Second day of Epic training went well. We were taught Inbox processing and how to interact with the patient portal. This was miles more straight forward than documenting a patient encounter. The following morning was “personalization lab” where things that are done every day can be made into macro-like phrases or entire notes, to make documenting faster. Unfortunately on arriving for my training, I couldn’t get into the live environment. For an hour and a half. Our trainer kept calling the IT security folks who would say “She should be able to get in now”. Nope. After one and a half years of preparation for this moment, they waited until the day before to give us access. Seriously? Since anything that can go wrong does, why was that felt to be a good idea?
The afternoon was spent in a dress rehearsal. Thank GOODNESS we did this before seeing live patients. The hardware, which had been tested with two previous technical dress rehearsals, did not work as expected. Multiple issues ensued and I have minimal hopes that GoLive will not see similar problems crop up. It took up to two minutes for the Epic software to load on our thin clients . In order for us to get faster loads we had to get rid of the ability to open up our previous software in the exam rooms. This means, in order to see the patient’s old charting, I will have to carry another piece of hardware or leave the room. Not efficient, especially since there is also trouble with the database with all our scanned information. Next we discovered that logging into the thin client took us to our patient schedule instead of straight into the patient’s chart. Not only an efficiency problem, but a compliance issue since a patient could theoretically see other patients’ names and reason for visit.
We had software issues as well but those were minimal. Of course with no trainers to help the end users, we could accomplish only the minimal tasks our eight hours of training gave us. Go Live should be interesting–my associate has armed us with dark chocolate M&Ms (since alcohol would be frowned upon) and is bringing a cowbell to make sure she has no trouble getting the trainers’ attention.
Cowbells, chocolate and a shiny EHR software right out of the box. What could go wrong?
In exactly two weeks my office will “GO LIVE” with Epic EHR (Electronic Health Record) 2015. This is a much anticipated systemwide move from our present EHR software and has been heralded with a circus analogy, a horde of analysts and other HIT experts, inconceivable amounts of money, two years of planning and general dis-ease among the doctors who are about to experience the change (see what I did there?). We are going live before the rest of our statewide system and I give credit to my associate, Dr. Diana Irvin, for not killing me when she learned that we would be one of the two pilot offices. Of course there is still time for her to rethink that…
We begin “for real” training this morning, the first of three sessions. I participated in pilot training three weeks ago. This was poorly done and now worries me as to how today will go. For a software product that has been around for so long, it was astonishing to me that the pilot was so badly organized. Epic disavowed any responsibility for that in the voice of its representative at our last GLRA (Go Live Readiness Assessment) meeting. Fortunately I have every confidence in our Medsys consultant and Chief Medical Officer (CMO) to make the training more meaningful and efficient for physicians. They have impressed me over the last two years by having an understanding of how to make things work better for the doctors in matters of our developing EHR.
As a Physician Champion for this effort, the most meaningful training I’ve experienced occurred last week when I sat down with three IT analysts and went through a couple of scenarios specific to my workflow. After almost a year of Epic video examples I could finally see the power of the software. It’s clear that it needs a lot of personalization to make it hum, but I caught a glimpse of possibility. As a geek that makes me excited. As a physician, I don’t know. How much will this tool speed up my ability to see patients while amassing helpful data and improve patient care? Will I finally get home before 7 pm every night I work? My colleagues just want to take care of patients. They are not interested in software and most of them are not digital natives. How much can I help my associates in my role as Physician Champion, to speed up the tool? We’ll see.
I hope the circus analogy doesn’t make clowns of us all.by
No argument that EHRs began as billing platforms, though I will argue that they work just as poorly with charging as they do for communicating patients’ stories or making better decisions in patient care. After two years our EHR still isn’t used for billing and even if it were, since it has no Natural Language Processing capabilities, the doctor would have to manually enter the correct CPT code.
