An update from Craig Norquist, MD, Chief medical information officer

Topics discussed:

1. High sensitivity troponin changes
2. Pain management order sets
3. Generative AI or ChatGPT
4. Removal of the Chrome browser

We were able to present with IT training at the Academic Affairs Grand Rounds on some high-level optimizations and trainings on Epic, particularly on In-Basket, Slicer Dicer, M*Modal, and Signal data. We helped many residents and attendings make changes to their commonly used tools in Epic, as well as the voice recognition tools. Using Signal to gauge how well we do before and after such trainings will help us modify how and what gets presented to larger groups with multiple provider types and what can be best used for smaller groups of similar specialties and locations. We will be growing these trainings for newly onboarded docs as well as those of us who have been here for a while. Please reach out to me or IT training for specific dates and times that trainings may be offered or if we should schedule more.

High sensitivity troponin changes

As many of you know, we have been forced to change workflows of our current high sensitivity (HS) troponin testing several months ago due to a shortage of reagent. As the shortage has eased, we will be transitioning back to the previous HS troponin at John C. Lincoln, Deer Valley and Sonoran Crossing medical centers.

This will happen as we prepare for the entire network shifting to the use of HS troponin, but with a different lab and test than we are currently using at those facilities. For various reasons including physical space available in the laboratories and validations of the machines, the rollout of such tests will be on a staggered basis. We understand this is not optimal. So, we will be creating multiple tools to support those providers who are working at different campuses while there are different tests being performed. Please look for communications around this as they become available.

Pain management order sets

As we are now in the order set review and management cycle, the pain management parts of most, if not all, order sets will be changed as agreed upon by the Opioid Stewardship Committee. They have been working hard to ensure the safety of our patients, respecting the burden of the providers and nurses alike, as well as conforming with the regulatory requirements from regulatory bodies on pain management. Please look for coming communications on how these changes might impact your commonly used order sets.

Generative AI or ChatGPT

Many of us have been following if not already using web-based tools such as ChatGPT or DALL-E, both tools from openAI. While these tools are interesting if not exciting and may eventually have uses in healthcare, there are currently very limited guidelines or boundaries around the how, when and where they should be used, and where they should be restricted, if possible.

While we as an organization work to come up with guidelines on the use of such tools, we implore you all to respect the personal health information (PHI) of patients by not putting any identifiable information into such prompts for these tools. There have been instances where information put into the tools has been inadvertently shared to others. Samsung engineers put some of their secure technical specs into what they thought was a secure tool only to later find that they had leaked out and were now out in the public domain. We cannot have identifiable details on patients “leaked” onto the web. If you choose to use these tools, never use patient names, dates of birth, zip or area codes together with visit dates, diseases or problems with problem lists or medications. These types of information can be easily triangulated to “discover” the identity of the person whose symptoms are being queried. While we will not be able to limit the use of these tools by patients or providers, we expect the respect of PHI to be paramount.

If you are using generative AI in a clinical situation, it should be treated as an “overconfident intern”, eager to please, mostly correct, but needs to be verified.

Removal of Chrome browser

As many of you have experienced, HonorHealth has made the decision to remove access to the Google Chrome browser for several security concerns. There are multiple “add-ones” or extensions that can be added to a Chrome browser that may lead to vulnerabilities to our network. Storing of passwords is also possible on Chrome which exposes potentially sensitive personal or health-related information. It is also recognized that not all systems or webpages work equally well on the Edge browser, so if you might need access to Chrome, we ask you to submit a request to have it loaded onto your workstation if no other solution exists.

As always please reach out to me or anyone in informatics if you have concerns, thoughts or questions.