101 | After Show: Deeper Dive into Changing Your EHR with Rachel O'Brien, MA, IBCLC

Annie
Hey there, Leah.

Leah
Hey there, Annie, how are you?

Annie
Well, I'm great, because we just spent an hour with Rachel O'Brien chatting about charting woes and trials and tribulations and all of our stressors, and was very cathartic. I felt seen, I was with my people. It was a lot of fun.

Leah
Definitely, I feel the same way. I think it was really helpful to hear that a lot of people have the same encountered, kind of like the same struggles and frustrations when it comes to charting and like, we were talking a lot about the unicorn that lactation charting is. So it was a such a great conversation. And we're so excited to have Rachel here for with us for this, like, after show. Let's talk about what we talked about. One of the thing else we want to talk about, right? Like, there's so many things I want to talk about.

Annie
One of the things we didn't really have time to talk about because we ran out of time we were it was just like it went so fast that deeper dive was Rachel mentioned, like not being able to use an in the box program because it doesn't chart the things that she wants to do, which is primarily, like the bottle refusals, which is your specialty, and I was thinking about for guiding bottle breakthroughs last year, and it'll be in this year's iteration too. You did that chart review where you went through and so when you're talking so one of the things that Rachel said was the pain point for her was like, I have to import all of my charts into a new system. And it's not just to have them. It's because I would love to hear tell us about that chart review you did and how you're using your data, because I know that's so important to you.

Rachel
Yeah. So IntakeQ has some cool features in terms of data collection, where, let me think, off the top of my head, it's in if you go into intake queue and then go into questionnaires, that tells you a lot of the stuff that I was looking at for my chart review. So that was one thing I did where I would go into questionnaires, and there would be certain questions in my intake forms that I could pretty easily pull out in terms of knowing what my chart review was, but then also what I did for the chart review was I found all of the charts that were bottle refusal consults. I keep a separate form so I have a bottle refusal chart template, so I looked for all of those that I had filled out, and then I downloaded the chart information in a Excel file for each one of those. So not one by one. I did the whole chunk at one, so I forget how many 700 something I think at the time. And then what I tried to do, which was hard, was I scrubbed through and looked to see what things I could figure out that were commonalities. So the nice thing about intake Q is there are a lot of check boxes and radio buttons and so those things are going to get the same answer. What I really struggled with, which I found amusing and annoying, was I have a lot of text fields that I fill out as the charting goes on right. So, like, I have one field that says, which bottles have you guys tried already? And so one of the things I was trying to do when doing my chart review was seeing like, oh, ever does everybody have Dr browns? But I wrote things slightly differently. So sometimes I would write Tommy tippy, and sometimes I would write TT, and sometimes I would write Tommy, and then, you know, nothing, and then tippy, it was very hard to get that information out if it was anything that I typed in, because, you know, I could do a typo, I could do whatever. And suddenly that information wasn't easily Grover or scrubbable. Now, I am sure that there are programs and things out there that will do that kind of analysis for you, if you, if you can, you know, upload a whole giant chunk of data. But then the other thing was, this is all my client data. I'm not sending this to anybody. I'm not I don't have permission from 700 people to, like, get their particular chart reviewed. So that's how I did that. I don't know how you would even do it in any of the other charting programs.

Annie
I do find the exports that intake you makes are really good. And there, actually, there is a way that you could do that if you took your Excel file and go by column and just delete all the columns that have protected health information in them. So Di. De identifying, and that includes the number of the client, like you're the sign number in your system, so everything that is phi, so you just have the data, and then you can take that and upload it to Claude and start asking it questions about it, and that is where it can figure some of that stuff out, but it also you can say, what questions do you have for me about this? And so using an AI though, not to tell you, not for it to interpret for you, but for it to help you organize things and to come up with questions to ask or point out things that maybe you hadn't noticed, but it might point out something, you might be like, no, no. That's I know why it did that the robot doesn't know.

Rachel
Last when I did this, when I was doing the program last year, I did do things like I would, I would copy the entire column of text that was the names of the bottles, and I would throw it all into chat GPT, and I would ask it to tell me how many. And it was just making so much stuff up.

Leah
I think it has the same problem we do, like, if it sees two slightly different ones, it's like, okay, that's one.

Rachel
And I couldn't even, like, I was like, okay, just anything that it says, Any word, just tell me how many times that word. And they were like, 73 per jillion. And it's one of those things, right? The thing about AI is, if you don't know the answer, it's very easy to believe what they tell you. Yeah, if you do not have the knowledge to know that's wrong, you go, Oh, cool. Now I know, but if you have enough knowledge about the topic to go back and double check, you realize, holy crap, you're just making stuff up, and we're all just taking it as real. So Claude wasn't around. I don't think.

