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 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. Today, Dr. Dirk Stanley joins us. He's the CMIO for Yukon Health and he is a phenomenal writer, but he's really excellent on Twitter as well.

He has a great blog around clinical informatics, and today we talk about his top 15 signs. You may work in clinical informatics. It was a post he did out on LinkedIn and on Twitter, and we utilize it as a framework for our conversation today. 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 partner at this week in health it.com. I wanna 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, uh, this week in Health it on LinkedIn. You can follow us on Twitter, bill Russell, HIT. You can follow the show this week in Health or in HIT on Twitter as well. We've got a lot of different things going on and 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. 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, uh, trying to really take a conversation. I. 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. We are trying to build a, a more broad community, so invite your friends in 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. Alright, today we have Dr.

Dirk, the Cmon Health. Ian with us to talk about clinical informatics. Good morning, Dirk. Welcome to the show. Good morning. Thank you for having me. I don't know why I always say, I say good morning. I, I'll assume that people only listen to podcasts in the morning. In the afternoon. They don't listen to it. I dunno why I do that.

This is our first time meeting. I'm looking forward to this conversation. And me too, I'm honored to be a, a guest on.

Uh, and we were talking earlier how we feel like we know each other because I've read so much of your stuff. I read your stuff on health system, CIOI, and uh, I see your stuff on Twitter and whatnot. You post some interesting things on Twitter. I remember the one post you had, you, you were describing a terminology and you had like a graphic with oranges and, and those kind of things.

Actually, I shoulda up talk about. Do you remember that post? Yeah, I was, I was just trying to explain how like. High terminology matters so much for usability and, and trying to explain. 'cause 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, um, make software more usable and less clicks. So these are like, and sometimes people don't appreciate how the terminology results in extra workflow, uh, challenges, but. 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. All right. Well we're gonna, we're gonna have a little fun. We're gonna 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.

I Did you intend it to be funny? I mean, because I've talked to people. It, it's kind of funny. Yeah. Actually, I, I did, I was sort of, I was thinking like sort, I, I had one of those moments where I'm like, boy, I wish people understood like what my life is like. I. And then I drew some inspiration from David Letterman's top 10 list.

And initially it started as a top 10, but then like I kept going, I'm like, oh, 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. It was great. Well, here, here's what we're, we're gonna, we're gonna share the top 15 and some of 'em, I'm just gonna throw questions in afterwards because I think it's, you know, a great framework to talk about what you do and how you do and how you doing.

So the 15, I guess the last is your it think you.

Let me ask you this. What makes a good clinical informaticist? What type of person should go into the field? , other than, you know, I mean, you know, there's lots of punchlines I have here, like seeking abuse or punishment or, but, but it's like, it's being a translator, right? It's, it's like being an interpreter.

Somebody who. My, my dad was a, was a military interpreter for a while when he was in his military career, and he, he was a, a, an interpreter and he always taught me something that kind of stuck with me. Good interpreters spend half their time in one culture and half of their time in another culture. 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 their words and their culture, then you become an effective interpreter between the two.

And I guess that would be my answer. Well, I'll tell you, I, you know, I've sat in those meetings where we're trying to take a single word. I've talked about this on the show a couple times or, or single event in the hospital. We're going, okay, well let's define this. And it sounds, you look at it and the terminology you, this is easy.

I mean, this should be a five minute meeting. Three hours later you're sitting there going, alright, we have six definitions for this very, what appears to be very simple thing. And the problem is it shows up reports.

Don't we have to get to a single day? I, 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? Yeah. I, I, I think we're. It's funny because when people hear what I do, they're like, well, you must be kind of a, a doctor. Or maybe you're like an IT person.

Maybe you do technology and, but really it's a lot of it is exactly what you said. It's about understanding both cultures and terminology is so important. It's so critical for effective communication between the two. And I often sit there. Like, it sounds like you have too, where you're, 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 gonna take for the communication to be established suddenly it just, it changes the whole dynamic. And, and, 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. 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. Those are fun words. I would ask you to define all of them, but the, but these are also extremely important. Ontology, again, we get back into the, the.

