes. And I think [00:13:30] in terms of usability, clinical informatics really has an important role in making sure that when the stairs are built, that whatever supposed to be at those stairs is like, is there too. And that’s not a future upgrade. You want to release them at the same time. 

[00:13:44] Bill Russell: [00:13:44] Yeah, but we actually have a lot of information now just digging around the EHR. You can get full-blown reports on using your vernacular. Who’s thirsty, right? Which clinicians are thirsty. They’re using the EHR maybe [00:14:00] at a suboptimum level.

[00:14:01] And you can identify. Is that, where you identify, is that how you identify projects or do the projects really bubble up more from the operation? 

[00:14:10] Dirk Stanley: [00:14:10] Usually they don’t, I don’t have to go I don’t have to work too hard to identify the projects. Usually it’s somebody knocking at my door, like, look at this.

[00:14:18] This is like, I walked up the stairs and there was no window. There’s no door. There’s no nothing. Like what’s going on here, so the projects usually identify themselves. But [00:14:30] there’s opportunities. Another way that I often see opportunities to insert better workflow design is really the project intake.

[00:14:38] Like when you’re when you’re, when people are requesting any sort of technology implementation you you want to. You want to insert design thinking at the beginning, right? Like in the way you analyze it, who’s going to be using the technology. How are they going to be using it? For what’s the clinical purpose?

[00:14:58] What is it to [00:15:00] treat pneumonia or to treat cancer or to treat COVID. What What are they trying to accomplish? Who are the people? It’s not just the doctors, it’s the nurses and the pharmacists, and even medical records plays a role in all this. And like knowing who are the people who shaped that particular workflow and then bringing them together and talking about it and getting their agreement.

[00:15:22] And then you can kind of like figure out where the big decision points are, like, where sometimes nurses have certain decisions that lead them down [00:15:30] to two branches and you look for those opportunities where like, what can we give the nurse to help them with that decision and same thing with doctors or pharmacists.

[00:15:39] So you learn a lot about like the DNA of healthcare as you’re doing.  

[00:15:45]Bill Russell: [00:15:45] You really get into the, you get a pretty deep level of what’s going on. Getting back to the list. You get panic attacks every time you hear the phrase new federal regulations? Well, we got, we get to hear those phrases pretty often these days. [00:16:00] So let’s talk a little bit about 21st Century Cures. Are are we ready for the information blocking rules and the API rules at this point. Do you feel like do you feel like we’re ready and do you feel, what kind of impact do you think that’s going to have on interoperability?

[00:16:16]Dirk Stanley: [00:16:16] It’s going to be interesting. I think there, there’s the like kind of frontline experience of this, which is not always easy to navigate. Like there are there are people who don’t want to [00:16:30] learn about a life-changing diagnosis in the electronic medical record and not have the the provider around.

[00:16:36] I think there’s almost a generational sort of divide. I don’t know what year it is. Every time every birthday that I have, I keep thinking like, maybe I’m still on this side of the fence, but you know, I don’t know exactly where the, where the line is, but there are people who legitimately don’t want to get, like unhappy news in the portal, if they’re to help kind of frame [00:17:00] it.

[00:17:01] On the other hand, there’s many people who are like I want my data. Like, it’s my data. I own it. Like, it’s not unlike a bank. Right. If I deposit the money in the bank, I have a right to withdraw it anytime I want. And nobody should you should ask me any questions. I can use my money for whatever I want and navigating that generational kind of divide if you will.

[00:17:25] Or at least that transition is what I think the biggest challenges [00:17:30] in developing these regulations. That being said, overall, clearly the benefits outweigh, in my opinion, the benefits outweigh the costs as a society, but on the individual level, you want to make sure that every patient gets the respect and care that they need.

[00:17:49] And so how do you do that? How do you balance the the greater good with like the individual needs of each patient? And that I think is the, that’s [00:18:00] the cultural challenge of it. But personally I’ve been a proponent for patients having access to their to their records. I think there’s so much opportunity for interoperability and even just like patient empowerment, allowing patients to.

