Intelligent Healthcare Information Integration 10/25/10

Moving Ahead with Albert’s Axe

OK, not to be overly the drama queen, but after taking a little time to let the situation unfold and sink in a bit, I’ve now come to the realization that, at least for me, hearing the news of my EHR’s impending death has triggered the grief cycle cascade as defined back in 1969 by Dr. Elizabeth Kübler-Ross.

Denial, anger, and bargaining are done. Depression settled in, but has just now started to lift as I head into acceptance (though perhaps begrudgingly).

Whether or not you accept the Kübler-Ross five stages of grief theory, or even the newer “extended” seven-stage version, I think everyone agrees that the loss of a loved one, even the loss of a loved “thing,” can trigger a profound series of emotional effects. While very few providers would consider our EHRs an objet de l’amour, it is still something which becomes a very intimate and engrained part of the majority of our working hours, perhaps even of the majority of our waking hours.

The transition from pen and paper is traumatic, filled with many a “I’m gonna heave this this freakin’ thing right out the second floor window and enjoy watching it disintegrate on the concrete” moment. Learning a new way of doing virtually everything you do during a working day is filled with numerous episodes of “I wanna go home” whines and “I hate this” whinnies.

Once you’re there, once you’ve tapped into your never-ending source of adaptability and allowed it to overtake your nostalgic inertia, you get on into the groove. The new way, assuming you’ve made a smart choice in your new workflow direction, starts to become a part of you. The new habits, patterns, and work styles begin to light up with the promise which had originally enticed you to embark upon this new path. You start to get your mojo thang workin’ again.

Whether by choice or vendor decree, going to a new EHR and enduring another workflow overhaul may not be as grandiose a change as moving from paper to digital, but prior advantages have been lost. Before the paper-to-PC switch, you have dreams of how much better the world will be. Now, though, the anticipation of what is to come is muted by the awareness of what is to come.

Simply and honestly put, workflow overhaul is a major bitch. Innocence lost, you know what you’ll have to endure, at least to some degree. Thus, the dread of re-experiencing the frustration blues associated with major change is difficult to offset because the anticipation and excitement allowed by naïveté are diminished.

I don’t know if making such system and workflow changes are more or less difficult in a larger group, hospital, or other institutional setting where the advantage of more support personnel may be offset by more people needing to make the transition. My sense is that it is tough for all. But, for us one- and two-horse practices, it is not only difficult, it is also quite personal. The depersonalizing corporate-think is not actuated and there are zero degrees of separation between the decision makers and the implementers.

From several experiences now, it has become apparent to me that it is difficult for EHR vendors to maintain a balance in dealing with both the very large and the very small medical worlds. Just as quantum physics requires quite the different vocabulary from that of the Newtonian world, the needs and vocabulary of small provider practices are quite divergent from their larger counterparts. Same healthcare universe, but very different scales and quite different perspectives.

Seems a Grand Unifying Theory is a tough thing to find regardless of your universe of concern.

From the trenches…

"Technological progress is like an axe in the hands of a pathological criminal." – Albert Einstein

Dr. Gregg Alexander, a grunt in the trenches pediatrician, directs the “Pediatric Office of the Future” exhibit for the American Academy of Pediatrics and is a member of the Professional Advisory Council for ModernMedicine.com. More of his blather…er, writings…can be found at hisblog, practice web site or directly from doc@madisonpediatric.com.