Thursday, December 11, 2014

Pride (in the name of love)

Pride (in the name of love)

I have not had a long career, but I have been in the workforce for two decades.  Interestingly, half of that career has been as a CIO in an academic medical center in Dallas.  Before that, I have worked as a clinic manager, as an analyst and as a consultant.  This background has allowed me to work with many healthcare organizations, many physicians, many administrators, and many patients --- across 20 different states.  But tonight, before I go to bed, I am met with one emotion that I have never felt before in my professional career: pride.

This note is not meant to disrespect any previous employer or any prior accomplishment.  I have learned a great deal in all of my professional opportunities.  I have been fortunate and I have been lucky.  I have been grateful and I have been happy.  In fact, happy and satisfied are probably the two most common emotions that come to mind when I think of my professional history.  OK, lucky comes up a close third.

Why Pride? Why Now?

On December 6th, our organization, UT Southwestern Medical Center, opened Clements University Hospital in Dallas, TX, a state of the art facility to serve our community.  I was a part of the team that helped design, build, prepare, test and open this new facility.  More specifically, information technology and the team that delivered it were at the forefront of this effort.

Many hospitals are opened every year in this country and even in this community.

This building is greater than the sum of its parts. 

This building brings together patient care, teaching and research in a way that could not be done separately on this campus.  This building brings together people, process and technology in a way that could not be done without thoughtful design.  This building brings together the collective aspirations of clinicians, investigators, and patients to improve the health of their community.

It also brings together an IT organization that has proved to be greater than the sum of its parts.  The three-year journey has tested our team: it has tested our people, it has tested our systems, and it has tested our patience and resolve.  We had to constantly re-invent ourselves to evolve our thinking, challenge our assumptions and innovate (not only in technology, but in preparation).  The journey has brought the team together as we have seen the many sacrifices that everyone has made, the many times that a team member has come to our rescue, and the great courage that so many showed in the face of adversity and setback.

Our work is only beginning, and we are all well aware that there is a long road ahead of us before we reach our ultimate goals of transforming care in our community.  What a great team to be a part of….

I am lucky to be a parent of two wonderful children that constantly remind me of what pride feels like.

Tonight, my professional life has its first taste of pride (in the name of love).

Sunday, October 5, 2014

Epic, Ebola, and the 1%

OK.  Maybe it's not the 1% and closer to the 3%.  The worthy percentage of hospitals in America that are wise enough, smart enough, and rich enough to have top of the line EHRs implemented.  I'm not just talking about the greatest Health IT vendor on the planet, Epic, but also others in this category from Cerner to Allscripts to Meditech (who might be equally great...or not).

I've been around the block to know a lot of great organizations with great leaders have put their faith in these informations systems and for the record they are a TON better than they were a decade ago.  In fact, I would offer that these systems categorically have exceeded the capabilities of their category.  They are the best electronic medical record systems we could have ever imagined.

They have done what they were built to do: replace the paper chart.  In so many ways, they are better than the paper chart.  So many that it is difficult to list.  Why would anyone every need a paper chart when you have an EHR?   Quite simply you don't.

The problem for Epic and Ebola and for that matter for any EHR and any disease is that no EHR was ever designed for the express purpose of helping doctor's treat patients better.  

No EHR vendor has spent R&D developing the best clinical pathways for the treatment of aneurisms or for that matter prostate cancer.  There is no part of the EHR that brings together the necessary lab results, medication list, surgical and family history, and for that matter recent literature and clinical guidelines on to one screen so that the doctor & care team can best manage a condition.

So is it difficult to imagine, that when 1 patient out of 75,000 patients you will see in your ER this year happens to have a rare condition that you have never seen before in your hospital's history that your EMR doesn't have special software designed to help the care team manage it.

Hell, your EHR doesn't have a screen that brings all of the relevant information together for the top 5 conditions that you see in your ER.  Now, the vendors will disagree with me, because all of this information is in the system (somewhere) and clinicians should be trained to know how to find what they're looking for (this is why physicians hate EHRs).

It is not Epic's fault that they provided an EHR that didn't help a hospital efficiently take care of an Ebola patient.

  1. They never promised us that they would help us treat patients better through the use of their software.
  2. They give us features that if we want to turn on might help care teams treat patients better as long as we don't configure the features in a way that don't.
  3. Care teams are free to try to come up with ideas on how software that was fundamentally designed to replace paper could help us achieve better outcomes with patients.
An EHR was designed to keep a record of care.  In fact, Epic succeeded at that 100%.  We know what happened in that ER much better now than if we had a paper record.  Congratulations.

For the record, Epic (and other vendors) have sent us complete procedures (suggestions) on the many features that exist within our purchased software that could be set-up to better manage the immense Ebola risk.  I will get to work on that right after I review the section on how to manage stroke patients or patients on Heparin.

October 2014.  State of the EHR industry:  All of the users of EHRs brainstorm the best ideas on how to use the many features given to us by the vendors to purposefully improve patient care.   We're trying hard but it's slow going.

The Feeling Begins....

The name of the first track from the Soundtrack to the Last Temptation of of Peter Gabriel's best works.  This blog is clearly not worthy of sharing the same title.

However, as will be common for this blog, the ideas will quite often be borrowed.  Think of this blog as more of a mix tape rather than original music.   Many times, the thoughts will be more emotional and aspirational rather than rational.  The punctuation will likely be flawed as much as some of the references.

This is not a blog to motivate or to tell the world how great I am/we are.  Rather, in this very complex inter web, there is that chance that when I scream my own very interesting thoughts out into the ether, I might attract a few equally interesting thoughts back.  Somewhere in that moment, perhaps my hopes, fears and frustrations will have some company.

The purpose of this blog is to discuss topics in healthcare information technology.  I will not share with you what I have learned at the supermarket, or raising my children, or taking a train in India.

I am stuck in moment.  The moment when so much is possible, yet it hasn't happened yet.  I'm firmly convinced that the revolution will come....just not where we are looking for it.