[00:18:16] Once they have access like full, like a fully transparent, fully portable chart that they can take anywhere. Then if they’re not getting the service that they need at one hospital, they can very quickly go to another hospital for [00:18:30] service. And I think it’ll help drive competition, improve service, improve quality.

[00:18:36] So I certainly see why we’re doing this year. And but what sort of figuring out the cultural nuances of this and making sure that you’re meeting every patient’s needs it’s kind of hard sometimes when you’re looking at the big picture and you, and I’ve had patients like complaining to me that they [00:19:00] learned about something that they didn’t want to inside the portal and.

[00:19:04] You want to be sensitive to their requests? Like there’s every. Every one is important. And so navigating that is, is a lot of work and takes a lot of planning. 

[00:19:14]Bill Russell: [00:19:14] And this is this is the interesting space that you sit in, right? So you’re talking to the clinicians and you’re understanding the system and the clinician needs, you’re hearing from the patient, understanding the patient needs. And you’re looking at the technology. 

[00:19:29] I mean, cause when you talk [00:19:30] about that, I’m a technologist. By background and trade. I think my gosh, that’s just a simple setting that you can put into the portal. They click it, you categorize all the diagnoses and instead of just sending them to the portal again, you’re doing it at the patient level.

[00:19:48] So  get to set the setting that says, I want to receive it. Or I want to talk to a doctor. I don’t want to receive in my portal. I could just click a button and then I’m not going to get it. So the next time somebody [00:20:00] says, Hey, I don’t want to receive it. It’s like, great. Go into your settings, hit this.

[00:20:04] You won’t you’ll receive an alert that it’s available, but you won’t receive it unless you want to receive it. 

[00:20:11]Dirk Stanley: [00:20:11] I think that’s the ideal situation. Like patients should be able to make that decision. Right. But I think different vendors have different opinions about this, or maybe some vendors haven’t quite developed that functionality yet. But you know, we need to, I, I think eventually though I can see most vendors [00:20:30] eventually supporting things that what you’re talking about.

[00:20:32] Bill Russell: [00:20:32] Yeah. It’s 21st century cures is interesting because it’s literally an end-run around the the people that have owned the data for years. And it’s making it available to the larger community. So it’ll be, that’ll be another thing that you have to wrestle with. All right. Back’s to the list. When bringing your car in for routine maintenance, you ask the mechanic about the ROI and TCO of your future state.

[00:20:59] Yeah, [00:21:00] actually, I mean, you bring it up. So how do you measure to ensure that projects are meeting the financial return goals for your organization? That, is that something that you guys have a pretty good handle on at this point? 

[00:21:13]Dirk Stanley: [00:21:13] It’s a work in progress with pretty much everyone I speak to but it’s an interesting challenge because there’s sort of the quantifiable benefits of the technology.

[00:21:23] You can talk about throughput and if we can see another 10 patients a day, that’ll [00:21:30] be we can quantify that. Or there’s sort of the tangible benefit, but then there’s the like intangible benefits, like. What does it mean to prevent medication errors? What does it mean to make patients happier with their, the way they get their results?

[00:21:50] What is it like what does it mean to make your staff happier? That they don’t have to click like 15 times to do something. They can only click like once or twice and  [00:22:00] it’s sort of. How do you measure those intangible things and especially when it comes to healthcare, right?

[00:22:06] Like healthcare is very, there are so many like gray situations and figuring out those intangible benefits is always interesting. I’ve had people say there’s no way to measure it. Like there’s no way to measure the happiness of your patients or the happiness of your staff.

[00:22:23] I think there are actually ways, at least you can kind of estimate them and they need to be part of the equation. To just [00:22:30] measure it in terms of financial benefit, there’d be opportunities to miss improving patient safety and improving staff or patient satisfaction. 

