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Mayo Clinic EMR Install Goes Poorly For Nurses

Posted on June 1, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Ordinarily, snagging a contract to help with an Epic install is a prized opportunity. Anyone involved with this kind of project makes very good money, and the experience burnishes their resume too.

In this case, though, a group of nurse contractors says that the assignment was a nightmare. After being recruited and traveling across the US to work, they say, they were treated horribly by the contractor overseeing the Mayo Clinic’s go-live of its Epic EMR.

According to a recent news story, the Clinic hired a team of seven nurses to help with the final stages of the rollout. The nurses, all of whom were familiar with Epic, were recruited by Mayo vendor the HCI Group. One nurse, Angela Coffaro, was offered $15,000 for her work. However, she found the way she was treated to be so offensive that she quit after only days on the job. Working conditions were “horrendous,” she told the reporter.

Nurse.org reported that another nurse said the contract nurses were verbally abused, intimidated, and even threatened that they would lose their jobs on an “hourly” basis. They also noted being assigned to positions well outside the skill set. For example, Coffaro said, she was sent to the outpatient eye clinic instead of the OR, and an OR nurse to radiology.

What’s more, the HCI Group executives apparently treated the nurses brutally during training sessions. According to some, they were not permitted to leave the training room even to use the restroom during 6 to 8-hour orientation sessions.

Adding insult to injury, the contractor allegedly failed to provide adequate housing. For example, Nurse.org tells the story of Cleveland-based nurse practitioner Kumbi Madiye, who arrived at 9 AM the day before her training was scheduled to begin and found only chaos. Madiye told the publication that she waited 14 hours without a room, only to find out at 11 PM that her assigned room was an hour and a half away.

The story stresses that while the nurses said they were astonished by HCI Group’s attitude and performance, they had no problem with the way they were treated by Mayo Clinic personnel.

That being said, if even half of the allegations are true, Mayo would certainly bear some responsibility for failing to supervise their vendor adequately. Also, my instinct is that one or more of the nurses must have told Mayo what was going on and if the Clinic’s leaders did anything about the problem the nurses never mentioned it.

I’m also very surprised any vendor might have abused IT-savvy nurses with precious Epic experience. As sprawling as the health IT world is, word gets around, and I doubt anyone can afford to alienate a bunch of Epic experts.

E-Patient Update: When EMRs Make A Bad Process Worse

Posted on August 14, 2017 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Last week, I wrote an item reflecting on a video interview John did with career CIO Drex DeFord. During the video, which focused on patient engagement and care coordination, DeFord argued that it’s best to make sure your processes are as efficient as they can get before you institutionalize them with big technology investments.

As I noted in the piece, it’d be nice if hospitals did the work of paring down processes to perfection before they embed those processes in their overall EMR workflow, but that as far as I know this seldom happens

Unfortunately, I’ve just gotten a taste of what can go wrong under these circumstances. During the rollout of its enterprise EMR, a health system with an otherwise impeccable reputation dropped the ball in a way which may have harmed my brother permanently.

An unusual day

My brother Joey, who’s in his late 40s, has Down’s Syndrome. He’s had a rocky health history, including heart problems that go with the condition and some others of his own. He lives with my parents in the suburbs of a large northeastern city about an hour by air from my home.

Not long ago, when I was staying with them, my brother had a very serious medical problem. One morning, I walked into the living room to find him wavering in and out of consciousness, and it became clear that he was in trouble. I woke my parents and called 911. As it turned out, his heart was starting and stopping which, unless perhaps you’re an emergency physician, was even scarier to watch than you might think.

Even for a sister who’d watched her younger brother go through countless health troubles, this is was a pretty scary day.  Sadly, the really upsetting stuff happened at the hospital.

Common sense notions

When we got Joey to the ED at this Fancy Northeastern Hospital, the staff couldn’t have been more helpful and considerate. (The nurses even took Joe’s outrageous flirting in stride.)  Within an hour or two, the clinical team had recommended implanting him with a pacemaker. But things went downhill from there.

