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 This is gonna be a wild episode. I am having work done at my house. You're gonna hear a lot of construction in the background. I apologize for that ahead of time. Amy Maner does a phenomenal job working through it, but, but it's still there, especially at the end. You'll just, you'll hear flat out the jackhammers going and those kind of things.

But a great episode. Enjoyed the conversation. Remember two things, clip notes is live. If you wanna stay current, keep your team current. Best way to do that. Send an email to clip notes at this week in health it.com. Fastest growing list. We've had, uh, it's up over 400 people already who have signed up for CliffNotes.

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Now onto the show.

Welcome to this Week in Health It where we amplify great thinking to Propel Healthcare Forward. My name is Bill Russell Healthcare, CIO, coach and creator of this Week in Health. It a set of podcast videos and collaboration events dedicated to developing the next generation of health leaders. This episode and every episode since we started the C Ovid 19 series that's been sponsored by Series Healthcare.

Now we're exiting that series and Sirius has stepped up to be a weekly sponsor of the show through the end of the year. Special thanks to Sirius for supporting the show's efforts during the crisis and beyond. Some topics are worth coming back to over and over again because they are front and center for anyone who's in health it.

And one of those is EHR satisfaction. And what I did is I reached out to Amy Maner, who was a guest on our show in the first year, and she's been doing a lot of work around this topic. For various health systems. She also partners with the arch collaborative, uh, around this work as well. And, uh, we have a great discussion.

Again, bunch of background noise. I apologize for that. But again, Amy is phenomenal. Appreciate her content and her wisdom. I hope you enjoy the show. This morning we're joined by Amy Maner, MD Experienced CMIO product of Penn Medicine University Hospitals in Ohio, Akron Children's, uh, physician executive advisor to the Arts Collaborative Board certified in Clinical Informatics, and I'm sure a lot more past guests to the show.

I've actually had more go on in the past two years than I had probably in the PA in the five years previous to that, which has been exciting. A little bit overwhelming, but has added a lot of wisdom, like I feel like I'm much wiser. I don't wanna add the older part to that comment though. So what have I been doing in the past two years?

So I did an engagement with a consulting firm internally to help them come up, help develop their offerings to address user satisfaction and developing physician informatics teams and, and gunner governance and ownership. Then I went on from there to be A-C-M-I-O advisor. New York Health and Hospitals during wave six of their Go Lives largest public health system in the us.

Phenomenal, impressive new CEO there who has really, their mission is just so impressive and it was a real joy to be a part of that in my hometown. And from there I went to the to be A-C-M-I-O at the largest health system in New Jersey while they implemented their. One of their districts, like regions they call it.

And I was there. So each of these are long engagements. And then after that it was, fortunately it was before the pandemic, I took some time off to deal with an ailing parent and then the pandemic hit. And so now I have been in since the pandemic, um, based in Cleveland

of still. Spending some time with the Arch collaborative. In fact, that's my next meeting today. Also working with a startup healthcare technology startup that has a new AI, artificial intelligence directed towards healthcare with based on quantum mechanics. So it takes into account probabilistic reasoning.

So that's been exciting and fun. Wow. But one of the things I find interesting people, uh, when I became ACIO for a health system and I was there for about six years, uh, I used to make the comment, and I don't want anyone to take offense at this. There's a certain aspect of this is true. I felt like every day I was the CIOI got dumber.

I. Part of that was I was so eng, there was so much work to do and I was so engrossed I didn't have as, as much time to read. I didn't have as much time to network and to talk to people and they said, what's the alternative? I said, when I was a consultant, one of the crazy things about that was I would visit, I.

50 different organizations and I'd see all the different ways that these really smart people were doing things and I get to engage with them. And I just felt like I became smarter by interacting with 50 different organizations than being within one. Not saying that it's better, I'm just saying it was.

That was one of the benefits of being in the consulting realm was just talking to a lot of different people. Is that what you're finding? Yeah, that's what I think I meant by wisdom. That I, working in the largest public health system and then working in the largest health system in New Jersey internally for months and months.

Really wildly different ends of the spectrum, but really gave me a lot of wisdom and knowledge. And now that I have a little more time, you are right. You have time to read. Time to catch up. One of my hobbies, I'm using air quotes and I'm a, I'm a nerd from way back and most people know that. Is I'm fascinated by living through an epidemic pandemic that's evolving before us.

