Wednesday, February 24

EHR - implementation success stories

The largest specialty clinic in Seattle - Polyclinic is at the 10 week point of their implementation and here are a couple of stories from doctors to doctors about the value of implementing an EHR.

Notes from the front line

At The Polyclinic Downtown, we are about 10 weeks after the start of “Epic Go-Live.”  After experiencing a staggeringly steep learning curve, long nights of work at home and the office, and episodes of extreme frustration, the benefits and rewards are clear every day.   My messy office is nearly clear of charts, my “dictations” are complete at the end of every patient care day, and the process is very close to being “mid-brain.”  This is exactly the time frame that we were led to expect – three months till it would be automatic.  

How an EHR Enhances Communication:
 Two Tales:
 Saw an infant patient of R's ’s today.  An 8 day old baby, who I also saw on Monday, after R had a family emergency.  This adorable little boy was born at Swedish on Jan 27, and quickly lost more than 10% of his birth weight.  Discharged on Saturday the 30th, with need for quick follow up.  Well, the little devil tried, and so did his mama, but he lost even more weight once he got home.  So, back to the hospital he went.  

HOW the EHR HELPED:  my notes from February 1 and from today, including weights, were available to the pediatric hospitalist before the family left our parking lot.  His note got to me (and to Robbie Sherman) before we left the office for the day.

 Sadder story:  long time patient of mine who chose to see a Swedish oncologist for her breast cancer.  The doc is a poor communicator – almost always fails to cc me on his notes.  She had a local recurrence when I saw her last.  Her cancer exploded in the last 4 months.  I didn’t know.  I haven’t been kept the loop, despite multiple requests on my part, and on the patient’s part.  She was admitted to the hospital today with me a blood clot, systemic weakness, and widely metastasized disease.  I think she’s going to die very soon.  I wouldn’t have known, but the EHR  sent me the note – knowing through the magic of cyberworld that I have been her primary care doc.  I’m going to see her tomorrow.
 Keep the faith.

I hope that the patients reap the benefit of our conversion – they seem very pleased at our level of innovation. They are fascinated by the tablets, and delighted that their prescriptions will fly through cyberspace to their pharmacies, with accuracy checked and double-checked by Epic.  They enjoy sitting side-by-side with me and with my tablet, reviewing lab results in chart, or even graph, form. 

Order entry is my favorite part – no more paper forms to complete.  Point-and-tap is the technique to master.  Dragon is more challenging for me, but as a compulsive proofreader, I am pleased to sign off on a “realtime” chart note that I have checked, without going through our previous editing process.

My words of advice:
1. Be patient – it will come.
2. Keep it simple – acquire knowledge and skills gradually, and you will perfect them. 
3. Plan to refine your skills over time.
4. Be calm – you will learn more quickly. 
5. Put in the time required to learn as much about the program as you can. 
6. If you are hospital-based and can learn Dragon there, do so.
7. Understand that it will be hard, but it will get better.  Much better.
8. Learn to type.
9. Make sure you can access the Secure Gateway from home.
10.Be humble – your younger staff may master aspects of Epic before you do.
11. Don’t relegate everything to Epic – remember to communicate.
12. Don’t let your difficulty with Epic impair your patient care.

Special note to baby boomers: The four downtown doctors born in the 1950s had a heightened level of anticipatory fear about our conversion.  Perhaps this gave us greater motivation to study hard beforehand.  With no false pride, I will say that the geezers among us have gone to the head of the class.  Keep an open mind, and work hard, and you’ll get there.

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