[00:22:38] Bill Russell: [00:22:38] Yeah, it’s I found the projects where you can just do the very clear ROI. They get approved very quickly. They move very quickly. The other ones, in some cases very much very important recognized by a lot of people to be necessary within the health system. You’ll struggle to get them approved if they don’t have that strong [00:23:00] financial return. And then you have to go into the making the case around all the other aspects that you just talked about.

[00:23:07] Some of which are quantifiable, some of which are not as quantifiable. And so those are, that’s a hard part of the job. I think 

[00:23:15]Dirk Stanley: [00:23:15] It is. And it’s hard there at the end of the day, these are difficult discussions and decisions, but it’s important. I do think it’s important to at least yeah,  try and understand those intangible benefits. 

[00:23:27] Bill Russell: [00:23:27] Allright. I’m going to, I’m going to hammer out a couple of these [00:23:30] next one. Your friends stage an intervention after you start inviting them to flow charting parties. Yes. So this is the new Pictionary is a flowcharting party. That would be fun.

[00:23:40] Although I’ll tell you the most impressive flow chart I’ve ever seen was we were migrating from one EHR to another. And we brought people in from all over the health system and they put up this flow chart that literally went around the entire room. It was unbelievable. But [00:24:00] it was it was really, it was impressive to see, first of all, the complexity of all the things that we were doing, the fact that there are experts who really understood it.

[00:24:09] And could put it on a piece of paper, I think, which somewhat defines that you can understand it and that it really helped us with the build after we got all that stuff down. All right, let me just go to the next one. At bedtime, your kids protest we’re tired of discussing project intake and change management. Can we just go to sleep? 

[00:24:28] Hey project intake. [00:24:30] That’s that’s pretty important. And you talked about it a little bit earlier. How do you prioritize this stuff? Do you have a, is there a governance process or how are you prioritizing the work? As you said, it’s the work finds you, it’s people knocking on your door. How do you get it into the, how do you get it into the pipeline? 

[00:24:49] Dirk Stanley: [00:24:49] So I have my sort of dream fantasy scenario where people are like kickboxing and whoever’s left standing, like gets their project on first. Right. But [00:25:00] apparently, like there, there are better ways to do it than that. Getting prioritization is an institutional Function like knowing what to work on is something that every institution really needs to spend time developing a process and governance.

[00:25:19] And you want to make sure that when projects go into let’s call it the project bucket that the easy the low cost, high [00:25:30] benefit projects identify themselves. And also the things that are clear safety issues or risks to the organization also needs to identify themselves.

[00:25:42] And the low benefit, high cost projects kind of go down in the list. So how you actually measure that? What are the questions you would ask to know, is this a low cost benefit or is this a high cost, low benefit? So [00:26:00] getting those questions right, is really requires a lot of sort of strategic planning and thinking and you want to develop algorithms, like like measurable like ways of constantly looking at those projects.

[00:26:17] And there were some very impressive tools that that I’ve seen and that I’ve personally helped implement where you’re looking at the risk to the organization and the risk of patients [00:26:30] that that brings things more to light. And those. Those topics get discussed personally, in my role, I discussed every project.

[00:26:38] Like whether like whatever people have ideas, they come to me. And I I kind of I listen to it and I look I try to get my own personal analysis of it, but it’s very helpful to have a formal methodology for it because otherwise it becomes one person’s opinion versus the other, and that can lead to arguments.

[00:26:57] Bill Russell: [00:26:57] All right. So people knock on your door. [00:27:00] I assume things fall into some things are just tasks. They just need to get done. Some things are a little bit more than a task that it’s an enhancement something that needs to be enhanced. And then some things are full-blown projects. Is that a determination that you’re sort of making that where you’re going, look, I’m just going to funnel this over to my team and they’ll take care of this. Or this has to go through a larger governance. Is that, does that squarely sit on your [00:27:30] shoulders or –

[00:27:30] Dirk Stanley: [00:27:30] No. So actually, fortunately I work with a really great team. We have our our vice presidents, our project manager, we have a new head of our project manager manifest and we are like, like, It’s everyone knows what we need to do. And we’re like, we’re we continue to enhance this process together. But but health IT is a team sport. There’s no doubt about it. Like you have to work with all of these people because everyone [00:28:00] has important contributions to that discussion. It’s really a natural price discussion, right? 