So I've become like the expert on covid. I attend all these grand rounds and even though I have a family of doctors here, they all call me like, okay, what's the Covid update? So I've spent a lot of time, I. Keeping up to date and doing stuff with informatics, learning a lot about ai, but also covid. Yes, you're right.

Sometimes when you're head down, focusing on keeping an organization afloat. It's hard to keep up on what's going on nationally or internationally, and that's been a gift for me recently. To keep up nationally and internationally. I, I'm gonna, I'm gonna push in on that topic a little bit. We're gonna, eventually, we're gonna get to talking about really the experience.

I'm gonna use physician burnout as a backdrop. We're gonna talk about the arch collaborative. We're gonna talk about the, just other elements of physician burnout. We're gonna talk about clinical informatics. So those are just some of the topics to give people. But I wanna push in a little bit. You're the expert.

One of the things I've wanted to talk to somebody about, and I, I realize. The co covid expert, but I'm just for my family, . Right, right. That I meant for my, but you're also a physician, so I have you looked at previous pandemics and the things that are the same or different, like when we look at the Spanish flu and this, what corollaries can be made between the two.

Do you know what one of the most fascinating things was? So there's a gentleman who wrote a book called, oh, I've forgotten it. A well-known book came out 10 years ago. And I've just forgotten the title. And when he was asked this woman, he, someone said, what's, what was the most notable thing learned or should have been learned?

He said, no. I believe that the only thing you learn from history is that we don't learn from history. I forgot. It's a quote of someone. And so isn't that fascinating? And that apparently Wilson, the president, never mentioned publicly the pandemic. Oh really? Yeah. He was so focused, although you have to give him credit, it was right at the end of World War I.

That was one of the greatest like faults of that pandemic. That's interesting. Interesting. You know, it's fascinating because we, one of the things, I try to stay away from these, first of all, I try to stay away from clinical topics 'cause I'm not a clinician. But second of all, I try to stay away from these potentially controversial topics, but transparency's an interesting concept.

Yeah. We have a problem with transparency just. The four walls of the United States. They're just the boundaries of the United States, but a pandemic doesn't exist within the boundaries of the United States. It exists around the world. So we're not just talking transparency within the us we're talking about transparency across many nations, many types of ways of delivering care and those kind of things.

Uh, but you, as we were talking earlier, some of this, the story hasn't been written. We don't, yeah's not, we don't know some of it, but let, alright, let's go to physician burnout. Huge topic. Uh, the last time you and I got together, we talked about the arch collaborative. In fact, you introduced me to the Arch Collaborative.

The last time we talked. I went on to have Taylor Davis on the show. And several, uh, other people have come on to talk about their results. Around collaborative 'cause it has done so much good work within the industry. And you talked about it, spend voice recognition scribes didn't correlate to user satisfaction and we talked about that a little bit.

'cause I think physician burnout is a much bigger topic and for the bigger topic, I look to the experts like Stanford and Tate Feld and all the components. But I think the EHR plays a role in burnout sometimes. It's because it's part of the cause, but sometimes there's also, it's where it's symptom of the disease.

So if there's more regulatory requirements put on the physician, you'll see it in the EHR. So they'll blame the EHR or if the physician is asked to be doing all these mundane tasks that really could be offloaded. If we did team-based care, they'll feel it in the EHR. So I don't think all of you have to separate it out.

And so then I try to talk about user satisfaction in the EHR, because I think that's more what. We can, um, focus on The arch collaborative is just one tool. There are many organizations who are addressing user satisfaction and may or may not be using Arch Collaborative. What I like about it is it's, it's a survey tool and it basically says.

Hey, does your EHR allow you to provide quality care? And if so, why or why not? What are the components and the three components despite more data than two years ago, much more data still hold true training slash education personalization and what I call shared ownership. They have different terms for it.

I think it's mastery. Let's see. I'll, I'll get you the exact terms.

It's strong user mastery, shared ownership, and IT EHR meets unique user needs. So strong user mastery is education and training. Shared ownership is ownership and engagement. And EHR meets unique user needs is personalization. And I think those, it's whether you do the arch collaborative or not, or get this data, I think that is becoming.

More standard understanding. So Judy Faulkner recently spoke at a forum at the Cleveland Clinic called Ideas for Tomorrow, and somehow it's been all over. I actually saw it because I'm connected to the Cleveland Clinic, but her 10, what she mentioned there has been seen everywhere in Twitter. And she even talked about, Hey, you have to have ongoing education and, and she talked about personalization.