Annie
I don't think so. I think cloud is better. They have this, like, deep analysis. It's expensive. I mean, you would have, you would be paying for it. But they have, like, where it takes longer and it thinks harder about it. My favorite AI thing that ever happened to me, which is when I was like, oh, yeah, we cannot trust anything. Was I was talking to John. I was like, How come nobody has ever made a movie about Ernest Shackleton, famed Antarctic explorer. Do you know about Ernest Shackleton? He took all his people in a boat, and they got encased in ice in the Antarctic and he led them all to safety and, like, they didn't die. And there's like a great IMAX document, yeah, there's like, an IMAX documentary about it. That's, like, amazing, but Eddie and I love survival stories. But I was like, they should make a movie about it. And I was like, I Googled, I'm like, Ernest Shackleton movie. And then it was like. I was like, Oh my gosh, John, there's an Ernest Shackleton movie coming out starring Tom Hardy from Mad Max and dearly wrote. And he was like, Wow. I was like, Oh my gosh, he's perfect to play Shackleton. And I was like, Oh no, Gemini just is like, this is a good idea. Because I was like, it's coming out tomorrow. Then I went on IMDb. I was like, this is all lies. I was like, how you can't do that to me. I wanted to see that movie now, so bad. And now I'm like, all I'm like, that would have been a great movie, and it doesn't exist, and it should definitely so,

Rachel
Yeah, it's fun. AI is super fun.

Leah
Yeah, and all the getting all of that with AI, you know, that's the other like ongoing when we we had just touched on that a little bit during our conversation, was kind of the limitations that different charting platforms have around that, and kind of different workarounds and things like that. But it was interesting to hear, like other people kind of what they're thinking about when they're thinking about charting platforms, like, if you're new and starting out, like, what would be some ways to come about it? You know, we we went through both like, oh, try to have one that you'd stay on forever, but also the point that Rachel was making. Like, here's some other perspectives to think about it. And definitely want to hear that conversation if you're somebody that's starting out in private practice, because really dived a little bit into, like, some different ways to think about how you would first approach a charting platform, which I thought was so helpful, and like, why weren't we around when we all started? I know, right? Like, why wasn't I helping me? We were having this conversation back when we started that Annie and I always say, like, our gift to everybody is like, don't do all the things that we did. Learn from our mistakes. Learn from all the ways that we're like, dang it. Why did I even do that so you don't have to go through all those trials and tribulations?

Annie
So I wanted to also ask Rachel, I think, because we're talking about, like, AI and like, now you've been doing this for I've registered your bio since 2015 so you again. Like also made a lot of mistake, but now this is a little bit of a swerve, but I have my clients are saying things to me, like I asked chat GPT, and I had one client that said, you told me to do this. I asked. Chat GPT, and chat GP told me to do something else, and now I don't know what to do. Oh my gosh. And so, like, I would imagine that for something like bottle refusal that there are probably a lot of people asking. Have you ever asked chat GPT what to do if your baby is refusing a bottle? The chat GPT was like, who needs food?

Rachel
I do it all the time. And, you know, like, I'm just always super curious. I'll go on Reddit. I get a lot of people from Reddit, a lot of clients from Reddit, which is funny, because when I go on Reddit and look for, like, bottle refusal posts, I'm like, I don't know where they're getting my name from, because I don't see but whatever. Anyway, they're starting a lot more too, to get the, you know, the generative AI that comes was a Gemini at the top of Google. So it's almost like I have this new, like final boss to fight. Because not only is it, the pediatricians and the grandmas and the aunties who are like, Oh no, just starve your baby. It'll be fine. I don't know why you're giving in to them, but now I have this supposedly all knowing, all seeing thing that's just vomiting stuff out at them. And it gets interesting sometimes, every time I check whatever program I'm looking at, you know, they they're constantly quote learning, right? So I feel like every time you get a slightly different answer or a very different answer. And so I'm always looking at, are you calling this an oral function issue, or are you calling this a behavioral issue? And that's one of the things that I tell my clients when they're trying to figure out whose advice to listen to. Like that. To me, the easy question is, do they frame this as your baby having a hard time doing something, or do they frame this as your baby as being stubborn, and whichever one of those is that informs the entire way that they're going to come at this. And the AI switches back and forth on it, which is, or, you know, it doesn't understand the context of like, it's an oral function problem. And also, you shouldn't feed them like it doesn't it can't do that stuff yet. But yes, I am also getting people who are checking with chat GPT or using that to figure out what to do, and then, for some reason, not having a lot of success, because it doesn't think the way that we do.

Annie
Yeah, yeah. Imagine that,

Leah
a robot doesn't think like us. Shocking, yeah. I've had some recently. Also tell me, like, Hey, I, you know, created this, like, expected growth things and like, I asked it, like, all these different questions. And like, Is this accurate? And I'm like, I don't even know where that it's pulling some of this stuff from. It was kind of crazy, because I was like, I don't know where it's getting this, like, definitely not from generally recognized, you know, authoritative text on this. It's right, I don't know it. That's the scariest thing. It's like it's pulling from everything, which means a whole bunch of it's not great.

