From Potholes to Piglets, 30 Years of Health IT Lessons| The 229 Podcast with CT Lin, MD

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From Potholes to Piglets, 30 Years of Health IT Lessons| The 229 Podcast with CT Lin, MD

[00:00:00] If you're still paying maintenance fees on legacy systems you can't shut down, you're not alone. Health systems are drowning in cost and risk just to store old data. Harmony Health IT migrates that clinical and financial data into a secure archive so you can finally decommission those systems and keep every record compliant and accessible.
[00:00:21] Find out more at harmanhit.com. [music] Hi, I'm Sarah Richardson, principal at This Week Health and the 229 Project and a former healthcare IT executive.
[00:00:34] [music] I spend a lot of time in rooms with the leaders shaping this industry at dinners, roundts, and events across the country. And every so often, someone says something that stops the whole table. You can feel the room shift and everyone leans in. That's the conversation I want to keep going.
[00:00:52] Welcome to the 229 Project podcast. Let's get into it. Welcome to the 229 podcast. I'm over the moon to have CT Lynn on the show because he recently completed his tenure as chief medical information officer at UC Health after 30 years with the organization. CT, you've now moved on to your next chapter as professor ammeritus at the University of Colorado and medical campus. And I'm
[00:01:18] loving the fact that the industry is not losing you to retirement. It's actually what I recently heard a term called preferment to the next phase of your career. So, welcome to the show.
[00:01:29] Thank you. And you have a new book out and I'm super excited to talk about it because you call it it's not about the tech from potholes to piglets real life lessons in health it tell us what it's about if it's not about technology.
[00:01:48] It's about trying to be successful with technology and the fact that we are always overemphasizing the tech, right? So when people come to me came to me in my role as CMIO, they're like, I saw this thing at this meeting and we have to have it. And you look at it and you go, yes, it's very shiny and no, it's going to be ridiculously difficult to implement and here are the reasons why.
[00:02:11] Um because you don't have leadership backing. this is just your, you know, back of the envelope idea and you haven't vetted it with anyone. In fact, your colleagues in your same specialty have no interest in doing so. So why would I, you know, move forward on it?
[00:02:24] And it turns out that it takes a lot of and I think it's sort of an 8020 that the success of an electronic pro project is only 20% about the technology and 80% about the psychosoccolitical skills of the team doing the work. And I have to say the first entire half of my career was me learning this lesson over and over again and like beating my head
[00:02:48] against the wall and thinking why does none of my stuff work? It's just a it's super shiny. It's super fantastic and no one will take it up. Like I built this thing for you and and you know I built it in the back room and then I show it completely finished and I didn't tell anyone about it before I turned it on.
[00:03:04] And why does everyone why is everyone mad at me? And it took me a long time to learn and you and I were talking about books earlier and to read the books that got me over the hump of oh there's this whole other thing beyond p values that is important. I I used to think physicians are physicians and technologists are all scientists and you're evidence-based. So all I have to do is give you the statistical significance and show you the graphs and
[00:03:28] instantly everyone will be on my side. Right. Right. Where's everybody? Where where's everybody going? Right. And so this is the the lesson that I've learned and and I talk about this uh store various stories of how I failed and sort of pick up the pieces and figured out how to carry on.
[00:03:44] Who needs to to read it most? Is it the technical leader, the physician executive, the person who thinks the implementation is someone else's responsibility? Because even maybe since you've written it, and I'd be curious, this is probably the follow on to a degree and maybe what you'll teach in your classes is now the whole aspect of vibe coding and anybody can go create an app over the weekend and bring it forward. It's only going to exacerbate
[00:04:03] exactly what you're talking about it. Who needs to read it and what's the current implication? [snorts] Oh my god. Do we have several hours? Because I would love to cover exactly what I would make it multi-art for sure.
