An IT Transformation

Years ago, when I started working at my system as an employed physician, my perception of the IT department wasn’t very flattering. My first interaction occurred when we wanted to download the patient demographics from my billing company’s software to theirs. The program used was a common one on the market but the answer was a resounding no. As a geek I know a little about databases, so I knew it could be done. When asked “why not” my IT deptpartner and I were told that IT was concerned about getting a virus. What?!?! Seriously? So my staff started from zero inputting data for a few thousand patients. What a waste of their time.

My next aggravation was software upgrades done at convenient hours–for IT. The idea of taking down a system during regular working hours at any large corporation was ludicrous but at a hospital? When discussing that the “tail seemed to wag the dog” in our system, administrator types would just nod sadly. When our outpatient EHR was being chosen I hoped to be on the physician committee to help. No such luck. Partly because there was no such committee. Seriously?

In early 2012 my geekiness finally became obvious to administration. Someone decided I would make a good EHR Physician Champion. As Allscripts Enterprise was implemented I threw myself into the job. The program and the process was frustrating in many ways but slowly I met a lot of people in the IT department. The first surprising thing was how excited analysts were to have a doctor willing to talk to them. I’d get email questions about how best to configure things to fit physician workflow. One day it hit me. The irritation doctors had often matched the analysts’ angst when making EHR configurations for patient care matters. Sometimes it was as simple as not having access to a doctor to ask the question.

It is clear that lack of usability in EHR systems has to do with inadequate end-user input.[1,2] The good news is that there is a refreshing change in attitude. As more physicians move into leadership positions, IT leaders appear delighted to partner with us to improve patient care.  Another silo is torn down to serve our patients better. Life as a doctor just got a little bit lighter. And maybe that’s true for the software analysts and project directors over in the IT building who more and more are recognized as being an important part of the healthcare team.

  1. 1. EHR design flaws causing doctors to revert to paper. Dolan, Pam. amednews.com 4/8/13  http://www.amednews.com/article/20130408/business/130409961/6/
  2. 2. What causes physicians to become dissatisfied with EHRs? Murphy Ph.D, Kyle. EHRIntelligence.com 12/13/2013 http://ehrintelligence.com/2013/12/03/what-causes-physician-to-become-dissatisfied-with-ehrs/

 

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An EHR Obsession

My Saturday morning walking partner asked me yesterday, “So when do you get to quit being an IT professional and go back to being a doctor?” Wow, good question.

In the not quite three weeks of this new form of documentation I have been consumed with trying to understand and make the EHR work for me. No longer do I have to consult a “superuser” every ten minutes with questions but every day I’m trying to figure out the most efficient way to care for people using this frustrating new tool. The “muscle memory” is beginning to kick in thank goodness, so time per patient is less. Now my frustrations are more with what seems to be a very inefficient system. I struggle to determine whether I am the problem or the EHR is. Most likely it’s a little of both. The term Mission Hostile User Experience coined by Scot Silverstein comes to mind. What is scary here is the potential for patient harm – between my distractibility due to the steep learning curve of the Allscripts system, the fact that no one has told us how to clean these “Toughbook” fomites that we carry from one patient exam room to the next, and the patient care error potential inherent in the software itself, these are the ever present worries that keeps me up at night.

On Thursday of this week, the EHR Steering Committee for my organization will meet and I will have the opportunity to present the go-live experience and make suggestions for improvement as other offices in the system go live. Throughout this process there has remained a sense of re-inventing the wheel, which seems odd considering that Allscripts EHR has been in existence for years, having gone public in 1999.

At any rate this blog is obsessed with EHR right now–but the essential question remains. When do I get to go back to taking care of patients?

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