She didn't, she talks about shared ownership by, they're very specific. They, they have one flavor of it at Epic, or they have one term physician builder. I think there's many more ways to do physician ownership and engagement beyond the builder, and that can be very between organizations and it can even vary within an organization.

So the orthopods may have a physician who's involved in a certain way, and the primary care providers may have a different. In fact, one of my compatriots says we don't use the title Physician builder. We, I make like, call it EMR Director. One of the tools they can use is being a builder. Interesting. So, uh, so that's what's going on with the Arch Collaborative.

They've more data, but it, it's still holding to, its those three tenets. Yeah. So I wanna break, I wanna, I wanna break those tenants down a little bit. And this isn't just epic. This is any EHR correct. Arch collaborative covers. And it's interesting. So when we talk about personalization, here's my, my quick story on this.

We do an EMR implementation. We have a bunch of physicians that love it, a bunch of physicians that hate it. And one of the stories is we sent a person to go elbow to elbow with a clinician who hated it. And it turned out he didn't, he hadn't done any personalization. And when the physician champion came back to me, he essentially said if I ran that same build that he was running off of, I would hate my job just as much as he does.

And so talk to us about personalization. What is available to us? What can we actually do in the areas of personalization? What you can do varies on what EMR you're on, but. I think you're, you're true. So you may have heard Taylor Davis will say, if I handed you your iPhone and they took away all your, the things you added to it or did to it, you wouldn't want it anymore.

So I think some organizations have heard the, the value of personalization surrounding implementation. What I think we're missing is that it's never ending. So one, you're, you, there's a new med or there's a new workflow, or you see a new type of patients or the software gets upgraded. Or you change what you're doing, the personalization is ongoing.

And so I think many organizations realize the import of doing personalization and go live, but then they never touched it again. So that's a loss. And then I, I agree that some people don't do it, and then some people don't even understand what the value of it's, and so they need help for someone to tell them.

A compatriot. And so if particularly with Epic, not everyone has to do the personalization. So I can create all kinds of cool things and share them. So I'll give you a goofy, I'm APDR doc and I'll give you a goofy example that resonates with physicians is during a time when we're a season, when we give a lot of eye drops, I would create a favorite where it was right eye, left eye, both eyes.

That it was one click, and when some people just couldn't wrap their head around the value of that. But if I told it to them and say, Hey, I built out the most common eyedrops, right? I left eye both eyes, or I built out the steroids, common topical steroids. And I write what strength they are and insurance, oh, I need this one for this insurance plan and I need that one for 'cause once you look it up, once, you don't wanna ever look it up again.

One, if it's someone in a different specialty, they'll look at me and say, oh, I just thought of the things that would help me. Two, if it's someone in your specialty, you don't all have to personalize it. One person can do it for you and share. So I think personalization, the, the take home messages, I would say it's not one and done, it's ongoing.

Two, not everyone can wrap their head around of what they need to personalize and where and nor should they have to. So they need someone to help coach them to where it would help them. And three, in certain specialties, you don't all need to do it. One person can do it and share with everyone. So a million years ago when I was an Ed PDD attending and we were implementing eclipsis, so think how long ago that one, one of the ways that you personalize there is by building specific patient lists.

And so I basically, when was on at night, get a little quiet with anyone, I would say, oh, don't sign off. I'll go and I'll build your lists. So I built them for anyone. This is long before you could share it. I would build them for everyone. Now some people would then go on and and say, oh, now that she taught me A, B, and C, I'm gonna build through Q.

Others would never touch it again. But as I said, not everyone would wrap their head around it. So personalization is a little bit more complex than it may seem at first blush. Did that help? Yeah, that does. So it's a little loud behind me. I'm gonna try to get the questions in. What are some best practices you've seen around getting people together to share, share those builds, share what they're working on, and those kind of things.

Have systems put together better frameworks for, well, I think that goes back to ownership and engagement. I think if you have a physician who, part of their job is the EMR now, it doesn't, once again, it's like team-based care. Everyone should be operating the highest level of their license. I'm not saying that they should provide the at the elbow support, but if they have someone they couldn't direct to provide the at the elbow support, but they're the person who's responsible for the upkeep of the specialty specific like preference list.

