OCT Meeting Dec 13

For my final post, I would like to comment on the OCT meeting I attended on Dec 13.  This was an interesting opportunity to see behind the scenes.  I remember when I first came into the hospital, I noticed a big push about everything EMR.  There was always a new poster somewhere about what new advance was being introduced.  And the net presenter usually have some new Cerner fix.  So, being able to see how these decisions are made and by who was quite interesting.


The start of the meeting was filled with talk of the slowed performance times in Cerner.  This was particularly a problem with patients who had been in the hospital for extended periods of time, such as in an ICU.  I guess what happens is that there are so many data points entered in for the patients, such as vitals, pain scores, etc.  This brings up the question in my mind as to if we actually need all the data we are recording.  I remember scrolling through countless care-giver assessments and such to find the one pice of data I needed.  Maybe we need to cut down on that stuff until we can get a system that can handle it.


They mentioned also that to gather data on this, there are people who follow providers around in the hospital and track how long it takes them to access the information.  I'd never seen this, but it seems like an interesting way to know what is actually happening on the wards, instead of just relying on random reports from users.


Another topic touched on was that of communication.  How to reach all the users to let them know of any changes.  I'd never realized how big of an issues this really can be.  If no one knows what the change is, then it doesn't matter that it was made.  It seems the team does a good job of publicizing changes, through net presenter, the Cerner welcome screen and posters around the hospital.  


One note about changes.  De McKenna mentioned in our earlier meeting, that some hospital systems just use the same version of their EMR for many years, getting to become experts in that without making lots of changes.  This is probably helpful, especially in instances where residents change every year, or where older physicians have difficulty learning new computer programs.


The safety dashboard was also mentioned.  This is interesting, and helpful, especially for nursing staff to be able to go to one place to see if each patient is taken care of.


Finally, they touched on the central line checklist.  I like checklists, especially for procedures or tasks that require many steps or many pieces of information.  I don't think we should think that we can always remember every little detail and to do every step in a complex procedure, because we can't.  Other industries use checklists and I think it's great that we are starting to implement them more.  Dr Atul Gwande's Checklist Manifesto has an interesting view on this:


"It somehow feels beneath us to use a checklist, an embarrassment. It runs counter to deeply held beliefs about how the truly great among us - those we aspire to be - handle situations of high stakes and complexity. The truly great are daring. They improvise. They do not have protocols and checklists. Maybe our idea of heroism needs updating." 


Overall, the meeting was very interesting to attend, and I got a feeling that wherever I end up, I would like to be involved in such meetings, helping to get the EMRs implemented correctly and helping the users get the most out of them that they can.