[00:04:15] So part of it is that yes, I I think some of it is for my colleagues who are medical leaders and technological leaders who who think well just turn it on. How hard is it? Just make it mandatory. I had a colleague, here's a story. Um, one of my car colleagues who shall go unnamed about 10 years ago said, "Well, now that we have Epic, it
[00:04:39] should be pretty simple for you to turn on some hard stops. I would like a hard stop, please. Please make it so that the primary care doctors," he was not a primary care doc. I would like to make it so that minutes exercised per week is mandatory. And I think every primary care doc should pause at every visit and record minutes exercised per week.
[00:04:59] That's the next vital sign. That's totally important. Just make it a hard stop. We're like, who did you vet this with? Did you talk to the primary care docs? How hard is it? Just turn it on. It's a hard stop, right? Just a switch.
[00:05:10] It's like right over there. Just instead of making it optional. And I said, well, we don't usually turn things on unless that we've sort of vetted it with leadership. And primary care leadership really seems to need to know about this.
[00:05:23] We do 2 million ambulatory visits a year. And this will take several minutes out of a check-in. two million times per year. So that's pretty important. Yeah. Yeah. Yeah. Yeah. But you don't understand it. It'll help my research project and it's good for patient care and so why would I? And so we asked him if you get primary care leaders to agree and send me an email that they all agree that this hard stop is important, we'd
[00:05:46] be happy to turn it on for you and we never heard from them again. And so this is the sort of thing that, you know, having stepped in the potholes earlier that we would go, "Oh, that's a good idea. let's flip this on and get immediate push back from folks who are like, do you not think I'm running as fast as I can and you're just going to make another thing to slow me down? Yes, theoretically it's a good idea, but there's no time in the day. What we we
[00:06:08] know that what is it primary care docs? I'm a primary care doc myself. If we were to perform every evidence-based action for an 8hour day of seeing patients, it would take us 24 hours to do that. And it's just there's so many things you can't do it all. And here's CTN turning on another hard stop. That's a terrible idea. So that's the sort of thing that we sort of have to work through all the time to get to the
[00:06:32] consensus to go forward. Well, you you chose stories of failure as teaching material. What made you willing to put your own mistakes in print? It was my daughter who was learning about mindfulness and studying Buddhism and talking about failure being the best way for us to learn from ourselves and to be humble enough and to be vulnerable to share that we've all
[00:06:56] failed. I think we're all victims right now of the Facebook syndrome, the social media syndrome of we only post things that we're proud of. The person who's vacationing in Fiji, so and so's skiing in the Alps, right?
[00:07:09] [clears throat] Everyone's online life is better than mine. And so, how dare I say anything about how terrible things are? And I think it's particularly poignant if you take or ask senior leaders to say, "Oh, you know, everything I've had so many failures in my life." I actually did have a junior informantist who is just getting started who joined our group just in the last few years when things were going better for me because I'd
[00:07:33] learned some lessons. They're like, "Well, well, how hard is it for you? everything you do is successful and like let's just talk about, you know, my my past because it's littered with things that were half done or came up against, you know, brick walls and completely fell apart. And it's kind of funny to look back now with tincture of time and be able to say, you know, I failed at this, we failed at this. I mean, one of
[00:07:57] my big examples for failure is radiology indications of use. So, um, this is about 10 years ago when there was rumor that the feds were going to allow insurance authorizations to go through seamlessly if at the time that you order a radiology study that you could select a reason that was already approved.
[00:08:20] We're like, well, great. That takes a whole um guessing game out of the ordering a head CT because we're going to just show you the 80 possible reasons that are already approved for headct worst headache of my life and so forth.
[00:08:36] Turns out there's some subtlety to that, right? So where do you put worst headache of my life? Do you put it under alphabetically neurology headache worst? Do you put it under W for worst headache of my life? Do you put it under headache? and we had a hard time arguing for how to design it. We ended up making it alphabetical and uh worst headache of life down near the bottom. Um we were very much patting ourselves on the back.
