345 Days Before Go-Live

Only a few days before Christmas. Can you imagine the craziness around my workplace? The majority of the project team will be out for the Christmas and New Year holidays and will be returning to work the first week of 2012. My colleagues and I are scrabbling to meet all of our deadlines.  I can already imagine the craziness in January.

I am currently on the implementation team of a hospital that has a legacy system.  Actually, the physicians, nurses, and other clinicians in my institution have been using an electronic medical record for 36 years.  The end users are not new to technology. Four years ago, the entire hospital upgraded the DOS based system to a graphical user interface (GUI).   In 345 days, they will have an entirely integrated system and the patient will have one chart.   From the time a patient is admitted in registration, the electronic system will play a major role throughout the patient’s inpatient stay.  If the patient is scheduled for surgery, surgeons, anesthesiologists, and the entire operating room staff will be charting on the integrated electronic medical record.  In fact, even the patient’s primary care physician will have access to the patient’s medical record. 

Having a integrated electronic medical system is a huge accomplishment and not many hospitals in the United States have it. This is a win-win for patients.  Paper charts will be non-existent and become an interdisciplinary chart, where all disciplines document in one chart.  The end users in my facility are always willing to embrace change and are ready for the new change in electronic systems.  

In order to accomplish all of my tasks, I learned to manage and prioritize my time wisely.  Here are some of my tips.

1.)  Write down all of your tasks in one place and spend a few minutes each day re-writing your task list.

2.)  Cross off all of your tasks as you complete them.

3.)  Don’t buy an expensive time management system. Spreadsheets or writing it down on a notebook works better.

4.)  Schedule time with people and stay on topic if you have a deadline.

5.)  Manage your time by looking ahead of the project timeline and allow yourself plenty of time to get all of your tasks accomplished.

6.)  One last tip – smile and have fun.  Implementing a healthcare system requires teamwork.  Remember one person cannot do it all.  Delegate tasks to other people.

5.)

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4 Fun Facts about Health Informatics You May Not Know

 

Happy business people laughing against white background
I think its important to have fun at work.  Health informatics is a dry topic and may not be much  fun, well at least for some people.  I always try to have fun at work because the content is dry and your end users will likely not be happy with all of the changes.  It’s always nice to infuse laughter and fun into the work.

Here are some fun facts I encountered in the health informatics field:

1.)  Traveling may be brutal when you are consulting but the benefits of air travel makes me feel like a queen especially in the airport.  I was always first to board the plane because the airport staff and the flight attendants got to know me.  Also, flight and hotel rewards are an added bonus.  I furnished my entire apartment using my rewards.

2.) When I present the EMR to the providers and clinicians I make the demonstration fun by creating fun demo patients and instilling laughter into the presentation so the end users can laugh.  The EMR will impact clinicians workflow so by adding a comic relief  will help physicians, nurses and other clinicians ease into the transition.

3.)  You will work with fun and  wonderful people. They will help you when you need help in the future.  I have met a lot of people and still keep in contact with them.  Also, if I have an issue I need to resolve in another facility, I do not hesitate to contact the people I have known in the past.

4.)  Network, network, network.  I cannot emphasize this enough.  I have gotten future jobs because of people I met in health informatics classes or seminars.  I always like networking since I am a very social person. Networking is easy for me since I like talking to people.

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A Day in the Life of a Nurse Informaticist

I’ve had positions implementing and maintaining a healthcare system and a nurse informaticist wear many hats, just like a clinical nurse. My job title may be clinical systems analyst but my job varies from project manager to trainer.  There is a difference maintaining a current health system to implementing a new health system.  The difference is maintaining a system there are hardly any deadlines unless your project team is optimizing new features.  On the other hand, implementing a system requires long hours to meet deadlines.  In my particular position, I am implementing a new electronic system to replace the legacy system.

Although each day varies, here is a sample of my typical day:

7:40 AM – Arrive to work

8 AM -Check calendar to see how day will look like (i.e. meetings for the day)

8: 15 AM Check and answer emails that need immediate attention

9 AM – Check deadlines to prioritize work

9:15 AM – Check to-do list

9:30 AM – Design and program system according to client needs based on upcoming deadline

9:45 AM – Check and answer emails

10 AM – Meeting

12 Noon – Eat lunch at desk while answering emails

12:30 PM – Continue with programming the system

12:45 PM – Answering questions from colleagues or answering emails

12:55 PM – Continue with programming the system

2 PM – Finished programming and now documenting what I just build on spreadsheet

4 PM – Meeting either formal or informal with individual team members

5 PM – Eat dinner

5:30 PM – Look over next day’s schedule (if any meeting scheduled, start prepping for meeting)

5:45 PM – Design and build system for next deadline

7:45 PM – Entering in my time worked on the project for the day

8 PM – Go home

This is somewhat of a typical day for me.  Most of the day I am answering emails or answering questions from colleagues. I like helping out my peers in case they get stuck with a problem that needs attention.  Being a systems analyst requires teamwork.  Building a healthcare system cannot be accomplished by yourself.  One person does not know all of the answers and consulting with my colleagues is how my problems are resolved.

