EPtalk by Dr. Jayne 3/11/21

I had an opportunity this week to do something I haven’t done in a while, and that was to support a go-live.

It was very different than my pre-pandemic experiences, with very few implementation support staff actually on the ground. I was pulled into it by chance. A friend of mine has been helping lead a major health system EHR replacement project for more than 18 months. Along the way, the health system acquired a small cardiology practice and had allowed them to stay on their legacy EHR until the main roll-out was complete. They planned to circle back and do the conversion.

I’ve been involved peripherally over the last couple of quarters since the cardiologists are on a fairly niche system and I had done a couple of conversions off of that system previously. Often people don’t realize until they get to an EHR conversion how bad the data management is in their current system. For example, the legacy system stores blood pressure values in a single text field rather than having separate fields for the systolic and diastolic numbers. It also didn’t have restrictions on it that prevented users from entering non-numerical values or excessively high values, so we had to make some difficult decisions on how much data we were going to try to bring into the new system and how we would prevent poor data from coming across.

Generally, the physicians understood the need to make those decisions, but they were a little more resistant to the overall conversion process because they would be giving up all their individually-customized visit templates and coming onto the health system’s enterprise version. I was asked to do a fair amount of “physician whispering” as part of the project, making sure that they understood the “what’s in it for me?” component of the conversion. We knew it would go more smoothly if they felt they were receiving a benefit as opposed to being forced to do something they didn’t want to do.

Surprisingly, one of the more difficult physicians was the youngest, who had actually trained on the EHR they were moving to. In breaking down his concerns, it seemed like most of his resistance stemmed from being upset that he had come into a private practice situation where he thought he would be on a partner track. Now he was one of hundreds of physicians employed by a large health system. There’s a lot of psychology to unpack there, and being able to explain the benefits of integration every time he threw up a red flag was helpful.

The practice’s super users were responsible for doing most of the support during the go-live, with backup from a vendor-specific consultant. I was engaged to be on call as escalation support for physicians who needed significant hand-holding or who had issues that would take a little longer to work through, since the super users were trying to do their day jobs as well as support the go-live. We knew that two of the doctors would be leaving early in the day due to other commitments and would likely need help in the evening as they logged back in to complete charts, and I was going to be plugged in there as well. One of them did really well and only sent me a couple of text messages with specific questions, but the other became an immersive support experience.

Most of his frustration was around the fact that he had decided to leave the office for a conflict that he decided wasn’t ultimately worth his time, and he was aggravated that he was now having to make up work in the evening. He wanted to do a web support session. We spent the first 15 minutes with me just listening to his frustrations as he worked through his inbox, which was full due to being out of office, not because of the new EHR.

He actually had a decent knowledge of the system, but felt like he needed someone to tell him he was doing the right things with his documentation rather than trusting his intuition. He kept getting interrupted by family issues and jumping off and on our support session, which didn’t help the situation. Having done this for a long time, I understand the importance of work-life balance and that family life happens, but the ability to focus on the thing in front of you is ultimately key for long-term success.

The physicians knew that their support window was closed between midnight and 6 a.m., so I did get a little bit of a break before starting the morning’s adventures. Everyone is scheduled to be in the office this morning (as opposed to being at the hospital or doing procedures), so that will be all hands on deck. Fortunately, the practice managers have held the line at making sure schedules are slightly reduced to allow the staff to adjust to the new system, so I hope things run smoothly. I hope the physicians who are used to being perpetually double-booked don’t find the relaxed schedule too shocking. Maybe they’ll be inspired by seeing how it can be when you’re not running every day on a steep uphill climb.

Everyone seemed to be in good spirits this morning and I’ve only had two calls, so that’s a win in my book. We’ll see what the rest of the week holds. I do like mid-week go-lives because they allow people to have a break after the first few days on a new system and then come back refreshed the following week.

I’m not on call for coverage this weekend, so I’ll be looking forward to a break as well. Spring has finally arrived in my neck of the woods and I will be spending some quality time outdoors. Although there’s a fair amount of rain in the forecast, it will be nice to get away somewhere out of cell service range and just enjoy the fact that winter is on its way out.

What are you most looking forward to about spring? Leave a comment or email me.

Email Dr. Jayne.