[00:08:59] We flipped the switch. This is going to be great. all these insurance things are going to go through more seamlessly. And within eight hours, we had a just a a title wave of complaints because when you open up the headct order, you have to scroll five or six pages of checklists and you can never find what you want because the way you think about ordering this list and someone else is completely different. Guess what? Within
[00:09:23] another day or two, there was an outbreak of acromegaly in our hospital. A no one knows what acromegaly is. B sounds good and C is right at the top of the alphabetical list and suddenly you know we see maybe two cases of acromegaly a year and suddenly there were 16 cases in the first in the next day and that's because well I know it's going to go through and and you know get out of my way kind of thing is what the behavior of my clinician colleagues so
[00:09:48] by the fourth day we removed this the the new the new design and it's just humbling to go you know what this is harder than it looks and we should be humble about testing this rather than you know flipping the switch and Oh, I'm sure you guys are going to love this.
[00:10:02] As opposed to just putting the most used or most common at the top, which would have created the same problem in a different way. And I've Yeah, I I'm having a little bit of flashback PTSD from similar initiatives in my career as well. And so often what seems like it might be the right thing to do ends up with so many different layers of complexity. It uncovers opportunities for us to explore in different workflow in our orgs, but at the same time,
[00:10:24] sometimes solving one problem creates a whole slew of others. For sure. Exactly. Wow. All right. Well, you recently completed your time as CMI at UC Health again after roughly 30 years with One System. Now that you're officially on the other side of that opportunity, what does it feel like today?
[00:10:41] You know, I'm only 21 days into this journey and uh it's a little unsettling. You know, the the biggest challenge I had and how terrible is this that I went back to look at my LinkedIn profile and the first word on my LinkedIn profile, CMIO. And you know, through my entire career, I thought, you know, my job is my job. That's not my identity. I'm I have, you know, I'm much more
[00:11:05] interesting than just CMIO. And I had a hard time. I sat there for an hour looking at that that description going, "Well, what the heck am I if not CMIO?" And uh um I still struggle with that.
[00:11:19] It's really kind of interesting to have decades of this being your identity and having that removed and figuring out what you are. I ended up writing author instead, which you know, fortunately, I'd been working on this book for nine years now and and to get it out the door sort of at the same time has been sort of a lifesaver for me to say, "Oh, I can turn my hyperachiever focus to, you know, scheduling a book tour and
[00:11:42] figuring out how to how to do this on my own." I feel like the work the structure of the way I would go through my life of 12 to 14 meetings a day came down to no meetings a day and then some patients to see I'm still seeing patients for a couple more months and so having two afternoons where I'm seeing patients gives me a little bit of structure but there's a lot of openings in my calendar now and how do you fill it how do you
[00:12:05] construct something that you feel useful going forward and so I'm still figuring that out lots of bucket list items that I'm looking at could I be cycling across the country, Portland to Portland.
[00:12:17] That's on the bucket list potentially. Spouse looks at me like you're nuts, but who knows? Book tour is on the on the list potentially. And creativity, you know, singing my songs, sketching, doing something that's artistic, going in a different direction. So, I don't know.
[00:12:32] Don't know yet. I feel like we could put best-selling author as part of that and adventurous and bucket bucket list pursuer. There's so many things about you that and I'm so grateful you shared that perspective because I mean even as a physician you know we often say like well you're still a doctor you always go back to practicing medicine but you had so many people that you touched in different aspects of your life although CT I
[00:12:53] haven't known you for a while I have this like sneaking suspicion that this time will fill with so many meaningful pieces that people start to realize you're available to help them with because you're now able to extend yourself into new spaces. So whether that's your creativity, seeing patients, writing more books, going on some of these big adventures, I imagine that that profile is going to climb in a
[00:13:17] totally new and different way for you. I'd hope so. It it's unsettling now because it's hard to know which of these paths to think about and maybe a little bit of everything to to sample right now. So yes, thank you. I I have lots of interest and I'm trying to figure out how to satisfy them at this point.
[00:13:35] It's going to be fun to watch the journey. Was writing the book connected to this transition in some way? A capstone, a handoff. I mean, something that you needed to say before leaving the CMIC.