They understand it, they like it, and if their job becomes it, they often are the person who will also create the personalization or help people . Understand what, where the value of personalization is. So I think the best practice ties into ownership and engagement of having someone at the specialty level or the practice level.

It's very dependent on how you are organized, have that role. So at one organization, we called it the EMR medical lead. Now remember Epic has this thing of physician builder, and I say no, there's all kinds of flavors in that organization was the medical lead. So it might get a little louder behind me at this point.

Give me an idea of around training. So a lot of different health systems have done training in different ways. What are some best practices in regard to initial training and then sustained ongoing training? So, to be clear, I don't think we know that much. As much as we should need, should know or wanna know someday.

The arch collaborative is perception. It asks you how good your training was. So an arch collaborative data is clearly someone who cares, know, knows their workflow, and I've learned the hard way that physicians do not tolerate poetic license. So if you come up with, you're doing the training and you use something that doesn't make medical sense, they get totally derailed by that.

They will not allow PO poetic license. So the training content, my belief is you really need a physician champion or expert to say what's going to be important. Not that with collaborating with the trainers now, um, some of the vendors believe in having the physicians train, and I think that's great when you find that valuable and find someone who can do it and you can justify the doc's time.

I think you can also have a physician just be responsible for the content. And have the trainers train and be equally successful. 'cause you know, some physicians aren't meant to be trainers or teachers, let alone cost of that. So that's training. And when I say training, I'm really talking about initial implementation.

Education ongoing comes in all kinds of flavors and I think it's probably varies by organization and how they're . Organized, configured. Are they independent docs, employee docs, are they all at one site? Are they 25 sites? But I think there's many ways to do that. And I personally think, once again, you, you need some physician owner who says, Hey, this is what my people need to know.

This is where they're struggling the most, my people in gi. And then have someone go out who can go out and do that. So I'll have some at the elbow support. Do that. There's been a lot of success with having training and ongoing training in the classroom, and you may have heard of, there's been a lot of success with what they call sprints.

It started, or it got the term from University of Colorado, where they do very focused. They come in and do very focused at the, at a group, specific group of people, group of. I think it's at the practice level, so specialty level, and they do some build cleanup and they come up with some specialty specific tools, but they do some very focused training.

I think there's also been shown from the arch collaborative that ongoing, sometimes just having. Someone meet with the physicians when they're already meeting, so their division meeting, their department meeting, and one field. Some questions like, what are your pain points? And they'll come back and also show them some things.

So I think there's a lot of ways to do it. I think the thing we've learned, I've been doing this a long time and I think we all thought, oh, we did training and we'd never come back. I think what we've all learned is no. So in other industries, like if you are an engineer and you use cad, computer assisted design, you get trained ongoing.

My understanding is accountants get trained ongoing. I think we didn't realize that, and I think we also didn't, I'm gonna use air quotes, budget for it, so that's resource intensive. I don't. And so I think a lot of organizations, we all didn't, now a lot of organizations have started, there's these programs, a few people call them home for dinner.

Kaiser started it years ago, Kaiser Northwest, where, I forgot what they call it, where they take them off site through a resort kind of thing. And they have a physician teaching it, and it's a number of days. So it's very resource intensive, but they got a huge value from that. So I think none of us have planned for it initially, and we're all wrapping our heads around how's the best way to do that?

And now some of the CEOs of the vendors now specifically say, Hey, you need ongoing education. Yeah, they, the home for dinner programs, we've heard it from a, a bunch of different, uh, health systems. We did a thing called 60 back and we were measuring can we give 60 minutes back to every clinician in their day?

And at first, when somebody said 60 minutes back, I thought, oh man, that's pretty daunting. But then you realize making this change to the order set, making this change, each one of those ads just they start to add up very quickly. And before long you're, you're looking way past 60 minutes back. Because that's how much time has been taken away with the regulatory burden and just the, the challenging document.

It's time. Physicians hate and I hate clicking around looking. Yeah. And so it's the frustration. And so we have found that when physicians know how the system works and does some, do some personalization, they may actually spend more time in the system. 'cause now they're not clicking around. Now they're.

They're actually delving into the patient's record and looking for trends and looking for what's going on in the past. 'cause they feel comfortable in it. So it's not always time, but that clicking around not knowing what to do is just a horrible feeling and a time, a time waste. So you've now been at a bunch of different organizations.

Uh, is the CMIO role distinct or different at each organization, or have you found they're pretty commonly distinct, wildly different, really.