[00:28:06] Bill Russell: [00:28:06] Yeah. So if it becomes a project, one of the challenges that I had when I was CIO was who builds the financial model, right? So in the planning phase, everybody had a chance to bring forward their projects. And you’d end up with that is not an exaggeration you’d end up with hundreds of projects.

[00:28:26] And then invariably, you want to sort of that risk reward [00:28:30] and investment. You sort of want to look at that whole thing to determine which projects you should be doing. But someone has to build out the financial model. And some, in some cases we put that on the individuals to put out the, to build the financial model.

[00:28:45] And we just found the financial models to be just flat out wrong. Had to be redone because people have different skills and those kinds of things. How do you get the financial models that I’m asking? There’s [00:29:00] like free consulting. I’m asking you to help me. How do you get those financial models to be as accurate as possible?.So you can make the best decisions you can make. 

[00:29:09] Dirk Stanley: [00:29:09] What everyone struggles with the same issue. I’ll just say that everyone has the same sort of challenges. 

[00:29:15] One of the things that we’re currently experimenting with is a, like, is basically a second set of eyes to like like kind of a system of checks and balances. Like there’s the first sort of estimate. And then another [00:29:30] person, like basically goes through the same process and if they both validate each other, then you have to minute in the financial model, but sometimes there are discrepancies, but we’re still trying to figure out though, because if you’re going to do that sort of a process, you basically need two people to do one function.

[00:29:50] And so we’re still balanced that out. Like can we make, maybe the first financial model will be on the local user level or the department that’s making the request. And then the [00:30:00] second one would be from finance or like, so we’re still trying to kind of work that out but. I think everyone kind of struggles with the same sort of things.

[00:30:09] Bill Russell: [00:30:09] Yeah. No I can see that. All right. So your list, I would probably going to skip a couple of here, go to the the last couple of, so you’ve wondered how to increase global awareness about the complexity of order set design. Gosh, I was just going to rifle through, but I’m going to stop there. Why is order set design so hard?

[00:30:32] [00:30:30] Dirk Stanley: [00:30:32] Oh, I’m so glad you asked me that question. So order sets, aren’t like, I don’t know, are you a doctor who fan, do you know, are you familiar with the Tardis like on the outside, it’s a phone booth and then you go inside and it’s like a whole world inside. That’s like, what order sets feel like when you’re on the outside, it looks at, you’re like, ah, it’s, I dunno, there’s like 20 orders here, maybe 40 or whatever it is like.

[00:30:59] But [00:31:00] on the inside to get to those, like, it’s not just about what the orders are. It’s the, what the defaults of the orders are like, what fields the orders need to ask who reacts to the orders. Like it’s not just about the person entering the orders and submitting the orders. It’s about the person who receives the orders and then does the order actually contain the information that you need to execute the task that’s at the end of the order.

[00:31:24] And so like, When you have medication orders, especially there’s a lot of information you need in [00:31:30] terms of the route the priority, the frequency, is that a one time order or repeating water is an inpatient order or in an outpatient order lab orders. Is it are you expecting who’s going to collect the lab?

[00:31:42] Is it, are you expecting the phlebotomist to collect it? The nurse to collected? Are you expecting the patient to walk to the draw station and get it collected? Like there’s so many details that need to be worked out. And so like, so I, it’s a frequent thing. I think most CMIOs [00:32:00] will tell you people come and they go, Oh I got a problem.

[00:32:02] I just need it. I want to make a little order set for it or whatever. And you’re like, okay, let’s start examining it. And then you start like it suddenly you find out there’s a whole Blossom of workflows that you have to kind of tackle to make that order set work 

[00:32:16] Bill Russell: [00:32:16] Well and people I’m sorry, people, clinicians are very passionate about the order sets. I mean, they will look at it and go, no, this is the way it should be. And this is how it should be. And then you’ll have a doctor sitting right across from him going where did you learn? [00:32:30] Medicine are that’s nuts kind of thing. And I’ve sat through those conversations and I’m glad I had a great CMIO who Who would sit in those conversations and I attended a handful of them.