[00:13:48] You may know I've been writing my blog now for about eight years. I have about 700 posts. In the beginning, the first few years, I'm pretty sure I was writing for myself and my mother. And occasionally someone would come up to a meeting and say, "Well, I I've read your read your blog." And I'm like, "Oh, so you've doubled my readership from like my mother." And then like you as well.
[00:14:05] So I found some solace in just writing for myself. You know, I failed at this. This was interesting. Hey, I learned something. I thought, you know, I read something. This is a nice little phrase that I'm going to keep in mind. I would write that for myself. And over the years, I thought this could cohhere into several narratives about, you know, how do you investigate? How do you really listen? Well, we think we're good
[00:14:27] listeners. We're not good listeners. Even today, you know, my kids are like, "Dad, you're not listening." Oh, yeah. Okay. Sure. It's part of the human condition, but the better I listen, I feel like the more effective our projects are. And and I learned that lesson over and over again. And to come have that come at me in a number of different stories and be able to talk about it, it was really a lot a lot of fun. It is kind of handy right now for
[00:14:49] me in this transition to say that I'm a book author. But this book has been in the works, like I said, for you know, seven, eight, nine years. And I feel really good about being able to encapsulate that in a way that might be useful to others. Well, what drew you to becoming a professor emeritus rather than moving into another health system operating role with your years of experience? There's no shortage of places that need that acumen from you.
[00:15:14] I don't have a good answer for you. Um I, you know, there's something to be said for feeling useful and feeling wanted. And I did actually go and talk with a number of head hunters about, hey, you know, do you think there's an opportunity? and for them to turn around and say, "Can you start tomorrow, but you'll have to move, right?" And I like where I am in Denver. And all of these folks are like, "Yeah, we need you in
[00:15:37] another state and you could start tomorrow if you'd like." So, it's both gratifying to know that I have a skill set that is useful. And also, do I need 14 meetings in a day and, you know, 60 80our weeks anymore? I don't think so. I I think I'm interested in sort of flexing, you know, my creativity and thinking about, you know, what else could I be good at and help helpful for?
[00:15:59] But I'm curious too from from the years that you have done, what you've done, what you wrote about. I also remember you saying one time that only 15% of your emails get opened and I was like, dang, there's a big message here. So I have a feeling like more and more people are going to be leaning into the things that they should have always been hearing from you when you were in the role that you were in. But so much of
[00:16:18] the digital initiatives or the new tech that we believe should be the easy button, they have a reputation for going wrong in what you now know as predictable ways. What is the pattern that leaders today need to be thinking about that they may not see coming?
[00:16:36] We're all enamored about the shiny new thing. Generative AI is going to solve everything. To your point, vibe coding is going to solve everything. Every frontline doctor can do vi coding and fix their own sort of things. And to some small degree, that's probably true.
[00:16:50] It can teach you how to improve your smartphones. Turns out you can ask it. Hey, I want to do this thing that I never knew how to do. And here, let me show you how to do that. I've learned that myself with even with my the blog that I host. I've been using WordPress and I probably using 10% of what WordPress tools can can do for me. And as I'm starting to work with Claude AI myself, I ask it questions. You I don't
[00:17:15] like this about my blog and I'd like to make this better. Oh, would you like me to show you how to do that? In fact, I could do that for you. What do you want? You want your image to move this way? You want the color to change? Yes, please. Okay, let me do that for you.
[00:17:27] And it will just work its way and go, what do you do? You like this better? I'm like, yes. So, here I am vibe coding my my my my blog site. And I and I think that many clinicians can take their workflow and ask AI in a hippoprotected way to think about improving their workflow. And so I think the the ultimate flexibility of tools that are better assistance to us is super cool.
[00:17:52] At the same time, when you try to scale this up, you're going to run into the same things that we have always run into, which is how do you govern it? How do you make sure it's not you're throwing everything in the kitchen sink and now it's a complete mess because you allowed everyone to customize to such a degree that you can't make the it's the tragedy of the commons. If you don't really curate your commons in a way that
[00:18:13] everyone can come in and be good partners to each other, then it's just chaos, right? That I I love the story. In fact, someone had to tell me this about early America where if you had the commons in the men in the city center, the town center, and everyone sent their cows to graze, it would just get ripped up because no one's going to take care of it. It belongs to everyone.