I've, I've been A-C-M-I-O or in ACMI role for years and like six, eight years ago. I thought it would start to normalize. You look at organizations and you even ask, what does the CFO do and responsible for? It varies, but I feel like the CMIO is all over the map from organizations that literally expect the CMIO to do at the elbow support, which I'm not above.

I like that, but. If you're at a big organization that's not very cost effective, that's not scalable, like what, who, how many people are you really gonna help? And then there are others where I've been, where the CMIOs on the CEO's executive cabinet and is really doing the strategy and vision of how we're gonna leverage technology to improve quality and value of healthcare and everything in between.

Yeah, I, and that's been my experience as well, uh, is that when I talk to people, there's, uh, some CMIOs are just focused on the EMR. That's what they do. They, they come in every day and it's, and that's a big job. It's a significant job and it's constantly changing. There's constant needs for education, as you described.

And then others really have a, a heavy focus on analytics. Informatics and those kind of things. So they're spending a lot of time on the, on the, the report side and on the dashboard side. And, and even somewhat on the research side, I, are we gonna see it normalized or is it just gonna be specific to each organization?

I don't know. I would've thought it would've normalized. And I'm beginning to see in some of the more mature organizations, we're beginning to see . When we go back to this whole idea of ownership and engagement, more physicians with roles, so you'll, I see more and more I'm the lead for gi. Remember I talked about one organization called it Epic Medical Lead, or another one calls it I think the medical director.

And then they have more associate CMIOs and they'll say, oh, my associate CMIO handles analytics, or my associate CMIO handles ongoing education and training. 'cause not one person can do that all. So that's what I'm seeing in the more mature organizations. The younger, or not even younger, just ones who just aren't getting there.

They still have the, the CIO owning these clinical things, and I'm always like, is that really the right role for the CIO who has so many other important things to do? And the CMIO is really, as I said, I've seen, I couldn't believe it, but I've seen large organizations where the CMIO basically was there to do elbow support.

Yeah, so we're now, so with the arch collaborative, we're now entering a couple years into it. So we're probably doing second and third surveys of some health systems. Ha have we seen significant progress in the area of, uh, experience and satisfaction amongst the clinicians? So there they are we surveying and not, so I do wanna caution as we also hear a lot about.

So there are many organizations who are very interested in all these parameters but aren't participating in the arts collaborative, aren't we? Surveying, and many of them will cite, they feel that their users are just not. Surveys not where they want them to focus their time and energy. Or maybe they survey them too much, they don't wanna throw that out there.

Yes, we are seeing, there's re surveys and with our collaborative data, we do see some wild success stories when people do some really interesting things to intervene, which we can talk about. And then we see some who they don't move much. Some of those have been. That even though they did a lot about the EHR, there were other detractors.

So when people are unhappy, so people were being asked to work more hours or less control of their schedule and when they delved into it, those are things that contribute to burnout. And so when you ask people how they feel about their EHR, if you're miserable, so there are some that they didn't see an improvement that they felt were due to competing factors.

There were very few. I think there may have only been one to date that got worse. And also there was like an explained reason. Explain a reason I could explain that. How's that? So give us an idea of some of the interventions. You said some interventions came in and really moved the needle. So one of my favorites is, and I'm gonna say who did is Ortho Virginia.

And the reason is it's orthopods in private practice, so not an even easy group to move. And one, they have a phenomenal leader. Who has always impressed me and he has this, I'll show it to you. You can. Here's the slide. He shows them, this is a climbing Denali, and he says, climbers of Denali survival is your personal responsibility.

High risk activities like nuclear technology require awareness, skill and commitment, and gratitude and contribution. So one, I think he's trying to tell the, these orthopods, like, you have some responsibility and ownership here. This wasn't just done to you. But then they also created a role. The acronym is PSS.

It's like provider support something. And I think it it who rounds and job is to help the orthopods. But what they found was that early on they wouldn't necessarily welcome the assistance. I think that's why their CMIO said, Hey, you need to have some gratitude and contribution. And when people understood the role, the value of this role and embraced it, they saw significant increase.

So with that, it was changing the attitude, Hey, it's your responsibility, but we're gonna provide you with the tools. Yep. So that are, are you finding that budgets change after an organization does, goes through the first survey process? I can't comment on that. I don't know that I know, I do know that people have talked about that.

