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The Skeptical Convert 4/5/13

April 5, 2013 Robert D. Lafsky, MD 2 Comments

Dispatch from the Beachhead

I’ve had a weekend to recover now, but on Friday, seven days into the Epic go-live (including the go-live weekend as the GI on call) I felt like Tom Hanks 20 minutes into “Saving Private Ryan.”

The D-Day analogy is actually pretty useful for both the negatives and the positive of the experience. The plus side is the incredible massive force brought to bear on the project — people everywhere, hardware guys, red-jacketed helpers, administrators, docs from the Big House, sometimes actual Epic people. The system was going live simultaneously for two community hospitals, but ours had the empty space for 140 call-in workstations, and when I went by there last week, every one of them was occupied. And so when I needed a beachmaster, I could walk on over there to find one without getting shot at (at least not yet). 

But even with massive firepower from the Navy and Air Force, the troops still had to take Omaha Beach. And every clinician seem to have reached that moment where he was hunched behind the seawall wondering how he would ever get out of this situation. 

Everybody survived, though, more or less. There was plenty of help from the red vest people standing around, although mostly of a very specific ground-level nature–sort of like the Bangalore Torpedoes that get way too much credit in all three of the cinematic depictions of Omaha Beach that I’ve seen (“Ryan,” “The Longest Day,” “The Big Red One”).

But historians say it was the individuals that were able to call in Naval artillery, and the ship commanders who responded with precision fire who turned the tide, and in my own (OK I admit overglorified) way, I had to find higher level people with a big-picture grasp of the situation to solve most of the problems I encountered. 

I know, I’m over the top, but I can carry this analogy further. The massive pre-landing bombing that fell behind enemy lines reminds me in a way of much of my 16 hours of training, with what in my ground-level opinion was overemphasis on detail (bombs/process) and not enough on fundamental principles (target/fundamental concepts).  

For example, in my training as a “surgeon,” with a lot of work on how to work the pre- and post-op navigators, there was no mention of the fact that apparently because of a fundamental issue in Epic, I wouldn’t see those navigators automatically if I opened up the patient from the inpatient list instead of the surgical schedule. 

But enough carping. The beach is secured, the smoke is clearing, the beachmaster did in fact show me how to get that navigator up from the inpatient list this morning. There are a lot of other details that will take months to figure out (I just discovered the existence of sticky notes about five minutes ago). But I’m up and walking forward, however shakily. Onward to Berlin. 

Robert D. Lafsky, MD is a gastroenterologist and internist in Lansdowne, VA.

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Currently there are "2 comments" on this Article:

  1. Will there come a day when we look back on these large-scale operations and decide that the current paradigm is not worth it? We spend millions of dollars on software and personnel for these enormous campaigns to win the war of implementing all-in-one systems. Perhaps in the end we’ll discover that technology needs to be agile, flexible and unexpected in order to win the hearts and minds and clinical care of the populations we are serving–providers and patients. Those of us who work in IT are the generals fighting wars with tanks and armies and logistics that have an insatiable appetite for resources. We win a major battle for implementation and we hope we are winning the war to implement effective technology.

    But I will not be surprised to discover that large and monolithic systems–even ones as fine as Epic–end up being yesterdays paradigm. Tomorrow we will have a simpler mandate than putting in extraordinarily expensive systems: Take cost out of healthcare, or there will be no money for patient care. In that world, perhaps the nimble, innovative and inexpensive will win the day. It will be interesting to see if tomorrow’s world makes yesterdays battles to implement large-scale systems look obsolete.

  2. That sounds like one of the worst go lives ever! wow 16 hours before you even used the app? Most places do just in time phased training – you lean by doing and I hate to imagine that anyone feels like it is a war? or that my provider is so stressed that is the analogy on the front of his mind? It should be intense but more like a birth with a lot of moaning and hand squeezing but with a focus on the goal of better patient care.

    The over emphasis on MU and $$ incentives has hijacked the entire process and most Epic implementations are slapped in now and the support is by people with little real world experience (due to the arcane way Epic locks staffers down after a go live else-where – via the illegal restraint of work clauses in its contracts)

    Hopefully during optimization you will discover how to not simply survive your EHR but actually use it to provide your patients even better care with a closer relationship. My one suggestion. – change where you sit in the room. Have them next to you as you enter in the notes Make them part of their own care team. (most docs can type 3x faster than writing in a chart but it is clearly slower than dictating – thankfully you will never waste time looking for a chart or information in one)

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