Curbside Consult with Dr. Jayne 4/17/17

Several of my friends in medicine, engineering, and other high-tech fields participate in decidedly “traditional” craft projects in their leisure time. I’ve got a handful of friends who make soap, and many others who knit, crochet, quilt, sew, cross stitch, needlepoint or do woodworking, stained glass, or paper crafts. I see a fair amount of people at professional conferences who are knitting or crocheting during sessions. I have a lot of respect for them, because those are two skills I can’t master. My grandmother tells me I used to be a proficient knitter as a child, and even made a set of golf club covers, but based on recent attempts to master knitting I can’t imagine how the club covers came to be, despite the fact that one or two of them are still in my garage.

Except for the yarn-related projects, several of my friends use technology to augment their abilities. When you spend a good chunk of your life pursuing a professional career, there’s not a lot of time to build leisure/hobby skills. Many of us spent our teens trying to get into competitive colleges, then our college years trying to get into graduate programs, etc. If we’re physicians, we may have a three to seven year “black hole” called residency in our lives from which no free time escaped. Now that we have leisure time, we want to be able to make cool-looking projects without waiting years to hone our crafts.

Over the past year, I’ve gotten deeper into a hobby that requires a bit of computer assistance, and it’s been a great stress reliever as well as a lot of fun. I’ve met some great people, several of whom are former healthcare types who have gone into the hobby as a business in part to get away from the stress of healthcare. There are also some former teachers, who are happy to take relative youngsters under their wings and point us in the right direction. Being in a competitive “day job” world where collaboration isn’t always valued, it’s been great to have people I can call or text when I get stuck or need a few tips. Thank goodness for the night owls, who are up crafting past midnight just like I am.

Over the past month or two, though, I’ve seen several parallels to healthcare IT. The equipment I purchased to do my hobby work is from a manufacturer that dominates the market. They value their customers and understand that the work that they do is a big part of what has built their reputation as a vendor. They’re a company that started from small-town roots and grew by word of mouth and then regionally, and now have customers all over the world. They also know they have people hooked, and that the cost to change to another vendor would be significant, not only from the equipment standpoint but due to downtime, lost knowledge, etc.

Every couple of years, they issue a major software release. I came into the market in 2016 on what was then the latest and greatest software, which honestly I have very few complaints about. More than 90 percent of the time when I’ve run into trouble, it’s been due to user error or some other problem between the keyboard and the chair. Still, I am looking forward to the new software and the potential that it might bring, especially as a relative newbie to the hobby. In releasing the new package, the vendor took a couple of departures from its previous practices but that from my IT viewpoint are pretty common place. They released a list of hardware specifications required for the new software. They also distributed a beta version to the client base, along with a list of features and enhancements, and a list of known issues. They gave clear direction that formal training would not occur until general release, and set up a process for reporting defects.

As in informaticist, I followed this process closely, particularly with regard to how the end users would adapt to this. Most of the end users are in their 50s or 60s, and many began the hobby in a non-automated fashion, transitioning to automated methods when they became available. In so many ways it parallels what we see in healthcare IT. I wanted to understand how they would react to change and what similarities or differences there would be from clinical end users. I belong to a couple of independent online support groups, as well the vendor-sponsored blogosphere, so I could see the dialogue in multiple venues.

It’s been surprising how similar the user psychology is to what we see when we’re talking about an upgrade or update to an EHR system. The user community is going through the cycle of grief, lamenting the process even though they’re being allowed to stay exactly where they are, if they want, without penalty. The vendor is committed to supporting every user on every version across the globe, which is largely unheard-of in the world of certified healthcare IT. And yet, people are yelling that the sky is falling, despite the fact that they don’t even have to change at all. I’ve worked with users who have been on the same old software since 1998 and they produce beautiful work that I couldn’t even dream of creating with brand new equipment. They’re efficient, productive, and creative yet are balking at the mere idea of an upgrade that they might have to or want to consider.

The biggest issue is the hardware requirements – the vendor is requiring that users move to a vendor-supplied PC to drive their hardware, which probably 80 percent of the customer base is already on. For those who don’t want to upgrade, they can stay right where they are and be supported, or they can buy the latest and greatest. There has been a great deal of angst among people who don’t understand the difference between Windows XP, Vista, 7, 8, and 10, and also some outright resistance to knowledgeable individuals who try to explain the difference and the various benefits of upgrading. At times, when I read the conversation threads, I feel like I’m right back in healthcare IT.

I’m not a huge fan of installing beta software, especially for a hobby at which I’m just becoming proficient. I decided to wait for the general release, until I had the opportunity to attend a class fairly close to home. One of the certified vendor trainers was going to be an hour and a half away, so I decided to go despite wanting to have my first look be a GR version. The class was an all-day affair, and again, I looked at the parallels to healthcare IT. At Big Hospital, providers balked when we asked them to be out of office for a half day to learn about a pending upgrade, even though it was going to change their workflow and they’d benefit from formal training. Many tried not to go and the decision ended up haunting them. Instead, I was surrounded by people who chose to close their businesses for a day to learn the latest and greatest, or to at least see what it had to offer them. Despite the turmoil on some of the online communities, in person people were very reasonable and willing to learn. How different would some of our EHR upgrades be if we had people willing to put in enough time to learn about software changes?

In addition to learning about the upcoming changes, one of the greatest benefits of going to training was meeting new people and creating new networking opportunities so that I can be better at what I’m trying to do. The same benefits could come from EHR training, if we could get people to acknowledge that just because it has to do with the EHR it’s not inherently undesirable. I met some serious super users who were happy to share their knowledge with a new user, and also learned some tips and tricks that I can do immediately without waiting for the upgrade. I was also gratified to learn that I must not be the only person making a mistake I make commonly, because the vendor has tweaked the software to reduce the impact of that particular workflow issue. Like many EHR vendors, they’ve also done a fair amount of usability work (some very formal, according to our instructor). Where people were surprised by the seeming blandness of the user interface, the instructor explained why they did it the way they did, and how other features were added to address users with low vision or other functional limitations.

If I wasn’t experiencing some serious déjà vu then, I really was when she mentioned that it wasn’t just an update of the workflows, that they had completely gotten off their old code base and had rewritten the program on a new platform. Then we launched into a discussion about making sure you are on the right version of the .NET framework, and I knew I had truly fallen down the rabbit hole. I did walk away from the experience with some new ideas about how to train and how to reduce anxiety for end users, which will translate nicely from the craft space to the healthcare IT space. I met several professional educators who experience similar challenges as I do, that I can stay in touch with ongoing. I got some great ideas about different ways to use my equipment, and some workarounds that I had never thought of for sticky situations.

All in all, it was a good opportunity to see that what we deal with in healthcare IT isn’t as unique as we think it is. Sure, there are some nuances, but there is a lot we can learn from other industries, processes, and people. What’s your favorite craft project? Email me.

Email Dr. Jayne.