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Practice Wise 9/17/11

September 17, 2011 News 4 Comments

Compassionate Expectations

Boy, I never thought I’d have such a love-hate relationship with a word as I do this one: expectations.

It’s been a long, hard summer in my world. We’ve been buried in Meaningful Use software upgrades and a rush of new practices starting up.

Who said all the small practices are selling to the hospital systems? Not in my neck of the woods! We usually start up one or two practices a year. We’re on #6 this year and they keep calling, and they all want to be open in three months. But I digress …

I started this summer with great anticipation of MU product releases. Although I knew that the upgrades would be arduous, what I didn’t anticipate fully was the varying degrees of expectations — met and unmet — around these upgrades.

My greatest expectation was that our clients would be thrilled with over 450 new features and functionality in their software. So thrilled, in fact, that they would embrace all the free training we offered and be enthusiastic at upgrade. We delivered a fully certified MU product in time for them to attest for Phase 1 this year if they desired. I was confident we met their expectations, in spades!

Suffice it to say that we met our own expectations of what we thought they wanted. But in the end, everyone had different expectations and perceptions of how this would play out.

In our experience, doctors expected us to provide an amazing product and it would just work. They wouldn’t have to learn anything new, even though it did a gazillion new things. Practice administrators expected their staff to participate in the training we provided and sign off when they actually did it. What we found is many signed off and never really did the work. When we showed up post-upgrade, they were lost and expected us to do training on the spot while we were troubleshooting technical issues.

Everybody in the practice had differing expectations and it was our challenge to meet them all.

Our own expectations of how our software vendor would handle their product release and ensuing support was the surprise of the summer. I have been doing medical practice software support and consulting for 11 years now and it hasn’t all been wine and roses. We expected reduced response for our support cases since our vendor was as overwhelmed as we were, but they didn’t leave us hanging.

They even pulled off a few miracle saves. A big was bug found at our favorite client’s office, a show-stopper that brought them to their knees. The developers fixed it in 48 hours.

Of course, the doctor’s expectation was that the code should haven been rewritten before end of business the same day it was found. I was praising the 48-hour miracle and she was complaining that it took so long. Our expectations were clearly out of alignment.

Just when I realized the toll this was taking on my staff and our clients, I was moved by the HIStalk post by Ed Marx on 8/17/11 titled Connect. This article motivated me to take action — first with myself and my staff, then with our customers.

It was posted the day before our quarterly user group, an informal meeting with all of our customers to check in, share ideas, and work together towards solutions. We were all feeling a little ragged from the first round of upgrades. Customers still waiting to be upgraded were anxious.

I started the meeting by sharing Ed’s discussion of compassion. It really touched a nerve (I still had a few left). It helped me refocus on what our intentions are. We are here to help providers and their staffs provide excellent patient care. We are not purely consultants with solutions. We are partners in the patient care they provide.

With this as the theme, I started our meeting on a different tact.  I did a level-set of expectations for all of us. It was a gamble, but I spoke from the heart to my customers about the challenges we were facing, the stress of the upgrades and their reactions to the changes, and the challenges within their own practices. I showed compassion for myself, my staff, and most of all, for our customers. How the interruptions of software changes often take their focus off caring for their patients while they battle data entry in their EHR.

They shared the same. It was transformative. We found commonality in purpose and compassion for each other.

We have continued to soldier on through the remaining upgrades. We continue to remind ourselves that compassion for the role and position of everyone involved is the key to getting through stressful encounters when they arise.

Did I mention that my Outlook crashed this summer during all this stress? I guess my expectation that this awesome piece of software can hold an unlimited amount of data (48,385 messages in fact) in a .pst file was unrealistic. Luckily, I have a compassionate engineer on board who took pity on me and didn’t berate me (too much) for not deleting more than three emails a day for the past nine years, and not launching our mail server years ago! We are currently planning a migration and setting appropriate expectations, because you never know how these things will go.

It’s been a great summer. I’ve learned to set clear expectations and practice doing so with compassion, every day. Thanks, Ed!

Julie McGovern is CEO of Practice Wise, LLC.

Comments 4
  • As a physician, I don’t want software to do new things. I want to practice medicine. New things means new buttons pulling me away from patients and getting in the way. Honestly, if I have to think about the software while I am practicing, even for a minute, then it has failed. This probably sounds crazy to a software vendor but it’s the truth and that’s what you’re dealing with. Personally, I think the software can get there. But software vendors don’t seem to have very high expectations for their own products.

  • To be fair… “new things” does not necessarily mean additional work – in fact, it ideally should mean less work if done well. For example, if an EMR vendor put in a new function for reviewing labs – it might require 1 new click but removes 5 steps from the old process- we’d all be very happy… but it is amazing how people often don’t like any change (usually because they have developed “muscle memory” to the old way). We had a recent EMR upgrade and as usual- the first week involved a lot of complaints about the “new stuff”, but within 1-2 weeks most docs developed new muscle memories and quickly accepted the changes… and then of course started bringing up other things which need to be better next – nature of the beast!

    Important to note is that many of our biggest usability problem are when EMR vendors try to make computers behave like paper because “that is what docs say they want”. So be careful what you ask for!! Computers are actually really BAD subsitutes for paper – forcing them to act like paper generally is unsatisfying. Unfortunately, a typical EMR design process is to talk to a few doctors and watch them for a few hours – and then have their engineers go work on the product for 9 months to simulate what they saw! Ugghh – it’s never pretty! We really have to keep pushing vendors to expand their thinking and create tools which take advantage of what a COMPUTER can do better than paper – automatically assemble relevant data, display in in different ways, predict what you need to do next, etc… not just serve as an electronic repository of information (more thoughts on EMR Usability at

    I think that the big vendors are likely too big now to make any substantive changes in their design, at least with any speed… so we are seeing more of them “open their platforms” to allow for other companies to build on top of their infrastructure with niche products that solve various needs… I think these “EMR Extender Tools” will become an increasingly important part of the IT solution needed in healthcare.

  • DrLyle you are exactly right. As Steve Jobs famously said, “It’s not the consumer’s job to know what they want.” And the current approach of asking doctors what they want is a recipe for feature-bloated clickorrhea. The problem is our workflow–in the ED anyway–is unlike anything a software engineer has ever experienced, and it changes form minute to minute. I have seen a couple products come close but none have found the balance between narrative and discrete data, and none are remotely as flexible (or mobile) as a piece of paper.

  • Brian makes the observation that no EMR is “remotely as flexible (or mobile) as a piece of paper” This is true, and for patient care and protection it’s a darn good thing. Paper disappears, gets thrown away, ends up in some doctors basement, or worse, scattered on a freeway as patient records fly out of the box sitting in the bed of his truck. (That last one is a true story by the way). While EMR may have complexity and a learning curve, it is the single greatest stride forward in patient care since doctors started washing their hands. EMR tracks things in ways that NO paper system could ever match. EMRs can systematically track drug interactions, allergies, question dosing choices on a sig, and many other things. EMR records, while susceptible to the same risks as any other electronic data, are far more secure than paper. How many charts have doctors lost or misplaced? How many chart notes have ended up in the wrong chart? And, by the way, how do you audit what happened to that paper chart? Yes, EMR is complex, yes learning new features causes a slow down while you learn, and yes on the surface paper seems faster and more flexible. But ask the patients whose charts were scattered all over the freeway which system is better. After all, isn’t all of this about patient care, safety, and security, not provider convenience?

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