[00:32:43] And then I was just like it’s, you’re as much an ambassador for I mean, bringing two sides together as I, I mean, there, there’s an awful lot of people work [00:33:00] and coalition building and that kind of stuff to get this stuff done is what I’ve seen.

[00:33:06] Dirk Stanley: [00:33:06] The trick to that situation that I always, like, I really embraced. This is you have to start with the clinical care first, right? Like, just start, like, what is good patient care? Like you described, like if you have two doctors who disagree. Just start with, like, what does good patient care look like to you? Like what what do you imagine? Give me your like most mouthwatering scenario, like almost like gourmet food.

[00:33:30] [00:33:29] Like what would the best cheeseburger in the world look like? Would it be like on a Shabbat or it won’t be like what kind of meat, what kind of cheese, what kind of would you want red onion? Would you want white onion? Describe to me what you want. And then once, like, usually both sides want the same thing.

[00:33:49] But then once they describe it, then what I usually do is I take my laptop, whether before it was in a conference room, but now it’s by WebEx and I literally start like [00:34:00] okay, you said you wanted a burger, like here’s the meat and then here’s the cheese and I start laying it out in front of them and they go, yeah.

[00:34:07] Yeah, that’s what I want. And that’s a way of getting them to align. It’s really about best clinical practice, right? And like, in, in those areas, they still don’t agree. Then we go to the literature, like like UpToDate or another product trying to figure out like, well, what does the literature support?

[00:34:27] Sometimes I’m going through medical journals or [00:34:30] in our medical library researching the literature. So. 

[00:34:34] Bill Russell: [00:34:34] Yep. All right. So your number three is your retirement planner asked you, are you sure you want to do this? So I’ll ask you, are you sure you want to do this? How difficult is it? Are you still do you still practice?

[00:34:46] Dirk Stanley: [00:34:46] So I’m not practicing right now know because I’m I’m effectively managing the the clinical informatics for a large academic institution. I do- [00:35:00] people always ask me, do you miss the bedside? I do miss the bedside and I am currently exploring ways of of returning to the bedside to some degree.

[00:35:09] I think we’re looking for opportunities to, I guess get additional informatics resources, probably make that more manageable for me. 

[00:35:21] Bill Russell: [00:35:21] How did you all right. So at some point somebody said, Hey, do you want to do this? And you had to sort of weigh the pros and cons, [00:35:30] walk us through that that decision of going from full-time practicing clinician into informatics and then eventually leading an informatics team.

[00:35:41] Dirk Stanley: [00:35:41] So I actually, I think everyone, I’d love to hear you, like, like everyone kind of falls into this somehow, but for me, I actually started as an IT person before I went to medical school. And so I did I started off in a small software company and then and then [00:36:00] I went to college actually.

[00:36:02] I started off in IT before college. Then I went to. Yeah, I guess that’s sort of a weird story. Let me think about that. So I started off like working after school in high school, doing server maintenance for a small software company. Then I went to college, came back after college. I did consulting.

[00:36:22] I worked for some large, I’ll just say technology firms, I guess I don’t need to drop their names, but I worked for some [00:36:30] companies and then I would say I got a little, maybe burnt out of technology for a little while. And then one of my friends, his mom was a nurse and she said, dirk, like like, why don’t you come and volunteer here at the hospital?

[00:36:43] And at least it’ll get you out of the house. I was sort of that post-college like trying to find your way sort of. So I started volunteering at the hospital and of course they looked at my my resume at that point. And they were like, Oh, you gotta work in the IT department. So I started working [00:37:00] This one’s at the Westchester medical center.

[00:37:02] And I started working in their IT department and that led to a data analyst position. I worked in their quality department and that led to a lot of projects where I was generating data, but I kept wondering like, what is the central line? Like, they keep talking about a central line. So I’m actually that person who wants sat in a meeting and said, can I just ask, like, Why does the central line get infected?