Things, uh, indexing usability is huge, which gets one in spare you interoperability, meaningful. That really has driven, so meaningful use really has driven a lot of the work of clinical informaticists for the better part of a decade. Is that still the case? Are we starting to move into maybe a new era beyond, uh, meaningful use, I think and about ontology and hierarchies, like clinical informatics has its own language, right?

Like its own sort of vernacular and traditions and custom, I think . Just like watching the interpreters at the United Nations, right? They have their own internal ways of, of handling things and certain protocols. I often think, for example, by the way, about like you ever wonder who the interpreters were who were trying to interpret wing during the Cuban Missile crisis, right?

And you have like two world leaders. One speaks Russian and one 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, that . So, so interpreters can start wars or escalate wars is essentially what you're saying. , right.

You know, you're probably like, 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 back to the writing poetry about meaningful use?

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 when I look forward to seeing what the next 10 years brings us, but, but yeah, these are the type of things when I was like, if you had to write like haiku about meaningful use, what would it look like?

Right. Yeah. Well, and your next one is.

There is sort of a mindset. One, once you get locked into, uh, efficient workflow and those kind of things, that's half joking. But, uh, all of us have been there. Like, you do it at work all this time and then you come home and you're like, this house could be a lot more efficient. We could do this. Or do you drive your family crazy with some of that stuff?

Yeah. I keep asking my dog like, could you walk yourself, do you think, would you be able to , you know, like, 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 them 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 savings somehow like, or in, if you've ever organized your closet, like, okay, is there any benefit?

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. It's, yeah. So have we turned the corner on EHR usability, do you think? Are we, uh, getting to the point where we are fine tuning things or we still have big, uh, big movement to go here from a usability of the technology, from a improvement of the workflow, from integrating all the different.

Dispar and data stores that we have out there. It's hard, like usability and interoperability are very difficult. Comp, you know, complicated things and, 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.

I remember, I think it was at hims a couple years ago. I 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, a glass of water and when you're hungry, somebody hands you food.

Like it should, like, it should feel natural and it should feel right. And. We're not quite there yet. Like I think there's a long way to go in terms of like, how do we know when 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. Like, and another example that I often use when I'm talking about it is. 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, 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 I. In terms of usability, clinical informatics really has an important role in making sure that when the stairs are built, that whatever's supposed to be at those stairs is like, is there too?

And that's not a future upgrade. You wanna release them at the same time. 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, uh, EHR, maybe, uh, at a sub optimum level, 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? 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 dirt, you know, look at this. 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, the projects usually identify themselves, but I. But there's opportunities. Another way that I often see opportunities to, to insert better workflow design is really in the project intake. 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 gonna be using the technology? How are they gonna be using it for? What's the clinical purpose? What is it to treat pneumonia or to treat cancer, or to treat covid? What? So 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. 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 to 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. So you learn a lot about like the DNA of healthcare as you're doing this. Yeah.

You really get into the, you get at 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. 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, uh, do you feel like we're ready? And do you feel what kind of impact you think that's.

It's gonna be interesting. I, I think there, there's the like kind of frontline experience of this, which is not always easy to navigate. Like there are, I. Um, there are people who don't want to learn about a life-changing diagnosis in the electronic medical record and not have the, the provider around. 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 isn't there to help kind of frame it.

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, should ask me any questions. I can use my money for whatever I want, and navigating that.

Generational kind of divide, if you will, or at least that transition is what I think the biggest challenge is, um, in developing these, these regulations. That being said, overall, clearly the benefits, um, outweigh in my opinion, the, um, benefits outweigh the cost as a society, but on the individual level, you want to make sure that every patient gets the respect and care that they need.

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 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.

So 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 service. And I think it'll help drive competition, improve service, improve quality.

So, so I certainly see why we're doing this year. And but, but 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 learned about something that they didn't want to inside the portal.

And you wanna be sensitive to their requests. Like there's. Every, everyone is important. And so navigating that is, is a lot of work and it takes a lot of planning. 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.

I mean, 'cause when you talk about that, I'm a technologist by background.

All diagnoses, and instead of just sending them to the portal, again, you're doing it at the patient level. So I get to set the setting that says I wanna receive it, or I want to talk to a doctor. I don't wanna receive in my portal. I could just click a button and then I'm not gonna get it. So next time somebody says, Hey, I don't wanna receive it, it's like, great.

