Curbside Consult with Dr. Jayne 6/23/25
You really don’t know how much you rely on certain technologies until they’re not available.
At one of our local hospitals, a PACS upgrade during daytime hours threw quite a few clinicians for a loop. I don’t think the IT teams really understood how important muscle memory is for clinicians who are trying to work efficiently in the EHR while seeing patients. Although a workaround was provided, it required physicians to go to a different part of the EHR to view images.
It sounds like some users had security issues and weren’t able to do their work from the new location, which caused frustration that was made worse by long wait times when they called the help desk. Even for those who were able to use the new link to access images, there were complaints that it took half the shift to get used to the new workflow. Later in the evening, it reverted back, which required another shift.
I’ve done plenty of upgrades in my career and I’m not sure what would be happening behind the scenes that would justify doing an upgrade during daytime hours. Most of the upgrades I’ve been involved in were conducted overnight so that they caused minimal impact to clinical workflows.
Based on the fact that nearly all of the IT decisions I’m seeing lately are made with significant attention to cost, I can hypothesize that it likely played a role. Still, I wonder if the people looking at that cost-benefit equation looked beyond the IT resources to include the cost for clinician inefficiency and the risk of clinical quality issues.
A colleague shared the downtime notification with me because they knew I wouldn’t believe it otherwise. I was surprised to see that it included mention of another clinical system that was being taken down from midnight to 2 a.m. the following weekend, so I’m sure there was some reason that this one was being done during peak hours.
If I had been on the leadership team that approved the communication, I would have recommended a mention of why we were doing the upgrade during the day. Users would at least understand that we had thought about them and were forced by extreme circumstances to do it that way.
I also was a fan of running our communications past people in different settings before finalizing them — including academic physicians, hospitalists, and community physicians — to make sure that we were covering all perspectives.
Just out of curiosity, I looked back through some communications from one of my hospitals to see if I could identify patterns from the biweekly newsletters. I was surprised to see that the newsletter had the same top blurb over a six-week period without any changes, which to me would create a risk for people ignoring the newsletter because they may have felt like they had already seen the materials.
I also noticed that over the last six months, the newsletter had become a compilation of unrelated blurbs rather than a more cohesive document. In the current version, each entry had different font and color schemes, including color choices that don’t meet accessibility guidelines for colorblindness. It also looks like it’s in a different order every time, with no standard formatting.
I would think that adding a framework to it might be useful so that people can quickly identify the items that are important to their work. Maybe start with a section for global updates that impact everyone, then move to updates by specialty, care setting, or a host of other categories that would keep people from having to wade through tons of irrelevant information.
I thought about offering some feedback (after all, I’m still a dues-paying member of the medical staff) but there wasn’t any information in the newsletter about who to contact if you have questions. I’ll just stay in the back row with my “Courtesy/Non-Admitting” privileges and hope I don’t have to look at any patient charts any time soon.
I have several major presentations coming up. For once, my week wasn’t completely full of back-to-back meetings. I decided to do some personal development while I was creating the slide decks and see what AI has to offer.
I try to make my slides as non-wordy as possible, often choosing images that tell a story, or images that prompt me to talk about certain content rather than having too many formal text elements on the slide. I always create an outline-style summary first, so it seemed ideal to be able to take that outline and hit it with some AI and maybe save a little time. I tend to be a little stuck in my ways about backgrounds and formatting, so I was looking forward to spicing things up a little bit.
Unfortunately, what my AI friend came up with was entirely unusable. Not only did it just drop the outline into slides in a somewhat disjointed fashion, but the backgrounds it selected bloated a 25-slide deck up to over 80 MB in size. I could see that being possible if I were incorporating high-resolution radiology images or something like that, but this was just from backgrounds and non-critical design elements.
I guess I’m back to creating my presentations in the old-school way, at least until I have time to research whether there is some other way to use the tools differently, or until one of the savvy college interns agrees to give me a quick tutorial on how to not wind up in that place again. When I finished that slide deck in my usual way, it ended up well below 2 MB, so I’m still not sure what happened the first time around.
One of the presentations I was creating was for first-year medical students, introducing them to clinical informatics and explaining the kind of work done by physicians in this space. The incoming students are coming into an educational environment that’s so different from where I trained, and I have to say that I envy them a little bit. Here’s to hoping that I don’t wind up being talked about as someone who was out of touch or uninteresting. Fortunately, my session is a lunchtime one with free food, so I don’t think attendance will be a problem.
If you could go back in time to when you were first learning in your field, what do you wish you had done differently? Leave a comment or email me.
Email Dr. Jayne.
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