Rachel
If you're pulling from everything, then you're getting nothing you can you if you if your source is everything ever that's not a sort like you just, you get mush.

Leah
Yeah, yeah. You can't collate that down to any kind of good information.

Rachel
I was just gonna say I'm not at all against, I mean, yes, on paper, I'm very against, AI, but I'm not one of those people who's like, I'm not going to use it, because I do use it. I'm not. I'm not saying this like it's TLN, and I say you couldn't pay me to go to your TLN. That's different. I think that we all need to really use our critical thinking skills with this and not only what it's telling us, but like the processes that it tries to guide us through. And you know how easy it is to be like, no chat. GPT, that wasn't exactly what I meant. And they're like, Oh, you're right, I was wrong. And sometimes maybe they weren't wrong, but they're just like, oh, you said I was wrong. And it's like, please, please.

Leah
Don't think so like anything I say. You're like, I'll turn it to a positive and make you happy.

Annie
That's a great question. What a wonderful way of framing that dialog. You put it so perfectly. Yeah, I'm not gonna say I don't like having that said about my writing, but it's also like you have to be, yeah, discerning. I mean, I think that people, though, as much as our clients and people are using AI and looking to these sources, I think there is an awareness of the limitations, and that, if anything, it's making enough people hungry for an actual person that having the kind of training that we have to be an IV, CLC to get extra training and bottle refusal, like in guiding bottle breakthroughs, or the other, you know, all the other kinds of specialized trainings. Rachel and I both have the perinatal mental health certification, like, just where you're like, I can show you what training I've done. I have an education, and I am able to make decisions, and I'm able to put things together that not. No amount of like, you don't even know how to ask the question to get the answer that you want. And so I do think that there's an awareness of that, and that that's only going to make the need for the kind of services that we provide, not they're not going to go anywhere. Ai, yes, it can sort of like replace us, but it's not doing a good job, and it really doesn't. And the AI can't, like, make you feel like, even if you don't give your clients a hug, you can make them feel like they got a hug. You know what I mean? Like, I don't hug my clients, but like, I want them to feel like they were taken care of. And that's something you can't replicate with. You can do it through a screen on virtuals, like Rachel. I know Rachel does with all the rituals she does, she really does an amazing job of communicating empathy through a screen, but a robot it doesn't love you. It never will.

Rachel
No one is going to walk away from an AI going, oh my gosh, I feel so much better. Like and that, that is my favorite thing. I'm realizing lately, my favorite thing to hear a client says so much better, like when as you're leaving, and no matter how much smoke AI is going to blow up your butt, you're not going to walk away feeling relieved unless you talked it into making you feel relieved.

Annie
Yeah, this is so great. Thank you for sticking around after the deeper dive and talking with us about all these things that bother us in common. It's just like, always Leah and I always say the reason we did these deeper dives and why we keep doing them is just the chance to talk to other people in private practice. Because, you know, it's such a weird like we were saying the deeper dive, it's the weirdest job. It is so unicorn unique. Nobody gets it, but you guys.

Leah
Yeah, and then we are reminded when we're all together, like one, probably whatever you're experiencing, you're not the only one in the world of lactation. And two, you are not alone. And we create these spaces so that we can support each other, but also, like grow our knowledge base, help each other see different perspectives, like keep sharpening each other so that we can be the best version of lactation consultants out there in the world. And we really appreciate you being here with us today, Rachel and in our deeper dive. And I hope everybody takes a minute to go check out both this deeper dive that we just got done, doing and reviewing, but also all the ones we've done with Rachel before, because I feel like we always have the best time.

Annie
We do. We do.

Leah
So we appreciate you coming back with us once again.

Rachel
Thank you so much for having me.

Annie
On, yeah, well, we've done two with you, on one or two on bottled. With you on bottled. So those are in there, guiding bottle breakthroughs. This is our third iteration, Rachel's third iteration. I say we because I build it and sell it for her, but I don't it's the content is 100% Rachel, but we are now going to, finally going to Evergreen. So once you're in, you're in, and you get the library, and you get can go back and watch her videos as many times as you want to, so it'll be lifetime access once you're in and we have some ideas, too about building community. Rachel's working on ways to really promote guiding bottle breakthroughs providers on her website, and I'm always looking trying to figure out ways to get us connected outside of meta, owned platforms. So the more of you that are there, the better it is for all of us. And it's a great training. I use it all the time. So yes, thank you. Rachel guidingbottlebreakthroughs.com. You can check it out. Check it out on Rachel's website. All right, thanks, everybody. Have a great rest of your day.

Rachel
Have a great rest of your day. Bye.