[00:37:26] It never the line on the left or the line on the right. And they were like, [00:37:30] ah you’re an it person. You don’t get this stuff. So, but I, I wanted to know, like I wanted to know what were these things that we were studying and that’s what led me to apply to medical school. And the funny thing is after I was in medical school and now I’m wearing a white coat and a stethoscope.

[00:37:48] And I saw what was going on with the computers. And I said, Oh, I think there’s a better way of doing that. And they’re like no, you’re a doctor. You don’t understand anything about it? I don’t understand. Two years ago I was on that [00:38:00] side of the fence. Now I’m on this side of the fence. So when I was so after residency I did my residency at Albany medical center.

[00:38:08] And I started applying for hospitalist jobs because that’s what that’s what direction I was headed in at that time. And, but when I was applying for jobs at, I’ll say at my previous employer, they looked at my resume and said like, wait a second. You’re you have all this, like IT experience of data we would like to invite you to be our CMIO. And that’s [00:38:30] basically how I got my foot in the door. 

[00:38:31] Bill Russell: [00:38:31] Yep. But they made you an interpreter is what they did. 

[00:38:35] Dirk Stanley: [00:38:35] I guess I’ve lived on both sides of the fence. So I became the defacto interpreter. 

[00:38:40] Bill Russell: [00:38:40] I actually just, I want to throw out a, an odd question just cause I want to know the answer. Where does nurse informatics sit at UConn? Is it its own deal or does it fall under the CMI? 

[00:38:51] Dirk Stanley: [00:38:51] So I would say informatics as a general topic is is a discussion. It’s an ongoing discussion. We don’t really have an, [00:39:00] like, I wouldn’t say we have a formally recognized nursing informatics group. I currently live with a nurse informaticist who is outstanding and together we solve a lot of problems.

[00:39:13] But you know, I’m hoping I’m hoping this, the clinical informatics discussion continues to evolve and that we develop more formality around the roles. 

[00:39:25] Bill Russell: [00:39:25] All right. So the last two here, you’re not and smile graciously every time someone asks you, [00:39:30] you work in IT right? It must be fun to work with those computers all day.

[00:39:34] Now, you know what cracks me up about that? Everybody who’s sitting in front of a Zoom meeting all day, who once said it must be fun to work with those computers all day. Are now stuck sitting in front of computers all day and they realize that it’s not as much fun, as fun as they think it is. Your number one is you spend countless holiday gatherings trying to explain clinical informatics to your [00:40:00] in-laws.

[00:40:00] I would imagine that’s an interesting conversation with your in-laws it’s like, all right, so let me get this straight. Are you the CIO? No, I’m not the CIO. So you’re are you practicing? No, not practicing. What are you doing again? 

[00:40:15] Dirk Stanley: [00:40:15] Something with computers and doctor? I don’t know. You’re like kind of I’m like, yeah, something like that. 

[00:40:22] Bill Russell: [00:40:22] No, that’s great. Actually. And we’re coming to the end here. I did want to, I wanted to touch on a couple of things. So we’re actually [00:40:30] recording this it’s the fourth or fifth. It’s the fourth, 4th of December a big event.

[00:40:36] So we have some vaccine coming to us. I just want to touch on a little bit from your perspective. You’re like a process guy. You’re the guy who looks at it and says, there’s gotta be a workflow or a thing that what are some of the things you’re thinking? We have some challenges in front of us logistically tracking it and all those other things. But I think some of the bigger challenges are we’ve got a two dose regimen coming in. [00:41:00] That’s going to be interesting to track. We’ve got to track it within our hospital, in the EHR. We’ve got to track it in the community. There’s a lot of challenges coming your way.

[00:41:09] Are, is there anything you’re able to talk about at this point in terms of how you guys are thinking about it or how you’re thinking about it? 

