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The "I Can't Believe There's No Abortion Thread" Part Deux: Electric Boogaloo

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dxmnkd316 said:
SAP consultants are the blurst. Almost every rollout goes like this

1. Hire consultants
2. Plan for 2 years
3. First roll out is a disaster
4. Push back dates a year, get informed you're 50% over budget
5. Second rollout is a disaster
6. Fire every ****ing one of the consultants
7. Delay everything 2-3 more years, double or triple the budget.
8. Attempt to survive the next 5 years
9. Spend the next twenty years healing scars and PTSD from your employees who went through it and stayed with you
Click to expand...

Perfect. I am going to use this if it's ok.
 
It's not my primary role, but I do some consulting and I'm sorry if some of them hurt you.

Yet if your company feels it necessary to seek assistance perhaps the issue isn't on the consultant's side.
 
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Driving through Rockford, MI yesterday, saw a sign that said "make our city a sanctuary city for the unborn."

Then again, Rockford/Sparta is so red it's burgundy.
 
Slap Shot said:
It's not my primary role, but I do some consulting and I'm sorry if some of them hurt you.

Yet if your company feels it necessary to seek assistance perhaps the issue isn't on the consultant's side.
Click to expand...

There are three major components of every solution - people, process, and technology. The platform is always the easiest thing to blame.
 
I guess I'm just going strongly disagree on healthcare IT. Some struggle, but many embrace it. Early EHRs were bears, but anything remotely modern (i.e. kept up to date within the past decade) is very good. Implementations vary, obviously, and when organizations half ass it by choosing to use multiple systems, well that's dumb and frustrating. There is only one truly enterprise-level EHR - Epic - but it's expensive. Choosing less expensive alternatives for the hospital itself requires yet other EHRs for ambulatory settings. Do they connect properly? Does data seamlessly flow between them? Maybe... but even then, the EHR itself is fine, it's the interconnectivity that's lacking.


Regarding SAP... yeesh. Look, it's a decent enough application. The problem, in my experience, (one implementation in last career, and my ol lady is going through one now at her company) comes from half-baked planning and the fact that they're often trying to combine many, many, many sources of data that are an absolute mess. SAP requires discrete data fields for almost everything and if your legacy database combined things... well. Good luck!
 
Swansong said:
I guess I'm just going strongly disagree on healthcare IT. Some struggle, but many embrace it. Early EHRs were bears, but anything remotely modern (i.e. kept up to date within the past decade) is very good. Implementations vary, obviously, and when organizations half *** it by choosing to use multiple systems, well that's dumb and frustrating. There is only one truly enterprise-level EHR - Epic - but it's expensive. Choosing less expensive alternatives for the hospital itself requires yet other EHRs for ambulatory settings. Do they connect properly? Does data seamlessly flow between them? Maybe... but even then, the EHR itself is fine, it's the interconnectivity that's lacking.


Regarding SAP... yeesh. Look, it's a decent enough application. The problem, in my experience, (one implementation in last career, and my ol lady is going through one now at her company) comes from half-baked planning and the fact that they're often trying to combine many, many, many sources of data that are an absolute mess. SAP requires discrete data fields for almost everything and if your legacy database combined things... well. Good luck!
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Sorry. All research shows the amount of time entering data and using EHR systems (all) shows the time suck is 4 times as long as it used to be. It has created jobs- scribes, other excess staff, to deal with the extra work load added. I cannot see my Provider one on one because they have a scribe to assist in the cumbersome documentation process (this is EPIC). I haven't seen a Provider who has any idea what is happening with me for at least 5 yrs- I have to fill them in because the info is not available or is so time consuming to find they don't bother and just ask me. This past yr all 3 of my Providers switched to EPIC. All 3 Practices were a CF. Lost data, lost appt reminders, discussions between staff and Providers on where they were supposed to enter data because there wasnt' a spot where they wanted to put it and they can't find previous data.

Watched the ICU the Nurses take less than 5 minutes to collect the info needed re INtake, OUTput, IV fluids hung/what was left at prescribed interval. They then spent 20+ minutes entering it, having to use multiple windows, redundant steps and documentation and needing to confer with each other. They also were talking about how someone else had entered something in a different place that meant the tracking they needed wouldn't work. This process used to take less than 30 seconds to document in a real chart. (Pretty sure this is EPIC).

Systems periodically update and lose data when they do. The way the data was entered didn't fit the way people thought it should have been used so doesn't migrate well. None of them take into account the interconnectedness and natural progression of care- there are little modules for everything that need to be opened. It shouldn't take anyone, never mind an ICU nurse, 20+ minutes to document input, output and vital signs after needing to confer with colleagues to make sure they are entering things in the right place.

If the system didn't change maybe things would improve with exposure and ability to create predictable work patterns. Unfortunately I can't remember the last time I entered a medical setting for myself or someone else, that they weren't dealing with an update or migration that was causing confusion, wasted time.

