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Curbside Consult with Dr. Jayne 3/25/13

I’m lucky to have started my career in health IT on the leading edge of ambulatory EHR adoption. My health system was forward thinking and data driven, so we’ve been in the game a long time.

When we decided to implement a system-wide health record, the group quickly realized they’d need a dedicated clinician to help steer the project. I applied for the job and my career in informatics began.

I quickly realized that although I knew a great deal about implementing EHR in my own practice and using it to drive evidence-based care, there was much I had to learn about doing it on a broad scale. I thought SQL was something that followed a blockbuster in an attempt to squeeze cash out of the movie-going public. I had no idea what lurked in the heart of a legacy app that was trying to be more than its architecture allowed.

The first move I made was to seek out a half dozen smart clinicians who had come before me. It was hard to do – most of us were starting our projects at a similar point in the product’s evolution and frankly my health system was the largest customer our vendor had signed to date. I decided that I was going to learn everything I could, regardless of the size of my the organizations of my peers. If they were successful in what they were doing, I figured I’d work with my team on how to scale it.

I ended up with a core group of five close friends, all of whom knew more than I did regardless of their size as a customer. We had that “we’re all in this together” attitude and quickly bonded through many a late night e-mail blast. We recognized that everyone had something to offer.

Half a decade later, I still count these fellow travelers as some of my closest friends. Some have moved to other vendor platforms, but not a week goes by that I don’t find myself thinking about something I learned from them. New faces have joined the group. There are quite a few weeks I still reach out with those, “When this happened to you, what did you do?” type questions. Sometimes they’re EHR related sometimes not, but I know my circle of “phone a friend” colleagues have my back.

Our primary EHR vendor knows this group of leading CMIOs well. We were recently asked to mentor a new client that was converting to our product after a failed pilot with another vendor. The new customer reminded me a lot of myself – they are a relatively large customer compared to the rest of us and I thought our group would have a lot to offer them.

Introductions were performed and one-on-one sessions were arranged at a regional user group meeting. We were poised to share everything we had with this client – from detailed conversion plans and assessment tools to the sacred “known issue” lists that we had compiled. We looked forward to having a new kid on our block to continue to push our mutual vendor to excellence.

We were not, however, prepared for the new customer’s reaction to our efforts. We were completely shot down. The prevailing attitude of, “You can’t possibly understand because you’re not as large as we are” made it impossible to communicate. The new CMIO was convinced that unless a live client looked exactly like their hospital, we had nothing to teach her. She used every opportunity to belittle our efforts despite our demonstrable outcomes.

Had this been middle school, I’d have dropped this new “friend” like a hot rock. Not only was she failing to take advantage of what we had to offer, but she was acting ungrateful and downright rude.

Several months have passed since the new CMIO blew us off. I spotted her recently at HIMSS. Not surprisingly, she’s been “made available to the workforce.” Her implementation never got off the ground and has been outsourced to a consultant.

I wish her luck and hope she’s learned something. Like Mark Twain said, it’s not the size of the dog in the fight, it’s the size of the fight in the dog. There is always something to learn and we can’t be afraid to open ourselves to the possibility.

I’m fortunate I had some great friends in my corner. I hope one day to pay it forward to someone who will appreciate it.


E-mail Dr. Jayne.