Each day is different for me.  Some days are all meetings while some are all programming.  In the end, my deadlines are met.

 

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354 Days

Countdown clock 354 days until our go-live.  There is still a lot more time. There hasn’t been much activity since I last wrote except the fact that I am super busy with programming and presenting what I built to the end users or clients.  I did have time to go to our holiday party last week and also to take a mini-vacation.

So now I am refreshed.  Tomorrow will be a busy day for me. I have two presentations to give – one is a dress rehearsal and the other will be presenting my flowsheets to the nurses.

The dress rehearsal will be for the project team to critique our workflow and presentation skills.   The other presentation is for the nurses. I worked hard at getting my script and powerpoint presentation polished. I anticipate what questions they will be asking me. 

For the last two weeks, my team and I have been showing our end users what the “content” of the electronic medical record will be. Even though our first session was a disaster, my team and I made a comeback.  The next few sessions were organized and polished.

Our workflow sessions  with our users will start in January.  And that is when the project team’s work will pick up. As you meet with end users, changes to the “build” will be necessary.

Our project team has been busy and putting in 12 hour days.  Even though implementation is exciting, it is also hard work and will eventually pay off. So far, everyone on our team has been pleasant to work with. No one is cranky or upset that they have to work long hours.  Everyone has one goal in mind:  to build the best electronic medical record there is.   Implementing an electronic medical record is a team approach and no one or even one team should be doing all of the work.  It’s impossible to do everything yourself.

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Lessons Learned

Last week, I wrote about my trials finding a job in nursing informatics.  If you missed my two part posts, you can read the first part here and the second part here.   This week I will write about my lessons learned and how you can learn from my own mistakes.

1.)  Just because you graduated with a masters degree doesn’t mean everyone wants to hire you.

2.)  Invest in a suit – you will wear it more than once, trust me.  Don’t wear scrubs to your interview. You may have just gotten off of the night shift or about to start, wear professional looking clothes to your interview, preferably a suit.

3.)  Read resume and interviewing books – polish up your resume, just because you have been a nurse for 15 years doesn’t mean you don’t have to update your resume.

4.)  Practice  your interviewing skills – It’s how you communicate and present yourself.  Speak in proper English and acknowledge the interviewer as with a title of Miss or Mister.  You don’t know who they are.  It’s better to be safe than sorry.

5.)  In your interview, ask for a job description and ask questions about the job if you do not understand.  Most nursing informatics positions are new and the people writing the job description may not know what a nurse informaticist is.

6.)  If you have been with your employer for several years as a nurse and would really like to be come a nurse informaticist, meet with the Chief Nursing Officer (CNO) or equivalent to discuss a new position of “nurse informaticist”.  If there is no job description, write it.  No one ever said you only have to apply for positions with job descriptions.

7.)  Never accept no as the final answer.  Obstacles were created for you to break them if you really want something.

8.)  Never accept the first offer.  Negotiate your salary if you think you are worth more.

9.)  If you are new to informatics, start your career either as a trainer or as a systems or clinical analyst.  As a systems or clinical analyst, you will develop technical skills and adapt to a new way of thinking.

10.)  Network.  Get to know who your nurse informaticists are in your area. Join local and national organizations.  See a list of nursing informatics organizations here.  Learn who the pioneers are in nursing informatics and read articles.

So that’s it, my words of wisdom.  I hope you were able to take something away from it.  If you need additional information, please contact me.

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365 Days

 

Countdown
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Well this is it. The countdown begins.  In 365 days, my hospital will go-live with our new healthcare software.  Our go-live has been in the works for some time now but the countdown to December 2, 2012 has officially begun.  Am I stressed?  You bet. This is my first inpatient implementation and quite excited about it.   I missed the previous software implementation a few years ago. 

So far, I have a few deadlines looming in the near future.  At this moment, what is difficult for me is prioritizing my time. It’s hard to see the big picture right now and there are so many people working on this project.  My own work is a smaller piece of that “bigger picture”. I know at the end it will be well worth it.

My experience has been implementing ambulatory clinics. I am comfortable with clinics – they are so much smaller than an actual hospital.  My other experience includes maintaining the electronic health record, not as exciting as implementing, but definitely challenging.  I know my experience is these two areas will help me as I continue my career.

