By Concepcion Guzman
After finishing my last shift at Cedars Sinai (Beverly Hills, CA) one Sunday afternoon, my cellphone rang with the sound of Hall of Fame ft. will.i.am’s “The Scripts.”
“Hey Mr. Guzman, I need you to fly out tomorrow to Albuquerque, Arizona” exclaims the EMR recruiter. She continues, “We have some consultants that did not make it on time, and we need people to start tomorrow morning.”
I said great, went online, purchased my tickets, and here I go!
If you have ever worked at Cedars Sinai, you know they do everything in their own style. They personalized their software (Epic) so much that it looks like they have their own piece of software.
Now, when I started on Monday morning in Arizona, I was a bit lost after spending 4 months at Cedars. It felt as if I had never seen Epic before. I was going through the expected learning curve of adapting to Arizona’s workflows for simple things as admission, transfers, and discharge. Those ADT workflows always vary from client to client. Everything from who release the orders to which unit acknowledges the transfer orders and who is responsible for moving the patient during a transfer (sending or receiving unit?) varies with each client.
Since it was a last minute deal, I did not have the benefit of attending the initial meeting/training where the hospital shows us exactly how they want us to train their staff, nor did I have access to one of their workflow booklets.
For the first few hours of Monday morning, I was working on learning as much as I could from their workflows in order to know the exact way to get things accomplished. But I was lucky enough to be working on a med-surge floor, which happened to have 2 discharges and 3 transfers line up right away. So it was time to take out my magician wand and figure it out on the fly!
It took me approximately 9 seconds and 2 attempts to find the right naming conversion for a home discharge order set. Only, after my first unsuccessful attempt to locate the right order set, the physician was already giving me the look…
Since we are the experts with the software, the clinical staff, especially physicians, anticipate that we will provide them ALL their answers in a split second. And when we do not, they automatically start getting frustrated. It is a normal reaction; they are going through one of the toughest changes in their career, and they see us as their light at the end of the tunnel to help them through the change.
Going back to the order set: apparently in Arizona they love shortcuts so much that they named the discharge order set “D/C HOS” with no synonyms associated. Of course, I learned later that HOS meant Home Order Set.
HOS? Of course, I would never figure that one out in my first attempt! It has absolutely nothing to do with consultants’ knowledge with Epic. We know where to go and what to do, but things such as modified naming conversions are out of our knowledge until we figure it out or somebody tells us.
The main point here to understand is that every hospital has their own workflows and ways of naming items. They have the freedom to modify the software to meet their own needs.
This is something that the end users will never understand at a glance because they believe that all EMR software, such as Epic, has only ONE way of accomplishing things. They assume we know every little thing in the software, when the reality is far from their assumptions. Due to the massive growth and expansion of Epic, it is impossible to know every module inside the software.
As EMR consultants, we know the full functionality of the software, but we may not know exactly how THAT hospital designed their workflows or named their order sets until we get our hands on it.
It’s our responsibility to learn their individual workflows as quickly as possible even before the project begins. Two of the most effective ways to learn their workflows is to attend the initial training/orientation and to review the workflow booklets given at the orientation and during the first few days of the project.
Our job is to deliver the correct information when the clinical staff needs it the most. Learning the correct workflows for each project we attend may take some time to master; for some EMR consultants, it may take a few minutes, for others a day, and the rest may never get it.
It’s key to identify workflow differences as quickly as possible because what you know works in one hospital may not work in another other one, especially if you are coming from a hospital like Cedars Sinai, which basically created their own piece of software.
It doesn’t have to be huge changes; simple things such as “Can RNs place discharge orders?” will vary across locations. Of course, they can (with the physician on the phone). Does the hospital want them to? That varies from place to place.
