Informatics Experts Share War Stories from the Front Lines

By Nick Klenske

Sachs

Nobody wants to open their email to find a message from their CIO written in all caps – especially one that concludes with the unnecessary clarification, "YES I AM YELLING AT YOU!"

But this is exactly the type of pulse-quickening message that Peter Sachs, MD, section chief of thoracic imaging and vice chair of informatics at the University of Colorado, Boulder, received from his CIO, who he described as an "an incredibly brilliant visionary, supportive leader."

As a physician informaticist, Dr. Sachs reports to numerous bosses and stakeholders, which is extremely complex.

"This can make keeping track of what you're doing and who you're doing it for a bit challenging," he said. "If you're not careful, you could easily end up being the recipient of a very angry email."

Dr. Sachs, who believes we can all learn from our mistakes, shared his story during the informative, entertaining session, "Radiology Informatics Mistakes and War Stories from the Front Lines," featuring leading informatics experts discussing some of their most challenging situations – and offering tips for navigating them.

The Nuclear Option

Before discussing the angry email, Dr. Sachs first offered the backstory.

"I was involved in a lengthy discussion about displaying relative cost for imaging studies," Dr. Sachs explained. "The providers wanted to display the information, the radiologists didn't, and the CIO and CMIO were rather ambivalent about the whole thing."

Long story short, the radiologists got their way. But what should have been the end of the matter was in fact just a prelude, Dr. Sachs said.

"A couple of months later a group of providers approached the finance department about displaying cost information for imaging studies without telling me," Dr. Sachs said. "Needless to say, I was not happy."

What rational steps did Dr. Sachs take to address the issue? Did he politely raise the issue with the providers? Or maybe he discussed the problem with his CIO? Unfortunately, he did neither. Instead, Dr. Sachs went for the nuclear option: sending a strongly worded email telling everyone that the issue had already been decided.

"My chairman was happy with me for standing up for the department, the providers were disappointed, and my CIO was furious," Dr. Sachs recalled.

Lessons Learned: Check Your Ego at the Door

So, what did Dr. Sachs learn from this incident? "First and foremost, the angry email should never, ever be your go-to reaction," he said. "Always wait at least 24 hours to let yourself cool off before sending any email."

He also learned how complex loyalties can be. "A good starting point is to think very carefully about which constituencies you are acting on behalf of," he said.

Another key takeaway is the importance of communication. "All of this could have been avoided if I had just gone to the CIO and discussed it with him," Dr. Sachs said.

Most importantly: Keep in mind, it isn't about you.

"I took not being included in the discussions as a personal affront, even though this was a good faith effort by our providers," he said. "We have to take our egos out of the equation and remember that, at the end of the day, it's all about the patients and the providers."

Sessions from other leading informaticists:

• When Control-Alt-Delete Won't Work, Peter Harri, MD
• Hope is Not a Downtime Solution, James Whitfill, MD
• I Almost Got Fired as the Enterprise IT Doc, Christopher Roth, MD
• System Upgrades Can be Downgrades, Safwan Halabi, MD
• What We've Got Here is a Failure to Communicate, Amy Kotsenas, MD

For More Information:

View the RSNA 2020 session, Radiology Informatics Mistakes and War Stories from the Front Lines — RC154 at RSNA2020.RSNA.org.