The Great and Mighty EMR

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Image by nffcnnr via Flickr

For the last 2 years I’ve been involved with helping (not quite so)Mammoth Health Systems build and roll-out a new Electronic Medical Record.  It has been a time fraught with elation, despair, doubt and a good dose of “meh” followed by “WTF?”  When the cards are down, the reality is that our new Skynet is better than our old WOPR, but they’re both equally broken.  Why?  They are built to be everything for everyone.  But Skynet actually works and once you get used to it, truly is the wave of the future.

So our site rolled out a little over a week ago.  It wasn’t as big of a cluster-fuck as I was expecting.  The gods of medicine smiled kindly on us, no codes or RRTs that first 2 days/night, excellent staffing and relatively low census.  Then the storm clouds rolled in.  The house census went up and there wasn’t enough resource pool nurses to go around so places started going “short”.  Truth is, they weren’t really short, in fact they were at staffing levels that we normal run at, but for learning to use a new system with all of its foibles, we were short.  This was compounded by piss-poor planing by other shifts and other floors.  Our manager told the schedulers to post for extra shifts all three weeks of implementation.  The night shift scheduler did that, opened 3 extra shift slots a night for the duration and we’ve had really good results and have been staffed very well.  There were 11 of us the other night for 21 patients (although 2 were orientees and one was a “superuser”).  Day shift not so much.  They didn’t have slots for every day, and only 1-2 each day.  They’ve been getting mauled when it comes to staffing because most of the other units did the same thing so every unit in the hospital is scrambling to split up the few nurses in the float pool – day shifters are not happy – especially since many of them thought our manager had said that the ratio was going to the 2:1 (yes, 2:1 on a tele floor) for the roll out.  She never did.

But as for the system, it’s pretty great.  It’s a giant technical leap from our previous archaic steam-powered claptrap.  But we loved that claptrap because we knew it.  The new one is sleek and can present a dizzying array of information and once you get used to it, pretty easy to use.  But I’ve been spending my days a superuser telling people where to click to find what they need.  Muttering under my breath saying, “It’s right there.  Yes, right there under your fucking cursor. Click the fucking link.  Yes, that one!”  And that’s from the fatigue of being asked the same question repeatedly over and over again.

The funny thing is that I had never used the new on a real live patient until early last week.  As a superuser I’m supposed to be able to figure it all out from a over-the-shoulder perspective, but when you’re doing it at the bedside for your patient it is something different.  It’s little things like having to bar code scan the patient and the medication when passing meds, muddling through all of the extra rows of the flow sheets to find where I need to chart my findings (some people cannot leave and empty cell blank, they didn’t get that memo) and ensuring I get everything charted I need to in a shift.  And guess what?  I did. It was pretty simple.  Wasn’t as fast as normal, but that will come with time.

The biggest issue is that people got themselves whipped to a frothy fury over that changes.  Nurses were telling me they couldn’t sleep because of the roll-out, they were anxious and plain scared.  It didn’t help that manglement put a count-down clock in the lobby and have been über-involved in the hour to hour running of things.  IT’s been kind of a mess.  Sometimes to much support is a bad thing.  But there is a success or two.  One, in particular makes me proud.  She’s been a nurse with use since I was in elementray shcool and is well known for her clipboard that is loaded with papaers and covered in scribbled notes.  You know they type, they rely on that like a drowning man does his life jacket.  She publicly announced at the nursing station the other night that she was leaving her clipboard behind.  We applauded as we all knew how big of a jump it was.  And leave it she did.  The only time she pulled it out was when she had to bring in lots of things to the patient. She did not use it the rest of the week.  And that my friends, is progress.

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2 Comments

  1. As a software engineer I feel for you. I struggle all the time to get user’s to even use software they’ve had a hand in designing! When I started my transition into medicine, I found any system I liked the other medics did not. Any system I did not like, the other medics loved.

    I think it comes down to personality. I’ve noticed curious people who are not afraid to forge new ground are the ones most willing to adopt software. They rarely give you a call, unless they’ve found an actual problem. These folks tend to own all the cool toys. I love these people.

    You can’t make it in a technical world without being willing to forge new ground…or as you put it, “click the link right under your cursor.”

    Reply

  2. I’m a 37 yr old nursing student and the large teaching hospital where I was doing clinicals this past semester was rolling out EPIC in the last 1/3 of the semester. We got advanced training–but it was short and barely applicable to clinical application. I’ll be happier next semester if I’m at that same hospital– as they’ll have had 6 months of live operation for all the kinks to get worked out. And the co-assigned nurse’s will be a bit more efficient using the rolling/portable computers. As nursing students we were less frustrated with the software and more frustrated with the lack of computers and trying to figure out how to get meds to our patients without a bedside computer.

    Reply

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