I know. Um, the sprints at University of Colorado is a significant budget. So I think what often, what I have seen anecdotally but don't have data is people doing like the CMIO at University of Colorado, a place where I worked, we did a significant intervention. 'cause we had some other leverage. Oh, and a friend of compatriot of mine in the Midwest, theirs was burnout.

Ours was access and ambulatory. I don't know what Colorado's was. So they do something then to intervene. 'cause they're riding, they put their caboose on the freight train. That the organization's big, um, endeavor or big goal, which I am a huge fan of, they prove the value and then they say, Hey, this is great, but this is what it costs to do.

And, and then I've seen those get, um, funded. But yeah, it doesn't happen. None of these things happen for free, unfortunately. And I think it's gonna be tough in this day and age when budgets are tight in healthcare. Did that make sense? Yeah, no, it makes sense. I I, I might end up doing a whole show on budgeting if I can find enough people to talk about it.

'cause it's interesting 'cause off the air and email wise, it's probably the area I get the most questions, like, how did you get enough money to do training and how did you get enough money to do whatever correctly? Because. Everything requires a certain amount of money to do it well, and then there's so many requirements in all these health systems in terms of where they need to in invest their money.

So it, it is a challenging area. I, I'm gonna ask you a couple questions, which I'm not sure. Can you speak to the budget thing before you do that? Oh, please. I'm a huge fan when you're in A-C-M-I-O role who often either don't have a budget or minimal one of tying your caboose or your car on the freight train to an organization's larger goal.

And so then you can at least do the pilot under that budget, or you're riding that forward wave, and that's where I've had success and I've seen success. Does that make sense? Oh, absolutely. Instead of saying, Hey, I need more money for training, let's say the organization is addressing physician unhappiness.

You say, look, it's been shown you need better training. While you have that huge endeavor about physician. Dissatisfaction, can we do some training interventions? And when you show that value, then you can circle back and say, okay, that's really valuable. This is what it would cost to continue to do that.

Can we tell, so what other, what are some other, uh, system-wide initiatives? Can we tie it to a quality initiative, do you think? Yeah, I, I think you could, you . Yeah, you, you probably could. I've seen it most likely, most commonly tied to user satisfaction, physician dissatisfaction, burnout, or a particularly an ambulatory.

So an ambulatory, if the physician isn't efficient and can't move through things, the whole office stops. So while on the inpatient, if I'm not efficient, I'm just there later. , but so I've seen an ambulatory when they wanna help improve access or efficiency, that you can intervene with the EMR and user satisfaction.

You've done a lot of things for your . I think you probably could do it for quality endeavors. If you say, we're not doing great with VT e prophylaxis, and the tools are in the EMR, but people don't know how to use them. We need to do some training. And then somehow make it bigger. You could probably do that.

Hey, we're not hitting our quality marks 'cause people aren't doing them in the EMR. We need to teach it in the EMR and spread that. I, I don't have an example of that, but I'm not saying it couldn't be done. Do you find that clinicians generally understand all the things the E EMR can do? I mean that it's one of the things, no.

Yeah, so it's interesting because the e EMR can do a gillion things literally, and what I find a lot is it organization's struggling because a physician wants to bring something in and they're like, you realize that our EHR has. That module or has that capability or those kind of things. It's not uncommon that when people ask for an optimization, I'm using air quotes, let me speak two things, but it's actually there.

But the other common thing in informatics is we need to focus on what they're trying to achieve, not what the user says they want. 'cause what they says they want is not necessarily a, the best way to achieve it. Or the software isn't gonna do it, or that's not really what they want. So someone recently said on a podcast, let the experts do their job.

It's like, get the CMIO, get the physician informaticist in there in the conversation. So you can say, this guy says, I want, and I can give a great example of this. I want something. And they're like, what are you trying to achieve? We can do it this way. So yes, we commonly see that what someone wants. In optimization, it may even be there.

But then if you say to them, what are you trying to achieve it, that the way to achieve it is there, so Amy, we had a discussion earlier about what are some of the priorities, what are some of the things that CMIOs are focusing on right now and what, what are some of those things that you think are critical that CMIOs should be focused in on?

I think there are some big regulatory changes coming down the pike. That I think are gonna blindside many CMOs because of through no fault of their own, they were dealing with Covid for six months and now all of a sudden we're looking right in the eye of some big regulatory changes. I, in top of mind for me is information blocking related to the 21st Century Cures Act.