My rant today is a brief one about how physicians document in an ambulatory EHR. On paper, we documented the patient’s story, any pertinent medical history and/or family history, the physical exam, our assessment and the plan (better known as a SOAP note). This was a short, succinct and usable communication device (assuming you could read the doctor’s handwriting). Today’s physicians, in the hopes of better compensation, pull in every possible bit of information into the note including their great great great grandmother’s penchant for getting hangnails. OK, that’s hyperbole, but it is almost that bad. And then complain that the EHR is a terrible way to communicate and that everyone else’s notes are too long.
Having been the “champion” for the EHR in our system I have a request to make — Hide, or have your assistant hide, all that past medical history. You didn’t put it in your paper note and IT DOESN’T NEED TO BE IN YOUR ELECTRONIC NOTE EITHER. If it’s a matter of training or you don’t know how to take it out, please ask your friendly IT trainer and they will gladly help you.
There, I’ve said it and I feel so much better!by
Google Glass is in its infancy, with over 8000 “explorers” who are eager to find compelling uses for it. The concept is cool: A hands-free cell phone that is voice activated. A month ago my healthcare social media friend Kathi Browne, who is a Glass Explorer, proposed driving to Louisville from Knoxville to allow me to play with Glass for two days.
|Kathi Browne‘s Google+ site|
I was excited to accept her generous offer. She was equally accommodating about spending two days in my home which is presently a construction area with two cats, to which she is allergic. She seemed to tolerate the experience admirably.
As expected with a beta product, we had a few setbacks. We couldn’t tether Glass to my iPhone unless I gave up my grandfathered unlimited data plan. That wasn’t happening. Next we tried using the local network in my office. When that didn’t work we thought we’d found an answer jumping on my MiFi. That was great until Glass went into sleep mode (which is frequent due to a short battery life) which disrupted the MiFi connection and I couldn’t get it back online until the battery was taken out of the unit. It isn’t easy to remove. Finally Kathi just handed me her phone and I stayed live on her account.
The main advantage over a regular smartphone is how surprisingly unobtrusive the device is, both to you and the patients. It’s easy for the wearer to ignore it except when in use. Patients were of three varieties–too polite to ask what was on my head until I brought it up and then not caring, knowing immediately what it was and wanting to play with it, and being unaware of the product but excited to learn about it. No one appeared worried and the first thing I told them on entering the room was that it was not recording.
While it’s easy to understand how surgeons, teaching physicians or ER personnel might use Glass, its implications in the primary care office are less clear. A few thoughts:
- Glass is much less obtrusive than the laptop I carry or even the chart I used to carry. If I could dictate into the EHR this could enhance communication with patients.
- Having a projection screen that would show the patient what I was looking at could be used for education, the way I sometimes use my iPad now. For instance, I had a patient with shingles on her back and I could project her rash or a reference rash for comparison. I can do that with my iPad now but that involves carrying an iPad and a laptop. I don’t use the laptop for education because the screen is awful.
- On the down side, there is no unobtrusive way to Google a question using voice activation. My patients would know exactly how dumb I am. Wait, I already do that with them on the laptop so with Glass I could look cool and dumb.
- In a rural setting, sending a picture or a video from the exam room to a specialist would be advantageous but no more than telemedicine could do.
- Calling up an examination video for something I don’t do a lot of, like a specific orthopedic exam, could be helpful but I’m not sure about the patient’s reaction. They usually prefer to think their doctor is well-versed in such things. Back to cool and dumb.
- It’s quicker to Google with Glass, an advantage over a cell phone.
- The voice recognition is amazing. Odd names and medical terms were usually nailed on the first try. However, there didn’t seem to be a way to correct recognition mistakes.
- I suppose patients would get used to it, but would they worry that I was secretly recording them?
- As Clive Thompson commented in today’s New York Times, using Glass is uncomfortable enough that constantly looking at the little screen is not an option. That could improve communicating time instead of the way the EHR takes away from it.
- How about an app in Glass that would identify a rash within certain parameters of likelihood? That is, a Watson for Glass. This was also suggested by Melissa McCormack of Software Advice in the Profitable Practice blog.
1. Googling Yourself Takes on a Whole New Meaning http://goo.gl/WAAWki
Post was edited 9-4-2013 by request of Ms. McCormack to better describe her blog.by