Go into your settings, hit this. You won't rece, you'll see Rece receive an alert that it's available, but you won't receive it unless you wanna receive it. I think that's the ideal situation, like patients should be able to make that decision. Right, but, but I think different vendors have different opinions about this, or maybe some vendors haven't quite developed that functionality yet and.

but you know, we need to, I, I think eventually though I can see most vendors eventually supporting exactly what you're talking about. Yeah. It's 20 is interesting because it's uh, literally an end run around. 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. Alright, back to the list. When bringing your car in for routine maintenance, you ask the mechanic about the ROI and TCO of your future state. Yeah, actually, I mean, you bring it up. So how do you measure to ensure the projects are meeting the financial return goals for your organization?

Is that something that you guys have a pretty good handle on at this point? I think, you know, it's, 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. You can talk about throughput and you know, if we can see another 10 patients a day, that'll 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. What does 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 it's sort of how do you measure those intangible things?

And especially when it comes to healthcare, right? Like healthcare is very. There's so many like gray situations and, and figuring out those intangible benefits is, 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.

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 measure it in terms of financial benefit. The opportunities to miss improving patient safety and improving staff or patient satisfaction? 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 'em approved if they don't have that strong financial return. And then you have to go into the making the case around all the other aspects that you just talked about, some of which are quantifiable, some of which not as quantifiable.

And so those are, that's a hard part of the job. I think it is. And it's hard there. At the end of the day, these are difficult discussions and decisions, but, but what's important, I, I do think it's important to at least try to understand those intangible benefits. All right. I'm gonna, I'm gonna hammer out a couple of these.

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 flowing party. That would be most impressive flow chart I've seen was we. 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. Wow. But 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 and could put it on a piece of paper, I think, which somewhat defines that. You can understand it and then it, it really helped us with the build after we got all that stuff down.

Alright, lemme just go to the next one At bedtime protest, we're tired of discussing project intake and change management. Can we just go to. Hey, project intake, that's. That's pretty important. And you talked about it a little bit earlier. How do you prioritize this stuff? Uh, do you have, uh, is there a governance process or how, 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, uh, how do you get it into the pipeline? So. I, I have my sort of dream fantasy scenario where people are like kickboxing and whoever's left standing like gets their project done first. Right? But , but apparently like there, there are better ways to do it than that.

Getting prioritization is an institutional. A function like knowing what to work on is something that every institution really needs to spend time developing a process and governance. 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 benefit projects identify themselves and also the things that are clear safety issues or risks to the organization.

Also need to identify themselves and the, um, low benefit high cost projects kind of bolt 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? Though, getting those questions right is really, requires a lot of sort of strategic planning and thinking and, and you want to develop algorithms like, like measurable, like ways of constantly looking at those projects.

And there are some very impressive tools that, that I've seen and that I've personally, uh, helped implement where you're looking at the risk to the organization and the risk to patients that. That brings things more to light and, and those, those topics get discussed. Personally in my role, I discuss every project, like whether, like whenever 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. Alright, so people knock on your door. 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.

I I, is that a determination that you're sort of making that, where you're going, look, I'm just gonna funnel this over to my team and they'll take care of this, or this has to go through a larger governance. Is is, is that, does that squarely sit on on your shoulders or No? No. So actually, fortunately I work with a really great team.

We have our, our vice presidents, our project manager, we have a new, um, head of our project 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 these people because everyone has important contributions to that discussion.

It's really an enterprise discussion, right? Yeah. So project challenges. When I was CI 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, this is not an exaggeration. You'd end up with hundreds of projects and then invariably you wanna sort of that risk, reward and investment.

You sort of wanna look at that whole thing, which project you should be doing.

Some. In some cases we put that on.

And we just found the financial models to be just flat out wrong, had to be redone because people have different skills and, and, and those kind of things. Uh, how do you get the financial models that I, I'm asking, this is like free consulting. I'm asking you to, to help me. How do you get the, those financial models to be as accurate as possible?

So you, the decision, you, everyone struggles with the same issue. I'll just say everyone. Has the same sort of challenges. 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, a system of checks and balances. Like there's the first sort of estimate and then another person like basically goes through the same process and if they both validate each other, then you have in the financial model.

