A Go Live of EPIC Proportions

circus-653851_1920In 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.

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The Catch-22 of the Physician Champion Role

Yes, I’m a geek. When my girls were in high school, their friends were amazed that they received texts from their mother. One daughter has commented on Facebook that her mother is more tech-savvy than she is. At the beginning of 2012 my interest in the healthcare benefits of social media was born and I began blogging. I investigated and use LinkedIn, Twitter and Google+ while remaining attentive to Pinterest, AboutMe, Doximity, Instagram and others. So when my employer offered me the position of EHR Physician Champion for our physician group a couple of months ago, I took on the challenge. And challenge is the operative word.

Presently there are about 25 physicians in our 180+ multi-specialty group “live” (using electronic records). In a meeting specifically called to discuss “Provider Go-Lives”, three individuals tasked with implementing EHR turned to me and said, “So Dr. Nieder, how can we encourage doctors who are not embracing EHR to do so.” Hmmm….good question.

Let me preface these remarks by stating that our administrators have tried everything in their well-researched knowledge base to make this transition work. As we move forward improvements are made with every new Go Live. My immediate response was two-fold:

  1. In training, don’t give physicians the impression that using an EHR is using a paper chart in electronic form. It is an entirely new way to document and, unfortunately, the learning curve resembles third year medical school with IT support instead of attendings. It is every bit as daunting. 
  2. Encourage the doctors to shadow with someone already successfully using the system. 
The next question was harder. “What can we do to push the physicians who are balking?” Ah, therein lies the rub. Of course I recognize that the question was also my responsibility in the role of Physician Champion. To answer it, I was going to have to do some thinking. There are many reasons doctors give for not wanting to use EHR as posts by Palmd, HealthcareTechReview, MITTechnologyReview, and others attest but the biggest one in my system is that it slows down physicians whose salaries are based on productivity. 

My understanding of the value of EHR is simple enough–more legible notes, better population care using “big data“, enhanced patient care using clinical decision support tools, improved documentation to increase reimbursement, establishment of direct patient communication through portals, healthcare savings by reducing duplicate test ordering, and improved communication between providers in continuity of care. Even though our present system is poised to realize all these goals, the only one it is capable of performing at this very moment is legibility. So how can I convince physicians to use a tool that is going to slow them down (i.e. reduce their pay) and doesn’t yet have the necessary functionality to improve patient care?

As a geek, the EHR experience has me torn between two emotions: incredulity at its lack of usability  and that sinking sensation I remember from the late 80’s when the software rarely did what it was advertised to and crashed all too frequently, freezing the computer and forcing the user to restart both the software and often the entire system. The promise was there but the reality was long in coming. So too is today’s EHR. 
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