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The Skeptical Convert 4/5/13

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.