But sometimes. There are discrepancies, but we're still trying to figure out though, because if you're gonna do that sort of a process, you, you basically need two people to do one function. And so we're still balanced that out. Like can we make, maybe the first financial model would be on the local user level or on the department that's making the request.

And then the second one would be from finance or like, so we're still trying to kind of work that out, but I think everyone, you know, kind of struggles with the same sort of things. I. Yeah. No, I, I can see that. Alright, so your list, I'm probably gonna a couple here. Go to the last couple. So you've wondered how to global awareness about the complexity of order set design.

I was just gonna through, but I stop there. Why is order set design so hard? So, um, , so I'm so glad you asked me that question. So order sets are like, I don't know, are you a Dr. Who fan? Do you know? Are you familiar with Oh yeah, absolutely. The Tardis like on the outside it's a phone booth, and then you go inside and it's like a whole world inside.

Yep. That's like what order sets feel like when you're . On the outside, it looks at, you're like, ah, it's, I don't know, there's like 20 orders here, maybe 40 or whatever it is like, but 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.

And so like when you have medication orders, especially, there's a lot of information you need in terms of the route, the priority, the frequency. Is it a one-time order or a repeating order? Is an inpatient order in an outpatient order with lab orders? Is it, are you expecting who's gonna collect the lab?

Is it, are you expecting the phlebotomist to collect it? The nurse to collect it. 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, uh, it's a frequent thing. I think most CMOs will tell you. People come and they go, oh, I got a problem.

I just need, I wanna make a little order set for 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 well. And people, and 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, a doctor sitting right across from going, where did you learn medicine? Or that, that's nuts. Uh, conversations, I. I would sit in those conversations and I, I attended a handful of them 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.

Coalition building and that kind of stuff to get this stuff done is what I've seen. The, the trick to that situation that I always like, I, I really embrace this, is you have to start with the clinical care first, right? Like, just start like. What is good patient care like you describe, 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. Like what would the best cheeseburger in the world look like? Would it be like on a CHO will be like, what kind of meat? What kind of cheese? What kind would you want? Red onion, would you want white on?

Describe to me what you want. Then once, like usually both sides want the same thing, but then once they describe it, then what I usually do is I take my, you know, laptop, whether before it was in a conference room, but now it's by WebEx. And I literally start like, 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, 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 where they still don't agree, then we go to the literature like, like up to date or another product.

Yep. Trying to figure out like, well, what does the literature support? Sometimes I'm going through medical journals or. In our medical library researching the, the literature. So, yep. Alright, 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 wanna do this?

Uh, how difficult is it? Are, are you still, do you still practice? So, I'm not practicing right now because I'm, I'm effectively managing the, the clinical informatics for a large academic institution. I do, I. People always ask me, do you miss the bedside? I do miss the bedside, and I'm currently exploring ways of of returning to the bedside to some degree.

I think we're looking for opportunities to, I guess, get additional informatics resources probably make that more manageable for me. How did you, alright, so at some point somebody said, Hey, do you want to do this? You had to sort of weigh, uh, the, the pros and cons. Uh, walk us through that, that decision of going from full-time, practicing clinician into informatics, and then eventually leading an informatics team.

So, I, I actually, I think everyone, I would love to hear your . Like, I, like everyone kind of falls into this somehow. Um, for me, I actually started as an IT person before I went to medical school and. So I did, I I started off in a small software company and then, and then I went to college. Actually, I, 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. 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 companies and then I, I would say I got a little maybe burnt out of technology for a little while and then I. One of my friends, his mom was a nurse and she said, do like, like why don't you come and volunteer here at the hospital? At least it'll get you outta the house.

I was sort of in that post-college, like trying to find your way, sort of. So I started volunteering at the hospital. I. And of course they looked at my, my resume at that point and they were like, you know, oh, you gotta work in the IT department. So I started working, this was at the Westchester Medical Center when I started working in their IT department.

And that led to a data, uh, analyst position. I worked in their quality department. 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 once sat in a meeting and said, can I just ask like, why does the central line get infected and never the line on the left or the line on the right.

And they were like, 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. Medical school, and now I'm wearing a white coat and a stethoscope, 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 were like, no, you're a doctor. You don't understand anything about it. . I'm like, I don't understand. Two years ago I was on that 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 and I started applying for hospitalist jobs because.

