Monday, March 19, 2012

The Invasion

D-Day for our hospital's implementation of our new EMR system finally arrived. Over the weekend, multiple frantic emails were sent out to everybody to remain calm and orderly. The hospital promised that there would be plenty of support for anybody who needed help. The program went live over a weekend to introduce the staff slowly to the computers. They even offered free food the entire weekend. Damn, why can't I ever be on call when there is free food?

When I arrived on Monday morning, I was overwhelmed by literally an army of support staff roaming every hallway, nursing station, and anywhere there is a computer. The multitude of assistants seemed to outnumber hospital staff two to one. I heard the hospital spent millions of dollars getting this system running and I can see where a lot of the money went. We even hired anesthesiologists from other hospitals who have already transitioned to this EMR program to come help us specifically on anesthesia related matters. What a sweet job that must be.

The problem that many of us feared would happen, that there would not be enough computers to go around, was resolved by the appearance of multiple portable workstations. In the electronic era, when the nurse, the surgeon, and the anesthesiologist all need a computer, usually at the same time, one computer per patient is not going to be enough. Now there are computers everywhere. EMR's must have been conceived by a conspiracy of Dell Computers, the federal government, and hand surgeons specializing in carpal tunnel syndrome.

The months of planning actually paid off pretty well for anesthesiologists. With the help of a couple of volunteer anesthesiologists, the IT guys developed templates that made entering the patient's histories quite painless. Just click, click, click, and you're done. I can definitely get used to this.

The only glitch occurred when I tried to enter my preop orders for my first patient. I clicked on my orders and thought I was finished. However the nurse said I had not yet signed my orders. Sigh. So I go back in and again signed my orders. The nurse still says my orders were not signed. After having prided myself on not needing any assistance yet, I finally succumbed to reality, swallowed my pride, and had one of the assistants come over to see what's wrong. We go through the process all over again. This time when I clicked to sign, the assistant saw the problem right away. I didn't actually sign it. I had clicked "sign and hold" instead of the "sign" button right next to it. And that is not to be confused with the "pend" button that I can also use on orders. I clicked "signed" and finally the nurse got my orders. We are only 30 minutes late for our first case. Not great but not as bad as people feared. At least I'm not the last one into the operating room which I consider a win for me.

The day started roughly like that for everybody. But it slowly smoothed out and by the afternoon the operating rooms were functioning pretty well, albeit slow. For anesthesiologists it's easy. We only have two sets of orders to write: preop and postop. Those orders were usually standardized anyway, even before the EMR. Therefore it was easy for IT to basically copy our previous orders from paper into the computer and all we have to do is electronically sign them. For the other hospital staff though, it could be quite a nightmare. Their postop orders could be quite challenging, especially since you can't just freehand write "Labs in AM, CBC, BMP, PT/PTT." Now there are cascading menus for ordering lab work, X-ray images, PRN meds, etc. There are submenus for stat, urgent, during the day, next day, every day, etc. Some orders require justification, like for chest films. Don't worry. There are cascading menus for that too. You can't just write the reason you're ordering something. It has to be one of the choices on the menu. It takes awhile to wade through all these choices. They're there. You just have to look for them.

Despite how painful the transition has been, and they forewarned us that the first six months of an EMR startup is usually very chaotic, we have muddled through quite well. The anesthesiology department has been commended for how smoothly our staff has adapted to the computers. We are not usually the ones holding up a case because of EMR issues. There is no turning back. This is the future of medicine. As we get further into our implementation, the bugs will eventually be worked out, or we will change how we work to fit the computer. I tend to think that it is the latter that will happen.

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