March 20198In My OpinionAN OUTSIDER'S VIEW OF THE HEALTHCARE TECHNOLOGY EXPERIENCEI'm a career technologist, but I didn't grow up in Healthcare IT. In my pre-healthcare career, the impact of a mistake could mean disruption to the enterprise operations, a delay in time to market, or it could materially affect our financials. These are significant pressures to contend with in and of themselves, but in joining Healthcare I'd be lying if I said that I wasn't worried that I could now impact someone's health, a life, or a family. I'm old bedfellows with "Brand Impact", "Operational Impact", and "Financial Impact", but "Patient Safety" was a new facet to the criticality matrix I was used to. I have also been a long time stalwart of the largest ERP systems, financial mainframes and back-office applications in the industry, but an EMR was new technology. To me at least.At St. Joseph Health we consolidated our 8 stand-alone EMR platforms for our 16 acute care facilities, spread across 3 geographical regions, to one single EMR instance serving our 20,000+ clinical users. A herculean effort by many great teams, and as you can imagine it was not without disruption to those that provide care.Post-consolidation everything ultimately settled in, and as we stabilized our enterprise EMR from an "engineer's eye", we continued to receive a loud roar of dissatisfaction from our clinical communities. The steady drum beat of "it's slow", "this is not working", and "just fix it!" were continually escalated from our first responders, but these aren't translatable for engineer remediation, especially when all system performance data looked fine? Queue to my first understanding of the plight of the caregiver. As a whole, doctors or nurses couldn't care less when I regale them with the technical intricacies of all the layers and components that come together seamlessly, and how every performance metric shows that all is operating as expected. I've seen eyes glaze over when I use too much "geek speak" trying to explain system performance. But how do you treat the patient when the symptoms they complain about are vague, and contradict the lab results?I thought it'd be prudent to hear from the providers themselves in their own facilities. I needed to understand what their normal interaction with the EMR was. What frustrations were they experiencing daily? Could we catch an issue real-time in the wild and correlate it to back-end metrics? With a small team we set out to meet with a statistically significant group of doctors, nurses and staff at each of our facilities to learn about their pains first hand.We methodically interviewed over 200+ doctors, nurses and staff across each of our facilities in our three distinct regions. Each interview was intentionally unstructured to ensure the flow of passion, and each discussion started with a simple question: "How are things going?" They let us have it! But don't let me paint the wrong picture here. The oft repeated undertone in every discussion across the entirety of our interviews was a simple and noble truth. A genuine desire to serve our patients, immediately followed by the frustration that the EMR makes it harder to do so.Now there are a lot of details behind this simplified statement, and as we transcribed our many discussions a pattern began to emerge that allowed us to aggregate into the following categories:· Process & Communication: "How am I being supported by IT"· Education & Training: "I don't know how to do X"· Technology & Infrastructure: "The underlying technologies"· General Performance: "The EMR's performance and stability"Rob RiceRob Rice, VP Infrastructure & IT Operations, St. Joseph HealthBy
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