Because he arrived on Friday afternoon, staff prepared for the implantation right away, as the procedure apparently wasn’t available Saturday and Sunday and he needed help immediately. (The lack of weekend coverage strikes me as ludicrous, but it’s a topic for another column.)

As part of the prep, staff let my mother know that the procedure was typically done without general anesthesia. At the time, my mother made clear that while Joey was calm now, he might very well get too anxious to proceed without being knocked out. She thought the hospital team understood and were planning accordingly.

Apparently, though, the common-sense notion that some people freak out and need to be medicated during this kind of procedure never entered their mind, didn’t fit with their processes or both. Even brother’s obvious impairment doesn’t seem to have raised any red flags.

“I don’t have his records!”

I wasn’t there for the rest of the story, but my mother filled me in later. When Joey arrived in the procedure room, staff had no idea that he might need special accommodations and canceled the implantation when he wouldn’t hold still. Mom tells me one doctor yelled: “But I don’t have his records!” Because the procedure didn’t go down that day, he didn’t get his implant until Monday.

This kind of fumbling isn’t appropriate under any circumstances, but it’s even worse when it’s predictable.  Apparently, my brother had the misfortune to show up on the first day of the hospital’s EMR go-live process, and clinicians were sweating it. Not only were they overtaxed, and rushing, they were struggling to keep up with the information flow.

Of course, I understand that going live on an EMR can be stressful and difficult. But in this case, and probably many others, things wouldn’t have fallen apart if their process worked in the first place prior to the implementation. Shouldn’t they have had protocols in place for road bumps like skittish patients or missing chart information even before the EMR was switched on?

Not the same

Within days of getting Joey back home, my mom saw that things were not the same with him. He no longer pulls his soda can from the fridge or dresses himself independently. He won’t even go to the bathroom on his own anymore. My mother tells me that there’s the old Joe (sweet and funny) and the new Joe (often combative and confused).  Within weeks of the pacemaker implantation, he had a seizure.

Neither my parents nor I know whether the delay in getting the pacemaker put in led to his loss of functioning. We’re aware that the episode he had at home prior to treatment could’ve led to injuries that affect his functioning today.  We also know that adults with Down’s Syndrome slip into dementia at a far younger age than is typical for people without the condition. But these new deficits only seemed to set in after he came home.

My mother still simmers over the weekend he spent without much-needed care, seemingly due to a procedural roadblock that just about anyone could’ve anticipated. She thinks about the time spent between Friday and Monday, during which she assumes his heart was struggling to work “His heart was starting and stopping, Anne,” she said. “Starting and stopping. All because they couldn’t get it right the first time.”

Study: Hospital EMR Rollouts Didn’t Cause Patient Harm

Posted on September 14, 2016 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Rolling out a hospital EMR can be very disruptive. The predictable problems that can arise – from the need to cut back on ambulatory patient visits to the staff learning curve to unplanned outages – are bad enough. And of course, when the implementation hits a major snag, things can get much worse.

Just to pull one name out of a hat, consider the experience of the Vancouver Island Health Authority in British Columbia, Canada. One of the hospitals managed by the Authority, which is embroiled in a $174 million Cerner implementation, had to move physicians in its emergency department back to pen and paper in July. Physicians had complained that the system was changing medication orders and physician instructions.

But fortunately, this experience is definitely the exception rather than the rule, according to a study appearing in The BMJ. In fact, such rollouts typically don’t cause adverse events or needless deaths, nor do they seem to boost hospital readmissions, according to the journal.

The study, which was led by a research team from Harvard, Brigham and Women’s Hospital, Beth Israel Deaconess Medical Center and Massachusetts General Hospital, looked at the association between EHR implementation and short-term inpatient mortality, adverse safety events or readmissions among Medicare enrollees getting care at 17 U.S. hospitals. The hospitals selected for the study had rolled out or replaced their EHRs in a “big bang”-style, single-day go-live in 2011 and 2012.