[00:18:34] Therefore, it belongs to nobody and no one's going to and this is kind of our problem list today. We talk about problem lists where people dump a bunch of problems in there. We don't curate it. We don't get rid of the duplication.
[00:18:44] And if no one's in charge, then it's a mess. So that that's the tragedy of the commons. And I feel like this is going to be the same thing with generative AI. If we're not careful about governing the way we work with each other, we have another tragedy coming. So we have to be very careful. As you see health moves through the CMO CMIO transition, what what have you tried to hand forward and not just projects and documentation but
[00:19:08] the relationships, the context and what gets missed most is the institutional memory. Right. Um, what I'm very encouraged about, first of all, I'm going to tell you that I name committees in a terrible way and actually some of my colleagues despise it. So my my favorite committee is my large pigs
[00:19:34] and and pig for us is the physician informatics group and so there are fair number of my colleagues who have some objection to being called a pig but I I I have a small or senior pig group which is my senior medical directors and then the large pig which is the entire group of 25 and I'm very encouraged that during this transition that our senior leaders in fact our entire large pig
[00:19:58] group has enough institutional members memory as a group that they can carry things forward. As our new leaders have come in, I'm very encouraged that as we sat in a room and our new leaders were sort of grilling my senior my senior pigs about what was going on that I actually spoke very little and for them to be able to carry the waterfront of all of the projects going forward. That was really a good feeling for me to say
[00:20:22] as I step away that the institutional memory does get carried on because this small group does carry much of that forward. So, I live in a pretty rural area and pigs are super smart and they're also hard to contain. Like, they are hard to like keep in their pens. And so, I I do not have one in the backyard, just for full disclosure. But it's actually kind of a compliment. You're smart and you can't be contained. Like,
[00:20:43] you know, there are worse animals to be identified with for sure. You you you could call me that and I'd be like, "Oh, I feel like it was a compliment coming from you quite [laughter] honestly." One last question for you because time is always the factor. But, you know what? Wow. will have you back on this show anytime you prefer. Is that after 30 years inside of a health system? What matters most now?
[00:21:07] And what are you most excited about contributing to this next chapter? Maybe I'll turn that around and offer to sing you a song. Would that be acceptable?
[00:21:17] I Yes. Okay. I was going to ask for a little ukulele moment as well, but I will take a song for sure. I love this. This is something in the way she computes.
[00:21:33] [music] Something [singing] in the way she computes attracts me [music] like no [singing] other toolar.
[00:21:45] All the easy [music] answers she gives me. She passes examinations now. You know I believe I'm wowed this unsettled CMI.
[00:22:09] Am I just a byone do bird? Can my work be done by tech bros generating [music] synthetic pros? My meaning is lost in shadows [music] with AI. Will [singing and music] my
[00:22:38] brain plate? I don't know. I don't [singing and music] know. My old thinking I must let go.
[00:22:52] But I'm still human. [music] I must [singing] grow. Something in [music and singing] the way she computes.
[00:23:06] Challenges my [singing and music] deepest point of view. When she expands my knowhow, [music] we can tackle tougher problems.
[00:23:19] [singing] Now, you know, I believe and how. [music] [music] Thank you for just your years of toutelage, friendship, contributions to our community. And again, I feel like you're just getting started.
[00:23:43] Thank you. Always great to see you. And uh for all of our community that gets chance to listen to this one, thank you for CT for being on the show and I know we'll do it again before too long.
[00:23:54] Great. Looking forward to it. Likewise. And for all of you listening, that's all for now. Thanks for listening. The conversations happening in healthcare IT right now are too important to stay in the room. And that's exactly why we bring them here.
[00:24:08] If today's episode made you think, share it with someone who needs to hear it. Subscribe to the 229 Project podcast at thisweek.com/subscribe and come find us at the next event 229pro.com.
[00:24:20] These conversations are better when more of us are in them. See you next time. [music] [music]