Curbside Consult with Dr. Jayne 4/30/12

I wrote a couple of weeks ago about the pending EHR upgrade at one of the emergency departments I cover on a part-time basis. The witching hour for go-live has come and gone – or at least I think it has, or might have, but who really knows because I have received no communication whatsoever from the project leadership or from my department chair.

For those of you who may have missed my previous post, here’s the scenario. I moonlight in the emergency department at a hospital that is unaffiliated with my primary employer. They have been preparing to upgrade the ED information system for the better part of a year, with several previously scheduled upgrades being canceled at the last minute. I’ve been eagerly waiting upgrade of the system, which was less than optimal from a provider perspective. Since I’m just a contractor, I have no say in the design, implementation, or support of this product, so it’s a unique opportunity to see a system from the same perspective that my own physicians see the system I manage. I know I’m hyper-critical since I do this for a living, but some of the things that occurred were pretty unbelievable.

In the Pro column, the hospital provided plenty of notice on the training sessions. We were e-mailed approximately six weeks before and asked to schedule a slot. Opportunities were offered at two locations over a three-day period, with plenty of seats available to cover the number of providers in our department. The downside of that approach would be that if a physician was on vacation that week, he or she would not have a training opportunity. Advice for the future: split your sessions over two different calendar weeks to better accommodate vacations.

The first Con was readily apparent when I couldn’t find the training room and there was no signage – another easy fix for next time. After 15 minutes of wandering, I eventually made my way to an obscure IT office on the top floor of a physician office building. They had 20 computers set up. Since I was still early, I settled in and started checking e-mail. Apparently only some of them were actually usable for training, so when the instructor arrived (late), I was forced to move and go through the whole painful log-in cycle again.

Another Con (is this only two, or are we at three with having to move workstations?) was that the copy of the production database used to create the training database was so old that none of the users’ previous three passwords would work. Unfortunately, this led to the instructor having to use his personal log-in for all five of us, resulting in many fun adventures as we documented all over each other since we were on the same log-in.

A considerable Pro was that our instructor was clearly a grizzled vet of the IT wars. He handled all of the issues with a sense of humor, which although warped, was truly appreciated and made a difficult situation tolerable. He started his preamble with an apology; as we were the second training session of the day, he already knew that the deck was stacked against him. Our training sessions were scheduled to be four hours, and apparently the IT staff had asked our department secretary to send out a notice that the scope of the upgrade had changed dramatically and training would only be an hour long. Needless to say, none of the physicians received this message (Con) and apparently he got an earful from the 8 a.m. session. The preemptive apology definitely helped mitigate the ire of my group.

Upon making it through the log-in screen (now boldly decorated with the “Meaningful Use Certified!” enthusiasm of the vendor) the first change we noted was that our beloved grey inbox was now shaded a delightful salmon color. I’m not sure exactly why a vendor would want to do that, but salmon isn’t exactly a crowd pleaser, and I found it more distracting than the relatively vanilla grey tone we had previously.

In the Pro column, the IT staff had built test patients for each provider to train with. As a Con, however, none was built for me, “because you’re just part time – but don’t worry, since we’re only giving you part of what you need, I don’t mind if I only get part of your attention.” This instructor was really on his game – deflecting the negative vibes and making us laugh. He also gave us fair warning that the morning class identified some elements of the system that were less than stable. Maybe it was good that training only took one of the projected four hours, because that gave him time to call the mother ship to request that they stop tinkering with the system while training was in progress.

One of the major upgrades to the system was the addition of templated patient visits, a big Pro in my book because of the ease of documentation. No one wants a beautiful flowing narrative in the ED – they want what we call the bullet: “This is a 43-year-old Caucasian male with a gunshot wound.” We do not want to know that this is a 43-year-old male of Germano-Irish descent who was walking along Elm Street two blocks south of Chestnut, minding his own business on a bright and sunny day, when two guys game out of nowhere and he heard a “pop.” I found the templates extremely intuitive and the system very responsive. In hindsight, however, after writing my recent piece on ICD-10, maybe I will need to know what street he was on and what the atmospheric conditions were at the time of the injury, as well as whether he heard a “pop” or a “bang” etc. For now, however, I’ll leave those questions for the police report.

The other docs in my class didn’t like the templates much, but I think that’s largely due to the fact that they’re full-time docs who don’t have any other vendor experience for reference and who have been allowed to use voice recognition in lieu of the painful “visit builder” native to the application. (As part-timers, we are not allowed to use voice recognition due to licensing costs. Go figure.)

I was pleased to see that the patient education module had been completely overhauled (big Pro) and replaced with a third-party component that allowed creation of physician-specific macros as well as those available for sharing across the department.

Unfortunately, the biggest Con is that the much-hated prescribing system received no updates at all. When I mentioned this disappointment and how I loathe not being able to prescribe exactly what I want, one of the other docs in the class was happy to demonstrate some “undocumented functionality” in the system that allowed me to do exactly what I wanted despite the constraints. Although it’s not officially sanctioned (the instructor actually covered his ears and said “la-la-la” while we were doing this) I’m ecstatic and can’t wait to try it out.

One Pro/Con was the lack of training material given to us. Good because a lot of people don’t read it anyway (can you say Sanskrit?) and it kills fewer trees, but bad for those of us that might actually want to look at it. Apparently they didn’t print anything, because even the morning of class, they were debating the scope of the upgrade. Promising to e-mail it made sense (although I have yet to receive it.)

I mentioned a few weeks ago that I was concerned that the support staff wasn’t aware of the upgrade. Apparently this is because other than the salmon-colored inbox, all of the changes were on the provider side. Assuring us that the team would e-mail us with instructions on downtime and the final preparations for the upgrade, he sent us on our way. The instructions never arrived, but I’m putting that blame on the department secretary rather than holding it against the IT team.

Totaling the score, that’s six Pro and seven Con, a mixed bag by any standard. I hope the upgrade went well (if it went at all) but I really don’t know since there’s been no communication. I’m scheduled to work later this week, so I’ll find out then.

Have any outstanding upgrade tips to share with the HIStalk community? E-mail me.

E-mail Dr. Jayne.