That's one component, which theoretically goes into effect November 2nd. In some ways that is no big deal. It's just some changes on your release rules. But it really, I think it's a really big deal, I suspect. 'cause one, it's how you interpret the laws and the exceptions. So there's seven, I think, exceptions.

And it'd be interesting to see people, organizations interpret it. And so you probably need to get legal and compliance and whoever involved. And then there's gonna be a change management component. So if our patients are now getting our notes. Our labs, radiology, pathology. The way to handle that is to have the D, what I used to say when we first did release is have a different conversation in the exam room.

So not only does everyone need to be familiar with it, so even the nurse needs to know the patient's gonna get these results and then say, Hey, your results are gonna come back as soon as they're finalized if you don't wanna see them. Before talking to the doctor, wait for the doctor to call. Like that's a reasonable plan.

They have a significant impact. You can make them have a, I think they should have a much bigger impact than you. You can get by with just teaching people. But in reality now all of a sudden, the e and m codes are not based on history and fiscal. They're either based on time or they're based on the number of problems addressed, amount of data reviewed, and risks and complications.

Well, that's a, that's a huge benefit to the physician, isn't it? Oh, it's a huge benefit, but. All those notes you created that blow all the information in, do you really wanna still use them? So this is really an opportunity to rethink all the templates and to put the right information. And oh, by the way, this is related to what we talked about, information blocking.

'cause the notes are going to the patient. So do you really want a note bloat, horribly bloated note to go to a patient that really doesn't communicate? It's hard to figure out. So this is really an opportunity to reconfigure notes, which is a heavy lift. And then the other part goes back to, we were talking about education.

So many people use all the things that blow into the note as their way of reviewing it. So I look at the patient's meds, I look at their medical problems 'cause it's all blown into the note. They don't need to be blown into the note, but now the doc needs to know how to efficiently and effectively review that information.

Interesting. So it could be, is that just ambulatory or is that acute and ambulatory? So my understanding is for now it's ambulatory. Yeah. It, it has gotten extremely loud at my house directly. I'm sorry. Breaking concrete right now, so I, I can barely hear myself talk at this point. Amy, this is a fantastic conversation.

I did want to go into Covid a little bit more and those kind of things, but as we were talking earlier, I realized, uh, as you pointed out, this story hasn't been written of the impact. That Covid has had on physicians and on providers at this point. And, uh, that's probably a, a conversation that we're gonna be having, but we'll have more data as we go into, into next year, I would think.

I agree. One, we don't have the data and as I mentioned in many organizations, the normal congregation. Isn't happening. The normal resident workroom where everyone hung out on the attending, dropped by and they traded stories, let alone they also said, Hey, what do you think of this patient? What should I do?

In many organizations, they aren't doing that as, like, the Harvard hospitals aren't needing everything's by Zoom, so all that trading, what they're experiencing isn't happening. So I don't even think in my experience in the, in the hospital that people have even necessarily congregated to see what's going on.

And I think that they really do feel the social isolation is a lot of my friend compatriots report that I think I told this anecdote, a friend of mine's a bench researcher at the med school and she goes in, you don't see anyone. If you we're gonna talk to someone down the hall, you'll do it by phone or by, you know, a video platform.

She says to someone, I, for 20 years, I always either saw at the coffee place or stopped and we had coffee together. I haven't seen since March. So I think we don't know, even with our own organizations what's going on with everyone and how everyone's failing. Yeah, absolutely. So Amy, thanks again for, for stopping in on the show.

I really appreciate your, as you say, your growing wisdom as you get out there. And I, I hope to visit with you again next year as you, as you get out there. You're A-C-M-I-O essentially for hire at this point. Yeah, I'd be happy to be A-C-M-I-O for hire. I'm also doing, you know, consulting and then my finger or my iron, lots of irons in the fire.

Um. Working on stuff related to informatics and my areas of expertise, which is really fun. Fantastic. And I, I apologize to my listeners, and I apologize to you for this background. I, I went and talked to 'em and they just looked at me like. We, we've gotta keep working, so they're breaking concrete behind me.

It's probably not the best studio right now, so Yeah, if we have to redo it, you'll let me know. All right. Hey, thanks. Thanks, Amy. Take care. My pleasure. That's all for this week. Don't forget to sign up for our clip notes. Send an email, hit the website. Uh, we wanna make you and your system more productive.

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