Archive for January, 2013

EPIC: learning another EMR system

January 31, 2013


Don’t keep this close to your vest,

It’s not something I’d utter in gest

I’ll reassure you

MedTech32

Certainly ranks as the best.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  In May 2010, I left my position of 23 years, and honoring my non-compete clause, traveled for a year doing locum tenens work.  In June of 2011 I joined up with the Community Health Center, which provides care for the underserved.  I’m now working part-time, which, for a doctor, means 54 hours a week.

One of our city’s two hospitals will soon adopt EPIC, a new electronic medical record (EMR) system.  In order to have privileges, all doctors must pass competency in its use by March 1.  The hospital pays for the training.  I spent 8 hours on Tuesday at the lectures, more training will follow.

I have trained into Allscripts, MedTech32, Centricity, and Cerner PowerChart.  MedTech32, the New Zealand national EMR, comes out the winner with no close second; easy to learn, easy to use, generating useful documents, and giving quick access to data.  All the others have steep learning curves, they all produce documents swollen to uselessness.  Allscripts brought slight workflow improvement after six months of getting used to the system.  Accessing data in Cerner and Centricity takes much longer than a paper chart.

The hospital in Barrow, Alaska gave me the option of learning a new EMR but I found using paper and pencil easier.  Given my short time there, I saw no advantage to spending 20 hours acquiring a skill set I would only use for 14 weeks.

At first impression, EPIC has attractive features.  With a consistent theme and layout, not exactly intuitive, but at least learning one section carries over to another section. 

I will reserve judgment till I’ve worked with it for six months. 

The class took place in a windowless basement room I had never visited despite working in that hospital for a quarter of a century.  I knew all 5 docs in the morning session and all 8 in the afternoon.

The lecturer and the book did a good job.  From time to time things the system did not respond as advertised.  I expressed dismay, the teacher reassured me that the learning environment has problems that the “real thing” doesn’t.

I voiced my skepticism.

Still, the EMR will not go away.  That the end-user doesn’t pay for the product constitutes the main problem; not nearly enough purchasing committees learned the moral of the story of The Emperor’s New Clothes.

 The daunting task of embracing new technology puts off many docs, especially ones that didn’t grow up with computers, and the record-keeping paradigm shift becomes the tipping point for a lot of physicians to leave medicine. 

The oft-cited complaint, “I went to med school to take care of patients, not to enter data,” carries a ring of truth.  I know I’d rather take care of patients, even smelly ones, than play with computers in a dark room for a couple of days.

At least one doctor announced he’ll retire the day before the system installs.

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DOCS: The Distant Obstreperous Child Syndrome

January 13, 2013

Even when long, life is brief

From the tree one must drop, like a leaf.

For those left behind,

We’re all of a kind,

Love is paid for with grief.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  In May 2010, I left my position of 23 years, and honoring my non-compete clause, traveled for a year doing locum tenens work.  In June of 2011 I joined up with the Community Health Center, which provides care for the underserved.  I’m now working part-time, which, for a doctor, means 54 hours a week.

Weekend call comes with a theme; this weekend I keep foundering in the shoals of familial dysfunction in the wake of parental alcoholism.

I do a lot of explaining from my own family story.  “It does something to you,” I said far too many times this weekend, “to watch someone you love killing themselves.”

Terrible ambivalence devolves upon the only child of a self-destructive parent, that same anguish spread through a larger sibling cohort pushes children into emotional roles that come to dominate their lives.  From experience, the most geographically distant child moved the furthest away emotionally; having left the most unsaid, when the final hours of that parent come that child has the least emotional preparation for the ultimate separation and will make the most trouble for the health care team and the entire family.  At the Practice Formerly Known As Mine we called it DOCS, the Distant Obstreperous Child Syndrome.

In those cases, I point out to the other siblings that the one child making the most noise really can never be ready for the parent to depart, and takes upon him or herself the feelings of unfinished business of all the brothers and sisters.  Thus the observation than under the best of circumstances a split in the siblings follows the death of a parent and that split seldom heals.

The child who has had the most involvement, who sees clearly the limitations of the human condition and knows that the time has come to embrace the grief and then move on, rarely makes a show out of their internal emotional state.

The same things happen in families without dysfunction but alcoholism or any other addictive behavior magnifies the drama and multiplies the irony, especially if the mechanism of death comes from the addictive behavior.

If a parent firmly places a finger on the self-destruct button, and has only one child, all those sociologic and emotional roles get concentrated into one psyche, and the whole grieving experience will increase by orders of magnitude.

Things only get worse in the absence of advanced directives.  If a person puts first things first, and, seeing the end coming, makes out a clear will, pre-arranges funeral plans, and attaches a Do Not Resuscitate form to the refrigerator, they probably didn’t indulge their destructive addictions at the expense of their families. 

By the same token, addicts, alcoholics, and adulterers maintain a steady stream of chaos and leave behind a mess of unfinished business when they go.

If people could live forever, we wouldn’t love the way we do.  Human love remains an undeniable force even in the face of bad parenting and addictive behaviors.

If a split comes between you and your siblings, I say, it can only continue if maintained, and don’t you be the ones who puts more energy into the maintenance than everyone else.   And if you have no siblings, don’t isolate yourself in your grief.