This last adventure with FIL les showed me- real time- just how scary the missed info, lack of coherence, lack of detail conveyed and lack of continuity due to disjointed way the records are. If we hadn't been supplying correct info he would be dead.
 
If you're genuinely advocating for a return to paper charts then I truly don't know what to tell you. Probably a story about buggy whips. You can't blame the system for additional required documentation that you were previously exempted from.

Implementations are hard. Learning a new system is hard. Data migration is hard. That doesn't mean the system is bad or that the mission isn't worthwhile.


Everyone's favorite system - in any industry - is the last one, no matter how much they complained about it when it was in use.
 
Swansong said:
If you're genuinely advocating for a return to paper charts then I truly don't know what to tell you. Probably a story about buggy whips. You can't blame the system for additional required documentation that you were previously exempted from.

Implementations are hard. Learning a new system is hard. Data migration is hard. That doesn't mean the system is bad or that the mission isn't worthwhile.


Everyone's favorite system - in any industry - is the last one, no matter how much they complained about it when it was in use.
Click to expand...

Lack of coordination of care can also be exacerbated by lack of ehr as I’m sure you’re aware. That’s one of swedens biggest issues- not having access to the right records when needed
 
Swansong said:
If you're genuinely advocating for a return to paper charts then I truly don't know what to tell you. Probably a story about buggy whips. You can't blame the system for additional required documentation that you were previously exempted from.

Implementations are hard. Learning a new system is hard. Data migration is hard. That doesn't mean the system is bad or that the mission isn't worthwhile.


Everyone's favorite system - in any industry - is the last one, no matter how much they complained about it when it was in use.
Click to expand...
Create a UI that mimics the paper forms, that UI would then transcribe their handwriting to values input into the DB.

Some level of compromise would be needed for the layout of the form to allow for easy translation from pure free-form to freeish-form. This would make data collection quicker and help reduce transcription errors.
 
Deutsche Gopher Fan said:
Lack of coordination of care can also be exacerbated by lack of ehr as I’m sure you’re aware. That’s one of swedens biggest issues- not having access to the right records when needed
Click to expand...

Absolutely. Without getting into details, someone I know has COPD and is just in and out of NY-area hospitals and the family refuses to allow hospitals to share data. The result is ridiculously disjointed care.
 
St. Clown said:
Create a UI that mimics the paper forms, that UI would then transcribe their handwriting to values input into the DB.

Some level of compromise would be needed for the layout of the form to allow for easy translation from pure free-form to freeish-form. This would make data collection quicker and help reduce transcription errors.
Click to expand...

Most of the documentation forms in Epic look vaguely like a piece of paper. the biggest issues are in the discrete data fields. You must choose a pre-defined option. Now, younger staff recognize shortcuts like "just type 'y' for 'yes'" and the like, but many will meticulously click the list, choose the option, and then to the next. Or they refuse to use note templates, or other efficiency boosters. Hell, we even have transcription available on the mobile app version.
 
Swansong said:
How is this even legal at this point, in 2023? It definitely isn't in MA.
Click to expand...

It isn’t. My company has decided it’s cheaper to pay the fines for not transitioning to electronic medical records than it is to pay for transitioning to electronic medical records. That said, they’re piloting electronic charting somewhere in the company, so I’m sure it’s just a matter of time before it’s rolled out everywhere.
 
psych said:
It isn’t. My company has decided it’s cheaper to pay the fines for not transitioning to electronic medical records than it is to pay for transitioning to electronic medical records. That said, they’re piloting electronic charting somewhere in the company, so I’m sure it’s just a matter of time before it’s rolled out everywhere.
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Wow. Crazy.

In MA, you can't even prescribe via paper without indicating that the eRX system is temporarily down.


How does this impact Medicare payments? They require all sorts of things related to digital validation and attestation.
 
dxmnkd316 said:
SAP consultants are the blurst. Almost every rollout goes like this

1. Hire consultants
2. Plan for 2 years
3. First roll out is a disaster
4. Push back dates a year, get informed you're 50% over budget
5. Second rollout is a disaster
6. Fire every ****ing one of the consultants
7. Delay everything 2-3 more years, double or triple the budget.
8. Attempt to survive the next 5 years
9. Spend the next twenty years healing scars and PTSD from your employees who went through it and stayed with you
Click to expand...

At my current company it went:

1. Hire consultants
2. Plan for 2 years
3. Realize it's too many different systems and too complicated so only do partial rollout
4. Push back dates a year, get informed you're 50% over budget
5. Second partial rollout
6. SAP doesn't communicate with your other systems that you didn't convert, creating a lot of duplicated work for everyone
7. Delay full roll out indefinitely
8. Sell division to a diferent company, now it's someone else's problem
 
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