Posts Tagged ‘Centricity’

Another road trip 10: starting with drama and finishing with a friend.

June 17, 2015

I started the day off with drama

For me, psychological trauma

But then at the end

I made a toddler a friend

And impressed the papa or mama.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record System (EMR) I can get along with. I spent the winter in Nome, Alaska, and I just finished an assignment in rural Iowa. Right now I’m working in suburban Pennsylvania, combining work with a family visit.

Bethany and I boarded the elevator this morning, and another passenger came on.  I looked at his name tag lanyard and recognized the monogram logo.  I looked closer and saw the words “Health Care.”

“You rep for GE?” I asked him.

“Yes,” he answered, grinning.

“Centricity?”

“Yep.”  He still smiled.

I will confess to evil thoughts that I trace to my involvement with that EMR system.

I fantasized picking my laptop up, throwing it as hard as I could through the glass window and into the street, timed just right so that a speeding semi going 70 mph on a city street would smash it on the grill.

I have imagined walking up to the promotional booth at the American Academy of Family Practice, and starting a strident, offensive series of questions, accusing the rep of complicity with the Forces of Darkness, and I would be joined in a matter of minutes with hundreds of sweating, frazzle-haired doctors carrying signs and chanting louder and louder until, screaming, we dismantled the booth.

Or, better yet, getting a humbled software engineer into the clinic and showing him how badly the system worked and kicking him in the shins and saying, “Why would you bury landmines in a sandbox?”

In the time it took for a hundred things to run through my mind, I decided to say, “I left a job because of that system.”

His grin didn’t dim.  “We don’t sell it anymore.”

I had to stop my runaway emotions in their tracks.  My grim imitation of a smile broadened to genuine and I laughed.  “You absolutely can’t imagine how validated I feel.”  I shook his hand and thanked him profusely.

***

I can’t write anything specific about the first patient of the day, but I can say things started unexpectedly early with unexpected drama.

After that, the pace slowed till 11:00AM.  While I ended up caring for 39, the majority came in after 5:00 PM.  Poison ivy accounted for half the business, earache for another quarter, and eyes for 10%.

Removing ear wax, making the patient better before they leave, brings me great satisfaction across a wide age range of patients.

But the clinical highlight came with a frightened 20 month old.  I played my way through the exam, I finished with more energy than when I had started, and left the patient more trusting of doctors.  The parent, impressed with my gentleness and patience, gave me permission to write that, and a good deal more.

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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.

Blog end: I’ve reintegrated

January 16, 2012

I had a great time, it’s a fact

My life had been so out of whack

I flew cross the sea

From Barrow to Leigh

Now I’m home and it’s good to be back.

I received an email from a doc who went walkabout to New Zealand for a good deal longer than I had, and asked me questions about my reintegration.  I asked for permission to post the original missive, but three weeks later haven’t heard back.

I replied: 

It’s interesting that you emailed me six months to the day after I started back into work here in the States, and if it’s OK with you I’ll use your email and this return as a post.

I’ve enjoyed reintegrating to US society and the medical care system.  I’m back doing hospital work, which, strangely, I really enjoy.   I know my consultants on a first-name basis and I like the camaraderie in the hospital.

It helps that I’m working for a Community Health Center.  For a lot of reasons, our patient population gets sicker earlier.  The pathology load weighs heavy on them.  At any one time, half of our twenty to thirty hospital patients also appear on the nephrologists’ list because of chronic renal failure and dialysis.  Usually we have three people in active DT’s and three others in liver failure. 

I have had to get used to the paranoid reality of defensive medicine.  Our patient population has made the transition easier because many have no money and no insurance and hence can’t pay for procedures that probably weren’t needed in the first place.

For those with insurance, I worry that I overuse medical technology.

Getting labs back the same day, like glycohemoglobin and TSH, makes patient management easier, as does having in-house x-ray.  

I liked MedTech32, the electronic medical record (EMR) system that makes documentation so easy throughout New Zealand, and the hardest part of coming home has been dealing with Centricity, whose software engineers remain isolated from any contact with this particular end user; for example, I have to click through five data fields to make a back to work/school slip and I have no way to fix it.  My productivity has gone way down; eleven patients in a morning or afternoon taxes my resources; not that I spend more time with each patient but I spend more time fighting the computer to enter data.  And about half the problems could be fixed easily.

I miss the way I always started on time in New Zealand because I brought my own patients back from the waiting room, and I miss the way the patients (mostly) respected my time.  In my current situation I limit the patients to three problems per visit.

Narcotics seeking remains a problem here as well as everywhere.  I’m building up a reputation in the street-drug community here, just like I did in the South Island, as parsimonious with opiates and benzodiazepines. 

Still, my practice swells with new patients every day.  I like pediatrics, and I find that a new practice attracts young people and young families, even with an old practitioner.

In the long run, most people either fit into the category of wanderers or homebodies, and I am definitely a homebody. 

But man, did I have a great time.