That's what direction I was headed in at that time. And, but when I was applying for jobs at, I'll say my, uh, previous employer, they looked at my resume and said like, wait a second. You're, you have all this like it experience at data. We would like to invite you to be our CMIO. And that's basically how I got my foot in the door.

Yep. They, they made you an interpreter is what they did. I, I guess I've lived on both sides of the fence, so I became the defacto interpreter. Actually just, I'm wanna throw out a, an odd question just because I wanna know the answer. Where does nurse informatics sit at Yukon? Is it its own deal or does it fall under the CMI?

So I would say informatics as a general topic is, is a discussion. It's an ongoing discussion. We don't really have an, like, I wouldn't say we have a formally recognized nursing, uh, informatics group. I currently with a nurse Informaticist who is outstanding, and together we solve a lot of problems. But, you know, I'm hoping, I'm hoping this, the clinical informatics discussion continues to, uh, you know, evolve and that we develop more formality around the roles.

All right. Hey, so the last two here, you nod and smile graciously. Every time someone asks you, you work in it, right? It must be fun to work with those computers all day. Now, you know what I do? You know what cracks me up about that? Everybody who's sitting in front of a Zoom meeting all day, who, who once said, it must be fun to work with those computers all day.

Sitting in front of computers all day and they realize not, it's, it's not, it's not as much fun, as fun as they, uh, think. It's your number one is you spend countless holiday gatherings trying to explain clinical informatics to your in-laws. I would imagine that's an interesting conversation with your in-laws.

It's, it's like, alright, so lemme get this straight. Are you the No, I.

Something with computers and doctor, I don't know, you're like kind of, I'm like, yeah, something like that.

We're coming to the end here. I did wanna, I, I wanted to touch on a couple things. So we're actually recording this. It's the fourth or fifth? It's the fourth. 4th of December, uh, big event. So we have some vaccine coming to us. I just wanted 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, there's gotta be a, a workflow, a thing that, uh, what are some of the things you're thinking? We, we have some challenges in front of us just 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, uh, that's gonna be interesting to track.

We've gotta track it within our hospital in the EHR. We've gotta track it in the community. There's a lot of challenges, uh, coming your way. Are 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? No, I mean, I don't have a lot to share because it's, it's an ongoing discussion.

Fortunately, we have a. A really great pharmacy who's working on this. We have really great clinical leadership. We're having almost like daily meetings about this also with our IT team. And there are a lot of like details to this workflow and, and we're still kind of like developing them and um, yeah, this is Anar.

This is a gnarly puzzle. I. Supply chain. You're not gonna get like a million doses in the first week. You're gonna get a certain amount. You gotta figure that out. But there's recommendations from the CDC of who gets it. There's 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 it. The, like 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 need to be mapped out and doing them this quickly has really been a challenge.

Again, though I work with a really great team, I'm very fortunate and 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 are understanding each other's roles better.

There's so much more collaboration and even just the online experience has like shortened the development time because in the past we 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, you know, a copy of the order set that we're working on, or I'll send you.

There were always these like action items after the meeting. 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, that's been, I, I would say that's been sort of a, a time saver in some ways.

So I. So more to come. But yeah. Dirk, I, I, I wanna thank you for this time. I also wanna thank you for your contribution back into the industry. I, I was reading your, your blog. I, I think it's a blog technically, if that's what we're still calling it. But may you really detailed some of the work that you're doing and I would think if I'm.

Just the detail and level of stuff that you're sharing, uh, I think would be really helpful for anybody who's, uh, you know, trying to attack some of these problems. So I appreciate that. Hey, uh, how can people follow you and how can people, uh, find you on the, uh, on the web? Sure. So super easy.

www.dirkstanley.com. That'll get you to my blog. I'm also on Twitter. I'm at Dirk Stanley. I've recently tried to, trying to develop more, a little bit, slightly more, uh, 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, or. There's no, I'm a very vendor agnostic sort of person. I think it's about clinical 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.

Yeah, it's fantastic. Dirk, thanks again. I appreciate the time. Thank you so much. What a great discussion. If you know of someone that might benefit from our channel, from these kinds of discussions, please forward them a note. They can subscribe on our website this week, health.com, or you can go to wherever you listen to podcasts.

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