To get a sense of how selected hospitals performed, the team studied patients admitted to the studied facilities 90 days before and 90 days after EHR implementation. The researchers also gathered similar data from a control group of all admissions during the same period by hospitals in the same referral region. For selected hospitals, they analyzed data on 28,235 patients admitted 90 days before the implementation, and 26,453 admitted 90 days after the EHR cutover. (The control size was 284,632 admissions before and 276,513 after.)

Apparently, researchers were expecting to see patient care problems arise. Their assumption was that in the wake of the go-live, the hospitals would see a short increase in mortality, readmissions and adverse safety events. One of the reasons they expected to see this bump in problems is that some negative problems related to time and season, such as the “weekend effect” and the “July effect,” are well documented in existing research. Surely the big changes engendered by an EHR cutover would have an impact as well, they reasoned.

But that’s not what they found. In fact, the researchers wrote, “there was no evidence of a significant or consistent negative association between EHR implementation and short-term mortality, readmissions, or adverse events.”

I was as surprised as the researchers to learn that EHR rollouts studied didn’t cause patient harm or health instability. Considering the immense impact an EHR can have on clinical workflow, it seems strange to read that no new problems arose. That being said, hospitals in this group may have been doing upgrades – which have to be less challenging than going digital for the first time – and were adopting at a time when some best practices had emerged.

Regardless, given the immense challenges posed by hospital EHR rollouts, it’s good to read about a few that went well.  We all need some good news!

Will Your EMR Go-Live Education Miss The Mark?

Posted on June 3, 2016 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

LinkedIn conversations can be quite the font of wisdom, and today was no exception. In comments on a post discussing how training can lead to buy-in, David Kelley, D.O. made it clear that such training often leaves participants cold:

[Have] been the recipient in a couple of Go Lives and been on a few Go Live support teams. The younger/tech-savvy people verbalize the pre-Go Live to have been not worth their time as it was targeted for below their knowledge base. In stark contrast, the more senior/less tech-savvy verbalize near-hatred of those pre-Go Live educational courses as they were so far above their heads as to equate to tech-gibberish.

By reposting these remarks, I’m by no means suggesting that go-live training is a waste of time. Nor am I suggesting that every time hospitals attempt to prepare staffers for EMR implementation, they bore the heck out of staffers while accomplishing nothing. But if Kelley’s experience is any guide, many such trainings are doing a lousy job of connecting with their audience.

His complaints also raise several questions for me, including the following:

  • Who was teaching the courses? Was it vendor reps? If so, it’s little wonder that they produced content only a developer could love.
  • What was the focus of the courses? From Kelley’s comments, it sounds like clinicians and staff typically got a general overview which didn’t do much to foster success.
  • Did the training offer hands-on instruction? And I don’t mean a quick look at basic functions, but rather specific guidance on how to perform key job functions.
  • Did instructors explain the advantages of the new systems? To get buy-in from clinicians and staff, instructors need to hammer home how the new technologies save time, improve efficiency and better patient care.

Regardless, what I gather from Kelley’s story is that too often, hospitals often talk at future EMR users rather than helping them get productive and oriented. It would appear that those responsible for go-lives often fail to consider how the implementation impacts specific functions, and talk around the issues rather than blending training with problem-solving.

I’ve actually seen the effects of what seems to have been a questionable go-live training strategy here in metro DC. Now, the hospital talked a good change management game — even loading screen savers onto all computers stating that “[vendor] is coming!” and posting signs letting patients know about the upcoming shift — for months prior to the system kickoff.

But what do you suppose happened when I spent a few days as an inpatient later that year? I saw nurses and doctors desperately trying to make the system behave by sharing workarounds with each other. Now, you tell me: Would clinical staffers be going to these lengths if they’d had thorough, pitch-perfect, hands-on training?