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Why ‘upgrade’ has become a dirty word thanks to EHRs


The electronic health records and electronic medical records implementations come with endless upgrades whether your clinic is prepared or not.


Take Home

The electronic health records and electronic medical records implementations come with endless upgrades whether your clinic is prepared or not.



By Dianna E. Graves, COMT

Joan Rivers was often known to say, “Can we talk,” And then she would tell us a grievance or tale “just between the two of us.”

Now that most of us have made the foray into the world of electron health records (EHR) or electronic medical records (EMR), there is one common theme across the board. It has no state boundaries, no clinic specialty boundaries, and no known cure.

If you have an EMR/EHR, you are going to be plagued with upgrades and/or patches. They will often suck the life out of you, your management team, and office staff in innumerable ways.

More from Dianna Graves: ‘Like’ it or not, it’s the talk of the clinic

Upgrades are very close in nature to the vine called kudzu: a type of climbing, coiling, and trailing vine most native to eastern Asia. These plants often become invasive, and are usually considered a noxious weed. They climb over other existing trees and shrubs and grow so rapidly that they kill these other plants due to the heavy shading abilities they provide. Other plants often die as a result of this shading as they are slowly suffocated.

If you feel this dramatization is slightly melodramatic, you have not recently gone through a computer upgrade, or you have forgotten your last one.

You may ask, “why is it so hard every time I go through an upgrade? Why does it cause such disruption to the schedule and my clinic flow?”


NEXT: Personal experiences


Personal experiences

After going through a traumatic upgrade last week, which has continued calamity into this week and is now threatening to flow into next week like the floodwaters in the Midwest that are eventually creeping into all of our basements, I have had many chances in the past two weeks, while cowering under my desk or staring at the ceiling at 3 a.m., to ask the questions above as well as this next question:

“Why do I feel like I’ve lived this day a hundred times before?”

Like Yogi Barra, the great philosopher, muttered one day, “It’s déjà vu all over again.”

Further reading: Symbols deciphered: The history of symbols and signs in medicine

While under the desk, I began to have moments of clarity to explain why we continue to have the same issues with every upgrade we have. It never changes-the uproar comes to a crescendo and then ends in a defeated whimper.

Then it dawns on me. It’s because ‘they’ don’t understand ‘us.’ They don’t really know our business and how we do it, and, alas, they don’t necessarily care because their job is to get the conversion done. They do what they have to do with the computers and that’s that.

I have begun to feel that after they do the upgrade, and warn us a patch will be imminent in a few months, I need to immediately race to the hardware store and buy copious amounts of mud and tape.

Perhaps you have tried to find ways to help the computer people know your group better, thereby making the upgrade less painful. Save your time, you would do better to push a watermelon through a straw. I do not say this in an evil way, I simply state that the twain shall never meet. This is because two things that are so different have no opportunity to unite.


NEXT: More and more problems


More and more problems

Your computer people have a goal in mind-upgrade your system with the newest bells and whistles using the specter of Meaningful Use, CMS, and PQRS penalties as impetus to do so. When we all began this, we often swallowed these bitter changes to our world because there was a reward for doing so. At the end of the year we received incentive checks and all the bad memories evaporated. Until the next year, and we then realized the incentives were less. Now we are doing the upgrades not because of the incentives, which are minimal for the pain, but to avoid being penalized in the upcoming years.

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I used to have doctors jokingly tell me on a bad day that retirement was getting closer and closer. Now when they say it, they are on their way down the hall to the accountant’s office to see if this is actually feasible. And when one of my technicians would act up and be disruptive, I used to tell them if this was a field that they really didn’t want to be in, the local tree farm was hiring. I even had blank applications in my desk drawer. Now I wouldn’t dare say this because I would be afraid one of them might take me up on it. I personally have my retirement agent on speed dial. Two years ago, I didn’t even know her name.

Don’t get me wrong. I am a big proponent of EMR for a number of reasons: medical legally (especially if you have multiple clinic locations), patient medication reconciliation and ordering, communication instantly between other clinics around the country, the ability to e-mail registrations, etc. with patients to name a few.

When we had the discussion about going to EMR, I was pushing and praying the doctors to let us get the clinic online. After we got the initial start-up bugs worked out, the doctors would agree that it was a good thing for our office.


NEXT: Problems continued


The upgrades have been the other side of the hill-the downhill side.

While upgrades mean increased technology, and the theory is excellent, these changes come in the form of widgets, apps, and clicks.

Doctors hate to click, drop down, and scroll. Computer companies don’t understand this because that is the world they live.

My doctors all have smart phones, and they drop down and click gleefully on their phones. Put them in a clinic with the same clicks and they bust a gasket.

You may be thinking, “Come on, we’re highly trained, smart, and adaptive people that can handle these changes. Not all of us get this tipped over by these upgrades.”

I have yet to go to a practice and meet any of you yet. Every practice I visit, or every conference I am teaching at, the doctors, managers, and administrators ask each other, “which system are you using and do you like it?” “Is it friendly?” “Can you navigate it easily or does it crash and burn all the time?”

“Oh, you have that system? That was our first system! Now we have __________.”


NEXT: Getting down to the real issue


Getting down to the real issue

The problem we all have is we are medical, analytical, problem-solving people. The upgraders are computer, analytical, problem-solving people, therefore, even though we share some similarities, the twain shall never meet is emphasized again.

You need to know the answer to the questions in order to ask the right question and avoid chaos. Being just a tech, I am not savvy enough to know that when they tell me the upgrade will be providing us with (5) new areas (apps) to fill in to comply with Meaningful Use that those apps are also called widgets. Widgets eat memory.

Therefore, we painfully have found out the following:

1.  Question number one we should have asked someone: Do you think we need more memory or do we have enough reserve? Before the upgrade, we had memory to spare. Now, a widget hungry Pac man ravaging our system has eaten it to no reserve.

2.  When you add these apps (widgets) will it change the screen configuration the doctors/technicians see? Prior to the update they were very happy with their view and there was no scrolling. Now, we scroll across to see the whole screen as well as up and down to see the whole length of the page. A double whammy!

3.   When you add a new app, does the old app we have been populating for 5 years go away or does it integrate? You mean we have to add all those codes in again?!

4.  Why didn’t you warn us about any of this?!


NEXT: Final conclusions


Final conclusions

So…if you have an upgrade coming, get ready. Imagine what could possibly go wrong: speed, space, effort. Investigate it fully. Call other groups and ask how they managed it. Ask your IT company what they are doing to prevent unseen issues. Prepare your staff. The morning of the upgrade is not the time. Make sure if the doctors choose not to come to upgrade classes, you go to them. Don’t just let them slide by because you think they know what these changes will be. They probably don’t, but they are doing their jobs and expect you to be the one to make these changes seamless.

Then, clean out under your desk so there is room under there for when the upgrade comes. You’ll be spending a little time under there and want to make sure you have enough space!

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