[00:41:16] Dirk Stanley: [00:41:16] No. I mean I don’t have a lot to share because it’s it’s ongoing discussion. Fortunately, we have a a really great pharmacy. Who’s working on this. We have really great clinical leadership. We’re having [00:41:30] almost like daily meetings about this also with our it team. And there were a lot of like details to this workflow and and we’re still kind of like developing them. 

[00:41:44] Bill Russell: [00:41:44] Yeah, this is a gnarly puzzle. I mean it’s like, I mean, it starts with supply chain. You’re not going to get like a million doses in the first week. You’re going to get a certain amount and you got to figure that out. There’s recommendations from the CDC of who [00:42:00] gets it, their store, heck there’s storage challenges with this. You may not have enough refrigeration units and stuff. I mean, this is one of those really interesting Rubik’s cubes to get all this stuff to line up. 

[00:42:12] Dirk Stanley: [00:42:12] The COVID as a whole, like the whole pandemic for the the last year has been a very challenging time for clinical care and for clinical IT because there’s so many details that needed to be mapped out and doing them this [00:42:30] quickly has really been a challenge. Again, though I work with really great team. I’m very fortunate, very blessed to work with a great team who everyone’s pulling up their sleeves and working together. And if there’s any kind of like maybe long-term benefit to this it’s that people this is broken down silos. This has like people that are understanding each other’s roles better.

[00:42:56] There’s so much more collaboration and even just the [00:43:00] online experience has like shortened the development time because. In the past you would have a meeting, people would discuss things, but then there was always kind of a follow up like, Oh, if you want, I’ll send you the copy of the order set that we’re working on and I’ll send you there always these like action items after the meeting.

[00:43:17] Now with with all the online conferences, there’s no, you don’t even need to, you just pull up what you’re looking at and you edit it in real time with the people that you need. And so that’s really [00:43:30] that’s been I would say that’s been sort of a time saver in some ways. So so more to come, but 

[00:43:38] Bill Russell: [00:43:38] Yeah Dirk I want to thank you for this time. I also want to thank you for your contribution back. Into the industry, I was reading your your blog. I think it’s a blog technically, if that’s what we’re still calling it, but man, you really detailed some of the work that you’re doing. And I would think if I’m a clinical informaticist, I, that would absolutely be a blog [00:44:00] that I would be a subscribed to just just the detail and level of stuff that you’re sharing.

[00:44:06] I think it would be really helpful for anybody who’s trying to attack some of these problems. So I appreciate that. Hey, how can people follow you and how can people find you on the on the web? 

[00:44:18] Dirk Stanley: [00:44:18] Sure. So super easy. www dot dirkstanley.com. That’ll get you to my blog. I’m also on Twitter. I’m at Dirk Stanley. I have recently tried [00:44:30] to. I kinda develop a little bit, slightly more professional version of my Twitter. So there’s at Dirk Stanley MD. But either one will effectively get to me. I’m hoping eventually to put out more clinical informatics resources for people I don’t I’m not doing this for any sort of financial or there’s no, I’m a very agnostic sort of person.

[00:44:57] I think it’s about clinical [00:45:00] people learning how to engineer their workflows. And there’s something that’s very empowering when people learn how to design their own workflows. And that’s the kind of stuff that I I share on my blog. 

[00:45:12] Bill Russell: [00:45:12] Yeah. It’s fantastic. Dirk. Thanks again. I appreciate the time.

[00:45:17] Dirk Stanley: [00:45:17] Thank you so much.

[00:45:19]Bill Russell: [00:45:19] What a great discussion. If you know someone that might benefit from our channel from these kinds of discussions, please forward them a note. They can subscribe on our website thisweekhealth.com or you can go [00:45:30] to wherever you listen to podcasts, Apple, Google, Overcast, that’s what I use. Spotify, Stitcher. We’re out there. You can find us. Go ahead, subscribe today or send a note to someone and have them subscribe. We want to thank our channel sponsors who are investing in our mission to develop the next generation of health IT leaders. Those are VMware, Hill-Rom and Starbridge Advisors. Thanks for listening. That’s all for now.

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