I will be writing a regular post about my go-live each week and counting the days.  Due to privacy, I will not be revealing anyone’s names or which software vendor we are working with.  I will be writing about my own experience and hopefully it will be a learning tool for me and others who may not be in the healthcare informatics industry but is considering in getting a job in the industry in the future. 

I became a nurse to make a difference in my patient’s lives and hopefully working on the information technology end will help many clinicians and patients and hopefully saving their lives as well.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*DISCLOSURE:  I will not disclose the name of the hospital or the software and people’s name have been changed for privacy.

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Transition from Clinical to Technology – Part II

In my previous post, I wrote about my obstacles finding a job in nursing informatics.  After I stopped thinking about finding a new job 24/7, I finally found one in New York City.  Well, it wasn’t instant but I did receive call-backs and interviews.  Too many interviews, in fact.  I accepted every phone and in-person interview.  Since this would be my first real job in informatics, I wanted to make sure I took the right job. Hence, why I accepted every interview.

I realized from this experience interviewing many times makes you a better interviewer.  It helped me to answer questions quickly and enabled me  to think about why I chose the intensive care unit and to explain that to the interviewer.  As I went on each interview, I became confident in myself and my skill set.  I wasn’t ashamed to let the interviewer know my skills and talents.

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My Two Conflicting Worlds – Part 1

 

Training Virtually and Safely

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*This blog post will be a three part series on how I transitioned from bedside nursing to the information technology sector.  I was inspired to write my own story after someone read my previous blog posts in this blog and asked me for some words of wisdom.

After I graduated from my nursing informatics program, I was determined to find a job in the field. No one said it was going to be easy. But no one said it was going to be hard either.  Even though my professors told my class what types of jobs to get, no one really helped us in transitioning from the clinical area to the technology world. 

I did get advice from my preceptor in my last semester of graduate school.  If I didn’t get advice from her, no one would have told me what kind of job I needed to get.  For some reason, I was under the assumption that I would be qualified to be an Information Technology manager or director.  Little did I know I had to start over and be either a systems analyst or trainer.  I thought to myself I had already paid my dues being a clinical nurse.

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Meaningful Use Criteria

 

Medical Symbol Vector

 

In my last post, I discussed how meaningful use of the EHR was initiated.  In this post, I will discuss the meaningful use criteria. Meaningful use refers to a set of fifteen criteria healthcare providers and hospitals must meet to prove they are using their EHR in a meaningful way. 

There are also ten more requirements but only 5 out of the 10 are required.  In total, providers need to demonstrate twenty of the twenty-five requirements.  There are the 15 mandatory requirements healthcare providers and hospitals must meet in order to qualify:

  1. Record patient demographics (50%) such as preferred language, gender, race, ethnicity, date of birth
  2. Record and chart changes in vital signs  (50%) Blood pressure, calculate and display BMI, height (may be self-reported) weight, plot and display growth charts for children 2-20 years
  3. Maintain active medication allergy list (80%) one or more allergies or an indication of no allergy for each patient
  4. Maintain an updated problem list of current and active diagnoses (ICD-9 or SNOMED) (80%) one or more problems, active diagnosis, or indication (i.e. “none” of no known problem for each patient)
  5. Maintain active medication list (80%) one or more medication or an indication (i.e “none” that the patient is not currently prescribed any medication) 
  6. Use computerized physician order entry for medication orders (CPOE) (30% including meds)
  7. Generate and transmit electronic prescriptions for non-controlled substances (40%)
  8. Implement drug-drug or drug-allergy interaction checks (functionality enabled)
  9. Record adult smoking status (50%)
  10. Provide clinical summaries for patients for each office visit (50% in 3 days)
  11. On request, provide patient and electronic copy of their hospital discharge instructions (50%)
  12. Implement capability to electronically exchange clincial information among care providers and patient authorized entities 
  13. Implement clinical decision support (one rule)
  14. Implement systems to protect privacy and security of patient data in the electronic health record (EHR)
  15. Report clinical quality measures to CMS for Medicare or states for Medicaid (Blood pressure, BMI, and smoking)

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What is Meaningful Use?

 

Laika presentation at HIMSS 2008 in Orlando
Meaningful use is a hot topic these days.  Do you know what meaningful use means for the electronic health record (EHR)?  Please note that EHR (electronic health record) and EMR (electronic medical record) are used interchangebly.

 On February 13  2009, President Obama signed the American Recovery and Reinvestment Act  (ARRA) to stimulate the economy.  In four days, the American Recovery and Reinvestment Act became a law.  The Recovery Act had three immediate goals:

  • Create new jobs and save existing ones
  • Spur economic activity and invest in long-term growth
  • Foster unprecedented levels of accountability and transparency in government spending

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