Countdown to D-Day

 
OK, I admit it – it’s only 12 days until Epic go-live, and since I am working in the ED starting at 8 am on D-Day (11/3), I admit I am nervous.  Rationally, I know the universe isn’t going to implode.  But realistically, while I’ve tried to be the voice of optimism, I know there are things that are going to be painful, or worse.  I’m especially worried about the wait times.  When things grind to a halt because of a prolonged resuscitation, families understand there is something up, and they cut us some slack.  But will they tolerate waiting longer because we’re trying to figure out how to enter their chief complaint, or record their allergies, or even how to turn the thing on?  How long will they tolerate it?

For those of you who missed the annual Rebecca Jayne Memorial Lecture Grand Rounds on 9/28/12, I urge you to watch it onlineDr. Lalit Bajaj, an emergency physician from Colorado Children’s, who has been using Epic for 8 years, talked about the EHR: The Good, The Bad, and The Ugly.  I was pleased at the level of relative confidence and optimism the listeners expressed about our own impending implementation using the audience response system.  But Lalit’s message was frankly, if not surprisingly, mixed.  Here were some of the take away messages:

  • Short term we’ll mostly notice the pain: most things will take longer; patients will wait longer; some types of errors will be harder to make but other types will be easier (I loved his anecdote about the 4 year old girl with normal penis and testes documented on the exam).
  • The longer term benefits are significant, but will take some work.  We can learn from others about how to get the most bang for our buck during optimization.  For example, they found that putting a lot of time into developing group templates was not worth it, since everyone wanted their own.  However, using structured data elements was critical to getting the most out of Epic’s ability to measure and ultimately improve quality, not to mention conducting research – as this article shows.
  • Understanding our workflows is the key to getting the most out of Epic.  Teams should consider practicing together in the playground in advance and doing pre-go-live personalization as a team.
  • Decision support is really cool, but will probably take longer to achieve than we’d like.  Patience is a virtue.  And when you get “alert fatigue”, don’t yell at the computer; make a note to add that to the optimization queue.

 As Lalit said, the EHR works for us, we do not work for it.  We just need to work to make that happen.

-Marc Gorelick, MD, mgorelick@chw.org

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